Social Psychiatry and Psychiatric Epidemiology

, Volume 48, Issue 9, pp 1389–1398 | Cite as

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

  • Kelly K. Anderson
  • Rebecca Fuhrer
  • Willy Wynant
  • Michal Abrahamowicz
  • David L. Buckeridge
  • Ashok Malla
Original Paper



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.


First-episode psychosis Schizophrenia Mental health services Primary care Administrative database 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kelly K. Anderson
    • 1
  • Rebecca Fuhrer
    • 1
  • Willy Wynant
    • 1
  • Michal Abrahamowicz
    • 1
    • 2
  • David L. Buckeridge
    • 1
    • 3
  • Ashok Malla
    • 1
    • 4
  1. 1.Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréalCanada
  2. 2.Division of Clinical EpidemiologyMcGill University Health CentreMontréalCanada
  3. 3.McGill Clinical and Health InformaticsMcGill UniversityMontréalCanada
  4. 4.Department of PsychiatryMcGill University, Douglas Mental Health University InstituteMontréalCanada

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