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

## TL;DR

This study shows that financial hardship during first-episode psychosis leads to worse long-term outcomes, especially in older adults.

## Contribution

The study identifies financial deprivation as a high-risk factor for poor recovery in psychosis, particularly in those over 42 years old.

## Key findings

- Financial deprivation at first-episode psychosis predicts worse clinical and functional outcomes after four years.
- Older adults (>42 years) show the strongest negative effects of financial hardship.
- Financial hardship does not significantly affect neurocognitive outcomes.

## Abstract

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.

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).

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.

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.

The online version contains supplementary material available at 10.1007/s00127-025-03006-y.