Background
Methods
Study setting
Data
Study population
Measures
Analyses
Ethics approval
Results
Common mental disorders | Serious mental disorders | Substance use disorders | ||||
---|---|---|---|---|---|---|
241,177 | (71.6%) | 48,138 | (14.3%) | 47,658 | (14.1%) | |
Concurrent disorders | ||||||
Also treated for common MD | N/A | N/A | 27,135 | (48.2%) | 21,866 | (45.9%) |
Also treated for serious MD | N/A | N/A | N/A | N/A | 8109 | (17.0%) |
Sex/gender | ||||||
Female | 164,373 | (68.2%) | 27,109 | (56.3%) | 17,666 | (37.1%) |
Male | 76,804 | (31.8%) | 21,029 | (43.7%) | 29,992 | (62.9%) |
Age | ||||||
15–24 | 28,150 | (11.7%) | 4587 | (9.5%) | 4665 | (9.8%) |
25–44 | 78,793 | (32.7%) | 14,763 | (30.7%) | 20,844 | (43.7%) |
45–64 | 88,587 | (36.7%) | 19,618 | (40.8%) | 17,824 | (37.4%) |
65+ | 45,647 | (18.9%) | 9170 | (19.0%) | 4325 | (9.1%) |
Health Authority | ||||||
Interior | 44,561 | (18.5%) | 6159 | (12.8%) | 8283 | (17.4%) |
Fraser | 85,244 | (35.3%) | 17,830 | (37.0%) | 16,184 | (34.0%) |
Vancouver Coastal | 51,243 | (21.2%) | 12,622 | (26.2%) | 11,160 | (23.4%) |
Vancouver Island | 48,000 | (19.9%) | 8211 | (17.1%) | 8889 | (18.7%) |
Northern | 11,969 | (5.0%) | 3241 | (6.7%) | 2442 | (5.1%) |
Unknown | 160 | (0.1%) | 75 | (0.2%) | 700 | (1.5%) |
Rural-Urban Residence | ||||||
Metropolitan (SACTYPE 1) | 161,712 | (67.1%) | 33,926 | (70.5%) | 30,315 | (63.6%) |
Small urban (SACTYPE 2–3) | 51,674 | (21.4%) | 9858 | (20.5%) | 10,721 | (22.5%) |
Rural/remote (SACTYPE 4–7) | 27,624 | (11.5%) | 4251 | (8.8%) | 5915 | (12.4%) |
Unknown | 167 | (0.1%) | 103 | (0.2%) | 707 | (1.5%) |
Neighbourhood income quintile | ||||||
Q1 (lowest) | 49,483 | (20.5%) | 14,010 | (29.1%) | 16,450 | (34.5%) |
Q2 | 47,486 | (19.7%) | 9947 | (20.7%) | 9885 | (13.0%) |
Q3 | 48,494 | (20.1%) | 8805 | (18.3%) | 7747 | (16.3%) |
Q4 | 49,671 | (20.6%) | 8134 | (16.9%) | 6590 | (13.8%) |
Q5 (highest) | 43,770 | (18.1%) | 6704 | (13.9%) | 5109 | (10.7%) |
Missing | 2273 | (0.9%) | 538 | (1.1%) | 1877 | (3.9%) |
Income assistance prescription drug coverage (plan C) | 25,818 | (10.7%) | 16,394 | (34.1%) | 22,014 | (46.2%) |
Charlson-Deyo index (mean, SD) | 0.8 | ± 1.6 | 0.9 | ± 1.6 | 1.0 | ± 1.8 |
Hospital admission in 2016/7 | ||||||
MSUD hospital admission | 7350 | (3.0%) | 9371 | (19.5%) | 16,279 | (34.2%) |
Involuntary hospitalisation | 2845 | (1.2%) | 6335 | (13.2%) | 7837 | (16.4%) |
Common mental disorders N = 241,177 (71.6%) | Serious mental disorders N = 48,138 (14.3%) | Substance use disorders N = 47,658 (14.1%) | ||||
---|---|---|---|---|---|---|
Emergency department visits in 2017/8 | ||||||
MSUD ED visits (mean, SD) | 0.1 | ± 0.5 | 0.3 | ± 1.2 | 0.9 | ± 3.2 |
0 | 227,018 | (94.1%) | 41,373 | (85.9%) | 33,783 | (70.9%) |
1 | 10,084 | (4.2%) | 3594 | (7.5%) | 6378 | (13.4%) |
2–5 | 3798 | (1.6%) | 2763 | (5.7%) | 5668 | (11.9%) |
6–11 | 238 | (0.1%) | 330 | (0.7%) | 1242 | (2.6%) |
12+ | 39 | (0.0%) | 78 | (0.2%) | 587 | (1.2%) |
Other ED visits | 70,836 | (29.4%) | 12,708 | (26.4%) | 14,848 | (31.2%) |
Outpatient service use 2016/7 or 365 days before first ED visit in 2017/8 | ||||||
Primary care visits (mean, SD) | 10.5 | ± 8.5 | 9.8 | ± 9.2 | 10.4 | ± 10.0 |
0 visits | 2794 | (1.2%) | 3417 | (7.1%) | 4176 | (8.8%) |
1 visit | 5565 | (2.3%) | 2475 | (5.1%) | 2905 | (6.1%) |
2 visits | 10,618 | (4.4%) | 2735 | (5.7%) | 2904 | (6.1%) |
3+ visits | 222,200 | (92.1%) | 39,511 | (82.1%) | 37,673 | (79.0%) |
MSUD primary care visits (mean, SD) | 3.2 | ± 3.1 | 3.2 | ± 4.2 | 3.7 | ± 5.0 |
0 visits | 18,521 | (7.7%) | 13,414 | (27.9%) | 13,537 | (28.4%) |
1 visit | 49,340 | (20.5%) | 7862 | (16.3%) | 7288 | (15.3%) |
2 visits | 54,878 | (22.8%) | 6683 | (13.9%) | 5714 | (12.0%) |
3+ visits | 118,438 | (49.1%) | 20,179 | (41.9%) | 21,119 | (44.3%) |
Continuity of care index | 5.8 | ± 3.4 | 5.5 | ± 3.7 | 4.3 | ± 3.5 |
Psychiatrist Visits (mean, SD) | 1.0 | ± 4.1 | 5.5 | ± 7.8 | 1.5 | ± 4.7 |
0 visits | 198,185 | (82.2%) | 11,442 | (23.8%) | 36,091 | (75.7%) |
1 visit | 10,750 | (4.5%) | 3307 | (6.9%) | 3011 | (6.3%) |
2 visits | 6597 | (2.7%) | 4231 | (8.8%) | 1684 | (3.5%) |
3+ visits | 25,645 | (10.6%) | 29,158 | (60.6%) | 6872 | (14.4%) |
Common mental disorders | Unadjusted | Adjusted | ||||
---|---|---|---|---|---|---|
Any MSUD ED visit | OR | 95% CI Upper confidence interval | Lower confidence interval | OR | 95% CI Upper confidence interval | Lower confidence interval |
1 primary care visit (vs. 0) | 0.54 | 0.47 | 0.62 | 0.82 | 0.68 | 1.00 |
2 primary care visits (vs. 0) | 0.36 | 0.32 | 0.41 | 0.84 | 0.70 | 1.02 |
3+ primary care visits (vs. 0) | 0.34 | 0.31 | 0.38 | 0.70 | 0.59 | 0.83 |
1+ primary care visit related to MSUD (vs. 0) | 0.53 | 0.50 | 0.56 | 0.80 | 0.75 | 0.87 |
Continuity of Care Index (range 0–10) | 0.93 | 0.92 | 0.93 | 0.96 | 0.96 | 0.97 |
1+ psychiatrist visit (vs. 0) | 1.69 | 1.62 | 1.76 | 0.98 | 0.93 | 1.03 |
Count of MSUD ED visits | RR | 95% CI | RR | 95% CI | ||
1 primary care visit (vs. 0) | 0.71 | 0.54 | 0.93 | 0.85 | 0.64 | 1.13 |
2 primary care visits (vs. 0) | 0.89 | 0.69 | 1.15 | 1.04 | 0.79 | 1.37 |
3+ primary care visits (vs. 0) | 0.71 | 0.58 | 0.87 | 0.88 | 0.69 | 1.12 |
1+ primary care visit related to MSUD (vs. 0) | 1.01 | 0.91 | 1.12 | 1.06 | 0.93 | 1.20 |
Continuity of Care Index (range 0–10) | 0.98 | 0.97 | 0.99 | 0.97 | 0.96 | 0.99 |
1+ psychiatrist visit (vs. 0) | 1.48 | 1.36 | 1.60 | 1.06 | 0.98 | 1.14 |
Serious mental disorders | Unadjusted | Adjusted | ||||
Any MSUD ED visit | OR | 95% CI | OR | 95% CI | ||
1 primary care visit (vs. 0) | 0.84 | 0.74 | 0.96 | 0.92 | 0.74 | 1.14 |
2 primary care visits (vs. 0) | 0.72 | 0.63 | 0.82 | 1.10 | 0.87 | 1.37 |
3+ primary care visits (vs. 0) | 0.61 | 0.56 | 0.67 | 0.75 | 0.62 | 0.89 |
1+ primary care visits related to MSUD (vs. 0) | 0.94 | 0.88 | 0.99 | 1.09 | 0.99 | 1.20 |
Continuity of Care Index (range 0–10) | 0.93 | 0.92 | 0.94 | 0.97 | 0.96 | 0.98 |
1+ psychiatrist visit (vs. 0) | 1.12 | 1.05 | 1.19 | 0.78 | 0.72 | 0.85 |
Count of MSUD ED visits | RR | 95% CI | RR | 95% CI | ||
1 primary care visit (vs. 0) | 0.89 | 0.70 | 1.13 | 0.92 | 0.77 | 1.10 |
2 primary care visits (vs. 0) | 1.03 | 0.81 | 1.31 | 1.13 | 0.93 | 1.37 |
3+ primary care visits (vs. 0) | 0.85 | 0.73 | 1.00 | 1.04 | 0.89 | 1.21 |
1+ primary care visit related to MSUD (vs. 0) | 0.95 | 0.85 | 1.05 | 1.02 | 0.92 | 1.12 |
Continuity of Care Index (range 0–10) | 0.97 | 0.96 | 0.98 | 0.98 | 0.97 | 1.00 |
1+ psychiatrist visit (vs. 0) | 1.34 | 1.19 | 1.51 | 1.04 | 0.95 | 1.14 |
Substance use disorders | Unadjusted | Adjusted | ||||
Any MSUD ED visit | OR | 95% CI | OR | 95% CI | ||
1 primary care visit (vs. 0) | 0.81 | 0.74 | 0.90 | 1.01 | 0.88 | 1.17 |
2 primary care visits (vs. 0) | 0.76 | 0.69 | 0.84 | 1.21 | 1.05 | 1.41 |
3+ primary care visits (vs. 0) | 0.59 | 0.55 | 0.63 | 0.98 | 0.87 | 1.09 |
1+ primary care visits related to MSUD (vs. 0) | 0.52 | 0.50 | 0.55 | 0.80 | 0.74 | 0.86 |
Continuity of Care Index (range 0–10) | 0.87 | 0.87 | 0.88 | 0.93 | 0.92 | 0.94 |
1+ psychiatrist visit (vs. 0) | 1.47 | 1.41 | 1.54 | 0.69 | 0.64 | 0.74 |
Count of MSUD ED visits | RR | 95% CI | RR | 95% CI | ||
1 primary care visit (vs. 0) | 0.92 | 0.78 | 1.08 | 0.89 | 0.76 | 1.04 |
2 primary care visits (vs. 0) | 1.00 | 0.85 | 1.18 | 0.97 | 0.82 | 1.14 |
3+ primary care visits (vs. 0) | 0.84 | 0.76 | 0.93 | 0.78 | 0.69 | 0.88 |
1+ primary care visit related to MD (vs. 0) | 1.16 | 1.07 | 1.25 | 1.22 | 1.11 | 1.34 |
Continuity of Care Index (range 0–10) | 0.96 | 0.96 | 0.97 | 0.97 | 0.96 | 0.98 |
1+ psychiatrist visit (vs. 0) | 1.30 | 1.21 | 1.40 | 0.86 | 0.79 | 0.93 |