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Original Investigation
May 2018

Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

Author Affiliations
  • 1Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
  • 2The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
  • 3School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
JAMA Psychiatry. 2018;75(5):458-464. doi:10.1001/jamapsychiatry.2018.0185
Key Points

Questions  Is an early intervention service associated with a reduction in the long-term suicide rate in patients with schizophrenia-spectrum disorders?

Findings  In this historical control study of 1234 patients with first-episode schizophrenia-spectrum disorders (617 each in the early intervention and standard care groups), patients receiving a 2-year early intervention service had a significantly lower suicide rate during 12 years, with the main difference observed during the first 3 years.

Meaning  An early intervention service may be associated with reductions in the suicide rate among patients with schizophrenia-spectrum disorders during their most vulnerable period, and the benefits may persist in the long term.

Abstract

Importance  Patients with schizophrenia have a substantially higher suicide rate than the general public. Early intervention (EI) services improve short-term outcomes. However, little is known about the association of EI with suicide reduction in the long term.

Objective  To examine the association of a 2-year EI service with suicide reduction in patients with first-episode schizophrenia-spectrum (FES) disorders during 12 years and the risk factors for early and late suicide.

Design, Setting, and Participants  This historical control study compared 617 consecutive patients with FES who received the 2-year EI service in Hong Kong between July 1, 2001, and June 30, 2003, with 617 patients with FES who received standard care (SC) between July 1, 1998, and June 30, 2001, matched individually. Clinical information was systematically retrieved for the first 3 years of clinical care for both groups. The details of death were collected up to 12 years from presentation to the services. Data analysis was performed from October 30, 2016, to August 18, 2017.

Main Outcomes and Measures  Suicide rate during 12 years was the primary measure. The association of the EI service with the suicide rates during years 1 through 3 and years 4 through 12 were explored separately.

Results  The main analysis included 1234 patients, with 617 in each group (mean [SD] age at baseline, 21.2 [3.4] years in the EI group and 21.3 [3.4] years in the SC group; 318 male [51.5%] in the EI group and 322 [52.2%] in the SC group). The suicide rates were 7.5% in the SC group and 4.4% in the EI group (McNemar χ2 = 5.55, P = .02). Patients in the EI group had significantly better survival (propensity score–adjusted hazard ratio, 0.57; 95% CI, 0.36-0.91; P = .02), with the maximum association observed in the first 3 years. The number of suicide attempts was an indicator of early suicide (1-3 years). Premorbid occupational impairment, number of relapses, and poor adherence during the initial 3 years were indicators of late suicide (4-12 years).

Conclusions and Relevance  This study suggests that the EI service may be associated with reductions in the long-term suicide rate. Suicide at different stages of schizophrenia was associated with unique risk factors, highlighting the importance of a phase-specific service.

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