title: Predictors of disengagement from treatment in an early psychosis program.
abstract: BACKGROUND
  Disengagement from treatment is a major concern in psychiatry. This is of particular concern for those presenting for care at their first episode of psychosis (FEP). The purpose of this study is to determine the rate of disengagement from a three year FE treatment program and the predictors of disengagement.
  
  
  METHODS
  We used a longitudinal cohort design. The cohort consisted of 286 FEP individuals. Measures included assessments of positive and negative symptoms, depression, substance use, premorbid and current functioning, cognition and duration of untreated psychosis. Disengagement from treatment was defined as leaving the program before the 30 months.
  
  
  RESULTS
  At 30 months after treatment, the estimated rate of disengagement from treatment was 31%. Predictors of disengagement were examined via Cox proportional hazards models which revealed that lower ratings on negative symptom scores at baseline (HR=0.946; CI=0.909-0.985), a shorter duration of untreated psychosis (HR=0.997; CI=0.994-0.999), and not having a family member involved in the program (HR=0.310; CI=0.196-0.490) contributed significantly to predicting disengagement from treatment. An examination of those who dropped out at different times revealed that those who dropped out prior to 6 months had significantly greater cannabis (p<0.05) and other drug use (p<0.01).
  
  
  CONCLUSIONS
  Engagement in early services may be helped by attending carefully to substance use to prevent early dropout, to those who may have had a short duration of untreated psychosis and to working with families to engage families in the program.
authors.affiliation: Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada. stowkowy@ucalgary.ca
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Stowkowy
authors.forename: Donald
authors.initials: D
authors.lastname: Addington
authors.forename: Lu
authors.initials: L
authors.lastname: Liu
authors.forename: Brett
authors.initials: B
authors.lastname: Hollowell
authors.forename: Jean
authors.initials: J
authors.lastname: Addington
mesh_terms: D000293:Adolescent; D000328:Adult; D003072:Cognition Disorders / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011788:Quality of Life; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult