BACKGROUND:The economic burden of chronic psychotic disorders is substantial. However, few studies have employed an incidence based approach to estimate the economic burden of chronic psychotic disorders. Furthermore, the existing work has mainly used models populated with data obtained from published literature, making several assumptions to estimate incidence-based costs.AIMS OF THE STUDY:The objective of this study was to estimate the direct cumulative mean health care costs of chronic psychotic disorders, using an incidence-based, cost-of-illness approach and real-world data from a single-payer health care system.METHODS:Using health records from Ontario, Canada, all individuals with a valid health card number, residing in the province, and diagnosed with a chronic psychotic disorder between the ages of 16 and 45 from April 1st, 2006, to March 31st, 2021, were included in the analysis. Using a mix of bottom-up and top-down methodologies and a robust cost estimator, cumulative mean health care costs were estimated from diagnosis to death or the end of observation period. Cumulative mean health care costs, and respective 95% confidence intervals (CIs), were estimated for the 1-year period (i.e., first year post-diagnosis), overall, by sex, age groups and health service, and for the 5-, 10- and 15-periods, overall and by sex.RESULTS:One-, 5-, 10- and 15-year total discounted cumulative mean health care costs were estimated at USD 24,441.16, 95% CI (USD 24,166.13, USD 24,716.19), USD 70,754.69, 95% CI (USD 69,827.48-USD 71,681.89), USD 117,136.88, 95% CI (USD 115,370.40-USD 118,903.35), and USD 157,829.01 95% CI (USD 155,599.32.-USD 160,058.70), respectively. Total mean 1-year costs post-diagnosis were higher for younger individuals. Although females had higher 1-year costs, males had higher 5-, 10- and 15-year costs. Psychiatric hospitalisations made up the largest component of total costs across all cost estimates.DISCUSSION:These results suggest that the costs of chronic psychotic disorders are high in the year of diagnosis and then increase at a decreasing rate thereafter. Compared to previous work, the cost estimates from the present study suggest that the use of real-world data produces lower estimates of cumulative costs, albeit likely more accurate ones. However, these estimates do not account for costs of care provided in community-based agencies.IMPLICATIONS FOR HEALTH POLICIES:These estimates will serve as important inputs for policymakers looking to make decisions around resource allocation.IMPLICATIONS FOR FUTURE RESEARCH:Future research should seek to follow incident cases in administrative data over a longer time period to obtain cumulative costs of longer duration.

ObjectivePopulation-based prevalence estimates of co-occurring mental illness and substance use disorder (herein dual diagnosis) are scarce and derived from a single source (e.g., survey data) which may lead to underestimation of prevalence. We linked administrative data to a representative mental health survey in Ontario, Canada to estimate dual diagnosis prevalence using a data triangulation method. Approach We retrospectively linked the 2002 and 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) to emergency department, inpatient hospital, and outpatient physician records in Ontario, Canada. Mental illness and substance use disorder were ascertained though self-report, Composite International Diagnostic Interview screening, and linked administrative health records. We estimated 1-year, 5-year, and lifetime prevalence of dual diagnosis. ResultsOf the CCHS-MH survey participants, 14,790 (99.8%) were included in the study. The 1-year, 5-year, and lifetime prevalence of dual diagnosis was 2.3%, 4.8%, and 9.8%, respectively, which attenuated to 2.1%, 4.1%, and 8.4%, respectively, when tobacco use disorder was removed from substance use disorder ascertainment. ConclusionDual diagnosis is more common in the general population than previously estimated. Considering barriers to accessing care for both mental illness and substance use disorders among people with dual diagnosis annually, our 5-year prevalence estimate is likely most informative for health system planning. ImplicationsIn the context of increased health burden, barriers to care access, and challenges to effective treatment associated with dual diagnosis, our findings present a case for increased investment in integrated models of mental healthcare and addiction medicine.

Purpose: Population-based data are required to obtain a comprehensive estimate of the health care costs associated with autism spectrum disorder (ASD) to ensure scarce resources are distributed equitably. Moreover, it is important to understand how the health care costs associated with ASD have changed over time. Methods: Using health records from Ontario, Canada, this analysis estimated the prevalence-based health care costs associated with ASD among children and adolescents in 2015, overall, by sex and age group, compared to a random sample of children and adolescents without ASD, and examined how these costs changed from 2015 to 2021.Results: Children and adolescents with ASD had mean health care costs of $3003.65, 95% CI [$2870.38-$3136.92], while those without ASD had mean health care costs of $814.74, 95% CI [$772.83-$856.64]. Costs were mostly due to home care and physician services, were higher for females, and increased with age. Total mean costs were relatively stable from 2015 to 2019 at about $3000 but then decreased to $2597.53 in 2020 and increased to $2723.61 in 2021.Conclusion: These estimates will be important for decision makers to inform resource allocation and may serve as useful inputs for future economic evaluations of ASD-related health care interventions.

OBJECTIVE:The impacts of the COVID-19 pandemic on psychiatric hospitalizations in Ontario are unknown. The purpose of this study was to identify changes to volumes and characteristics of psychiatric hospitalizations in Ontario during the COVID-19 pandemic.METHODS:A time series analysis was done using psychiatric hospitalizations with admissions dates from July 2017 to September 2021 identified from provincial health administrative data. Variables included monthly volumes of hospitalizations as well as proportions of stays <3 days and involuntary admissions, overall and by diagnosis (mood, psychotic, addiction, and other disorders). Changes to trends during the pandemic were tested using linear regression.RESULTS:A total of 236,634 psychiatric hospitalizations were identified. Volumes decreased in the first few months of the pandemic before returning to prepandemic volumes by May 2020. However, monthly hospitalizations for psychotic disorders increased by ∼9% compared to the prepandemic period and remained elevated thereafter. Short stays and involuntary admissions increased by approximately 2% and 7%, respectively, before trending downwards.CONCLUSION:Psychiatric hospitalizations quickly stabilized in response to the COVID-19 pandemic. However, evidence suggested a shift towards a more severe presentation during this period.

Few studies have estimated cumulative health care costs post-diagnosis for individuals with autism spectrum disorder (ASD). Using an incidence-based approach, the objective of this analysis was to estimate cumulative costs of ASD to the Ontario health care system of children and adolescents. Using administrative health records from Ontario, Canada’s most populous province, a retrospective, population-based, incident cohort study of children and adolescents aged 0–19 years old diagnosed with ASD was undertaken to estimate cumulative health care costs of ASD to the health care system from 2010 to 2019. Cumulative health care costs in 2021 Canadian dollars (CAD) from diagnosis to death or end of observation period were estimated using a consistent estimator based on the inverse probability weighting technique. Cumulative health care costs (and respective 95

OBJECTIVE The economic burden of eating disorders is substantial. One potential way to reduce costs, without sacrificing care, may be to target preventable (i.e., potentially unnecessary) acute care. This study sought to determine the amount and proportion of preventable and non-preventable acute care spending among individuals with eating disorders. METHOD We undertook a population-based, cross-sectional study of all individuals over the age of 17 with eating disorders (diagnosed through hospitalization) in Ontario, Canada, to determine potentially preventable and non-preventable acute care spending. Preventable acute care (i.e., preventable emergency department visits and hospitalizations) was defined using previously validated algorithms. We undertook analyses for the full sample, by sex and by eating disorder diagnosis (anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, multiple). RESULTS Among 7547 individuals with eating disorders, 15% of all acute care spending (i.e., $1.33 million) was considered preventable; this figure was higher for females (14%) and those with bulimia nervosa (21%). Among emergency department visits, 25% of visits were considered preventable; the largest proportions were for non-emergent (11%) and primary care treatable (10%) conditions. Among hospitalizations, 9% were considered preventable; the highest proportions of preventable care spending were for short-term diabetes complications (1.8%) and urinary tract infections (1.8%). DISCUSSION Although the economic burden of eating disorders is substantial, there is some scope to decrease acute care spending among this patient population. Care coordination and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some acute care episodes. PUBLIC SIGNIFICANCE Many jurisdictions have implemented strategies to reduce costs and improve the quality of care among patients with high health care needs, such as those with eating disorders; however, it is unclear whether any costs can be reduced and, if so, which costs. Cost-savings resulting from the reduction of unnecessary care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.

We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.

Research on substance use challenges in First Nations communities is often deficit-focused and can reinforce paternalistic stereotypes that lead to further discrimination. In this article, we report on findings of a strengths-based Photovoice project done in collaboration with a First Nations' community in southern Ontario, Canada to better understand experiences with substance use challenges in the community. We analyzed interview data collected with seventeen individuals who have lived experience or are supporting a loved one with lived experience with a substance use challenge. Participants described sources of strength that characterized their path to wellness, including strong family and social connections, cultural practices, identity, spirituality, day-to-day activities, and helpful supports and services. Furthermore, participants made several suggestions for improving services, including the need for integrated and flexible systems of care and trustful client-provider relationships. At its core, nurturing wellness involved a transformative process involving social and/or cultural connections. The stories shared by participants demonstrate the unique and varied strengths drawn from by individuals dealing with a substance use challenge.

We report on the system of care and sources of strength and resilience for mental health among First Nations People experiencing the impacts of historical and contemporary colonization. Aamjiwnaang First Nation, a vibrant community of approximately 2400 members in southwestern Ontario, Canada, partnered in research to reveal sources of strength and resilience among community members with lived experiences (PWLE) with mental health and/or substance use challenges. A thematic content analysis was done using qualitative data collected as part of two complementary studies. In the first study called the "Five Views on a Journey" study, interviews with PWLE and family members of PWLE were conducted to better understand strengths and deficits in the system of care for mental health and substance use. In the second study entitled "A Strengths-Based Approach to Understanding How First Nations People Cope with Stress and Trauma," Photovoice was used to examine sources of strength and resilience among PWLE. Combined, these studies revealed that mental health supports and services that are trustworthy, open, and confidential are foundational to healing, helping PWLE find pathways to wellness by engendering feelings of hope, self-worth and pride. The integral roles of Anishinaabe culture and cultural identity as well as strong connections with family and community were key sources of strength and resilience. Our findings are discussed in the context of Aamjiwnaang's informal and formal systems of care, culture as wellness, inner strength, and the Truth and Reconciliation Commission of Canada's Calls to Action.