Suicidality among clients in a network of coordinated specialty care (CSC) programs for first-episode psychosis: Rates, changes in rates, and their predictors.

Autor: Phalen P; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: pphalen@som.umaryland.edu., Jones N; School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Davis B; National Institute of Mental Health, Bethesda, MD, USA., Sarpal D; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Dickerson F; Department of Psychology, Sheppard Pratt, Baltimore, MD, USA., Vatza C; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Jumper M; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Kuczynski A; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA., Thompson E; Alpert Medical School, Brown University, USA., Jay S; University of Maryland Baltimore County, Baltimore, MD, USA., Buchanan R; Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA., Chengappa KNR; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Goldberg R; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA., Kreyenbuhl J; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA., Margolis R; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Dong F; Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA., Riggs J; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Moxam A; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, USA., Burris E; Wesley Family Services First Episode Psychosis Program-ENGAGE, USA., Campbell P; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Cooke A; Johns Hopkins Bayview Medical Center Community Psychiatry Program, Baltimore, MD, USA., Ered A; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Fauble M; UPMC Western Behavioral Health at Safe Harbor, Erie, PA, USA., Howell C; Johns Hopkins Bayview Medical Center Community Psychiatry Program, Baltimore, MD, USA., Kelly C; University of Pittsburgh Medical Center, Western Psychiatric Hospital, Pittsburgh, PA, USA., Namowicz D; Children's Services Center, Wilkes Barre, PA, USA., Rouse K; First Episode Clinic/Maryland Psychiatric Research Center, University of Maryland School of Medicine, Catonsville, MD, USA., Smith W; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Wolcott M; Johns Hopkins Bayview Medical Center Community Psychiatry Program, Baltimore, MD, USA., Boumaiz Y; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA., Harvin A; Department of Psychology, Sheppard Pratt, Baltimore, MD, USA., Scheinberg R; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Saravana A; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA., Nayar S; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Kohler C; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Calkins ME; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Bennett M; Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Schizophrenia research [Schizophr Res] 2024 Dec; Vol. 274, pp. 150-157. Date of Electronic Publication: 2024 Sep 19.
DOI: 10.1016/j.schres.2024.07.054
Abstrakt: Background: People experiencing their first episode of psychosis have high risk of suicide, and programs specializing in early psychosis have not always achieved reduced risk. The present study analyzes patterns of suicide ideation, self-harm, and suicide attempts within the Connection Learning Healthcare System of 23 early psychosis programs in Pennsylvania and Maryland that follow the Coordinated Specialty Care treatment model.
Method: People with first episode psychosis (n = 1101) were assessed at admission and every six months using a standardized battery that included self-reported past-month ideation and clinician-reported past-six-month ideation, self-harm, and suicide attempts.
Results: At admission, there were 28 % rates of self-reported past-month suicide ideation and 52 % rates clinician-reported past-six-month suicide ideation, 23 % rate of clinician-reported self-harm, and 15 % rate of attempts. After the first six months of treatment there were significantly lower rates of clinician-reported suicidality (with reductions of at least 77 %), and after the first year of treatment there was significantly lower self-reported ideation (with approximately 54 % reporting lower past-month ideation). Changes were not accounted for by differential early discharge. A range of psychosocial variables predicted within- and between-subject variability in suicidality. Social and role functioning, depressive symptom severity, and a sense of recovery were significant within-subject predictors of all four measures of suicidality.
Conclusions: Compared to admission, we observed substantially lower rates of suicidality within the first year of treatment for clients with first episode psychosis in Coordinated Specialty Care. Reductions were predicted by some of the variables targeted by the treatment model.
Competing Interests: Declaration of competing interest Robert W. Buchanan has consulted for Boehringer-Ingelheim; serves on the Data Safety and Monitoring Boards of Roche, Merck and Newron; and has served on the Advisory Boards of Merck, Acadia, Karuna, and Neurocrine. All other authors have no declarations.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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