BACKGROUND:Due to the side effects of antipsychotics, overtreatment is an important concern. Previous research focused on antipsychotic polypharmacy and excessively high doses. In this study, the aim is to map changes over the years in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden. Moreover, the association of the total dose and antipsychotic polypharmacy with the subjective side effect burden will be investigated. STUDY DESIGN:Data from a naturalistic longitudinal cohort were used (PHAMOUS, 2013-2021). Potential overtreatment was defined as a antipsychotic dose equivalent to > 5 mg risperidone or antipsychotic polypharmacy, in combination with a high subjective side effect burden. Mixed effect models were used to investigate trends in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden and to assess the association of total dose and antipsychotic polypharmacy with subjective side effect burden. STUDY RESULTS:Overall, 15,717 observations nested in 5,107 participants were used. One-third of the participants were potentially overtreated, which did not change over time. The prevalence of a dose above the equivalent of 5 mg risperidone decreased, antipsychotic polypharmacy prevalence increased, and the subjective side effect burden decreased. A higher dose and antipsychotic polypharmacy were associated with higher subjective side effect burden. CONCLUSION:Potentially overtreated patients should be revaluated to assess whether changes are needed. To assess whether a patient is truly overtreated, their clinical history, number of relapses, patients' preferences, overall functioning, previous attempts to reduce antipsychotic treatment, and previous severity of disease should be taken into account.

Background Auditory hallucinations (AH) are subclinical psychotic experiences occurring in childhood and adulthood. Although common in childhood, their long-term course and impact on adult mental health remain unclear. This study presents the third, 18-year follow-up of a population-based case–control cohort originally including children aged 7–8 years reporting AH, examining (i) the 18-year course of childhood AH, (ii) their association with mental health in young adulthood, and (iii) associations between current AH and adult mental health. Methods At T3, 150 participants (30% male, mean age 26.5 years) of the original N=694 participants completed online questionnaires assessing AH, trauma, cannabis use, mental healthcare utilization, and psychopathology. Descriptive statistics, t-tests, and chi-square analyses were conducted. Results Four participants (3%) reported current AH, compared with 67 (44.7%) at baseline, indicating a largely transient course of AH. Childhood AH at baseline did not significantly predict adult mental health outcomes at T3. Participants with current AH reported more traumatic experiences, higher mental healthcare use, and medication use compared to those without AH, but this difference could not be tested statistically due to the small N. Conclusions Childhood AH were not significantly associated with adverse mental health outcomes in young adulthood, although limited statistical power and attrition may have reduced the ability to detect associations. Persistence of AH into adulthood, although rare, may indicate ongoing vulnerability, emphasizing the potential value of monitoring and support.

Background Antipsychotics are used to manage symptoms and reduce the risk of relapse. However, the antipsychotic side effects are associated with a lower quality of life and are seen as major barriers to achieving societal recovery by antipsychotic users. In this study, we investigate the association of side effects, antipsychotic dose, and antipsychotic polypharmacy with societal recovery and happiness. Study Design Data were used from a large, naturalistic, longitudinal cohort of people using an antipsychotic in long-term care (Pharmacotherapy Monitoring and Outcome Survey [PHAMOUS], 2013-2021). The association between subjective antipsychotic side-effect burden (measured with the Subjective Response to Antipsychotics questionnaire), antipsychotic dose, and antipsychotic polypharmacy with societal recovery and happiness was investigated using mixed-effect linear regression models. In an exploratory analysis, the associations between individual side effects with societal recovery and happiness were assessed. Study Results Data from 5971 observations nested in 2490 participants were used. The subjective antipsychotic side-effect burden, total antipsychotic dose, and antipsychotic polypharmacy were significantly negatively associated with societal recovery. Subjective antipsychotic side-effect burden and total antipsychotic dose were significantly negatively associated with happiness, but antipsychotic polypharmacy was not. Cognitive, mood, and physical anticholinergic side effects were most strongly negatively associated with societal recovery. Mood-, sedation-, cognitive-, and sexual-related side effects were most strongly negatively associated with happiness. Conclusions These results show that side effects and a higher dose of antipsychotic medication are negatively associated with societal functioning and happiness. Future research should focus on whether dose reduction is beneficial for societal recovery and happiness in the long-term.

Background Harmonization of research methodology, measures, and existing cohort data is needed to advance the field of psychosis epidemiology. The International Psychosis Epidemiology Consortium (IPEC) has been initiated to create a data-sharing platform for psychosis cohorts globally and provide infrastructure for data harmonization. This profile paper describes the design and data harmonization process, and the technical, ethical, and legal steps taken to set up the IPEC virtual databank, as well as the organizational structure we developed for IPEC. Study Design An international group of researchers, collaborating in the Schizophrenia International Research Society—Epidemiology Research Harmonization Group, drafted inclusion and exclusion criteria for participating cohorts and selected, among others, sociodemographic, socioeconomic, and clinical variables for harmonization. Drawing upon current guidelines for data harmonization, a guideline specifically for psychosis cohorts and a software architecture for federated analysis were developed. Finally, as proof of principle, all steps of data harmonization were applied to 2 cohorts, and summary statistics on core variables were calculated. Study Results A platform for remote and nondisclosive analyses of multisite individual-level data and a data catalog with information on IPEC’s variables and harmonization procedures were built. The 6-step design, harmonization procedure, ethical and legal procedures, future organizational structure and how to join IPEC were described. Data harmonization of variables of the 2 proof-of-principle cohorts was successful. Conclusions IPEC has created a virtual databank for individual-level data of psychosis cohorts and implemented a technical infrastructure for remote federated analysis. This databank facilitates future large-scale collaborative international psychosis epidemiology research.

BACKGROUND:Cognitive Behavioural Therapy for psychosis (CBTp) is an effective psychological treatment for Schizophrenia Spectrum and other psychotic Disorders (SSD). Despite guidelines recommending CBTp for all psychotic disorder patients, many SSD patients lack access to the treatment and little is known about its long-term cost-effectiveness. The aim of this study is to evaluate the cost-effectiveness of CBTp for the treatment of psychotic disorders through scenario analysis from a healthcare perspective. METHODS:Increased implementation of CBTp was evaluated using a real-world SSD population (N = 12,835) from the northern Netherlands (2010-2019). A patient-level model was used to simulate the long-term effects of rehospitalisation rate. We compared treatment as usual (TAU) with the same TAU plus hypothetical CBTp for all individuals not having received such in TAU, hence patients who received any CBTp sessions prior were excluded (N = 2,679). Outcomes considered were quality-adjusted life years gained and total costs of mental healthcare. Additional sensitivity and scenario analyses were performed to evaluate structural and parameter uncertainty. RESULTS:TAU+CBTp was a cost-effective treatment in 61.2% of the simulations. The simulated net present values for QALY gains were 0.038, and for incremental costs were €492 per patient on average, resulting in an expected incremental cost-effectiveness ratio (ICER) of €12,947. CONCLUSIONS:The evaluation shows that CBTp is likely a cost-effective treatment, although results were uncertain. These findings stress the importance of sufficient availability of CBTp for SSD patients. Making CBTp available for all eligible SSD patients may lead to substantial health gains for the SSD population and cost savings from the healthcare perspective in The Netherlands.

Background:Major depressive disorders significantly impact the lives of individuals, with varied treatment responses necessitating personalized approaches. Shared decision-making (SDM) enhances patient-centered care by involving patients in treatment choices. To date, instruments facilitating SDM in depression treatment are limited, particularly those that incorporate personalized information alongside general patient data and in cocreation with patients. Objective:This study outlines the development of an instrument designed to provide patients with depression and their clinicians with (1) systematic information in a digital report regarding symptoms, medical history, situational factors, and potentially successful treatment strategies and (2) objective treatment information to guide decision-making. Methods:The study was co-led by researchers and patient representatives, ensuring that all decisions regarding the development of the instrument were made collaboratively. Data collection, analyses, and tool development occurred between 2017 and 2021 using a mixed methods approach. Qualitative research provided insight into the needs and preferences of end users. A scoping review summarized the available literature on identified predictors of treatment response. K-means cluster analysis was applied to suggest potentially successful treatment options based on the outcomes of similar patients in the past. These data were integrated into a digital report. Patient advocacy groups developed treatment option grids to provide objective information on evidence-based treatment options. Results:The Instrument for shared decision-making in depression (I-SHARED) was developed, incorporating individual characteristics and preferences. Qualitative analysis and the scoping review identified 4 categories of predictors of treatment response. The cluster analysis revealed 5 distinct clusters based on symptoms, functioning, and age. The cocreated I-SHARED report combined all findings and was integrated into an existing electronic health record system, ready for piloting, along with the treatment option grids. Conclusions:The collaboratively developed I-SHARED tool, which facilitates informed and patient-centered treatment decisions, marks a significant advancement in personalized treatment and SDM for patients with major depressive disorders.

Recovery is a key objective in mental health services for people with severe mental illness (SMI). In addition to clinical and functional recovery, personal recovery has gained increasing attention. The CHIME Framework identifies five personal recovery processes—Connectedness, Hope, Identity, Meaning, Empowerment—and is the theoretical foundation for the Brief INSPIRE, a validated Patient-Rated Experience Measure (PREM) to evaluate recovery support. Brief INSPIRE was modified to a five-item Patient-Rated Outcome Measure (PROM) assessing recovery, called Brief INSPIRE-Outcome (Brief INSPIRE-O). Subject of this study are the psychometric properties of the Brief INSPIRE-O. Data on validity and reliability gathered through annual routine outcome monitoring were collected for 861 individuals with SMI of Flexible Assertive Community Treatment teams and a follow-up measurement was available for 232 of these individuals. Test–retest reliability was evaluated in a separate subset of 30 individuals with SMI. The Brief INSPIRE-O shows good internal consistency (Cronbach’s alpha 0.77), test–retest reliability, construct validity, sensitivity to change and no floor or ceiling effects. Furthermore, change in Brief INSPIRE-O was positively related to changes in quality of life and negatively to problems in clinical functioning and unmet care need. Brief INSPIRE-O can be used for research and monitoring to better understand and improve processes of personal recovery in individuals with SMI.

BACKGROUND:Childhood maltreatment is associated with an elevated risk of psychological disorders, including posttraumatic stress disorder (PTSD), but the impact on somatic consequences such as metabolic syndrome (MetS) is less well-known. This study aimed to examine these direct and indirect associations, and to exploratively assess whether these associations differ by sex. METHODS:Somatic monitoring data of 528 outpatients (43.2% male; 56.8% female) were analysed. MetS was defined as the presence of at least three of five criteria: increased waist circumference, increased blood pressure, increased blood levels of triglycerides, increased blood levels of glucose, decreased blood levels of high-density lipoprotein (HDL-) cholesterol. Multiple regression analyses investigated the effects of childhood maltreatment severity directly and indirectly via PTSD symptom severity, relative to the influence of demographic and lifestyle related risk factors (age, sex, lifestyle-related behaviours, psychological distress, BMI and psychotropic medication use). Interaction terms between sex and childhood maltreatment severity and PTSD symptom severity were included. Moreover, two-way ANOVAs examined between-group differences of participants with or without presence of a history of childhood maltreatment and/or with or without presence of a PTSD. RESULTS:Childhood maltreatment severity was directly related to increased waist circumference (2.115 [.06, 3.62]) and increased diastolic blood pressure (1.201 [0.23, 2.17]). Indirect associations between childhood maltreatment severity and metabolic outcomes through PTSD symptom severity were not significant, nor were the interaction terms. Indirect associations were found between lifestyle-related factors including smoking and unhealthy diet and MetS diagnosis and its components. Finally, higher blood glucose levels were found in participants with presence of a history of childhood maltreatment compared to those without. CONCLUSIONS:Childhood maltreatment is both directly and indirectly, via lifestyle-related factors, associated with components of MetS. Lifestyle-enhancing programs seem important to augment standard treatment for clinical populations, specifically with a history of childhood maltreatment, to reduce long-term somatic adversity. TRIAL REGISTRATION:The MOPHAR research project has previously been registered with the Netherlands Trial Register on the 19th of November 2014 (NL4779). The research aspects of MOPHAR were approved by the independent medical ethics committee (RTPO 928, rTPO Leeuwarden, The Netherlands).

BACKGROUND:Optimizing depression treatment intensity and duration is crucial, given an overburdened mental healthcare system. However, decision-making is challenged by heterogeneous treatment effects. We aimed to investigate these effects, accounting for confounders and population heterogeneity, in a real-world dataset from specialized mental healthcare. METHODS:The study included 36,946 participants from mental healthcare providers in the Northern Netherlands. We measured the effects of treatment duration and intensity on time to depression recurrence, using monthly costs as a proxy for treatment intensity. An accelerated failure time model was used, adjusting for confounding via entropy weighting. Non-linear effects were examined using restricted cubic splines to identify turning points, after which linear analyses were stratified. Population heterogeneity was explored through K-means clustering analyses, followed by cluster-specific analyses. RESULTS:In the high-intensity group (above €360/month), a €1000/month increase in treatment intensity may reduce time to recurrence by 16% (acceleration factor [AF] 0.84, 95% CI 0.77-0.92). Conversely, the same increase in the low-intensity group might prolong recurrence-free time by 9.6-fold (AF 9.6, 95% CI 2.18-42.31). Extending treatment duration by 6 months may reduce time to recurrence by 7% (AF 0.93, 95% CI 0.89-0.97) in the long-duration group, with no significant effect in the short-duration group. Five clusters emerged, three of which comprised only women, with AFs of 0.67, 0.80, and 0.81, respectively, under high treatment intensity. CONCLUSIONS:Increasing treatment intensity appears worthwhile only in the low-intensity group, though residual confounding remains possible.

To enable patient-centred treatment choices, shared decision-making (SDM) is essential. To date, instruments facilitating SDM in depression treatment are scarce, especially those that add personalized information, next to more general patient information. Co-creation is essential and seldom used in the development of such tools. We describe the development of an instrument that provides patients with depression and their clinicians with: (1) systematic information regarding symptoms, medical history, situational factors and potentially successful treatment strategies in a digital report and (2) objective treatment information guiding treatment decisions. The study was co-led by researchers and patient representatives, indicating all decisions regarding the development of the instrument were taken together. Data collection, analyses and tool development took place between 2017 – 2021. A mixed-methods approach was applied. Qualitative research provided insight into the end-users’ needs and preferences. A scoping review provided a summary of the available literature on identified predictors of treatment response. K-means cluster analysis was applied to suggest potentially successful treatment options based on similar patients and their outcomes in the past. These data were combined in a digital report. Treatment option grids were developed by patient advocacy groups to provide objective information on evidence-based treatment options. The ‘Instrument for SDM in Depression’ (I-SHARED) was developed, incorporating individual characteristics and preferences. Qualitative analysis and the scoping review resulted in the identification of four categories of predictors of treatment response. The cluster analysis identified five distinct clusters based on symptoms, functioning and age. The co-created I-SHARED report combined all findings and was integrated into an existing electronic health record system ready for piloting, together with the treatment option grids. The collaboratively developed decision aid for depression, including a clustering algorithm to predict potentially successful treatment options, has the potential to support SDM between patients and clinicians.

PURPOSE:For many individuals with a psychotic disorder societal recovery is not accomplished. Research on societal recovery trajectories is mostly focussed on patients with a first episode psychosis. The present study aims to identify distinct societal trajectories in those with long duration of illness, through the identification of patient subgroups that are characterized by homogeneous trajectories. METHODS:Longitudinal data were used from an ongoing dynamic cohort in which people with a psychotic disorder receive yearly measurements to perform a latent class growth analysis. Societal functioning was assessed with the Functional Recovery tool, consisting of three items (1) daily living and self-care, (2) work, study and housekeeping, and (3) social contacts. Furthermore, logistic regression was used to compare subgroups with similar societal recovery at baseline, but distinct trajectories. RESULTS:A total of 1476 people were included with a mean treatment time of 19 years (SD 10.1). Five trajectories of functioning were identified, a high stable (24.5%), a medium stable (28.3%), a low stable (12.7%), a high declining (11.2%) and a medium increasing subgroup (23.3%). Predictors for not deteriorating included happiness, recent hospitalisation, being physically active, middle or higher education and fewer negative symptoms. Predictors for improving included fewer positive and negative symptoms, fewer behavioural problems and fewer physical and cognitive impairments. CONCLUSION:While the majority of individuals show a stable trajectory over four years, there were more patients achieving societal recovery than patients deteriorating. Predictors for improvement are mainly related to symptoms and behavioural problems, while predictors for deteriorating are related to non-symptomatic aspects such as physical activity, happiness and level of education.

INTRODUCTION:Most studies on recovery of psychotic disorders focus on first-episode populations using premorbid and baseline data to predict recovery. However, many patients experience a long duration of illness and many factors are dynamic and change during life. AIMS:To investigate factors strongest associated with clinical, societal and personal recovery, and recovery change scores in people with a long duration of illness using current data measured at the same assessment. METHODS:Least absolute shrinkage and selection operator regression analyses with cross-validation were used to identify the correlates of (changes in) clinical (N = 1054), societal (N = 1145) and personal recovery (N = 1187) in people with psychotic disorders. Subsequently, the identified associated factors were included in separate linear regression models, examining the associative strength of the identified variables and overall fit of the models. RESULTS:Better clinical recovery was associated with better societal and personal recovery, experiencing fewer problems with daily functioning and social relations. Participants had a better societal recovery when they were employed, had fewer problems in daily life, less negative symptoms, had a life partner and better clinical recovery. Personal recovery was associated with greater satisfaction with life in general, no depressive mood and increased clinical recovery. Change scores were small with minimal fluctuation and no significant associations with change scores were detected. CONCLUSIONS:Recovery domains strongly influence each other in people with a long illness duration of psychosis and should therefore have an equally important focus during treatment.

Psychotic disorders have a strong negative impact on multiple aspects of daily life, including people's financial situation. This exploratory study examines the level of financial dissatisfaction and its correlates in a large cohort of people with psychotic disorders. Data from the first assessments of people with psychotic disorders (n = 5271) who were included in the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS; 2006-2020), which is conducted in the northern Netherlands, were used. The Manchester Short Assessment of Quality of Life (MANSA) was used to measure financial dissatisfaction. In addition, sociodemographic and psychiatric characteristics, substance use and global and social functioning were assessed. One -fifth to one-third of people with psychotic disorders report financial dissatisfaction, fluctuating over the year in which they were assessed. These proportions are considerably higher than in the general population. Cannabis and other substance use were associated with higher levels of financial dissatisfaction (small to medium effect). The other significant associations showed (very) small effect sizes. Therefore, we conclude that financial dissatisfaction in people with psychotic disorders appears to be relatively independent of other demographic and psychiatric characteristics, and global and social functioning. These findings are an important first step for increasing knowledge on financial dissatisfaction among people with psychotic disorders. The findings can also contribute to raising awareness about the topic for healthcare professionals working in this field.

Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder.

Background More knowledge on the cost-effectiveness of various depression treatment programmes can promote efficient treatment allocation and improve the quality of depression care.Objective This study aims to compare the real-world cost-effectiveness of an algorithm-guided programme focused on remission to a predefined duration, patient preference-centred treatment programme focused on response using routine care data.Methods A naturalistic study (n=6295 in the raw dataset) was used to compare the costs and outcomes of two programmes in terms of quality-adjusted life years (QALY) and depression-free days (DFD). Analyses were performed from a healthcare system perspective over a 2-year time horizon. Incremental cost-effectiveness ratios were calculated, and the uncertainty of results was assessed using bootstrapping and sensitivity analysis.Findings The algorithm-guided treatment programme per client yielded more DFDs (12) and more QALYs (0.013) at a higher cost (€3070) than the predefined duration treatment programme. The incremental cost-effectiveness ratios (ICERs) were around €256/DFD and €236 154/QALY for the algorithm guided compared with the predefined duration treatment programme. At a threshold value of €50 000/QALY gained, the programme had a probability of <10% of being considered cost-effective. Sensitivity analyses confirmed the robustness of these findings.Conclusions The algorithm-guided programme led to larger health gains than the predefined duration treatment programme, but it was considerably more expensive, and hence not cost-effective at current Dutch thresholds. Depending on the preferences and budgets available, each programme has its own benefits.Clinical implication This study provides valuable information to decision-makers for optimising treatment allocation and enhancing quality of care cost-effectively.

Abstract Background Patients with a mental illness are more likely to develop, and die from, cardiovascular diseases (CVD), necessitating optimal CVD-risk (CVR)-assessment to enable early detection and treatment. Whereas psychiatrists use the metabolic syndrome (MetS)-concept to estimate CVR, GPs use absolute risk-models. Additionally, two PRIMROSE-models have been specifically designed for patients with severe mental illness. We aimed to assess the agreement in risk-outcomes between these CVR-methods. Methods To compare risk-outcomes across the various CVR-methods, we used somatic information of psychiatric outpatients from the PHAMOUS-, and MOPHAR-database, aged 40–70 years, free of past or current CVD and diabetes. We investigated: (1) the degree-of-agreement between categorical assessments (i.e. MetS-status vs. binary risk-categories); (2) non-parametric correlations between the number of MetS-criteria and absolute risks; and (3) strength-of-agreement between absolute risks. Results Seven thousand twenty-nine measurements of 3509 PHAMOUS-patients, and 748 measurements of 748 MOPHAR-patients, were included. There was systematic disagreement between the categorical CVR-assessments (all p < 0.036). Only MetS-status versus binary Framingham-assessment had a fair strength-of-agreement (κ = 0.23–0.28). The number of MetS-criteria and Framingham-scores, as well as MetS-criteria and PRIMROSE lipid-scores, showed a moderate-strong correlation (τ = 0.25–0.34). Finally, only the continuous PRIMROSE desk and lipid-outcomes showed moderate strength-of-agreement (ρ = 0.91). Conclusions The varying methods for CVR-assessment yield unequal risk predictions, and, consequently, carry the risk of significant disparities regarding treatment initiation in psychiatric patients. Considering the significantly increased health-risks in psychiatric patients, CVR-models should be recalibrated to the psychiatric population from adolescence onwards, and uniformly implemented by health care providers. Trial registration The MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014 (NL4779).

Background: Adult-onset airway disease (AD), including asthma and COPD, may be characterized by eosinophilic inflammation. Why eosinophilic AD develops in adults remains largely unclear, but air pollutants have been suggested as potential triggers. Aim: To assess effects of ambient air pollution on incident adult-onset AD, focusing on distinct subgroups based on level of eosinophilic inflammation. Methods: In adults from the LifeLines cohort study who were free of AD at baseline, incident AD was defined as self-reported asthma or COPD, FEV1/FVC0.17 <0.47 109 cells/L) (Coumou, H. et al. Respir Med 2018; 141:81-86). Adjusted associations between air pollutants (based on ELAPSE models) and incident AD (subgroups) were assessed with log-binomial regression models. Results: At ±4 years follow-up, we identified 13,866 controls and 2,581 AD cases (169 eosinophilic and 1,256 non-eosinophilic). Nitrogen dioxide (NO2), ozone (O3) and black carbon but not particulate matter (PM2.5) were associated with incident AD. Associations appeared more pronounced for eosinophilic vs. non-eosinophilic AD (figure 1). Conclusion: In line with proposed mechanisms in literature, results from this study suggest that air pollution may play a role in the development of the eosinophilic subtype of adult-onset airway disease.

BACKGROUND:Personality and coping may be related to symptom severity and psychosocial functioning in patients with recent-onset psychosis. This study aimed to investigate associations of personality traits and coping strategies with concurrent and follow-up symptom severity and functioning in those patients, and identify whether coping mediates relations between personality and symptoms or functioning. METHODS:At baseline, 527 recent-onset psychosis patients (73 % male, mean age = 28 years) received assessments on personality (Neuroticism-Extraversion-Openness - Five-Factor Inventory), coping (Utrecht Coping List), symptom severity (Positive And Negative Syndrome Scale) and psychosocial functioning (Global Assessment of Functioning Scale). Of those, 149 also received symptom and functioning assessments at follow-up. Multivariable linear regression analyses were performed to assess cross-sectional associations of personality and coping with symptoms and functioning at baseline. Longitudinal associations of baseline personality and coping with follow-up symptomatic remission and functioning were analyzed with multivariable linear and binary logistic regression analyses, respectively. Lastly, it was investigated whether coping mediated associations between personality and symptoms or functioning. RESULTS:Higher baseline Agreeableness (B = -0.019, [95%CI: -0.031; -0.007]) and Neuroticism (B = -0.017, [95%CI: -0.028; -0.006]) were associated with lower concurrent symptom severity. Reassuring Thoughts were associated with better functioning at baseline (B = 0.833, [95%CI: 0.272; 1.393]). Neither personality nor coping were associated with follow-up symptomatic remission or functioning. Coping did not mediate associations between personality and symptoms or functioning. CONCLUSION:Only the coping strategy Reassuring Thoughts is associated with better baseline functioning in patients with recent-onset psychosis. Personality traits seem to have limited clinically relevant relations with symptom severity or functioning.