TY - JOUR
AU - K. K. Anderson
AU - R. Fuhrer
AU - W. Wynant
AU - M. Abrahamowicz
AU - D. L. Buckeridge
AU - A. Malla
A1 - 
AB - PURPOSE: The observed association between treatment delay and poor outcomes in first-episode psychosis has led to an interest in the topography of symptom development preceding the onset of psychosis and associated help-seeking behaviors. We estimated the extent to which socio-demographic, clinical, and health service indicators are associated with patterns of service use for mental health reasons preceding a first diagnosis of psychosis. METHODS: Population-based administrative data from physician billings, hospitalizations, and public health clinics were used to identify incident cases of schizophrenia-spectrum psychosis among individuals aged 14-25 years in Montreal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed. RESULTS: Thirty-two percent of cases had no contact with services for a mental health reason preceding the index diagnosis, and nearly 50 % received the index diagnosis of psychosis in the emergency department. Individuals in contact with primary care had a reduced likelihood of contact with the emergency department and inpatient services (OR = 0.15, 0.06-0.39) and of receiving the index diagnosis in the emergency department (OR = 0.36, 0.24-0.54), but also had a longer time to contact with a psychiatrist (HR = 0.32, 0.23-0.45). CONCLUSIONS: Improving access to primary care may reduce the burden on emergency departments and inpatient units; however, primary care providers may need additional training in the symptoms of early psychosis and referral protocols. Given the limitations associated with using clinical samples from specialized services, population-based administrative data are an important source of information for understanding patterns of health services use preceding a first diagnosis of psychosis.
BT - Social psychiatry and psychiatric epidemiology
C5 - General Literature
DO - 10.1007/s00127-013-0665-3
JF - Social psychiatry and psychiatric epidemiology
N2 - PURPOSE: The observed association between treatment delay and poor outcomes in first-episode psychosis has led to an interest in the topography of symptom development preceding the onset of psychosis and associated help-seeking behaviors. We estimated the extent to which socio-demographic, clinical, and health service indicators are associated with patterns of service use for mental health reasons preceding a first diagnosis of psychosis. METHODS: Population-based administrative data from physician billings, hospitalizations, and public health clinics were used to identify incident cases of schizophrenia-spectrum psychosis among individuals aged 14-25 years in Montreal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed. RESULTS: Thirty-two percent of cases had no contact with services for a mental health reason preceding the index diagnosis, and nearly 50 % received the index diagnosis of psychosis in the emergency department. Individuals in contact with primary care had a reduced likelihood of contact with the emergency department and inpatient services (OR = 0.15, 0.06-0.39) and of receiving the index diagnosis in the emergency department (OR = 0.36, 0.24-0.54), but also had a longer time to contact with a psychiatrist (HR = 0.32, 0.23-0.45). CONCLUSIONS: Improving access to primary care may reduce the burden on emergency departments and inpatient units; however, primary care providers may need additional training in the symptoms of early psychosis and referral protocols. Given the limitations associated with using clinical samples from specialized services, population-based administrative data are an important source of information for understanding patterns of health services use preceding a first diagnosis of psychosis.
PY - 2013
SN - 1433-9285; 0933-7954
T1 - Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care
T2 - Social psychiatry and psychiatric epidemiology
TI - Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care
U1 - General Literature
U2 - 23429939
U3 - 10.1007/s00127-013-0665-3
VO - 1433-9285; 0933-7954
Y1 - 2013
ER -