UBC Theses and Dissertations
Incidence of non-affective psychotic disorders and access to psychiatric care among adolescents in South-Western British Columbia Magee, Carly Elizabeth
Objectives: Estimate (1) diagnosed incidence of non-affective psychotic disorders (NAP) over adolescence (2) the distribution of risk in the population (3) the level of psychiatric service use and (4) predictors of psychiatric service use following a first diagnosis of NAP among adolescents in British Columbia (BC). Study 1: I used linked administrative data (e.g. hospitalization, physician visit, and immigration records) to estimate the incidence of NAP over adolescence and variation in risk by age, sex, family and neighbourhood income, migration background, parent mental health, and birth year. Study 2. I used the same data to estimate relative risk of adolescent-onset NAP by migrant generation and region of origin adjusting for class of entry into Canada, birth year, low family income and neighbourhood income. Study 3. I examined psychiatric service use (time to psychiatry follow up visit, antipsychotic prescription, hospitalization, rate of psychiatry visits and odds of service gap) following a first diagnosis of NAP among adolescents in BC, and clinical and demographic (migration background, family and neighbourhood income, sex, age) predictors of psychiatric service use. Findings: 0.64% of females and 0.88% of males were diagnosed with a NAP between age 13-19. Incidence increased over the age range, especially among males. Low family income, lower neighbourhood income, parent mental health contact history, and later birth year were associated with higher risk of diagnosis, whereas immigrant adolescents had lower risk of diagnosis compared to non-immigrant adolescents. In study 2 I found that first-generation migrants from East, South and Southeast Asia and second-generation migrants from East and South Asia exhibited lower risk of diagnosed NAP over adolescence compared to non-migrants. In study 3 I found that half of outpatient cases and one third of inpatient cases did not access psychiatry follow up within 30 days of index, and a majority experienced gaps of more than 90 days between psychiatry visits. Moreover, I identified clinical and demographic predictors of psychiatric service use.
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