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van Ens W, Sanches S, Beverloo L, Swildens WE. Place-Based FACT: Treatment Outcomes and Patients' Experience with Integrated Neighborhood-Based Care. Community Ment Health J 2024; 60:1214-1227. [PMID: 38727946 PMCID: PMC11199251 DOI: 10.1007/s10597-024-01277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/27/2024] [Indexed: 06/27/2024]
Abstract
Locating specialized mental healthcare services in the neighborhood of people with severe mental illnesses (SMI) has been suggested as a way of improving treatment outcomes by increasing patient engagement and integration with the local care landscape. The current mixed methods study aimed to examine patient experience and treatment outcomes in three Flexible Assertive Community Treatment (FACT) teams that relocated to the neighborhood they served, compared to seven teams that continued to provide FACT as usual from a central office. Routine Outcome Measurement (ROM) and care use data were analyzed to compare change in treatment outcomes for patients in place-based FACT (n = 255) and FACT as usual (n = 833). Additionally, retrospective in-depth interviews were conducted with twenty patients about their experience with place-based FACT. Quantitative analysis showed mental health admission days decreased more in place-based than FACT as usual, although this difference was small. Both groups showed improved quality of life, psychosocial functioning, and symptomatic remission rates, and decreased unmet and overall needs for care. There was no change over time in met needs for care, employment, and daily activities. Qualitative analysis showed that patients experienced place-based FACT as more accessible, a better safety net, a more personal approach, better integrated with other forms of care, involving their social network, and embedded in their neighborhood and daily environment. This study showed that location and integration matter to patients, and the long term impact of place-based FACT on treatment outcomes should be explored.
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Affiliation(s)
- Welmoed van Ens
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Sarita Sanches
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
- Avans University of Applied Sciences, Breda, The Netherlands
| | | | - Wilma E Swildens
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
- Department of Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.
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2
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Murlender L, Choe K, Fernandez MA, Agrest M, Ardila-Gómez SE. 'We see they are abandoned': Social support between people discharged from long-term psychiatric hospitalizations and their neighbors in Argentina. Int J Soc Psychiatry 2024; 70:498-506. [PMID: 38160416 DOI: 10.1177/00207640231216929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Neighbors are an important component of personal social network (PSN) and despite their peripheral role and being considered as familiar strangers, they typically provide instrumental support. For people who is discharged after long-term psychiatric hospitalizations, neighbors would offer other types of social support and play a different role fostering the process of becoming full member of a given community. AIMS To analyze the effects of neighboring on both, those who have had long-term psychiatric hospitalizations and their neighbors. METHOD Data was collected between 2020 and 2021, including interviews with formal care staff of three housing support experiences in Argentina, and short testimonies from formerly discharged mental health service users living in the community and their neighbors. We analyzed the data using the Framework Method with a focus on the different aspects of social support and equity and reciprocity theories. RESULTS Results suggest that emotional support was a frequent function displayed by neighbors toward people with a history of long-term psychiatric hospitalizations, which differs from typical neighboring relationships. CONCLUSIONS Despite reciprocity was observed, users and neighbors displayed an unbalanced helping relationship.
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Affiliation(s)
- Liza Murlender
- Universidad de Buenos Aires, Facultad de Psicología, Buenos Aires, República Argentina
| | - Karen Choe
- NYU School of Global Public Health, New York, USA
| | - Marina Ayelén Fernandez
- Universidad de Buenos Aires, Facultad de Psicología, CONICET, Buenos Aires, República Argentina
| | | | - Sara Elena Ardila-Gómez
- Universidad de Buenos Aires, Facultad de Psicología, CONICET, Buenos Aires, República Argentina
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3
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Petrovic AD, Barjaktarevic AM, Kostic OZ, Dimitrijevic JM, Mijailovic SS, Gogic AD, Jankovic SM, Andjelkovic MV, Stanojevic Pirkovic MS, Parezanovic Ilic KD, Kostic MJ, Janjic VS. Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study. Open Med (Wars) 2024; 19:20240947. [PMID: 38584834 PMCID: PMC10998673 DOI: 10.1515/med-2024-0947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
Schizophrenia is a chronic mental illness with a poor quality of life (QoL). The main aim of this study was to measure the QoL and factors that affect the QoL of patients with schizophrenia placed in a social welfare institution. This cross-sectional study included 287 patients with schizophrenia who were treated in a long-stay social care institution in which QoL was assessed using five different instruments: the World Health Organization Quality of Life scale, the EuroQoL Five-Dimension-Five-Level scale (including the visual analog scale), the Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form, and the Brief Psychiatric Rating Scale. To determine the impact of patients' characteristics on score values, multiple linear regression using backward elimination was employed. Due to non-normality in the distribution of the dependent variables, a Box-Cox power transformation was applied to each dependent variable prior to conducting multiple linear regression analysis. Results revealed that patients with schizophrenia have lower QoL. Our study revealed that age, level of education, type of accommodation, type of pavilion, age of onset of the disease, number of prescribed antipsychotics, number of psychiatric comorbidities, duration of therapy, and the number of daily doses of antipsychotics are dominant contributors to the QoL in patients with schizophrenia who were treated in social welfare institution.
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Affiliation(s)
- Aleksandra D. Petrovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ana M. Barjaktarevic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olivera Z. Kostic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center for Research on Harmful Effects of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
| | - Jelena M. Dimitrijevic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sara S. Mijailovic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Andjela D. Gogic
- Department of Medical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan M. Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marija V. Andjelkovic
- Center for Research on Harmful Effects of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
- Department of Medical Biochemistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marijana S. Stanojevic Pirkovic
- Center for Research on Harmful Effects of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
- Department of Medical Biochemistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina D. Parezanovic Ilic
- Department of Physical Medicine and Rehabilitation, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina J. Kostic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center for Research on Harmful Effects of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir S. Janjic
- Center for Research on Harmful Effects of Biological and Chemical Hazards, University of Kragujevac, Kragujevac, Serbia
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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4
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García E, Ares-Lavalle G, Borelli M, Fernández MA, Agrest M, Ardila-Gómez S. [Attitudes of neighbors about the treatment and community life of people with severe mental health disorders in Argentina]. CAD SAUDE PUBLICA 2023; 39:e00083123. [PMID: 37851727 PMCID: PMC10581681 DOI: 10.1590/0102-311xes083123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 10/20/2023] Open
Abstract
A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.
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Affiliation(s)
- Elena García
- Centro de Salud Mental Comunitaria E. Pichón Riviere, La Plata, Argentina
| | | | - Mariana Borelli
- Hospital José A. Estéves, Ministerio de Salud, Temperley, Argentina
| | - Marina A Fernández
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Martín Agrest
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Proyecto Suma, Buenos Aires, Argentina
| | - Sara Ardila-Gómez
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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5
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Wu MC, Hung CC, Fang SC, Lee TSH. Change of home visit frequency by public health nurses predicts emergency escorts for psychiatric patients living in the community: A retrospective medical record review. Front Public Health 2023; 11:1066908. [PMID: 36844831 PMCID: PMC9948617 DOI: 10.3389/fpubh.2023.1066908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background Improper or insufficient treatment of mental health illness harms individuals, families, and society. When psychiatric treatment shifts from a hospital-based to a community-based health care system, risk management is essential to the provision of effective care. Objective We examine whether an upgrade in home visit frequency of psychiatric patients as identified by public health nurses can predict the subsequent need for emergency escort services for medical treatment. Design A 2-year retrospective medical record review. Settings A district of New Taipei City in Taiwan. Participants A total of 425 patients with a diagnosed mental health illness cared for through home visits by public health nurses from January 2018 to December 2019. Methods We accessed the Ministry of Health and Welfare's psychiatric care management information system to identify a set of medical records, and analyzed these records using chi-square and regression analyses. Results The analyses indicated that the groups experiencing the greatest need for emergency escort services were: male, 35-49 years old, with a senior high school level of education, without a disability identification card, with a schizophrenia diagnosis, and had been reported by the nurse as having progressed to a serious level. Nurses' increased frequency of home visits (an indicator that the patient's overall condition was worsening) and nurses' reports of increased severity of problems were significant predictors of the need for emergency escort services. Conclusions The nurses' adjustment of visit frequency based on the results of the visit assessment predicts the need for emergency escort services for mental patients. The findings support not only the professional roles and functions of public health nurses, but also the importance of strengthening psychiatric health community support services.
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Affiliation(s)
- Meng-Chieh Wu
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chun Hung
- Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan,Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan,*Correspondence: Tony Szu-Hsien Lee ✉
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6
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He XY, Migliorini C, Huang ZH, Wang F, Zhou R, Chen ZL, Xiao YN, Wang QW, Wang SB, Harvey C, Hou CL. Quality of life in patients with schizophrenia: A 2-year cohort study in primary mental health care in rural China. Front Public Health 2022; 10:983733. [PMID: 36159297 PMCID: PMC9495714 DOI: 10.3389/fpubh.2022.983733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/17/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Quality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time. Methods Patients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE). Results Four hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia. Conclusion According to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.
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Affiliation(s)
- Xiao-Yan He
- Liuzhou Worker's Hospital, Liuzhou, China,Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China
| | - Christine Migliorini
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Zhuo-Hui Huang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China
| | - Fei Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China
| | - Rui Zhou
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China
| | | | | | - Qian-Wen Wang
- Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shi-Bin Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Cai-Lan Hou
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Center, Guangzhou, China,*Correspondence: Cai-Lan Hou ;
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7
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Lin YY, Lin ML, Huang YH, Ma WF, Yen WJ, Lee SK. Effects of Rehabilitation Models on Self-Stigma among Persons with Mental Illness. Healthcare (Basel) 2022; 10:healthcare10020213. [PMID: 35206828 PMCID: PMC8871629 DOI: 10.3390/healthcare10020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/04/2022] Open
Abstract
Social stigma is inevitable for mentally ill patients, but how patients treat themselves is a priority for rehabilitation and an important buffer mechanism. This study thus aimed to measure the effectiveness of rehabilitation models for improving self-stigma. This quasi-experimental research design applied purposeful sampling. The participants (n = 250) were persons with mental illness who received rehabilitation treatment in central Taiwan. They were divided into community- (n = 170) and institution-based (n = 80) rehabilitation groups. The Internalized Stigma of Mental Illness Scale was evaluated at the time of recruitment, and a follow-up was conducted after 1 and 3 months. A generalized estimation equation was used in data analysis to measure whether self-stigma improved with the rehabilitation model and time, and to test the effect of different rehabilitation models on participants’ self-stigma improvement. The study found that the self-stigma of patients receiving CBR improved more than that of those receiving IBR when behavioral problems, education, OT level, sex, and first-time self-stigma were controlled. Returning to the community is the goal of rehabilitation for patients with mental illness, but IBR still dominates the rehabilitation model in Taiwan. Thus, it is necessary to continue promoting CBR plans for future mental health policies.
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Affiliation(s)
- Yao-Yu Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou 54249, Taiwan; (Y.-Y.L.); (Y.-H.H.); (S.-K.L.)
| | - Mei-Ling Lin
- College of Nursing, Huangkung University, Taichung 433304, Taiwan;
| | - Yao-Hui Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou 54249, Taiwan; (Y.-Y.L.); (Y.-H.H.); (S.-K.L.)
| | - Wei-Fen Ma
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
| | - Wen-Jiuan Yen
- Department of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan
- Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence:
| | - Shih-Kai Lee
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou 54249, Taiwan; (Y.-Y.L.); (Y.-H.H.); (S.-K.L.)
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8
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Finkel D, Bülow PH, Wilińska M, Jegermalm M, Torgé CJ, Ernsth Bravell M, Bülow P. Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 years and older: shorter-stay versus longer-stay. Int J Geriatr Psychiatry 2021; 36:1223-1230. [PMID: 33577096 DOI: 10.1002/gps.5515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI. METHODS In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N = 118) and longer stays (N = 117). RESULTS After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced 're-institutionalization' to another care setting, as opposed to living independently. CONCLUSIONS The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life.
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Affiliation(s)
- Deborah Finkel
- Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden.,Department of Psychology, Indiana University Southeast, USA
| | - Pia H Bülow
- Department of Social Work, School of Health and Welfare, Jönköping University, Sweden.,Department of Social Work, University of the Free State, South Africa
| | - Monika Wilińska
- Department of Social Work, School of Health and Welfare, Jönköping University, Sweden
| | - Magnus Jegermalm
- Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden.,Department of Social Work, School of Health and Welfare, Jönköping University, Sweden.,Department of Social Work, Ersta Sköndal Bräcke University College, Sweden
| | - Cristina Joy Torgé
- Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden
| | - Marie Ernsth Bravell
- Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden
| | - Per Bülow
- Department of Social Work, School of Health and Welfare, Jönköping University, Sweden.,Regional Forensic Psychiatric Hospital, Vadstena, Sweden.,Psychiatric Clinic, Ryhov County Hospital, Region Jönköping County, Sweden
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9
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Bülow P, Topor A, Andersson G, Denhov A, Stefansson CG. The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP): A 10-year Follow-up 2004-2013. Community Ment Health J 2021; 57:1121-1129. [PMID: 33191458 PMCID: PMC8217026 DOI: 10.1007/s10597-020-00740-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022]
Abstract
Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004-2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.
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Affiliation(s)
- Per Bülow
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Regional Forensic Psychiatric Hospital, Vadstena, Sweden.
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway.,Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Gunnel Andersson
- Department of Social Work, Stockholm University, Stockholm, Sweden
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10
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Sleep disturbance and quality of life in clinically stable inpatients with schizophrenia in rural China. Qual Life Res 2020; 29:2759-2768. [DOI: 10.1007/s11136-020-02541-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 01/20/2023]
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11
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Koopmans AB, van Hoeken D, Clarke DE, Vinkers DJ, van Harten PN, Hoek HW. Proxy WHO Disability Assessment Schedule 2.0 Is Clinically Useful for Assessing Psychosocial Functioning in Severe Mental Illness. Front Psychiatry 2020; 11:303. [PMID: 32351419 PMCID: PMC7174765 DOI: 10.3389/fpsyt.2020.00303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
AIMS This study explores how well the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assesses problems with psychosocial functioning in patients with severe mental illness (SMI). Further, we assessed the relationships between psychosocial functioning and psychopathology, medication side effects, treatment setting, and quality of life. METHODS We performed an observational, cross-sectional study on the island of Curaçao to assess psychosocial functioning in 77 patients with SMI; they mainly had psychotic disorders. We interviewed their healthcare providers using the proxy version of the WHODAS 2.0. In addition, patients were examined for psychiatric symptoms, medication side effects (including drug-induced movement disorders), and quality of life. Associations were examined with Spearman's rank correlation (ρ). RESULTS Difficulties in psychosocial functioning were reported by patients with SMI in the WHODAS 2.0 domains of understanding and communicating [mean (M)=34.5, standard deviation (SD)=18.6), participation in society (M=25.5, SD=15.6), and getting along with people (M=24.1, SD=16.1)]. Notably, outpatients had more problems participating in society than inpatients (M=33.6, SD=18.5 versus M=23.2, SD=14.1, p=0.03). A positive correlation was observed between drug-induced parkinsonism and the WHODAS 2.0 total score (ρ =0.30; p=0.02), as well as with various subscales, getting around, and household activities. CONCLUSION The proxy version of the WHODAS 2.0 is clinically useful for patients with severe mental illness. The highest scores on the WHODAS 2.0 were found in domains related to interactions with other people and to participation in society. Inpatient status appeared to aid participation in society; this might be due to living in the sheltered clinic environment and its associated daily activities. We further found that drug-induced parkinsonism was associated with a broad spectrum of psychosocial disabilities. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02713672; retrospectively registered in February 2016.
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Affiliation(s)
- Anne B Koopmans
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Daphne van Hoeken
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Diana E Clarke
- Division of Research, American Psychiatric Association, Arlington, VA, United States.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - David J Vinkers
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Peter N van Harten
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.,Innova, Psychiatric Centre GGz Centraal, Amersfoort, Netherlands
| | - Hans W Hoek
- Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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12
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The association between family dysfunction and admission to an acute mental health inpatient unit: a prospective study. Ir J Psychol Med 2019; 39:340-350. [PMID: 31511120 DOI: 10.1017/ipm.2019.41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES With the shift from deinstitutionalization to community care in mental health services, relatives of persons with severe and enduring mental illnesses have had to take over the role as primary caregivers. Disturbed family dynamics have been observed within families with an 'ill' member. Although schizophrenia and related mental illnesses are biologically based disorders, environmental stress (including stress within family relationships) plays a major role in the onset and maintenance of symptoms. With this study, we assume that family dynamics play a central role in the course of severe psychiatric illness and hypothesized that dysfunction within family systems is a prognostic indicator of hospitalization in the course of schizophrenia/bipolar and schizoaffective disorders. METHODS Prospective, observational cohort study evaluating family functioning of 121 patients (schizophrenia/bipolar and schizoaffective disorder) from community at baseline and followed-up over 12-month period after recruitment. Measurements included demographics, diagnosis, Family Assessment Device - General Functioning, Perceived Criticism Scale, Brief Psychiatric Rating Scale, Global Assessment of Functioning and Social Support Questionnaire-6. RESULTS Significant differences found between patients admitted and not admitted during the 12-month time period for age (p = 0.003), Brief Psychiatric Rating Scale (BPRS; p = 0.026), Family Assessment Device - General Functioning (FAD-GF; p = 0.007) and Social Support Questionnaire total satisfaction level (p = 0.042) at baseline. Bivariate analysis showed that those admitted into hospital were younger with a higher BPRS score, less social satisfaction and disturbed family dynamics. FAD-GF (p = 0.006) and age (p = 0.022) were significant independent predictors for admission. CONCLUSION This provides further evidence supporting importance of promoting better family functioning through modified family dynamics, integrating and involving family into the care of such patients.
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