Real-world effectiveness of a multicomponent early intervention program for first episode psychosis in Emilia Romagna (Italy): Timeliness, specificity and fairness

BACKGROUND: This study provides a real-world evaluation of the multicomponent Emilia-Romagna First Episode Psychosis Program (RER-FEP) (2013-2019). It assesses how timeliness, treatment specificity, and socio-demographic factors related to fairness (including citizenship) are associated with clinical outcomes. METHOD: A naturalistic cohort of 1085 FEP patients (aged 18-35) was analyzed. Outcomes included recovery (Δ HoNOS) and remission (HoNOS score ≤ 8). Predictors included duration of untreated psychosis (DUP) as a measure of timeliness and the frequency of FEP-specific interventions (CBT/psychoeducation) as an indicator of treatment specificity. RESULTS: The 1085 participants (mean age 23.8 years; mean follow-up 2.5 years) showed significant improvements in HoNOS scores (p < 0.001), with the largest reduction observed in the first six months. Longer duration of untreated psychosis was associated with poorer recovery outcomes. Treatment specificity was associated with improved outcomes: exposure to more than 36 FEP-specific interventions was linked to higher odds of remission (OR = 1.74). Regarding fairness, single status and lower educational level were associated with lower likelihood of remission, while foreign citizenship was associated with higher baseline and follow-up severity. Substance use was associated with improvement in behavioral symptoms. CONCLUSION: This real-world study suggests that multicomponent early intervention programs are associated with continuous clinical improvement. Outcomes appear to be influenced by timeliness of access, delivery of specific interventions, and socio-demographic factors. These findings highlight the importance of integrating effectiveness and equity considerations within early psychosis services.