Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population-based study

Saunders, Natasha; Gill, Peter; Holder, Laura; Vigod, Simone N.; Kurdyak, Paul; Gandhi, Sima; Guttmann, Astrid

doi:10.1503/cmaj.180277

Cited by 53 publications

(48 citation statements)

References 26 publications

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“…Migrant groups have been shown to have lower intensity of primary care use prior to a first diagnosis of psychosis (Anderson, McKenzie, & Kurdyak, 2017), which may increase the likelihood of inpatient admission (Anderson, Fuhrer, Wynant, et al, 2013). Immigrant and refugee youth with a mental illness are more likely to visit an emergency department at first contact (Saunders et al, 2018), which may contribute to higher hospitalization rates. Differences between migrants and non-migrants may also be due to language barriers, knowledge of the health care system, and helpseeking behaviour of different cultures (Thomson, Chaze, George, & Guruge, 2015).…”

Section: Discussionmentioning

confidence: 99%

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

Rodrigues

Beswick

Anderson

2019

Early Intervention Psych

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Aim There is limited evidence examining admissions in early psychosis. We sought to estimate the proportion of people with a psychiatric admission within 2 years of the first diagnosis of psychosis, and to identify associated risk factors. Method We constructed a cohort of incident non‐affective psychosis cases using health administrative data and identified the first psychiatric hospitalization after psychosis onset. We compared hospitalization rates across sociodemographic, clinical and service‐use factors. Results One in three patients had an admission within 2 years of first diagnosis. Younger age, migrant status, diagnosis of psychosis not otherwise specified, and prior substance use were associated with increased hospitalization rates, whereas family physician involvement in diagnosis was protective. Conclusions Adolescents, immigrants and people presenting with diagnostic instability or prior substance use issues may benefit from interventions aimed at reducing hospitalization risk. Increasing primary care access and utilization among youth with early psychosis may also reduce hospitalization rates.

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Section: Discussionmentioning

confidence: 99%

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

Rodrigues

Beswick

Anderson

2019

Early Intervention Psych

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“… 116 In fact, when compared with non-immigrant youth, immigrant youth are more likely to present to the ED rather than other medical facility with their first mental health crisis. 117 The ED practitioner should offer trauma-informed care, addressing psychosocial needs when possible. ED physicians can also emphasize inherent strengths that may provide a protective benefit to our patients, including extensive community and extended family support.…”

Section: Special Populations: Children Seeking Safe Havenmentioning

confidence: 99%

Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department

Russell

Tsai

Linton

2020

Clinical Pediatric Emergency Medicine

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In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to healthcare among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access healthcare and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department (ED). Once in the ED, language, cultural and health literacy barriers make providing high quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.

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“…[17][18][19] Refugee youth, meanwhile, rely more on the emergency department as a first mental health contact than immigrant and non-refugee youth. 20 Although the exact role of trauma in health status is unclear, other health issues documented in refugees are increased morbidity, decreased life expectancy, and elevated acute and chronic health disparities. 2,13,[21][22][23] Poor health outcomes, comorbidities, and greater reliance on the emergency department highlight the importance of properly diagnosing PTSD in this population and the need to address barriers in care.…”

Section: Diagnosing Ptsdmentioning

confidence: 99%

Diagnosing Posttraumatic Stress Disorder in Refugees

Veettil

Vinokurtseva²

2020

UWOMJ

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Global crises has amounted to the forced international displacement of 25.4 million refugees. Refugees from conflict-affected areas are especially vulnerable to posttraumatic stress disorder (PTSD) compared to the general population due to their past and present hardships and history of trauma. PTSD is characterized by a constellation of symptoms identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM-5 departed from DSM-IV by reclassifying PTSD as a trauma- and stressor-related disorder and introducing a fourth symptom cluster—negative alterations in mood/cognition—to the previous three-symptom cluster model. In severely traumatized refugees, this new cluster exhibited relatively high sensitivity, specificity, positive predictive power, and negative predictive power—in concordance with the range of symptoms exhibited by this population—and allowed for the applicability of the DSM-5 criteria. However, the Western sample basis of the DSM-5 might make it inferior to alternative models as a diagnostic tool for PTSD in refugees and as a springboard for treatment. In addition (and possibly due) to PTSD, refugees are at high risk for mental health distress and suffer from poor health outcomes. Optimizing diagnostic criteria and overcoming barriers to diagnosis and access to care would benefit patients and facilitate treatment.

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Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population-based study

Cited by 53 publications

References 26 publications

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data

Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department

Diagnosing Posttraumatic Stress Disorder in Refugees

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