Disparities in access to early psychosis intervention services: comparison of service users and non-users in health administrative data

Objective —There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of non-affective psychosis that do not access these services and to examine factors associated with EPI admission.

Methods — Using health administrative data, we constructed a retrospective cohort of incident cases of non-affective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI-users. We used multivariate logistic regression to model socio-demographic and service factors associated with EPI admission.

Results — Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI-users were significantly younger, more likely to be male (OR 1.58, 95% CI 1.24 – 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51, 95% CI 0.36 – 0.73). EPI-users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35, 95% CI 5.43 – 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50, 95% CI 0.38 – 0.65), and had lower odds of prior alcohol-related (OR 0.42, 95% CI 0.28 – 0.63) and substance-related (OR 0.68, 95% CI 0.50 – 0.93) disorders.

Conclusions — We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services – our findings suggest that this group is sizable, and there may be socio-demographic and clinical disparities in access. Non-psychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.