Antipsychotic Adherence Linked to More Behavioral Health Visits and Less ED Visits

Among commercially insured young people who began antipsychotic treatment after a first episode of psychosis, 19.1% met a prescription-fill threshold for adherence during the following year. Adherence was associated with fewer emergency department (ED) visits and more behavioral health outpatient visits, according to a retrospective cohort study published in JAMA Network Open.

Investigators analyzed US commercial insurance claims from 2013 through 2021. They identified 27,592 people aged 15 to 40 years with first-episode psychosis; 11,889 received a first antipsychotic prescription and entered the analytic cohort. Adherence was measured by the proportion of days covered (PDC) during 365 days of follow-up, with a PDC of at least 0.8 classified as adherent.

Patients had antipsychotic prescriptions covering an average of 43.3% of follow-up days, or 158 of 365 days. The adherence threshold was met by 2,270 of 11,889 patients (19.1%). Rates were 23.1% among those with schizophrenia spectrum disorders, 16.9% with mood disorders with psychotic features, and 13.5% with other psychotic spectrum disorders.

Compared with patients who did not meet the threshold, adherent patients had fewer ED visits (incidence rate ratio [IRR], 0.85; 95% CI, 0.81-0.90), more behavioral health outpatient visits (IRR, 1.53; 95% CI, 1.47-1.59), and more general outpatient visits (IRR, 1.07; 95% CI, 1.02-1.13). Adherence was not significantly associated with psychiatric or general hospitalization.

When antidepressants and mood stabilizers were counted alongside antipsychotics, 32.7% met the adherence threshold. The authors noted that claims show prescriptions filled rather than medication taken, and that findings from commercially insured patients may not extend to people with public insurance. The reported differences in service use were associations in a retrospective cohort study.

Source: Chi E, Sridhar S, Montesano V, Ramos J, Breitborde NJK, Seiber EE. Treatment adherence and health care utilization after a first episode of psychosis. JAMA Netw Open. 2026;9(9):e2635805. doi:10.1001/jamanetworkopen.2026.35805