Schizophrenia Research
Volume 193, 2018, Pages 399-405

Disengagement in immigrant groups receiving services for a first episode of psychosis (Article)

Maraj A. , Veru F. , Morrison L. , Joober R. , Malla A. , Iyer S. , Shah J.*
  • a Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
  • b Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
  • c Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada
  • d Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada, ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada
  • e Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada, ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada
  • f Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada, ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada
  • g Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Quebec, Canada, ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada

Abstract

Objective: Although early intervention (EI) programs for psychosis invest in clients remaining engaged in treatment, disengagement remains a concern. It is not entirely clear whether immigrants are likelier to disengage. The rates and predictors of disengagement for immigrant vis-à-vis non-immigrant clients in a Canadian EI setting were analyzed. Method: 297 clients were included in a time-to-event analysis with Cox Proportional Hazards regression models. Immigrant status (first- or second-generation immigrant or non-immigrant), age, gender, education, substance abuse, family contact, social and material deprivation and medication non-adherence were tested as predictors of service disengagement. Results: 24.2% (n = 72) of the clients disengaged from services before completing two years. Disengagement rates did not differ between first-generation immigrants (23.3%), second-generation immigrants (22.7%) and non-immigrants (25.3%). For all clients, only medication non-adherence predicted disengagement (HR = 3.81, 95% CI 2.37–6.14). For first-generation immigrants, age (HR = 1.17, 95% CI 1.02–1.34) and medication non-adherence (HR = 2.92, 95% CI 1.09–7.85) were significant predictors. For second-generation immigrants, material deprivation (HR = 1.03, 95% CI 1.00–1.05) and medication non-adherence (HR = 11.07, 95% CI 3.20–38.22) were significant. Conclusion: Disengagement rates may be similar between immigrants and non-immigrants, but their reasons for disengagement may differ. Medication adherence was an important predictor for all, but the role of various sociodemographic factors differed by group. Sustaining all clients' engagement in EI programs may therefore require multi-pronged approaches. © 2017 Elsevier B.V.

Author Keywords

Psychosis Early intervention Disengagement Immigrant

Index Keywords

education prospective study immigrant proportional hazards model mental health service Proportional Hazards Models analysis demography Prospective Studies human social isolation psychosis controlled study social aspect time factor priority journal Time Factors substance abuse medication compliance ethnology procedures Young Adult Humans migrant family psychology Adolescent male Canada Emigrants and Immigrants female prediction Psychotic Disorders Article patient compliance major clinical study adult gender age patient attitude neuroleptic agent Patient Acceptance of Health Care Medication Adherence time-to-event analysis early childhood intervention material deprivation Early Intervention (Education)
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85028347206&doi=10.1016%2fj.schres.2017.07.054&partnerID=40&md5=6930b5ad3c9dd54a91c5ae96b41ee505
DOI: 10.1016/j.schres.2017.07.054
ISSN: 09209964
Cited by: 5
Original Language: English