{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:47:17Z","timestamp":1788317237922,"version":"build-2803163510"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"Importance<\/jats:title>Characterizing 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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine mental health service use and diagnostic trajectories before first diagnosis of psychotic disorder and identify utilization and diagnostic patterns.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This 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 2018 to November 2019.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcomes were rates, timing, and setting of mental health\u2013related 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.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 10\u202f501 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\u2013related 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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This 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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2024.1467","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T15:19:06Z","timestamp":1718723946000},"page":"928","source":"Crossref","is-referenced-by-count":10,"title":["Mental Health Service Use Before First Diagnosis of a Psychotic Disorder"],"prefix":"10.1001","volume":"81","author":[{"given":"Wanda","family":"Tempelaar","sequence":"first","affiliation":[{"name":"Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada"},{"name":"Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Child and Adolescent 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