, Volume 48, Issue 9, pp 1389-1398
Date: 21 Feb 2013

Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care

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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.


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 Montréal. Mental health contacts in the 4 years preceding the index diagnosis were analyzed.


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).


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.