Intersectionality in Early Psychosis: Impact on Mental Health Outcomes, Pathways to Care, and Treatment Engagement

TaKaya McFarland (1,2), James Green (1,2, 5), Kelsey Johnson (1,2), Matcheri Keshavan (1,2) , Margaret Guyer (4), Dost Ongur (5), Michelle Friedman-Yakoobian (1,2,3)
1 Beth Israel Deaconess Medical Center, Boston, MA, USA
2 Harvard Medical School, Boston, MA, USA
3 Brookline Center for Community Mental Health, Brookline, MA, USA
4 Massachusetts Department of Mental Health, 5 McLean Hospital, Belmont, MA, USA
5 University of North Carolina Charlotte, Charlotte NC, USA

Background: Previous literature has suggested that clients with longer duration of untreated psychosis (DUP) have poorer long term outcomes in treatment. Marginalized populations often experience longer DUP, which can impact their treatment outcomes. Research investigating Adverse Childhood Experiences (ACEs) suggests that stressful childhood events are predictive of health outcomes. To measure the risk of marginalization and adversity due to intersectionality, this study developed an additive intersectionality score.
Methods: De-identified quality improvement longitudinal data at baseline, follow-up, and discharge was analyzed from the Massachusetts Psychosis Network for Early Treatment (MAPNET), Self-report and clinical interviews were used to gather participants' demographic data, referral information, clinical and functional outcomes, and client satisfaction. Spearman rank correlations and Dunn Test’s were used to assess baseline correlations and differences while linear mixed effects models were used to examine differences in longitudinal outcomes. False-Discovery rate adjustments were applied to p-values.
Results: Our analysis included 856 clients from various early psychosis clinics Clients were most likely to be white (52.1%), cis-male (58%), straight (80.5%), non-hispanic/latinx (84.5%), English speaking (97.1%), held a high-school diploma or higher (97.2%), had private insurance (13.6%), and were housed (94.9%). Higher intersectionality scores were associated with higher rates of self-referral, lower rates of family referrals, more severe depression, suicidality and self-injurious behavior, and greater occupational functioning at baseline (p < 0.05). Client’s with higher intersectionality scores were more likely to decline in depression and suicidality symptoms over time (p < 0.05) and spend less time in care (p < 0.05).
Conclusion: These results suggest that clients with higher intersectionality scores present to care with more severe depressive symptomatology, potentially due to their pathways to care. Although these clients show improvement in symptom severity overtime, clients with higher intersectionality scores are more likely to drop-out of care.