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Salam Z, Carranza M, Newbold B, Wahoush O, Joseph A. Racialized Immigrants' Encounters of Barriers and Facilitators in Seeking Mental Healthcare Services in Ontario, Canada. Community Ment Health J 2024:10.1007/s10597-024-01362-8. [PMID: 39316360 DOI: 10.1007/s10597-024-01362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024]
Abstract
Racialized immigrants have low rates of accessing mental healthcare services. However, there are notable differences among immigrant groups (e.g., refugees, international students, dependants). The aim of this study is to understand racialized immigrants' experiences of accessing mental healthcare services at both systemic and individual levels. Through a qualitative descriptive methodology, interviews were conducted in English with 16 racialized immigrants to understand barriers and facilitators encountered. Additionally, focusing on how cultural and social conceptualizations ideas shape mental healthcare services. Interviews were analyzed through Braun & Clarke's six-step method to reflexive thematic analysis in identifying factors. Three major themes were identified: structural constraints, individual influences, and appraisal of services. With the first, racialized immigrants signaled to issues related to the systemic level that included affordability, wait times, and trust in the system. Individual influences highlighted factors of mental health literacy, social supports, stigma, severity of the issues, and awareness of services themselves. Lastly, extending on the previous theme, appraisal of services was reflective of how social and cultural ideals shaped attitudes towards the appropriateness of the provider or services themselves. The findings from this paper emphasize that racialized immigrants are not homogenous in their experiences and attitudes towards mental healthcare services. While there were similarities across different groups in the individual and systemic factors identified, there were key distinctions driven by appraisal of services themselves and if they were congruent based on their needs, more specifically, what was contributing to their negative mental health status.
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Affiliation(s)
- Zoha Salam
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Mirna Carranza
- School of Social Work, McMaster University, Hamilton, ON, Canada
| | - Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, ON, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Ameil Joseph
- School of Social Work, McMaster University, Hamilton, ON, Canada
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2
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Valdez C, Rodrigues R, Reid J, Anderson KK. Disparities in Access to a Regular Primary Care Physician Among First-Generation Migrants with Early Psychosis in Ontario, Canada. Community Ment Health J 2024; 60:1237-1241. [PMID: 38592350 DOI: 10.1007/s10597-024-01266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
Disparities in primary care utilization among migrants with early psychosis may be related to lack of access to a regular primary care physician. This study aimed to investigate access to a regular primary care physician among first-generation migrants with early psychosis. People aged 14-35 years with first onset non-affective psychotic disorder in Ontario, Canada were identified in health administrative data (N = 39,440). Access to a regular primary care physician through enrollment in the year prior to diagnosis was compared between first-generation migrants (categorized by country of birth) and the general population using modified Poisson regression. Most migrant groups had a lower prevalence of regular primary care physician access relative to the general population, particularly migrants from Africa (African migrants: 81% vs. non-migrants: 89%). Adjustment for sociodemographic and clinical factors attenuated these differences, although the disparities for migrants from Africa remained (PR = 0.96, 95%CI = 0.94-0.99). Interventions aimed at improving primary care physician access in migrant groups may facilitate help-seeking and improve pathways to care in early psychosis.
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Affiliation(s)
- Crystal Valdez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, ON, Canada.
- ICES Western, London, ON, Canada.
- Department of Psychiatry, Schulich School of Medicine & Dentistry, London, ON, Canada.
- Department of Epidemiology and Biostatistics, The Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, N6G 2M1, London, ON, Canada.
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3
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Cénat JM, Dromer É, Darius WP, Dalexis RD, Furyk SE, Poisson H, Mansoub Bekarkhanech F, Diao DG, Gedeon AP, Shah MS, Labelle PR, Bernheim E, Kogan CS. Incidence, Racial Disparities and Factors Related to Psychosis among Black Individuals in Canada: A Scoping Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:713-731. [PMID: 37269120 PMCID: PMC10517652 DOI: 10.1177/07067437231178957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Black communities are increasingly concerned about psychosis, a worry echoed by provincial health-care systems across Canada. Responding to the lack of evidence on psychosis in Black communities, this scoping review examined the incidence and prevalence of psychosis, access to care (pathways to care, coercive referrals, interventions, etc.), treatments received, and stigma faced by individuals with psychosis. METHOD To identify studies, a comprehensive search strategy was developed and executed in December 2021 across 10 databases, including APA PsycInfo, CINAHL, MEDLINE and Web of Science. Subject headings and keywords relating to Black communities, psychosis, health inequalities, Canada and its provinces and territories were used and combined. The scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping review (PRISMA-ScR) reporting standard. RESULTS A total of 15 studies met the inclusion criteria, all of them conducted in Ontario and Quebec. Results highlight different disparities in psychosis among Black communities. Compared to other Canadian ethnic groups, Black individuals are more likely to be diagnosed with psychosis. Black individuals with psychosis are more likely to have their first contact with health-care settings through emergency departments, to be referred by police and ambulance services, and to experience coercive referrals and interventions, and involuntary admission. Black individuals experience a lower quality of care and are the ethnic group most likely to disengage from treatment. CONCLUSION This scoping review reveals many gaps in research, prevention, promotion and intervention on psychosis in Black individuals in Canada. Future studies should explore factors related to age, gender, social and economic factors, interpersonal, institutional and systemic racism, and psychosis-related stigma. Efforts should be directed toward developing trainings for health-care professionals and promotion and prevention programs within Black communities. Culturally adapted interventions, racially disaggregated data, and increased research funding are needed.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- University of Ottawa Research Chair on Black Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Wina Paul Darius
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Hannah Poisson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Muhammad S. Shah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Emmanuelle Bernheim
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Law, Civil Law Section, University of Ottawa, Ottawa, Ontario, Canada
- Canada Research Chair on Mental Health and Access to Justice, University of Ottawa, Ottawa, Ontario, Canada
| | - Cary S. Kogan
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, Ontario, Canada
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Anderson KK, Rodrigues R. Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1329-1341. [PMID: 36922459 DOI: 10.1007/s00127-023-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission. METHODS Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009-2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted. RESULTS Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups. CONCLUSIONS First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
- ICES, London, ON, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada
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Wiener JC, Rodrigues R, Reid JNS, Archie S, Booth RG, Cheng C, Jan SH, Kurdyak P, MacDougall AG, Palaniyappan L, Ryan BL, Anderson KK. Patient and Physician Factors Associated with First Diagnosis of Non-affective Psychotic Disorder in Primary Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:212-224. [PMID: 36403173 DOI: 10.1007/s10488-022-01233-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/21/2022]
Abstract
Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.
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Affiliation(s)
- Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,Western Centre for Public Health and Family Medicine, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Suzanne Archie
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Richard G Booth
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Chiachen Cheng
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Saadia Hameed Jan
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Paul Kurdyak
- ICES, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Robarts Research Institute, Western University, London, ON, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Waxmann A, Thompson A, McGorry P, O'Donoghue B. Pathways to care for first-generation migrants with first episode psychosis in northwestern metropolitan Melbourne. Aust N Z J Psychiatry 2022; 56:1566-1575. [PMID: 35128958 DOI: 10.1177/00048674221075980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Understanding the pathways to care for migrants experiencing a first episode of psychosis is important, as they are more likely to experience longer delays to treatment and negative experiences, such as involuntary treatment. Despite the increased risk of developing a psychotic illness and barriers associated with pathways to care, there are limited studies exploring pathways to care in migrants in Australia. This study seeks to examine pathways to care for young people with a first episode of psychosis to a publicly funded youth mental health service. METHODS This study included all young people aged 15-24 years who presented with a first episode of psychosis to the Early Psychosis Prevention and Intervention Centre (EPPIC) between 1 February 2011 and 31 December 2016. Referral sources and place of birth were recorded at the time of presentation. The severity of psychotic symptoms was rated at baseline. RESULTS A total of 1220 young people presented with a first episode of psychosis during the study period, including 293 (24.5%) first-generation migrants. First-generation migrants with a first episode of psychosis were more likely to be admitted to hospital than Australian-born youth (odds ratio = 1.67, 95% confidence interval = [1.27, 2.18], p < 0.001) and this remained significant when controlled for demographic (adjusted odds ratio = 1.41, 95% confidence interval = [1.07, 1.88], p = 0.016) and clinical factors (adjusted odds ratio = 1.38,95% confidence interval = [1.01, 1.89], p = 0.044). First-generation migrants were also more likely to have an involuntary admission (odds ratio = 1.67, 95% confidence interval = [1.26, 2.21], p < 0.001) and this remained significant when controlled for demographic (adjusted odds ratio = 1.42, 95% confidence interval = [1.05, 1.91], p = 0.022) and clinical factors (adjusted odds ratio = 1.50, 95% confidence interval = [1.08, 2.09], p = 0.017). Migrants had more severe delusions (p = 0.005), bizarre behavior (p < 0.001) and positive formal thought disorder (p = 0.003) at the time of presentation. Migrants were also more likely to attend the emergency department during their presentation with first episode of psychosis (odds ratio = 1.76, 95% confidence interval = [1.31, 2.36], p < 0.001). CONCLUSION First-generation migrants who develop a psychotic disorder are at greater risk of experiencing negative pathways to care than the Australian-born population. Further research is needed to identify the factors that lead to migrants being involuntarily admitted to hospital for first episode of psychosis.
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Affiliation(s)
- Alexandra Waxmann
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Psychiatry St Vincent's University Hospital, Dublin, UK
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7
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Anderson KK, Le B, Edwards J. Comparing Risk Factors for Non-affective Psychotic Disorders With Common Mental Disorders Among Migrant Groups: A 25-Year Retrospective Cohort Study of 2 Million Migrants. Schizophr Bull 2022; 48:1011-1020. [PMID: 35243490 PMCID: PMC9434455 DOI: 10.1093/schbul/sbac021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Although migration is a well-established risk factor for psychotic disorders, less is known about factors that modify risk within migrant groups. We sought to assess whether socio-demographic, migration-related, and post-migration factors were associated with the risk of non-affective psychotic disorders (NAPD) among first-generation migrants, and to compare with estimates for common mental disorders (CMD) to explore specificity of the effect. STUDY DESIGN We constructed a retrospective cohort of first-generation migrants to Ontario, Canada using linked population-based health administrative data (1992-2011; n = 1 964 884). We identified NAPD and CMD using standardized algorithms. We used modified Poisson regression models to estimate incidence rate ratios (IRR) for each factor to assess its effect on the risk of each outcome. STUDY RESULTS Nearly 75% of cases of NAPD met the case definition for a CMD prior to the first diagnosis of psychosis. Our findings suggest that younger age at migration, male sex, being of African-origin, and not having proficiency in national languages had a specificity of effect for a higher risk of NAPD. Among migrants who were over 19 years of age at landing, higher pre-migratory education and being married/common-law at landing showed specificity of effect for a lower risk of NAPD. Migrant class, rurality of residence after landing, and post-migration neighborhood-level income showed similar effects across disorders. CONCLUSIONS Our findings help identify high-risk groups to target for intervention. Identifying factors that show specific effects for psychotic disorder, rather than mental disorders more broadly, are important for informing prevention and early intervention efforts.
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Affiliation(s)
- Kelly K Anderson
- To whom correspondence should be addressed; Department of Epidemiology & Biostatistics, The University of Western Ontario, 1465 Richmond Street, Western Centre for Public Health and Family Medicine, Room #3135, London, ON N6G 2M1, Canada; tel: 519-661-2111ext. 81001, e-mail:
| | | | - Jordan Edwards
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
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Edwards J, Chiu M, Rodrigues R, Thind A, Stranges S, Anderson KK. Examining Variations in the Prevalence of Diagnosed Mood or Anxiety Disorders Among Migrant Groups in Ontario, 1995-2015: A Population-Based, Repeated Cross-Sectional Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:130-139. [PMID: 34714183 PMCID: PMC8978215 DOI: 10.1177/07067437211047226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND International evidence on the frequency of mood or anxiety disorders among migrant groups is highly variable, as it is dependent on the time since migration and the socio-political context of the host country. Our objective was to estimate trends in the prevalence of diagnosed mood or anxiety disorders among recent (<5 years in Canada) and settled (5-10 years in Canada) migrant groups, relative to the general population of Ontario, Canada. METHODS We used a repeated cross-sectional design consisting of four cross-sections spanning 5 years each, constructed using health administrative databases from 1995 to 2015. We included all Ontario residents between the ages of 16 and 64 years. We assessed differences in the prevalence of mood or anxiety disorders adjusting for age, sex, and neighbourhood-level income. We further evaluated the impact of migrant class and region of birth. RESULTS The prevalence of mood or anxiety disorders was lower among recent (weighted mean = 4.10%; 95% confidence interval [CI], 3.59% to 4.60%) and settled (weighted mean = 4.77%; 95% CI, 3.94% to 5.61%) migrant groups, relative to the general population (weighted mean = 7.39%; 95% CI, 6.83% to 7.94%). Prevalence estimates varied greatly by region of birth and migrant class. We found variation in prevalence estimates over time, with refugee groups having the largest increases between 1995 and 2015. CONCLUSIONS Our findings highlight the complexity of mood and anxiety disorders among migrant groups, and that not all groups share the same risk profile. These results can be used to help inform health service allocation and the development of supportive programs for specific migrant groups.
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Affiliation(s)
- Jordan Edwards
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy and Evaluation, Dalla Lana School of Public Health, 274071University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London Ontario, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London Ontario, Canada.,Interfaculty Program in Public Health, The University of Western Ontario, London Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, 70384The University of Western Ontario, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, 70384The University of Western Ontario, London, Ontario, Canada.,Department of Population Health, 58942Luxembourg Institute of Health, Strassen, Luxembourg
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, The University of Western Ontario, London Ontario, Canada
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Salam Z, Odenigbo O, Newbold B, Wahoush O, Schwartz L. Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:552-574. [PMID: 35066740 DOI: 10.1007/s10488-021-01183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.
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Affiliation(s)
- Zoha Salam
- Department of Global Health, McMaster University, 1280 Main St. West MDCL 3500, Hamilton, ON, L8S 4L8, Canada.
| | - Odera Odenigbo
- School of Counselling, Psychotherapy, and Spirituality, Saint Paul University, Ottawa, Canada
| | - Bruce Newbold
- School of Earth, Environment and Society, McMaster University, Hamilton, Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Canada
| | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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10
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Garrido-Torres N, Alameda L, Cristóbal JP, Padilla MV, Robles CS, Canal-Rivero M, Crespo-Facorro B, Ruiz-Veguilla M. Examining the relationship between psychosis and immigration in Spain: The effect of cannabis use and language barrier in a large psychosis sample. J Psychiatr Res 2022; 145:361-365. [PMID: 34801256 DOI: 10.1016/j.jpsychires.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/19/2021] [Accepted: 11/02/2021] [Indexed: 11/24/2022]
Abstract
The main aim of this study is to examine the association between psychosis and immigration, independent of the language barrier, drug consumption, and the social support index. The second aim is to explore the clinical and demographic characteristics of the immigrants in the catchment area, compared with the native Spanish population suffering from psychosis. All consecutive patients admitted to a hospital in Spain during 2018 and 2019 (n = 1484) were identified through the hospital's clinical records. The general representative sample (n=1484) was divided into two groups: immigrants (n=131) and non-immigrants (n=1353). Demographic, clinical, and social variables were then obtained and included in a logistic regression model. A subsample with all consecutive cases with psychosis (93 immigrants and 543 no immigrants) was also analysed to describe the diagnosis and evolution after admission. Our results show that there is higher significant prevalence of admissions due to psychosis in the immigrant population than in the non-immigrant population. This association is prominent in the population of Sub-Saharans, and is independent of cannabis use, a low social support index, or a language barrier. Understanding the specificities not only in the social context of this population but also the clinical needs is determinant for being able to shape the therapeutic intervention.
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Affiliation(s)
- Nathalia Garrido-Torres
- University Hospital Virgen Del Rocio, Sevilla, Spain; Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain; Seville Biomedical Research Centre (IBIS), Sevilla, Spain; University of Seville, Spain
| | - Luis Alameda
- University Hospital Virgen Del Rocio, Sevilla, Spain; Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain; Seville Biomedical Research Centre (IBIS), Sevilla, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), CH-1008, Lausanne, Switzerland; University of Seville, Spain
| | | | | | | | - Manuel Canal-Rivero
- University Hospital Virgen Del Rocio, Sevilla, Spain; Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain; Seville Biomedical Research Centre (IBIS), Sevilla, Spain; University of Seville, Spain
| | - Benedicto Crespo-Facorro
- University Hospital Virgen Del Rocio, Sevilla, Spain; Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain; Seville Biomedical Research Centre (IBIS), Sevilla, Spain; University of Seville, Spain.
| | - Miguel Ruiz-Veguilla
- University Hospital Virgen Del Rocio, Sevilla, Spain; Spanish Network for Research in Mental Health (CIBERSAM), Sevilla, Spain; Seville Biomedical Research Centre (IBIS), Sevilla, Spain; University of Seville, Spain
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Knight S, Jarvis GE, Ryder AG, Lashley M, Rousseau C. Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis. Psychiatr Serv 2022; 73:2-8. [PMID: 34253035 DOI: 10.1176/appi.ps.202000715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Using a retrospective sample, the authors sought to determine whether Black patients with first-episode psychosis (FEP) in Canada were at a higher risk for coercive referral and coercive intervention than non-Black patients with FEP. METHODS Retrospective data from patients referred to an FEP program in 2008-2018 were collected via chart review (N=208). The authors used chi-square and logistic regression analyses to explore the relationships among race-ethnicity, diagnosis of psychosis, and coercive referral and intervention. RESULTS Results showed that Black persons of Caribbean or African descent with FEP were significantly more likely to be coercively referred (χ2=9.24, df=2, p=0.010) and coercively treated (χ2=9.21, df=2, p=0.010) than were non-Black individuals with FEP. Age and violent or threatening behavior were predictors of coercive referral. Ethnoracial status, age, and violent or threatening behavior were predictors of coercive intervention. CONCLUSIONS This study contributes to the dearth of research on Black Canadians and offers insight into factors that may place patients with FEP at risk for coercive treatment. More research is needed to explore the role that ethnoracial status may play in hospital admissions and to uncover the role of racial prejudices in the assessment of danger.
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Affiliation(s)
- Sommer Knight
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - G Eric Jarvis
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Andrew G Ryder
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Myrna Lashley
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
| | - Cécile Rousseau
- Department of Social and Transcultural Psychiatry, Faculty of Medicine, McGill University, Montreal (all authors); First Episode Psychosis Program (FEPP), Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal (Jarvis); Department of Psychology, Faculty of Arts and Science, Concordia University, Montreal (Ryder)
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12
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Hollander AC, Mackay E, Sjöqvist H, Kirkbride JB, Bäärnhielm S, Dalman C. Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5 150 753 people. BMJ Glob Health 2021; 5:bmjgh-2020-002471. [PMID: 32972966 PMCID: PMC7517566 DOI: 10.1136/bmjgh-2020-002471] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background To investigate differences in psychiatric care use over time between Swedish born and those born abroad who migrate to Sweden. Methods Population-based cohort study analysing linked population and health registers, following individuals born 1944–1990 from 1 January 2005 to 31 December 2016. Time-stratified survival analysis using Cox regression estimated time to psychiatric care use. Population included 5 150 753 individuals with 78.1% Swedish born. Migrant status was coded as Swedish born or migrant. Migrants were grouped by year of immigration and region of origin. The main outcome: psychiatric care use, defined as any psychiatric care; psychiatric inpatient or outpatient care; or use of psychotropics. Results Migrants arriving before 2005 had a higher use of any psychiatric care relative to Swedish born but migrants arriving 2005 onwards had lower use. Migrants from sub-Saharan Africa and Asia had a lower use of any psychiatric care during the first decade in Sweden whereas migrants from Middle East and North Africa had a higher use, driven by use of psychotropics. Conclusions The lower use of psychiatric care during the first decade contrasts with higher use among migrants with a longer duration of stay. Psychiatric care use among migrants should be analysed multi-dimensionally, taking duration of stay, region of origin and type of care into account.
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Affiliation(s)
| | - Euan Mackay
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofie Bäärnhielm
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Transkulturellt Centrum, Stockholm Region, Stockholm, Sweden
| | - Christina Dalman
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centrum för epidemiologi och samhällsmedicin, Stockholm Region, Stockholm, Sweden
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13
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Ai AL, Appel HB, Lee J, Fincham F. Family Factors Related to Three Major Mental Health Issues Among Asian-Americans Nationwide. J Behav Health Serv Res 2021; 49:4-21. [PMID: 34097207 DOI: 10.1007/s11414-021-09760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/25/2022]
Abstract
Asian-Americans (AAs) constitute the fastest growing minority group in the USA. AAs share a common emphasis on collective cultural strengths, especially family values. Using the National Latino and Asian American Study (NLAAS) data, this study investigated the roles of family cohesiveness, along with other cultural strength factors and negative family interactions in three psychiatric disorders. Supporting the study's hypotheses, multivariate analyses showed that family cohesiveness was associated with a lower incidence of general anxiety disorder (GAD), while regular religious attendance was linked with a lower likelihood of having substance use disorder (SUD). Conversely, negative family interactions increased the likelihood of experiencing major depression disorder (MDD) and SUD. Whereas perceived discrimination was related to higher odds of all diagnoses, family cohesiveness moderated the relationship between discrimination and GAD. These findings suggest that family relationships play a critical role in AAs' mental health and should be further explored through a prospective design.
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Affiliation(s)
- Amy L Ai
- Colleges of Social Work, Medicine, and Nursing, Florida State University, 2570 University Building C, Tallahassee, FL, 32306, USA.
| | - Hoa B Appel
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, 98011, USA
| | - Jungup Lee
- Department of Sociall Work, National University of Singapore, Singapore, 117570, Singapore
| | - Frank Fincham
- Colleges of Family Sciences, Florida State University, Tallahassee, FL, 32306, USA
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14
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Heun-Johnson H, Menchine M, Axeen S, Lung K, Claudius I, Wright T, Seabury SA. Association Between Race/Ethnicity and Disparities in Health Care Use Before First-Episode Psychosis Among Privately Insured Young Patients. JAMA Psychiatry 2021; 78:311-319. [PMID: 33355626 PMCID: PMC7758828 DOI: 10.1001/jamapsychiatry.2020.3995] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Racial/ethnic disparities in health care use and clinical outcomes for behavioral health disorders, including psychosis, are well documented, but less is known about these disparities during the period leading up to first-episode psychosis (FEP). OBJECTIVE To describe the racial/ethnic disparities in behavioral health care use and prescription drug use of children and young adults before the diagnosis of FEP. DESIGN, SETTING, AND PARTICIPANTS An observational cohort study was conducted using medical and prescription drug claims from January 1, 2007, to September 30, 2015, obtained from Optum's deidentified Clinformatics Data Mart Database, a commercial claims database augmented with race/ethnicity and socioeconomic variables. Data analysis was performed from February 6, 2018, to October 10, 2020. First-episode psychosis was determined by the presence of psychosis diagnoses on claims for at least 1 hospitalization or 2 outpatient events, with a continuous enrollment requirement of at least 2 years before the first diagnosis. Participants included 3017 Black, Hispanic, or White patients who were continually enrolled in commercial insurance plans and received an FEP diagnosis between the ages of 10 and 21 years. MAIN OUTCOMES AND MEASURES Race/ethnicity was determined from a commercial claims database. Rates of inpatient admission, emergency department presentation, and outpatient visits (including psychotherapy), behavioral health disorder diagnoses, and antipsychotic/antidepressant prescription fills were determined for the year before FEP. Race/ethnicity was also obtained from Optum's claims database. With use of multivariable logistic regression, results were adjusted for covariates including estimated household income, age, sex, and geographic division in the US. RESULTS Of the 3017 patients with FEP, 643 Black or Hispanic patients (343 [53.3%] Black, 300 [46.7%] Hispanic, 324 [50.4%] male, mean [SD] age, 17.2 [2.76] years) were less likely than 2374 White patients (1210 [51.0%] male, mean age, 17.0 [2.72] years) to receive comorbid behavioral health disorder diagnoses in the year before the diagnosis of FEP (410 [63.8%] vs 1806 [76.1%], χ2 = 39.3; P < .001). Except for emergency care, behavioral health care use rates were lower in Black and Hispanic patients vs White patients (424 [65.9%] vs 1868 [78.7%]; χ2 = 45.0; P < .001), particularly for outpatient visits with behavioral health care professionals (232 [36.1%] vs 1236 [52.1%]; χ2 = 51.7; P < .001). After adjustment for socioeconomic covariates, behavioral health care use rates (68.9% vs 79.2%; P < .001), outpatient visits with behavioral health professionals (37.7% vs 51.2%; P < .001), and other outcomes remained significantly lower for Black and Hispanic patients vs White patients. CONCLUSIONS AND RELEVANCE The results of this study extend existing research findings of well-known racial/ethnic disparities in the population of patients who are diagnosed with FEP. These differences were apparent in young patients with continuous commercial health insurance and after controlling for household income. Providing equal access to preventive outpatient behavioral health care may increase opportunities for timely detection of psychotic symptoms and early intervention and improve differential outcomes after FEP.
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Affiliation(s)
- Hanke Heun-Johnson
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Michael Menchine
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sarah Axeen
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Khristina Lung
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Sol Price School of Public Policy, University of Southern California, Los Angeles
| | - Ilene Claudius
- Department of Emergency Medicine, David Geffen School of Medicine, University of California Los Angeles
| | - Tyler Wright
- LAC+USC Medical Center, Los Angeles, California,University of Southern California, Los Angeles
| | - Seth A. Seabury
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles,Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles
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15
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Mahajan S, Meyer SB, Neiterman E. Identifying the impact of social networks on mental and emotional health seeking behaviours amongst women who are refugees from Syria living in Canada. Glob Public Health 2021; 17:700-716. [PMID: 33460363 DOI: 10.1080/17441692.2021.1872679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Between 2015 and 2017, over 24,000 Syrian women came to Canada as refugees. Refugees are two to three times more likely than native Canadians to suffer from depression and other mental health challenges. A qualitative approach was taken to understand roles of social networks in shaping the mental and emotional health resource-seeking behaviours of twelve Syrian women who are refugees. Semi-structured telephone interviews were conducted in both English and Arabic. Interviews were audio-recorded, transcribed, and thematically coded using NVivo 12. Findings reveal that (1) families play large roles in teaching and providing information about Canada's health system, including mental health services; (2) Social networks influence assumptions about mental and physical health services; (3) women feel more welcomed into social networks in Canada than in countries of first asylum; and (4) social networks act as alternatives to seeking formal mental and emotional health care. Through first-hand stories and experiences of Syrian women's transitions into Canada, this study identifies the ways in which social networks may help or hinder engagement with mental and emotional health services.
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Affiliation(s)
- Shreya Mahajan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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16
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Rodrigues R, Beswick A, Anderson KK. Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data. Early Interv Psychiatry 2020; 14:235-240. [PMID: 31696672 DOI: 10.1111/eip.12893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/18/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
AIM There is limited evidence examining admissions in early psychosis. We sought to estimate the proportion of people with a psychiatric admission within 2 years of the first diagnosis of psychosis, and to identify associated risk factors. METHOD We constructed a cohort of incident non-affective psychosis cases using health administrative data and identified the first psychiatric hospitalization after psychosis onset. We compared hospitalization rates across sociodemographic, clinical and service-use factors. RESULTS One in three patients had an admission within 2 years of first diagnosis. Younger age, migrant status, diagnosis of psychosis not otherwise specified, and prior substance use were associated with increased hospitalization rates, whereas family physician involvement in diagnosis was protective. CONCLUSIONS Adolescents, immigrants and people presenting with diagnostic instability or prior substance use issues may benefit from interventions aimed at reducing hospitalization risk. Increasing primary care access and utilization among youth with early psychosis may also reduce hospitalization rates.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adam Beswick
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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17
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Risk of involuntary admission among first-generation ethnic minority groups with early psychosis: a retrospective cohort study using health administrative data. Epidemiol Psychiatr Sci 2019; 29:e59. [PMID: 31610825 PMCID: PMC8061249 DOI: 10.1017/s2045796019000556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS Ethnic minority groups often have more complex and aversive pathways to mental health care. However, large population-based studies are lacking, particularly regarding involuntary hospitalisation. We sought to examine the risk of involuntary admission among first-generation ethnic minority groups with early psychosis in Ontario, Canada. METHODS Using health administrative data, we constructed a retrospective cohort (2009-2013) of people with first-onset non-affective psychotic disorder aged 16-35 years. This cohort was linked to immigration data to ascertain migrant status and country of birth. We identified the first involuntary admission within 2 years and compared the risk of involuntary admission for first-generation migrant groups to the general population. To control for the role of migrant status, we restricted the sample to first-generation migrants and examined differences by country of birth, comparing risk of involuntary admission among ethnic minority groups to a European reference. We further explored the role of migrant class by adjusting for immigrant vs refugee status within the migrant cohort. We also explored effect modification of migrant class by ethnic minority group. RESULTS We identified 15 844 incident cases of psychotic disorder, of whom 19% (n = 3049) were first-generation migrants. Risk of involuntary admission was higher than the general population in five of seven ethnic minority groups. African and Caribbean migrants had the highest risk of involuntary admission (African: risk ratio (RR) = 1.52, 95% CI = 1.34-1.73; Caribbean: RR = 1.58, 95% CI = 1.37-1.82), and were the only groups where the elevated risk persisted when compared to the European reference group within the migrant cohort (African: RR = 1.24, 95% CI = 1.04-1.48; Caribbean: RR = 1.29, 95% CI = 1.07-1.56). Refugee status was independently associated with involuntary admission (RR = 1.16, 95% CI = 1.02-1.32); however, this risk varied by ethnic minority group, with Caribbean refugees having an elevated risk of involuntary admission compared with Caribbean immigrants (RR = 1.72, 95% CI = 1.15-2.58). CONCLUSIONS Our findings are consistent with the international literature showing increased rates of involuntary admission among some ethnic minority groups with early psychosis. Interventions aimed at improving pathways to care could be targeted at these groups to reduce disparities.
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18
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Rodrigues R, MacDougall AG, Zou G, Lebenbaum M, Kurdyak P, Li L, Shariff SZ, Anderson KK. Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data. Schizophr Res 2019; 208:276-284. [PMID: 30728106 DOI: 10.1016/j.schres.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Paul Kurdyak
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lihua Li
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Institute for Clinical Evaluate Sciences, Toronto, ON, Canada.
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19
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Bosqui T, Väänänen A, Koskinen A, Buscariolli A, O’reilly D, Airila A, Toivanen M, Kouvonen A. Antipsychotic medication use among working-age first-generation migrants resident in Finland: An administrative data linkage study. Scand J Public Health 2019; 48:64-71. [DOI: 10.1177/1403494819841960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Higher incidence of psychotic disorders in high-income countries for migrants compared with the settled majority has been well established. However, it is less clear to what extent different migrants groups have accessed and utilised mental health care. This study aimed to identify the hazard of antipsychotic medication use in the largest migrant groups in Finland, compared with a Finnish-born comparison group, using high quality datasets maintained by Statistics Finland and Social Insurance Institution Finland, and linking socio-demographic and -economic characteristics to antipsychotic prescription purchases. Methods: The study draws on a representative sample of 33% of the adult working-age population of Finland in 2005 ( n = 1,059,426, 50.2% male, 2.5% migrant). The use of antipsychotic drugs was followed-up from 2005 to 2014. Results: The results show that the hazard of antipsychotic medication purchases differed between migrant groups, with a higher hazard for migrants from North Africa and the Middle East before socio-economic adjustment (men HR 1.19, 95% CI 1.04–1.37; women HR 1.37, 95% CI 1.12–1.66), and a lower hazard for all migrant groups after adjustment for socio-economic characteristics compared with the Finland-born population. Conclusions: The findings suggest that attention should be paid to the lower use of medication for psychotic disorders in some migrant groups, as well as the potential role of social disadvantage for migrants from North Africa and Middle East.
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Affiliation(s)
- Tania Bosqui
- Department of Psychology, American University of Beirut, Lebanon
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, UK
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Finland
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Finland
| | - André Buscariolli
- Finnish Institute of Occupational Health, Finland
- Faculty of Social Sciences, University of Helsinki, Finland
| | - Dermot O’reilly
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, UK
- UKCRC Centre of Excellence for Public Health (Northern Ireland), Queen’s University Belfast, UK
| | - Auli Airila
- Finnish Institute of Occupational Health, Finland
| | | | - Anne Kouvonen
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, UK
- Faculty of Social Sciences, University of Helsinki, Finland
- SWPS University of Social Sciences and Humanities in Wroclaw, Poland
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20
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Kline E, Thomas L. Cultural factors in first episode psychosis treatment engagement. Schizophr Res 2018; 195:74-75. [PMID: 28864280 DOI: 10.1016/j.schres.2017.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
Abstract
Specialized First Episode Psychosis (FEP) services have been conceptualized in part around the issue of engagement. Creating treatment that is easier to access, with more frequent contacts, assertive outreach to clients between appointments, and an explicit youth-oriented culture could make services more attractive to those most in need of care. However, engagement has remained a mostly fuzzy, peripheral construct rather than the object of study in itself. As we recognize the importance of treatment engagement, we must prepare to address it more rigorously within psychosis and schizophrenia research. At the same time, factors enhancing or obstructing treatment engagement are inevitably local, rather than universal. The availability of care, its associated costs and stigmas, individuals' motivations for seeking treatment, and their beliefs and expectations about providers' roles are determined by local and cultural features. There can be no singular "best practice" for engagement - but curiosity about how culture and locale influence clients' willingness to participate in care, and creativity in how we account for and incorporate these variables into study designs, will help to shed light on the critical issue of engagement in FEP treatment.
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Affiliation(s)
- Emily Kline
- Harvard Medical School, Department of Psychiatry, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center, USA.
| | - Latoya Thomas
- Department of Psychiatry, Beth Israel Deaconess Medical Center, USA
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21
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Anderson KK. Ethnic differences in physician follow-up after a first diagnosis of psychotic disorder. Schizophr Res 2018; 193:463-464. [PMID: 28709775 DOI: 10.1016/j.schres.2017.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Denstistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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