Epidemiology of psychiatric care of patients with severe mental disorders in Italy. Rationale and design of a prospective study, and characteristics of the cohort. Italian Collaborative Study Group

Poor longitudinal continuity of care is associated with an increased mortality rate among patients with mental disorders: results from the French National Health Insurance Reimbursement Database

BACKGROUND

Research on the impact of the continuity of care (COC) on health outcomes in patients with mental illness is limited. This observational study examined whether the longitudinal COC is associated with a decreased likelihood of death among patients with mental disorders in the French general population.

METHOD

Data were derived from the French National Health Insurance (NHI) reimbursement database. Patients with any mental disorder who visited a psychiatrist at least twice within 6 months were included. The primary endpoint was death by all causes. We measured longitudinal COC with a psychiatrist twice a year between 2007 and 2010, using the COC index developed by Bice and Boxerman. The COC index was analysed as a time-dependent variable in a survival analysis after adjustments for age, gender and stratifying on comorbidities and social status.

RESULTS

Among 14,515 patients visiting a psychiatrist at least twice in 6 months and tracked over 3 years, likelihood of death was significantly lower in patients with higher continuity of care (hazard ratio for an increase in 0.1 of continuity, adjusted for age, sex, and stratified on comorbidities and social status: 0.83 [0.83-0.83]), particularly in those with bipolar disorder, major depressive disorder and schizophrenia.

CONCLUSION

Improving longitudinal continuity of care in mental health care may contribute to substantially decrease mortality.

[The effectiveness of psychosocial care centers for the mentally ill in a medium-sized city in southern Brazil: a stratified analysis]

The objective was to analyze the effectiveness of Psychosocial Care Centers (PCCs) for persons with mental disorders in Pelotas, Rio Grande do Sul State, Brazil. This was a prospective cohort study with users of the centers, based on two home visits. Three treatment exposure variables and two health status variables were compared and stratified according to treatment modality and time attending the health service. We interviewed 1,013 patients on the first visit and 875 on the second. The most frequent diagnoses were mood disorder (39%), schizophrenia (24%), and neuroses (13%). More than 50% were receiving intensive or semi-intensive care, and nearly 60% had attended the center for at least three years. There was a significant reduction in crisis reports (p = 0.000) and fewer hospitalizations among those in intensive treatment (p = 0.002) and with longer time attending the center (p = 0.003). Among non-intensive patients, there was a decrease in the use of medication (p = 0.032) and increased participation in groups (p = 0.000). The Psychosocial Care Centers can be considered effective for persons with mental disorders.

The impact of professional and social network support on the burden of families of patients with schizophrenia in Italy

OBJECTIVE

(a) To explore burden related to caregiving and support received from professionals and social network in relatives of patients with schizophrenia in Northern, Central and Southern Italy; and (b) to test whether a higher level of family burden is associated with a lower level of professional and social network support.

METHOD

Seven hundred and nine patients with schizophrenia and their key-relatives were consecutively recruited in 30 Italian mental health departments. Data were collected on: (a) patients' clinical status and levels of disability; (b) relatives' burden, social and professional support; (c) interventions received by patients and their families.

RESULTS

Family burden was found lower in Northern Italy. However, after controlling for psychosocial interventions, differences in family burden among the three geographical areas disappeared. Family burden was associated with patients' levels of disability and manic/hostility symptoms, and with professional and social network support received by the family.

CONCLUSION

Professional and social network support represent crucial resources to reduce family burden in schizophrenia.

Italian psychiatric reform 20 plus years after

OBJECTIVE

To describe the current situation of mental health care in Italy and implementation of mental health reform legislation.

METHOD

The current mental health care system and studies of the implementation of psychiatric reform are described.

RESULTS

The 1978 reform law inaugurated fundamental changes in the care system (prohibiting admissions to state mental hospitals, stipulating community-based services, allowing hospitalization only in small general-hospital units). Uneven reform implementation was reported initially. However, in 1984 in- and out-patient services in the community were available to >80% of the population. There is a comprehensive network of in- and out-patient, residential and semi-residential facilities. Recently, services have been jeopardized by the managed-care revolution, and non-profit organizations supplement the public system (especially residential care, employment and self/mutual help).

CONCLUSION

Implementation of the psychiatric reform law has been accomplished, and the year 1998 marked the very end of the state mental hospital system in Italy.