Patterns of health services use prior to a first diagnosis of psychosis: the importance of primary care
- First Online:
- 625 Downloads
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.
KeywordsFirst-episode psychosis Schizophrenia Mental health services Primary care Administrative database
- 12.Anderson KK, Fuhrer R, Schmitz N, Malla AK. (2012) Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol (in press). doi: 10.1007/s00127-012-0571-0
- 19.Gamache P, Pampalon R, Hamel D. (2010) The material and social deprivation index: a summary. Institut National de Santé Publique Québec [cited 2011 Feb 20]; Available from: URL: http://www.inspq.qc.ca/santescope/documents/Guide_Metho_Indice_defavo_Sept_2010_A.pdf
- 24.SAS. (2008) Version 9.2., SAS Institute, North CarolinaGoogle Scholar
- 25.R (2010). Version 2.12.1., R foundation for statistical computing, ViennaGoogle Scholar
- 30.Logan R, Spiegelman D. (2004) The SAS %BLINPLUS Macro. Harvard School of Public Health Available from: URL: http://www.hsph.harvard.edu/faculty/donna-spiegelman/software/blinplus-macro/index.html
- 31.Vanasse A, Courteau J, Fleury MJ, Gregoire JP, Lesage A, Moisan J (2012) Treatment prevalence and incidence of schizophrenia in Quebec using a population health services perspective: different algorithms, different estimates. Soc Psychiatry Psychiatr Epidemiol 47(4):533–543PubMedCrossRefGoogle Scholar
- 44.Statistics Canada. (1986) Canadian classification of diagnostic, therapeutic, and surgical procedures. 2nd[82-562-XPE]. Ottawa, Statistics Canada Health DivisionGoogle Scholar
- 45.World Health Organization (1977) Manual of the international statistical classification of diseases, injuries, and cause of death - 9th revision [PHS 80–1260]. World Health Organization, GenevaGoogle Scholar
- 46.World Health Organization (1992) Manual of the international statistical classification of diseases, injuries, and cause of death - 10th revision. World Health Organization, GenevaGoogle Scholar