Maria Ferrara1, Sinan Guloksuz2, Fangyong Li3, Shadie Burke4, Cenk Tek5, Svein Friis6, Wenche Ten Velden Hegelstad7, Inge Joa8, Jan Olav Johannessen9, Ingrid Melle10, Erik Simonsen11, Vinod H Srihari12. 1. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Dipartimento di Salute Mentale e Dipendenze Patologiche, AUSL Modena, viale Muratori 201, 41121 Modena, Italy. Electronic address: maria.ferrara@yale.edu. 2. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200, MD, Maastricht, the Netherlands. Electronic address: sinan.guloksuz@yale.edu. 3. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA; Yale University Center for Science and Social Science Information, PO Box 208111, 06520 New Haven, CT, USA. Electronic address: fang-yong.li@yale.edu. 4. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA. Electronic address: burkes188@gmail.com. 5. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA. Electronic address: cenk.tek@yale.edu. 6. Division of Mental Health and Addiction, Oslo University Hospital, Postbox 1039, Blindern, 0315 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postbox 1171, Blindern, 0318 Oslo, Norway. Electronic address: svein.friis@medisin.uio.no. 7. Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway. Electronic address: wenchetenvelden@mac.com. 8. Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway. Electronic address: ijo@sus.no. 9. Center for Clinical Psychosis Research, TIPS, Stavanger University Hospital, PO Box 8600, 4036 Stavanger, Norway; Network for Medical Sciences, Faculty of Health, PO Box 8600, 4036 Stavanger, Norway. Electronic address: jojo@sus.no. 10. NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, Building 49, P.O. Box 4956, Nydalen, N-0424, University of Oslo, Oslo, Norway. Electronic address: ingrid.melle@medisin.uio.no. 11. Psychiatric Research Unit, Faelledvej 8, 4200 Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: es@regionsjaelland.dk. 12. Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT, USA. Electronic address: vinod.srihari@yale.edu.
Abstract
BACKGROUND: Prolonged duration of untreated psychosis (DUP) is associated with poor outcomes. The TIPS study halved DUP with an early detection (ED) campaign; however, conventional statistical analyses, focused on mean estimates, failed to reveal the effects of ED across the full DUP distribution, restricting inferences about ED's effectiveness. Utilizing a novel quantile regression based analysis, we examined the differential impact of ED across DUP. Secondary analysis explored possible predictors of DUP, and moderators of the effect of the campaign. METHODS: The TIPS ED campaign was conducted in two health care sectors in Norway, with two equivalent health care sectors serving as controls. Quantile regression analysis was performed to analyze ED campaign's effect. RESULTS: 281 patients with first episode psychosis were recruited, including 141 from the ED area. ED had no effect on the first quartile (Q1) of DUP, whereas a significant reduction in Q2 (11weeks), and Q3 (41weeks) of DUP was observed. The effect of ED was significantly stronger on reducing Q3 than Q1 or Q2, suggesting that the campaign was more effective in longer DUP samples. Male gender and single status predicted longer DUP in Q3: by 38 and 27weeks, respectively. Single status, but not gender, emerged as a significant moderator of ED campaign effect. CONCLUSIONS: Quantile regression provided in depth information about the non-uniformity, and moderators, of TIPS's ED effort across the full distribution of DUP, demonstrating the value of this analytic approach to re-examine prior, and plan analyses for future, early detection efforts.
BACKGROUND: Prolonged duration of untreated psychosis (DUP) is associated with poor outcomes. The TIPS study halved DUP with an early detection (ED) campaign; however, conventional statistical analyses, focused on mean estimates, failed to reveal the effects of ED across the full DUP distribution, restricting inferences about ED's effectiveness. Utilizing a novel quantile regression based analysis, we examined the differential impact of ED across DUP. Secondary analysis explored possible predictors of DUP, and moderators of the effect of the campaign. METHODS: The TIPS ED campaign was conducted in two health care sectors in Norway, with two equivalent health care sectors serving as controls. Quantile regression analysis was performed to analyze ED campaign's effect. RESULTS: 281 patients with first episode psychosis were recruited, including 141 from the ED area. ED had no effect on the first quartile (Q1) of DUP, whereas a significant reduction in Q2 (11weeks), and Q3 (41weeks) of DUP was observed. The effect of ED was significantly stronger on reducing Q3 than Q1 or Q2, suggesting that the campaign was more effective in longer DUP samples. Male gender and single status predicted longer DUP in Q3: by 38 and 27weeks, respectively. Single status, but not gender, emerged as a significant moderator of ED campaign effect. CONCLUSIONS: Quantile regression provided in depth information about the non-uniformity, and moderators, of TIPS's ED effort across the full distribution of DUP, demonstrating the value of this analytic approach to re-examine prior, and plan analyses for future, early detection efforts.
Authors: Vinod H Srihari; Maria Ferrara; Fangyong Li; Emily Kline; Sinan Gülöksüz; Jessica M Pollard; John D Cahill; Walter S Mathis; Laura Yoviene Sykes; Barbara C Walsh; Glen McDermott; Larry J Seidman; Ralitza Gueorguieva; Scott W Woods; Cenk Tek; Matcheri S Keshavan Journal: Schizophr Bull Open Date: 2022-01-04