Suchergebnisse

IntroductionSurveys and registers have provided important insights into the mental health of the community. However, both sources have strengths and limitations. While participation in surveys has been shown to be lower among those with mental disorders, misclassification and limited information on confounders are typical issues for registers.
ObjectivesTo examine if participants of the Central Denmark Region's 2017 How are you? survey were representative of the general population in terms of mental disorder diagnoses.
MethodsBy linking data from the Central Denmark Region's 2017 How are you? survey with the Danish national registers, we compared the frequency of mental disorder diagnoses among (a) participants in the survey (n = 32,417), before and after applying non-response weights, and (b) the entire population who were eligible to participate (n = 1,063,082; 16 years of age or older on 10th January 2017 and registered as living in the Central Denmark Region). Using logistic regression models, we estimated associations between being diagnosed with any mental disorder and nine general medical conditions to assess whether selection into the survey appeared to bias these associations.
ResultsBased on register data, 10.4% (n = 110,492) of the eligible population had received a diagnosis of any mental disorder prior to the date of this survey. Among the unweighted survey sample, 8.2% (n = 2,648) had received a diagnosis; once non-response weights were applied, this corresponded to 9.5%. Representativeness varied by sex, age and type of mental disorder. For example, people with organic disorders or substance use disorders were generally underrepresented among survey participants of all ages; however, representativeness of common disorders such as mood or neurotic disorders was generally good. With respect to the association of any mental disorder and general medical conditions, we found that estimates were similar for survey samples (both weighted and unweighted) compared to the entire eligible population.
ConclusionsPeople with a previous diagnosis of a mental disorder are slightly underrepresented in the survey. However, this selection bias was minimized when non-response weights were applied. Associations between mental disorders and general medical conditions did not appear to be affected by selection bias. With the application of non-response weights, the survey provided a sample representative of the general population in terms of mental disorder diagnoses.

IntroductionKnowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting emergency departments (EDs) for mental health or substance use concerns in Ontario, Canada is lacking.
ObjectivesUsing data from a population-based survey linked at the individual level to administrative health data, this study leverages a provincially representative sample and quasi-experimental design to strengthen inferences regarding the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit.
Methods9,301 children aged 4-17 years participating in the 2014 Ontario Child Health Study were linked retrospectively (6 months) and prospectively (12 months) with administrative health data on ED visits from the National Ambulatory Care Reporting System. Modified Poisson regression was used to examine correlates of mental health and substance use related ED visits among children aged 4-17 years over a 12-month period following their survey completion date, adjusting for ED visits in the 6 months prior to their survey completion date. Subgroup analyses of youths aged 14-17 years who independently completed survey content related to peer victimisation, substance use, and suicidality were also conducted.
ResultsAmong children aged 4-17 years, older age, parental immigrant status, internalising problems, and perceived need for professional help were statistically significant correlates that increased the risk of a mental health or substance use related ED visit; low-income and suicidal ideation with attempt were statistically significant only among youths aged 14-17 years.
ConclusionsKnowledge of the sociodemographic, behavioural, and clinical characteristics of children visiting EDs for mental health and substance use related concerns is required to better understand patient needs to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits.
Highlights

Growing rates of child mental health and substance use related ED visits have been observed internationally.
A population-based survey linked at the individual level to administrative health data was used to examine the extent to which children's sociodemographic, behavioural, and clinical characteristics are associated with the risk of a mental health or substance use related ED visit in Ontario, Canada.
Older age, low-income, parental immigrant status, perceived need for professional help, internalising problems, and suicidality increase the risk of an ED visit.
Knowledge of the characteristics of children visiting EDs can be used to coordinate effective emergency mental health care that optimises child outcomes, and to inform the development and targeting of upstream interventions that have the potential to prevent avoidable ED visits.

Background: Cannabis is associated with the onset and persistence of psychotic disorders. Evidence suggests that accessibility of substances is associated with an increased risk of use-related harms. We sought to examine the effect of residing in proximity to non-medical cannabis retailers on the prevalence of health service use for psychosis. Methods: We conducted a cross-sectional study using linked health administrative data, and used geospatial analyses to determine whether people in Ontario, Canada (aged 14–60 years) resided within walking (1.6 km) or driving (5.0 km) distance of non-medical cannabis retailers (open as of February-2020). We identified outpatient visits, emergency department (ED) visits, and hospitalizations for psychotic disorders between 01-April-2019 and 17-March-2020. We used zero-inflated Poisson regression models and gamma generalized linear models to estimate the association between cannabis retailer proximity and indicators of health service use. Results: Non-medical cannabis retailers were differentially located in areas with high levels of marginalization and pre-existing health service use for psychosis. People residing within walking or driving distance of a cannabis retailer had a higher rate of psychosis-related outpatient visits, ED visits, and hospitalizations, compared to people living outside these areas. This effect was stronger among those with no prior service use for psychosis. Conclusions: Proximity to a non-medical cannabis retailer was associated with higher health service use for psychosis, even after adjustment for prior health service use. These findings suggest that opening of non-medical cannabis retailers could worsen the burden of psychosis on mental health services in areas with high-risk populations.