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

TY - JOUR

T1 - The Early Youth Engagement (EYE-2) intervention in first-episode psychosis services:

T2 - pragmatic cluster randomised controlled trial and cost-effectiveness evaluation

AU - Greenwood, Kathryn

AU - Jones, Christopher

AU - Yaziji, Nahel

AU - Healey, Andrew

AU - May, Carl

AU - Bremner, Stephen

AU - Hooper, Richard

AU - Rathod, Shanaya

AU - Phiri, Peter

AU - de Visser, Richard

AU - Mackay, Tanya

AU - Bartl, Gergely

AU - Abramowicz, Iga

AU - Gu, Jenny

AU - Webb, Rebecca

AU - Nandha, Sunil

AU - Lennox, Belinda

AU - Johns, Louise

AU - French, Paul

AU - Hodgekins, Jo

AU - Law, Heather

AU - Plaistow, James

AU - Thompson, Rose

AU - Fowler, David

AU - Garety, Philippa

AU - O'Donnell, Anastacia

AU - Painter, Michelle

AU - Jarvis, Rebecca

AU - Clark, Stuart

AU - Peters, Emmanuelle

N1 - Publisher Copyright: © The Author(s), 2024.

PY - 2025/3/1

Y1 - 2025/3/1

N2 - 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 standalone 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.

AB - 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 standalone 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.

KW - cost-effectiveness

KW - Early intervention

KW - engagement

KW - psychosis

KW - randomised controlled trial

UR - https://www.scopus.com/pages/publications/85210938623

U2 - 10.1192/bjp.2024.154

DO - 10.1192/bjp.2024.154

M3 - Article

C2 - 39581220

AN - SCOPUS:85210938623

SN - 0007-1250

VL - 226

SP - 144

EP - 152

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 3

ER -