Socioeconomic status and the effectiveness of treatment for first-episode psychosis.

Abstract

To assess whether patient socioeconomic status (SES) moderates the effectiveness of coordinated specialty care for first-episode psychosis and to investigate possible mechanisms. A secondary analysis of data from the RAISE-ETP Trial, which was conducted from 2010-2014. RAISE-ETP was a cluster-randomized trial comparing a coordinated specialty care (CSC) intervention called NAVIGATE with usual community care. We constructed a patient SES index based on parental education, parental occupational prestige, and race/ethnicity. After identifying correlates of SES, we used OLS regression analysis to estimate treatment effects on the major study outcomes across quartiles of the index. We also examined whether correlates of SES including the duration of untreated psychosis (DUP), and participation in NAVIGATE might account for the observed difference in effectiveness of CSC by SES. The trial sample had a similar SES distribution to the US population, and SES was positively correlated with all mental health outcomes and several potential moderators at baseline. CSC substantially improved the main trial outcomes compared to community care for patients in the highest SES quartile but had small and statistically insignificant benefits for the remaining 75% of patients. Intervention participation rates and several potential moderators did not explain this disparity. CSC may be more effective for high-SES patients with early psychosis than low-SES patients. Additional research is needed to understand why CSC is less effective for low-SES patients and to develop methods to increase effectiveness for this subgroup.