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

Publication ,  Journal Article
Chan, SKW; Chan, SWY; Pang, HH; Yan, KK; Hui, CLM; Chang, WC; Lee, EHM; Chen, EYH
Published in: JAMA Psychiatry
May 1, 2018

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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Published In

JAMA Psychiatry

DOI

EISSN

2168-6238

Publication Date

May 1, 2018

Volume

75

Issue

5

Start / End Page

458 / 464

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Analysis
  • Suicide Prevention
  • Suicide
  • Schizophrenia
  • Risk Factors
  • Male
  • Humans
  • Hong Kong
  • Historically Controlled Study
 

Citation

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Chan, S. K. W., Chan, S. W. Y., Pang, H. H., Yan, K. K., Hui, C. L. M., Chang, W. C., … Chen, E. Y. H. (2018). Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry, 75(5), 458–464. https://doi.org/10.1001/jamapsychiatry.2018.0185
Chan, Sherry Kit Wa, Stephanie Wing Yan Chan, Herbert H. Pang, Kang K. Yan, Christy Lai Ming Hui, Wing Chung Chang, Edwin Ho Ming Lee, and Eric Yu Hai Chen. “Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders.JAMA Psychiatry 75, no. 5 (May 1, 2018): 458–64. https://doi.org/10.1001/jamapsychiatry.2018.0185.
Chan SKW, Chan SWY, Pang HH, Yan KK, Hui CLM, Chang WC, et al. Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry. 2018 May 1;75(5):458–64.
Chan, Sherry Kit Wa, et al. “Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders.JAMA Psychiatry, vol. 75, no. 5, May 2018, pp. 458–64. Pubmed, doi:10.1001/jamapsychiatry.2018.0185.
Chan SKW, Chan SWY, Pang HH, Yan KK, Hui CLM, Chang WC, Lee EHM, Chen EYH. Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry. 2018 May 1;75(5):458–464.

Published In

JAMA Psychiatry

DOI

EISSN

2168-6238

Publication Date

May 1, 2018

Volume

75

Issue

5

Start / End Page

458 / 464

Location

United States

Related Subject Headings

  • Young Adult
  • Survival Analysis
  • Suicide Prevention
  • Suicide
  • Schizophrenia
  • Risk Factors
  • Male
  • Humans
  • Hong Kong
  • Historically Controlled Study