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. 2023 Sep 5;6(9):e2333526.
doi: 10.1001/jamanetworkopen.2023.33526.

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Alexia Polillo  1 , George Foussias  1   2 , Wei Wang  1   2 , Aristotle N Voineskos  1   2 , Jacqueline Veras  3 , Nicole Davis-Faroque  1   2 , Albert H C Wong  1   2 , Nicole Kozloff  1   2   3
Affiliations

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Alexia Polillo et al. JAMA Netw Open. .

Abstract

Importance: Broad efforts to improve access to early psychosis intervention (EPI) services may not address health disparities in pathways to care and initial engagement in treatment.

Objective: To understand factors associated with referral from acute hospital-based settings and initial engagement in EPI services.

Design, setting, and participants: This retrospective cohort study used electronic medical record data from all patients aged 16 to 29 years who were referred to a large EPI program between January 2018 and December 2019. Statistical analysis was performed from March 2022 to February 2023.

Exposures: Patients self-reported demographic information in a structured questionnaire. The main outcome for the first research question (referral source) was an exposure for the second research question (initial attendance).

Main outcomes and measures: Rate of EPI referral from acute pathways compared with other referral sources, and rate of attendance at the consultation appointment.

Results: The final study population included 999 unique patient referrals. At referral, patients were a mean (SD) age of 22.5 (3.5) years; 654 (65.5%) identified as male, 323 (32.3%) female, and 22 (2.2%) transgender, 2-spirit, nonbinary, do not know, or prefer not to answer; 199 (19.9%) identified as Asian, 176 (17.6%) Black, 384 (38.4%) White, and 167 (16.7%) other racial or ethnic groups, do not know, or prefer not to answer. Participants more likely to be referred to EPI services from inpatient units included those who were older (relative risk ratio [RRR], 1.10; 95% CI, 1.05-1.15) and those who identified as Black (RRR, 2.11; 95% CI, 1.38-3.22) or belonging to other minoritized racial or ethnic groups (RRR, 1.79; 95% CI, 1.14-2.79) compared with White participants. Older patients (RRR, 1.16; 95% CI, 1.11-1.22) and those who identified as Black (RRR, 1.67; 95% CI, 1.04-2.70) or belonging to other minoritized racial or ethnic groups (RRR, 2.11; 95% CI, 1.33-3.36) were more likely to be referred from the emergency department (ED) compared with White participants, whereas participants who identified as female (RRR, 0.51 95% CI, 0.34-.74) had a lower risk of ED referral compared with male participants. Being older (odds ratio [OR], 0.95; 95% CI, 0.90-1.00) and referred from the ED (OR, 0.40; 95% CI, 0.27-0.58) were associated with decreased odds of attendance at the consultation appointment.

Conclusions and relevance: In this cohort study of patients referred to EPI services, disparities existed in referral pathways and initial engagement in services. Improving entry into EPI services may help facilitate a key step on the path to recovery among youths and young adults with psychosis.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Polillo reported grants from the Centre for Addiction and Mental Health (CAMH) Foundation, grants from Canadian Institutes of Health Research, and personal fees from The Ontario College of Social Workers and Social Service Workers outside the submitted work. Dr Foussias reported personal fees from AbbVie (advisory board) outside the submitted work. Dr Voineskos reported grants from National Institute of Mental Health, grants from Canadian Institutes of Health Research, grants from Canada Foundation for Innovation, grants from CAMH Foundation, grants from University of Toronto, grants from Brain Canada, and grants from Wellcome Trust during the conduct of the study. Dr Veras reported that as a graduate student, involvement in this work was in affiliation with the University of Toronto, as it occurred in the context of an unpaid field practicum course. Dr Veras reported nonfinancial support provided by the University of Toronto by means of access to the university's library database. Dr Wong reported personal fees from Lucid Psycheceuticals outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Sample of Patients Referred to Early Psychosis Intervention Services Between January 2018 and December 2019
Figure 2.
Figure 2.. Attendance at Early Psychosis Intervention Program Consultation by Referral Source
ED indicates emergency department.
See this image and copyright information in PMC

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