Greenwood Kathryn, Jones Christopher, Yaziji Nahel, Healey Andrew, May Carl, Bremner Stephen, Hooper Richard, Rathod Shanaya, Phiri Peter, de Visser Richard, Mackay Tanya, Bartl Gergely, Abramowicz Iga, Gu Jenny, Webb Rebecca, Nandha Sunil, Lennox Belinda, Johns Louise, French Paul, Hodgekins Jo, Law Heather, Plaistow James, Thompson Rose, Fowler David, Garety Philippa, O'Donnell Anastacia, Painter Michelle, Jarvis Rebecca, Clark Stuart, Peters Emmanuelle
Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK; and School of Psychology, University of Sussex, Falmer, UK.
Brighton and Sussex Medical School, Falmer, UK.
Br J Psychiatry. 2025 Mar;226(3):144-152. doi: 10.1192/bjp.2024.154. Epub 2024 Nov 25.
Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.
To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.
We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14-35 years) presenting with a first episode of psychosis between May 2019 and July 2020 ( = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12-26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.
Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP ( = 652) versus sEIP alone ( = 375) was 1.07 (95% CI 0.76-1.49; = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.
We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.
精神病早期干预（EIP）服务可改善年轻人的治疗效果，但约30%的人会退出。
测试一种新的动机参与干预措施是否能延长参与时间以及是否具有成本效益。
我们进行了一项多中心、单盲、平行组、整群随机对照试验，涉及英国国民健康服务（NHS）五个地点的20个EIP团队。团队使用按NHS信托分层的置换块进行随机分组。参与者均为2019年5月至2020年7月期间首次出现精神病发作的年轻人（年龄14 - 35岁，n = 1027）。我们将新型早期青年参与（EYE - 2）干预措施加标准化EIP（sEIP）与单独的sEIP进行了比较。主要结局是12至26个月内退出的时间。经济结局是12个月内的心理健康成本、社会成本和社会职业结局。评估者对主要退出和成本效益结局的治疗分配情况不知情。分析遵循意向性分析原则。该试验在ISRCTN51629746注册。
在标准化的独立服务中，总体退出率较低，为15.9%。EYE - 2 + sEIP组（n = 652）与单独的sEIP组（n = 375）的调整后风险比为1.07（95%可信区间0.76 - 1.49；P = 0.713）。健康经济评估表明，EYE - 2组因计划外心理保健减少而导致心理健康护理成本降低，且临床结局不受影响，同时有一些证据表明社会成本降低，在教育、培训、就业和稳定住所方面的天数增加。
我们没有发现证据表明EYE - 2能增加退出时间，但有一些证据表明其具有成本效益。这是迄今为止在整个EIP人群样本中报告积极参与、健康和成本结局的最大规模研究。局限性包括次要结局的随访失访率高以及社会和社会职业数据的完成率低。COVID - 19影响了保真度和实施情况。未来的参与研究应针对最需要帮助的人群，包括住院患者和有社会职业目标的人群。
