College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.
School of Medicine, University of Maryland, Baltimore, Maryland, USA.
Early Interv Psychiatry. 2022 Jan;16(1):78-90. doi: 10.1111/eip.13134. Epub 2021 Feb 17.
Many emerging adults disengage from early intervention in psychosis (EIP) services prematurely. Service disengagement may be in part due to having unresolved treatment decision-making needs about use of mental health services. A basic understanding of the decision-making needs of this population is lacking. The purpose of this qualitative study was to identify the range of treatment decisions that emerging adults face during their initial engagement in an EIP program and elucidate barriers and facilitators to decision-making.
Twenty emerging adults with early psychosis were administered semistructured interviews to capture treatment decision-making experiences during the first six months after enrolment in an EIP program. Interviews were audio-recorded and transcribed verbatim. Responses were independently coded by two authors using an integrated thematic analysis approach; differences in coding were discussed to consensus. Data analysis was facilitated using NVivo 12 Plus.
Emerging adults identified numerous decisions faced after EIP enrolment. Decisions pertaining to life and treatment goals and to starting and continuing psychiatric medication were commonly selected as the most difficult/complicated. Decision-making barriers included not having the right amount or type of information/knowledge, social factors (e.g., lacking social support, opposition/pressure), lacking internal resources (e.g., cognitive and communication skills, self-efficacy, motivation) and unappealing options. Obtaining information/knowledge, social supports (e.g., connection/trust, learning from others' experiences, encouragement), considering personal values, and time were decision-making facilitators.
This study informs development and optimization of interventions to support decision-making among emerging adults with early psychosis, which may promote service engagement.
许多成年早期患者过早地退出早期精神病干预（EIP）服务。服务脱节可能部分是由于在使用心理健康服务方面未解决的治疗决策需求。对该人群的决策需求的基本了解不足。本定性研究的目的是确定成年早期患者在最初参与 EIP 计划期间面临的一系列治疗决策，并阐明决策的障碍和促进因素。
对 20 名早期精神病患者进行半结构化访谈，以了解他们在参加 EIP 计划后的头六个月内的治疗决策经验。采访进行了录音并逐字记录。两名作者使用综合主题分析方法独立对答复进行编码；对编码差异进行了讨论，以达成共识。使用 NVivo 12 Plus 促进数据分析。
成年早期患者确定了在 EIP 注册后面临的许多决策。与生活和治疗目标以及开始和继续使用精神药物有关的决策通常被认为是最困难/复杂的。决策障碍包括缺乏适当数量或类型的信息/知识、社会因素（例如缺乏社会支持、反对/压力）、缺乏内部资源（例如认知和沟通技巧、自我效能、动机）和不吸引人的选择。获取信息/知识、社会支持（例如，联系/信任、从他人的经验中学习、鼓励）、考虑个人价值观和时间是决策的促进因素。
这项研究为支持早期精神病成年早期患者的决策提供了干预措施的开发和优化，这可能会促进服务的参与。
