Return to College After a First Episode of Psychosis

Abstract

A first episode of psychosis (FEP) can derail a patient's educational goals, including attainment of a college education, and this can have lasting ramifications for socioeconomic and health outcomes. Despite this, few studies have examined return to college, which is an important index of real-world educational success after a FEP. In this study, we conducted a longitudinal medical record review of patients in a transdiagnostic outpatient FEP program and performed survival analysis, setting return to college as the endpoint, among the subset of patients whose college education was interrupted. We found that 82% (93/114) of college-enrolled FEP individuals experienced disruptions to their education after FEP, but that return to college also occurred in a substantial proportion (49/88, 56%) among those on leave who had follow-up data. In this sample, the median time to college return was 18 months. When separated by baseline diagnostic category, FEP patients with affective psychotic disorders (FEAP, n = 45) showed faster time to college return than those with primary psychotic disorders (FEPP, n = 43) (median 12 vs 24 mo; P = .024, unadjusted). When adjusted for having no more than 1 psychiatric hospitalization at intake and absence of cannabis use in the 6 months prior to intake (which were also significant predictors), differences by diagnostic category were more significant (hazard ratio 2.66, 95% CI 1.43-4.94, P = .002). Participation in education is an important outcome for stakeholders, and students with FEP can be successful in accomplishing this goal.

Keywords: bipolar disorder; college reintegration; educational attainment; functional outcomes; recovery; schizophrenia.

Fig. 1.

Flow diagram of patients.

Fig. 2.

Kaplan-Meier curve for return to college for all first episode of psychosis (FEP) patients on leave (n = 88). A total of 46 patients (56%) returned to college while in OnTrack. The median time to college return was 18 months for the first-episode primary psychotic disorder (FEPP) and first-episode affective psychotic disorder (FEAP) combined.

Fig. 3.

Kaplan-Meier curves for return to college by diagnostic group. The survival curves for the first-episode primary psychotic disorder (FEPP) and first-episode affective psychotic disorder (FEAP) were significantly different (log-rank test P = .024); more patients in the FEAP group (27/45, 60%) than the FEPP group (22/43, 51%) returned to college, and the median time to return was sooner in FEAP than FEPP (median 12 vs 24 mo).