Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada; ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
Schizophr Res. 2018 Mar;193:399-405. doi: 10.1016/j.schres.2017.07.054. Epub 2017 Aug 10.
Although early intervention (EI) programs for psychosis invest in clients remaining engaged in treatment, disengagement remains a concern. It is not entirely clear whether immigrants are likelier to disengage. The rates and predictors of disengagement for immigrant vis-à-vis non-immigrant clients in a Canadian EI setting were analyzed.
297 clients were included in a time-to-event analysis with Cox Proportional Hazards regression models. Immigrant status (first- or second-generation immigrant or non-immigrant), age, gender, education, substance abuse, family contact, social and material deprivation and medication non-adherence were tested as predictors of service disengagement.
24.2% (n=72) of the clients disengaged from services before completing two years. Disengagement rates did not differ between first-generation immigrants (23.3%), second-generation immigrants (22.7%) and non-immigrants (25.3%). For all clients, only medication non-adherence predicted disengagement (HR=3.81, 95% CI 2.37-6.14). For first-generation immigrants, age (HR=1.17, 95% CI 1.02-1.34) and medication non-adherence (HR=2.92, 95% CI 1.09-7.85) were significant predictors. For second-generation immigrants, material deprivation (HR=1.03, 95% CI 1.00-1.05) and medication non-adherence (HR=11.07, 95% CI 3.20-38.22) were significant.
Disengagement rates may be similar between immigrants and non-immigrants, but their reasons for disengagement may differ. Medication adherence was an important predictor for all, but the role of various sociodemographic factors differed by group. Sustaining all clients' engagement in EI programs may therefore require multi-pronged approaches.
尽管精神病早期干预（EI）计划投资于客户保持参与治疗，但仍存在脱失的问题。目前尚不清楚移民是否更容易脱失。本文分析了在加拿大 EI 环境中，移民与非移民客户的脱失率及其预测因素。
采用 Cox 比例风险回归模型对 297 例患者进行了生存分析。将移民身份（第一代或第二代移民或非移民）、年龄、性别、教育、药物滥用、家庭联系、社会和物质剥夺以及药物不依从作为服务脱失的预测因素进行检验。
在完成两年治疗之前，24.2%（n=72）的患者停止了服务。第一代移民（23.3%）、第二代移民（22.7%）和非移民（25.3%）的脱失率没有差异。对于所有患者，只有药物不依从预测了脱失（HR=3.81，95%CI 2.37-6.14）。对于第一代移民，年龄（HR=1.17，95%CI 1.02-1.34）和药物不依从（HR=2.92，95%CI 1.09-7.85）是显著的预测因素。对于第二代移民，物质剥夺（HR=1.03，95%CI 1.00-1.05）和药物不依从（HR=11.07，95%CI 3.20-38.22）是显著的。
移民和非移民的脱失率可能相似，但脱失的原因可能不同。药物依从性是所有患者的重要预测因素，但各种社会人口因素的作用因群体而异。因此，维持所有患者对 EI 计划的参与可能需要多管齐下的方法。
