Racial/ethnic disparities remain in diagnosis, treatment of first-episode psychosis

Racial/ethnic disparities in diagnoses and treatment of first-episode psychosis were apparent before the first psychosis diagnosis, according to results of an observational cohort study published in JAMA Psychiatry.

“Behavioral health–related visits during the time before [first-episode psychosis] represent opportunities to decrease the duration of untreated psychosis after the onset of symptoms and thereby increase the probability of improved long-term outcomes, even if those improvements may not fully persist after discontinuing specialized, early intervention services,” Hanke Heun-Johnson, PhD, of the Schaeffer Center for Health Policy and Economics at the University of Southern California, and colleagues wrote. “Thus, disparities in access to care before [first-episode psychosis] could exacerbate disparities in long-term outcomes for patients after the diagnosis of [first-episode psychosis].”

The researchers sought to evaluate racial/ethnic disparities in behavioral health care use and prescription drug use among children and young adults before the first-episode psychosis diagnosis. They analyzed medical and prescription drug claims from January 2007 to September 2015 of 3,017 Black, Hispanic or white patients who were continually enrolled in commercial insurance plans and received a diagnosis of first-episode psychosis between ages 10 and 21 years. Participants were included in Optum’s deidentified Clinformatics Data Mart Database, which was augmented with variables on race/ethnicity and socioeconomics. The researchers determined first-episode psychosis according to the presence of psychosis diagnoses on claims for at least one hospitalization or two outpatient events, with a continuous enrollment requirement of 2 or more years prior to first diagnosis. Main outcomes and measures included rates of inpatient admission, emergency department presentation and outpatient visits, behavioral health disorder diagnoses and antipsychotic/antidepressant prescription fills, all of which were determined for the year before first-episode psychosis. Heun-Johnson and colleagues used multivariable logistic regression to adjust results for covariates, including estimated household income, age, sex and geographic division in the United States.

Black (n = 343) and Hispanic (n = 324) participants were less likely than white (n = 2,374) patients to receive comorbid behavioral health disorder diagnoses in the year prior to first-episode psychosis diagnosis. Behavioral health care use rates, aside from emergency care, were lower among Black and Hispanic patients compared with white patients, especially for outpatient visits with behavioral health care professionals. Behavioral health care use rates, outpatient visits with behavioral health professionals and other outcomes were significantly lower among Black and Hispanic patients compared with white patients after adjustment for socioeconomic covariates.

“Because Black and Hispanic patients have fewer behavioral health–related clinical contacts before the occurrence of [first-episode psychosis], these patients may have reduced opportunities for timely detection of psychotic symptoms and early interventions,” Heun-Johnson and colleagues wrote. “Additional efforts to encourage behavioral health care use in Black and Hispanic populations and combat racism in health care are required to help break down real and perceived barriers, allow for equal access to high-quality behavioral health care and eventually help reduce racial/ethnic differences in clinical outcomes before and after a diagnosis of [first-episode psychosis].”