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Xin Y, Zhu JL, Huang QZ, Chen Y, Chen C, Lu W. Medical expenses of patients with severe mental disorders in Beijing, China. Public Health 2024; 229:50-56. [PMID: 38401192 DOI: 10.1016/j.puhe.2024.01.022] [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: 07/16/2023] [Revised: 12/13/2023] [Accepted: 01/23/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Mental health has become a significant public health problem that impacts both economic and social development, with severe mental disorders (SMDs) being the top priority. Over recent years, Beijing, China, has introduced several policies to reduce the economic burden on patients with mental health disorders. The aim of this study was to investigate the current status and composition of patients' medical expenses following the introduction of multiple medical policies, explore the factors that may impact the utilisation of medical services and provide a reference and basis for subsequent policy improvements. STUDY DESIGN Multistage sampling was used to select a representative study population. A retrospective survey was used to collect patient information and data on medical expenses in 2019. METHODS Descriptive statistics were applied to analyse the current status of patients' medical expenses, and a two-part model was used to examine the factors influencing healthcare utilisation and to model predicted expenses. RESULTS Among 4940 participants, the average outpatient expenses of patients with SMD who incurred medical expenses were 8373.61 Yuan, and the average hospitalisation expenses were 81,594.05 Yuan. The out-of-pocket expenses were 29.22% of outpatient expenses and 8.13% of inpatient expenses. Factors such as age, household status, economic status, marital status, participation in the Community Free-Medication Service (CFMS) and the type of disease diagnosed influenced the differences in medical expenses and utilisation of services. CONCLUSIONS The medical expenses of patients with SMD in Beijing are high, but a number of introduced policies have effectively reduced these costs for patients. Future studies should focus on the impact of factors such as age, economic status, participation in the CFMS and the type of disease diagnosed on medical expenses.
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Affiliation(s)
- Y Xin
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
| | - J-L Zhu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China.
| | - Q-Z Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - Y Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, People's Republic of China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - C Chen
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
| | - W Lu
- School of Public Health, Capital Medical University & Research Center for Capital Health Management and Policy, Beijing, People's Republic of China; Research Center for Capital Health Management and Policy, Beijing, People's Republic of China
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Melvin CL, Barnoux M, Alexander R, Roy A, Devapriam J, Blair R, Tromans S, Shepstone L, Langdon PE. A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience. BJPsych Open 2022; 8:e187. [PMID: 36268640 PMCID: PMC9634562 DOI: 10.1192/bjo.2022.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. AIMS The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. METHOD A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). RESULTS A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. CONCLUSIONS There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
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Affiliation(s)
| | | | - Regi Alexander
- Broadland Clinic and Community Forensic Learning Disability Team, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Ashok Roy
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; and Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK
| | - John Devapriam
- Trust Headquarters, Herefordshire and Worcestershire Health and Care NHS Trust, UK
| | - Robert Blair
- School of Computing Sciences, University of East Anglia, UK
| | - Samuel Tromans
- Adult Learning Disabilities Service, Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK; and Research and Development, Herefordshire and Worcestershire Health and Care NHS Trust, UK
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Shooshtari S, Brownell M, Mills RSL, Dik N, Yu DCT, Chateau D, Burchill CA, Wetzel M. Comparing Health Status, Health Trajectories and Use of Health and Social Services between Children with and without Developmental Disabilities: A Population-based Longitudinal Study in Manitoba. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:584-601. [DOI: 10.1111/jar.12253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Shahin Shooshtari
- Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
- St. Amant Research Centre; Winnipeg MB Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy; Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
| | - Rosemary S. L. Mills
- Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
| | - Natalia Dik
- Manitoba Centre for Health Policy; Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
| | - Dickie C. T. Yu
- Department of Psychology; Faculty of Arts; University of Manitoba; Winnipeg MB Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy; Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
| | - Charles A. Burchill
- Manitoba Centre for Health Policy; Department of Community Health Sciences; College of Medicine; University of Manitoba; Winnipeg MB Canada
| | - Monika Wetzel
- Department of Family Social Sciences; Faculty of Human Ecology; University of Manitoba; Winnipeg MB Canada
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Hensel JM, Lunsky Y, Dewa CS. The mediating effect of severity of client aggression on burnout between hospital inpatient and community residential staff who support adults with intellectual disabilities. J Clin Nurs 2013; 23:1332-41. [PMID: 24128052 DOI: 10.1111/jocn.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities (ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. BACKGROUND Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. DESIGN This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. METHODS Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. RESULTS Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion (EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. CONCLUSIONS Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. RELEVANCE TO CLINICAL PRACTICE There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe.
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Affiliation(s)
- Jennifer M Hensel
- Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Shooshtari S, Martens PJ, Burchill CA, Dik N, Naghipur S. Prevalence of Depression and Dementia among Adults with Developmental Disabilities in Manitoba, Canada. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2011; 2011:319574. [PMID: 22295184 PMCID: PMC3263837 DOI: 10.1155/2011/319574] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 05/19/2011] [Indexed: 05/31/2023]
Abstract
Study Objective. To estimate and compare the prevalence of dementia and depression among adults with and without developmental disabilities (DDs). Methods. We linked data from several provincial administrative databases to identify persons with DDs. We matched cases with DD with persons without DD as to sex, age, and place of residence. We estimated the prevalence of dementia and depression and compared the two groups using the Generalized Estimating Equations (GEEs) technique. Results. The estimated prevalence of depression and dementia among younger adults (20-54) and older adults (50+) with DD was significantly higher than the estimated rates for the matched non-DD group (Depression: younger adults: RR = 2.96 (95% CI 2.59-3.39); older adults: RR = 2.65 (95% CI 1.84-3.81)), (Dementia: younger adults: RR = 4.01 (95% CI 2.72-5.92); older adults: RR = 4.80 (95% CI 2.48-9.31)). Conclusion. Significant disparities exist in mental health between persons with and without DDs.
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Affiliation(s)
- Shahin Shooshtari
- Departments of Family Social Sciences and Community Health Sciences, University of Manitoba and St. Amant Research Centre, Manitoba, Canada R3T 2N2
| | - Patricia Joan Martens
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3E 3P5
| | - Charles A. Burchill
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3E 3P5
| | - Natalia Dik
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada R3E 3P5
| | - Saba Naghipur
- Faculty of Science, University of Manitoba, Manitoba, Canada R3T 2N2
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Lunsky Y, Balogh R. Dual diagnosis: A national study of psychiatric hospitalization patterns of people with developmental disability. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:721-8. [PMID: 21070700 DOI: 10.1177/070674371005501106] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report national demographics and diagnostic profiles of people with developmental disability hospitalized for psychiatric reasons, and to contrast results to psychiatric hospitalizations among patients with no comorbid developmental disability. METHOD People with developmental disability across Canada were identified using data administered by the Canadian Institute for Health Information. Among this cohort of people with developmental disability, records of hospitalization for psychiatric reasons were aggregated for the 2005/06 fiscal year (April 2005 to March 2006). Descriptive statistics on province of residence, age, sex, specific diagnoses, length of stay, and hospitalization frequency were calculated and compared with people without developmental disability. RESULTS In Canada, people with developmental disability were hospitalized a total of 8378 times in 2005/06; among these, 3478 (42%) were for psychiatric conditions. The number of people with developmental disability hospitalized for a psychiatric condition represents about 2% of the general population hospitalized for such conditions. Among people with developmental disability hospitalized for a psychiatric condition most were men and people aged between 15 and 34 years. For almost all psychiatric disorder categories, people with developmental disability were hospitalized at rates significantly different than their counterparts without developmental disability. Lengths of hospital stays for psychiatric conditions were very similar when comparing the study groups; however, people with developmental disability were more likely to have 2 or more hospitalizations during the year. CONCLUSIONS People with developmental disability display unique hospitalization patterns, compared with the general population.
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Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario.
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Cleaver S, Ouellette-Kuntz H, Sakar A. Participation in intellectual disability research: a review of 20 years of studies. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:187-193. [PMID: 20146739 DOI: 10.1111/j.1365-2788.2010.01256.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Researchers have noted difficulties in attracting adequate numbers of participants with intellectual disabilities (ID) to their studies. METHODS This study was a review of participation by adults with ID in research conducted in South Eastern Ontario over a 20-year period (1987-2006). Original research studies were identified by local investigators and then reviewed for inclusion and exclusion criteria. The report of each study was then reviewed by three reviewers and key information was extracted. The extent of study participation was calculated using three methods and compared along with key design characteristics. RESULTS Nine studies met all inclusion/exclusion criteria and provided sufficient data to calculate participation. Among the studies there was a variety of purposes, research designs and recruitment strategies. Using the participant/approached calculation, participation varied between 41.8% and 100%. Higher participation was observed in studies where investigators had direct access to participants, the data collection was non-invasive and consent was required from substitute decision-makers only. There was no clear trend of increasing or decreasing participation over time. CONCLUSIONS Researchers seeking the participation of adults with ID in their studies must incorporate factors influencing participation into study designs to ensure robust results and effective use of research resources.
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Affiliation(s)
- S Cleaver
- Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Preti A, Rucci P, Santone G, Picardi A, Miglio R, Bracco R, Norcio B, de Girolamo G. Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy. Psychol Med 2009; 39:485-496. [PMID: 18578893 DOI: 10.1017/s0033291708003607] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy. METHOD Sociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales. RESULTS Non-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions. CONCLUSIONS In a mixed, public-private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted.
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Affiliation(s)
- A Preti
- Department of Psychology, University of Cagliari, Cagliari, Italy
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Chaplin R. Annotation: New research into general psychiatric services for adults with intellectual disability and mental illness. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:189-199. [PMID: 19067781 DOI: 10.1111/j.1365-2788.2008.01143.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND There are a variety of models for the mental health care of adults with comorbid intellectual disability (ID) and mental illness. There has been a long-running debate as to whether this should be provided by general psychiatric or specialised ID services. A previous review concluded that there was no clear evidence to support either model with research being often of a poor quality, lacking replication, and outcome measures were often inappropriate or varied between studies. This review aims assess differences in outcome for patients with ID and mental disorders treated in general or specialised ID mental health services. METHOD A literature review was conducted using electronic databases and websites of ID and mental health organisations to locate all references where people with ID receive mental health care in general psychiatric services from 2003. No meta-analysis was attempted because of the divergent nature of the studies. RESULTS People with ID (especially severe ID) have reduced access to general psychiatric services. General psychiatric inpatient care is unpopular especially with carers but can be improved by providing specially trained staff and in-reach from community ID teams. Opportunities may exist to enhance the care of people with borderline intellectual functioning within general psychiatric services. CONCLUSIONS Although no new randomised controlled trials have been published, the weight of research is accumulating to suggest that provision of general psychiatric services without extra help is not sufficient to meet the needs of people with ID.
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Affiliation(s)
- R Chaplin
- Neill Unit, Warneford Hospital, Oxford, UK and Royal College of Psychiatrists' Research and Training unit, Standon House, London, UK.
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Lunsky Y, Bradley E, Durbin J, Koegl C. A comparison of patients with intellectual disability receiving specialised and general services in Ontario's psychiatric hospitals. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:1003-1012. [PMID: 18341526 DOI: 10.1111/j.1365-2788.2008.01049.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Over the years, the closure of institutions has meant that individuals with intellectual disabilities (IDs) must access mainstream (i.e. general) mental health services. However, concern that general services may not adequately meet the needs of patients with ID and mental illness has led to the development and implementation of more specialised programmes. This study compares patients with ID receiving specialised services to patients with ID receiving general services in Ontario's tertiary mental healthcare system in terms of demographics, symptom profile, strengths and resources and clinical service needs. METHOD A secondary analysis of Colorado Client Assessment Record data collected from all tertiary psychiatric hospitals in the province was completed for all 371 inpatients with ID, from both specialised and general programmes. RESULTS Inpatients in specialised programmes were more likely to have a diagnosis of mood disorder and were less likely to have a substance abuse or psychotic disorder. Individuals receiving specialised services had higher ratings of challenging behaviour than those in more general programmes. The two groups did not differ significantly in terms of recommended level of care, although more inpatients from specialised programmes were rated as requiring Level 4 care than inpatients from general programmes. CONCLUSIONS In Ontario, inpatients in specialised and general programmes have similar overall levels of need but unique clinical profiles that should be taken into consideration when designing interventions for them.
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Affiliation(s)
- Y Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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11
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Burge P. Prevalence of mental disorders and associated service variables among Ontario children who are permanent wards. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:305-14. [PMID: 17542381 DOI: 10.1177/070674370705200505] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the prevalence rate of mental disorders among Ontario children who are permanent wards and also the key practice and descriptive variables associated with their diagnostic status. METHOD I reviewed case files from a stratified random sample of 429 Ontario children who were permanent wards with no access to biological parents on December 31, 2003. Data abstracted from files included information on descriptive variables (such as age, sex, and type of permanent ward), all disorders (that is, mental and other current medical diagnoses and disabilities), family history, maltreatment experiences, service history (such as age at admission to care and current residential placement type), and permanency plans. RESULTS The prevalence of mental disorders was 31.7%. A significantly higher proportion of children with mental disorders experienced maltreatment. Children with mental disorders were almost 3 times more likely than those without mental disorders to be placed by Children's Aid Societies in privately operated resources, such as group homes, and almost 10 times less likely to be living in a probationary adoption home. Although children with mental disorders were less likely to have a permanency plan of adoption than were children without mental disorders, regression analysis found that only 2 variables--age on becoming a permanent ward and age at the time of the study--were predictive of children's adoption plans. CONCLUSIONS The findings support the need for improved monitoring of the aggregate mental health needs of children who are permanent wards. Numerous implications for service delivery and future research are discussed.
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Affiliation(s)
- Philip Burge
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario.
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Balogh RS, Hunter D, Ouellette-Kuntz H. Hospital Utilization among Persons with an Intellectual Disability, Ontario, Canada, 1995-2001. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2005. [DOI: 10.1111/j.1468-3148.2005.00247.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lunsky Y. Suicidality in a clinical and community sample of adults with mental retardation. RESEARCH IN DEVELOPMENTAL DISABILITIES 2004; 25:231-243. [PMID: 15134790 DOI: 10.1016/j.ridd.2003.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2002] [Revised: 03/08/2003] [Accepted: 06/07/2003] [Indexed: 05/24/2023]
Abstract
This paper will argue that suicidal ideation and suicidal gestures are evident in adults with mental retardation, including individuals not receiving mental health services currently, and that psychosocial correlates of suicidality are similar to those noted in the general population. Findings are based on structured interviews with 98 adults with mental retardation, with corroborative information from caregivers and clinical charts. One in three individuals reported that they think "life is not worth living" sometimes or a lot. Eleven percent of individuals reported previous suicide attempt(s). Twenty-three percent of informants were unaware of the current suicidal ideation that their family member/client was reporting. Individuals reporting suicidal ideation endorsed more loneliness, stress, anxiety and depression, along with less social support than other individuals, consistent with reports of suicidal individuals in the general population. Adults with mental retardation who report thinking that life is not worth living should be a target group for future suicide prevention efforts. More research is needed to better understand the risk factors and protective factors for suicidality in this population.
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Affiliation(s)
- Y Lunsky
- Centre for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Toronto, Ont., Canada M6J 1H4.
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Chaplin R. General psychiatric services for adults with intellectual disability and mental illness. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:1-10. [PMID: 14675225 DOI: 10.1111/j.1365-2788.2004.00580.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. METHODS A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. RESULTS There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths of stay in general psychiatric beds for people with and without ID. CONCLUSIONS Although 27 studies were located, only two were randomized controlled trials. The evidence is poor quality therefore further evaluation of services employing a variety of designs need to be employed to give more robust evidence as to which services are preferred.
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Affiliation(s)
- R Chaplin
- Littlemore Hospital, Oxford, OX4 4XN, UK.
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15
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Xenitidis K, Gratsa A, Bouras N, Hammond R, Ditchfield H, Holt G, Martin J, Brooks D. Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2004; 48:11-18. [PMID: 14675226 DOI: 10.1111/j.1365-2788.2004.00586.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services. METHOD All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area. RESULTS Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement. CONCLUSIONS Specialist units are an effective care option for this group of people.
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Affiliation(s)
- K Xenitidis
- South London and Maudsley NHS Trust, York Clinic, Guy's Hospital, London SEI 3RR, UK.
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Saeed H, Ouellette-Kuntz H, Stuart H, Burge P. Length of stay for psychiatric inpatient services: a comparison of admissions of people with and without developmental disabilities. J Behav Health Serv Res 2003; 30:406-17. [PMID: 14593664 DOI: 10.1007/bf02287428] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated associations between the presence of developmental disabilities and length of inpatient stay for mental health care. All psychiatric admissions of people with developmental disabilities over a 5-year period were selected (n = 294), and were compared using survival analysis to a random sample of admissions from the general psychiatric population (n = 287). Overall, people with developmental disabilities stayed in hospital longer than those without developmental disabilities, and this extra stay was partially attributed to casemix differences between the cohorts. Subanalysis in both cohorts showed that those going back to their usual living arrangement stayed a shorter period than those who were discharged elsewhere, and that people with developmental disabilities were less likely to be discharged to their usual living arrangement than were people without the disability. This study highlighted the importance of specialized residential and personal supports for people with developmental disabilities and a coexisting mental disorder.
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Affiliation(s)
- Haider Saeed
- Department of Community Health & Epidemiology, Abramsky Hall, Queen's University at Kingston, Kingston, Ontario, Canada.
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Saeed H, Ouellette-Kuntz H, Stuart H, Burge P. Length of Stay for Psychiatric Inpatient Services. J Behav Health Serv Res 2003. [DOI: 10.1097/00075484-200310000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ouellette-Kuntz H, Burge P, Henry DB, Bradley EA, Leichner P. Attitudes of senior psychiatry residents toward persons with intellectual disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:538-45. [PMID: 14574829 DOI: 10.1177/070674370304800805] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examined the attitudes of senior residents in psychiatry toward persons with intellectual disabilities. Examining residents' attitudes will highlight areas of training that could be enhanced to better prepare psychiatrists to work with individuals with intellectual disabilities. METHOD A questionnaire was distributed to senior psychiatry residents at a Canada-wide preparatory session for the Royal College of Physicians and Surgeons of Canada. Included in the questionnaire was the Community Living Attitudes Scale Mental Retardation--Short Form (CLAS) as well as demographic items (for example, age, sex, and marital status) and questions about training in intellectual disabilities. Scores on the 4 CLAS subscales (Empowerment, Similarity, Exclusion, and Sheltering) are reported, and analyses of variance were performed to identify factors associated with each subscale score. The residents' scores are compared with those obtained in surveys of other groups. RESULTS Fifty-eight senior residents from across Canada completed the questionnaire. The residents' scores favored Empowerment and Similarity over Exclusion and Sheltering. Men and women responded differently. Training in intellectual disabilities during residency only appeared to influence the Similarity subscale scores. CONCLUSION Senior psychiatry residents hold attitudes toward persons with intellectual disabilities that are not entirely consistent with the community living philosophic paradigm. More research is needed to uncover how attitudes of psychiatrists develop, as well as how training can influence attitudes.
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Affiliation(s)
- Hélène Ouellette-Kuntz
- Departments of Community Health and Epidemiology and Psychiatry, Queen's University, Kingston, Ontario.
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Burge P, Ouellette-Kuntz H, McCreary B, Bradley E, Leichner P. Senior residents in psychiatry: views on training in developmental disabilities. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:568-71. [PMID: 12211886 DOI: 10.1177/070674370204700610] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the proportion of senior residents who believed their education in the field of developmental disabilities was adequate and to collect suggestions for improvements. METHOD We distributed a self-administered questionnaire to senior residents prior to an annual voluntary preparatory exam. Their views on training in developmental disabilities and ideas about improving curricula were solicited in detail, and their feedback results were analyzed. RESULTS Of the 89 senior residents who attended the exam, 60 (67.4%) completed the survey. This represents 29% of the national complement. Most (85%) of the one-half who reported receiving undergraduate training in developmental disabilities felt the quantity was inadequate. Almost 90% of those who did not receive training felt they should have. Of respondents, 85% received residency training in dual diagnosis, but most (59%) felt more curriculum time was needed. CONCLUSIONS Senior residents also desire curricular enhancements that experts in developmental disabilities have long recommended.
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Affiliation(s)
- Philip Burge
- Department of Psychiatry, Queen's University, Kingston, Ontario.
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