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Study identifies target populations for first-episode psychosis interventions

Incidence of first-episode psychosis was higher among individuals in ethnic minority groups, lower socioeconomic groups and those who lived in more urban or deprived neighborhoods, suggesting potential target areas for intervention services.

“Unfortunately, psychosis epidemiology is predominantly informed by an older literature, conducted prior to the widespread introduction of these services, almost exclusively based in urban settings. This research has revealed important heterogeneity in incidence by person and place, generating new directions for etiological research. However, national implementation efforts being developed in countries such as Denmark, Australia, and Canada, and currently undergoing revision in the United Kingdom, require accurate, relevant estimates about the epidemiology of psychotic disorders in populations served by early intervention psychosis services,” James B. Kirkbride, PhD, of University College London, and colleagues wrote.

“Such data will also be critical in countries such as the United States, where early intervention initiatives are gaining traction but where little recent epidemiological data exist to inform service provision.”

To characterize the epidemiology of first-episode psychosis in rural and urban settings, researchers identified new individuals presenting with first-episode psychosis to early intervention psychosis services in the East of England. Analysis included 2 million person-years follow-up. Study participants (n = 687) were aged 16 to 35 years. Median age at referral was 22.5 years for men and 23.4 years for women.

Incidence rates were highest for men and women before age 20 years.

After adjusting for confounders, rates increased for ethnic minority groups (IRR = 1.4; 95% CI, 1.1-1.6), individuals with lower socioeconomic status (IRR = 1.3; 95% CI, 1.2-1.4) and in more urban (IRR = 1.4; 95% CI, 1-1.8) and deprived (IRR = 2.1; 95% CI, 1.3-3.3) neighborhoods.

“Our findings highlight substantial demand for early intervention psychosis services in a large, diverse, mixed rural and urban population in the East of England,” the researchers wrote. “In a U.S. context, where early intervention psychosis services are currently gaining momentum, service provision is primarily predicated on the treatment of nonaffective psychoses. If, however, earlier intervention in the critical period for psychosis generates greater diagnostic uncertainty, this will inevitably result in a higher proportion of undifferentiated psychopathologies at first referral.” – by Amanda Oldt

Disclosure: Kirkbride reports receiving support from a Sir Henry Wellcome Research Fellowship from the Wellcome Trust (grant number, WT085540) and a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (grant number, 101272/Z/13/Z). Please see the study for a full list of relevant financial disclosures.