Reduction in incidence of hospitalizations for psychotic episodes through early identification and intervention

Abstract

Objective: This study examined whether the incidence of hospitalization for psychosis was reduced by a communitywide system of early identification and intervention to prevent onset of psychosis.

Methods: The Portland Identification and Early Referral program (PIER) was initiated in 2001. Youths and young adults ages 12-35 were identified by professionals in a wide variety of educational, health, and mental health settings. PIER program staff assessed, confirmed risk of psychosis, and provided treatment for 24 months to eligible and consenting young people (N=148). The monthly rate of first hospital admission for psychosis was the outcome measure for efficacy of identification and intervention. Admission rates before and after the program began accepting referrals were compared, both in the experimental area (Greater Portland) and in aggregated urban areas of Maine (control areas). Autoregressive integrated moving-average (ARIMA) models were used to assess the effect.

Results: On the basis of ARIMA models, the rate of first hospital admission for psychosis decreased significantly by 26% (95% confidence interval [CI]=-64% to -11%) in the Greater Portland area. The rate increased by 8% (CI=-5% to 36%) in the control areas. Taking into account the increase in the control areas, the actual percentage reduction in Greater Portland during the intervention period was 34% (26% plus 8%). The reduction in admissions was largest for individuals with nonaffective nonschizophrenic psychosis.

Conclusions: PIER has demonstrated that populationwide early identification is feasible. Preventive intervention can reduce rates of initial hospitalizations for psychosis in a midsized city.

Figures

Figure 1

Rates of hospital admission for first episode psychosis: Greater Portland Area vs. Urban Control Area

Figure 2

Rates of hospital admission for first episode psychosis per 100,000 per year: Ratio of Greater Portland area to Urban Control area, 1999-2007 The ratio is the rate for FEP hospitalizations per 100,000 persons age 12-35 per calendar year in Greater Portland divided by the same rate for the Urban Control area in the same year.