Factors associated with employment and hospitalizations in early-onset psychosis: a clinical study with register-based follow-up

BACKGROUND: The prognosis of psychosis with onset in childhood and adolescence is highly variable. This study explores long-term outcomes of early-onset psychosis (EOP) compared to controls (HC) and examines predictors of employment as well as psychiatric and somatic hospitalizations in EOP.

METHODS: We combined data from four clinical studies, comprising a total of 205 individuals with first-episode EOP and 199 age- and sex-matched HCs. Long-term follow-up data (mean = 11 years) on demographic, functional, and clinical outcomes were retrieved from Danish national registers. Factors associated with employment, psychiatric hospitalizations, and somatic hospitalizations were analyzed in univariable and multivariable models.

RESULTS: Compared to HCs, individuals with EOP had less favorable demographic, functional, and clinical outcomes. In EOP, higher household income and better neurocognitive functioning at baseline were associated with higher rates of competitive employment at follow-up in univariable albeit not multivariable analyses. Higher age, female sex, substance use, lower parental education and moderate household income at baseline were associated with more somatic inpatient days during follow-up in both uni- and multivariable analyses, while low social functioning was associated with somatic hospitalization in the univariable model only. We identified no baseline factors associated with frequency of psychiatric inpatient days during follow-up.

CONCLUSION: Our study highlights the need for improving prognosis of EOP across functional, psychiatric, and somatic outcomes. The identified baseline factors associated with later unfavorable outcomes can serve as prognostic markers, potential treatment targets, and for identifying individuals in need of intensified support.