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An early intervention for psychosis and its effect on criminal accusations and suicidal behaviour using a matched-cohort design

Schizophrenia Research, Volume 176, Issue 2-3, October 2016, Pages 307 - 311

Abstract

Background

Early interventions for psychosis have been shown to reduce psychotic symptoms and hospital use for first-episode patients, but the effect on suicidal and criminal behaviour has not been reliably determined. This study aimed to examine whether an early intervention for psychosis program (EPPIS) reduced criminal behaviour, suicide attempts, and hospital-based service use.

Methods

The study utilized administrative data to match clients of EPPIS to historical controls. Regression was used to determine the effect of treatment by EPPIS on inpatient use, emergency department use, suicide attempts/deaths, and criminal accusations.

Results

A sample of 244 patients was matched to 449 controls. EPPIS patients had lower odds of being accused of a crime both during and after treatment. Suicidal behavior was less frequent among patients, both during treatment (p < 0.0001) and after (HR = 0.39; 95% CI: 0.17 to 0.94). During treatment there were more emergency department visits for the patients (RR = 2.54; 95% CI: 1.56 to 4.58), but no difference in inpatient usage compared to controls. Post-treatment, both emergency department and inpatient usage were higher among patients.

Conclusions

EPPIS patients had reduced suicide attempts and criminal accusations. Increased emergency department use could indicate that encouraging treatment during a crisis may increase service use, while reducing suicidal and criminal behaviour.

Keywords: Psychosis, Suicide, Emergency medicine, Health service use, Psychiatry, Crime.

Footnotes

a Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

b Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

c Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Canada

Corresponding author at: Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Declaration of interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from CIHR and the Heart & Stroke Foundation of Canada for the submitted work; JRR reports support from the University of Manitoba's GETS program for the submitted work. No financial relationships with any organisations that might have an interest in the submitted work in the previous three years: MB reports the financial support of the Government of Manitoba through the Manitoba Centre for Health Policy Population-Based Child Health Research Award; JB reports support from a CIHR new investigator award, and a NARSAD Young Investigator Grant.

☆☆ Transparency declaration

☆☆ The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

Funding: This work was supported by the Canadian Institutes of Health Research (CIHR: ROH - 115206) and the Heart & Stroke Foundation of Canada (PG-12-0534), under the program of research entitled “PATHS Equity for Children: a program of research into what works to reduce the gap for Manitoba's children.” Jason R Randall wishes to acknowledge funding from the University of Manitoba's Graduate Enhancement of Tri-Council Stipends program. Dr Brownell acknowledges the financial support of the Government of Manitoba through the Manitoba Centre for Health Policy Population-Based Child Health Research Award. Dr Bolton is supported by a Canadian Institutes of Health Research New Investigator Award (113589) and a Brain & Behavior Research Foundation NARSAD Young Investigator Grant. The funders had no role in the conduct of this study or the writing of the manuscript.