{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T03:20:07Z","timestamp":1778728807331,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2016,5,9]],"date-time":"2016-05-09T00:00:00Z","timestamp":1462752000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 ( N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0706743716644764","type":"journal-article","created":{"date-parts":[[2016,5,9]],"date-time":"2016-05-09T20:12:43Z","timestamp":1462824763000},"page":"358-366","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario"],"prefix":"10.1177","volume":"61","author":[{"given":"Jennifer M.","family":"Hensel","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Women\u2019s College Hospital, Toronto, Ontario"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario"},{"name":"Women\u2019s College Research Institute, Toronto, Ontario"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie H.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Women\u2019s College Hospital, Toronto, Ontario"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario"},{"name":"Women\u2019s College Research Institute, Toronto, Ontario"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kinwah","family":"Fung","sequence":"additional","affiliation":[{"name":"Women\u2019s College Research Institute, Toronto, Ontario"},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone N.","family":"Vigod","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Women\u2019s College Hospital, Toronto, Ontario"},{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario"},{"name":"Women\u2019s College Research Institute, Toronto, Ontario"},{"name":"Institute for Clinical Evaluative Sciences, Toronto, Ontario"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,5,9]]},"reference":[{"key":"bibr1-0706743716644764","unstructured":"World Health Statistics 2014, part III: global health indicators [Internet]. 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