Background
Identification of psychosis risk
Potential benefits and shortcomings from identifying psychosis risk status
Comorbidity considerations
Limited reporting about implementation of specialised psychosis related services
The current study
Methods
The Psychological Assistance Service (PAS)
Data sources
PAS data (presentations: 1997–2007, +2 years for ongoing treatment profiles and other outcomes)
Community data (1997–2009)
Hospital admission records (1993–2009)
Ethics and data access approvals
Allocation to baseline groups
Statistical analyses
Results
Sample characteristics
Characteristic (%) | Overall | A: Existing psychosis (in pre-PAS period) | B: Recent psychosis (during PAS presentation window) | C: Ultra High Risk (UHR) group | D: Non-psychosis MH disorders | E: Uncertain |
---|---|---|---|---|---|---|
(N =1997) | (N =289) | (N =395) | (N =191) | (N =872) | (N =250) | |
Gender (% males) | 59.0 | 68.5 | 62.8 | 57.1 | 56.3 | 52.8 |
Age | ||||||
Mean (SD) | 19.2 (4.5) | 21.0 (4.7) | 19.6 (3.8) | 17.6 (3.0) | 18.9 (4.6) | 19.1 (5.5) |
Less than 18 years (%) | 55.6 | 36.0 | 52.7 | 70.7 | 59.2 | 59.2 |
Referral source | ||||||
Self or family | 18.4 | 5.9 | 12.2 | 16.8 | 23.1 | 28.0 |
Community MH | 13.5 | 21.1 | 20.3 | 8.9 | 10.7 | 7.2 |
Hospital | 14.8 | 42.9 | 15.4 | 6.3 | 10.1 | 4.4 |
GP | 2.7 | 0.7 | 3.5 | 3.1 | 3.2 | 1.6 |
Other services | 17.5 | 5.9 | 13.7 | 17.8 | 23.2 | 17.2 |
Unknown | 33.0 | 23.5 | 34.9 | 47.1 | 29.8 | 41.6 |
Other demographic information available | 53.6 | 46.4 | 71.9 | 67.5 | 44.6 | - |
Characteristics of clients with available demographic data (%)
|
(N =936)
|
(N =134)
|
(N =284)
|
(N =129)
|
(N =368)
| |
Marital status | ||||||
Single | 92.9 | 92.5 | 92.6 | 96.9 | 92.0 | |
Educational level | ||||||
High school only | 86.8 | 86.4 | 84.4 | 89.1 | 87.9 | |
Accommodation | ||||||
Live with family | 77.9 | 81.2 | 78.9 | 81.3 | 74.9 | |
Live in house/flat | 16.3 | 12.8 | 16.5 | 15.6 | 17.6 | |
Short term | 5.8 | 6.0 | 4.6 | 3.1 | 7.5 | |
Employment status | ||||||
Employed | 21.1 | 24.6 | 18.4 | 23.0 | 21.2 | |
Unemployed | 43.8 | 57.5 | 46.3 | 27.8 | 42.4 | |
Student | 35.2 | 17.9 | 35.3 | 49.2 | 36.4 |
Psychosis profiles
Diagnostic or problem category (%) | A: Existing psychosis (N =289) | B: Recent psychosis (N =395) |
---|---|---|
Formal ICD-10 diagnoses | [92.7] | [63.8] |
1. Schizophrenia | 46.7 | 24.5 |
2. Persistent delusional disorder | 8.0 | 2.0 |
3. Acute or transient psychotic disorder | 21.8 | 22.0 |
4. Schizoaffective disorder | 6.9 | 1.7 |
5. Other nonorganic psychotic disorder | 1.4 | 0.7 |
6. Unspecified nonorganic psychotic disorder | 33.2 | 21.5 |
7. Bipolar disorder (including mania) | 20.4 | 7.1 |
Other clinical records (e.g., CHIME) | [38.8] | [49.9] |
8. Schizophrenia (problem/issue) | 11.1 | 18.9 |
9. Bipolar (problem/issue) | 5.2 | 9.4 |
10. Other psychosis (problem/issue) | 26.3 | 21.7 |
Comorbidity profiles
Comorbid condition (%) | Overall (Excluding E: Uncertain group) | A: Existing psychosis | B: Recent psychosis | C:Ultra High Risk (UHR) group | D: Non-psychosis MH disorders | Statistical comparison (Groups A to D) |
---|---|---|---|---|---|---|
(N =1747) | (N =289) | (N =395) | (N =191) | (N =872) | ||
Depression | 43.8 | 36.7 | 49.6 | 62.3 | 39.4 | χ2
(3) =44.7** |
Anxiety | 25.1 | 21.5 | 34.2 | 42.9 | 18.3 | χ2
(3) =72.7** |
Substance misuse | 26.5 | 52.9 | 37.0 | 6.8 | 17.3 | χ2
(3) =201.7** |
Personality disorder | 17.1 | 16.6 | 16.2 | 20.9 | 16.7 | χ2
(3) =2.3 |
Other MH problems^ | 67.3 | 68.9 | 55.7 | 67.5 | 72.0 | χ2
(3) =33.3** |
Psychosocial issues | 40.4 | 70.2 | 39.2 | 41.9 | 30.7 | χ2
(3) =141.1** |
Physical disorders | 14.0 | 37.7 | 13.2 | 6.3 | 8.3 | χ2
(3) =168.3** |
Other Non-MH problems | 15.1 | 25.6 | 14.2 | 7.3 | 13.8 | χ2
(3) =35.3** |
Service utilisation
Overall | A: Existing psychosis | B: Recent psychosis | C: Ultra High Risk (UHR) group | D: Non-psychosis MH disorders | E: Uncertain | |
---|---|---|---|---|---|---|
(N =1997) | (N =289) | (N =395) | (N =191) | (N =872) | (N =250) | |
Estimated availability of medical records - mean (median) years | 6.3 (5.9) | 7.7 (7.5) | 6.6 (6.1) | 5.4 (5.1) | 6.2 (5.8) | 5.5 (5.4) |
Community contacts | ||||||
Total contacts | 9618 | 2499 | 2253 | 980 | 3631 | 255 |
Average contact days per year (excluding presentation window) | 0.98 (0.31) | 1.25 (0.57) | 0.99 (0.28) | 1.38 (0.37) | 0.99 (0.31) | 0.33 (0.00) |
Average number of PAS contacts within presentation window | 2.25 | 2.32 | 2.96 | 3.16 | 2.07 | 1.01 |
All admissions (Min. age 12 years) | ||||||
Total admissions | 1788 | 674 | 357 | 87 | 601 | 69 |
Total beddays | 12748 | 6739 | 3042 | 297 | 2452 | 218 |
Any admission (%) | 40.7 | 85.5 | 45.1 | 26.7 | 33.1 | 18.8 |
Average admission days per year | 1.08 | 3.62 | 1.48 | 0.30 | 0.48 | 0.17 |
MH admissions | ||||||
Total admissions | 1090 | 537 | 210 | 40 | 303 | 0 |
Total beddays | 10787 | 6343 | 2438 | 214 | 1792 | - |
Any admission (%) | 28.2 | 84.1 | 33.4 | 12.0 | 19.0 | 0.0 |
Average admission days per year | 0.91 | 3.39 | 1.23 | 0.22 | 0.35 | - |
Potential confounders
PAS treatment status
Baseline characteristic | % Receiving ongoing PAS treatment | Unadjusted Odds Ratio (OR) | 99% CI | Adjusted Odds Ratio (AOR) | 99% CI |
---|---|---|---|---|---|
Gender: Male | 23.2 (vs. 23.0) | 0.98 | (0.73, 1.32) | 0.89 | (0.64, 1.26) |
Age: Less than 18 years | 26.1 (vs. 19.5) | 1.45** | (1.07, 1.96) | 1.05 | (0.59, 1.87) |
Diagnostic group | |||||
Existing psychosis | 25.6 | 2.46** | (1.59, 3.81) | 3.40** | (2.11, 5.48) |
Recent psychosis | 33.4 | 3.58** | (2.44, 5.25) | 5.80** | (3.75, 8.96) |
Ultra high risk | 47.6 | 6.50** | (4.11, 10.28) | 9.57** | (5.66, 16.18) |
Non-psychosis MH disorders | 12.3 (ref) | 1.00 | 1.00 | ||
Comorbid condition¥
| |||||
Depression | 28.5 (vs. 18.9) | 1.70** | (1.27, 2.28) | 1.54* | (1.07, 2.22) |
Anxiety | 33.7 (vs. 19.6) | 2.09** | (1.52, 2.86) | 1.62* | (1.09, 2.39) |
Substance misuse | 17.3 (vs. 25.2) | 0.61** | (0.43, 0.88) | 0.53** | (0.33, 0.84) |
Personality disorder | 23.5 (vs. 23.1) | 1.02 | (0.69, 1.50) | 0.87 | (0.54, 1.39) |
Other MH problems^ | 28.1 (vs. 12.8) | 2.67** | (1.85, 3.84) | 1.59* | (1.00, 2.54) |
Psychosocial issues | 22.1 (vs. 23.8) | 0.90 | (0.67, 1.22) | 0.81 | (0.54, 1.21) |
Physical disorders | 29.0 (vs. 22.2) | 1.43 | (0.96, 2.12) | 1.20 | (0.70, 2.03) |
Other Non-MH problems | 22.3 (vs. 23.3) | 0.94 | (0.62, 1.43) | 0.66 | (0.39, 1.11) |