Defining disengagement from mental health services for individuals experiencing first episode psychosis: a systematic review
Individuals affected by psychotic disorders frequently disengage from mental health services, although reports of this rate in the literature have ranged from 6 to 60%. One of the potential explanations for the large variation is that studies have adopted different definitions. Without a universal definition it is challenging to compare rates and factors leading to disengagement across studies. This systematic review aims to identify and compare how disengagement from psychosis services has been defined, measured and operationalised in the literature to date.
A systemic literature search of the PubMed, PsycINFO and CINAHL databases was completed following the PRISMA guidelines for systematic reviews.
1506 Studies were identified, of which 30 were eligible to be included. It was found that disengagement was operationalized as either a categorical or continuous variable across studies, with 18 studies classifying it as a categorical, binary variable. Only four studies applied a time period over which disengagement was said to occur, and only four studies used an instrument to measure or predict disengagement. Few studies considered similar factors in their definition, when this occurred it was because the papers came from the same research group.
To truly understand the phenomenon of disengagement, studies need to have a comparable outcome variable. The need for consensus on a gold standard definition of disengagement that considers the full breadth of its complexity remains. A potential process for establishing a definition that includes set parameters, agreed upon terminology and time periods of assessment is discussed.
KeywordsDisengagement Systematic review First episode psychosis Psychotic disorders Psychosis
There is no funding associated with this review.
Compliance with ethical standards
Conflict of interest
The authors acknowledge they have no conflicts of interest.
- 2.Milner EC, Rowlands P, Gardner B, Ashby F (2001) First episode of psychosis - an audit of service engagement and management at 1–2 year follow-up. Med Sci Monit Int Med J Exp Clin Res 7(6):1299–1302Google Scholar
- 7.Morgan MG, Scully PJ, Youssef HA, Kinsella A, Owens JM, Waddington JL (2003) Prospective analysis of premature mortality in schizophrenia in relation to health service engagement: a 7.5-year study within an epidemiologically complete, homogeneous population in rural Ireland. Psychiatry Res 117(2):127–135CrossRefGoogle Scholar
- 9.Kim DJ, Brown E, Reynolds S, Geros H, Sizer H, Tindall R, McGorry P, O’Donoghue B (2019) The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol. https://doi.org/10.1007/s00127-019-01698-7 CrossRefPubMedGoogle Scholar
- 16.National Heart L, Institute B (2014) Quality assessment tool for observational cohort and cross-sectional studies. National Institutes of Health, Department of Health and Human Services, BethesdaGoogle Scholar
- 23.Craig T, Power P (2010) Inpatient provision in early psychosis. In: French P, Smith J, Shiers D, Reed M, Rayne M (eds) Promoting recovery in early psychosis: a practice manual, vol xv. Wiley, Amsterdam, pp 17–26 299 pp Google Scholar
- 26.Kendrick T, Burns T, Garland C, Greenwood N, Smith P (2000) Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice. Br J Gen Pract J R Coll Gen Pract 50(451):121–126Google Scholar
- 27.Schimmelmann BG, Conus P, Schacht M, McGorry P, Lambert M (2006) Predictors of service disengagement in first-admitted adolescents with psychosis. J Am Acad Child Adolesc Psychiatry 45(8):990–999. https://doi.org/10.1097/01.chi.0000223015.29530.65 CrossRefPubMedGoogle Scholar
- 34.Anderson KK (2012) Health services use and treatment delay for patients experiencing a first-episode of psychosis: a mixed methods study. McGill University, CanadaGoogle Scholar
- 37.Lau KW, Chan SK, Hui CL, Lee EH, Chang WC, Chong CS, Lo WT, Chen EY (2017) Rates and predictors of disengagement of patients with first-episode psychosis from the early intervention service for psychosis service (easy) covering 15 to 64 years of age in Hong Kong. Early Interv Psychiatry 13(3):398–404CrossRefGoogle Scholar
- 38.Schottle D, Schimmelmann BG, Ruppelt F, Bussopulos A, Frieling M, Nika E, Nawara LA, Golks D, Kerstan A, Lange M, Schodlbauer M, Daubmann A, Wegscheider K, Rohenkohl A, Sarikaya G, Sengutta M, Luedecke D, Wittmann L, Ohm G, Meigel-Schleiff C, Gallinat J, Wiedemann K, Bock T, Karow A, Lambert M (2018) Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: four-year follow-up of the ACCESS II study. PLoS One 13(2):e0192929. https://doi.org/10.1371/journal.pone.0192929 CrossRefPubMedPubMedCentralGoogle Scholar
- 43.Lam CCSF, Reeves SJ, Stewart R, Howard R (2016) Service and treatment engagement of people with very late-onset schizophrenia-like psychosis. Psychiatr Bull 40(4):185–186Google Scholar
- 45.Kruse M (2012) Predicting disengagement from care in an early psychosis patient cohort in the United States. Yale Med Thesis Digit Lib 1737:1–42Google Scholar
- 51.Conus P, Cotton S, Schimmelmann BG, McGorry PD, Lambert M (2017) Rates and predictors of 18-months remission in an epidemiological cohort of 661 patients with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 52(9):1089–1099. https://doi.org/10.1007/s00127-017-1388-7 CrossRefPubMedGoogle Scholar
- 55.Linstone HA, Turoff M (1975) The delphi method. Addison-Wesley, ReadingGoogle Scholar