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

Soc Psychiatry Psychiatr Epidemiol. 2013 Sep;48(9):1389-98. doi: 10.1007/s00127-013-0665-3. Epub 2013 Feb 21.


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 Montréal. 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Canada / epidemiology
  • Female
  • Health Services Accessibility
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Mental Health Services / statistics & numerical data*
  • Patient Acceptance of Health Care / psychology*
  • Primary Health Care / organization & administration*
  • Propensity Score
  • Proportional Hazards Models
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / psychology
  • Psychotic Disorders / therapy
  • Regression Analysis
  • Socioeconomic Factors
  • Young Adult