Evidence map›Paper›PMID 41108831›Full record

ArticlePsychiatry research2025

Is treatment during a first hospitalization for an acute psychotic episode and after discharge associated with race or ethnicity?

Clifton Chow, Esi Coro, Victoria Hasler, Andrew Hyatt, Rajendra Aldis, Norah Mulvaney-Day, Lynn E DeLisi

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Article in Psychiatry research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Clifton ChowRecovery In Shared Experiences, RISE Research Team, Cambridge Health Alliance Out-patient Department, Cambridge, MA, USA; Department of Psychiatry Cambridge Health Alliance, Cambridge, Massachusetts and Harvard Medical School, Cambridge, MA, USA.
Esi CoroRecovery In Shared Experiences, RISE Research Team, Cambridge Health Alliance Out-patient Department, Cambridge, MA, USA.
Victoria HaslerMassachusetts General Hospital, Department of Psychiatry, Boston, MA, USA.
Andrew HyattDepartment of Psychiatry Cambridge Health Alliance, Cambridge, Massachusetts and Harvard Medical School, Cambridge, MA, USA; The Health Evaluation Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
Rajendra AldisDepartment of Psychiatry Cambridge Health Alliance, Cambridge, Massachusetts and Harvard Medical School, Cambridge, MA, USA; The Health Evaluation Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.
Norah Mulvaney-DayDepartment of Psychiatry Cambridge Health Alliance, Cambridge, Massachusetts and Harvard Medical School, Cambridge, MA, USA.
Lynn E DeLisiRecovery In Shared Experiences, RISE Research Team, Cambridge Health Alliance Out-patient Department, Cambridge, MA, USA; Department of Psychiatry Cambridge Health Alliance, Cambridge, Massachusetts and Harvard Medical School, Cambridge, MA, USA. Electronic address: LDeLisi@challiance.org.

Funding

Randomized controlled trial of enhanced coordinated specialty care (CSC 2.0)P50MH115846 · NIMH · MCLEAN HOSPITAL · PI MIGUEL HERNAN · 2019 to 2026
$16.9M
Understanding the Role of Trauma Over the Lifecourse in Order to Improve Trauma-informed TreatmentP50MH126283 · NIMH · CAMBRIDGE HEALTH ALLIANCE · PI COOK, BENJAMIN LE, WANG, PHILIP S · 2021 to 2024
$6.6M
AHRQ HHS R01 HS021486NIMH NIH HHS P50 MH115846NIMH NIH HHS P50 MH126283
6 · The paper itself

Abstract

backgroundHistorically, a first psychotic episode was thought to lead to lifelong disability. The advent of early intervention programs like Coordinated Specialty Care (CSC) now offers the potential to change this trajectory. However, racial and ethnic minoritized populations in the United States may face barriers in accessing CSC treatment, may be treated differently when hospitalized, and may have poorer outcomes, possibly associated with differences in the use of follow-up outpatient programs.

methodsA total of 275 individuals were identified aged 15-35 with a first hospitalization for psychosis between January 2019 and December 2020, who were treated in an urban public healthcare system with specialized inpatient and outpatient mental health services, including a CSC program. Inpatient care variables were examined using electronic medical records (EMR) for the index hospital stay. Follow-up data were obtained from the EMR, supplemented by insurance claims data over a 36-month post-discharge period. The primary predictor for care post initial hospitalization was race and ethnicity. Key outcomes included rehospitalization, emergency visits and number of follow-up outpatient behavioral health visits. Statistical analyses included negative binomial regression adjusting for demographic and clinical characteristics. Descriptive analyses also compared the pre-pandemic (2019) and first-year pandemic (2020) cohorts (Tables 1b and 1c).

resultsWhile in the hospital, no significant disparities in care existed between racial and ethnic groups. Only 41 (14.9%) of the 275 patients were referred to the available coordinated specialty care (CSC) program, regardless of race or ethnicity. However, significant disparities in 36-month follow-up care across racial and ethnic groups were identified. Adjusting for demographic and clinical covariates, Black patients had significantly more rehospitalizations, emergency room visits, and behavioral health outpatient visits when compared to other race/ethnic groups (p<0.05). Additionally, those who used multiple substances, regardless of race and ethnicity, also had increased re-hospitalizations and outpatient behavioral health encounters (p<0.05).

conclusionsThe referral to state-of-the-art CSC care subsequent to a first hospitalization for psychosis is crucial for leading to good outcomes. In this cohort, race and ethnicity did not influence choice of referrals, but too few were made. More research is needed to determine if a lack of referral to a CSC programs could be a reason for repeated subsequent emergency room visits and hospitalizations. Education of referring clinicians at acute hospital settings may mitigate this problem. Independent factors that contributed to poorer long-term outcome included either identifying racially as Black, or being a person who abuses substances, regardless of racial identity.

Indexed as

EthnicityHospitalizationMental Health ServicesPatient ReadmissionPsychotic DisordersRacial GroupsAdolescentAdultFemaleFollow-Up StudiesHumansMalePatient DischargeUnited StatesYoung AdultCannabisCoordinated specialty careSchizophreniaSchizophreniform

Identifiers

PMID41108831
PMCPMC12762377

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.