What impact did the COVID-19 pandemic have on the delivery of early intervention psychosis services?

Sorcha COTTER¹, Caroline X GAO³, Rahul KHANNA¹, Brian O'DONOGHUE², Ellie BROWN³, Andrew THOMPSON³

¹University of Melbourne, Melbourne, Australia
²University College Dublin, Dublin, Ireland
³Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia

Background: The COVID-19 pandemic brought challenges for early intervention psychosis (EIP) services. In Australia, the first nationwide lockdown occurred in March 2020. Evidence on the impact of COVID-19 on treatment outcomes among EIP clients remains limited.

Methods: This prospective cohort study analysed routine data from 15 headspace Early Psychosis programme centres in Australia. Participants were 12 to 25 years, meeting criteria for First Episode Psychosis (FEP) or Ultra High Risk of psychosis (UHR) comparing those who commenced treatment ‘pre-COVID-19’ (between 16th August 2018 and 15th August 2019), and ‘during-COVID-19’ (between 1st March 2020 and 15th September 2020). Clinical symptoms at treatment commencement were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Kessler Psychological Distress Scale (K10). with outcomes after 6 months compared between cohorts using linear mixed-effects regression, controlling for confounders.

Results: 1246 young people were analysed (653 FEP, 596 UHR). Baseline FEP clinical presentation were comparable. UHR clients had lower BPRS negative symptoms during-COVID-19 (p=0.020). Significant improvements were observed with treatment pre- and during-COVID-19 in both groups (5 to 13-point reduction in BPRS score per 6-months treatment). Treatment effectiveness reduced during-COVID-19 for psychosis symptoms, with the FEP BPRS treatment effect lower by 4.3 points (95%CI: 0.5, 8.1). Service contacts and duration of contacts increased during-COVID-19, with increased telehealth services (p<0.001).

Conclusions: These findings support the efficacy of early intervention for FEP and UHR. Treatment effects were evident despite the pandemic and transition of EIP services to virtual service delivery. Reduced treatment efficacy in FEP psychosis symptoms may suggest the shift to telehealth was less effective than in person service delivery. Further research to examine longer term clinical and functional outcomes due to the pandemic is required.