Psychiatric Hospitalization After Enrollment in Coordinated Specialty Care: Unexpected Gender and Age Related Disparities

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ABSTRACT Background and hypotheses Hospitalization is common during first-episode psychosis (FEP) and is linked to functional decline, stigma, and healthcare burden. Coordinated Specialty Care (CSC) programs aim to reduce hospitalization and improve outcomes through early, multidisciplinary intervention. This study examined hospitalization outcomes and predictors among participants in the Academic Community Early Psychosis Intervention Network (AC-EPINET), a multisite CSC hub in the United States. Study design Participants with FEP (N = 701; mean age = 21.6 years, 64% male) were followed after CSC admission, with analyses restricted to the first 24 months. Primary outcomes included time to first hospitalization, number of hospitalizations, and length of stay (LOS). Kaplan-Meier survival and multivariable Cox regression examined predictors of time to first hospitalization, while negative binomial regression assessed hospitalization frequency and LOS. Study results Hospitalization rates declined after CSC enrollment. Females had shorter time to first hospitalization (HR = 2.96, 95% CI [1.24–7.10]) and more frequent admissions (IRR = 1.38, 95% CI [1.06–1.79]) than males. Younger age also predicted earlier (HR = 0.80, 95% CI [0.67–0.95]) and more frequent hospitalizations ( IRR = 0.70 per 5 years, 95% CI [0.58–0.84]). Prior hospitalization predicted more admissions (IRR = 4.83, p < .0001) and longer LOS (RR = 10.72, p < .0001). Black/African American participants had longer LOS than White participants (RR = 1.67, p = .01). Conclusions While CSC reduces overall hospitalization risk, females, younger individuals, and those with prior admissions remain at elevated risk. These findings underscore the need for tailored strategies to mitigate disparities and optimize early psychosis care.

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