Table 2.

Study Characteristics and Main Findings

Author Name Year Location Focus/ Aim Setting	Intervention Framework	Sample Demographics	Study details	Operational definition or measure of engagement	Disengagement Predictors	Disengagement Rate Average time in treatment Risk of disengagement
Schimmelmann et al21 Australia Focus: Predictors of disengagement in adolescents with FEP in EIS Setting: A stand-alone EIS service in Melbourne	EPPIC (Early Psychosis Prevention and Intervention Centre) a well-established 1.5-2-year program. Coordinated MDT care provides support for accommodation, vocational activities, recreation, welfare and primary health services. The program also provides psychoeducation, medical management, and access to psychological interventions, family/ carer therapy, physical health interventions, psychosocial recovery groups and online support	Sample size: 134 Population: FEP Age: 15–18 years Mean age: 16.9(SD1.1) Females: 29% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders Bi-polar 1 & other psychoses (NOS, major depressive disorder with psychotic symptoms, delusional disorder, brief psychotic episode, substance-induced psychosis) Exclusions: IQ<70 Organic disorders	Design: Retrospective cohort study Data collection: From clinical files Timescale: January 1998 – December 2000	Disengagement definition: “Actively refused any contact with the treatment facility or were not traceable” Routine efforts were made by clinical staff by phone, letter and home visits to participants and/ or their families. Disengagement was counted from the date of last face-to-face meeting with	Predictors of disengagement were: - Lower symptom severity at baseline - Living without family during treatment - Persistent substance use during treatment	The overall disengagement rate at 2 years was 23.4% (n = 33). 21 refused contact 12 did not respond to phone calls, letters or home visits 18-month time to event analysis found the median time to disengagement was 15.6months (CI 14.7-16.5) with a risk of 0.28 and a roughly linear distribution
Turner et al22 New Zealand Focus: Predictors of 12-month service disengagement from EIS for people with FEP Setting: A stand-alone EIS in Christchurch	Totara House: Established in 1997. And offers MDT care for 2 years Mental health nurses, social workers and occupational therapists have a case-load of 15. With external supervisionand ongoing training. Other staff include a clinical psychologist, Maori mental health worker and psychiatrist. Treatment provides access to social and therapeutic groups, psychoeducation, family therapy, individual CBT and substance abuse treatment program	Sample size: 232 Population: FEP Age: 18–30 years Mean age: 22.4(SD3.9) Females: 29.3% Ethnicity: 16.5% Maori Diagnoses: Schizophrenia spectrum disorders, Bi-polar disorder, major depressive disorder with psychotic features & other psychoses Exclusions: IQ<70 Those in the criminal justice system FEP with greater than 12 weeks previous antipsychotic treatment	Design: Longitudinal naturalistic cohort study Data collection: From psychiatrist interview and case manager interview at admission for all referrals to the service Timescale: 2000–2005 N = 232	Termination of treatment despite therapeutic need within 12 months of entry. Included those who moved without a referral but not those who were discharged to another mental-health service or appropriately out of services	Predictors of disengagement were: - Longer duration of untreated psychosis (DUP) - Lower insight - Lower symptom severity at baseline - Substance use at baseline - Diagnoses that were not mood disorders	The overall disengagement within 12 months was 24.6% (n = 57) 68.4% (n = 39) self-discharged 24.6% (n = 14) moved out of catchment without follow up 3.5% (n = 2) committed suicide 3.5% (n = 2) were imprisoned
Turner et al25 New Zealand Focus: Outcomes for a 2-year EIS for FEP Setting: A stand-alone EIS in Christchurch	Totara House	Sample size: 236 Population: FEP Age: 16–30 years Mean age: 22.4(SD3.9) Females: 37.5% Ethnicity: 16.9% Maori Diagnoses: Schizophrenia spectrum disorders, Bi-polar disorder, major depressive disorder with psychotic features & other psychoses Exclusions: IQ<70 Those in the criminal justice system	As above	As above (at 24 months) Additionally, patients who discontinued treatment but returned within 6 months were considered engaged	Predictors of disengagement were baseline measures of: - Unemployment at baseline - Higher global functioning scores at baseline - Higher HoNOS score (greater impairment)	The overall disengagement rate at 2 years was 34% (n = 71) Including: 7% (n = 5) who were imprisoned 4% (n = 3) who committed suicides Time to event analysis at 105.7 weeks found the average time to disengagement was 45.2 weeks and was non-linear compared with 105.7 for those who completed treatment
Conus et al31 Australia Focus: Rates and predictors of service disengagement Setting: A stand-alone EIS in Melbourne	EPPIC	Sample size: 660 Population: FEP Age: 15–29 Mean age: 22(SD3.4) Females: 34.2% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders, bi-polar, NOS Exclusions: IQ<70 Organic conditions	Design: Retrospective cohort study Data collection: From clinical files Timescale: January 1998–December 2000	Disengagement definition: “Actively refused any contact with the treatment facility or were not traceable” Routine efforts were made by clinical staff by phone, letter and home visits to participants and/ or their families. Disengagement was counted from date of last face-to-face meeting with	Predictors of disengagement were: - Forensic history - Lower baseline symptom severity - Persistent substance use - Living without family at discharge	The overall disengagement rate at 18 months was 23.3% (n = 154) 18-month time to event analysis found the mean time to disengagement was 15.8months (CI 15.4–16.2) with a risk of 0.11 0–6 months 0.16 0–12 months 0.26 0–18 months There was a roughly linear distribution
Anderson et al15 Canada Focus: Negative pathways to care and service disengagement Setting: A stand-alone EIS in Montréal	PEPP – (Prevention and Early InterventionProgram for Psychosis): A 2-year program individually tailored providing intensive case management, psychosocial (family and psychoeducation) and medical management	Sample size: 324 Population: FEP Age: 14–30 years Median age: 22.6 (IQR 19.8–25.9) Females: 30.2% Ethnicity: 60.5% White 13% Black 12.3 % Asian Diagnoses: Affective or non-affective psychosis Exclusions: Organic disorders Epilepsy Developmental disorder Not in or soon likely to be in the criminal justice system IQ<70 30+ days of antipsychotic medication	Design: Longitudinal cohort study Data collection: From clinical files Timescale: January 2003 – October 2010	No clinical contact for at least 3 consecutive months (not attending appointments and no response from phone calls). Not including those who moved or were transferred. Time to disengage was measured in months and recorded from program entry to the first month of no-contact	Predictors of disengagement were: - Older age - Ethnicity (black service-users were more likely to disengage compared to white)	The overall disengagement rate at 2years was 28% (n = 89) The median time to drop out was 5 months (IQR 1–11)
Stowkowy et al32 Canada Focus: Predictors of disengagement Setting: A stand-alone EIS in Calgary	EPTS (Early psychosis treatment service) a well-established 3-year program that delivers psychiatric care, case management with a range of group programs, individual therapy and family interventions	Sample size: 266 Population: FEP (24% inpatients) Age: Not reported Mean age: 24.5(SD8.2) Females: 33% Ethnicity: 76.4% Caucasian Diagnoses: Schizophrenia spectrum disorders, NOS, brief psychotic disorder, delusional disorder Exclusions: Affective psychosis Neurological disorders Head injury Epilepsy Poor English language	Design: Longitudinal cohort study Data collection: By informed consent Prospective assessment Timescale: January 1997 – December 2000	Dropping out of treatment before 30 months. Defined by no contact for 3 months. Reengagement anytime within the three years was not counted as disengaged	Predictors of disengagement were: - Lack of family involvement in treatment - Shorter DUP - Lower negative symptoms severity at baseline - Disengagement before 6 months was predicted by cannabis and other substance use	The overall disengagement rate at 30 months was 31% (n = 82) Time to event analysis at 30 months was roughly linear. Average time to disengage was not reported
Zheng et al26 Singapore Focus: Rates and predictors of disengagement Setting: Stand-alone EIS in Singapore	EPIP (Early Psychosis Intervention Program) Established 2001 MDT case management, medical treatment and psychosocial interventions	Sample size: 775 Population: FEP or minimal prior treatment Age: 15–40 years Mean age: Not reported Females: 49% Ethnicity: 77% Chinese, 14% Malay, 7% Indian Diagnoses: Schizophrenia spectrum disorders, Bi-polar disorder, major depressive disorder with psychotic features and other psychoses Exclusions: Substance use Forensic involvement Major medical illness Major neurological illnesses	Design: Naturalistic longitudinal cohort study Data collection: From clinical records Timescale: April 2001 – 2009	Semi-structured scale measured at 2 years: (i) Did not disengage (ii) Telephone contact with service user, family or both (iii) Telephone contact with family only (iv) No contact (iii) & (iv) were deemed disengaged Those who returned within 2 years of dropping out were considered engaged Those who moved or were discharged to private care were excluded	Predictors of disengagement were: - Malay ethnicity - Lower levels of education - Longer DUP	At 2 years 29% of participants (n = 127) disengaged at some level: 14% (n = 109) were deemed to have completely disengaged: Type (iii) 7% (n = 55) and Type (iv)7% (n = 54) 15% (n = 118) only maintained telephone contact type (ii)
Chan et al33 Hong Kong Focus: Prevalence and predictors of disengagement Setting: A stand alone EIS in Hong Kong	EASY (Early Assessment Service for Young people with psychosis) Established 2001 3 main components: Public education Easy referral process 2 yr phase specific interventions that include: Psychosocial education covering stress and coping strategies; psychotherapy for comorbidities and cognitive therapy	Sample size: 700 Population: FEP Age: 15–25 years Mean age: 20.5(SD3.4) Females: 48.5% Ethnicity: Not reported Diagnoses: Psychotic disorders Exclusions: Drug induced psychosis Organic conditions IQ < 50	Design: Longitudinal cohort study Data collection: From clinical records Timescale: January 2001 – December 2003	Continuous default of appointments till the end of 2ears despite therapeutic need and active tracing from staff for follow up.	Predictors of disengagement were: - Poor medication compliance - Lower negative symptoms - Diagnosis other than Schizophrenia spectrum disorders	The overall disengagement rate at 2 years was 13% (n = 94) 24-month time to event analysis found the mean time to disengagement was 671.8days (CI 659.51–684.02) with a risk of: 0.05 0–6 months 0.09 0–12 months 0.13 0–24 months There was a roughly linear distribution
Ouellet-Plamondon et al24 Canada Focus: A comparison of the effect of immigration status on service engagement in EIS Setting: 2 stand-alone EIS in Montréal	5-year specialised EIS based on EPPIC guidelines	Sample size: 215 Population: FEP Age: 18–30 years Mean age: Not reported Females: Not reported Ethnicity: Not reported Diagnoses: Psychotic disorder (primary diagnosis) Exclusions: Developmental disability Inadequate proficiency in English or French	Design: Longitudinal cohort study Data collection: Informed consent Timescale: 2005–2012	Attrition rates at 12 months and 24 months Excluded if they were referred to another service	A predictor of disengagement was: - Immigration status	Attrition at 12 months: Total = 10.7% Non-immigrants 6% (n = 7) 1st generation immigrants 15% (n = 8) 2nd generation immigrants 22% (n = 8) Attrition at 24 months: Total: 13.5% Non-immigrants 8% (n = 9) 1st generation 25% (n = 13) 2nd generation 19% (n = 7)
Albert et al28 Denmark Focus: Comparison of 5 years of OPUS model vs 2 years of OPUS plus 3 years TAU Setting: A 5-year stand-alone EIS in Copenhagen	OPUS II MDT with 12-person caseloads 3 core elements: Modified assertive treatment Family involvement Social skills training Plus, individually tailored groups or individual interventions	Sample size: 319 Population: FEP Age: 18–35 years Mean age: 25.6 (SD4.3) Females: 51% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders Exclusions: IQ<70	Design: Randomised superiority group comparison. Stratified sampling with blinded outcome assessment and statistical analysis. Data collection: By informed consent at 19 to 24 months into treatment Follow up after 5 years Timescale: 2009–2012	Non-attendance/ no contact for the last 3 months before the end of the study time	Not evaluated	There was a highlysignificant difference between the two experimental groups The disengagement rate for the 5-year group was 9.6% compared to 44.4% for the 2 year plus treatment as usual group
Maraj et al23 Canada Focus: Disengagement and immigrant groups Setting: A stand-alone EIS in Montréal	PEPP	Sample size: 297 Population: FEP Age: 14–35 years Mean age: Not reported Females: 31.6% Ethnicity: 66.2% White 14.1% Black 7% Asian Diagnoses: Affective or non-affective psychosis with <1-month medication Exclusions: Organic conditions, Pervasive developmental disorder IQ<70 Epilepsy Substance induced psychosis	Design: Longitudinal cohort study Data collection: By informed consent Timescale: Between January 2003–July 2012	No clinical contact for at least 3 consecutive months (not attending appointments and no response from phone calls). Not including those who moved or were transferred. Time to disengage was measured in months and recorded from program entry to the first month of no-contact	Predictors of disengagement were: - Age (first generation immigrants) - Material deprivation (second generation immigrants) - Medication non-adherence (all groups) Disengagement was not affected by immigrant status or ethnicity	The overall disengagement rate at 2 years was 24.2% (n = 72)
Solmi et al34 England Focus: Predictors of disengagement Setting: 6 stand-alone EIS in a mixed rural and urban setting in East Anglia	NHS EIS’s in East Angliaa MDT care up to 5 years Pharmacological and psychological interventions, family and social support, supported employment, and physical health care checks	Sample size: 786 Population: “suspected” FEP Age: 16–35 years Mean age: Not reported Females: 33.2% Ethnicity: 74.8 % White 25.2 % Black Diagnoses: Not reported Exclusions: Intellectual disability Organic conditions	Design: Naturalistic longitudinal cohort study Data collection: From clinical files Timescale: July 2009 to March 2013	Considered to be disengaged after all possible ways to engage had been explored by the clinical team. Usually 6–8 attempts over 2–3 months	Predictors of disengagement were: - Not meeting an FEP diagnostic criteria - Being in employment or education - Substance use, particularly poly-substance abuse - Lower negative symptoms - Less first rank delusions - A duration of illness between 5–8 weeks (compared to 0–4 weeks)	The overall disengagement rate at 3 years was 11.7% (n = 92) A total of 59.4% (n = 467) participants were discharged early, 5.1% (n = 40) to another service Median time in treatment for those who disengaged was 15.0 months (IQR = 8.2–21.2).
Kim et al27 Australia Focus: Rates and determinants of disengagement and re-engagement Setting: A stand-alone EIS in Melbourne	EPPIC	Sample size: 707 Population: FEP Age: 15–24 years Mean age: 19.3(SD2.9) Females: 39.9% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders, Bi-polar disorder, major depressive disorder with psychotic features, other psychoses Exclusions: None reported Includes those with intellectual disabilities and comorbid personality disorders	Design: Naturalistic cohort study recorded prospectively with retrospective Data collection: From clinical files Timescale: January 2011–September 2014	Disengagement definition: “Actively refused any contact with the treatment facility or were not traceable” Routine efforts were made by clinical staff by phone, letter and home visits to participants and/ or their families. Disengagement was counted from date of last face-to-face meeting with	Predictors of disengagement were: - Not being in employment or education at baseline - Family history of psychosis (2nd degree relative but not 1st degree) - Cannabis use There were no predictors of re-engagement	At 2 years 56.3% (n = 394) disengaged at least once Of those: 42.9% (n = 169) disengaged once 27.2% (n = 107) disengaged twice 18.8% (n = 74) disengaged three times 11.2% (n = 44) disengaged more than three times 7.6% never re-engaged (n = 54) The median time to disengagement was 166.5days (SD±178.9, IQR = 64.25 – 321.75) The mean duration of first episode of disengagement was 82days (SD±83.7)
Lau et al35 Hong Kong Focus: Rates and predictors of disengagement comparing 15–25 vs 26 to 64-year olds in EIS Setting: A stand-alone EIS In Hong Kong	EASY (See Chan 2014 above) In 2011 it extended its service to a 3-years with the age range widened from 16–25 to 15–64	Sample size: 277 Population: FEP Age: 15–64 years Mean age: Not reported Females: 53% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders and other psychosis Exclusions: Drug induced psychosis Organic condition IQ < 50	Design: Longitudinal cohort study Data collection: From service-user records Timescale: Patients newly registered from January to December 2012	Defines 3 different types of disengagement: Type 1: Complete disengagement despite therapeutic need (continuous default until the end of the three years) Type 2: Disengaged and re-engaged through hospitalisation Type 3: Disengaged at least twice and re-engaged through outpatients Those who died or were transferred were excluded	Predictors of disengagement were: - Previous suicide attempts (type 3) - Persistent substance use (type 3) - Medication non-adherence (type 3) at an early stage (types 1&2) - Overall, the younger age group predicted disengagement	The overall disengagement rate at 3 years was:30.7% Type 1: n = 36 (13%) 17.2% were <25 9.7% were >25 years old Type 2: n = 12 (4.3%) 4.9% were <25 3.9% were >25 years old Type 3: n = 37 (13.4%) 18% were <25 9.7 were > 25 years old
Hamilton et al35 USA Focus: Treatment retention in an integrated Co-ordinated Speciality Care (CSC) service Setting: An integrated service in a community mental health setting for FEP in Texas	Co-ordinated Speciality Care for FEPl est. 2015 Recovery orientated integrated care model within a community mental health clinic Individualised care using core concepts from PREP (Prevention and Recovery in Early Psychosis) Evidence-based, person-centred, phase specific, integrated, continuous and comprehensive care Pharmacotherapy with an FEP trained psychiatrist. Home based service including CBT, employment support and education, case management and peer support	Sample size: 129 Population: FEP Age: 15–30 Mean age: 23.14 Females: 41% Ethnicity: 53.9% African-American Diagnoses: Schizophrenia, Bi-polar disorder & major depressive disorder with psychotic features Exclusions: People with pre-existing medical insurance	Design: A mixed methods retrospective service evaluation (mixed methods) Data collection: By informed consent Timescale: A 2015 pilot study	Those remaining in treatment for less than 9 months	Predictors of disengagement were: - Female gender - Not undertaking a home-based CBT (cognitive behavioural therapy) course - Non-African American ethnicity	The overall disengagement rate at 9 months was: 41.1%
Maraj et al36 Canada Focus: Vocational inactivity and disengagement Setting: A stand-alone EIS in Montréal	PEPP	Sample size: 394 Population: FEP Age: 14–35 years Mean age: 22.7(SD3.55) Females:28.1% Ethnicity: 59.8% white Diagnoses: Affective or non-affective psychosis with <1-month medication Exclusions: Organic conditions IQ<70 Substance induced psychosis	Design: Cross-sectional cohort study Data collection: By informed consent Timescale: January 2003–February 2018	No clinical contact for at least 3 consecutive months (not attending appointments and no response from phone calls). Not including those who moved or were transferred. Time to disengage was measured in months and recorded from program entry to the first month of no-contact	Predictors of disengagement were: - Those not in employment or education during the first year of treatment There was no difference between rates of disengagement for those who were vocationally active or inactive at baseline	N/A
Reynolds et al20 Australia Focus: Community and service level factors associations with disengagement Setting: A stand-alone EIS in Melbourne	EPPIC	Sample size: 707 Population: FEP Age: 15–24 years Mean age: 19.3(SD2.9) Females: 39.9% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders, Bi-polar disorder, major depressive disorder with psychotic features, and other psychoses Exclusions: None reported Includes those with intellectual disabilities and comorbid personality disorders	Design: Naturalistic cohort study recorded prospectively with retrospective Data collection: From clinical files Timescale: January 2011 to September 2014	Disengagement definition: “Actively refused any contact with the treatment facility or were not traceable” Routine efforts were made by clinical staff by phone, letter and home visits to participants and/ or their families. Disengagement was counted from date of last face-to-face meeting with	Predictors of disengagement: - Higher social deprivation	(As Kim et al)
Iyer et al6 Canada and India Focus: Family and patient engagement in low- and middle-income countries vs high-income countries Setting: Two stand-alone EIS models in Montreal Canada and Chennai, India	Both are 2-year programs based on international guidelines (i.e. the EPPIC framework) In Montreal publicly funded and in Chennai funded by the NGO Schizophrenia Research Foundation (SCARF) in collaboration with the Montreal service. Both comprise low dose antipsychotics, case management in Canada 1:22–25 and in India 1:30–35, psychoeducational and psychosocial interventions	Sample size: 333 Canada: 165 India: 168 Population: FEP Age: 16–35 Mean Age: Canada: 24.20(SD5.3) India:26.60(SD5.24) Females: Canada: 33% India: 51% Ethnicity: Canada:58% White India: Not reported Diagnoses: Schizophrenia spectrum disorders Affective psychosis Exclusions: Antipsychotic treatment <30 days IQ<70	Design: A prospective cohort study Data collection: Clinician assessment and by Informed consent Timescale: 2012 to 2018	Disengagement definition: Patients were considered disengaged if they had not been in contact with the clinical team for three consecutive months. Patients who reengaged after disengaging for 3 months were considered disengaged	Predictors of disengagement were: -Lack of family contact -Higher income country (Canada)	The overall disengagement rate at 24 months was: 19% (n = 31) in the Canadian cohort 1% (n = 2) in the Indian cohort
Golay et al37 Switzerland Focus: Rates and predictors of disengagement Setting: Treatment and early intervention in Psychosis Program Lausanne, Switzerland	A three-year EIS that offers MDT care and assertive community outreach	Sample size: 336 Population: FEP Age: 18–35 Mean Age: 24.53(SD4.69) Females: 35% Ethnicity: Not reported Diagnoses: Schizophrenia spectrum disorders Affective psychosis Major depressive disorder with psychotic features Bi-polar disorder other Exclusions: Antipsychotic treatment >6 months IQ<70 Organic disorders Drug induced psychosis	Design: Longitudinal cohort study Data collection: Clinician rated through structured questionnaire and semi-structured interview with access to clinical data granted for research purposes Timescale: 2004–2017	Disengagement definition: Actively refused and contact with the treatment team despite active and repeated attempts or when contact was impossible despite attempts throughout the entire treatment period Participants who moved, were referred out of services or died were excluded.	Predictors of disengagement: -Low socioeconomic status -Patents who committed offenses during the treatment period -A diagnosis of schizophreniform/ brief psychotic disorder	The overall disengagement rate at 36 months was: 6.3% (n = 21)
Theuma et al38 New Zealand Focus: Service evaluation of an EIS for FEP Setting: A stand-alone EIS in New-Zealand	A 2-year EIS in New-Zealand est. 1997 based on the EPPIC framework The team treats up to 40 patients at one time and comprises a psychiatric nurse, family worker, occupational therapist, psychiatrist and psychologist.	Sample size: 100 Population: FEP Age: 15–40 years Mean age: Not reported Females: 44% Ethnicity: 52% European 15% Maori 14% Pacific islanders 7% Asian Diagnoses: Schizophrenia Exclusions: Unclear	Design: Longitudinal cohort study (mixed methods) Data collection: Clinician rated Informed consent not clear Timescale: Date unclear (post 1997)	Engagement is a secondary outcome measure where clinicians rated strength of engagement at four timepoints on a 5-point Likert scale from 1 = Nil to 5 = Excellent.	Weaker engagement was predicted by: - Male gender - Higher score for negative symptoms over time - Higher HoNOS score (igreater impairment) - Lower medication adherence	Not measured
Lecomte et al39 Canada Focus: Predictors and profiles of treatment non-adherence and service engagement in EIS for FEP Setting: 4 EIS in Vancouver 2 stand-alone EIS and 1 specialised care psychosis clinic and one general psychiatric outpatient clinics	Care frameworks from 2 stand-alone EIS around Vancouver, one specialized psychosis outpatients service and one general psychiatric outpatient clinic	Sample size: 118 Population: FEP Age: 18+ years Mean age: 25(SD5.9) Females: 39% Ethnicity: 60% Caucasian 16% Asian 5% First nations Diagnoses: Schizophrenia, Schizoaffective disorder, bi-polar, NOS or “early psychosis” Exclusions: IQ<70 Organic disorders Drug induced psychosis	Design: Cross-sectional cohort study Data collection: By Informed consent Timescale: Not clear	The Service Engagement Scale (SES): A clinician rated 14 item scale to assess overall engagement with four subscales: availability, collaboration, help seeking and treatment adherence.	Weaker engagement was predicted by: - High agreeableness - Low neuroticism - Poor therapeutic alliance - Male gender - Forensic history - Childhood physical abuse	N/A
MacBeth et al.40 Scotland Focus: Attachment, mentalization and their correlates Setting: A stand-alone NHS EIS in Glasgow and Clyde	NHS EIS Glasgow and Clydea	Sample size: 34 Population: FEP Age: 15–45 Mean age: Not reported Females: 42% Ethnicity: 94.1% white Diagnoses: Schizophrenia spectrum disorders, Bi-polar, delusional disorder, mania Exclusions: A primary diagnosis ofsubstance use Head injury Organic disorder	Design: A cross-sectional cohort study Data collection: By informed consent in the first 12 months of treatment Time scale: November 2004–November 2007	Service Engagement Scale (SES): A clinician rated 14 item scale to assess overall engagement with four subscales: availability, collaboration, help seeking and treatment adherence.	Weaker engagement was predicted by: - Insecure attachment style (either preoccupied or dismissing) - Preoccupied attachment style for the sub-scale treatment adherence	N/A
MacBeth et al41 Scotland Focus: Clinical and premorbid correlates of engagement Setting: A stand-alone NHS EIS in Glasgow and Clyde	NHS EIS Glasgow and Clydea	Sample size: 64 Population: FEP Age: 15–45 years Mean age: Not reported Females: 33% Ethnicity: 90.6% white Diagnoses: Schizophrenia spectrum disorders, Bi-polar, delusional disorder, mania, major depressive disorder with psychotic features Exclusions: A primary diagnosis of substance use Head injury Organic disorder	Design: A cross- sectional cohort study Data collection: By informed consent in the first 12 months of treatment Time scale: November 2004–November 2007	Service Engagement Scale (SES) (as above)	Weaker engagement was predicted by: - Higher negative symptoms	N/A
MacBeth et al42 Scotland Focus: Quality of Life associations with symptomology and premorbid adjustments Setting: A stand-alone NHS EIS in Glasgow and Clyde	NHS EIS Glasgow and Clydea	Sample size: 64 Population: FEP Age: 15–45 years Mean age: 23.5(SD7.0) Females: 33% Ethnicity: 90.6% White British Diagnoses: Schizophrenia, Schizoaffective disorder, delusional disorder and bipolar Exclusions: A primary diagnosis of substance use Head injury Organic disorder	Design: Cross-sectional cohort study Data collection: By informed consent in first 12 months of treatment Timescale: October 2005–March 2008	Service Engagement Scale (SES) (as above)	Weaker engagement was predicted by Quality of Life factors: - Poorer perceived quality of interpersonal relationships - Poorer perceived quality of environment	N/A
MacBeth et al43 Scotland Focus: Associations between metacognition in FEP and engagement Setting: A stand-alone NHS EIS in Glasgow and Clyde	NHS EIS Glasgow and Clydea	Sample size: 34 Population: FEP Age: 15–45 years Mean age: 23.3(SD7.6) Females: 41% Ethnicity: 94% White Diagnoses: Schizophrenia spectrum disorders, bi-polar, delusional disorder, mania Exclusions: A primary diagnosis of substance use Head injury Organic disorders	Design: Cross-sectional cohort study Data collection: By informed consent Timescale: 2014 Cohort	Service Engagement Scale (SES) (as above)	Weaker engagement was predicted by: - Higher negative symptoms - Higher cognitive disorganisation symptomology - Poorer cognitive identification scores (an item from the “Understanding of One’s Own Mind” sub-scale from the revised metacognition assessment scale) (but non-significant when adjusted for negative symptoms)	N/A
Casey et al44 England Focus: Predictors of engagement in FEP Setting: An NHS stand-alone EIS in Birmingham	NHS EIS Birminghama	Sample size: 103 Population: FEP Age: Not reported Mean age: 23 (SD not reported) Females 29% Ethnicity: 33% White 24% Black, 35% Asian Diagnoses: Not reported Exclusions: Not reported	Design: Cross sectional cohort study Data collection: By informed consent Timescale: recruited over a 2-year period	Singh O’Brien Level of Engagement Scale (SOLES): A 16 item self-report scale validated for FEP that predicts longitudinal disengagement, cross sectional disengagement and appointment attendance	Weaker engagement was predicted by: - The belief that social stress causes mental illness	N/A

Note: CI, 95% Confidence intervals; DUP, Duration of untreated psychosis (time period from first psychotic symptom to treatment compliance); EIS, Early intervention for psychosis service; FEP, First episode psychosis; HoNOS, Health of the Nation Outcomes Scales a 12-item scale measuring behaviour, impairment, symptoms and social functioning. Higher scores indicate more problematic features; IQR, Interquartile range; MDT, Multi-disciplinary team; NHS, National Health Service (UK); NOS, Non-specific psychotic disorder; NGO, Non-government organisation; SD, Standard deviation.

^aThe NHS EIS care model is a community MDT providing 3 years treatment including: CBT for psychosis, family interventions, antipsychotic medication, education and employment support, physical health assessments, psychosocial wellbeing.

= Strength of engagement studies.

= Disengagement studies.