Novel digital intervention improves vocational attainment in first-episode psychosis

A new digital intervention added to treatment as usual improved vocational or educational attainment and reduced usage of hospital emergency services in first-episode psychosis, according to results of a randomized controlled trial.

However, the intervention, a comprehensive digital platform called the Horyzons project, did not have a significant effect on social functioning compared with treatment as usual. The intervention combined peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions that address social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation.

“Drawing on our previous evidence-based interventions in preventing psychosis relapse and improving vocational attainment in [first episode psychosis], combined with novel approaches to social recovery (strengths- and mindfulness-based interventions) and the principles of self-determination theory, our team developed a world-first digital intervention (Horyzons) designed to foster long-term recovery in [first-episode psychosis],” Mario Alvarez-Jimenez, PhD, D.Clin.Psy, of the Centre for Youth Mental Health at the University of Melbourne in Australia, and colleagues wrote. “Horyzons blends evidence-based models of social functioning, vocational recovery and relapse prevention into a therapeutic social media environment supported by peer workers as well as clinicians and vocational professionals.”

Alvarez-Jimenez and colleagues sought to whether, after 2 years of specialized support for first-episode psychosis, adding Horyzons to treatment as usual was associated with better outcomes compared with 18 months of treatment as usual alone. Treatment as usual feature transfer to primary or tertiary community mental health services. They enrolled 170 participants with first-episode psychosis who were aged 16 to 27 years and were in clinical remission and nearing discharge from a specialized service. Between October 2013 and January 2017, they assigned 86 participants to Horyzons plus treatment as usual and 84 to treatment as usual alone. Social functioning at 18 months according to the Personal and Social Performance Scale (PSP) served as the primary outcome. A total of 55.5% of the Horyzons plus treatment as usual group logged on for 6 months or longer and 47% for 9 months or longer.

Results showed high and stable social functioning among both groups from baseline to 18-month follow-up. The researchers observed no evidence of significant between-group differences, with PSP mean difference of –0.29 (95% CI, –4.2 to 3.63). Horyzons group participants were 5.5 times more likely to find employment or enroll in education vs. those in treatment as usual (OR = 5.55; 95% CI, 1.09-28.23), and the researchers noted evidence of a dose-response effect. Those in the treatment as usual group were twice as likely to use emergency services vs. those in the Horyzons group, for 39% vs. 19% (OR = 0.31; 95% CI, 0.11-0.86). In the Horyzons group (13%) vs. the treatment as usual group (27%), the researchers noted a non-significant trend for lower hospitalizations linked to psychosis (OR = 0.36; 95% CI, 0.11-1.08).

“Ultimately, with specialized [first-episode psychosis] services now being available across the U.S., Canada, Europe, Asia and Australasia, Horyzons holds significant promise as a novel, engaging and sustainable intervention to improve vocational recovery, reduce utilization of emergency services and provide continuous support for young people with [first-episode psychosis] beyond specialized care,” the researchers wrote.