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- Title
Self-Harm and Suicide Rates Before and After an Early Intervention Program for Patients With First-Episode Schizophrenia.
- Authors
Chai, Yi; Tang, Jennifer Yee-Man; Ma, Dennis Chak Fai; Luo, Hao; Chan, Sherry Kit Wa
- Abstract
Key Points: Question: Are early intervention services (EISs) associated with decreases in self-harm and suicide risk among patients older than 25 years with first-episode schizophrenia (FES)? Findings: In this population-based cohort study of 37 040 patients with FES, immediate and long-term decreases in self-harm were observed among patients older than 25 years after the implementation of the EIS. Suicide rates decreased immediately among patients aged 15 to 44 years. Meaning: This study suggests that the EIS was associated with decreases in self-harm and suicide among patients with FES, underscoring the importance of designing and implementing EISs for patients across all age ranges. Importance: Evidence on the association of early intervention services (EISs) with self-harm and suicide among patients with first-episode schizophrenia (FES) at older than 25 years is lacking. Objective: To examine changes in self-harm and suicide rates among patients with FES before and after the implementation of an EIS program. Design, Setting, and Participants: This population-based cohort study conducted among 37 040 patients aged 15 to 64 years with FES between January 1, 2001, and March 31, 2020, used electronic medical records from the Hong Kong Clinical Data Analysis and Reporting System. All patients were followed up from the first diagnosis of schizophrenia (the index date) until the date of their death or the end of the study period (March 31, 2021), whichever came first. Statistical analysis was performed from July to November 2023. Exposure: The EIS extended the Early Assessment Service for Young People With Early Psychosis (EASY) program from patients aged 15 to 25 years to those aged 15 to 64 years (EASY Plus). The exposure was the implementation of the EASY Plus program in April 2011. The exposure period was defined as between April 2012 and March 2021 for the 1-year-time-lag analysis. Main Outcomes and Measures: The outcomes were monthly rates of self-harm and suicide among patients with FES before and after the implementation of the EASY Plus program. Interrupted time series analysis was used for the main analysis. Results: This study included 37 040 patients with FES (mean [SD] age at onset, 39 [12] years; 82.6% older than 25 years; 53.0% female patients). The 1-year-time-lag analysis found an immediate decrease in self-harm rates among patients aged 26 to 44 years (rate ratio [RR], 0.77 [95% CI, 0.59-1.00]) and 45 to 64 years (RR, 0.70 [95% CI, 0.49-1.00]) and among male patients (RR, 0.71 [95% CI, 0.56-0.91]). A significant long-term decrease in self-harm rates was found for all patients with FES (patients aged 15-25 years: RR, 0.98 [95% CI, 0.97-1.00]; patients aged 26-44 years: RR, 0.98 [95% CI, 0.97-0.99]; patients aged 45-64 years: RR, 0.97 [95% CI, 0.96-0.98]). Suicide rates decreased immediately after the implementation of the EASY Plus program among patients aged 15 to 25 years (RR, 0.33 [95% CI, 0.14-0.77]) and 26 to 44 years (RR, 0.38 [95% CI, 0.20-0.73]). Compared with the counterfactual scenario, the EASY Plus program might have led to 6302 fewer self-harm episodes among patients aged 26 to 44 years. Conclusions and Relevance: This cohort study of the EASY Plus program suggests that the extended EIS was associated with reduced self-harm and suicide rates among all patients with FES, including those older than 25 years. These findings emphasize the importance of developing tailored interventions for patients across all age ranges to maximize the benefits of EISs. This 20-year cohort study examines changes in self-harm and suicide rates among patients older than 25 years with first-episode schizophrenia before and after the implementation of an early intervention services program.
- Subjects
HONG Kong (China); SCHIZOPHRENIA treatment; SUICIDE prevention; POISSON distribution; EARLY medical intervention; HUMAN services programs; MENTAL health services; CLINICAL trials; TREATMENT effectiveness; TIME series analysis; DESCRIPTIVE statistics; SELF-mutilation; LONGITUDINAL method; ODDS ratio; PRE-tests &; post-tests; SUICIDE; ELECTRONIC health records; CONFIDENCE intervals; COMPARATIVE studies; DATA analysis software; REGRESSION analysis
- Publication
JAMA Network Open, 2024, Vol 7, Issue 8, pe2426795
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.26795