title: Twelve-Month Health Care Use and Mortality in Commercially Insured Young People With Incident Psychosis in the United States.
abstract: To assess 12-month mortality and patterns of outpatient and inpatient treatment among young people experiencing an incident episode of psychosis in the United States.
  
  
  
  Prospective observational analysis of a population-based cohort of commercially insured individuals aged 16-30 receiving a first observed (index) diagnosis of psychosis in 2008-2009. Data come from the US Department of Health and Human Services' Multi-Payer Claims Database Pilot. Outcomes are all-cause mortality identified via the Social Security Administration's full Death Master File; and inpatient, outpatient, and psychopharmacologic treatment based on health insurance claims data. Outcomes are assessed for the year after the index diagnosis.
  
  
  
  Twelve-month mortality after the index psychosis diagnosis was 1968 per 100000 under our most conservative assumptions, some 24 times greater than in the general US population aged 16-30; and up to 7372 per 100000, some 89 times the corresponding general population rate. In the year after index, 61% of the cohort filled no antipsychotic prescriptions and 41% received no individual psychotherapy. Nearly two-thirds (62%) of the cohort had at least one hospitalization and/or one emergency department visit during the initial year of care.
  
  
  
  The hugely elevated mortality observed here underscores that young people experiencing psychosis warrant intensive clinical attention-yet we found low rates of pharmacotherapy and limited use of psychosocial treatment. These patterns reinforce the importance of providing coordinated, proactive treatment for young people with psychosis in US community settings.
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, MSC 9669, Bethesda, MD 20892.
authors.forename: Michael
authors.initials: M
authors.lastname: Schoenbaum
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD.|Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Sutherland
authors.affiliation: Office of the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services, Washington, DC.
authors.forename: Andre
authors.initials: A
authors.lastname: Chappel
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, MSC 9669, Bethesda, MD 20892.
authors.forename: Susan
authors.initials: S
authors.lastname: Azrin
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, MSC 9669, Bethesda, MD 20892.
authors.forename: Amy B
authors.initials: AB
authors.lastname: Goldstein
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, MSC 9669, Bethesda, MD 20892.
authors.forename: Agnes
authors.initials: A
authors.lastname: Rupp
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, MSC 9669, Bethesda, MD 20892.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heinssen
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002423:Cause of Death; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D011446:Prospective Studies; D011613:Psychotherapy / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: mortality; psychosis; quality of care