Gender differences in needs and care of severely mentally ill persons: findings from a Swedish cross-sectional and longitudinal study

Maternal Schizophrenia and the Risk of a Childhood Chronic Condition

BACKGROUND AND HYPOTHESIS

Maternal schizophrenia heightens the risk for certain perinatal complications, yet it is not known to what degree future childhood chronic health conditions (Childhood-CC) might arise.

STUDY DESIGN

This population-based cohort study using health administrative data from Ontario, Canada (1995-2018) compared 5066 children of mothers with schizophrenia to 25 324 children of mothers without schizophrenia, propensity-matched on birth-year, maternal age, parity, immigrant status, income, region of residence, and maternal medical and psychiatric conditions other than schizophrenia. Cox proportional hazard models generated hazard ratios (HR) and 95% confidence intervals (CI) for incident Childhood-CCs, and all-cause mortality, up to age 19 years.

STUDY RESULTS

Six hundred and fifty-six children exposed to maternal schizophrenia developed a Childhood-CC (20.5/1000 person-years) vs. 2872 unexposed children (17.1/1000 person-years)-an HR of 1.18, 95% CI 1.08-1.28. Corresponding rates were 3.3 vs. 1.9/1000 person-years (1.77, 1.44-2.18) for mental health Childhood-CC, and 18.0 vs. 15.7/1000 person-years (1.13, 1.04-1.24) for non-mental health Childhood-CC. All-cause mortality rates were 1.2 vs. 0.8/1000 person-years (1.34, 0.96-1.89). Risk for children exposed to maternal schizophrenia was similar whether or not children were discharged to social service care. From age 1 year, risk was greater for children whose mothers were diagnosed with schizophrenia prior to pregnancy than for children whose mothers were diagnosed with schizophrenia postnatally.

CONCLUSIONS

A child exposed to maternal schizophrenia is at elevated risk of chronic health conditions including mental and physical subtypes. Future research should examine what explains the increased risk particularly for physical health conditions, and what preventive and treatment efforts are needed for these children.

Treatment Goals for Patients with Schizophrenia - A Narrative Review of Physician and Patient Perspectives

INTRODUCTION

There are many possible treatment goals for patients with schizophrenia. Two major perspectives on treatment goals are the patient's and the physician's perspective. Patient-centered treatment mandates that an individual patient's treatment goals are taken into account when treatment is planned. In this narrative review, we address the commonalities and differences of the patient's and physician's perspectives.

METHODS

We searched for literature on treatment goals for patients with schizophrenia from the last 10 years.

RESULTS

Fifty-two relevant records were identified, 4 of which directly compare patient's and physician's perspectives. Two further articles used the same set of goals to ask patients or physicians for their assessment.

DISCUSSION

Agreement between patients and physicians regarding valuation of treatment goals was high. However, physicians tended to put more emphasis on the classical "textbook" goals of symptom resolution and functioning, while patients stressed well-being and quality of life more. Results on treatment goals from patients are difficult to generalize, since recruiting representative patient samples is challenging and patient subgroups may have differing priorities.

E-IMR: e-health added to face-to-face delivery of Illness Management & Recovery programme for people with severe mental illness, an exploratory clustered randomized controlled trial

BACKGROUND

E-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR).

METHOD

In this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T₀), halfway (T₁), and at twelve months (T₂). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group.

RESULTS

Notwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T₁, and for general health perception (p = .02) at T₂, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T₁ and T₂, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T₁. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect.

CONCLUSION

Because of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention.

TRIAL REGISTRATION

The Dutch Trial Register ( NTR4772 ).

Health care use, drug treatment and comorbidity in patients with schizophrenia or non-affective psychosis in Sweden: a cross-sectional study

BACKGROUND

This study investigated the prevalence of schizophrenia (ICD-10 F 20) and of other non-affective psychosis (NAP, ICD-10 F 21 - F 29) in Sweden. It further assessed health care use, comorbidity and medication for these patient groups. Most studies either have a study population of patients with strictly defined schizophrenia or a psychosis population of which strict schizophrenia cases form a smaller set. The present study permits comparison of the two mutually exclusive patient groups using data at the individual level in the diagnosis of non-affective psychosis, use of health care, medical treatment and comorbidity by diagnosis or medical treatment.

METHODS

In 2012, data were extracted from a regional registry containing patient-level data on consultations, hospitalisations, diagnoses and dispensed drugs for the total population in the region of Stockholm (2.1 million inhabitants). The size of the total psychosis population was 18,769, of which 7284 had a diagnosis of schizophrenia. Crude prevalence rates and risk rates with 95% confidence intervals were calculated.

RESULTS

In 2012, the prevalence of schizophrenia and NAP was 3.5/1000 and 5.5/1000, respectively. Schizophrenia was most common among patients aged 50-59 years and NAP most common among patients aged 40-49 years. Schizophrenia patients used psychiatric health care more often than the NAP patients but less overall inpatient care (78.6 vs. 60.0%). The most prevalent comorbidities were substance abuse/dependence (7.9% in the schizophrenia group vs. 11.7% in the NAP group), hypertension (7.9 vs. 9.7%) and diabetes (6.9 vs. 4.8%). The parenteral form of long-acting injectable antipsychotics was more often dispensed to patients with schizophrenia (10 vs. 2%).

CONCLUSIONS

This study, analysing all diagnoses recorded in a large health region, confirmed prevalence rates found in previous studies. Schizophrenia patients use more psychiatric and less overall inpatient health care than NAP patients. Differences between the two patient groups in comorbidity and drug treatment were found. The registered rates of a substance abuse/dependence diagnosis were the most common comorbidity observed among the patients investigated. The observed differences between the schizophrenia and the NAP patients in health care consumption, comorbidity and drug treatment are relevant and warrant further studies.

Assessment of Needs: Differences between male and female patients with schizophrenia needs in psychiatric hospitals in Baghdad city

BACKGROUND

Gender differences are one of the most important and crucial subjects in evaluating the nursing care as well as mental health care system for psychiatric patients especially patients with schizophrenia.

AIMS

We aimed to identify differences in needs of male and female patients with schizophrenia in psychiatric hospitals in Baghdad city and its relationship with some variables.

METHOD

A descriptive, analytical design that was carried out by using Camberwell needs assessment, short appraisal schedule, self-report version (CANSAS-P) after translating to Arabic.

RESULTS

Results indicated that there were a lot of unmet needs of male and female patients with schizophrenia, according to the entire CANSAS-P domains especially psychological symptoms. Differences were found in types of needs as the majority of men have more social needs while females was found to be more occupied with their fears and need safety.

CONCLUSION

there were differences in types of need between male and female patients with schizophrenia; needs were affected by some variables such as educational level, first 10 days of admission and family visiting.

Measuring Users' Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study

Background

Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice.

Objective

The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST).

Methods

Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework.

Results

A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution.

Conclusions

Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact.

Rehabilitation Needs of Chronic Female Inpatients Attending Day-care in a Tertiary Care Psychiatric Hospital

BACKGROUND

Female patients hospitalized for a long duration in psychiatric hospitals are a special population with unique needs.

AIMS AND OBJECTIVES

To assess rehabilitation needs of chronic female inpatients attending psychiatric rehabilitation services in a tertiary care psychiatric hospital.

MATERIALS AND METHODS

Rehabilitation needs of nine chronic female inpatients were assessed with an interview schedule developed by expert consensus. The needs were elicited from the patients. Perspectives of nursing staff, vocational instructors, and treating psychiatrists were also sought.

RESULTS AND CONCLUSION

Most patients expressed the need for more incentives for working in day-care, variety in food and grooming items. The nursing staff felt many patients could be placed outside, and the family members should come more frequently to meet them. Vocational instructors felt that patients need more incentives, variety in food and work. Treating psychiatrists said that major barriers in discharging and placing them were nonavailability or poor involvement of family members. Services like supported housing, supported education and supported employment are necessary to cater to their complex needs.

Gender-related differences in the human rights needs of patients with mental illness

BACKGROUND

Individuals with mental illness commonly experience human rights violations while seeking to meet their basic needs. There is lack of research in developing countries on gender-related differences in human rights needs.

PURPOSE

This study investigated gender differences in perceived human rights needs at the family and community levels in individuals with mental illness in India.

METHODS

This descriptive study surveyed 100 asymptomatic individuals with mental illness at a tertiary care center. Subject selection employed a random sampling method. Data were collected using face-to-face interviews based on a structured needs assessment questionnaire. Data were analyzed and interpreted using descriptive and inferential statistics.

RESULTS

Subjects enjoyed a satisfactory level of fulfillment in the physical dimension of human rights needs, which included food, housing, and clothing. Men expressed lower satisfaction than women with perceived human rights needs fulfillment in the emotional dimension. This included fear of family members (χ = 9.419, p < .024) and being called derogatory names (χ = 8.661, p < .034). Women expressed lower satisfaction than men with perceived human rights needs fulfillment in social and ethical dimensions. The former included freedom to leave the home (χ = 11.277, p < .010), and the latter included sexual abuse by family members (χ = 9.491, p < .019). Men felt more discriminated than women due to perceptions of mental illness in the community domain (χ = 10.197, p < .037).

CONCLUSION

This study suggests that family members and communities need to be educated regarding the human rights needs of people with mental illness and that legislation must be strengthened to meet the human rights needs of this disadvantaged population.

Women and psychosis

BACKGROUND

There are subtle differences in the presentation of psychosis that depend on the biological sex of the person exhibiting the symptoms. Because much of the early research in the field was conducted on male animals and on men, several issues of importance to women have been relatively neglected until recently. Current research into psychotic illness is beginning to analyze results for men and women separately and greater emphasis on qualitative methods has allowed the experiences of women patients to be documented.

METHODS

The last decade of research into the many facets of psychosis in women were reviewed for this paper by introducing the relevant search terms into PubMed, PsycINFO and SOCINDEX.

RESULTS

Subtle differences are reported in several areas, with important ramifications for treatment.

CONCLUSIONS

It is important for service providers to devise treatment programs that address the different needs of the two sexes. Effective treatment of women with psychosis is especially important in that these women are often mothers, whose well being impacts on the health of the next generation.

Sex differences in the disability associated with mental disorders

PURPOSE OF REVIEW

It is well established that women have a higher prevalence of depression and anxiety disorders, but sex differences in the disability associated with depression and anxiety disorders have been less well researched. Earlier studies suggested that women were more disabled by their depression than were men. Studies of schizophrenia, in contrast, have always found that men were more disabled. Recent studies cast new light on this topic and suggest that sex differences in the disability associated with mental disorders may be more consistent than previously thought.

RECENT FINDINGS

Two general population studies found that men (and boys) with depression or anxiety disorders (or symptoms) reported greater impairment in everyday functioning and social relationships than women with depression and anxiety. These findings are consistent with the research on psychotic disorders and with much of the research on sex differences in long-term sickness absence due to psychiatric disorder.

SUMMARY

Men experience more functional and social impairment in association with episodes of depression, anxiety, and psychosis than their female counterparts. The greater social isolation among men with mental disorders may be attributable to male reticence about disclosing emotional distress, limiting their access to support.