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Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services.

Abstract：

BACKGROUND:Discrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates. METHODS:We constructed a retrospective cohort (1997-2015) of incident cases of non-affective psychosis aged 16-50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach. RESULTS:Our case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4-35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4-20.3). CONCLUSIONS:Case ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

journal_name

Psychol Med

journal_title

Psychological medicine

authors

Anderson KK,Norman R,MacDougall AG,Edwards J,Palaniyappan L,Lau C,Kurdyak P

doi

10.1017/S0033291718002933

subject

Has Abstract

pub_date

2019-09-01 00:00:00

pages

2091-2099

issue

eissn

0033-2917

issn

1469-8978

pii

S0033291718002933

journal_volume

pub_type

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Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services.