Service engagement in psychosis: the role of psychological variables
View/ Open
Date
30/11/2018Author
Murray, Caroline
Reid, Caroline
Metadata
Abstract
Introduction: In psychosis, low engagement with mental health services is
both prevalent and frequently associated with negative outcome. The
overarching objective of this thesis was to investigate the role of
psychological variables in service engagement in people with psychosis. A
systematic review was conducted to examine the evidence for clinical and
psychological correlates of engagement. An empirical study sought to
investigate the association between engagement and psychological variables
of a relational nature (i.e. mentalizing and interpersonal functioning).
Methods: A systematic search strategy across four electronic databases
yielded seventeen journal articles. For the empirical study, forty-two people
with multiple-episode psychosis completed self-report measures of service
engagement, symptoms, mentalizing and interpersonal functioning, within a
cross-sectional design.
Results: The review found relatively robust evidence supporting the
association between engagement and numerous clinical variables. Eleven
psychological variables were revealed as significant correlates of service
engagement, encompassing developmental, individual and relational factors.
Assessment of quality and risk of bias highlighted a number of limitations
within included studies. In the empirical study, greater
cognitive/disorganization symptomology was predictive of lower service
engagement. Service engagement was significantly correlated with
mentalizing, but not with interpersonal functioning. The relationship between
cognitive/disorganized symptomology and engagement was not mediated by
mentalizing performance.
Conclusion: Numerous psychological variables are associated with service
engagement, which has the potential to inform clinical practice in view of
enhancing engagement. Qualitative and longitudinal studies with both service
user and provider samples are required to capture the contextual information
surrounding fluctuations in levels of engagement.