Impact of the COVID-19 Pandemic on First Episode Psychosis Services & Populations in Massachusetts

Ananya Saluja (1), Kelsey A. Johnson (1), Margaret Lanca (5), Dost Ongür (4,2), Raquelle I. Mesholam-Gately (1,2), Margaret E. Guyer (3), Matcheri S. Keshavan (1,2)

1. Beth Israel Deaconess Medical Center
2. Harvard Medical School
3. Massachusetts Department of Mental Health
4. McLean Hospital
5. Cambridge Health Alliance

Abstract

Background: The COVID-19 pandemic led outpatient psychiatric services to rapidly transition from in-person to telehealth services for first episode psychosis (FEP) patients receiving coordinated specialty care (CSC). Ongoing clinical data monitoring in CSC clinics by the Massachusetts Psychosis Network for Early Treatment (MAPNET) presents an opportunity to investigate the impact of a large-scale natural event – the pandemic – on patient characteristics and service utilization.
Methods: A common assessment battery was collected with 772 patients across 10 CSC clinics in Massachusetts from 1/2017 to 10/2022. Analyses assessed changes in gender, race, diagnosis, education level, service use, self-reported satisfaction with FEP care, symptom severity, quality of life, and functioning between pre-pandemic (1/2017-2/2020), early pandemic (3/2020-5/2021), and late pandemic (6/2021-10/2022) timepoints. Division into these stages was based on the initiation of COVID-19 lockdown procedures (3/2020) and widespread vaccine availability (6/2021) in Massachusetts.
Results: CSC clinics saw significantly more white and male patients in the early and late pandemic timepoints. New patients in these post-pandemic timepoints also showed decreased symptom severity and treatment engagement, as well as increased quality of life and social functioning. There were no significant changes in self-reported satisfaction with FEP services at 6 months. Change in symptoms at 6 month follow-up also did not differ between timepoints, indicating that treatment efficacy was not significantly impacted by the pandemic despite the significant change in patient demographics.
Conclusions: Results suggest that FEP patients who began CSC post-pandemic showed higher functioning, lower service utilization, and equal satisfaction with CSC interventions, and have notable implications regarding equitable access to care. Many of these trends have persisted even beyond the initial stage of the pandemic. These observations may suggest that those with more severe illness are accessing care less frequently; understanding this better will help to improve approaches to health care delivery.