The Early Youth Engagement (EYE-2) intervention in first episode psychosis services: Pragmatic cluster randomised controlled trial and cost-effectiveness evaluation

Greenwood, Kathryn, Jones, Christopher, Yaziji, Nahel, Healey, Andrew, May, Carl, Bremner, Stephen, Hooper, Richard, Rathod, Shanaya, Phiri, Peter, de Visser, Richard, Mackay, Tanya, Bartl, Gergely, Abramowicz, Iga, Gu, Jenny, Webb, Rebecca, Nandha, Sunil, Lennox, Belinda, Johns, Louise, French, Paul, Hodgekins, Jo, Law, Heather, Plaistow, James, Thompson, Rose, Fowler, David, Garety, Philippa, O’Donnell, Anastacia, Painter, Michelle, Jarvis, Rebecca, Clark, Stuart and Peters, Emmanuelle (2024) The Early Youth Engagement (EYE-2) intervention in first episode psychosis services: Pragmatic cluster randomised controlled trial and cost-effectiveness evaluation. British Journal of Psychiatry. ISSN 0007-1250

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Abstract

Background: Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage. Aims: To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective. Method: We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746. Results: Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group. Conclusions: We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.

Item Type:	Article
Additional Information:	Data availability statement: Fully anonymized data will be available from KG upon reasonable request, subject to submission and approval of a research proposal and review and contract with Sussex Partnership NHS Foundation Trust, following the publication of all results from this study. Due to the personal nature of case note data pertaining to engagement or disengagement, this data will only be made available in a suitable abbreviated form to ensure anonymity. Analytic Code Availability: Analytic code will be available from CJ, SB, RH, AH upon reasonable request. Research Material Availability: Trial materials can be obtained from KG on reasonable request. Intervention resources are also available at www.likemind.nhs.uk Funding Statement: This work was supported by the NIHR Health Services and Delivery Research programme (KG: grant number 16/31/87).
Uncontrolled Keywords:	cost-effectiveness,early intervention,engagement,psychosis,randomised controlled trial,psychiatry and mental health,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2738
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health Faculty of Medicine and Health Sciences > Research Groups > Mental Health
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	20 Dec 2024 01:12
Last Modified:	20 Dec 2024 01:12
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98039
DOI:	10.1192/bjp.2024.154

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