Background Discharge from early psychosis intervention is a critical stage of treatment that may occur for a variety of reasons. This study characterizes reasons for discharge among participants in early psychosis intervention programs participating in the Early Psychosis Intervention Network (EPINET) which comprises >100 programs in the United States organized under 8 academic hubs. Study Design We analyzed 1787 discharges, focusing on program completion, unilateral termination by the client/family, and lost contact with the client/family. We performed exploratory analyses of demographic, clinical, and functional predictors of discharge reason. Variables predictive of discharge type were included in multilevel logistic regressions, allowing for the estimation of predictors of discharge reason and variability in rates by program and hub. Study Results An estimated 20%–30% of enrolled patients completed the program. Program completion rates were higher among participants who were older on admission, had lower negative symptoms severity, spent more time in education, employment, or training, and who were covered by private insurance (a close proxy for socioeconomic status). Programs were more likely to lose contact with male participants, Black participants, and participants who were never covered by private insurance. After accounting for patient-level factors, there was substantial program-level variation in all 3 discharge outcomes, and hub-level variability in the proportion of participants who completed the program. The impact of race on program completion varied substantially by program. Conclusions Participants were discharged from early psychosis intervention services for diverse reasons, some of which were associated with sociocultural factors. Disengagement is a widespread problem affecting all hubs.

中文翻译：

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国家早期精神病干预计划网络中出院的原因


背景 早期精神病干预的出院是治疗的关键阶段，可能因多种原因而发生。本研究描述了参与早期精神病干预网络 (EPINET) 的早期精神病干预项目参与者的出院原因，该网络由美国 8 个学术中心组织的超过 100 个项目组成。研究设计 我们分析了 1787 例出院案例，重点关注项目完成情况、客户/家人单方面终止以及与客户/家人失去联系。我们对出院原因的人口统计学、临床和功能预测因素进行了探索性分析。预测出院类型的变量包含在多级逻辑回归中，从而可以估计出院原因的预测因素以及按计划和中心划分的比率变异性。研究结果 据估计，20%–30% 的入组患者完成了该计划。入院时年龄较大、阴性症状严重程度较低、在教育、就业或培训上花费更多时间以及有私人保险（社会经济地位的密切代表）的参与者的项目完成率较高。项目更有可能与男性参与者、黑人参与者和从未享受过私人保险的参与者失去联系。考虑到患者层面的因素后，所有 3 个出院结果都存在很大的项目层面差异，并且完成项目的参与者比例也存在中心层面的差异。比赛对项目完成的影响因项目而异。结论 参与者因多种原因退出早期精神病干预服务，其中一些原因与社会文化因素有关。 脱离是影响所有枢纽的普遍问题。