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Shakya P, Sood M, Mathur R, Prajapati N, Patil V. Pathways to care and barriers in treatment among patients with Dissociative disorders. Asian J Psychiatr 2024; 95:104000. [PMID: 38507864 DOI: 10.1016/j.ajp.2024.104000] [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: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Nisha Prajapati
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Vaibhav Patil
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Leach MJ, Gunn K, Muyambi K. The determinants of healthcare utilisation in regional, rural and remote South Australia: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4850-e4863. [PMID: 35770728 PMCID: PMC10084113 DOI: 10.1111/hsc.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 06/10/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
Accessibility of health services outside metropolitan centres in Australia is sub-optimal. Recognising the barriers and enablers of healthcare access in rural, remote and regional settings is necessary to improving health service access in these disadvantaged populations. Accordingly, this study aimed to examine the determinants of healthcare use in rural, remote and regional South Australia. Cross-sectional survey data were collected from adults living outside metropolitan Adelaide in South Australia between April 2017 and March 2018. Using a multi-modal recruitment campaign, eligible adults were invited to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument. Independent predictors of health service utilisation (dependent variable) were determined using negative binomial regression. The questionnaire was completed by 3926 predominantly female (52.5%) adults aged ≥50 years (56.7%), residing in regional South Australia (84.5%). Fifteen independent variables were significantly associated with health service utilisation using univariate analyses. Using negative binomial regression analysis, two predisposing factors (sex, remoteness), three enabling factors (income, health literacy, employment), two need factors (health rating, multimorbidity) and two personal health practices (alcohol, diet) were independently and significantly associated with healthcare use. Female sex (OR = 1.436, p < 0.001), good/excellent health rating (OR = 0.589, p < 0.001) and high multimorbidity (OR = 1.408, p < 0.001) were the strongest predictors of health service use. These findings will help inform the development of targeted health promotion and service engagement strategies for regional populations, which in addition to addressing workforce shortages, may help address inequity in health outcomes, particularly for groups engaging with regional healthcare services infrequently.
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Affiliation(s)
- Matthew J. Leach
- National Centre for Naturopathic MedicineSouthern Cross UniversityEast LismoreNew South WalesAustralia
- Department of Rural HealthUniversity of South AustraliaWhyalla NorrieSouth AustraliaAustralia
| | - Kate Gunn
- Department of Rural HealthUniversity of South AustraliaWhyalla NorrieSouth AustraliaAustralia
| | - Kuda Muyambi
- Department of Rural HealthUniversity of South AustraliaWhyalla NorrieSouth AustraliaAustralia
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Andersen E, Bang-Kittilsen G, Bigseth TT, Egeland J, Holmen TL, Martinsen EW, Stensrud T, Engh JA. Effect of high-intensity interval training on cardiorespiratory fitness, physical activity and body composition in people with schizophrenia: a randomized controlled trial. BMC Psychiatry 2020; 20:425. [PMID: 32854688 PMCID: PMC7457274 DOI: 10.1186/s12888-020-02827-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Exercise may improve cardiorespiratory fitness in people with schizophrenia, however, possible condition-specific cardiorespiratory disadvantages, a scarcity of methodologically sound studies, and conflicting results raise questions about the effect of exercise on maximal oxygen uptake (VO2max) in this group. The primary aim of this study, therefore, was to investigate the effect of high-intensity interval training on VO2max in people with schizophrenia. Second, we sought to determine whether the intervention would have an effect on general physical activity (PA) level and body composition. METHODS Eighty-two patients with schizophrenia were randomly assigned to supervised high-intensity interval training or computer gaming skills training, performed twice a week for 12 weeks. Oxygen uptake was measured directly, during a maximum exercise session on a treadmill. PA level were assessed using ActiGraph accelerometer, and body composition was assessed by bioelectrical impedance. Differences between groups were assessed by analysis of variance using a univariate general linear model. RESULTS There were no significant differences between the groups on any of the cardiorespiratory variables neither at baseline nor after the program. There were also no significant within-group differences in any of the cardiorespiratory fitness variables between the baseline and post-program time points, despite that 61% of the participants performing high-intensity interval training showed a significant increase in workload on the treadmill. However, 47% of the participants in the high-intensity interval training group had a ≥ 5% increase in VO2max. Participants supervised by mental health care providers with PA competence (e.g. rehabilitation center staff, sport scientist, physical trainer) had a much larger increase in VO2max compared to participants supervised by mental health workers without such competence, and when adding PA competence to the model, the intervention group increased VO2max significantly compared to the comparison group. The intervention had no significant effect on PA level or body composition. CONCLUSIONS The intervention did not improve VO2max, PA level or body composition but succeeded in increasing workload on the treadmill. With regard to VO2max, approximately half of the patients may be considered responders. TRIAL REGISTRATION ClinicalTrials.gov ; NCT02205684 , registered July 2014.
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Affiliation(s)
- Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, PO box 235, 3603, Kongsberg, Horten, Norway.
| | - Gry Bang-Kittilsen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Tom Langerud Holmen
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Egil Wilhelm Martinsen
- Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - John Abel Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
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Ride J, Kasteridis P, Gutacker N, Doran T, Rice N, Gravelle H, Kendrick T, Mason A, Goddard M, Siddiqi N, Gilbody S, Williams R, Aylott L, Dare C, Jacobs R. Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness. Health Serv Res 2019; 54:1316-1325. [PMID: 31598965 PMCID: PMC6863233 DOI: 10.1111/1475-6773.13211] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). Data Sources Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007‐2014. Study Design This observational cohort study used discrete‐time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care‐sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long‐term averages. Data Collection/Extraction Methods Individual‐level family practice administrative data linked to hospital administrative data. Principal Findings Higher relational continuity was associated with 8‐11 percent lower risk of ED presentation and 23‐27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. Conclusions Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic., Australia
| | | | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Tony Kendrick
- Department of Primary Care, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, York, UK.,Bradford District Care, NHS Foundation Trust, Bradford, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | | | - Lauren Aylott
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Ceri Dare
- Service User, York, North Yorkshire, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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Amaral CE, Onocko-Campos R, de Oliveira PRS, Pereira MB, Ricci ÉC, Pequeno ML, Emerich B, dos Santos RC, Thornicroft G. Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies. Int J Ment Health Syst 2018; 12:65. [PMID: 30450125 PMCID: PMC6208112 DOI: 10.1186/s13033-018-0237-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil. METHODS LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley's 'model of Levels and Filters' and on Kleinman's framework of 'Popular, Folk and Professional health sectors'. Analysis also considered the changes in national mental health policy over time. RESULTS 25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care. CONCLUSIONS The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.
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Affiliation(s)
- Carlos Eduardo Amaral
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
- Department of Psychology, University Centre Unicatólica of Quixadá, Quixadá, Brazil
- Fortaleza, Ceará CEP 60125-001 Brazil
| | - Rosana Onocko-Campos
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Mariana Barbosa Pereira
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Éllen Cristina Ricci
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Bruno Emerich
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Orsolini L, Sarchione F, Vellante F, Fornaro M, Matarazzo I, Martinotti G, Valchera A, Di Nicola M, Carano A, Di Giannantonio M, Perna G, Olivieri L, De Berardis D. Protein-C Reactive as Biomarker Predictor of Schizophrenia Phases of Illness? A Systematic Review. Curr Neuropharmacol 2018; 16:583-606. [PMID: 29357805 PMCID: PMC5997872 DOI: 10.2174/1570159x16666180119144538] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/07/2017] [Accepted: 11/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Schizophrenia is a complex illness in which genetic, environmental, and epigenetic components have been implicated. However, recently, psychiatric disorders appear to be related to a chronic inflammatory state, at the level of specific cerebral areas which have been found as well impaired and responsible for schizophrenia symptomatology. Hence, a role of inflammatory mediators and cytokines has been as well defined. Accordingly, the role of an acute inflammatory phase protein, the C-reactive protein (CRP) has been recently investigated. OBJECTIVE The objective of the present study is to evaluate how PCR may represent a biomarker in schizophrenia, i.e. correlated with illness phases and/or clinical manifestation and/or psychopathological severity. METHODS A systematic review was here carried out by searching the following keywords ((C-reactive protein AND ((schizophrenia) OR (psychotic disorder))) for the topics 'PCR' and 'Schizophrenia', by using MESH terms. RESULTS An immune dysfunction and inflammation have been described amongst schizophrenic patients. Findings reported elevated CRP levels in schizophrenia, mainly correlated with the severity of illness and during the recrudescent phase. CRP levels are higher when catatonic features, negative symptomatology and aggressiveness are associated. CRP levels appeared not to be related to suicidal behaviour and ideation. CONCLUSION CRP and its blood levels have been reported higher amongst schizophrenic patients, by suggesting a role of inflammation in the pathogenesis of schizophrenia. Further studies are needed to better understand if CRP may be considered a biomarker in schizophrenia.
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Affiliation(s)
- Laura Orsolini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, Hatfield, HertsAL10 9AB, UK
- Polyedra Research, Teramo, Italy
| | - Fabiola Sarchione
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Michele Fornaro
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine ‘Federico II’ Naples, Naples, Italy
| | - Ilaria Matarazzo
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Alessandro Valchera
- Polyedra Research, Teramo, Italy
- Villa S. Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario “A. Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “Madonna Del Soccorso”, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, Chieti, Italy
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, Como, Italy
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Florida, USA
| | - Luigi Olivieri
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4 Teramo, Italy
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Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4:295-301. [PMID: 28237639 DOI: 10.1016/s2215-0366(17)30078-0] [Citation(s) in RCA: 673] [Impact Index Per Article: 96.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies and meta-analyses have shown that mortality in people with schizophrenia is higher than that in the general population but have used relative measures, such as standardised mortality ratios. We did a systematic review and meta-analysis to estimate years of potential life lost and life expectancy in schizophrenia, which are more direct, absolute measures of increased mortality. METHODS We searched MEDLINE, PsycINFO, Embase, Cinahl, and Web of Science for published studies on years of potential life lost and life expectancy in schizophrenia. Data from individual studies were combined in meta-analyses as weighted averages. We did subgroup analyses for sex, geographical region, timing of publication, and risk of bias (estimated with the Newcastle-Ottawa Scale). FINDINGS We identified 11 studies in 13 publications covering all inhabited continents except South America (Africa n=1, Asia n=1, Australia n=1, Europe n=7, and North America n=3) that involved up to 247 603 patients. Schizophrenia was associated with a weighted average of 14·5 years of potential life lost (95% CI 11·2-17·8), and was higher for men than women (15·9, 13·8-18·0 vs 13·6, 11·4-15·8). Loss was least in the Asian study and greatest in Africa. The overall weighted average life expectancy was 64·7 years (95% CI 61·1-71·3), and was lower for men than women (59·9 years, 95% CI 55·5-64·3 vs 67·6 years, 63·1-72·1). Life expectancy was lowest in Asia and Africa. Timing of publication and risk of bias had little effect on results. INTERPRETATION The effects of schizophrenia on years potential life lost and life expectancy seem to be substantial and not to have lessened over time. Development and implementation of interventions and initiatives to reduce this mortality gap are urgently needed. FUNDING None.
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Hensel JM, Banayan DJ, Cheng C, Langley J, Dewa CS. Client and key worker ratings of need in first-episode psychosis early intervention programmes. Early Interv Psychiatry 2016; 10:246-51. [PMID: 25112944 DOI: 10.1111/eip.12171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/18/2014] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood. METHODS Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client-key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa. RESULTS At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ > 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ < 0.4) was found in the domains of psychological distress, sexual expression, company, daytime activities and intimate relationships. CONCLUSIONS While congruence is present in concrete domains, there is substantial variability in how clients and their key workers perceive need in more personal areas. The initial focus of care may necessarily be on needs such as shelter, food and treatment; however, subsequent care should incorporate a shared assessment of need to support strong relationships with providers and ongoing engagement in treatment.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - David J Banayan
- Department of Psychiatry and Behavioural Neuroscience, University of Chicago, Chicago, Illinois, USA
| | | | - John Langley
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, St.Michael's Hospital, Toronto, Canada
| | - Carolyn S Dewa
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Research on Employment and Workplace Health, Centre for Addiction and Mental Health, Toronto, Canada
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Raudino A, Carr VJ, Bush R, Saw S, Burgess P, Morgan VA. Patterns of service utilisation in psychosis: findings of the 2010 Australian national survey of psychosis. Aust N Z J Psychiatry 2014; 48:341-51. [PMID: 24226893 DOI: 10.1177/0004867413511996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper reports patterns of health service utilisation in the second Australian national survey of psychosis corresponding with changes in available services of this period. METHOD Semi-structured interviews were carried out of an age-stratified random sample of adults who screened positive for psychosis. Multivariate logistic regressions were used to identify predictors of service use for a sample of 1825 individuals. RESULTS Use of psychiatric inpatient services was associated with higher symptom levels, suicidal ideation, poor social functioning and younger age. High users of emergency mental health services similarly reported higher symptom levels, poor functioning and younger age, and also reported being married or in a de facto relationship. Recipients of general practitioner services had greater anxiety symptoms and suicidal thoughts, fewer negative symptoms, single marital status and English as their first language. Rehabilitation service use was associated with greater anxiety symptoms, unemployment, younger age of illness onset, living alone and having no dependent children living at home. Last, outpatient/community services were more frequently used by younger people with good premorbid adjustment, hallucinations and a less severe course of illness. CONCLUSIONS Service utilisation patterns vary with the clinical and socio-demographic features of those who use them - inpatient and emergency service users being similar in such features and differing from users of other services. Comparison with the first national survey of psychosis revealed a significant decline in acute inpatient service use and a substantial increase in the use of outpatient/community and rehabilitation services over the past 10 years.
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Pratt SI, Bartels SJ, Naslund JA, Wolfe R, Pixley HS, Mueser KT, Josephson L. Feasibility and Effectiveness of an Automated Telehealth Intervention to Improve Illness Self-Management in People With Serious Psychiatric and Medical Disorders. Psychiatr Rehabil J 2013; 36:297-305. [PMID: 24320837 PMCID: PMC5472060 DOI: 10.1037/prj0000022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. METHODS We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. RESULTS Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as "much better" or "somewhat better" postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.
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Affiliation(s)
| | | | | | | | | | | | - Louis Josephson
- Riverbend Community Mental Health Center, Concord, New Hampshire
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Ungar T, Goldman S, Marcus M. Reversed Shared Care in Mental Health: Bringing Primary Physical Health Care to Psychiatric Patients. ACTA ACUST UNITED AC 2013. [DOI: 10.7870/cjcmh-2013-022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Thomas Ungar
- North York General Hospital and University of Toronto
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12
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van Hasselt FM, Schorr SG, Mookhoek EJ, Brouwers JRBJ, Loonen AJM, Taxis K. Gaps in health care for the somatic health of outpatients with severe mental illness. Int J Ment Health Nurs 2013; 22:249-55. [PMID: 22762306 DOI: 10.1111/j.1447-0349.2012.00859.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health-care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross-sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.
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Affiliation(s)
- Fenneke M van Hasselt
- Department of Pharmacy, Section Pharmacotherapy and Pharmaceutical Care, University of Groningen, The Netherlands
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Fleury MJ, Grenier G, Bamvita JM, Perreault M, Kestens Y, Caron J. Comprehensive determinants of health service utilisation for mental health reasons in a Canadian catchment area. Int J Equity Health 2012; 11:20. [PMID: 22469459 PMCID: PMC3366873 DOI: 10.1186/1475-9276-11-20] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 04/02/2012] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area. METHODS To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out. RESULTS Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females. CONCLUSIONS Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada
| | - Jean-Marie Bamvita
- Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada
| | - Michel Perreault
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada
| | - Yan Kestens
- Department of Social and Preventive Medicine, University of Montreal, 3850, St-Urbain Street, Montreal, Quebec H2W 1T7, Canada
| | - Jean Caron
- Department of Psychiatry, McGill University, Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada
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Moreno-Küstner B, Mayoral F, Rivas F, Angona P, Requena J, García-Herrera JM, Navas D, Moreno P, Serrano-Blanco A, Bellón JA. Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis. BMC Health Serv Res 2011; 11:257. [PMID: 21982430 PMCID: PMC3210099 DOI: 10.1186/1472-6963-11-257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 10/07/2011] [Indexed: 11/10/2022] Open
Abstract
Background Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders. Methods This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records. Results The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001). Conclusions As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.
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Affiliation(s)
- Berta Moreno-Küstner
- Research Unit Distrito Sanitario Malaga, IMABIS Fundation, Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Spain.
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Dewa CS, Tugg L, Stergiopoulos V, Ghavam-Rassoul A, deRuiter WK. Examining Factors Associated with Primary Care and Continuity of Care Among Adults with Severe Mental Illness. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2011. [DOI: 10.1007/s10879-011-9185-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCann TV, Lubman DI, Clark E. First-time primary caregivers' experience accessing first-episode psychosis services. Early Interv Psychiatry 2011; 5:156-62. [PMID: 21352509 DOI: 10.1111/j.1751-7893.2010.00246.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Easy access to first-episode psychosis (FEP) services is critical in reducing the duration of untreated illness. However, primary caregivers can encounter difficulties accessing services on behalf of young people with FEP. This qualitative study describes the lived experience of first time primary caregivers of young adults with FEP, with a focus on examining how they access specialist FEP services. METHODS A qualitative study was undertaken using semi-structured, in-depth interviews with 20 caregivers in Melbourne. RESULTS Most carers were women (85%, n = 17) and parents (85%, n = 17). Nearly all lived in the same households as the young people with FEP (90%, n = 18). The mean duration of their involvement with the FEP service was 14.5 months (standard deviation = 8.9). Three competing themes were identified in the data, reflecting caregivers' polarized experiences accessing FEP services. First, general practitioners were regarded as either a resourceful or an unresourceful means of access to FEP services. Second, caregivers often encountered service-focused and carer-focused barriers when initially accessing services. Third, a combination of acquired knowledge, experience with services and caregiver assertiveness enhanced access on subsequent occasions. CONCLUSION This study highlights the important contribution and experience of first-time primary caregivers and the difficulties they face accessing services. The findings suggest access should be influenced more by clinical need and less by caregivers'perseverance. The findings also underline the importance of providing clinical training that acknowledges the needs and contributions of caregivers, as well as interventions that meet the unique challenges faced by first-time caregivers accessing services after the onset of FEP.
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Affiliation(s)
- Terence V McCann
- School of Nursing and Midwifery, Victoria University, Melbourne,Victoria, Australia.
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