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Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 11, pp 1325–1335 | Cite as

Defining disengagement from mental health services for individuals experiencing first episode psychosis: a systematic review

  • Siobhan Reynolds
  • Da Jung Kim
  • Ellie Brown
  • Rachel Tindall
  • Brian O’DonoghueEmail author
REVIEW

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.

Keywords

Disengagement Systematic review First episode psychosis Psychotic disorders Psychosis 

Notes

Funding

There is no funding associated with this review.

Compliance with ethical standards

Conflict of interest

The authors acknowledge they have no conflicts of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Siobhan Reynolds
    • 1
    • 2
  • Da Jung Kim
    • 1
    • 2
  • Ellie Brown
    • 1
    • 2
  • Rachel Tindall
    • 1
    • 2
  • Brian O’Donoghue
    • 1
    • 2
    • 3
    Email author
  1. 1.Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
  2. 2.Centre for Youth Mental Health, The University of MelbourneParkvilleAustralia
  3. 3.Orygen Youth HealthParkvilleAustralia

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