Lessons from EPINET-TX

Consistent with prior research, the rate of suicidal ideation is significant in EPINET-TX participants, with providers reporting that 49% of CSC participants had suicidal ideation in the six months before program entry. Rates did not differ across age groups (14-17, 18-24, and 25+), but individuals identifying as non-cisgender or non-heterosexual were more likely to experience suicidal ideation prior to entering the program. Individuals who reported substance use were also more likely to experience suicidal ideation.

While only a small sample of young people have data available across three time points within CSC care, early signs show a reduced rate of suicidal ideation within CSC care. The figure below presents the rate of suicidal ideation for young people with measurements at baseline, 6-month, and 12-month assessments (N=53). Of this sample, 8% had no reported ideation at baseline, but ideation was present at 12 months. Twenty-eight percent had ideation reported at baseline, but not at 12 months, with 25% maintaining ideation at both baseline and 12 months.

Research Highlights

Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders

Chan SKW, Chan SWY, Pang HH, et al. Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry. 2018;75(5):458–464. doi:10.1001/jamapsychiatry.2018.0185. Access the article.

Background: Youth with schizophrenia have a high risk of suicide and suicidal behaviors. Risk factors for suicide attempts and dying by suicide in individuals with schizophrenia include history of suicidal ideation, prior self-harm behaviors, previous depression episodes, substance use, poor medication adherence, and previous hospitalizations. Previous studies have found that early psychosis intervention programs have successfully reduced suicidal attempts but have less evidence for reducing death by suicide. The Early Assessment Service for Young People with Psychosis (EASY) program is a 2-year intervention program for individuals aged 15 -25 in Hong Kong. This study was a 12-year large-scale retrospective cohort study in Hong Kong whose aim was to explore the association between early psychosis intervention programs and suicide rates.

Methods: A total of 617 youth diagnosed with a schizophrenia-spectrum disorder enrolled in the EASY program from 2001 to 2003 were included in the study. The same number of sex, diagnosis, and age-matched controls receiving standard psychiatric services from 1998 to 2001 served as the control group. All deaths in the cohort during the 12-year follow-up period were recorded using a centralized clinical database of the Hong Kong hospital system. Deaths resulting from intentional self-harm or undetermined intent were coded as a suicide. Suicide survival was defined as the elapsed time between entry into the program and the date of suicide death.

Findings: A total of 1,234 persons were included in the analysis, with 617 people in each group. Overall, 73 youth (5.9%) died by suicide during the 12-year follow-up, including 27 (4.4%) in the EASY program and 46 (7.5%) in the standard care group (p = 0.02). Youth who participated in the EASY program had significantly fewer suicides and longer life expectancy, particularly during the first three years compared to those who received general services.

Limitations: The reliability of the suicide data used in this study depends on the quality of the clinical records, which are likely to differ between the two groups, limiting interpretations of the findings. Given the retrospective study design, causality cannot be determined between program participation and suicide reductions. Findings also have limited generalizability for persons with different diagnoses, duration of treatment, and ages than those included in the study.

Implications for Practice

Findings highlight the association between FEP-specific service provision and lower rates of suicide in the first 3 years, suggesting that specialized early psychosis treatment may help reduce the increased risk of suicide in this population.

Building Time for Teams in Spindletop

Teamwork is one of the critical elements in CSCs!

The FEP team at Spindletop Center celebrated this winter season by planning a potluck. Linda Williams, the Team Lead for the FEP program at Spindletop, planned the potluck for her team members and other teams located in their building. Team members described how much fun they had talking with providers from other programs and getting to know them beyond their work. They also shared that it was special because they do not often have the time to pause work and socialize together. This event highlights the importance of taking time for team building and the positive impact a team event can have. Additionally, now the whole building dreams of Linda’s famous banana pudding and is encouraging her to sell it!

Take a few minutes to think about how you can contribute to an effective team culture!

Upcoming Events and Training Opportunities

Education, Special Education, and Accommodations for Students with Psychosis: Working with Youth, Families, Teachers, and Schools

In this webinar, clinical psychologist Dr. Jason Schiffman will provide information and tangible suggestions on how to effectively work with schools, families, and students on behalf of high school students with psychosis.

March 29 at 10:00 AM - 1:00 AM CST | Register Here

Cultural Considerations in Early Psychosis Care

This webinar will highlight important cultural considerations (broadly defined) to integrate into early psychosis work, discuss how these factors have been addressed to date, offer practical suggestions, and propose next steps for the field.

March 31 at 11:00 AM EST | Register Here

Case Conceptualization for First Episode Psychosis Series 2: Session 1: Compassion Focused Therapy

Attendees will learn how case conceptualization can inform team-based, recovery-oriented care and the foundations of three different approaches: Next up is a 3-part focus on Culturally Informed Therapy for Schizophrenia.

April 17 at 10:00 - 11:00 AM CST |Register Here

Trauma and Psychosis Webinar Series

In this series sponsored by the American Psychological Association, participants will learn about the possible relationships between psychosis and trauma, identify approaches to collaborative treatment for co-occurring trauma and psychosis, and understand how dissociation as a trauma response can create risk for psychosis.

April 21 at 12:00 PM - 1:00 PM CST | Register

Website: https://sites.utexas.edu/mental-health-institute/projects/epinet-tx/