Early Intervention Reduces Self-Harm, Suicide in First-Episode Schizophrenia

The implementation of an expanded early intervention service (EIS) for patients with first-episode schizophrenia is associated with significant reductions in self-harm and suicide rates across age groups, according to study results published in JAMA Network Open.

Although EISs have demonstrated substantial effectiveness in reducing suicidality among young patients with first-episode psychosis, there is a paucity of data on the utility of EISs among patients aged 45 years and older. In April 2011, the Early Assessment Service for Young People With Early Psychosis (EASY) program expanded its eligibility criteria from patients aged 15 to 25 years to include those aged 15 to 64 years (EASY Plus).

To evaluate whether the EASY Plus program was effective in reducing self-harm and suicide rates among patients up to 64 years of age with first-episode schizophrenia, researchers conducted a population-based cohort study using territory-wide electronic medical records from the Clinical Data Analysis Reporting System (CDARS) in Hong Kong. The primary exposure of interest was the implementation of the EASY Plus program between April 2012 and March 2021 (to account for the 1-year time-lag analysis). The primary outcome of interest were the monthly rates of self-harm and suicide before and after the implementation of EASY Plus.

A total of 37,040 participants with first-episode schizophrenia diagnosed between January 1, 2001, and March 31, 2020, validated using International Classification of Diseases (ICD) codes, were included in the analysis. The mean (SD) age at onset was 39 (12) years, 82.6% of participants were older than 25 years of age, and 53.0% were women.

During the study period, the overall self-harm rate was 15.9% (95% CI, 15.5%-16.3%), and the overall suicide rate was 1.7% (95% CI, 1.6%-1.8%). Patients aged 15 to 25 years had the highest rates of self-harm (23.0%; 95% CI, 21.8%-24.2%) and suicide (2.5%; 95% CI, 2.2%-3.0%), while individuals aged 45 to 64 years had the lowest rates of self-harm (10.0%; 95% CI, 9.5%-10.5%) and suicide (1.0%; 95% CI, 0.9%-1.2%).

The EASY Plus program was associated with significant reductions in monthly self-harm and suicide rates. In a 1-year time-lag analysis, the researchers observed an immediate decrease in self-harm rates for patients aged 26 to 44 years (rate ratio [RR], 0.77; 95% CI, 0.59-1.00) 45 to 64 years (RR, 0.70; 95% CI, 0.49-1.00), and among men (RR, 0.71; 95% CI, 0.56-0.91). Long-term reductions in self-harm rates were also observed across all age groups, with the most notable reductions observed among patients aged 15 to 25 years (RR, 0.98; 95% CI, 0.97-1.00), 26 to 44 years (RR, 0.98; 95% CI, 0.97-0.99), and 45 to 64 years (RR, 0.97; 95% CI, 0.96-0.98).

Additionally, suicide rates decreased significantly 1 year after the program’s implementation, particularly among patients aged 15 to 25 years (RR, 0.33; 95% CI, 0.14-0.77), 26 to 44 years (RR, 0.38; 95% CI, 0.20-0.73), and among both men (RR, 0.43; 95% CI, 0.23-0.80) and women (RR, 0.45; 95% CI, 0.23-0.88).

The intervention was associated with an estimated reduction of 1314 self-harm episodes among patients aged 15 to 25 years, 6302 episodes among those aged 26 to 44 years, and 4711 episodes among those aged 45 to 64 years during the intervention period.

Study authors concluded, “Our results highlight the importance of tailoring the EIS to meet the unique needs of diverse patient subgroups when developing and implementing EISs for a broader adult population.”

Study limitations include the potential underreporting of self-harm incidents, possible inaccuracies in electronic medical records, and the inability to provide EASY Plus services to all eligible patients due to workload constraints.

This article originally appeared on Psychiatry Advisor