Substance Use, Duration of Symptoms Predict Hospitalization in First-Episode Psychosis

A lack of belief in the value of medication and the number of previous hospitalizations also predict hospitalization in first-episode psychosis.

In patients with first-episode psychosis (FEP), frequency of substance misuse, presence of positive symptoms, and less belief about the value of medication are strong predictors of hospitalization, according to research published in Psychiatric Services.

Inpatient psychiatric hospitalization rates for individuals with FEP are high, despite other treatment advances. More than a third of individuals are hospitalized during the first 2 years of treatment. To work toward reducing hospitalization, researchers sought to identify predictors of hospitalization using a univariate and multivariate baseline and time-varying covariate analyses of data from the Recover After an Initial Schizophrenia Episode-Early Treatment Program study. This 2-year cluster randomized trial enrolled 404 participants experiencing a first episode of psychosis who were outpatients at study entry. Researchers compared an early intervention treatment model (NAVIGATE) with usual community care at 34 US clinics. Postbaseline hospitalization data from at least 1 assessment were available for 382 participants (mean ± standard deviation age =23.2±5.1 years, 73% male, and racially diverse).

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Researchers found that 34% of NAVIGATE and 37% of usual-care participants were hospitalized. Based on one multivariate model, researchers determined such significant predictors of hospitalization as the duration of untreated psychosis >74 weeks (hazard ratio [HR] 1.78; 95% CI, 1.14-2.79), time-varying days of illegal drug use (HR 1.03; 95% CI, 1.01-1.05), and time-varying brief evaluation of medication influences and beliefs (HR 0.82; 95% CI, 0.67-0.99). Hospitalizations before study entry were also significant.

The study was limited by the possibility that the clinics selected had above-average resources to serve patients with FEP. In addition, the data did not address predictors of hospitalization for individuals who did not receive outpatient treatment.

Based on these findings, hospital use may be decreased by reducing the duration of untreated psychosis and prior hospitalization, minimizing residual symptoms, preventing substance misuse, and facilitation of medication adherence. Researchers wrote, “Addressing these factors could enhance the impact of first-episode early intervention treatment models and also enhance outcomes of people with [FEP] treated using other models.” The results clarify areas of focus for future intervention models to decrease hospitalization for individuals with FEP.


Robinson DG, Schooler NR, Rosenheck RA, et al. Predictors of hospitalization of individuals with first-episode psychosis data from a 2-year follow-up of the RAISE-ETP [published online May 14, 2019]. Psychiatr Serv. doi:10.1176/