Individual determinants of first admission, mental health service utilization, and clinical and functional outcomes in first episode psychosis: The Suffolk County Mental Health Project, 1989--1992 versus 1993--1995

Guided by the Behavioral Model of Health Services Use and social control theories, two complementary theoretical frameworks which explain how people come to use mental health services, this study examined how changes in contextual characteristics, namely the organization and financing of inpatient and outpatient mental health services, may have influenced individual determinants of first hospital admission; mental health services utilization and its determinants following first admission; and clinical and functional outcomes and its determinants at month six, for individuals in their first episode of psychosis. This study is a secondary analysis of data from the Suffolk County Mental Health Project, a prospective cohort study of the natural course of illness of first episode psychosis which recruited participants from 1989 to 1995, a time of mental health system changes in Suffolk County, New York. Findings from logistic and OLS regression analyses indicate that there were significant differences in individual enabling and need characteristics between participants recruited into the study in the earlier (1989-1992) versus later years (1993-1995), but that there were no changes in individual predisposing characteristics. In terms of mental health services utilization, findings indicate no change across rehospitalization rates and outpatient services following first admission, except for an increase in day treatment for participants recruited in the later years. Individual predisposing, enabling, and need characteristics were found to be determinants of mental health services utilization. Finally, clinical and functional outcomes did not differ between earlier and later recruited participants; and individual predisposing and need characteristics were found to be determinants of clinical and functional outcomes.