■缺乏早期干预服务(EISs)与25岁以上的首发精神分裂症(FES)患者的自我伤害和自杀相关的证据。
■研究实施EIS计划前后FES患者的自我伤害和自杀率的变化。
这项基于人群的队列研究在2001年1月1日至2020年3月31日期间对37,040名年龄在15至64岁的FES患者进行,使用了香港临床数据分析和报告系统的电子病历。从首次诊断为精神分裂症(指标日期)到死亡或研究期结束(2021年3月31日),对所有患者进行了随访。以先到者为准。统计分析于2023年7月至11月进行。
■EIS将早期精神病患者的早期评估服务(EASY)计划从15至25岁的患者扩展到15至64岁的患者(EASYPlus)。曝光是2011年4月EASYPlus计划的实施。对于1年时滞分析,暴露期定义为2012年4月至2021年3月。
■结果是实施EASYPlus计划前后FES患者的月自残率和自杀率。主分析采用中断时间序列分析。
■这项研究包括37,040例FES患者(发病时的平均[SD]年龄,39[12]岁;82.6%年龄大于25岁;53.0%女性患者)。1年时滞分析发现,在26至44岁的患者中,自我伤害率立即下降(比率[RR],0.77[95%CI,0.59-1.00])和45至64年(RR,0.70[95%CI,0.49-1.00])和男性患者(RR,0.71[95%CI,0.56-0.91])。发现所有FES患者的自我伤害率长期显着下降(15-25岁的患者:RR,0.98[95%CI,0.97-1.00];26-44岁的患者:RR,0.98[95%CI,0.97-0.99];45-64岁患者:RR,0.97[95%CI,0.96-0.98])。在15至25岁的患者中实施EASYPlus计划后,自杀率立即下降(RR,0.33[95%CI,0.14-0.77])和26至44年(RR,0.38[95%CI,0.20-0.73])。与反事实情景相比,EASYPlus计划可能使26~44岁患者的自残事件减少了6302次.
■这项EASYPlus计划的队列研究表明,延长的EIS与所有FES患者的自我伤害和自杀率降低有关,包括25岁以上的人。这些发现强调了为所有年龄段的患者开发量身定制的干预措施的重要性,以最大限度地提高EISs的益处。
UNASSIGNED: Evidence on the association of early intervention services (EISs) with self-harm and suicide among patients with first-episode schizophrenia (FES) at older than 25 years is lacking.
UNASSIGNED: To examine changes in self-harm and suicide rates among patients with FES before and after the implementation of an EIS program.
UNASSIGNED: This population-based cohort study conducted among 37 040 patients aged 15 to 64 years with FES between January 1, 2001, and March 31, 2020, used electronic medical records from the Hong Kong Clinical Data Analysis and Reporting System. All patients were followed up from the first diagnosis of schizophrenia (the index date) until the date of their death or the end of the study period (March 31, 2021), whichever came first. Statistical analysis was performed from July to November 2023.
UNASSIGNED: The EIS extended the Early Assessment Service for Young People With Early Psychosis (EASY) program from patients aged 15 to 25 years to those aged 15 to 64 years (EASY Plus). The exposure was the implementation of the EASY Plus program in April 2011. The exposure period was defined as between April 2012 and March 2021 for the 1-year-time-lag analysis.
UNASSIGNED: The outcomes were monthly rates of self-harm and suicide among patients with FES before and after the implementation of the EASY Plus program. Interrupted time series analysis was used for the main analysis.
UNASSIGNED: This study included 37 040 patients with FES (mean [SD] age at onset, 39 [12] years; 82.6% older than 25 years; 53.0% female patients). The 1-year-time-lag analysis found an immediate decrease in self-harm rates among patients aged 26 to 44 years (rate ratio [RR], 0.77 [95% CI, 0.59-1.00]) and 45 to 64 years (RR, 0.70 [95% CI, 0.49-1.00]) and among male patients (RR, 0.71 [95% CI, 0.56-0.91]). A significant long-term decrease in self-harm rates was found for all patients with FES (patients aged 15-25 years: RR, 0.98 [95% CI, 0.97-1.00]; patients aged 26-44 years: RR, 0.98 [95% CI, 0.97-0.99]; patients aged 45-64 years: RR, 0.97 [95% CI, 0.96-0.98]). Suicide rates decreased immediately after the implementation of the EASY Plus program among patients aged 15 to 25 years (RR, 0.33 [95% CI, 0.14-0.77]) and 26 to 44 years (RR, 0.38 [95% CI, 0.20-0.73]). Compared with the counterfactual scenario, the EASY Plus program might have led to 6302 fewer self-harm episodes among patients aged 26 to 44 years.
UNASSIGNED: This cohort study of the EASY Plus program suggests that the extended EIS was associated with reduced self-harm and suicide rates among all patients with FES, including those older than 25 years. These findings emphasize the importance of developing tailored interventions for patients across all age ranges to maximize the benefits of EISs.