Care of Youth in Their First Emergency Presentation for Psychotic Disorder: A Population-Based Retrospective Cohort Study

Objective: Emergency departments (EDs) are often the first point of care for youth with psychotic disorders; however, the care and aftercare they receive have not been well described. The aim of this study was to examine care and aftercare following first ED visit for psychotic disorder among youth.

Methods: We conducted a population-based retrospective cohort study of first ED presentations for psychotic disorder among youth 16 to 24 years old (N = 2,875) in Ontario, Canada. The youth were diagnosed with a psychotic disorder according to ICD-10 coding. We captured all first visits for psychotic disorder between April 2010 and March 2013. Our primary outcome was rate of outpatient mental health care within 30 days. We also examined factors associated with timely psychiatric aftercare, rates of outpatient mental health follow-up by provider type, ED revisit, and psychiatric admission within 30 days and 1 year.

Results: Forty percent of youth discharged to the community from their first ED presentation for psychotic disorder received no outpatient mental health care within 30 days. Factors associated with psychiatric aftercare included higher neighborhood income (income quintile 5 vs 1, hazard ratio [HR] = 1.48; 95% CI, 1.05-2.09; P = .026), rural residence (HR = 0.46; 95% CI, 0.31-0.70; P < .001), and mental health care in the 1 year before presentation (outpatient psychiatrist visit: HR = 1.89; 95% CI, 1.50-2.37; P < .001; psychiatric admission: HR = 0.71; 95% CI, 0.52-0.98; P = .038).

Conclusions: Many youth do not receive timely follow-up after their first ED visit for psychotic disorder. There is an urgent need to improve service access for this vulnerable population.