History Of Psychiatric Admission Research Articles

The factors affecting rehabilitation to society of emergency department based post-suicidal care program recipients

The aim of this study is to investigate the factors affecting rehabilitation to society of Emergency Department (ED) based post-suicidal care program recipients. This prospective observational study was conducted at the ED of a general hospital in Seoul between March 2018 and October 2020. Patients who agreed to ED based post-suicidal care were followed up after 2 and 4 months and classified into a rehabilitated group and a non-rehabilitated group respectively. We analyzed the patients’ demographic data and suicide-related data. We used the Chi-square test or the Fisher’s exact test, the student’s t-test and multivariate logistic regression analysis. A total of 86 patients were included in this study. Factors that disturb rehabilitation of suicidal attempters were the presence of a housemate, a history of psychiatric admission, an acute disease or disability on 1st follow-up and the presence of a housemate, educational level and 1st non-rehabilitation on 2nd follow-up on univariate analysis. Multivariate logistic regression analysis showed that the absence of a housemate and 1st rehabilitation were associated with rehabilitation. This study shows that fast rehabilitation is important for rehabilitation of suicidal attempters and the presence of housemate can be a risk factor for non-rehabilitation.

Prevalence of Violent Victimization and Associated Factors among Psychiatric Outpatients

Background: Victimizations, coupled with the existing political and socioeconomic instability in East Africa, poses unbearable burden on people with mental illness. Methods: Six hundred twenty nine psychiatric patients were interviewed by trained psychiatry clinicians consecutively to study prevalence, and associated factors of victimization by using interviewer administered standard international crime victim survey questions. Analysis was done by using SPSS version 20. Adjusted odds ratio with 95% confidence interval and p-value =<0.05 were used to declare the statistical significance. Results: Lifetime and past year prevalence of victimization were 57.4% and 27.4% respectively. Majority of men were perpetrated by Strangers and acquaintances where as majority of women by near family members. In Binary Logistic Regression analysis: factors such as being female; history of psychiatric admission, suicidal attempt, previously cigarette smoking, khat chewing; criminal history and violent perpetration had significant association with victimization. Conclusion: The study identified high prevalence of victimization on people with mental illness which is potential for the formation of stress strain reaction as well as violation of legal rights of that population. Cooperation between law enforcers and mental health clinicians is needed.

The characteristics associated with alcohol co-ingestion in patients visited to the emergency department with deliberate self-poisoning: retrospective study

Objective: The aim of this study was to investigate the characteristics associated with alcohol co-ingestion by measuring blood alcohol concentration in patients visited to the emergency department with deliberate self-poisoning. Also, it was to evaluate the accuracy of self-reported alcohol ingestion. Methods: The initial assessment forms, medical records and laboratory tests of patients visited to the ED after DSP between March 2017 and June 2020 were retrospectively reviewed. Based on the patients’ BAC, two groups were formed: the non-alcohol group and the alcohol group. Results: This study included 286 patients (56.6%, n = 162) in the non-alcohol group and 43.4% (n = 124) in the alcohol group. In multivariate logistic analysis, alcohol co-ingestion was independently associated with no history of psychiatric admission (Odds Ratio = 6.222, 95% Confidence Interval = 1.148-33.716, P = 0.034), lactate (mg/dL)(Odds Ratio = 1.961, 95% Confidence Interval = 1.274-3.019, P = 0.002), and C-reactive protein level (mg/dL) (Odds Ratio = 0.003, 95% Confidence Interval = 0.000-0.897, P = 0.046). The receiver operating characteristics analysis of lactate value for the association with alcohol co-ingestion showed a cutoff value of 1.45, with 88.1% sensitivity, 71.6%specificity, and an area under the curve of 0.845. There was no statistically significant difference in emergency department disposition between the two groups. Using the 261 subjects who completed the self-report of alcohol co-ingestion, self-report resulted in 77.6% sensitivity and 76.6% specificity for the assessment of alcohol co-ingestion. The positive and negative predictive values for self-reporting were 72.6% and 81.0%, respectively. Conclusions: Alcohol co-ingestion was associated with no history of psychiatric ward admission, high lactate levels, and low C-reactive protein values in patients who visited the emergency department with deliberate self-poisoning. This study showed that self-reported alcohol co-ingestion was not a substitute for the blood alcohol concentration test.

Homicide by men diagnosed with schizophrenia: national case-control study.

Some people diagnosed with schizophrenia are more prone to committing acts of serious violence, especially in the presence of drug or alcohol misuse. The rarity of homicide has meant that no large controlled study has previously examined clinical risk factors. To determine the risk factors for homicide by males diagnosed with schizophrenia. A national nested case-control study of all previously admitted males diagnosed with schizophrenia, convicted of homicide between 1 January 1997 and 31 December 2012. Univariate and multivariable conditional logistic regression models were fitted to identify predictors of homicide in this population. During the observation period 160 male patients with schizophrenia and a history of psychiatric admission were convicted of homicide, and they were matched with 542 male control patients who had not been convicted of homicide. Patients who committed homicide were more likely to have a history of violence and comorbid personality disorder or drug misuse. They were more likely to have missed their last contact with services prior to the offence and to have been non-adherent with their treatment plan. Almost all (94%) of homicides were committed by patients who had a history of alcohol or drug misuse and/or who were not in receipt of planned treatment. In England and Wales, homicides by patients with schizophrenia without substance misuse and in receipt of planned care are exceptionally rare. To prevent serious violence, mental health services should focus on drug and alcohol misuse, treatment adherence and maintaining contact with services.

Reproductive health outcomes among eating disordered females: a register-based follow-up study among former adolescent psychiatric inpatients

Objective To analyze an association of eating disorders (EDs) to reproductive health outcomes among former adolescent psychiatric inpatients, hospitalized between the ages 13 and 17 years. The register-based follow-up information on psychiatric comorbidity and use of prescribed addictive psychotropic medication up to early adulthood were also explored. Methods A total of 31 (10.3%) women with a diagnosed ED were identified from the initial sample of 300 female adolescents, treated in psychiatric inpatient care between 2001 and 2006. The K-SADS-PL and EuropASI research instruments were used to gather information during the adolescent psychiatric hospitalization. The follow-up data for reproductive health outcomes and psychiatric comorbidity up to early adulthood were obtained from the national health care registers. Information on prescribed addictive psychotropic medication was provided by the Social Insurance Institution of Finland. In analyses, EDs were categorized into anorexia nervosa (AN) and other EDs (OED). AN accounted for 58.1% of all EDs. Of OEDs, the majority (69.1%) were bulimia. Results None of the women with AN, but 53.8% of those with OED had undergone medical abortions by early adulthood. Childbirths were emphasized in women with OED (61.5%) and a history of hospital-treated poisonings in women with AN (55.6%). High nicotine dependence in adolescence (30.8%) was a characteristic of women with OED. Conclusion Our study findings suggest that OED may expose affected women to various unfavorable reproductive health outcomes, particularly women with a history of psychiatric admissions. Recognizing the differences in young women with different subtypes of ED is important when discussing contraception and pregnancy.

Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study

SummaryBackgroundDischarged psychiatric inpatients are at elevated risk of serious adverse outcomes, but no previous study has comprehensively examined an array of multiple risks in a single cohort.MethodsWe used data from the Danish Civil Registration System to delineate a cohort of all individuals born in Denmark in 1967–2000, who were alive and residing in Denmark on their 15th birthday, and who had been discharged from their first inpatient psychiatric episode at age 15 years or older. Each individual in the discharged cohort was matched on age and sex with 25 comparators without a history of psychiatric admission. Data linked to each individual were also obtained from the Psychiatric Central Research Register, Register of Causes of Death, National Patient Register, and the National Crime Register. We used survival analysis techniques to estimate absolute and relative risks of all-cause mortality, suicide, accidental death, homicide victimisation, homicide perpetration, non-fatal self-harm, violent criminality, and hospitalisation following violence, until Dec 31, 2015.FindingsWe included 62 922 individuals in the discharged cohort, and 1 573 050 matched comparators. Risks for each of all eight outcomes examined were markedly elevated in the discharged cohort relative to the comparators. Within 10 years of first discharge, the cumulative incidence of death, self-harm, committing a violent crime, or hospitalisation due to interpersonal violence was 32·0% (95% CI 31·6–32·5) in the discharged cohort (37·1% [36·5–37·8] in men and 27·2% [26·7–27·8] in women). Absolute risk of at least one adverse outcome occurring within this timeframe were highest in people diagnosed with a psychoactive substance use disorder at first discharge (cumulative incidence 49·4% [48·4–50·4]), and lowest in those diagnosed with a mood disorder (24·4% [23·6–25·2]). For suicide and non-fatal self-harm, risks were especially high during the first 3 months post-discharge, whereas risks for accidental death, violent criminality, and hospitalisation due to violence were more constant throughout the 10-year follow-up.InterpretationPeople discharged from inpatient psychiatric care are at higher risk than the rest of the population for a range of serious fatal and non-fatal adverse outcomes. Improved inter-agency liaison, intensive follow-up immediately after discharge, and longer-term social support are indicated.FundingMedical Research Council, European Research Council, and Wellcome Trust.

Evaluation of Resilience, Quality of Life and Depression in Family Members of Alcohol/Substance Dependent Patients

Objective: The aim of this study was to compare resilience, quality of life, and depression levels in family members of patients suffering from dependence with a control group and to assess the relationship between resilience, quality of life, depression, and clinical features in family members. Method: The sample consisted of 41 female participants who had a family member with a history of at least one year of alcohol or substance dependence with outpatient and/or inpatient treatment and 41 female participants with no history of psychiatric admission or treatment matched to the family members by age, length of education, and marital status. Written informed consent was obtained from all participants and a sociodemographic data form, the Resilience Scale for Adults (RSA), the Short Form-36 (SF-36), and the Beck Depression Inventory (BDI) were administered. Results: Levels of resilience and quality of life were lower and levels of depression were higher in family members of alcohol or substance-dependent individuals compared to the control group. Depression scores were negatively correlated with resilience and quality of life scores. Resilience was positively correlated with all subscale scores for quality of life except general health. In family members, there were positive correlations between the duration of dependence and the scores on the family cohesion subscale and between the number of substance withdrawal periods and structured style subscale scores. With regard to family members’ resilience and quality of life, levels in siblings were higher compared to those of mothers and spouses, whereas the depression levels were higher in mothers compared to siblings of alcohol or substance-dependent patients. There was no difference between the scores for the family cohesion dimension among family members. Conclusion: Strengthening resilience is important for understanding, preventing, and treating psychiatric conditions. Resilience is a dynamic concept that can be learned and improved; therefore, resilience-enhancing programs may be beneficial in improving the quality of life and alleviating the level of depression in family members of dependent patients.

Evaluation of emotional expression, psychiatric symptoms, burnout, hopelessness and depression in relatives of substance dependent patients

The aim of the study was to compare psychiatric symptoms, burnout, hopelessness and depression between first-degree caregivers of dependent patients and control groups and to investigate the relation between emotional expression, psychiatric symptoms, burnout, hopelessness, depression and clinical features in relatives of the dependent group. The sample consisted of 40 participants who were primary caregiving relatives of dependent patients with history of at least one year dependence and being treated for dependence in in-patient or out-patient clinics and 40 participants with similar age, education year, gender, and marital status with relative group and with no history of psychiatric admission. Written informed consent was provided and demographic data form, Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Scale (BDS), Beck Hopelessness Scale (BHS), Maslach Burnout Inventory (MBI) were administered. Expressed Emotion Scale (EES) was only administered in relatives of the dependent group. In the present study, negative expectation score and total score of BHS were significantly higher than the control group in relatives of dependent patients. SCL-90-R somatization, interpersonal sensitivity, depression, anxiety and additional scales scores of the relatives of dependent patients were significantly higher than the control group. There was a positive correlation between the education year and the EES subscales and total scores. There was a positive correlation between the EES overprotective attitudes and total score of BHS. There was a negative correlation between BHS total score and the EES judgmental/hostile attitudes and additional scales.As a result, being relatives of patients with dependence was found to be associated with burnout, depression, hopelessness, and the risk of developing mental illness.

A study of the impact of child and adolescent abuse on personality disorders in adult women

IntroductionResearches on female offenders have indicated a high degree of psychiatric morbidity amongst women. Since the rates of female criminality are rising it would appear important to conduct the study of the relationship between criminal behaviour and psychiatric diagnoses in female offenders.ObjectivesThe main purpose of this investigation is to find out origins of crimes in women and to reveal the influence of child and adolescent maltreatment on personality disorders in adult women.MethodsClinical psychopathological, psychological, statistical.ResultsA cohort of 24 females with diagnosis of personality disorders was examined. All of them had committed crimes of violence. In the majority of the sample women had a previous history of psychiatric admissions (child psychiatric hospitals, adolescent units). The retrospective review revealed that the majority of women in their childhood were exposed to emotional, physical and sexual abuse in their families. Our results point that maltreatment may distort personality formation and social adjustment and contribute to behavior problems, negative relation to socialization and criminal behavior in adulthood.ConclusionThe study revealed that psychiatric disorders in childhood and adolescence are predictive of adult criminality in females. This findings may be used as prognostic indicators of development of aggression in female forensic patients.The study is supported by the Russian Fund of Fundamental Investigations 6-06-00314Disclosure of interestThe authors have not supplied their declaration of competing interest.

Are ICAM, VCAM and E-selectin levels different in first manic episode and subsequent remission?

ObjectiveIn bipolar patients, the rate of mortality from cardiovascular diseases is two-fold higher than that in other psychiatric disorders. The risk of cardiovascular diseases was found to be associated with some cellular adhesion molecules: Intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) and E-selectin. The aim of this study was to compare ICAM, VCAM and E-selectin levels at first manic episode and subsequent remission period, and to investigate the presence of a relationship between adhesion molecules levels and clinical and metabolic variables. MethodsIn line with this purpose, 50 patients diagnosed with mania according to DSM IV-TR criteria, who had their first episode were evaluated consecutively. The control group consisted of 50 healthy individuals without any history of psychiatric admission and treatment, matched with the manic patients in terms of age, gender, BMI and smoking status. For the confirmation of subsequent remission period (n=40), Young Mania Rating Scale and Hamilton Depression Rating Scale were used. In three groups plasma ICAM, VCAM and E-selectin, fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels were measured and compared. ResultsICAM and VCAM levels were found to be higher in first manic episode than those in subsequent remission and healthy individuals. A weak correlation was found between ICAM levels and YMRS scores in manic patients. In first manic episode, a weak correlation was found between ICAM and total cholesterol and LDL cholesterol levels and a weak correlation was found between ICAM, VCAM and E-selectin levels and BMI. ConclusionIn the present study, which is the first investigation of proinflammatory and prothrombotic state, which is defined as a risk for metabolic syndrome and cardiovascular disease, in bipolar disorder, ICAM and VCAM levels were found to be higher in first episode mania than those in subsequent remission and healthy individuals. As the study group included first episode mani cases, there was no effect of chronic psychotropic use. Probable risk of cardiovascular disease, reflected by increased ICAM and VCAM levels is already present in bipolar patients at the onset of the disease. In addition, ICAM and VCAM levels increasing in manic episode, return to normal in the subsequent remission period.

Suicide and unintentional injury mortality among homeless people: a Danish nationwide register-based cohort study

Homeless people have elevated mortality, especially due to external causes. We aimed to examine suicide and unintentional injury mortality levels and identify predictors in the homeless population. A nationwide, register-based cohort study of homeless people aged 16 years and older was carried out using the Danish Homeless Register, 1999-2008. In all, 32 010 homeless people (70.5% men) were observed. For men, the mortality rate was 174.4 [95% confidence interval (CI) = 150.6-198.1] per 100 000 person-years for suicide and 463.3 (95% CI = 424.6-502.0) for unintentional injury. For women, the corresponding rates were 111.4 (95% CI = 81.7-141.1) for suicide and 241.4 (95% CI = 197.6-285.1) for unintentional injury. Schizophrenia spectrum, affective, personality and substance use disorders were strongly associated with increased risk of suicide; the highest risk estimates were found for schizophrenia spectrum disorders among both men [hazard ratio (HR) = 3.1, 95% CI = 2.0-4.9] and women (HR = 15.5, 95% CI = 4.5-54.0). Alcohol and drug use disorders were predictors of death by unintentional injury for both men and women, whereas schizophrenia spectrum disorders and personality disorders were only significant predictors among men; the highest risk estimates were found for drug use disorders among men (HR = 2.2, 95% CI = 1.8-2.8) and women (HR = 3.1, 95% CI = 1.8-5.4). A history of psychiatric admission and emergency room contact were predictors for dying by suicide and unintentional injury. People in the homeless shelter population with a history of a psychiatric disorder constitute a high-risk group regarding the elevated suicide and unintentional injury mortality.

The relation between affective temperament and resilience in depression: A controlled study

BackgroundThe aim of this study was to investigate the presence of a relationship between affective temperament and resilience in patients with major depressive disorder (MDD) diagnosis, and to examine whether this relationship, if present, differs from healthy individuals. MethodsIn line with this purpose, 100 cases with major depressive disorder diagnosis who were in their remission period were evaluated consecutively in their regular outpatient control interviews. The control group consisted of 100 healthy individuals without any history of psychiatric admission and treatment, matched with the depressive group in terms of age and sex. Diagnostic interviews were conducted with SCID-I, affective temperament and resilience were evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and San Diego-Auto questionnaire) and The Resilience Scale for Adults (RSA)—Turkish version, respectively. ResultsWe observed a strong relationship between resilience and hyperthymic temperament both in depressive and healthy individuals. There was an inverse relation between psychological resilience and irritable and anxious temperament in both groups. A negative correlation was observed between irritable temperament and family cohesion in depressive disorder group, while in healthy individuals a strong correlation was observed between family cohesion and depressive and anxious temperament, and a weak correlation between family cohesion and hyperthymic temperament. LimitationsThe measurements of temperament and resilience were estimated depending on the patient's statement. ConclusionThere is a strong relationship between hyperthymic temperament and psychological resilience in MDD. The relationship between the type of affective temperament and the family cohesion sub-dimension of psychological resilience differs from that of healthy individuals.

Risk of drug-related mortality during periods of transition in methadone maintenance treatment: A cohort study

This study aims to identify periods of elevated risk of drug-related mortality during methadone maintenance treatment (MMT) in primary care using a cohort of 3,162 Scottish drug users between January 1993 and February 2004. Deaths occurring during treatment or within 3 days after last methadone prescription expired were considered as cases “on treatment.” Fatalities occurring 4 days or more after leaving treatment were cases “off treatment.” Sixty-four drug-related deaths were identified. The greatest risk of drug-related death was in the first 2 weeks of treatment (adjusted hazard ratio 2.60, 95% confidence interval 1.03–6.56). Risk of drug-related death was lower after the first 30 days following treatment cessation, relative to the first 30 days off treatment. History of psychiatric admission was associated with increased risk of drug-related death in treatment. Increasing numbers of treatment episodes and urine testing were protective. History of psychiatric admission, increasing numbers of urine tests, and coprescriptions of benzodiazepines increased the risk of mortality out of treatment. The risk of drug-related mortality in MMT is elevated during periods of treatment transition, specifically treatment initiation and the first 30 days following treatment dropout or discharge.

Suicide in later life: A comparison between cases with early-onset and late-onset depression

Suicide rates are high in elderly people with depressive disorder. We compared behavioural, clinical and care characteristics of depressed elderly patients, aged 60years and over at the time of death by suicide, with an early-onset depression (EOD, onset before 60years) with those patients with a late age of onset (LOD). From a 10-year national clinical survey of all suicides in England and Wales (n=13066) we identified 549 LOD cases, and 290 EOD cases. EOD and LOD cases were compared by logistic regression adjusted for age at suicide. Method of suicide did not differ by age of onset of depression. LOD cases were significantly less likely to have a history of psychiatric admissions (OR=0.2 [0.1-0.3]), alcohol misuse (OR=0.6 [0.4-0.9]) and self-harm (0.6 [0.4-0.8]). LOD cases also had a lower prevalence of a psychiatric co-morbid diagnosis (0.6 [0.4-0.7]) and a lower prescription rate for psychotropic drugs other than antidepressants. Furthermore, the number of recent life-events was significantly higher (OR=1.4 [1.0-1.9]) in LOD while the frequency of recent self-harm was similar to EOD. Although our study suggests that psychopathology of suicide among elderly depressed patients differs between EOD and LOD, the final pathway (via recent self-harm) to suicide may be similar in up to a quarter of patients in both groups. Our results suggest that strategies to enhance coping abilities and provision of support to negate the effects of life-events might be especially important in the prevention of suicide in LOD.

Primary prevention for offspring of parents with mental illness

Byline: T. Sathyanarayana Rao, Chittaranjan. Andrade Much literature has addressed caregiver burden in relation to depression, [sup][1] anxiety disorders, [sup][2] bipolar disorder, [sup][3] schizophrenia, [sup][4] dementia, [sup][5] and other mental illnesses. [sup][6] How are families, specifically children, affected when the patients are themselves the caregivers? This question is important because the offspring of parents with mental illness are at increased risk of medical, psychological, and social adversity for psychosocial and biological reasons, such as inadequate parental care, socioeconomic difficulties, genetic disadvantage, and psychotropic drug exposure in utero and during the puerperium. Much literature is available on certain of these issues, such as the effects on children resulting from the use of psychotropic medications during pregnancy and lactation. However, there is only a modest body of research on the medical health of these children during their preschool years. Two very recent studies on the early survival of children of parents with mental illness are briefly reviewed. One study addresses the sudden infant death syndrome (SIDS) in infants of parents with a history of psychiatric admission, and the other addresses the natural and unnatural causes of death in preschool children of parents with mental illness. Both studies highlight new areas for primary prevention; areas that would otherwise be neglected in routine clinical practice. Sudden Infant Death Syndrome Sudden infant death syndrome (SIDS) refers to sudden, unexplained death occurring during the first year of life. The risk of SIDS is known to be higher in infants of persons with mental illness. [sup][7],[8] Webb et al , [sup][9] investigated the possible reasons for this finding. The study was based on data collected on nearly 2.5 million singleton live births in Sweden between 1978 and 2004. There were 1531 cases of SIDS in the whole cohort, and the crude rate of SIDS was 0.6 per 1000 live births. The study threw up several important findings. Relative to the infants of women who were never admitted for psychiatric treatment, the risk of SIDS was trebled in infants of mothers with a history of psychiatric admission (OR, 3.1; 95% CI, 2.6-3.8). The risk was particularly high in mothers admitted for alcohol or drug-related disorders (OR, 6.5; 95% CI, 4.9-8.7), and was also high in mothers admitted with other diagnoses (OR, 2.3; 95% CI, 1.8-2.9). Relative to the infants of control fathers, the risk of SIDS was more than doubled in infants of fathers with a history of psychiatric admission (OR, 2.5; 95% CI, 2.0-3.1). The risk was significantly elevated with alcohol and drug-related diagnoses (OR, 2.8; 95% CI, 2.1-3.8), as well as with other diagnoses (OR, 2.1; 95% CI, 1.5-3.0). The risk of SIDS was elevated nearly seven-fold when both parents had a history of admission for any mental illness (OR, 6.8; 95% CI, 4.7-10.0). Again, the risk was higher in association with alcohol and drug-related admissions (OR, 9.5; 95% CI, 5.5-16.4) than with admissions for other diagnoses (OR, 5.4; 95% CI, 3.2-9.2). Curiously, the risks were not significant for parental affective and non-affective psychoses, specifically, but this could have been because the analyses were underpowered. Strikingly, the risk remained elevated even if the last maternal admission was five or more years before the infant's birth. After a national campaign to reduce SIDS, the risk factor prevalence (especially maternal antenatal smoking) remained high in parents with a history of mental illness, and therefore, the relative risk of SIDS increased. During 1992-2004, smoking and individual social adversity measures together accounted for approximately half of the excess risk associated with maternal psychiatric admission, whereas the risk associated with obstetric factors remained minimal. Preschool Mortality Chen et al,[10] provided a good review of the previous research and presented the first Asian data on preschool mortality in children of parents with mental illness. …

Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study

Objective To assess predictors of mortality in a population of people prescribed methadone.Design Retrospective cohort study.Setting Geographically defined population in Tayside, Scotland.Participants 2378 people prescribed and dispensed liquid methadone between...

Trends in Suicide Risk Associated With Hospitalized Psychiatric Illness

In light of the consistent reduction in suicide rate during the past 20 years in Denmark, this study aims to investigate trends in suicide risk associated with hospitalized psychiatric illness and to explore differences in the changes with regard to clinical phases of illness, sex, age, and diagnosis. This population-based study includes all of 21,169 suicides in Denmark during the years 1981 through 1997 and 423,128 controls matched for sex, age, and time (using a nested case-control design). Personal data on psychiatric history and socioeconomic status were retrieved from Danish longitudinal registers. Data were analyzed using conditional logistic regression. This study shows that the reduction in suicide rate is generally faster among individuals with a history of psychiatric admission than among individuals without such a history. However, this substantial reduction is mainly accounted for by the reduction among patients who had been discharged from psychiatric hospitals for more than 1 year. For patients who had been discharged from hospitals within 1 year, the reduction is similar to that of the general population; while for patients hospitalized for treatment at the time of suicide or the index date, the reduction in suicide rate is relatively slower. Such trends hold for all diagnostic groups. Further analyses stratified by age indicate that the faster reduction in suicide rate associated with history of hospitalized psychiatric illness is more pronounced among patients aged 36 years and older. The reduction in suicide rate is substantial for patients who have been discharged from psychiatric hospitals for more than 1 year and for middle-aged and older patients. Recent improvement in psychiatric care and treatment and promotion of new generation antidepressants may contribute to these changes.

Psychiatric comorbidity in a cohort of heroin and amphetamine users in Perth, Western Australia

Aims To determine if amphetamine and opioid users attending a drug treatment service were more likely to be admitted to psychiatric services than users not receiving treatment.Method Client records from Next Step Specialist Drug and Alcohol Services (Next Step) and the Community Based Methadone Program (CBMP) were linked to mental health and hospital morbidity data files using probabilistic matching.Participants The sample comprised 4280 drug users (2887 opioid users, 1393 amphetamine users). Of these, 928 received methadone at either Next Step or the CBMP, 541 attended counselling or a support group at Next Step, and 2811 did not receive any treatment from Next Step or the CBMP during the study.Findings Irrespective of treatment received, clients who had recently withdrawn from treatment were at the highest risk of a psychiatric admission, experiencing seven times the hazard of admission compared with those who did not access drug treatment. Amphetamine users had at least three times the hazard of psychiatric admission compared with opioid users. Clients with a history of psychiatric admissions had twice the hazard of subsequent admission compared with those with no psychiatric history.Conclusions Clients presenting at a drug treatment service should be screened for mental health diagnoses at their initial assessment so that appropriate treatment strategies can be offered to these dually diagnosed clients.

Aftercare and clinical characteristics of people with mental illness who commit suicide: a case-control study

Suicide prevention is now a health priority in many countries. In the UK, there are specific targets for reducing the suicide rate in the general population and in people with mental illness. However, there is almost no evidence for the effectiveness of health services in reducing suicide, and little evidence linking suicide to any aspect of health-service care. We conducted a case-control study of people who committed suicide after discharge from psychiatric inpatient care. Cases were a 30-month sample of 149 people who had received an inquest verdict of suicide or open verdict in Greater Manchester, and who had a history of psychiatric admission in the 5 years before death. Controls were surviving psychiatric patients individually matched for age, sex, diagnosis, and date of last admission. Cases and controls were compared on aspects of psychiatric care, and on clinical and social variables, information being obtained from case notes. Those who took their own lives were more likely to have had their care reduced (odds ratio 3.7 [95% CI 1.8-7.6]) at the final appointment in the community before death. Suicide was also associated with a history of self-harm (3.1 [1.7-5.7]), suicidal thoughts during aftercare (1.9 [1.0-3.5]) and the most recent admission as the first illness (2.0 [1.1-3.6]). The associations reported above took account of a number of confounding factors, including the predictable risk of suicide judged from case notes. Only 34% of suicides had an identifiable key worker, the essence of the Care Programme Approach. This frequency was no higher than that for controls, reflecting the difficulty of identifying those likely to commit suicide. Reductions in care are strongly associated with suicide by people with mental illness, and may be contributory. The implication is that maintaining care beyond the point of clinical recovery is important in protecting high-risk individuals. Several clinical variables indicate high risk but greater risk is not generally addressed in health service provisions.

The mental health residential care study: predicting costs from resident characteristics.

Little information is available on the costs of residential care for people with mental health problems, and there are very few research data on how or why the costs of provision vary. As part of a broader study based on data collected from across the residential care sectors in eight districts and using multiple regression analysis, research has examined whether and which resident characteristics are associated with higher or lower costs. Resident characteristics account for approximately 21% of the observed variation in inter-resident costs. Separate analyses were conducted for people in the London and non-London districts. The resident characteristics that were found to be significant predictors of cost include: age, gender, ethnic group, history of psychiatric admissions, diagnosis, emotional lability, daily living skills, social interaction and network, aggression, suicidal tendencies, drug abuse and legal status. Examination of the residual ('unexplained') costs found significant differences between facility types, sectors (private and voluntary being less costly than public, other things being equal) and districts. The associations uncovered by these analyses can inform commissioners' planning and purchasing activities, at both the macro and micro levels, by revealing those resident needs and circumstances that are associated with higher costs.