Kelly K Anderson1,2,3, Ross Norman1,2, Arlene G MacDougall1,2, Jordan Edwards1, Lena Palaniyappan2,4,5, Cindy Lau3, Paul Kurdyak3,6. 1. 1 Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario. 2. 2 Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario. 3. 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario. 4. 4 Department of Neuroscience, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario. 5. 5 Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario. 6. 6 Health Outcomes and Performance Evaluation, Centre for Addiction and Mental Health, Toronto, Ontario.
Abstract
OBJECTIVE: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. METHODS: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. RESULTS: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. CONCLUSIONS: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.
OBJECTIVE: There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. METHODS: Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. RESULTS: Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. CONCLUSIONS: We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.
Entities:
Keywords:
access to care; early intervention; first-episode psychosis; health administrative data
Authors: Kelly K Anderson; Ross Norman; Arlene MacDougall; Jordan Edwards; Lena Palaniyappan; Cindy Lau; Paul Kurdyak Journal: Am J Psychiatry Date: 2018-03-02 Impact factor: 18.112
Authors: Emily Liffick; Nicole F Mehdiyoun; Jenifer L Vohs; Michael M Francis; Alan Breier Journal: Psychiatr Serv Date: 2016-10-03 Impact factor: 3.084
Authors: Julia M Lappin; Margaret Heslin; Peter B Jones; Gillian A Doody; Ulrich A Reininghaus; Arsime Demjaha; Timothy Croudace; Thomas Jamieson-Craig; Kim Donoghue; Ben Lomas; Paul Fearon; Robin M Murray; Paola Dazzan; Craig Morgan Journal: Aust N Z J Psychiatry Date: 2016-10-18 Impact factor: 5.598
Authors: Brooke Carter; Jared Wootten; Suzanne Archie; Amanda L Terry; Kelly K Anderson Journal: Arch Womens Ment Health Date: 2022-06-24 Impact factor: 4.405
Authors: Rebecca Rodrigues; Arlene G MacDougall; Guangyong Zou; Michael Lebenbaum; Paul Kurdyak; Lihua Li; Salimah Z Shariff; Kelly K Anderson Journal: Epidemiol Psychiatr Sci Date: 2019-10-15 Impact factor: 6.892
Authors: Kelly K Anderson; Suzanne Archie; Richard G Booth; Chiachen Cheng; Daniel Lizotte; Arlene G MacDougall; Ross M G Norman; Bridget L Ryan; Amanda L Terry; Rebecca Rodrigues Journal: BJPsych Open Date: 2018-10-30