{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T03:34:34Z","timestamp":1790307274382,"version":"4.1.0"},"reference-count":41,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006373","name":"Ohio Department of Mental Health and Addiction Services","doi-asserted-by":"publisher","award":["2500161"],"award-info":[{"award-number":["2500161"]}],"id":[{"id":"10.13039\/100006373","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,12]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Understanding drivers of high healthcare utilisation costs among individuals experiencing first-episode psychosis (FEP) is essential for improving care in those with psychotic disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterise and compare patient-level factors and longitudinal healthcare utilisation costs across 3 years in FEP high-cost (HC) versus non-high-cost (NHC) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Commercial US insurance claims data from 2013 to 2019 were used to identify HC and NHC patients with FEP. HC were patients accounting for \u226550% of total direct healthcare expenditures within the FEP cohort. Binomial logistic regression was used to identify patient-level factors associated with the HC group. Total healthcare costs and service modalities, including inpatient, outpatient, emergency and prescription drugs, were compared between HC and NHC across time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 27 587 patients with FEP, 12% were HC with higher rates of multiple psychotic disorder diagnoses (p&lt;0.001), chronic medical conditions (p&lt;0.001) and exposure to adverse social determinants of health (p&lt;0.01), particularly for economic category (p&lt;0.001), with vitamin deficiency listed as the highest frequency. Cost analysis revealed a positive relationship between psychosis- and non-psychosis-related conditions, with HC having increased inpatient use for both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Factors associated with being HC in this nationally representative private-payer FEP population were behavioural diagnostic instability, comorbid mental and physical health conditions, and exposure to adverse social factors, including nutritional deficiency. Additionally, psychosis and non-psychosis-related costs stabilise within 2 years. These findings may be important in identifying individuals who may benefit from additional, more intensive services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108031","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:30:49Z","timestamp":1777480249000},"page":"e108031","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Factors associated with high-cost patients with first-episode psychosis: a retrospective study of direct healthcare costs using US private-payer claims data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1749-2588","authenticated-orcid":false,"given":"Srinivasan","family":"Sridhar","sequence":"first","affiliation":[{"name":"Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A","family":"Hasenstab","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Lochotzki","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki L","family":"Montesano","sequence":"additional","affiliation":[{"name":"The Ohio Department of Behavioral Health, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Ramos","sequence":"additional","affiliation":[{"name":"The Ohio Department of Behavioral Health, Columbus, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tory","family":"Hogan","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L","family":"Hefner","sequence":"additional","affiliation":[{"name":"The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas JK","family":"Breitborde","sequence":"additional","affiliation":[{"name":"Early Psychosis Intervention Center (EPICENTER), Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E","family":"Seiber","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes and Policy Evaluation Studies, The Ohio State University College of Public Health, Columbus, Ohio, USA"},{"name":"The Ohio State University College of Public Health, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"2026042909301248000_16.4.e108031.1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1212\/01.CON.0000466662.89908.e7","article-title":"Psychosis","volume":"21","author":"Arciniegas","year":"2015","journal-title":"Continuum (Minneap Minn)"},{"key":"2026042909301248000_16.4.e108031.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7893.2009.00148.x"},{"key":"2026042909301248000_16.4.e108031.3","doi-asserted-by":"crossref","first-page":"43278","DOI":"10.4088\/JCP.22m14458","article-title":"The Economic Burden of Schizophrenia in the United States","volume":"83","author":"Kadakia","year":"2022","journal-title":"J Clin Psychiatry"},{"key":"2026042909301248000_16.4.e108031.4","doi-asserted-by":"publisher","DOI":"10.1177\/070674379704200105"},{"key":"2026042909301248000_16.4.e108031.5","unstructured":"Davenport S , Gray TJ , Melek S . 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