Improving Ongoing Engagement for Adolescents with a Psychotic Disorder: Investigating Predictors and Temporal Patterns of Mental Health Service Utilization

Background and Purpose:

Psychotic disorders are serious mental health problems that are increasingly recognized as having early onset, affecting both adolescents and their families. Early treatment in the course of psychosis can improve prognostic outcomes, facilitate adaptive functioning, and reduce familial and societal burden. Unfortunately, non-adherence and discontinuation of psychosocial treatment are common problems early in the course of treatment for psychosis. The following study was conducted to better understand variables predicting ongoing mental health service utilization for adolescents following their first episode of psychosis and to examine associated temporal patterns in service utilization.

Methods:Data were collected about 52 adolescents (under 18 years) treated and discharged from six psychiatric hospitals following their first episode of a primary psychotic disorder. A  Chart Review Data Instrument was utilized to extract information from hospital records (e.g., diagnosis and prominent symptoms, demographics, treatment, family history) (Kappa/ICC 0.74-1.00). Information on treatment and service utilization after discharge was collected by a questionnaire that was mailed to each adolescent’s parent/caregiver along with the consent materials. The time period covered was a minimum of 2 years post-discharge from initial hospitalization. A bivariate analysis was conducted on predictor variables associated with psychiatric service utilization. All significant predictor variables were included in a logistic regression model.

Results:

The average age at first-episode admission to the hospital was 14.4 years (SD=2.5). The majority of adolescents had a family history of psychiatric disorders (54%).  At discharge, 100% of adolescents were under the care of mental health professionals. Time since last psychiatric inpatient discharge was 30.9 months on average (SD=18.0). The following five variables were significantly associated with psychiatric service utilization: having a first degree relative with depression, presence of positive symptoms at discharge, presence of depression at discharge, being discharged on a mood stabilizer, and time since last psychiatric inpatient discharge.  In the logistic regression model only two variables, the presence of a first degree relative with depression and the number of months since last psychiatric inpatient discharge, were significantly associated with ongoing service utilization. For adolescents with a first degree relative with depression the odds of continued service utilization were 87% less than for adolescents without a first degree relative with depression (OR=0.13; p=.05).  The odds of continued service utilization decreased by 8% for each additional month since discharge (OR=0.92; p=.03).

Conclusion and Implications:

These findings support the long recognized need for mental health providers to work with families of adolescents with psychosis, as a first degree relative (e.g., parent, sibling) with depression may negatively influence service utilization. More interestingly, time since the youth’s last hospital discharge predicts discontinued service utilization at 18 months post-discharge. Consequently, this suggests that mental health professionals should be aware that 18 months post-discharge may a be critical time to review current treatment strategies and collaborate with youth and families to ensure that services continue to meet their needs. A better understanding of treatment utilization predictors and temporal patterns can assist mental health providers to promote ongoing engagement in services with adolescents and their families.