PATTERNS OF HEALTH CARE UTILIZATION BEFORE FIRST EPISODE PSYCHOSIS IN RACIAL AND ETHNIC GROUPS

Objective: To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients. Design: The study was a retrospective observational design. Settings: The study was conducted in five health care systems in the western United States. All sites were also part of the National Institute of Mental Health-funded Mental Health Research Network (MHRN). Participants: Patients (n = 852) were aged 15 - 59 years (average 26.9 +/- 12.2 years), 45% women, and primarily non-Hispanic White (53%), with 16% Hispanic, 10% non-Hispanic Black, 6% Asian, 1% Native Hawaiian/Pacific Islander, 1% Native American/Alaskan Native, and 12% unknown race/ethnicity. Methods: Data abstracted from electronic medical records and insurance claims data were organized into a research virtual data warehouse (VDW) and used for analysis. Main Outcome Measures: Variables examined were patterns of health care utilization, type of comorbid mental health condition, and type of treatment received in the three years before first presentation of psychosis. Results: Compared with non-Hispanic Whites, Asian patients (16% vs 34%; P=.007) and non-Hispanic Black patients (20% vs 34%; P=.009) were less likely to have a visit with specialty mental health care before their first presentation of psychosis. Conclusions: Early detection of first episode psychosis should start with wider screening for symptoms outside of any indicators for mental health conditions for non-Hispanic Black and Asian patients.