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Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis

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Abstract

Purpose

Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little is known about their predictors. Therefore, we aimed to analyze the rate and reasons for drop-out and service disengagement in CHR-P patients and investigate their sociodemographic and clinical predictors.

Methods

Data from 200 patients of the prospective Früherkennung von Psychosen (FePsy) study were analyzed with competing risks survival models, considering drop-out and transition to psychosis as competing events. To investigate whether symptoms changed immediately before drop-out, t tests were applied.

Results

Thirty-six percent of patients dropped out within 5 years. Almost all drop-outs also disengaged from our service. Hence, study drop-out was used as a proxy for service disengagement. Patients with more severe baseline disorganized symptoms and a late inclusion into the study were significantly more likely to disengage. Immediately before disengagement, there was significant improvement in negative symptoms only.

Conclusion

A considerable proportion of CHR-P patients disengaged from our clinical study and service. Patients who were included during a later study period with more assessments disengaged more often, which might have been due to more frequent invitations to follow-up assessments and thereby increasing participation burden. Hence, our study provides a cautionary note on high-frequency follow-up assessments. Larger-scale studies evaluating predictors on multiple domains would help to further elucidate drop-out and disengagement.

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Acknowledgements

We thank all patients who participated in the study as well as the referring specialists.

Funding

This project was supported by Grants of the Swiss National Science Foundation (nos. 3200-057 216.99, 3200-0572 216.99, PBBSB-106 936, and 3232BO-119 382) and the Nora van Meeuwen-Haefliger Stiftung, Basel (CH). These institutions had no further role in the study design; collection, analysis and interpretation of data; in the writing of the report and in the decision to submit the paper for publication.

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Author notes

  1. Shared last-authorship: Christina Andreou and Anita Riecher-Rössler.

Authors and Affiliations

  1. Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland

    Letizia Leanza, Amatya J. Mackintosh, Leonie Seiler & Christina Andreou

  2. Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland

    Letizia Leanza, Amatya J. Mackintosh & Katharina Beck

  3. Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland

    Erich Studerus

  4. University of Basel, Basel, Switzerland

    Anita Riecher-Rössler

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  1. Letizia Leanza
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  2. Erich Studerus
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  3. Amatya J. Mackintosh
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  4. Katharina Beck
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Correspondence to Anita Riecher-Rössler.

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Leanza, L., Studerus, E., Mackintosh, A.J. et al. Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis. Soc Psychiatry Psychiatr Epidemiol 55, 539–548 (2020). https://doi.org/10.1007/s00127-019-01796-6

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