Tuesday, August 28, 2018

Engagement in Family Psychoeducation for FEP May Vary by Race, Ethnicity

While connecting individuals with first-episode psychosis (FEP) to coordinated specialty care is known to benefit patients, a report published today in Psychiatric Services in Advance suggests that patients who are members of racial/ethnic minority groups may be less likely to receive a key component of this care.

Oladunni Oluwoye, Ph.D., of Washington State University and colleagues conducted a secondary data analysis of the Recovery After an Initial Schizophrenia Episode, Early Treatment Program (RAISE-ETP) data set. The study included 181 patients with schizophrenia and related disorders who received usual community care and 223 who received coordinated specialty care called NAVIGATE. NAVIGATE includes four core interventions: personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported employment and education.

As part of the RAISE-ETP study, patients were assessed at baseline and at months 6, 12, 18, and 24 using the Positive and Negative Syndrome Scale (PANSS) total score and scores on five PANSS subscales (negative symptoms, positive symptoms, uncontrolled hostility, disorganized thoughts, and anxiety and depression). Also, the participants were asked to assess their use of services, such as medication management, family psychoeducation, and individual therapy monthly over the 24-month treatment period.

Among those in the community care group, “non-Hispanic blacks scored significantly higher throughout treatment on measures of positive symptoms, disorganized thoughts, and uncontrolled hostility compared with non-Hispanic whites, and non-Hispanic blacks were less likely than non-Hispanic whites to receive individual therapy,” Oluwoye and colleauges wrote. “Families of Hispanic participants in usual community care were less likely than non-Hispanic white families to receive family psychoeducation.”

Race and ethnicity were not associated with differences in psychiatric symptoms over time in the NAVIGATE group; however, “among NAVIGATE participants, non-Hispanic blacks and those in the group categorized as other were less likely than non-Hispanic whites to engage in family psychoeducation during the 24-month treatment period,” the authors reported. “These findings suggest that family psychoeducation may not appeal, may not be consistently offered, or may not be appropriately tailored [to] non-Hispanic blacks and other racial and ethnic minority groups.”

Oluwoye and colleagues concluded, “[O]ur secondary data analyses highlight the effectiveness of NAVIGATE, compared with usual community care, as a coordinated specialty care program for improving functioning and symptoms for individuals from racial-ethnic minority groups experiencing FEP. However, the findings also highlight racial-ethnic disparities in the NAVIGATE condition in participation in family psychoeducation, resulting in lower rates of family engagement among non-Hispanic blacks and individuals from other racial and ethnic minority groups.”

For related information, see the Psychiatric News article “Social Therapy Improves Engagement in Early Psychosis Treatment.”

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