Regional and sociodemographic variation of incident first-episode psychosis in Ontario, Canada

Introduction — Psychotic disorders are associated with high levels of disability and poor clinical outcomes but little is known about the regional incidence of psychosis in Ontario.

Objective — This study aimed to understand regional incidence variation and demographic and regional characteristics of individuals who may be suitable for receiving early psychosis intervention (EPI) services, as well as evaluate post-diagnosis healthcare utilisation.

Methods — A population-based retrospective cohort study captured incident affective and non-affective psychosis cases among Ontario, Canada residents aged 12-50 from 2017-2021. The sociodemographic characteristics of the cohort were described, including Ontario Health region of residence. Incident cases were followed for 6-months post-diagnosis to capture health service utilisation. Logistic regression was used to model post-diagnosis hospitalisations and Poisson regression to model outpatient psychiatrist visits.

Results — The cohort contained 44,188 individuals (41,257 non-affective psychosis; 3,058 affective psychosis). We observed substantial regional variation in incidence rates, which were higher in the North Western region for non-affective psychosis (167.44/100,000) and North Eastern region for affective psychosis (14.23/100,000) compared to the provincial average (92.24; 6.84/100,000, respectively). Compared to the Toronto region, post-diagnosis hospitalisations were significantly higher in the North East (non-affective psychosis aOR 1.14, 95%CI 1.01-1.30; affective psychosis aOR 1.69, 95%CI 1.13-2.54). Among those with non-affective psychosis, outpatient psychiatrist visits were significantly lower in all regions compared to Toronto (e.g., East aRR 0.61, 95%CI 0.60-0.62; North West aRR 0.34, 95%CI 0.32-0.36).

Conclusions — There is considerable regional variation in incident psychosis and inverse relationships between hospitalisations and outpatient care. To successfully plan for future EPI programs in Ontario, it is essential to understand regional needs using a systematic, population-based approach.