title: The Epidemiology of First-Episode Psychosis in Early Intervention in Psychosis Services: Findings From the Social Epidemiology of Psychoses in East Anglia [SEPEA] Study.
abstract: OBJECTIVE
  Few studies have characterized the epidemiology of first-episode psychoses in rural or urban settings since the introduction of early intervention psychosis services. To address this, the authors conducted a naturalistic cohort study in England, where such services are well established.
  
  
  METHODS
  All new first-episode psychosis cases, 16-35 years old, presenting to early intervention psychosis services in the East of England were identified during 2 million person-years follow-up. Presence of ICD-10 F10-33 psychotic disorder was confirmed using OPCRIT [operational criteria for psychotic illness]. Incidence rate ratios were estimated following multivariable Poisson regression, adjusting for age, sex, ethnicity, socioeconomic status, neighborhood-level deprivation, and population density.
  
  
  RESULTS
  Of 1,005 referrals, 687 participants (68.4%) fulfilled epidemiological and diagnostic criteria for first-episode psychosis (34.0 new cases per 100,000 person-years; 95% CI=31.5-36.6). Median age at referral was similar for men (22.5 years; interquartile range: 19.5-26.7) and women (23.4 years; interquartile range: 19.5-29.1); incidence rates were highest for men and women before 20 years of age. Rates increased for ethnic minority groups (incidence rate ratio: 1.4; 95% CI=1.1-1.6), as well as with lower socioeconomic status (incidence rate ratio: 1.3; 95% CI=1.2-1.4) and in more urban (incidence rate ratio: 1.4;95%CI=1.0-1.8) and deprived (incidence rate ratio: 2.1; 95% CI=1.3-3.3) neighborhoods, after adjustment for confounders.
  
  
  CONCLUSIONS
  Pronounced variation in psychosis incidence, peaking before 20 years old, exists in populations served by early intervention psychosis services. Excess rates were restricted to urban and deprived communities, suggesting that a threshold of socioenvironmental adversity may be necessary to increase incidence. This robust epidemiology can inform service development in various settings about likely population-level need.
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: James B
authors: JB
authors: Kirkbride
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Yasir
authors: Y
authors: Hameed
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Gayatri
authors: G
authors: Ankireddypalli
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Konstantinos
authors: K
authors: Ioannidis
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Carolyn M
authors: CM
authors: Crane
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Mukhtar
authors: M
authors: Nasir
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Nikolett
authors: N
authors: Kabacs
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Antonio
authors: A
authors: Metastasio
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Oliver
authors: O
authors: Jenkins
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Ashkan
authors: A
authors: Espandian
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Styliani
authors: S
authors: Spyridi
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Danica
authors: D
authors: Ralevic
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Suneetha
authors: S
authors: Siddabattuni
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Ben
authors: B
authors: Walden
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Adewale
authors: A
authors: Adeoye
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Jesus
authors: J
authors: Perez
authors: From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.
authors: Peter B
authors: PB
authors: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D061345:Early Medical Intervention; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population; D055815:Young Adult
keywords: Community Mental Health; Epidemiology; Psychosis; Schizophrenia