Psychiatric Hospitalization Outcomes after Enrollment in Coordinated Specialty Care for First-Episode Psychosis: Findings from the Early Psychosis Intervention Network (EPINET) in the United States.

Abstract

Background: Psychiatric hospitalization is a key outcome in first-episode psychosis (FEP). Coordinated Specialty Care (CSC) is increasingly implemented across the United States, but hospitalization outcomes in real-world CSC settings remain uncertain.

Study design: This cohort study used data from the Early Psychosis Intervention Network. The sample included 2951 individuals across six networks (87 clinics in 15 states), assessed at admission and every 6 months for 2 years. Outcomes included psychiatric hospitalization, number of admissions, and total nights hospitalized. Logistic, Poisson, and negative binomial regression models were used.

Study results: At admission, 71.2% had been hospitalized in the prior 6 months. Older age was associated with lower hospitalization risk (odds ratios [OR], 0.95; 95% confidence intervals [CI], 0.92-0.98; P < .001), fewer admissions (incidence rate ratios [IRR], 0.98; 95% CI, 0.96-0.99; P = .003), and fewer nights hospitalized (risk ratios [RR], 0.96; 95% CI, 0.94-0.99; P = .002). Prior hospitalization predicted higher risk (OR, 1.52; 95% CI, 1.18-1.98; P = .001), more admissions (IRR, 2.89; 95% CI, 2.49-3.36; P < .001), and more nights hospitalized (RR, 3.04; 95% CI, 2.47-3.71; P < .001). Shorter duration of untreated psychosis (DUP) was associated with more admissions (IRR, 0.93; 95% CI, 0.89-0.96; P < .001) and more nights hospitalized (RR, 0.92; 95% CI, 0.88-0.96; P = .001).

Conclusions: Hospitalizations decreased substantially after CSC admission and remained low over 2 years in this large national FEP cohort. Prior hospitalization and markers of earlier illness course (younger age and shorter DUP) were associated with higher hospitalization burden, highlighting targets for CSC care refinement.