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Kaier K, Heidenreich A, Jäckel M, Oettinger V, Maier A, Hilgendorf I, Breitbart P, Hartikainen T, Keller T, Westermann D, von Zur Mühlen C. Reweighting and validation of the hospital frailty risk score using electronic health records in Germany: a retrospective observational study. BMC Geriatr 2024; 24:517. [PMID: 38872086 PMCID: PMC11177354 DOI: 10.1186/s12877-024-05107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND In the hospital setting, frailty is a significant risk factor, but difficult to measure in clinical practice. We propose a reweighting of an existing diagnoses-based frailty score using routine data from a tertiary care teaching hospital in southern Germany. METHODS The dataset includes patient characteristics such as sex, age, primary and secondary diagnoses and in-hospital mortality. Based on this information, we recalculate the existing Hospital Frailty Risk Score. The cohort includes patients aged ≥ 75 and was divided into a development cohort (admission year 2011 to 2013, N = 30,525) and a validation cohort (2014, N = 11,202). A limited external validation is also conducted in a second validation cohort containing inpatient cases aged ≥ 75 in 2022 throughout Germany (N = 491,251). In the development cohort, LASSO regression analysis was used to select the most relevant variables and to generate a reweighted Frailty Score for the German setting. Discrimination is assessed using the area under the receiver operating characteristic curve (AUC). Visualization of calibration curves and decision curve analysis were carried out. Applicability of the reweighted Frailty Score in a non-elderly population was assessed using logistic regression models. RESULTS Reweighting of the Frailty Score included only 53 out of the 109 frailty-related diagnoses and resulted in substantially better discrimination than the initial weighting of the score (AUC = 0.89 vs. AUC = 0.80, p < 0.001 in the validation cohort). Calibration curves show a good agreement between score-based predictions and actual observed mortality. Additional external validation using inpatient cases aged ≥ 75 in 2022 throughout Germany (N = 491,251) confirms the results regarding discrimination and calibration and underlines the geographic and temporal validity of the reweighted Frailty Score. Decision curve analysis indicates that the clinical usefulness of the reweighted score as a general decision support tool is superior to the initial version of the score. Assessment of the applicability of the reweighted Frailty Score in a non-elderly population (N = 198,819) shows that discrimination is superior to the initial version of the score (AUC = 0.92 vs. AUC = 0.87, p < 0.001). In addition, we observe a fairly age-stable influence of the reweighted Frailty Score on in-hospital mortality, which does not differ substantially for women and men. CONCLUSIONS Our data indicate that the reweighted Frailty Score is superior to the original Frailty Score for identification of older, frail patients at risk for in-hospital mortality. Hence, we recommend using the reweighted Frailty Score in the German in-hospital setting.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, Freiburg, 79106, Germany.
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Adrian Heidenreich
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Markus Jäckel
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Alexander Maier
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Philipp Breitbart
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Tau Hartikainen
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Till Keller
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Centre for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
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Gonçalves-Pinho M, Martins B, Costa A, Ribeiro JP, Freitas A, Azevedo E, Fernandes L. Psychiatric Comorbidities in Neurologic Hospitalizations in Portugal: A Nationwide Retrospective Observational Study. ACTA MEDICA PORT 2024; 37:455-466. [PMID: 38848702 DOI: 10.20344/amp.20969] [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: 11/19/2023] [Accepted: 03/27/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Psychiatric comorbidities have a significant impact on patients' quality of life and often go undetected in neurologic practice. The aim of this study was to describe and characterize psychiatric comorbidities among patients hospitalized due to a neurologic disorder in mainland Portugal. METHODS A retrospective observational study was performed by analyzing hospitalization with a primary diagnosis of neurologic disorder defined as categories 76, 77, 79 - 85, 95, 109 of the Clinical Classification Software for International Classification of Diseases, Ninth Revision, Clinical Modification, occurring between 2008 and 2015 in adult patients (≥ 18 years of age). Psychiatric comorbidities were determined as the presence of a secondary diagnosis belonging to the Clinical Classification Software categories 650 to 670. RESULTS A total of 294 806 hospitalization episodes with a primary diagnosis of a neurologic disorder were recorded in adult patients between 2008 - 2015 in Portuguese public hospitals. Approximately 26.9% (n = 79 442) of the episodes had a recorded psychiatric comorbidity (22.1%; 32.2%, female versus male hospitalizations). Patients with registered psychiatric comorbidities were younger (66.2 ± 16.2 vs 68.6 ± 17.2 with no psychiatric comorbidities, p < 0.001), presented lower all-cause in-hospital mortality rates, and significantly longer mean hospital stays. 'Delirium, dementia, amnestic and other cognitive disorders' were recorded in 7.4% (n = 21 965) of the hospitalizations, followed by alcohol-related disorders in 6.5% (n = 19 302) and mood disorders in 6.1% (n = 18 079). Epilepsy/seizures were the neurologic disorders with the highest proportion of recorded psychiatric comorbidities (39.9%). CONCLUSION Psychiatric comorbidities were recorded in more than a quarter of the hospitalizations with a primary diagnosis of a Neurologic disorder. Psychiatric comorbidities varied among neurological disorders and were associated with different demographic and clinical features.
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Affiliation(s)
- Manuel Gonçalves-Pinho
- *Shared first co-authorship. CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel. Portugal
| | - Bárbara Martins
- *Shared first co-authorship. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto. Portugal
| | - Andreia Costa
- Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Department of Neurology. Unidade Local de Saúde de São João. Porto. Portugal
| | - João Pedro Ribeiro
- Department of Psychiatry and Mental Health. Unidade Local de Saúde do Tâmega e Sousa. Penafiel. Portugal
| | - Alberto Freitas
- CINTESIS@RISE, MEDCIDS. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Elsa Azevedo
- Department of Neurology. Unidade Local de Saúde de São João. Porto; UnIC@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Lia Fernandes
- CINTESIS@RISE. Department of Clinical Neurosciences and Mental Health. Faculdade de Medicina. Universidade do Porto. Porto; Psychiatry Service. Unidade Local de Saúde de São João. Porto. Portugal
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Meinlschmidt G, Frick A, Baenteli I, Karpf C, Studer A, Bachmann M, Dörner A, Tschudin S, Trost S, Wyss K, Fink G, Schwenkglenks M, Caviezel S, Rocco T, Schaefert R. Prevention of psychosocial distress consequences in somatic hospital inpatients via a stepped and collaborative care model: protocol of SomPsyNet, a stepped wedge cluster randomised trial. BMJ Open 2023; 13:e076814. [PMID: 37996236 PMCID: PMC10668178 DOI: 10.1136/bmjopen-2023-076814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Approximately 30% of somatic hospital inpatients experience psychosocial distress, contributing to increased (re-)hospitalisation rates, treatment resistance, morbidity, and direct and indirect costs. However, such distress often remains unrecognised and unaddressed. We established 'SomPsyNet', a 'stepped and collaborative care model' (SCCM) for somatic hospital inpatients, aiming at alleviating this issue through early identification of distress and provision of appropriate care, providing problem-focused pathways and strengthening collaborative care. We report the protocol of the 'SomPsyNet' study, aiming to evaluate implementation and impact of the SCCM on distressed patients' health-related quality of life. Secondary objectives include assessing efficacy of the screening procedures, influence of SCCM on other health outcomes and associated costs. METHODS AND ANALYSIS Our stepped wedge cluster randomised trial conducted at three tertiary hospitals comprises three conditions: treatment as usual (TAU) without screening for distress (phase 0), TAU with screening but without consequences (phase I, main comparator) and TAU with screening and psychosomatic-psychiatric consultations for those distressed (phase II). The time-of-transition between phases I and II was randomised. Sample size target is N=2200-2500 participants, with 6 month follow-up for distressed (anticipated n=640-700) and a subsample of non-distressed (anticipated n=200) patients. Primary outcome is mental health-related quality of life (SF-36 'Mental Health Component Summary score'); secondary outcomes include psychosocial distress, anxiety, depressive and somatic symptoms, symptom burden and distress, resilience, social support and qualitative of life, assessed by internationally accepted instruments, with good psychometric properties. Further, health claims data will be used to assess SCCM's impact on direct and indirect costs. ETHICS AND DISSEMINATION SomPsyNet adheres to the Helsinki Declaration and is approved by the 'Ethikkommission Nordwest- und Zentralschweiz' (2019-01724). Findings will be published in peer-reviewed journals and communicated to participants, healthcare professionals and the public. TRIAL REGISTRATION NUMBER Swiss National Clinical Trials Portal; ClinicalTrials.gov (NCT04269005, updated 19.09.2023).
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Affiliation(s)
- Gunther Meinlschmidt
- Department of Digital and Blended Psychosomatics and Psychotherapy, Psychosomatic Medicine, University of Basel, Basel, Switzerland
- Clinical Psychology and Psychotherapy (focus CBT), International Psychoanalytic University Berlin gGmbH, Berlin, Germany
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University of Basel, Basel, Switzerland
| | - Alexander Frick
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Iris Baenteli
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University of Basel, Basel, Switzerland
| | - Christina Karpf
- Division of Prevention, Department of Health Canton Basel-Stadt, Basel, Switzerland
| | - Anja Studer
- Division of Prevention, Department of Health Canton Basel-Stadt, Basel, Switzerland
| | - Marco Bachmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinik Barmelweid AG, Barmelweid, Switzerland
| | | | - Sibil Tschudin
- Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
- Department of Obstetrics and Gynecology, University of Basel, Basel, Switzerland
| | - Sarah Trost
- Department of Geriatric Medicine, Universitäre Altersmedizin FELIX PLATTER, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
| | - Seraina Caviezel
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University of Basel, Basel, Switzerland
| | - Tabea Rocco
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University of Basel, Basel, Switzerland
| | - Rainer Schaefert
- Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Psychosomatic Medicine, University of Basel, Basel, Switzerland
- Department of Psychosomatics and Psychiatry, Bethesda Hospital Basel, Basel, Switzerland
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Michel M, Hariz AJ, Chevreul K. Association of mental disorders with costs of somatic admissions in France. L'ENCEPHALE 2023; 49:453-459. [PMID: 35973851 DOI: 10.1016/j.encep.2022.04.003] [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: 10/29/2021] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mentally ill patients have worse health outcomes when they suffer from somatic conditions compared to other patients. The objective of this study was to assess the association of mental illness with hospital inpatient costs for somatic reasons. METHODS All adult inpatient stays for somatic reasons in acute care hospitals between 2009 and 2013 were included using French exhaustive hospital discharge databases. Total inpatient costs were calculated from the all-payer perspective and compared in patients with and without a mental disorder. Only patients who had been admitted at least once for a mental disorder (either full-time or part-time) were considered to be mentally ill in this study. Generalized linear models with and without interaction terms studied the factors associated with hospital inpatient costs. RESULTS 17,728,424 patients corresponding to 37,458,810 admissions were included. 1,163,972 patients (6.57%) were identified as having a mental illness. A previous full-time or part-time admission for a mental disorder significantly increased hospital inpatient costs (+32.64%, 95%CI=1.3243-1.3284). Interaction terms found an increased impact of mental disorders on costs in patients with low socio-economic status, as well as in men, patients aged between 45 and 60, and patients with a cardiovascular disease or diabetes. CONCLUSION Mentally ill patients have higher hospital costs than non-mentally ill patients. Improving curative and preventive treatments in those patients could improve their health and decrease the burden on healthcare systems.
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Affiliation(s)
- M Michel
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France.
| | - A J Hariz
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France
| | - K Chevreul
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France
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Stahl-Toyota S, Nikendei C, Nagy E, Bönsel S, Rollmann I, Unger I, Szendrödi J, Frey N, Michl P, Müller-Tidow C, Jäger D, Friederich HC, Hochlehnert A. Interaction of mental comorbidity and physical multimorbidity predicts length-of-stay in medical inpatients. PLoS One 2023; 18:e0287234. [PMID: 37347745 PMCID: PMC10287009 DOI: 10.1371/journal.pone.0287234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mental comorbidities of physically ill patients lead to higher morbidity, mortality, health-care utilization and costs. OBJECTIVE The aim of the study was to investigate the impact of mental comorbidity and physical multimorbidity on the length-of-stay in medical inpatients at a maximum-care university hospital. DESIGN The study follows a retrospective, quantitative cross-sectional analysis approach to investigate mental comorbidity and physical multimorbidity in internal medicine patients. PATIENTS The study comprised a total of n = 28.553 inpatients treated in 2017, 2018 and 2019 at a German Medical University Hospital. MAIN MEASURES Inpatients with a mental comorbidity showed a median length-of-stay of eight days that was two days longer compared to inpatients without a mental comorbidity. Neurotic and somatoform disorders (ICD-10 F4), behavioral syndromes (F5) and organic disorders (F0) were leading with respect to length-of-stay, followed by affective disorders (F3), schizophrenia and delusional disorders (F2), and substance use (F1), all above the sample mean length-of-stay. The impact of mental comorbidity on length-of-stay was greatest for middle-aged patients. Mental comorbidity and Elixhauser score as a measure for physical multimorbidity showed a significant interaction effect indicating that the impact of mental comorbidity on length-of-stay was greater in patients with higher Elixhauser scores. CONCLUSIONS The findings provide new insights in medical inpatients how mental comorbidity and physical multimorbidity interact with respect to length-of-stay. Mental comorbidity had a large effect on length-of-stay, especially in patients with high levels of physical multimorbidity. Thus, there is an urgent need for new service models to especially care for multimorbid inpatients with mental comorbidity.
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Affiliation(s)
- Sophia Stahl-Toyota
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ede Nagy
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Stefan Bönsel
- Department of Medicine Controlling, Medical University Hospital, Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Inga Unger
- Nursing Management, Department of Internal Medicine, Medical University Hospital, Heidelberg, Germany
| | - Julia Szendrödi
- Department of Endocrinology and Clinical Chemistry, Medical University Hospital, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Medical University Hospital, Heidelberg, Germany
| | - Patrick Michl
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical University Hospital, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, Medical University Hospital, Heidelberg, Germany
| | - Dirk Jäger
- Department of Medical Oncology, Medical University Hospital, National Center for Tumor Diseases, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Achim Hochlehnert
- Department of Medicine Controlling, Medical University Hospital, Heidelberg, Germany
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Caballer-Tarazona V, Zúñiga-Lagares A, Reyes-Santias F. Analysis of hospital costs by morbidity group for patients with severe mental illness. Ann Med 2022; 54:858-866. [PMID: 35318876 PMCID: PMC8956305 DOI: 10.1080/07853890.2022.2048884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES The goal of this study is to analyse hospital costs and length of stay of patients admitted to psychiatric units in hospitals in a European region of the Mediterranean Arc. The aim is to identify the effects of comorbidities and other variables in order to create an explanatory cost model. METHODS In order to carry out the study, the Ministry of Health was asked to provide data on access to the mental health facilities of all hospitals in the region. Among other questions, this database identifies the most important diagnostic variables related to admission, like comorbidities, age and gender. The method used, based on the Manning-Mullahy algorithm, was linear regression. The results were measured by the statistical significance of the independent variables to determine which of them were valid to explain the cost of hospitalization. RESULTS Psychiatric inpatients can be divided into three main groups (psychotic, organic and neurotic), which have statistically significant differences in costs. The independent variables that were statistically significant (p <.05) and their respective beta and confidence intervals were: psychotic group (19,833.0 ± 317.3), organic group (9,878.4 ± 276.6), neurotic group (11,060.1 ± 287.6), circulatory system diseases (19,170 ± 517.6), injuries and poisoning (21,101.6 ± 738.7), substance abuse (20,580.6 ± 514, 6) and readmission (19,150.9 ± 555.4). CONCLUSIONS Unlike most health services, access to psychiatric facilities does not correlate with comorbidities due to the specific nature of this specialization. Patients admitted to psychosis had higher costs and a higher number of average staysKEY MESSAGESThe highest average hospital expenditure occurred in patients admitted for psychotic disorders.Due to the particularities of psychiatry units and unlike other medical specialties, the number of comorbidities did not influence the number of hospital stays or hospital expenditure.Apart from the main diagnostic group, the variables that were useful to explain hospital expenditure were the presence of poisoning and injuries as comorbidity, diseases of circulatory system as comorbidity, history of substance abuse and readmission.
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Snaychuk LA, Ferrão YA, Fontenelle LF, Miguel EC, de Mathis MA, Scanavino MDT, Kim HS. Co-Occurring Obsessive-Compulsive Disorder and Compulsive Sexual Behavior: Clinical Features and Psychiatric Comorbidities. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:4111-4123. [PMID: 36066680 DOI: 10.1007/s10508-022-02412-6] [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: 03/09/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Obsessive-compulsive disorder (OCD) commonly co-occurs with other psychiatric conditions. Though research is limited, there is preliminary evidence that OCD also co-occurs with compulsive sexual behavior (CSB). Yet, few studies have investigated the demographic, clinical, and psychiatric comorbidities associated with co-occurring OCD and CSB. To address this gap, the current study aimed to evaluate rates of co-occurring OCD and CSB, identify demographic and clinical factors associated with comorbid OCD and CSB, and assess associated psychiatric comorbidity. Participants (N = 950) were patients of a large multisite treatment for OCD. Standardized self-report measures were used to assess demographic and clinical characteristics such as anxiety, depression, and severity and dimensions of OCD. Semi-structured interviews including the SCID were used to assess psychiatric comorbidities. A total of 36 (3.8%) of participants met the criteria for CSB. Binary logistic regression analysis revealed that males were significantly more likely to present with CSB than females and CSB was associated with greater psychiatric comorbidity, particularly impulse control disorders. These findings suggest that individuals with co-occurring OCD and CSB may have more complex treatment needs, and more tailored interventions may be necessary.
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Affiliation(s)
- Lindsey A Snaychuk
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada
| | - Ygor A Ferrão
- Clinical Neurosciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Leonardo F Fontenelle
- Departamento de Psiquiatria e Medicina Legal, Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB/UFRJ) e Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | | | - Maria A de Mathis
- Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | | | - Hyoun S Kim
- Department of Psychology, Toronto Metropolitan University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.
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Sharrock J, Happell B, Jeong SYS. The impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions: An integrative literature review. Int J Ment Health Nurs 2022; 31:772-795. [PMID: 35319133 PMCID: PMC9313616 DOI: 10.1111/inm.12994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 12/22/2022]
Abstract
Mental Health Nurse Consultants are advanced practice mental health nurses who consult with nurses and other health professionals in a general hospital setting. The aim of this review was to analyse and synthesize the available evidence related to the impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions. The integrative literature review method was utilized as it allows for the inclusion and integration of quantitative, qualitative, and mixed methods research which produces a synthesized understanding of data to inform practice, policy, and research. The Preferred Reporting Items of Systematic Review and Meta-Analyses guided the search strategy. All published studies examining the impact of clinical consultations provided by Mental Health Nurse Consultants on the mental health care of general hospital patients were included. The 19 selected articles were from North America, Australia, the United Kingdom, and Europe. Fifteen were quantitative, three were qualitative, and one used mixed methods. The findings highlight the role is generally positively received by hospital staff. The results indicate that clinical consultations provided by Mental Health Nurse Consultants (i) may improve patient experiences of mental health conditions, (ii) influence aspects of care delivery, (iii) are valued by staff, particularly nurses, and (iv) increase staff competence and confidence in the provision of mental health care. The review highlighted significant limitations of the available evidence, the need for contemporary discussion and debate of MHNC theory and practice, and further evaluation of the role to inform future service delivery.
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Affiliation(s)
- Julie Sharrock
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brenda Happell
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sarah Yeun-Sim Jeong
- School of Nursing and Midwifery, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Nasir BF, Vinayagam R, Rae K. "It's what makes us unique": Indigenous Australian perspectives on genetics research to improve comorbid mental and chronic disease outcomes. Curr Med Res Opin 2022; 38:1219-1228. [PMID: 35410562 DOI: 10.1080/03007995.2022.2061710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The role of personalized treatment approaches, including those based on genetic testing, are increasingly enabling informed decision-making to improve health outcomes. Research involving Indigenous Australians has been lagging behind, although this population experiences a higher prevalence of chronic disease and mental health disorders. METHODS Using community-based participatory research principles, this study purposefully interviewed participants with a diagnosed common mental disorder and a comorbid chronic disease condition. This was an inductive thematic analysis on semi-structured interviews with consenting participants (n = 48). Common themes and analytical domains were identified that provided a semantic understanding shared by participants. RESULTS Five emerging themes were identified, primarily focusing on: (1) The perceptions and understanding of genetics research; (2) culturally appropriate conduct of genetics research; (3) the role of indigenous-led genetics research; (4) future prospects of genetics research; and (5) the importance of genetics research for patients with mental and physical health comorbidities. CONCLUSION Indigenous Australians are under-represented in pharmacogenomics research despite well-documented epidemiological research demonstrating that Indigenous people globally experience greater risk of developing certain chronic diseases and more severe disease progression. Positive outcomes from this study highlight the importance of not only involving Indigenous participants, but providing leadership and governance opportunities for future genetics research.
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Affiliation(s)
- Bushra Farah Nasir
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Ritwika Vinayagam
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kym Rae
- Indigenous Health, Mater Research Institute, The University of Queensland, Brisbane, Australia
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10
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Wulsin LR, Sagui-Henson SJ, Roos LG, Wang D, Jenkins B, Cohen BE, Shah AJ, Slavich GM. Stress Measurement in Primary Care: Conceptual Issues, Barriers, Resources, and Recommendations for Study. Psychosom Med 2022; 84:267-275. [PMID: 35067657 PMCID: PMC8976751 DOI: 10.1097/psy.0000000000001051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Exposure to stressors in daily life and dysregulated stress responses are associated with increased risk for a variety of chronic mental and physical health problems, including anxiety disorders, depression, asthma, heart disease, certain cancers, and autoimmune and neurodegenerative disorders. Despite this fact, stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment. METHOD In this narrative review, we describe the primary reasons for this striking disjoint between the centrality of stress for promoting disease and how rarely it is assessed by summarizing the main conceptual, measurement, practical, and reimbursement issues that have made stress difficult to routinely measure in primary care. The following issues will be reviewed: a) assessment of stress in primary care, b) biobehavioral pathways linking stress and illness, c) the value of stress measurements for improving outcomes in primary care, d) barriers to measuring and managing stress, and e) key research questions relevant to stress assessment and intervention in primary care. RESULTS On the basis of our synthesis, we suggest several approaches that can be pursued to advance this work, including feasibility and acceptability studies, cost-benefit studies, and clinical improvement studies. CONCLUSIONS Although stress is recognized as a key contributor to chronic disease risk and mortality, additional research is needed to determine how and when instruments for assessing life stress might be useful in the primary care setting, and how stress-related data could be integrated into disease prevention and treatment strategies to reduce chronic disease burden and improve human health and well-being.
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Affiliation(s)
- Lawson R Wulsin
- From the Departments of Psychiatry and Family Medicine, University of Cincinnati, and Cincinnati Veterans Administration Medical Center (Wulsin), Cincinnati, Ohio; Osher Center for Integrative Medicine (Sagui-Henson), University of California, San Francisco, San Francisco, California; Health Psychology PhD Program (Roos), University of North Carolina at Charlotte, Charlotte, North Carolina; Center for Economic and Social Research (Wang), University of Southern California, Los Angeles; Department of Psychology, Chapman University, Center on Stress & Health, and Department of Anesthesiology and Perioperative Care (Jenkins), University of California, Irvine; Department of Medicine, University of California, San Francisco, and San Francisco Veterans Affairs Healthcare System (Cohen), San Francisco, California; Department of Epidemiology (Shah), Rollins School of Public Health, Emory University; Department of Medicine, Division of Cardiology (Shah), Emory University School of Medicine, Atlanta; and Atlanta Veterans Affairs Healthcare System (Shah), Decatur, Georgia; and Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences (Slavich), University of California, Los Angeles, Los Angeles, California
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11
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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution. J Psychiatr Ment Health Nurs 2022; 29:346-358. [PMID: 34032356 DOI: 10.1111/jpm.12773] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | | | - Jerry Allon
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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12
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Tyagi S, Ganesan G, Subramaniam M, Abdin E, Vaingankar JA, Chua BY, Chong SA, Tan KB. A prospective observational study exploring the association of comorbid chronic health conditions with total healthcare expenditure in people with mental health conditions in an Asian setting. BMC Psychiatry 2022; 22:203. [PMID: 35305602 PMCID: PMC8933898 DOI: 10.1186/s12888-022-03827-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is pertinent to focus on chronic medical condition (CMC) comorbidity with mental health conditions (MHC) as their co-occurrence has significant cost and health implications. However, current evidence on co-occurrence of MHC with CMC is mixed and mostly from Western settings. Therefore, our study aimed to (i) describe the association between MHC and total healthcare expenditure, (ii) examine the association between CMC and total healthcare expenditure and (iii) examine determinants of total and different types of healthcare expenditure in respondents with and without MHC in an Asian setting. METHODS The data from Singapore Mental Health Study (SMHS) 2016, a nationwide epidemiological survey, were linked with the National claims record (from 2017 to 2019). Multivariable Generalized Linear Models (GLM) were used to examine the association between MHC and total and different types of healthcare expenditure. RESULTS A total of 3077 survey respondents were included in current analysis. Respondents with MHC had a lower mean age of 38.6 years as compared to those without MHC (47.1 years). MHC was associated with increased total healthcare expenditure after adjusting for covariates (b = 0.508, p < 0.05). In respondents with MHC, presence of CMC increased the total healthcare expenditure by 35% as compared to 40% increase in those without MHC. Interestingly, 35-49 years age group with MHC had almost 3 times higher total healthcare expenditure and 7.5 times higher inpatient expenditure as compared to the 18-34 years age group. CONCLUSION Our study highlights variations in association of CMC and age with total healthcare expenditure in those with versus without MHC in an Asian setting. Practical recommendations include appropriate planning and resource allocation for early diagnosis and management of MHC, proactive screening for CMC in those with MHC and addressing the dual issues of treatment gap and stigma to facilitate early help seeking and prevent episodic, costly healthcare utilization.
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Affiliation(s)
- Shilpa Tyagi
- MOH Office for Healthcare Transformation, Harbourfront Centre, Maritime Square, Singapore, 099253, Singapore.
| | - Ganga Ganesan
- grid.415698.70000 0004 0622 8735Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore
| | - Mythily Subramaniam
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Janhavi Ajit Vaingankar
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Boon Yiang Chua
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Kelvin Bryan Tan
- grid.415698.70000 0004 0622 8735Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore
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13
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Hui A. Use of a Structured Framework with Novel Outcome Measures to Describe a Consultation-Liaison Psychiatry Service and its Effectiveness. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210708-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Proactive C-L Psychiatry Beyond Academic Hospital Settings: A Pilot Study of Effectiveness in a Suburban Community Hospital. PSYCHOSOMATICS 2020; 61:688-697. [DOI: 10.1016/j.psym.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
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15
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Bruno A, Mattei A, Arnone F, Barbieri A, Basile V, Cedro C, Celebre L, Mento C, Rizzo A, Silvestri MC, Muscatello MRA, Zoccali RA, Pandolfo G. Lifetime Psychiatric Comorbidity and Diagnostic Trajectories in an Italian Psychiatric Sample. CLINICAL NEUROPSYCHIATRY 2020; 17:263-270. [PMID: 34909002 PMCID: PMC8629092 DOI: 10.36131/cnfioritieditore20200501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Comorbidity in psychiatric patients has been widely examined in the literature, enucleating the role in misinterpretation of symptom's root in a multi-disease background, as well as the impact on the quality of life, outcome, and health-care effects. This research aimed to examine, in an Italian population of psychiatric patients, the diagnostic continuum in the context of lifetime psychiatric comorbidity, assessing possible differences related to the onset disorder. METHOD A retrospective analysis of medical records of 458 subjects, in which various psychiatric diagnoses were represented and categorized in 16 nosographic classes, was conducted. RESULTS Results showed that "Bipolar disorder" (22.06%) was the most frequent diagnosis, "Eating disorder" had the earliest age onset (Mean age years = 16 ± 1.41), and "Schizophrenia" showed the longest disease duration (Mean years = 24.20±12.76). Moreover, 54,4% of the final sample presented at least one psychiatric comorbidity in disease history, while "Other personality disorders" was the most comorbidity-associated diagnosis, representing 29% of all the cases with more than 3 past diagnoses. Heterotypic transition was observed in fairly all considered onset diagnoses, exception made for "Schizophrenia" with 75% of the subjects showing homotypic progression. CONCLUSIONS Our results suggest a tendency to make multiple diagnoses over psychiatric patients' lifetime in the majority of cases, often escaping from the original onset nosographic domain. More generally, our findings agree with a broad consensus that describes psychiatric symptomatic dimensions rather overlapped and correlated with each other, leading to a more transdiagnostic clinical approach.
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Affiliation(s)
- Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.,Corresponding author Dr. Antonio Bruno Department of Biomedical and Dental Sciences and Morphofunctional Imaging Policlinico Universitario Via Consolare Valeria, 1 – 98125 Messina - Italy Phone: 0039-090-22212092 Fax: 0039-090-695136 E-mail:
| | - Antonella Mattei
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Italy
| | - Federico Arnone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Arianna Barbieri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Valerio Basile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Laura Celebre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Amelia Rizzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Maria Catena Silvestri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | | | - Rocco Antonio Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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Bruno A, Mattei A, Arnone F, Barbieri A, Basile V, Cedro C, Celebre L, Mento C, Rizzo A, Silvestri MC, Muscatello MRA, Zoccali RA, Pandolfo G. Lifetime Psychiatric Comorbidity and Diagnostic Trajectories in an Italian Psychiatric Sample. CLINICAL NEUROPSYCHIATRY 2020. [PMID: 34909002 DOI: 10.36131/cn-fioritieditore20200501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Comorbidity in psychiatric patients has been widely examined in the literature, enucleating the role in misinterpretation of symptom's root in a multi-disease background, as well as the impact on the quality of life, outcome, and health-care effects. This research aimed to examine, in an Italian population of psychiatric patients, the diagnostic continuum in the context of lifetime psychiatric comorbidity, assessing possible differences related to the onset disorder. METHOD A retrospective analysis of medical records of 458 subjects, in which various psychiatric diagnoses were represented and categorized in 16 nosographic classes, was conducted. RESULTS Results showed that "Bipolar disorder" (22.06%) was the most frequent diagnosis, "Eating disorder" had the earliest age onset (Mean age years = 16 ± 1.41), and "Schizophrenia" showed the longest disease duration (Mean years = 24.20±12.76). Moreover, 54,4% of the final sample presented at least one psychiatric comorbidity in disease history, while "Other personality disorders" was the most comorbidity-associated diagnosis, representing 29% of all the cases with more than 3 past diagnoses. Heterotypic transition was observed in fairly all considered onset diagnoses, exception made for "Schizophrenia" with 75% of the subjects showing homotypic progression. CONCLUSIONS Our results suggest a tendency to make multiple diagnoses over psychiatric patients' lifetime in the majority of cases, often escaping from the original onset nosographic domain. More generally, our findings agree with a broad consensus that describes psychiatric symptomatic dimensions rather overlapped and correlated with each other, leading to a more transdiagnostic clinical approach.
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Affiliation(s)
- Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Antonella Mattei
- Department of Health, Life and Environmental Sciences, University of L'Aquila, Italy
| | - Federico Arnone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Arianna Barbieri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Valerio Basile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Laura Celebre
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Amelia Rizzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Maria Catena Silvestri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | | | - Rocco Antonio Zoccali
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Gianluca Pandolfo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
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Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Robert CA, Caraballo-Rivera EJ, Isola S, Oraka K, Akter S, Verma S, Patel RS. Demographics and Hospital Outcomes in American Women With Endometriosis and Psychiatric Comorbidities. Cureus 2020; 12:e9935. [PMID: 32968596 PMCID: PMC7505646 DOI: 10.7759/cureus.9935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives To explore sociodemographic differences and hospital outcomes in endometriosis patients with versus without psychiatric comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS, 2012-2014), and included 63,160 females with primary diagnosis of endometriosis. We used descriptive statistics and Pearson’s chi-square test to measure the differences in demographics and utilization of gynecologic procedures by the presence of psychiatric comorbidities. Results Psychiatric comorbidities were present in 18.7% inpatients with endometriosis. About three-fourth of these inpatients were in reproductive age group 26-45 years (75.7%) and were whites (79.1%). Psychiatric comorbidities were seen more in females from middle-income families and from the midwest region of the US. There was no significant difference in the utilization of gynecological procedures by the presence of psychiatric comorbidities. However, inpatients with psychiatric comorbidities had a longer mean length of stay (2.5 vs. 2.3 days) and total charges ($35,489 vs. $34,673) compared to the non-psychiatric cohort. Anxiety disorders predominated at 45% in patients with endometriosis followed by depressive disorder (31.3%), psychotic disorders (12.3%), and drug abuse (6.3%). Conclusion Endometriosis with psychiatric comorbidities is prevalent in young white females from a middle-income family. Anxiety and depressive disorders are most prevalent and are associated with extended hospitalization stay and higher charges, thereby negatively impacting the healthcare burden compared to those without psychiatric comorbidities.
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Affiliation(s)
| | | | - Sasank Isola
- Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Kosisochukwu Oraka
- Medicine, Vinnytsia National Medical University, N.I Pirogov, Vinnytsia, UKR
| | - Sabiha Akter
- Psychiatry, Bergen New Bridge Medical Center, Paramus, USA
| | - Shikha Verma
- Psychiatry and Behavioral Health, Rosalind Franklin University, North Chicago, USA.,Child and Adolescent Psychiatry, Rogers Behavioral Health, Kenosha, USA
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Bahji A, Altomare J, Sapru A, Haze S, Prasad S, Egan R. Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study. Psychiatry Res 2020; 290:113149. [PMID: 32512355 DOI: 10.1016/j.psychres.2020.113149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission. METHODS We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission. RESULTS A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission. CONCLUSION A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | | | - Amer Sapru
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Spencer Haze
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Samir Prasad
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
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von der Warth R, Hehn P, Wolff J, Kaier K. Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study. HEALTH ECONOMICS REVIEW 2020; 10:23. [PMID: 32653959 PMCID: PMC7354685 DOI: 10.1186/s13561-020-00281-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. METHODS The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. RESULTS N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268 - €3355], while reimbursement rose by €1387 [€563 - €2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. CONCLUSION Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Jan Wolff
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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Wolff J, Gary A, Jung D, Normann C, Kaier K, Binder H, Domschke K, Klimke A, Franz M. Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach. BMC Med Inform Decis Mak 2020; 20:21. [PMID: 32028934 PMCID: PMC7006066 DOI: 10.1186/s12911-020-1042-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/31/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A common problem in machine learning applications is availability of data at the point of decision making. The aim of the present study was to use routine data readily available at admission to predict aspects relevant to the organization of psychiatric hospital care. A further aim was to compare the results of a machine learning approach with those obtained through a traditional method and those obtained through a naive baseline classifier. METHODS The study included consecutively discharged patients between 1st of January 2017 and 31st of December 2018 from nine psychiatric hospitals in Hesse, Germany. We compared the predictive performance achieved by stochastic gradient boosting (GBM) with multiple logistic regression and a naive baseline classifier. We tested the performance of our final models on unseen patients from another calendar year and from different hospitals. RESULTS The study included 45,388 inpatient episodes. The models' performance, as measured by the area under the Receiver Operating Characteristic curve, varied strongly between the predicted outcomes, with relatively high performance in the prediction of coercive treatment (area under the curve: 0.83) and 1:1 observations (0.80) and relatively poor performance in the prediction of short length of stay (0.69) and non-response to treatment (0.65). The GBM performed slightly better than logistic regression. Both approaches were substantially better than a naive prediction based solely on basic diagnostic grouping. CONCLUSION The present study has shown that administrative routine data can be used to predict aspects relevant to the organisation of psychiatric hospital care. Future research should investigate the predictive performance that is necessary to provide effective assistance in clinical practice for the benefit of both staff and patients.
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Affiliation(s)
- J Wolff
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Department of Business Development, Evangelical Foundation Neuerkerode, Braunschweig, Germany.
| | - A Gary
- Department of Business Development, Forensic Commitment and Quality Management, Vitos GmbH, Kassel, Germany
| | - D Jung
- Vitos Hospital for Psychiatry und Psychotherapy, Kassel, Germany
| | - C Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Kaier
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - H Binder
- Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Klimke
- Vitos Hochtaunus, Friedrichsdorf, Germany
- Heinrich-Heine-University, Düsseldorf, Germany
| | - M Franz
- Vitos Hospital Giessen-Marburg, Giessen, Germany
- Justus-Liebig-University, Giessen, Germany
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Finlay-Jones A, Boyes M, Perry Y, Sirois F, Lee R, Rees C. Online self-compassion training to improve the wellbeing of youth with chronic medical conditions: protocol for a randomised control trial. BMC Public Health 2020; 20:106. [PMID: 31992269 PMCID: PMC6986046 DOI: 10.1186/s12889-020-8226-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) affect up to 35% of children and adolescents. Youth with chronic medical conditions are at an increased risk of psychological distress and reduced health-related quality of life, and report rates of mental illness up to double that of their physically healthy peers. Accessible, evidence-based interventions for young people with chronic illness are urgently required to improve their mental health and daily functioning. Self-compassion involves taking a mindful, accepting approach to difficult experiences, being aware that one is not alone in one's suffering, and being kind and understanding with oneself during challenging times. Self-compassion shares strong associations with mental health outcomes among young people and preliminary work indicates that interventions that build self-compassion have the potential to substantially improve youth mental health. Self-compassion is also associated with better physical and mental health outcomes among individuals living with CMCs. While face-to-face self-compassion training is available, there are several barriers to access for youth with CMCs. Online self-compassion training potentially offers an accessible alternative for this high-risk group. METHODS Self-Compassion Online (SCO) is a self-compassion program that has been tested with a non-clinical adult group. For the proposed trial, a reference group of youth (16-25 years) with chronic illness reviewed the program and proposed adaptations to improve its suitability for youth with chronic illness. In alignment with the SPIRIT Checklist, this paper outlines the protocol for a CONSORT-compliant, single-blind randomised controlled trial to test the efficacy of the adapted program, relative to a waitlist control, for improving self-compassion, wellbeing, distress, emotion regulation, coping and quality of life among young Australians with CMCs. Mechanisms of action and feasibility of SCO will be analysed using quantitative data and participant interviews, respectively. Finally, cost-utility will be analysed using health-related quality of life data. DISCUSSION The SCO program could provide a scalable solution for improving psychological outcomes and quality of life among youth with chronic illness. The proposed trial will be the first to determine its efficacy for improving these outcomes, relative to waitlist control. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry on the 11th April 2019, ACTRN12619000572167. Protocol version: Version 2, 21 December 2019.
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Affiliation(s)
- Amy Finlay-Jones
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia. .,School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia. .,University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Mark Boyes
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Yael Perry
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Rachael Lee
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Clare Rees
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Franz M, Gary A, Jung D, Wolff J. [Disorder-related case groups for needs-based hospital care]. DER NERVENARZT 2020; 91:814-821. [PMID: 31965201 DOI: 10.1007/s00115-019-00853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The individual needs of patients are central to hospital care. Due to the resulting complexity grouping of patients with similar therapeutic needs seems to facilitate an efficient organization of processes and the required treatment resources in hospital care. OBJECTIVE The aim of this study was to develop a system of disorder-related, treatment-oriented case groups as a possible tool for the efficient and needs-based organization of hospital care. MATERIAL AND METHODS The disorder-related groups were developed in a multistage, mixed-methods design. The technical content and quantitative description of the case groups and the extent of treatment included all consecutive inpatient treatment cases discharged between 1 January 2017 and 31 December 2017 from 9 psychiatric hospitals in Hesse, Germany. RESULTS All diagnoses in chapter F of the German modification of the International Statistical Classification of Diseases 10 (ICD-10-GM) were grouped into a total of 10 disorder-related groups. Analyses included 20,252 inpatient hospital treatment cases. Substantial management-relevant differences between the case groups could be identified and the various case group-specific configurations of clinically relevant comorbidities could be demonstrated. DISCUSSION The presented disorder-related grouping system and configuration of comorbidities suggest a modular organization of therapeutic measures and constitute a promising basis for needs-based management of patient care. Future work will show to what degree the disorder-related groups can facilitate a needs-specific treatment and align economic and therapeutic interests of psychiatric care.
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Affiliation(s)
- Michael Franz
- Vitos Klinikum Gießen-Marburg, Licher Straße 106, 35394, Gießen, Deutschland.
- Justus-Liebig-Universität Gießen, Gießen, Deutschland.
| | - Alexander Gary
- Geschäftsbereich Unternehmensentwicklung, Maßregelvollzug und Qualitätsmanagement, Vitos GmbH, Kassel, Deutschland
| | - Daniela Jung
- Vitos Klinik für Psychiatrie und Psychotherapie Kassel, Kassel, Deutschland
| | - Jan Wolff
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
- Evangelische Stiftung Neuerkerode, Neuerkerode, Deutschland
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The Impact of Integrated Psychiatric Care on Hospital Medicine Length of Stay: A Pre-Post Intervention Design With a Simultaneous Usual Care Comparison. PSYCHOSOMATICS 2019; 60:582-590. [DOI: 10.1016/j.psym.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/18/2019] [Accepted: 05/20/2019] [Indexed: 11/17/2022]
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Happell B, Scholz B, Bocking J, Platania-Phung C. Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic. Issues Ment Health Nurs 2019; 40:140-147. [PMID: 30763139 DOI: 10.1080/01612840.2018.1490834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.
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Affiliation(s)
- Brenda Happell
- a School of Nursing and Midwifery, University of Newcastle , Newcastle , New South Wales , Australia
| | - Brett Scholz
- b ANU Medical School, College of Health and Medicine, The Australian National University , Woden , Canberra , Australia
| | - Julia Bocking
- c Consumer Academic , University of Canberra, Faculty of Health, and ACT Health , Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- a School of Nursing and Midwifery, University of Newcastle , Newcastle , New South Wales , Australia
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Siddiqui N, Dwyer M, Stankovich J, Peterson G, Greenfield D, Si L, Kinsman L. Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions. BMC Health Serv Res 2018; 18:498. [PMID: 29945622 PMCID: PMC6020383 DOI: 10.1186/s12913-018-3316-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions. METHODS The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days' use between patients with and without comorbidity of mental illness. RESULTS Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days' use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%-159%) and 109% (78%-146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%-59.9%). CONCLUSIONS Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Mitchell Dwyer
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Jim Stankovich
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Gregory Peterson
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - David Greenfield
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Lei Si
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leigh Kinsman
- Conjoint appointment, University of Tasmania and Tasmanian Health Service (North), Tasmania, Australia
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