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Am J Psychiatry. 2017 Feb 1;174(2):143-153. doi: 10.1176/appi.ajp.2016.16010103. Epub 2016 Oct 24.

The Epidemiology of First-Episode Psychosis in Early Intervention in Psychosis Services: Findings From the Social Epidemiology of Psychoses in East Anglia [SEPEA] Study.

Author information

1
From the PsyLife Group, Division of Psychiatry, UCL, London; the Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; the Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom; the North Essex Partnership NHS Foundation Trust, Chelmsford, Essex, United Kingdom; and the Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom.

Abstract

OBJECTIVE:

Few studies have characterized the epidemiology of first-episode psychoses in rural or urban settings since the introduction of early intervention psychosis services. To address this, the authors conducted a naturalistic cohort study in England, where such services are well established.

METHOD:

All new first-episode psychosis cases, 16-35 years old, presenting to early intervention psychosis services in the East of England were identified during 2 million person-years follow-up. Presence of ICD-10 F10-33 psychotic disorder was confirmed using OPCRIT [operational criteria for psychotic illness]. Incidence rate ratios were estimated following multivariable Poisson regression, adjusting for age, sex, ethnicity, socioeconomic status, neighborhood-level deprivation, and population density.

RESULTS:

Of 1,005 referrals, 687 participants (68.4%) fulfilled epidemiological and diagnostic criteria for first-episode psychosis (34.0 new cases per 100,000 person-years; 95% CI=31.5-36.6). Median age at referral was similar for men (22.5 years; interquartile range: 19.5-26.7) and women (23.4 years; interquartile range: 19.5-29.1); incidence rates were highest for men and women before 20 years of age. Rates increased for ethnic minority groups (incidence rate ratio: 1.4; 95% CI=1.1-1.6), as well as with lower socioeconomic status (incidence rate ratio: 1.3; 95% CI=1.2-1.4) and in more urban (incidence rate ratio: 1.4;95%CI=1.0-1.8) and deprived (incidence rate ratio: 2.1; 95% CI=1.3-3.3) neighborhoods, after adjustment for confounders.

CONCLUSIONS:

Pronounced variation in psychosis incidence, peaking before 20 years old, exists in populations served by early intervention psychosis services. Excess rates were restricted to urban and deprived communities, suggesting that a threshold of socioenvironmental adversity may be necessary to increase incidence. This robust epidemiology can inform service development in various settings about likely population-level need.

KEYWORDS:

Community Mental Health; Epidemiology; Psychosis; Schizophrenia

PMID:
27771972
PMCID:
PMC5939990
DOI:
10.1176/appi.ajp.2016.16010103
[Indexed for MEDLINE]
Free PMC Article

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