Service engagement and disengagement in first episode psychosis

McPhilemy, Kirsty (2020) Service engagement and disengagement in first episode psychosis. D Clin Psy thesis, University of Glasgow.

Abstract

Aims:
The effectiveness of early intervention (EI) services for people with first episode psychosis is dependent on meaningful service engagement. Difficulties with engagement in EI services increases risk of drop out which has implications for poorer functioning and poorer clinical outcomes. The purpose of the current study was to explore associations between engagement, clinical, and relational variables, and to investigate factors that predict service engagement in an early intervention service for first episode psychosis.
Methods:
The study gathered prospective routine date from an early intervention service using a naturalistic cohort of 83 individuals with first episode psychosis in Scotland, UK. Cross sectional associations between engagement, attachment, and carer’s burden of care were explored. Sociodemographic, clinical and psychiatric predictors of engagement were examined using hierarchical and stepwise regression.
Results:
Poorer clinician engagement as measured by the service engagement scale (SES) was associated with greater positive symptoms and greater disorganisation, poorer insight, more effortful caregiving and higher number of adverse childhood experiences. In regression analysis, only lack of insight predicted engagement at 12-weeks. We found that engagement scores at 12-weeks predicted engagement at 26-weeks. Additionally, engagement scores at an earlier point of treatment were predictive of psychiatric recovery at 12-month follow-up.
Conclusions:
Our findings suggest that clinicians in early intervention services are well placed to identify those who are at risk of poorer engagement and subsequent poorer psychiatric outcomes which has implications for treatment planning. Additionally, people who lacked insight into their diagnosis of psychosis and need for treatment, as rated by clinicians, were rated with poorer levels of service engagement. This may reflect clinicians framework of psychosis and mental illness and might suggest the need for clinicians to work within the patients own beliefs of their experiences and framework of mental illness to help increase engagement.

• Item Type: Thesis (D Clin Psy)
• Qualification Level: Doctoral
• Keywords: Early intervention, engagement, first episode psychosis, predictors, schizophrenia
• Subjects: B Philosophy. Psychology. Religion > BF Psychology
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Supervisor's Name: Gumley, Professor Andrew
• Date of Award: 2020
• Depositing User: Ms Kirsty McPhilemy
• Unique ID: glathesis:2020-81751
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 23 Oct 2020 15:13
• Last Modified: 13 Sep 2022 12:19
• Thesis DOI: 10.5525/gla.thesis.81751
• URI: https://theses.gla.ac.uk/id/eprint/81751