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Published Online: 28 February 2023

Impact of Treatment Initiation and Engagement on Deliberate Self-Harm Among Individuals With First-Episode Psychosis

Heather M. Wastler, Ph.D. [email protected], Elyse Llamocca, Ph.D., Aubrey M. Moe, Ph.D., Danielle L. Steelsmith, Ph.D., Guy Brock, Ph.D., Jeffrey A. Bridge, Ph.D., John V. Campo, M.D., and Cynthia A. Fontanella, Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 74, Number 9
https://doi.org/10.1176/appi.ps.20220372
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Abstract

Objective:

Individuals with psychosis are at increased risk for suicide, with the greatest risk being present during the first few months after diagnosis. The authors aimed to examine whether treatment initiation within 14 days of diagnosis and treatment engagement within 90 days of initiation reduce the risk for deliberate self-harm (DSH) among individuals with first-episode psychosis (FEP).

Methods:

A retrospective longitudinal cohort design was adopted by using Ohio Medicaid claims for 6,349 adolescents and young adults ages 15–24 years with FEP. Logistic regression was used to examine factors associated with treatment initiation and engagement. Cox proportional hazard models were used to estimate the impact of treatment initiation and engagement on DSH. Propensity score weighting was used to control for sociodemographic and clinical covariates.

Results:

Approximately 70% of the sample initiated treatment, 55% of whom engaged in treatment. Treatment initiation and engagement were associated with both demographic and clinical variables. Treatment initiation significantly reduced the hazard of DSH (average treatment effect in the entire population: hazard ratio [HR]=0.62, 95% CI=0.47–0.81; average treatment effect among those treated: HR=0.64, 95% CI=0.52–0.80). In contrast, treatment engagement was not significantly associated with DSH.

Conclusions:

These results suggest that the initial treatment contact is essential for reducing DSH among adolescents and young adults with FEP. Additionally, the finding that treatment engagement did not reduce DSH suggests that standard clinical care may not be sufficient for reducing DSH in this population. These findings highlight the need for suicide-specific interventions for individuals with FEP.

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Supplementary Material

File (appi.ps.20220372.ds001.pdf)

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Volume 74 • Number 9 • September 01, 2023
Pages: 921 - 928
PubMed: 36852553

History

Received: 19 July 2022
Revision received: 7 December 2022
Accepted: 4 January 2023
Published online: 28 February 2023
Published in print: September 01, 2023

Keywords

  1. Epidemiology
  2. Psychosis
  3. Schizophrenia
  4. Suicide
  5. Treatment
  6. Self-destructive behavior

Authors

Affiliations

Heather M. Wastler, Ph.D. [email protected]
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Elyse Llamocca, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Aubrey M. Moe, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Danielle L. Steelsmith, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Guy Brock, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Jeffrey A. Bridge, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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John V. Campo, M.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Cynthia A. Fontanella, Ph.D.
Departments of Psychiatry and Behavioral Health (Wastler, Llamocca, Moe, Fontanella), Psychology (Moe), Biomedical Informatics (Brock), and Pediatrics (Bridge), Ohio State University, Columbus; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Llamocca); Center for Suicide Prevention and Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio (Steelsmith, Bridge, Fontanella); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Campo).
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Notes

Send correspondence to Dr. Wastler ([email protected]).

Competing Interests

Dr. Campo serves on the editorial board of JAMA Pediatrics. Dr. Bridge serves on the scientific advisory board of Clarigent Health. The other authors report no financial relationships with commercial interests.

Funding Information

Dr. Wastler received support from the American Foundation for Suicide Prevention (YIG-0-184-20). Dr. Moe received support from the National Center for Advancing Translational Sciences (KL2TR002734) and a Research Innovation Career Development Award (RICDA) from the Ohio State University College of Medicine. Dr. Brock received support from the Clinical and Translational Science Award (UL1TR002733). Dr. Campo received support from the NIH and Patient-Centered Outcomes Research Institute. Drs. Bridge and Fontanella received support from NIMH (R01 MH-117594-01).The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the American Foundation for Suicide Prevention or NIMH.

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