How High? Trends in Cannabis Use Prior to First Admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017.

OBJECTIVES: To examine the trends in cannabis use within 30 days of first admission to inpatient psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting cannabis use. METHODS: A retrospective cross-sectional analysis was conducted for first-time admissions to nonforensic inpatient psychiatric beds in Ontario, Canada, between January 1, 2007, and December 31, 2017, using data from the Ontario Mental Health Reporting System (N = 81,809). RESULTS: Across all years, 20.1% of patients reported cannabis use within 30 days of first admission. Use increased from 16.7% in 2007 to 25.9% in 2017, and the proportion with cannabis use disorders increased from 3.8% to 6.0%. In 2017, 47.9% of patients aged 18 to 24 and 39.2% aged 25 to 34 used cannabis, representing absolute increases of 8.3% and 10.7%, respectively. Increases in cannabis use were found across almost all diagnostic groups, with the largest increases among patients with personality disorders (15% increase), schizophrenia or other psychotic disorders (14% increase), and substance use disorders (14% increase). A number of demographic and clinical factors were significantly associated with cannabis use, including interactions between schizophrenia and gender (area under the curve = 0.88). CONCLUSIONS: As medical cannabis policies in Canada have evolved, cannabis use reported prior to first admission to inpatient psychiatry has increased. The findings of this study establish a baseline for evaluating the impact of changes in cannabis-related policies in Ontario on cannabis use prior to admission to inpatient psychiatry.

Factors associated with delayed diagnosis of mood and/or anxiety disorders. / Facteurs associés au diagnostic tardif d'un trouble de l'humeur et/ou d'anxiété.

INTRODUCTION: This study examined the association between time to diagnosis and sociodemographic and clinical characteristics as well as time to diagnosis and physical and mental health status, among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis. METHODS: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n=3212) was divided into three time to diagnosis subgroups: long (> 5 years), moderate (1-5 years) and short (< 1 year). We performed descriptive and multinomial multivariate logistic regression analyses. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. RESULTS: The majority (61.6%) of Canadians with a mood and/or anxiety disorder diagnosis reported having received their diagnosis more than one year after symptom onset (30.0% reported a moderate delay and 31.6% a long delay). Upon controlling for individual characteristics, we found significant associations between a moderate delay and having no or few physical comorbidities; a long delay and older age; and both moderate and long delays and early age of symptom onset. In addition, a long delay was significantly associated with "poor" or "fair" perceived mental health and the greatest number of activity limitations. CONCLUSION: These findings affirm that a long delay in diagnosis is associated with negative health outcomes among Canadian adults with mood and/or anxiety disorders. Time to diagnosis is particularly suboptimal among older adults and people with early symptom onset. Tailored strategies to facilitate an early diagnosis for those at greatest risk of a delayed diagnosis, especially for those with early symptom onset, are needed.

INTRODUCTION: Cette étude examine les relations entre le délai écoulé avant l'établissement d'un diagnostic et les caractéristiques sociodémographiques et cliniques, ainsi que les relations entre ce délai de diagnostic et l'état de santé physique et mental des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété. MÉTHODOLOGIE: L'Enquête sur les personnes ayant une maladie chronique au Canada ­ Composante sur les troubles de l'humeur et d'anxiété de 2014 a été utilisée pour cette étude. L'échantillon de l'étude (n = 3 212) a été divisé en trois sous-groupes en fonction du délai de diagnostic : long (plus de 5 ans), modéré (1 à 5 ans) et court (moins d'un an). Nous avons réalisé des analyses de régression logistique multivariées descriptives et multinomiales. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. RÉSULTATS: La plupart (61,6 %) des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété ont dit avoir reçu leur diagnostic plus d'un an après l'apparition des symptômes (délai modéré : 30,0 %; délai long : 31,6 %). Après ajustement des caractéristiques individuelles, nous avons constaté qu'un délai modéré était significativement associé à la présence d'un faible nombre de comorbidités physiques ou d'aucune, qu'un délai long était significativement associé à un âge plus avancé, et qu'un délai long ou modéré étaient significativement associés à l'apparition de symptômes à un jeune âge. Finalement, un délai long était significativement associé à une santé mentale perçue comme « mauvaise ¼ ou « passable ¼ et à un nombre plus élevé de limitations d'activité. CONCLUSION: Ces résultats confirment qu'un long délai de diagnostic est associé à des résultats de santé négatifs chez les adultes canadiens atteints de trouble de l'humeur et/ou d'anxiété. Le délai de diagnostic est particulièrement sous-optimal chez les adultes plus âgés et les personnes dont les symptômes sont apparus à un jeune âge. La mise en oeuvre de stratégies adaptées facilitant l'établissement d'un diagnostic précoce chez les personnes les plus susceptibles d'obtenir un diagnostic tardif, surtout chez celles dont les symptômes sont apparus à un jeune âge, est nécessaire.

Participation in programs designed to improve employment outcomes for persons with psychiatric disabilities: evidence from the New York WORKS demonstration project.

The New York WORKS demonstration project was designed to improve employment outcomes for persons with psychiatric disabilities receiving Supplemental Security Income (SSI) disability payments. This article shows how the individual characteristics of participants were related to outcomes at each stage of the multistage recruitment process used in the project and how those characteristics contributed to enrollment. The findings are important to program administrators who are interested in ensuring that SSI recipients receive equal access to employment-related services and who want to improve recruitment strategies for future demonstration projects. The New York WORKS recruitment process used administrative records from the Social Security Administration (SSA) to identify the population of over 68,000 SSI recipients with a diagnosis of a psychiatric disability in Erie County and New York City. Staff involved in the project documented the results of each stage of the recruitment process. The New York WORKS project included four stages: (1) the provision of information (sending a letter and information packet); (2) demonstrated awareness of the project (response to a letter containing an overview of the project); (3) expression of interest (indication of interest in the project, using a postmarked form returned to New York WORKS project staff); and (4) participation (actual enrollment in the program). The project staff members were also able to identify data from administrative records that described the characteristics of the population, including age, sex, type of psychiatric diagnosis, the number of months that the person collected benefits before the recruitment process, employment experience before the recruitment process, and annual earnings in the year before the recruitment process. The data on outcomes at each stage of the recruitment process and the characteristics of SSI recipients were analyzed using an empirical method recently suggested by Heckman and Smith. The analysis identified the relationship between the characteristics of SSI recipients and the outcomes at each stage of the recruitment process and demonstrated how those characteristics contributed to the overall likelihood of enrollment. Demographic characteristics, information about diagnosis, and characteristics related to work history had different effects on outcomes at different stages of the recruitment process. For example, younger SSI recipients were less likely to reply to the information letter but more likely to express an interest in the project and more likely to enroll, given that interest. This result suggests that there may be an information barrier for the younger group of SSI recipients during the early recruitment stages. There were also interesting differences by psychiatric diagnosis and by recent employment experience at each stage of the process. Most notably, persons with anxiety disorders were less likely to express an interest in the project and less likely to enroll in the project if they expressed an interest. This finding suggests that project administrators may need to examine more effective methods to accommodate persons with an anxiety disorder at the enrollment stage of the recruitment process. Persons with relatively low earnings in the year before the project were more likely to respond, to express interest in the project, and to enroll than were those with no earnings and those with relatively high earnings. This finding suggests that the recruitment strategy used by the New York WORKS project is more effective at enrolling a subset of the population that has some demonstrated work capacity and that, of those with a demonstrated work capacity, New York WORKS is enrolling those who are likely to have the most to gain from the project. This finding has implications for the development of sample designs for other demonstration projects, in particular the SSA-proposed mental health treatment study. A number of strategies may lead to improvements in future evaluations of participation in SSA projects and programs. For example, the New York WORKS data did not contain information for all SSI recipients on race, education, or literacy. These factors have been shown to be important in the Job Training Partnership Act literature and are likely to play a role in participation. The inclusion of these data in future evaluations may provide important information on participation in SSA projects. Another useful strategy for future evaluations includes the identification of random samples of those who choose not to enroll at different stages in the process and the collection of information on the reason for the decision. These additional data may help project administrators to gain a clearer description of the reasons for differences in outcome that occur at each stage of the process, assess the overall performance of the recruitment process, and improve the recruitment processes used in future projects.