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Objective: We recently found that the risk of diagnosed non-affective psychotic disorder between the ages of 13 and 19 was lower for immigrant adolescents compared to those without a personal or parental migration history in British Columbia (BC), Canada. In the current study, we further examined the risk for migrants compared to non-migrants by region of origin and immigrant generation (first vs. second), adjusting for several demographic factors and migration class., Methods: Administrative data were used to construct a cohort of individuals born 1990-98 and residing in South-Western BC ( N  = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits with a primary diagnosis of a non-affective psychotic disorder. Poisson regression was used to estimate incidence rate ratios (IRR) of a diagnosed non-affective psychotic disorder by region of origin among first- and second-generation migrants compared to non-migrants, adjusting for sex, birth year, neighbourhood income and low family income., Results: Risk of diagnosed non-affective psychotic disorder was lower among first-generation migrants from East Asia (IRR = 0.34[95% CI: 0.25-0.46]), South-Asia (IRR = 0.47[95% CI: 0.25-0.89]) and South-East Asia (IRR = 0.55[95% CI: 0.32-0.93]) and second-generation migrants from East Asia (IRR = 0.49[95% CI: 0.35-0.69]) and South Asia (IRR = 0.52[95% CI: 0.37-0.73]), compared to non-migrants. Adjusting for migration class attenuated but did not fully explain variation in risk by region among first-generation migrants. No groups exhibited a significantly elevated risk of the diagnosed non-affective psychotic disorder compared to non-migrants., Conclusion: Findings from this study underline the complexity of the association between migration and psychotic disorders. Future research should investigate why certain groups of migrants are less likely to be diagnosed and whether there are specific sub-groups that face an elevated risk.

Objectives: To estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year., Methods: Linked individual-level administrative data were used to construct a cohort of individuals born in 1990-1998 and residing in South-Western BC ( n  = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20-29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period., Results: We found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants., Conclusions: Findings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.

Objective: To examine the association between usual place of primary care and mental health consultation among those with self-reported mood or anxiety disorders. We also describe access to mental health services among people who are recent immigrants, longer-term immigrants, and nonimmigrants and determine whether the association with place of primary care differs by immigration group., Methods: We used data from the Canadian Community Health Survey (2015 to 2016) to identify a representative sample of individuals with self-reported mood or anxiety disorders. We used logistic regression, with models stratified by immigration group (recent, longer-term, nonimmigrant), to examine the association between usual place of primary care and receiving a mental health consultation in the previous 12 months., Results: Higher percentages of recent and longer-term immigrants see a doctor in solo practice, and a higher percentage of recent immigrants use walk-in clinics as a usual place of care. Compared with people whose usual place of care was a community health center or interdisciplinary team, adjusted odds of a mental health consultation were significantly lower for people whose usual place of care was a solo practice doctor's office (AOR = 0.71; 95% CI, 0.62 to 0.82), a walk-in clinic (AOR = 0.75; 95% CI, 0.66 to 0.85), outpatient clinic/other place (AOR = 0.72 95% CI, 0.59 to 0.88), and lowest among people reporting no usual place other than the emergency room (AOR = 0.59; 95% CI, 0.51 to 0.67). Differences in access to mental health consultations by usual place of primary care were greatest among immigrants, especially recent immigrants., Conclusions: People with mood or anxiety disorders who have access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Expanded access to team-based primary health care may help reduce barriers to mental health services, especially among immigrants.

Objective: To examine the essential and potentially inappropriate use of antipsychotics across income groups., Method: Linked health, pharmaceutical use, and income data from British Columbia were analyzed to examine antipsychotic use in 2 study cohorts. In the first cohort, the essential use of antipsychotics was assessed among adults who had a recorded diagnosis of schizophrenia in a 2-year period, 2004-2005. In the second cohort, potentially inappropriate use of antipsychotics was examined in people with no recorded diagnosis of schizophrenia or bipolar disorders in 2004-2005. The second cohort was also composed exclusively of seniors with a dementia-related diagnosis who are either in long-term care or living in the community. Income-related differences in antipsychotic use in these 2 cohorts were assessed using logistic regression, controlling for health and sociodemographic characteristics known to influence medicine use., Results: Among adults, the prevalence of essential antipsychotic use was high (85%), with higher odds of use evident among those in the middle-income group. Among seniors, the prevalence of potentially inappropriate antipsychotic treatment is 23%, with prevalence higher in long-term care (56%) than in the community (13%). No income-related differences were found in long-term care; however, in the community, higher odds of use were found in low-income seniors., Conclusion: People from low-income households have slightly lower levels of essential antipsychotic use and are more likely to receive potentially inappropriate antipsychotic treatment.