The impact of geography and social context on ultra high risk for schizophrenia research in rural Australia

Introduction: The Detection, Evaluation and Psychological Therapy (DEPTh) project, an Australian randomised controlled trial of cognitive behavioural therapy for ultra high risk (UHR) youths, began in 2006 across rural and urban sites. There are known difficulties in recruitment to UHR studies and a lack of research directed towards early intervention service delivery for rural youth. Factors that impact on UHR research in rural areas include limited specialist mental health services2, vast distances coupled with sparse population distribution, and the social context for rural youths. Aim: This paper will present findings regarding recruitment and retention in treatment for DEPTh, focusing on the unique characteristics of the rural site, where no early intervention service or UHR research program existed prior to the study. Method: Recruitment at the rural site involved many non health youth services. Rural recruitment strategies involved: referrer education aboutUHRmental states; repeated promotion of the DEPTh project; extensive travel for staff; provision of comprehensive assessment reports to referring agencies; case management; and enhanced interaction between research staff and referring agencies. Results: Stronger rural referral rates compared to urban were indicative of a lack of early intervention services. Rural participants were generally marginalised youth, often disengaged from ‘‘main stream’’ services, families and education. Clinical profiles showed some differences compared to the urban sample. Discussion: Geography, social context and presence of clinical services impact on the rate of recruitment as well as pathways and clinical profiles of youth for UHR research in rural areas. The use of videoconferencing and close linkage to existing mental health and youth related services facilitated recruitment and retention for DEPTh.