Table 2. Associations between exposures and relapse (primary outcome).
This table presents the unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the primary outcome (relapse, defined as inpatient admission or CRHTT referral). The ‘Full Model’ includes all exposure variables and covariates, while the ‘Final Model’ is based on a refined selection of variables informed by statistical and theoretical considerations. Hazard ratios represent the relative likelihood of relapse occurring at any given time for individuals in one category of a variable compared with the reference category, holding all other variables constant. HR > 1 indicates an increased likelihood of relapse, while HR < 1 indicates a decreased likelihood. Results are adjusted for clustering within services. Results in bold indicate p-values ≤0.001 which were considered strong evidence. Results in italics indicate p-values between 0.001 and 0.05 which were considered suggestive but not definitive evidence.
| Variables | Unadjusted HR (95% CI) |
Adjusted HR - Full Model (95% CI) |
Adjusted HR - Final Model (95% CI) |
|---|---|---|---|
| Age* | |||
| 0.98 (0.98–0.98), p<0.001 | 0.98 (0.96–1.00), p=0.055 | 0.98 (0.98–0.98), p<0.001 | |
| Sex | |||
| Female | Ref | Ref | - |
| Male | 1.15 (1.08–1.21), p<0.001 | 0.94 (0.89–1.00), p=0.054 | - |
| Ethnicity | |||
| White | Ref | Ref | Ref |
| BAME | 1.25 (1.18–1.33), p<0.001 | 1.11 (1.08–1.15), p<0.001 | 1.18 (1.11–1.26), p<0.001 |
| Other | 1.13 (1.02–1.24), p=0.020 | 1.08 (0.98–1.20), p=0.129 | 1.09 (0.98–1.20), p=0.108 |
| Patient in employment or education | |||
| No | Ref | Ref | Ref |
| Yes | 0.90 (0.85–0.96), p=0.001 | 0.73 (0.61–0.88), p=0.001 | 0.92 (0.86-0.97), p =0.003 |
| Psychiatric admission prior to EIP involvement | |||
| No | Ref | Ref | Ref |
| Yes | 2.43 (2.29–2.58), p<0.001 | 2.21 (2.06–2.38), p<0.001 | 2.25 (2.11–2.40), p<0.001 |
| Average care coordinator caseload at treating EIP service* | |||
| 1.02 (1.01–1.02), p<0.001 | 1.02 (1.01–1.02), p<0.001 | 1.02 (1.01–1.02), p<0.001 | |
| Likelihood that treatment began in <2 weeks (based on proportion meeting waiting time standard at treating service)* | |||
| 1.00 (1.00–1.00), p=0.05 | 1.00 (0.99–1.02), p=0.751 | - | |
| Received Cognitive Behavioural Therapy for Psychosis | |||
| No | Ref | Ref | - |
| Refused | 1.05 (0.97–1.14), p=0.202 | 1.00 (1.00–1.00), p=0.999 | - |
| Yes | 0.92 (0.85–0.99), p=0.021 | 0.95 (0.88–1.03), p=0.199 | - |
| Received Family Intervention | |||
| No | Ref | Ref | - |
| Refused | 1.07 (1.01–1.15), p=0.031 | 0.98 (0.91–1.05), p=0.485 | - |
| Yes | 1.24 (1.15–1.33), p<0.001 | 1.05 (0.97–1.14), p=0.191 | - |
| Received carer-focussed intervention | |||
| Not eligible | Ref | Ref | - |
| No | 1.11 (1.03–1.20), p=0.006 | 1.04 (0.96–1.12), p=0.354 | - |
| Yes | 1.28 (1.19–1.37), p<0.001 | 1.09 (1.01–1.18), p=0.021 | - |
| Received vocational support | |||
| No | Ref | Ref | - |
| Refused | 1.12 (1.07–1.18), p<0.001 | 1.07 (0.99–1.15), p=0.091 | - |
| Yes | 1.23 (1.18–1.29), p<0.001 | 1.09 (1.02–1.17), p=0.013 | - |
| Received antipsychotic | |||
| No | Ref | Ref | Ref |
| Yes | 2.20 (2.00–2.41), p<0.001 | 2.30 (1.54–3.43), p<0.001 | 1.32 (1.15–1.52), p<0.001 |
| Received clozapine | |||
| Not eligible | Ref | Ref | Ref |
| Not offered | 1.36 (1.25–1.47), p<0.001 | 1.51 (1.36–1.67), p<0.001 | 1.50 (1.36–1.67), p<0.001 |
| Refused | 1.63 (1.43–1.85), p<0.001 | 1.51 (1.36–1.66), p<0.001 | 1.38 (1.17–1.63), p<0.001 |
| Yes | 1.74 (1.60–1.90), p<0.001 | 0.96 (0.84–1.10), p=0.588 | 0.97 (0.85–1.10), p=0.614 |
| Received intervention for alcohol cessation | |||
| Not required | Ref | Ref | - |
| No | 0.85 (0.79–0.91), p<0.001 | 1.01 (0.85–1.19), p=0.942 | - |
| Refused | 0.82 (0.75–0.89), p<0.001 | 0.91 (0.79–1.05), p=0.211 | - |
| Yes | 1.06 (0.98–1.15), p=0.142 | 1.19 (1.06–1.33), p=0.002 | - |
| Received intervention for smoking cessation | |||
| Not required | Ref | Ref | - |
| No | 0.89 (0.83–0.96), p<0.001 | 0.94 (0.81–1.09), p=0.388 | - |
| Refused | 1.00 (0.95–1.06), p=0.996 | 1.00 (0.90–1.11), p=0.959 | - |
| Yes | 1.09 (1.04–1.14), p<0.001 | 1.05 (0.97–1.13), p=0.244 | - |
| Received intervention for substance use | |||
| Not required | Ref | Ref | Ref |
| No | 0.85 (0.79–0.92), p<0.001 | 1.04 (0.86–1.25), p=0.703 | 1.02 (0.91–1.13), p=0.783 |
| Refused | 1.01 (0.95–1.09), p=0.697 | 1.50 (1.33–1.70), p<0.001 | 1.45 (1.32–1.59), p<0.001 |
| Yes | 1.17 (1.11–1.23), p<0.001 | 1.47 (1.35–1.59), p<0.001 | 1.52 (1.42–1.63), p<0.001 |
| Received intervention for weight loss | |||
| Not required | Ref | Ref | - |
| No | 1.02 (0.92–1.14), p=0.695 | 1.07 (0.91–1.25), p=0.408 | - |
| Refused | 1.01 (0.91–1.13), p=0.875 | 0.91 (0.77–1.08), p=0.277 | - |
| Yes | 1.15 (1.10–1.19), p<0.001 | 0.89 (0.84–0.95), p=0.001 | - |
| Interaction effect: age x employment** | |||
| AGE : EMPLOYMENT No | NA | Ref | - |
| AGE : EMPLOYMENT Yes | NA | 1.01 (1.00–1.01), p=0.011 | - |
| Interaction effect: age x antipsychotic** | |||
| AGE : ANTIPSYCHOTIC No | NA | Ref | - |
| AGE : ANTIPSYCHOTIC Yes | NA | 0.98 (0.97–0.99), p=0.002 | - |
For the continuous variables ‘age’, ‘care coordinator caseload’ and ‘proportion meeting waiting time standard’, stated hazard ratios indicate the change in hazard with a one-unit increase in the exposure. For example, each additional person on a care coordinator’s caseload increased the hazard of relapse by 2% (HR 1.02, 95% CI 1.01–1.02, p<0.001).
Interaction effects indicate the change in the hazard ratio for the second variable for each unit of change in the first. For example, for individuals taking antipsychotic medication, each additional year of age decreases the hazard rate by 2% compared with those not taking it. This suggests that the increased hazard rate of relapse associated with antipsychotic medication reduces with age.