ImportanceCharacterizing mental health service use trajectories preceding diagnosis of a psychotic disorder may help identify individuals at highest risk and in which settings they are at highest risk.ObjectiveTo examine mental health service use and diagnostic trajectories before first diagnosis of psychotic disorder and identify utilization and diagnostic patterns.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used linked provincial health administrative data. The sample included individuals aged 15 to 29 years diagnosed with a psychotic disorder in Ontario, Canada, between April 1, 2012, and March 31, 2018. These individuals were matched to individuals with a diagnosis of a mood disorder. Data were analyzed from November 2108 to November 2019.Main Outcomes and MeasuresThe main outcomes were rates, timing, and setting of mental health–related service use and associated diagnoses in the 3 years before the index disorder among individuals first diagnosed with a psychotic disorder compared with those first diagnosed with a mood disorder.ResultsA total of 10 501 individuals with a first diagnosis of psychotic disorder were identified (mean [SD] age, 21.55 [3.83] years; 72.1% male). A total of 72.2% of individuals had at least 1 mental health service visit during the 3 years before their first psychotic disorder diagnosis, which was significantly more than matched controls with a first mood disorder diagnosis (66.8%) (odds ratio [OR], 1.34; 95% CI, 1.26-1.42). Compared with individuals diagnosed with a mood disorder, individuals diagnosed with a psychotic disorder were significantly more likely to have had mental health–related hospital admissions (OR, 3.98; 95% CI, 3.43-4.62) and emergency department visits (OR, 2.27; 95% CI, 2.12-2.43) in the preceding 3 years. Those with psychotic disorders were more likely to have had prior diagnoses of substance use disorders (OR, 2.57; 95% CI, 2.35-2.81), other disorders (personality disorders, developmental disorders) (OR, 1.75; 95% CI, 1.61-1.90), and self-harm (OR, 1.64; 95% CI, 1.36-1.98) in the past 3 years compared with those diagnosed with mood disorders.Conclusions and RelevanceThis study found that in the 3 years prior to an index diagnosis, individuals with a first diagnosis of psychotic disorder had higher rates of mental health service use, particularly emergency department visits and hospitalizations, compared with individuals with a first diagnosis of a mood disorder. Individuals with psychotic disorders also had a greater number of premorbid diagnoses. Differences in health service utilization patterns between those with a first psychotic disorder diagnosis vs a first mood disorder diagnosis suggest distinct premorbid trajectories that could be useful for next steps in prediction and prevention research.

中文翻译：

---

首次诊断精神障碍之前使用心理健康服务


重要性描述精神障碍诊断前的心理健康服务使用轨迹可能有助于识别风险最高的个体以及他们处于最高风险的环境。目的在首次诊断精神障碍之前检查心理健康服务的使用和诊断轨迹，并确定利用和诊断模式设计、设置和参与者这项基于人群的回顾性队列研究使用了相关的省级卫生行政数据。该样本包括2012年4月1日至2018年3月31日期间在加拿大安大略省被诊断患有精神障碍的15至29岁的个体。这些个体与被诊断为情绪障碍的个体进行了匹配。数据分析时间为 2108 年 11 月至 2019 年 11 月。 主要结果和措施主要结果是首次诊断为精神障碍的个体在出现指标障碍之前 3 年中心理健康相关服务的使用率、时间和设置以及相关诊断。结果共确定了 10 501 名首次诊断为精神障碍的个体（平均 [SD] 年龄，21.55 [3.83] 岁；72.1% 为男性）。共有 72.2% 的人在首次诊断出精神障碍之前的 3 年内至少接受过 1 次心理健康服务，这显着高于首次诊断出情绪障碍的匹配对照组 (66.8%)（比值比 [OR]， 1.34；95% CI，1.26-1.42）。与诊断为情绪障碍的个体相比，诊断为精神障碍的个体更有可能因心理健康问题入院（OR，3.98；95% CI，3.43-4.62）和急诊科就诊（OR，2.27；95% CI，3.43-4.62）。 95% CI，2.12-2。43) 在过去的三年里。患有精神障碍的人更有可能先前诊断出物质使用障碍（OR，2.57；95% CI，2.35-2.81）、其他障碍（人格障碍、发育障碍）（OR，1.75；95% CI，1.61-与被诊断为情绪障碍的人相比，过去 3 年中存在自残行为（OR，1.64；95% CI，1.36-1.98）。结论和相关性本研究发现，在指数诊断前的 3 年中，个体与首次诊断出情绪障碍的人相比，首次诊断出精神障碍的人使用精神卫生服务的比例更高，特别是急诊就诊和住院治疗。患有精神障碍的人也有更多的病前诊断。首次精神障碍诊断与首次心境障碍诊断的患者之间的卫生服务利用模式存在差异，这表明不同的病前轨迹可能对预测和预防研究的后续步骤有用。