Impact of financial deprivation in first-episode psychosis: a prospective 4-year follow-up study

Abstract

Purpose: Socioeconomic disadvantage can exacerbate psychosis outcomes, yet the long-term impact of financial deprivation remains underexplored. This study examined how financial deprivation at first-episode psychosis affects clinical, functional, and neurocognitive outcomes over four years. Methods: Participants were 240 adults (26–55 years) from the Jockey Club Early Psychosis project in Hong Kong, China. Financial deprivation was defined as household income < 50% of the median for household size. Regression analyses assessed the predictive value of baseline financial deprivation on four-year outcomes, controlling for sociodemographic and premorbid confounders. Age-subgroup analyses explored differential effects across developmental periods (< 33, 33–42, > 42 years). Results: At baseline, 121 participants (51.7%) were financially deprived, characterized by lower education, more siblings, foreign-born status, and residence in public housing. Baseline financial deprivation predicted worse four-year clinical, functional, and quality of life outcomes four years later. Financial hardship did not appear to predict neurocognitive outcomes at follow-up. Age-subgroup analyses indicated the strongest and most consistent effects in participants > 42 years, with minimal to modest effects in younger subgroups. Conclusions: Financial deprivation during early psychosis represents a high-risk subgroup, particularly in later adulthood, with persistent symptomatic and functional impairments. Early identification and age-sensitive interventions, such as vocational support, social benefits assistance, and programs promoting social integration and independent living, are essential. Policy measures targeting socioeconomic disadvantage may mitigate long-term impacts on illness trajectory and recovery.