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Wimalaratne I, McLay J, Menkes DB. Assessing general hospital doctors' attitudes toward psychiatric care in multicultural settings. BMC Res Notes 2024; 17:125. [PMID: 38698409 PMCID: PMC11067133 DOI: 10.1186/s13104-024-06788-7] [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: 10/12/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE Psychiatric care in general hospitals depends on collaboration with non-psychiatrist doctors. The Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH) is a two-factor scale designed to address this issue and validated in the UK in 2010. However, its applicability in contemporary, culturally diverse settings is unknown and therefore this study was aimed at determining its validity and consistency using data from our 2021 international study. Confirmatory and exploratory factor analyses were used, comparing results from our 2021 study (n = 889) with those from the 2010 UK study (n = 225). RESULTS The DACC-MH consultation subscale, but not the management subscale, aligned with data from our larger, international study. The 2-factor model failed the Chi-square goodness of fit test (χ2(19) = 53.9, p < 0.001) but had acceptable other fit indices. While the previously identified attitudinal difference between physicians and surgeons was replicated, measurement invariance for this result could not be established. Exploratory factor analysis suggested a 6-factor model, contrasting with the 2-factor model proposed in 2010 for the UK sample. The DACC-MH scale shows significant limitations when applied to a larger, international dataset. Cultural and generational differences in doctors' attitudes appear relevant and should be considered in assessing barriers to psychiatric care in general hospitals.
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Affiliation(s)
- Inoka Wimalaratne
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
- Monash Health Mental Health Programme, 126-128, Cleeland Street, Dandenong Vic, Melbourne, 3175, Australia.
| | - Jessica McLay
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - David B Menkes
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Knorr M, Hofmann AB, Miteva D, Noboa V, Rauen K, Frauenfelder F, Seifritz E, Quednow BB, Vetter S, Egger ST. Relationship Between Time of Admission, Help-Seeking Behavior, and Psychiatric Outcomes: "From Dusk Till Dawn". Front Psychiatry 2022; 13:842936. [PMID: 35573363 PMCID: PMC9091816 DOI: 10.3389/fpsyt.2022.842936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Day and time of admission influence treatment outcomes and prognosis in several medical specialties; this seems related to resources' ability. It is largely unknown whether this also applies to mental health services. We investigate the relationship between time of admission, patients' demographic and clinical profile, and treatment outcomes. METHODS Demographic and clinical profiles of admitted and discharged patients to a general psychiatric ward between January 1st, 2013 and December 31st, 2020, were analyzed. In addition, we used the last year (i.e., 2020) to monitor rehospitalization. Time of admission was defined as weekdays (working day, weekend) and dayshifts (daytime, dusk, and dawn). RESULTS During the study period, 12,449 patient admissions occurred. The mean age of the sample was 48.05 ± 20.90 years, with 49.32% (n = 6,140) females. Most admissions (n = 10,542, 84%) occurred on working days. Two-fifths of admissions (39.7%, n = 4,950) were compulsory, with a higher rate outside daytime hours. Patients had slight differences in the clinical profile, resulting from evaluating the different items of the Health of Nation Outcome Scale (HoNOS). Patients admitted on night shifts, weekends, and holidays showed a shorter length of stay; patients compulsorily admitted during daytime (disregarding the day of the week) had a longer length of stay. All patient groups achieved a robust clinical improvement (i.e., an HoNOS score reduction of around 50%), with similar readmission rates. DISCUSSION The main finding of our study is the relationship between "daytime hours" and fewer compulsory admissions, a result of the interplay between demographics, clinical characteristics, and out-of-clinic service availability (such as ambulatory psychiatric- psychological praxis; day-clinic; home-treatment). The differing clinical profile, in turn, determines differences in treatment selection, with patients admitted after office hours experiencing a higher rate of coercive measures. The shorter length of stay for out-of-office admissions might result from the hospitalization as an intervention. These results should encourage the implementation of outpatient crisis-intervention services, available from dusk till dawn.
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Affiliation(s)
- Marius Knorr
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas B Hofmann
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Dimitrina Miteva
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Vanessa Noboa
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, University San Francisco de Quito, Quito, Ecuador
| | - Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Institute for Stroke and Dementia Research, Laboratory of Experimental Stroke Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Fritz Frauenfelder
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Boris B Quednow
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, Department of Psychiatry, University of Oviedo, Oviedo, Spain
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Karpenko OA, Melikhov OG, Tyazhelnikov AA, Kostyuk GP. Diagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement? CONSORTIUM PSYCHIATRICUM 2021; 2:2-12. [PMID: 39045451 PMCID: PMC11262072 DOI: 10.17816/cp112] [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: 10/27/2021] [Accepted: 12/12/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Common mental disorders - anxiety and depression - are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. AIM To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS >7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS The proportions of patients with borderline abnormal and abnormal HADS scores (>7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS >7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS >7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS >7 met a psychiatrist through PCPh referral. CONCLUSIONS Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.
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