School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
South London & Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
Soc Psychiatry Psychiatr Epidemiol. 2024 Jan;59(1):25-36. doi: 10.1007/s00127-023-02522-z. Epub 2023 Jun 23.
We investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS.
We used incidence data linked to the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders.
343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15-1668); and the median LOS was 130.5 days (IQR 0-663). We found that women (adj.HR 0.58; 95%C I 0.42-0.78), living alone (adj.HR: 0.63; 95% CI 0.43-0.92) and ethnicity ('Other': adj.HR 0.47; 95% CI 0.23-0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01-1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS.
Our analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes.
我们调查了社会人口学和临床特征对早期干预服务（EIS）延迟和 EIS 住院时间（LOS）的影响。
我们使用了与临床记录交互式搜索-首发精神病（CRIS-FEP）研究相关的发病数据。我们从 2010 年 5 月至 2016 年 3 月对患者进行了随访。我们通过多变量 Cox 回归来估计 EIS 延迟的风险比。我们使用负二项回归来确定社会人口学和临床特征与 EIS 的 LOS，同时控制混杂因素。
343 名患者符合 EIS 条件，其中 34.1%的患者未接受该服务。总体而言，EIS 的中位延迟时间为 120 天（IQR；15-1668）；中位 LOS 为 130.5 天（IQR 0-663）。我们发现，女性（adj.HR 0.58；95%CI 0.42-0.78）、独居（adj.HR：0.63；95%CI 0.43-0.92）和族裔（“其他”：adj.HR 0.47；95%CI 0.23-0.98）与 EIS 延迟延长相关。然而，家庭参与精神病的求治（adj.HR 1.37；95%CI 1.01-1.85）与 EIS 延迟缩短密切相关。之前曾使用过精神卫生服务的患者也经历了较长的 EIS 延迟。
我们的分析强调了社会人口统计学地位、求治行为与 EIS 延迟之间的联系。我们的研究结果还表明，那些以前有精神健康问题后来发展为精神病的患者在接受精神病专科治疗方面面临着脆弱性。迫切需要采取措施改善社会劣势指标，以减少健康不平等，改善临床结局。
