Psychosis rates climb among young people in Ontario, researchers find

People aged 14 to 20 are more often being diagnosed with psychotic disorders, including schizophrenia, compared with those born earlier, a large Ontario study examining 30 years of data suggests.

To conduct the study, published in Monday’s issue of the Canadian Medical Association Journal (CMAJ), researchers looked at health administrative data from more than 12 million Ontario residents born between 1960 and 2009 to look for cases of a psychotic disorder.

Residents had to reach age 14 to be diagnosed and eligible for the analysis. Looking at the 30-year study period, researchers found more than 152,000 diagnoses of schizophrenia — with the annual rate increasing by 60 per cent for those aged 14 to 20, but staying flat or declining for people aged 21 to 50. 

Schizophrenia is a lifelong condition where people can experience hallucinations, delusions and breaks from reality that typically require years of treatment. About one per cent of people in Canada are living with schizophrenia, based on federal data from 2016 to 2017.

“Rather than just looking at what’s the overall rate of schizophrenia and psychotic disorders, we said, is it differing by birth cohorts?” said Dr. Daniel Myran, a family physician and research chair at North York General Hospital in Toronto. “So did people born in the 1960s have a different rate of psychotic disorders than people born in the ’70s, ’80s or ’90s?” 

Specifically, the researchers found that in the 14-20 age group, the rate in the ’90s was 62.5 per 100,000 people and rose to nearly 100 cases per 100,000 by the end of the study. 

Doctors say catching the symptoms early helps. To that end, at the Ottawa Hospital, psychiatrist Sarah Brandigampola treats people experiencing early symptoms of psychosis alongside a team of other health professionals. 

The study’s findings fit with what Brandigampola said she’s seeing clinically. 

“This is a crisis,” she said. “We know that if we can get them into effective treatment early, we can really dramatically change their life.”

The study’s authors said that while evidence on birth cohort changes in psychotic disorders is limited, two recent studies from Denmark and Australia also found increases over time in schizophrenia diagnoses in younger individuals.

Speculating on why

In the Ontario study, those diagnosed with psychotic disorders not linked to mood disorders, such as schizophrenia, were more likely to be male, live in low-income neighbourhoods, be a long-standing resident of Canada and have received care for mental health disorders and substance use.  

Why isn’t known. Myran and his co-authors suggest several possible reasons for the increases: older parental age, socioeconomic- and migration-associated stress and an increase in some negative childhood experiences in more recent decades.  

Myran said there likely isn’t a single explanation, but he called substance use — including cannabis, stimulants, hallucinogens and synthetic drugs — a leading possibility contributing to the rising rates over 20 years. 

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Brandigampola also suspects substance use as a possibility. “In males, we’re seeing a younger age of onset and a stronger correlation to cannabis use.” 

But observational studies can’t prove cannabis use is causing the increase. 

When the researchers tried to account for changes in health-care access and better detection over time, the statistical association with birth cohort was still there. Myron said finding people sooner doesn’t fully explain the observed increases.

Seeing lights 

While the study points to a rising incidence of psychotic disorders with no clear cause, in the big picture, psychiatrists say earlier diagnoses can help people live well with schizophrenia.

Samantha Mercanti said that’s been her experience. 

Mercanti was in her 20s and writing final exams in her first year of university when she had her first episode. She said she continued to hallucinate and by third year, the symptoms worsened. 

“I remember just seeing lights,” Mercanti said. “It was a very strange experience. It was kind of like I was hearing things that were outside of this world.”

Mercanti returned home and got help at a hospital’s outpatient program.

Now 44, Mercanti is a businesswoman and loves to dance and run recreationally. 

She said she aims to bring hope to those in the midst of mental illness and to let everyone know that recovery is possible.

“I don’t want to forget that girl,” said Mercanti, referring to her younger self when she first experienced symptoms of psychosis and was scared.

“My story is a very positive story and I think we forget that sometimes.”