12-year follow-up study of mortality due to suicide among first episode psychosis cohort: Is the early intervention program more effective in reducing excess mortality due to suicide in psychosis

Abstract

Background: The mortality gap between the general public and people with psychotic disorders remains large. Despite the excess mortality particularly due to suicide observed in people with psychosis, little has been done to investigate measures that may effectively prevent premature deaths. It remains unclear if early intervention (EI) for psychosis can have sustainable effect to prevent excess mortality. This study compared the mortality rates at 12-year between first-episode psychosis patients from the EI program, and those who received standard care service. Methods: Seven hundred consecutive patients who received the EI service between 2001 and 2003 in Hong Kong, and 700 matched patients who received the standard care (SC) service between 1998 and 2001 were traced over a 12-year period following their first presentation. The EI service in Hong Kong (EASY) provides phase specific intervention to patients with first episode psychosis of age 15–25. All deaths within the cohort were identified via the centralized digital patient records system. Official verdict on cause of death was then obtained from the Coroner’s Court. Results: Of all 1,400 patients, 80 (5.7%) people had died within the follow-up period, 74 (5.3%) cases committed suicide. There were 4.1% (N = 29) among the EI group and 7.3% (N = 51) among the SC group. The difference of suicide rates between the two groups was statistically significant, χ 2 (1) = 4.71, Po0.03. Multivariate Coxproportional hazards regression analysis revealed that, EI patients were at reduced risk of mortality than those in the SC group (adj. rate ratio [RR] 1.68, 95% CI 1.05–2.69). However, when suicide occurred within the first three years following the initial onset were excluded, there was no significant difference between the two groups (adj. rate ratio [RR] 1.08, 95% CI.60–1.97), with 1.5% (N = 21) from the EI group and 1.5% (N = 22) from the SC group. Compared with the general population, the standardized mortality ratios for suicide [SMR] for EI (SMR 31.5, 95% CI 21.52–44.71) and SC (SMR 51.4, 95% CI 38.64–66.99) were both very high. Discussion: This study investigated mortality among 1,400 individuals with first-episode psychosis at 12-year follow-up. Significantly more deaths were observed within people in the EI program than in those who received the SC service. After controlling for the gender difference, the analyses revealed that the EI program is more effective than the SC service in reducing mortality rates in psychosis patients, especially for the first three years of illness. However, the excess mortality in psychosis patients yet remains large. These points to the need in refining the EI service in targeting the tractable clinical and social risk factors that underlie excess mortality in psychosis.