Changes in first-episode psychosis care delivery and outcomes throughout the COVID-19 pandemic: Insights from a learning healthcare system in Massachusetts

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a notable and continued impact on global mental health and healthcare delivery. Data regarding the effect of the pandemic on first-episode psychosis (FEP) services are limited but emerging. This study assessed changes in demographics, treatment engagement, baseline clinical presentations, and treatment outcomes in Massachusetts psychosis clinics throughout the COVID-19 pandemic.

Methods: Between January 2017 and October 2022, routine clinical assessment data were collected from 735 individuals receiving care in one of 12 FEP clinics in Massachusetts. Assessments were completed at intake and at 6-month intervals thereafter over the course of patients' usual care. This dataset was divided into three periods: pre-pandemic (01/2017-02/2020), pre-vaccination pandemic (03/2020-05/2021), and post-vaccination pandemic (06/2021-10/2022). Chi-square, ANOVA, and time-series analyses were conducted on demographic and clinical variables of interest across these three timepoints.

Results: Demographic profiles of new patients differed between the pre-pandemic and post-vaccine periods, with significant decreases in female (F = 30.9, p < 0.01) and Black (F = 28.8, p < 0.01) individuals obtaining care. Service use also decreased significantly and showed sustained changes into the late-pandemic period. New patients in the post-pandemic periods showed overall lower symptom severity and higher social functioning (F = 4.62, p < 0.01), self-reported quality of life (F = 4.15, p = 0.02), and recent alcohol use (χ² = 11.7, p < 0.01). No significant changes were observed in treatment outcomes at 6 months.

Conclusions: We propose three explanations for these findings. First, improvements in baseline presentations post-pandemic may be related to systemic changes in care availability that occurred. Second, decreases in symptom severity and service use suggest a growing subgroup of individuals with FEP who require a broader but less intensive range of services. Third, and most critically, the COVID-19 pandemic may have led to some disparities in access to care for FEP services. Future efforts to expand early intervention services for psychosis need to consider the lasting changes in care delivery that still exist post pandemic, novel stepped care models, equity and access to care.