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

Published online by Cambridge University Press:  12 October 2018

Kelly K. Anderson Open the ORCID record for Kelly K. Anderson [Opens in a new window] ,
Ross Norman ,
Arlene G. MacDougall ,
Jordan Edwards ,
Lena Palaniyappan ,
Cindy Lau  and
Paul Kurdyak
Kelly K. Anderson*
Affiliation:
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Ross Norman
Affiliation:
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Arlene G. MacDougall
Affiliation:
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Jordan Edwards
Affiliation:
Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Lena Palaniyappan
Affiliation:
Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
Cindy Lau
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Paul Kurdyak
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Kelly K. Anderson, E-mail: kelly.anderson@schulich.uwo.ca
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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.

Keywords

Early intervention servicesfirst-episode psychosishealth administrative dataincidence
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 12 , September 2019 , pp. 2091 - 2099
Copyright
Copyright © Cambridge University Press 2018 

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