Siobhan Reynolds1,2, Da Jung Kim1,2, Ellie Brown1,2, Rachel Tindall1,2, Brian O'Donoghue3,4,5. 1. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia. 2. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. 3. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia. brian.odonoghue@orygen.org.au. 4. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. brian.odonoghue@orygen.org.au. 5. Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia. brian.odonoghue@orygen.org.au.
Abstract
BACKGROUND: Individuals affected by psychotic disorders frequently disengage from mental health services, although reports of this rate in the literature have ranged from 6 to 60%. One of the potential explanations for the large variation is that studies have adopted different definitions. Without a universal definition it is challenging to compare rates and factors leading to disengagement across studies. This systematic review aims to identify and compare how disengagement from psychosis services has been defined, measured and operationalised in the literature to date. METHODS: A systemic literature search of the PubMed, PsycINFO and CINAHL databases was completed following the PRISMA guidelines for systematic reviews. RESULTS: 1506 Studies were identified, of which 30 were eligible to be included. It was found that disengagement was operationalized as either a categorical or continuous variable across studies, with 18 studies classifying it as a categorical, binary variable. Only four studies applied a time period over which disengagement was said to occur, and only four studies used an instrument to measure or predict disengagement. Few studies considered similar factors in their definition, when this occurred it was because the papers came from the same research group. DISCUSSION: To truly understand the phenomenon of disengagement, studies need to have a comparable outcome variable. The need for consensus on a gold standard definition of disengagement that considers the full breadth of its complexity remains. A potential process for establishing a definition that includes set parameters, agreed upon terminology and time periods of assessment is discussed.
BACKGROUND: Individuals affected by psychotic disorders frequently disengage from mental health services, although reports of this rate in the literature have ranged from 6 to 60%. One of the potential explanations for the large variation is that studies have adopted different definitions. Without a universal definition it is challenging to compare rates and factors leading to disengagement across studies. This systematic review aims to identify and compare how disengagement from psychosis services has been defined, measured and operationalised in the literature to date. METHODS: A systemic literature search of the PubMed, PsycINFO and CINAHL databases was completed following the PRISMA guidelines for systematic reviews. RESULTS: 1506 Studies were identified, of which 30 were eligible to be included. It was found that disengagement was operationalized as either a categorical or continuous variable across studies, with 18 studies classifying it as a categorical, binary variable. Only four studies applied a time period over which disengagement was said to occur, and only four studies used an instrument to measure or predict disengagement. Few studies considered similar factors in their definition, when this occurred it was because the papers came from the same research group. DISCUSSION: To truly understand the phenomenon of disengagement, studies need to have a comparable outcome variable. The need for consensus on a gold standard definition of disengagement that considers the full breadth of its complexity remains. A potential process for establishing a definition that includes set parameters, agreed upon terminology and time periods of assessment is discussed.
Entities:
Keywords:
Disengagement; First episode psychosis; Psychosis; Psychotic disorders; Systematic review
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