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1.
BACKGROUND: The difference between the services provided by day hospitals and day centres is far from clear. The supposition that day hospitals would provide an acute service, while day centres would offer social support for a more chronic population has been contentious and there is little evidence of how they are currently used. AIMS: We aimed to ascertain the differences between day hospitals (partial hospitalisation) and social service day centres in functions and roles, as perceived by staff, service users and referrers. METHODS: The views of service users and staff at two day hospitals and four day centres were ascertained through questionnaires and interviews, along with those of staff of eight Community Mental Health Teams, who constitute the sole pathway to the two services. RESULTS: Day hospitals were perceived by both referrers and clients to offer short-term, more intensive 'treatment' to more acutely ill people in need of mental health monitoring. Day centres were perceived to offer longer-term support, particularly social support, to people more likely to have longer-term and psychotic illnesses. CONCLUSION: There is currently a clear distinction between day centres and day hospitals, in key features of their services and client groups. It would be unwise to treat them as interchangeable. 相似文献
2.
OBJECTIVES: To promote the discussion of leadership and management skills development among psychiatrists in Australia and New Zealand. METHOD: A key informant survey of fellows of the Royal Australian and New Zealand College of Psychiatrists was conducted via a semi-structured interview. This canvassed views about leadership and management issues including levels of confidence and needs for additional skills. RESULTS: There was widespread support for psychiatrists to be in management roles in mental health services; however, on entering management positions, psychiatrists often felt inadequately trained and prepared for their new role. Furthermore, many who had made the transition to management perceived a lack of support from their clinical colleagues. Clinicians appeared to believe that management was not difficult to learn and could be done by any experienced clinician. The provision of short courses and mentoring programmes is the preferred option for most psychiatrists seeking to acquire leadership and management skills. CONCLUSIONS: For psychiatrists to maximize their potential as leaders in Australian and New Zealand mental health services, greater attention to promoting the acquisition of relevant skills throughout training and in the post-fellowship years is required. Psychiatrists need to be supported and encouraged to pursue further education, training and research in this area. Failure to address this issue risks psychiatrists continuing to feel disadvantaged in management roles and hence reluctant to undertake the challenge. 相似文献
3.
Helbig S Lampert T Klose M Jacobi F 《Social psychiatry and psychiatric epidemiology》2006,41(11):889-896
BACKGROUND: Despite some reports on a potential link between parenthood and mental health, associations have not been systematically investigated yet. The present article provides prevalence rates of the most common mental disorders for parents and non-parents. Interactions between demographic and socio-economic variables, parental status and mental health are explored. METHODS: Data from the 1998/99 German Health Survey (GHS) and its Mental Health Supplement (GHS-MHS) were analysed using logistic regression models. Analyses were restricted to participants in the age group 18 to 49 (N=2,801). Mental disorders and syndromes were assessed with a standardized diagnostic interview (M-CIDI). RESULTS: Parenthood was associated with lower rates of psychiatric morbidity in general, and depressive and substance use disorders, in particular. The association between parental status and mental health was more distinct in men than in women, whereas partnership status moderated this relationship: An absence of partnership was associated with increased rates of all common mental disorders. Among non-parents, such a difference could not be found. Full-time employment, compared to part-time employment or unemployment, was linked to lower rates of the common mental disorders among fathers but not among mothers and non-parents. Age, education and income had no effects on the association between parental status and mental health. CONCLUSION: Parenthood is positively associated with mental health, particularly for men. Most differences can be found for depressive and substance use disorders. Partnership seems especially important for parents since it does not affect prevalence rates of mental disorders among non-parents. 相似文献
4.
Reigstad B Jørgensen K Sund AM Wichstrøm L 《Social psychiatry and psychiatric epidemiology》2006,41(4):323-331
Background
The study investigates whether adolescents referred to specialty mental health services from local services differ from adolescents who only have received help for psychiatric problems locally. If so, which factors associate strongest with referral?Method
Adolescents (n = 76) from an adolescent population sample (N = 2,538) who had received help during the last year for mental problems from local services were compared to a clinical sample of adolescents (N = 129) referred to specialty mental health services from such local services. Comparisons were made according to scores on the Youth Self-Report (YSR); depressive symptoms; family functioning; attachment to parents; self-concept; coping styles; response styles; dysfunctional attitudes; negative life events; daily hassles; socio-demographics.Results
As compared to adolescents receiving help locally, adolescents in specialty mental health care scored higher on YSR internalising syndrome; YSR attention problems; YSR thought problems; suicidality; psychosocial stressors; knowing someone who had attempted suicide; parental divorce; substance use; recent moves; living in lodgings; lost a pal or boy/girlfriend; and lower on attachment to parents. Multivariate logistic regression analysis identified four factors associated with receiving specialty mental health care: low family functioning; moved previous year; knowing someone who had attempted suicide; own suicidality.Conclusions
Family functioning as reported by the adolescents, and not mental health problems except for suicidality, was found to be the strongest associated with referral to specialty mental health services. Contrary to findings from many other studies, referral was associated with internalising problems, not externalising ones. 相似文献5.
6.
Estimates of the level of unmet need for mental health treatment often rely on self-reported use of mental health services. However, depressed persons may over-report their use in relation to administrative records if they are highly distressed. This study seeks to replicate and explicate the finding that persons at a high level of distress report more mental health service use than recorded in their healthcare records. The study sample, N = 36,892, 12 years and older, was drawn from the 1996/97 Ontario portion of the Canadian National Population Health Survey. Respondents were individually linked to their administrative mental healthcare records 12 months backward in time. Of these, 96.5% agreed to the link and 23,063 (62.5%) were linked. Almost two-thirds of those who were depressed in the past year were currently at a high level of distress. Differential reporting of use for highly distressed persons in excess of 100% remained in the use of different types of physician providers after adjustments for other potential determinants of use. Telescoping was also not an explanation. The patterns of differential reporting between groups expected to diverge and converge in their recall ability were consistent with a recall bias. As this study was not able to rule out a recall bias, it further accentuates concerns about the impact of bias in the measurement of mental health-service use and inferences made concerning the determinants of use. 相似文献
7.
Rhodes AE Lin E Mustard CA 《International journal of methods in psychiatric research》2002,11(3):125-133
Studies of mental health services have emphasized that people in need are not receiving treatment. However, these studies, based on self-reported use, may not be consistent with administrative records. This study compared self-reports of mental health service use with administrative records in a large representative sample. Respondent reports within the Ontario portion of the 1994/95 Household Component of the National Population Health Survey (NPHS) were individually linked to the provincial mental-health physician reimbursement claims. A total of 5187 Ontarians, aged 12 years or more, reported on their use of mental healthcare within the NPHS and 4621 (89%) consented and were successfully linked to administrative records. Comparisons between the two sources identified that the agreement for any use and volume of use was moderate to low and varied according to select respondent characteristics. These differences affected estimates of the associations with use and volume of use. People who reported high levels of distress reported more visits than those who did not and this effect was stronger in the self-reported data. These results suggest that recall bias may be present. Regardless of the definition of care, access for those in need remains a concern despite universal medical insurance coverage. 相似文献
8.
Background Depression is frequently associated with pain, yet the exact nature of this relationship is still not completely understood.
Increasingly it is thought that pain and depression may share a common causal pathway that may originate in childhood.
Methods A cross-sectional population-based survey recruited participants aged 18–25 years. Participants were asked about their current
and childhood pain experiences. Current levels of anxiety and depression were assessed using the Hospital Anxiety and Depression
Scale.
Results A total of 858 young adults responded to the questionnaire. Depression was associated with having a family member with pain
during childhood (OR 1.50; 95% CI 1.00, 2.26), having more illness than peers during secondary school (1.66; 1.03, 2.67) and
having more than three relatives with pain during childhood (OR 2.48; 1.48, 4.15). Adult anxiety was associated with more
illness than peers at primary school (1.73; 1.15, 2.61), more ‘emotional’ causes of pain at both primary (1.73; CI 1.13, 2.65)
and secondary school (2.06; 1.41, 3.00), and having a family member with pain during childhood (1.39; 1.04, 1.86).
Conclusions This study adds further evidence of an association between pain experiences in childhood and mental health problems in adulthood.
Clinicians should be aware of the importance of assessing childhood pain exposures in adult patients with common mental health
problems. 相似文献
9.
10.
M. ten Have R. de Graaf J. Ormel G. Vilagut V. Kovess J. Alonso 《Social psychiatry and psychiatric epidemiology》2010,45(2):153-163
Objective
To investigate the prevailing attitudes towards mental health help-seeking in Europe, their correlates, and whether these attitudes are associated with actual service use for mental health problems. 相似文献11.
Buston K 《Journal of adolescence》2002,25(2):231-242
This study explored the health-related views and experiences of adolescent users of mental health services through semi-structured interviews with 32 14-20-year olds who had been diagnosed with a mental illness. The majority of respondents had both negative and positive things to say about their contact with health services. These relate to: the doctor-patient relationship, treatment received, the health-care system, and the environs of the hospital or clinic. The views and experiences of young people with regard to their health care must be taken into account in efforts to boost help-seeking, attendance and compliance rates and, generally, to improve child and adolescent mental health services. In particular, further attention needs to be given to the development of empathic communication skills by health professionals working with adolescents with mental health problems. Work on the health-related views and experiences of representative samples of young people with mental health problems should be prioritized. 相似文献
12.
The aim of the study was to investigate the association of physical activity in three categories (inactive, insufficiently active and active) with health outcomes in people with epilepsy. The dependent variables and the instruments used in the study were: a) quality of life — measured by Quality of Life in Epilepsy-31 for adults and Quality of Life in Epilepsy for Adolescents, b) side effects of medication — measured by Adverse Events Profile, c) depression — measured by Neurological Disorders Depression Inventory for Epilepsy, and d) state and trait anxiety — measured by State–Trait Anxiety Inventory. Physical activity levels were analyzed using the International Physical Activity Questionnaire (IPAQ) for adults in the commuting and leisure domains and Physical Activity Questionnaire for Adolescents (PAQ-A). Simple and multiple linear regression was used in the statistical analysis. The cross-sectional study with one hundred and one individuals was conducted in Pelotas/RS, Brazil, at the Neurology Clinic of the Faculty of Medicine of the Federal University of Pelotas. In the crude analysis, physical activity was positively associated with quality of life (p < 0.001) and negatively associated with depression (p = 0.046), state of anxiety (p = 0.014), trait of anxiety (p = 0.015) and side effect of medication (p = 0.01). In addition, physical activity levels explained 10% of the quality of life (R2 = 0.10). In the adjusted analysis, physical activity remained associated with side effect of medication (p = 0.014) and was not associated with trait anxiety (p = 0.066). However, quality of life showed a positive linear trend (p = 0.001) while depression (p = 0.033) and anxiety state (p = 0.004) showed a negative trend according to physical activity levels. Physical activity was associated with health outcomes, and can be a nonpharmacological treatment in people with epilepsy for improving health and life conditions. 相似文献
13.
Purpose
Sexual minority mental health disparities are well documented. However, distinct sexual minority subgroups are often collapsed into a single “lesbian, gay, or bisexual” (LGB) analytic group. While limited research has shown sexual minority subgroup differences in mental health, little is known about the factors underlying these differences. This study examines whether sociodemographic, lifestyle, and psychosocial characteristics are associated with sexual orientation subgroup differences in mental health.
MethodsUsing the National Epidemiologic Survey on Alcohol and Related Conditions, Wave III, differences in various mental health measures, and sociodemographic, lifestyle, and psychosocial characteristics were assessed across three sexual minority subgroups [lesbians/gay men, bisexuals, and heterosexuals reporting same-sex attractions or behaviors (“heterosexual-identified sexual minorities, HSM”)] and heterosexuals reporting only opposite-sex attractions and behaviors (“heterosexuals”). Sequential linear regressions evaluated the degrees to which different factors attenuated mental health (SF-12) disparities between heterosexuals and sexual minority subgroups. Analyses were sex-stratified.
ResultsSeveral sociodemographic, lifestyle, and psychosocial characteristic differences existed between sexual orientation groups. Further, all sexual minority subgroups had lower SF-12 scores than heterosexuals, except lesbian women. Sociodemographic factors attenuated the disparity for bisexual men. Sociodemographic, lifestyle, plus psychosocial factors attenuated the disparity for HSM men. However, sociodemographic, lifestyle, and psychosocial factors partially, but did not fully, attenuate the disparity for gay men, bisexual women, or HSM women.
ConclusionsDifferent factors are associated with mental health disparities for sexual minority subgroups. To maximize health intervention efforts, additional research is needed to uncover the specific mechanisms contributing to health disparities across diverse sexual minority populations.
相似文献14.
15.
BACKGROUND: This paper examines what has been achieved in the specialist mental health services by the vastly increased health expenditures that the National Health Service (NHS) has enjoyed in the past 5 years. AIMS: To describe the way money has been spent in specialist mental health services and examine why problems remain after such admirable changes to already available resources. METHOD: Changes in staff employed by mental health services, where the extra staff are deployed, and patterns of expenditure within the whole service and within community mental health teams are examined. RESULTS: Some of the new expenditure has been well spent, and has produced improvements in the service. However, one must also take account of the costs of the greatly increased numbers of managers, who impose two sorts of costs: that of their own salaries, and the opportunity costs of front-line staff having to attend meetings and write reports rather than seeing patients. Throughout the rest of the NHS, money has been wasted on needless reorganisations, on consultant and general practitioner contracts, and on information technology that has so far failed to deliver tangible advantages. CONCLUSIONS: The emphasis on central control undermines local initiatives and wastes resources. Some central control is inevitable, but policies need to be developed in collaboration with clinicians. At local level, expenditure by primary care trusts and mental health trusts also needs to be scrutinised by committees that should include representatives of front-line mental health staff. 相似文献
16.
ten Have M Oldehinkel A Vollebergh W Ormel J 《Social psychiatry and psychiatric epidemiology》2005,40(6):425-431
AbstractBackground Little is known about the role of personality characteristics in service utilisation for mental health problems. We investigate whether neuroticism: 1) predicts the use of primary and specialised care services for mental health problems, independently of whether a person has an emotional disorder; and 2) modifies any association between emotional disorder and service use.Methods Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) a prospective cohort study in the general population aged 18–64. Neuroticism was recorded at baseline, and emotional disorder and service use at 12-month follow-up, in a representative sample (N=7076), using the Composite International Diagnostic Interview.Results People with high neuroticism were more likely to receive care in the specialised mental health sector, and after entry to care they made more visits to the services, whether or not they had an emotional disorder. If they had an emotional disorder, their likelihood of receiving specialised mental health care showed an additional increase. Neuroticism also predicted the use of primary care for mental health problems, but greater numbers of visits were made only by clients with both high neuroticism and an emotional disorder.Conclusions It would be useful to incorporate personality characteristics into models to understand variations in service utilisation for mental health problems. The findings suggest that professionals would be wise to focus not just on their clients’ emotional problems and disorders, but also on strengthening their problem-solving abilities through approaches like cognitive behavioural therapy. 相似文献
17.
Robin A. Richardson Arijit Nandi Surinder Jaswal Sam Harper 《Social psychiatry and psychiatric epidemiology》2017,52(12):1501-1511
Purpose
High work demands might be a determinant of poor mental health among women in low- and middle-income countries, especially in rural settings where women experience greater amounts of labor-intensive unpaid work. Research originating from such settings is lacking.Methods
We estimated the cross-sectional association between work demands and mental distress among 3177 women living in 160 predominantly tribal communities in southern Rajasthan, India. A structured questionnaire captured the number of minutes women spent on various activities in the last 24 h, and we used this information to measure women’s work demands, including the total work amount, nature of work (e.g., housework), and type of work (e.g., cooking). Mental distress was measured with the Hindi version of the 12-item General Health Questionnaire. We used negative binomial regression models to estimate the association between work demands (amount, nature, and type) and mental distress.Results
On average, women spent more than 9.5 h a day on work activities. The most time, intensive work activity was caring for children, the elderly, or disabled (149 min). In adjusted models, we found a U-shaped association between work amount and mental distress. High amounts of housework were associated with higher distress, whereas paid work and farmwork amount were not. Certain types of housework, including collecting water and cleaning, were associated with increased distress scores.Conclusions
We found an association between aspects of work demands and mental distress. Research in other contexts where women perform high amounts of unpaid work, particularly within the home or farm, is warranted.18.
Vanheusden K van der Ende J Mulder CL van Lenthe FJ Verhulst FC Mackenbach JP 《Social psychiatry and psychiatric epidemiology》2008,43(10):808-815
Objective Mental health problems are highly prevalent in young adults. Despite possibilities for effective treatment, only about one-third
of young adults with mental health problems seek professional help. Little knowledge exists of which groups of young adults
are underusing mental health services and for what reasons. The present study examined socio-demographic inequalities in the
use of mental health services by young adults, and examined whether such inequalities were attributable to differences in
objective need, subjective need, predisposing or enabling factors.
Design Cross-sectional study among the general population aged 19–32 years (2,258 respondents). A postal survey was administered
including questions on socio-demographic factors and mental health service use. Data were analyzed with logistic regression
analysis.
Setting South–West Netherlands.
Participants All respondents with serious internalizing and externalizing problems (n = 367).
Main outcome measure Twelve-month primary and specialty mental health services use.
Results Only 34.6% of young adults with psychopathology had used any mental health services: 16.2% had used only primary mental health
services and 18.4% had used specialty mental health services. No socio-demographic differences were found in the use of only
primary mental health services. However, recipients of specialty mental health services were more often female (OR = 2.12,
95% CI = 1.14–3.96), economically inactive (OR = 3.12, 95% CI = 1.59–6.09) or students (OR = 2.38, 95% CI = 1.05–5.42) and
they were less often higher educated (OR = 0.49, 95% CI = 0.25–0.97). The higher odds ratio for specialty service use among
young adults who were female or economically inactive attenuated when adjusting for need for care. The other socio-demographic
disparities in specialty service use did not attenuate when adjusting for need, enabling or predisposing factors.
Conclusion Among young adults, equal use of specialty mental health services for equal needs has not been achieved. The underserved groups
of young adults oppose the traditionally underserved groups in the general population, and may inform interventions aimed
at improving young people’s help-seeking behaviours. 相似文献
19.
Turton P Demetriou A Boland W Gillard S Kavuma M Mezey G Mountford V Turner K White S Zadeh E Wright C 《Social psychiatry and psychiatric epidemiology》2011,46(2):127-136
Introduction
The ??recovery approach?? to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users.Method
This qualitative pilot study explored the meaning of ??recovery?? with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews.Results
The relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ??Clinical?? recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness. 相似文献20.
OBJECTIVE: To report recent findings regarding differences in the provision, cost and outcomes of mental health care in Europe, and to examine to what extent these studies can provide a basis for improvement of mental health services and use of findings across countries. METHOD: Findings from a number of studies describing mental health care in different European countries and comparing provision of care across countries are reported. RESULTS: The development of systems of mental health care in western Europe is characterized by a common trend towards deinstitutionalization, less in-patient treatment and improvement of community services. Variability between national mental healthcare systems is still substantial. At the individual patient level the variability of psychiatric service systems results in different patterns of service use and service costs. However, these differences are not reflected in outcome differences in a coherent way. CONCLUSION: It is conceivable that the principal targets of mental healthcare reform can be achieved along several pathways taking into account economic, political and sociocultural variation between countries. Differences between mental healthcare systems appear to affect service provision and costs. However, the impact of such differences on patient outcomes may be less marked. The empirical evidence is limited and further studies are required. 相似文献
