Mental health service users' experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries

Background

Psychiatric re-hospitalisation is considered costly and disruptive to individuals. The perspective of the mental health service user is largely unexplored in literature.

The purpose of our study was to explore service users’ experiences of psychiatric re-hospitalisation across six countries in Europe.

Method

Eight focus groups were conducted in Romania, Slovenia, Finland, Italy, Austria and Norway.

Results

A total of 55 service users participated in the study. All participants had been in receipt of mental health services for at least 1 year, and had experienced more than one psychiatric hospitalisation. The experience of re-hospitalisation was considered: (1) less traumatising than the first hospitalisation, (2) to be necessary, and a relief, (3) occurring by default and without progress, (4) part of the recovery process.

Conclusions

Psychiatric re-hospitalisation was considered inevitable by the study participants, in both positive and negative terms. Striking similarities in service user experiences were found across all of the six countries, the first experience of psychiatric hospitalisation emerging as especially significant. Findings indicate the need for further action in order to develop more recovery and person-centred approaches within hospital care. For psychiatric inpatient care to be a positive part of the recovery process, further knowledge on what therapeutic action during the hospital stay would be beneficial, such as therapy, activities and integration with other services.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3317-1) contains supplementary material, which is available to authorized users.

Psychiatric readmissions and their association with physical comorbidity: a systematic literature review

BACKGROUND

Comorbidity between mental and physical disorder conditions is the rule rather than the exception. It is estimated that 25% of adult population have mental health condition and 68% of them suffer from comorbid medical condition. Readmission rates in psychiatric patients are high and we still lack understanding potential predictors of recidivism. Physical comorbidity could be one of important risk factors for psychiatric readmission. The aim of the present study was to review the impact of physical comorbidity variables on readmission after discharge from psychiatric or general inpatient care among patients with co-occurring psychiatric and medical conditions.

METHODS

A comprehensive database search from January 1990 to June 2014 was performed in the following bibliographic databases: Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. An integrative research review was conducted on 23 observational studies.

RESULTS

Six studies documented physical comorbidity variables only at admission/discharge and 17 also at readmission. The main body of studies supported the hypothesis that patients with mental disorders are at increased risk of readmission if they had co-occurring medical condition. The impact of physical comorbidity variables on psychiatric readmission was most frequently studied in in patients with affective and substance use disorders (SUD). Most common physical comorbidity variables with higher probability for psychiatric readmission were associated with certain category of psychiatric diagnoses. Chronic lung conditions, hepatitis C virus infection, hypertension and number of medical diagnoses were associated with increased risk of readmission in SUD; Charlson Comorbidity Index, somatic complaints, physical health problems with serious mental illnesses (schizophrenia, schizoaffective disorder, personality disorders); not specified medical illness, somatic complaints, number of medical diagnoses, hyperthyroidism with affective disorders (depression, bipolar disorder). Co-occurring physical and mental disorders can worsen patient's course of illness leading to hospital readmission also due to non-psychiatric reasons.

CONCLUSIONS

The association between physical comorbidity and psychiatric readmission is still poorly understood phenomenon. Nevertheless, that physical comorbid conditions are more common among readmitted patients than single admission patients, their association with readmission can vary according to the nature of mental disorders, characteristics of study population, applied concept of comorbidity, and study protocol.

Transcriptomics and the mechanisms of antidepressant efficacy

The mechanisms by which antidepressants have their effects are not clear and the reasons for variability in treatment outcomes are also unknown. However, there is evidence from candidate gene research that indicates gene expression changes may be involved in antidepressant action. In this study, we examined antidepressant-induced alterations in gene expression on a transcriptome-wide scale, exploring associations with treatment response. Blood samples were taken from a subset of depressed patients from the GENDEP study (n=136) before and after eight weeks of treatment with either escitalopram or nortriptyline. Transcriptomic data were obtained from these samples using Illumina HumanHT-12 v4 Expression BeadChip microarrays. When analysing individual genes, we observed that changes in the expression of two genes (MMP28 and KXD1) were associated with better response to nortriptyline. Considering connectivity between genes, we identified modules of genes that were highly coexpressed. In the whole sample, changes in one of the ten identified coexpression modules showed significant correlation with treatment response (cor=0.27, p=0.0029). Using transcriptomic approaches, we have identified gene expression correlates of the therapeutic effects of antidepressants, highlighting possible molecular pathways involved in efficacious antidepressant treatment.

Enduring personality changes in patients living at home and challenges for community nursing

Introduction: Personality and behaviour disorders include enduring personality changes which cannot be attributed to brain injury or disease. Traumatic experiences can cause personality vulnerability. The research aimed to determine the characteristic enduring personality changes, the risk factors and the quality of life of patients living in their home environment. Methods: The field research is based on a quantitative method. The data were gathered through a structured questionnaire. The sample consisted n = 606 of patients (18.56 %) from the Central Slovenia region, aged between 20 and 92 years. The data were processed using descriptive statistics, the χ2 test, group classification and discriminant analysis. Results: The enduring personality changes are present in 9 % (n = 53) of the patients who tend to be older, with lesser educational attainment. Only a quarter of the enduring personality changes patients (n = 10) are receiving psychiatric treatment. Among the groups of patients with or without enduring personality changes statistically significant differences have been observed in relation to their past experiences with a traumatic event (p < 0.001), level of independence in the performance of the activities of daily living (p < 0.001), incidence rate of chronic pain (p = 0.002), social integration (p = 0.016), suicidal thoughts (p < 0.001) and incidence rate of comorbidity of somatic illnesses and psychological disorders (p < 0.001). Discussion and conclusion: Results of the study point to the share of enduring personality changes patients living at home in which the condition remains largely unrecognized, untreated and shadowed by other mental and physical health issues. Community nurses play a crucial role in timely recognition and detection of the changes and the patients' referral to multidisciplinary treatment. A national research project conducted by community nurses is needed to highlight the prevalence, treatment and good practice in the delivery of pertinent services.

Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder

BACKGROUND

So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression.

METHODS

100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A).

RESULTS

The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile.

LIMITATIONS

We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers.

CONCLUSION

Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.

Self-report and clinician-rated measures of depression severity: can one replace the other?

BACKGROUND

It has been suggested that clinician-rated scales and self-report questionnaires may be interchangeable in the measurement of depression severity, but it has not been tested whether clinically significant information is lost when assessment is restricted to either clinician-rated or self-report instruments. The aim of this study is to test whether self-report provides information relevant to short-term treatment outcomes that is not captured by clinician-rating and vice versa.

METHODS

In genome-based drugs for depression (GENDEP), 811 patients with major depressive disorder treated with escitalopram or nortriptyline were assessed with the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Rating Scale for Depression (HRSD), and the self-report Beck Depression Inventory (BDI). In sequenced treatment alternatives to relieve depression (STAR*D), 4,041 patients treated with citalopram were assessed with the clinician-rated and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) in addition to HRSD.

RESULTS

In GENDEP, baseline BDI significantly predicted outcome on MADRS/HRSD after adjusting for baseline MADRS/HRSD, explaining additional 3 to 4% of variation in the clinician-rated outcomes (both P < .001). Likewise, each clinician-rated scale significantly predicted outcome on BDI after adjusting for baseline BDI and explained additional 1% of variance in the self-reported outcome (both P < .001). The results were confirmed in STAR*D, where self-report and clinician-rated versions of the same instrument each uniquely contributed to the prediction of treatment outcome.

CONCLUSIONS

Complete assessment of depression should include both clinician-rated scales and self-reported measures.

Specific cognitive abilities are associated with diabetes self-management behavior among patients with type 2 diabetes

AIM

Patients with diabetes differ in compliance to diabetes self-management which influences their long-term health. Psychological factors, namely depression and cognitive abilities, are associated with diabetes self-management behavior. The aim of the study was to identify independent association of particular cognitive functions with diabetes self-management.

METHODS

In a cross sectional study 98 adults with type 2 diabetes attending Diabetes Outpatient Clinic were examined using the measures of diabetes self-management (Summary of Diabetes Self-Care Activities (SDSCA) measure), depression (Hamilton Depression Inventory (HDI)), diabetes distress (Problem Areas In Diabetes scale (PAID)), and the neuropsychological battery of tests for assessment of cognitive functions. Sociodemographic and diabetes-related data were collected. Univariate and multivariate regression analyses were used to identify and evaluate the predictors of diabetes self-management.

RESULTS

Specific cognitive functions, namely immediate memory, visuospatial/constructional abilities, attention, and specific executive functions (planning and problem solving) were significantly associated with diabetes self-management. Among cognitive factors, planning and problem solving abilities were strongest predictors; furthermore, in a multivariate regression their association was independent from depression.

CONCLUSIONS

Specific cognitive abilities, particularly planning and problem solving, play an independent role in diabetes self-management behaviors. Assessing patients' cognitive abilities may be of value for adjusting self-management education and treatment regimen.

Strategy for care for the elderly persons in Slovenia

Introduction

The size and age-structure of Europe’s population is undergoing dramatic changes due to low fertility rates, continuous increases in life expectancy and the retirement of the baby-boom generation. ‘The Strategy for care for the elderly till 2010—Solidarity, good intergenerational relations and quality ageing of the population’, prepared by Ministry of Labour, Family and Social Affairs, is the response of the Republic of Slovenia to the ageing society and to the European demands for new solidarity between the generations. The main purpose of the strategy is to create good conditions for preserving and strengthening solidarity, for good intergenerational relations and to ensure quality ageing and care for the fast growing third generation. Special attention is given to the long-term care and the implementation of the new insurance for it.

Description of care

Slovenia was 40 years ago one of the first countries with an efficient gerontological institute. The social welfare system in Slovenia today is based on the welfare system of public social insurance implemented in former Yugoslavia, which for elderly primarily developed nursing homes. Nursing homes in Slovenia are fully occupied at the moment. There are approximately 3.8% of people older than 65 live in nursing homes. The number of applications has been growing and waiting list for a bed to become available has been prolonging.

Discussion

Like in other European countries, there are also in Slovenia trends toward developing specific services for the elderly, adjusted to their needs and preferences. However, to a large share of the elderly population these services are not accessible—partly due to their small number and partly due to their high price. Furthermore, the majority of the elderly people wish to live in their current dwelling and familiar environment.

Conclusion

In developed societies the quality of life of the elderly population is coming to the forefront of research, as well as political agendas. This strategy is the only Slovenian document of this kind, in which different ministries took part in setting goals regarding ageing population. The strategy covers work of the governmental departments of work, employment, social care, health care, education, economy, traffic, science and other relevant areas and the civil society of the Third sector.