Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal; Department of Psychiatry, McGill University, Montreal (Maraj, Joober, Malla, Shah, Iyer).
Psychiatr Serv. 2019 Apr 1;70(4):302-308. doi: 10.1176/appi.ps.201800319. Epub 2019 Feb 5.
Given the benefits of early intervention for psychosis and the social disengagement of youths not in education, employment, or training (NEET), this study sought to examine how being vocationally inactive (NEET) affects engagement in early intervention services. Both baseline vocational status and vocational trajectory in the first year of treatment were analyzed.
Data from 394 patients of a Canadian early intervention service were analyzed using time-to-event and Cox proportional hazards regression analyses. Two-year disengagement rates were compared between patients who were vocationally inactive and active at baseline and between those who remained vocationally inactive until month 12 and those who were vocationally inactive only at baseline. Pertinent sociodemographic (age, sex, visible minority status, social and material deprivation indices, and family involvement), and clinical (duration of untreated psychosis, substance use disorder, medication nonadherence, and baseline positive and negative symptoms) factors were considered.
There was no statistically significant difference between the disengagement rates of those who were vocationally inactive (N=154) and those who were vocationally active (N=240) at baseline. Those who remained vocationally inactive at month 12 (N=77) were likelier to disengage in the second year than those who were vocationally inactive only at baseline (N=48) (χ=5.44, df=1, p<0.05). This comparison remained significant in the regression analysis (hazard ratio [HR]=8.52, 95% confidence interval [95% CI]=1.54-47.1). The association of disengagement from services with lack of family contact with the treatment team (HR=3.91, 95% CI=0.98-15.6) and with greater material deprivation (HR=1.03, 95% CI=1.00-1.07) trended toward significance.
The functional recovery of youths who are vocationally inactive when they enter services can affect their long-term service engagement and merits targeting by evidence-based interventions.
鉴于精神病早期干预的益处，以及未接受教育、就业或培训（未就业、未受教育或未培训，NEET）的青少年社会脱节问题，本研究旨在探讨职业上不活跃（NEET）如何影响他们接受早期干预服务。分析了基线职业状况和治疗第一年的职业轨迹。
使用生存分析和 Cox 比例风险回归分析，对加拿大早期干预服务的 394 名患者的数据进行分析。比较基线时职业不活跃和活跃的患者、以及在第 12 个月前仍职业不活跃的患者与仅基线时职业不活跃的患者之间，两年的脱离率。考虑了相关的社会人口学（年龄、性别、少数族裔身份、社会和物质剥夺指数以及家庭参与）和临床（未治疗精神病的持续时间、物质使用障碍、药物不依从和基线阳性和阴性症状）因素。
基线时职业不活跃（N=154）和职业活跃（N=240）的患者脱离率之间没有统计学上的显著差异。在第 12 个月仍职业不活跃的患者（N=77）比仅基线时职业不活跃的患者（N=48）在第二年更有可能脱离（χ=5.44，df=1，p<0.05）。在回归分析中，这一比较仍然具有显著性（危险比[HR]=8.52，95%置信区间[95%CI]=1.54-47.1）。与服务脱离相关的因素包括与治疗团队缺乏家庭联系（HR=3.91，95%CI=0.98-15.6）和物质剥夺程度更高（HR=1.03，95%CI=1.00-1.07），呈显著趋势。
进入服务时职业不活跃的青少年的功能恢复会影响他们的长期服务参与度，值得通过基于证据的干预措施来解决。
