Department of Mental Health Law and Policy, Louis de la Parte Mental Health Institute, University of South Florida, Tampa, Florida.
Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
Early Interv Psychiatry. 2019 Jun;13(3):488-494. doi: 10.1111/eip.12508. Epub 2017 Oct 27.
In order to strengthen specialized early intervention in psychosis (EIP) services, a contextually nuanced understanding of psychosocial forces driving suboptimal treatment response is critical. This study sought to examine factors driving poor outcomes through a systematic emic coding of psychosocial assessments for discharged EIP clients categorized as leaving with all treatment goals met (AG) or no treatment goals met (NG).
Psychosocial assessments at baseline, 1 year, 2 years and discharge were extracted from an EIP research registry and systematically coded. One hundred and thirty clients met the study's inclusion criteria (72 NG, 58 AG) from a larger pool of 278. Assessments were coded, quantized and analysed using a combination of basic inferential statistics and thematic analysis.
Structural adversity, individual trauma, history of aggression/violence, limited insight and long treatment histories prior to EIP, were strong and significant predictors of poor client outcomes (NG), while motivation for treatment, college goals or preparedness at baseline, baseline engagement in constructive activities, social strengths, individual strengths, talents and family support strongly predicted better outcomes (AG). Race/ethnicity also significantly predicted outcome group. Analyses underscore the powerful impact of multiple converging forms of structural disadvantage, on the one hand, and individual, family and social strengths and supports on the other, in shaping clients' response to EIP treatment.
Findings emphasize the importance of greater empirical attention to background structural and socio-economic conditions among early psychosis clients and their multifaceted impacts and underscore the potential value of programmatic components explicitly designed to support clients from multiply disadvantaged backgrounds.
为了加强精神病的专业早期干预（EIP）服务，深入了解导致治疗反应不佳的社会心理因素至关重要。本研究旨在通过对出院 EIP 患者的社会心理评估进行系统的内在编码，来检查导致不良结果的因素，这些患者分为所有治疗目标都达到（AG）和没有达到治疗目标（NG）。
从 EIP 研究登记处提取基线、1 年、2 年和出院时的社会心理评估，并进行系统编码。从 278 名更大的患者中，有 130 名患者符合研究纳入标准（72 名 NG，58 名 AG）。使用基本推理统计和主题分析相结合的方法对评估结果进行编码、量化和分析。
结构性逆境、个体创伤、既往攻击性/暴力史、洞察力有限和 EIP 治疗前的治疗史较长，是导致患者预后不良（NG）的强烈且显著的预测因素，而治疗动机、大学目标或基线准备情况、基线积极参与建设性活动、社会优势、个体优势、才能和家庭支持则强烈预测预后较好（AG）。种族/民族也显著预测了结果组。分析强调了多种形式的结构性劣势，一方面，以及个体、家庭和社会优势和支持，对客户对 EIP 治疗的反应产生了强大的影响。
研究结果强调了在早期精神病患者中，更需要关注背景结构性和社会经济条件及其多方面影响的重要性，并强调了专门为支持来自多种不利背景的患者而设计的方案组件的潜在价值。
