Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang).
Psychiatr Serv. 2021 Jan 1;72(1):49-60. doi: 10.1176/appi.ps.201900375. Epub 2020 Nov 25.
Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze rates of disengagement in early psychosis services and identify predictors of disengagement in these settings.
A systematic search for studies published in the 1966-2019 period was conducted in PubMed, Google Scholar, EBSCO, Ovid, and Embase. The Observational Cohort and Cross-Sectional Studies scale was used to assess the methodological quality of reports identified in this search. A revised version of the behavioral model of health service use was employed to evaluate and understand predictors of disengagement (categorized as predisposing, enabling, and need factors) identified in the studies with the highest quality.
Twenty studies met the inclusion criteria. Disengagement rates (12% to 53%) and definitions of disengagement varied widely across these studies. Most did not find a compelling association between predisposing factors (e.g., age) and disengagement. Enabling factors, such as lack of family support and living alone, were consistently found to be related to increased disengagement across studies. Finally, need factors, such as lower medication adherence and higher drug misuse, were associated with higher risk for disengagement.
Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services. Substantial between-study variation in identified predictors of disengagement may be addressed by developing and applying a consensus definition of disengagement in future research.
与精神病早期服务相关的治疗益处受到参与者接受治疗程度的影响。本研究的主要目的是分析早期精神病服务中脱离治疗的比率，并确定这些环境中脱离治疗的预测因素。
在 PubMed、Google Scholar、EBSCO、Ovid 和 Embase 中进行了 1966 年至 2019 年期间发表的研究的系统检索。采用观察性队列和横断面研究量表评估该检索中报告的方法学质量。采用修订后的卫生服务使用行为模型来评估和理解质量最高的研究中确定的脱离治疗的预测因素（分为倾向因素、促成因素和需要因素）。
符合纳入标准的研究有 20 项。脱离治疗率（12%至 53%）和脱离治疗的定义在这些研究中差异很大。大多数研究没有发现倾向因素（如年龄）与脱离治疗之间存在强烈关联。促进因素，如缺乏家庭支持和独居，在研究中被一致发现与脱离治疗的风险增加有关。最后，需要因素，如较低的药物依从性和较高的药物滥用，与脱离治疗的风险增加有关。
促成因素和需要因素似乎是早期精神病服务中脱离治疗的最主要预测因素。通过在未来的研究中开发和应用脱离治疗的共识定义，可以解决确定的脱离治疗预测因素方面存在的大量研究间差异。
