Hospitalization For Mental Illness Research Articles

Occupational differences in the effects of retirement on hospitalizations for mental illness among female workers: Evidence from administrative data in China

Retirement, a major transition in the life course, may affect many aspects of retirees’ well-being, including health and health care utilization. Leveraging differential statutory retirement age (SRA) by occupation for China’s urban female workers, we provide some of the first evidence on the causal effect of retirement on hospitalizations attributable to mental illness and its heterogeneity. To address endogeneity in retirement decisions, we take advantage of exogeneity of the differing SRA cut-offs for blue-collar (age 50) and white-collar (age 55) female urban employees. We apply a Fuzzy Regression Discontinuity Design (RDD) around the SRA cut-offs using nationally representative hospital inpatient claims data that cover these workers. We show that blue-collar females incur more hospitalizations for mental illness after retirement, while no similar change is found for white-collar females. Conditional on blue-collar females being hospitalized, probabilities of overall and ER admissions due to mental illness increase by 2.3 and 1.2 percentage points upon retirement, respectively. The effects are primarily driven by patients within the categories of schizophrenia, schizotypal and delusional disorders; and neurotic, stress-related and somatoform disorders. Moreover, the ‘Donut’ RDD estimates suggest that pent-up demand at retirement unlikely dominates our findings for blue-collar females. Rather, our results lend support to their worsening mental health at retirement. These findings suggest that occupational differences in mental illness and related health care utilization at retirement should be considered when optimizing retirement policy schemes.

Association between comorbid chronic pain or prior hospitalization for mental illness and substance use treatment among a cohort at high risk of opioid overdose

IntroductionChronic pain and serious mental illness increase risk of opioid use, and opioid use can exacerbate both conditions. Substance use disorder (SUD) treatment can be lifesaving, but chronic pain and serious mental illness may make recovery challenging. We evaluated the association between current chronic pain and prior hospitalization for mental illness and 90-day SUD treatment engagement, among emergency department (ED) patients at high risk of opioid overdose. MethodsWe conducted a cohort analysis of 648 ED patients enrolled in a randomized controlled trial in Rhode Island. We linked baseline study data on chronic pain and prior hospitalization for mental illness to statewide administrative data on state-licensed treatment programs (including methadone) and buprenorphine treatment via prescription. We defined treatment engagement as initiation of a state-licensed treatment program, transfer between state-licensed programs/providers, or a buprenorphine prescription (re-)fill. We used modified Poisson models to estimate the association between each baseline comorbidity and treatment engagement within 90 days following the ED visit, adjusted for a priori potential confounders. In an exploratory analysis, models were stratified by baseline treatment status. ResultsThe mean age of participants was 37 years; 439 (68 %) were male, and 446 (69 %) had been recently unhoused. Overall, 278 participants (43 %) engaged in treatment within 90 days of the ED visit. Participants with prior hospitalization for mental illness were more likely to engage in treatment than those without (adjusted risk ratio [ARR] = 1.24, 95 % confidence interval [CI] = 1.01–1.53), although this association was only among those already accessing treatment at baseline (ARR = 1.58, 95 % CI = 1.10–2.27). Chronic pain was not associated with 90-day treatment engagement overall (ARR = 1.12, 95 % CI = 0.91–1.38) or within baseline treatment subgroups. ConclusionsAmong ED patients at high risk of opioid overdose and accessing treatment at baseline, those with prior hospitalization for mental illness (but not chronic pain) were more likely to engage in treatment following the ED visit, which may reflect disproportionate initiation of additional treatment programs, transfer between programs/providers, or ongoing buprenorphine treatment. Touchpoints within the medical system should be leveraged to ensure that everyone, including those with serious mental illness, can access high-quality SUD treatment at the desired intensity level.

Analysis of inpatient cost burden and influencing factors of seniors’ patients with mental illness in Dalian, China

BackgroundAs China's aging population continues to grow, the prevalence of mental illness among the seniors has been steadily increasing. The aim of this study is to reveal the changing trends and characteristics of economic burden among seniors patients with long-term hospitalization for mental illness, and to analyze the influencing factors.MethodsThe data for this study were gathered from seniors’ patients with mental illness who were hospitalized and aged 60 years or older. The patients were admitted to four specialized and general hospitals located in Dalian city between January 2018 and December 2020. The types of diseases include affective mental disorders (mood disorders), Schizophrenia, schizotypal, and delusional disorders, Organic (including symptomatic) mental disorders, Neurotic, stress-related and somatoform disorders, Mental retardation, Mental and behavioral disorders due to substance use. (Identify the main diagnosis at discharge using ICD-10 coding). This study analyzed the basic characteristics and disease-related information of seniors patients with long-term psychiatric disorders who were hospitalized, and explored the factors influencing hospitalization costs among patients with different illnesses.ResultsAmong the 3871 study subjects, the average length of hospital stay was 127.51 days. The average hospitalization expenses per case were 33,656.07 yuan. Seniors’ patients with mental illness who receives treatment in specialized hospitals have higher hospitalization costs. Long-term hospitalization increases the total hospitalization costs. Age has an impact on hospitalization costs for patients with organic mental disorders. Patients with affective disorders (mood disorders) and neurotic, stress-related, and somatoform disorders who are covered by urban employee medical insurance have higher hospitalization costs.Patients with severe psychiatric disorders who have a 31-day readmission plan, as well as senior patients with somatoform disorders comorbid with other illnesses, incur higher hospitalization costs.ConclusionsWe should take corresponding measures to reduce the number of readmissions for patients with severe mental illnesses. The impact of treatment methods and differences in healthcare institutions on total hospitalization costs deserves further research. It is necessary to strengthen the prevention and diagnosis of comorbid physical illnesses in patients with mental disorders. The burden of mental illnesses in the seniors is significant, and medical insurance policies should be inclined towards providing support.

Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization.

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization. This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization. The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01). Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

How ambient temperature affects mood: an ecological momentary assessment study in Switzerland

BackgroundRecent research has suggested that an increase in temperature can negatively affect mental health and increase hospitalization for mental illness. It is not clear, however, what factors or mechanisms mediate this association. We aimed to (1) investigate the associations between ambient temperatures and bad daily mood, and (2) identify variables affecting the strength of these associations (modifiers) including the time, the day of the week and the year of the mood rating, socio-demographic characteristics, sleep quality, psychiatric disorders and the personality trait neuroticism in the community.MethodsData stemmed from the second follow-up evaluation of CoLaus|PsyCoLaus, a prospective cohort study conducted in the general population of Lausanne (Switzerland). The 906 participants rated their mood level four times a day during seven days using a cell phone app. Mixed-effects logistic regression was used to determine the association between daily maximum temperature and mood level. Participant ID was inserted as a random effect in the model, whereas the time of the day, the day of the week and the year were inserted as fixed effects. Models were controlled for several confounders (socio-demographic characteristics, sleep quality, weather parameters and air pollutants). Stratified analyses were conducted based on socio-demographic characteristics, sleep quality, presence of psychiatric disorders or a high neuroticism.ResultsOverall, the probability of having a bad mood for the entire day decreased by 7.0% (OR: 0.93: 95% CI 0.88, 0.99) for each 5 °C increase in maximum temperature. A smaller and less precise effect (-3%; OR: 0.97: 95% CI 0.91, 1.03) was found when controlling for sunshine duration. A higher association was found in participants with bipolar disorder (-23%; OR: 0.77: 95% CI 0.51, 1.17) and in participants with a high neuroticism (-13%; OR: 0.87 95% CI 0.80, 0.95), whereas the association was reversed for participants with anxiety (20%; OR: 1.20: 95% CI 0.90, 1.59), depression (18%; OR: 1.18 95% CI 0.94, 1.48) and schizophrenia (193%; OR: 2.93 95% CI 1.17, 7.73).ConclusionsAccording to our findings, rising temperatures may positively affect mood in the general population. However, individuals with certain psychiatric disorders, such as anxiety, depression, and schizophrenia, may exhibit altered responses to heat, which may explain their increased morbidity when exposed to high temperatures. This suggests that tailored public health policies are required to protect this vulnerable population.

PCR159 The Clinical and Financial Impact of Blue Cross and Blue Shield of Louisiana Waiving Cost Share for the First Mental Health and Substance Use Disorder Follow-up Visit

Waiving cost share for the first Mental Health and Substance Use Disorder (MHSU) follow-up visit after MHSU hospitalization is a Blue Cross and Blue Shield of Louisiana health care quality improvement program designed to remove potential financial barriers that the follow-up visit must take place within seven days of discharge from an inpatient stay. A mental health provider must perform the follow-up visit. The purpose of this effort is to encourage patient compliance of completing follow-up visits within seven days of a MHSU inpatient discharge. Follow-up within seven days helps close the gap for the Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS measure. This study evaluates the clinical and financial effect of this waived cost share.

Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study.

Twin pregnancy is a risk factor for postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness in the short-term or long-term is unknown. This study was a population-based retrospective cohort study, using linked health administrative databases for the entire province of Ontario, Canada. Included were primiparas aged 15-50years with a twin vs. singleton hospital livebirth, between January 1, 2003, and March 31, 2019. Propensity-score inverse probability of treatment weights accounted for potential confounding. The primary outcome of severe mental illness comprised a composite of an emergency department visit or hospitalization for mental illness or self-injury, or death by suicide, assessed in the first year after birth, and in long-term follow-up, up to 17years thereafter. Fifteen thousand twenty-four twin and 796,804 (15,022 weighted) singleton births were included, with a mean (IQR) duration of follow-up of 9 (5-13) years. After weighting, the mean (SD) maternal age was 31.3 (5.5) years. In the first 365days postpartum, severe mental illness occurred at rates of 10.5 and 8.7 per 1000 person-years in twin and singleton mothers, respectively, corresponding to a hazard ratio (HR) of 1.21 (95% CI 1.07-1.47). From 366days onward, the corresponding figures were 5.9 and 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Individuals with a twin birth appear to experience an increased risk for severe mental illness in the first year postpartum, but not thereafter. This suggests a potential need for targeted counselling and mental health services for mothers within the first year after birth.

Longitudinal risk of maternal hospitalization for mental illness following preterm birth

BackgroundPreterm birth may affect maternal mental health, yet most studies focus on postpartum mental disorders only. We explored the relationship between preterm delivery and the long-term risk of maternal hospitalization for mental illness after pregnancy.MethodsWe performed a longitudinal cohort study of 1,381,300 women who delivered between 1989 and 2021 in Quebec, Canada, and had no prior history of mental illness. The exposure was preterm birth, including extreme (<28 weeks), very (28-31 weeks), and moderate to late (32-36 weeks). The outcome was subsequent maternal hospitalization for depression, bipolar, psychotic, stress and anxiety, personality disorders, and self-harm up to 32 years later. We used adjusted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between preterm birth and mental illness hospitalization.ResultsCompared with term, women who delivered preterm had a higher rate of mental illness hospitalization (3.81 vs. 3.01 per 1000 person-years). Preterm birth was associated with any mental illness (HR 1.38, 95% CI 1.35-1.41), including depression (HR 1.37, 95% CI 1.32-1.41), psychotic disorders (HR 1.35, 95% CI 1.25-1.44), and stress and anxiety disorders (HR 1.42, 95% CI 1.38-1.46). Delivery at any preterm gestational age was associated with the risk of mental hospitalization, but risks were greatest around 34 weeks of gestation. Preterm birth was strongly associated with mental illness hospitalization within 2 years of pregnancy, although associations persisted throughout follow-up.ConclusionsWomen who deliver preterm may be at risk of mental disorders in the short and long term.

Clinical characteristics of admission for mental illness in a Regional Psychiatric Hospitalization Unit. Descriptive study 2008-2018

To describe the admissions of patients diagnosed with severe mental illness (SMI) and anxiety disorder in a regional hospital; to explore factors related to the patient’s referrer upon admission and prolonged stay. Cross-sectional study of episodes of admission to the regional Psychiatric Hospitalization Unit over a period of 11 years with ICD-10 diagnostic codesF20-29, F30-39, F60-69 and F40-48. The data was extracted through the Admissions Unit and the information from the electronic medical record. For the statistical treatment, descriptive or inferential tests were used with a confidence level of 95%. 961 patients were included (2,324 total discharges), aged 40.8±14.0 years. The most frequent reasons for admission were: positive symptoms (agitation, delusions and hallucinations), followed by suicidal ideation and attempt. The main remitting agent of the patients was the family itself. Approximately 1/5 of the cases were referred by the health system itself, and ¼ of those admitted had self-excluded themselves from specialized supervision for more than a year. The problems that caused the admission and its origin, as well as its lack of follow-up, can be considered as a clear opportunity for improvement in the follow-up of patients with severe mental illness. An orientation towards proactivity, acting before the decompensation, would contribute to improving the care and quality of life of patients with severe mental illness and their environment.

The Role of Group Sharing: An Action Research Study of Psychodrama Group Therapy in a Psychiatric Inpatient Ward

Numerous studies point to the acute distress associated with the experience of coping with severe mental illness and psychiatric hospitalization. Another strand of research notes the therapeutic benefits of psychodrama and its efficacy in increasing empathy and self-awareness, improving interpersonal relationships, reducing stress and anxiety, and in treating particularly vulnerable populations for whom traditional psychotherapy’s usefulness is limited. The goal of this paper is to provide a framework for understanding the potential of group sharing in dealing with the experience of loneliness and distress, and to serve as a space for relatedness and self-expression in psychodrama group therapy. A qualitative action research study following an open inpatients’ psychodrama group in a psychiatric hospital in Israel demonstrates the role of group sharing in creating an accommodating space of self-expression, relatedness, and mutual support, which offers relief for the distress of psychiatric inpatients. Within the inpatients’ group, the participants used sharing to distribute the burden among the group members along with the resources to cope with it. The paper seeks to illuminate the unique contribution of a therapeutic tool rarely dealt with by the existing literature–the group sharing—in dealing with situations of acute mental distress.

Rural disparities in the quality of clinical care are notable and larger for males.

To investigate whether rural-urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males. Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban-rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through evaluation of statistical interactions). Across all 7 categories of measures, scores for rural residents were worse than scores for urban residents. For 4 categories-care for patients with (suspected) chronic obstructive pulmonary disease, avoiding prescription misuse, behavioral health, and diabetes care-the average difference across measures in the category was greater than 3 percentage points. Across all 34 measures, there were 15 statistically significant rural-by-sex interactions that exceeded 1 percentage point. In 11 of those cases, the deficit associated with living in a rural area was greater for males than for females. In 3 cases, the deficit associated with living in a rural area was larger for females than for males. In 1 case involving Follow-up After Hospitalization for Mental Illness, rural residents had an advantage, and it was larger for males than for females. Interventions may help address patient- (eg, health literacy and patient activation), provider- (eg, workforce recruitment and retention), and structural-level issues contributing to these disparities, especially for rural males.

COVID-19 outbreak in a psychiatric hospital: what makes it worse?

BackgroundPsychiatric patients could be at risk of worse outcomes from COVID-19 than the general population. The primary objective of the present study was to describe the symptoms and clinical characteristics of COVID-19 patients living in long-term hospital for mental illness in Lebanon. The secondary objective was to evaluate the factors related to COVID-19 disease severity among these patients.Methods A retrospective observational study was conducted from September 2020 to January 2021 at the Psychiatric Hospital of the Cross. The total number of COVID‐19 patients in the infected floors is 410 out of 548. The outcome variable was the severity of COVID-19 illness classified into five categories: asymptomatic, mild, moderate, severe and critically ill.ResultsThe rate of infection in the affected floors was 74.81%. Almost half of the patients were asymptomatic (49.3%), 43.4% had hyperthermia and only 28.0% had tachycardia and 25.1% developed hypoxia. The multivariate regression analysis showed that higher temperature (ORa = 6.52), lower saturation (ORa = 0.88), higher BMI (ORa = 1.12), higher CRP (ORa = 1.01), being a female (ORa = 4.59), having diabetes (ORa = 8.11) or COPD (ORa = 10.03) were significantly associated with the increase of the COVID-19 severity.ConclusionsThe current study showed that a high rate of infection from COVID-19 was detected in a psychiatric hospital with the majority having asymptomatic to mild symptoms. Female psychiatric patients, desaturation, increase inflammation and comorbidities such as diabetes and COPD were associated with the severity of COVID‐19 among psychiatric patients. Future studies are needed to better understand the causal relation of the factors with severity and long term effects or sequelae of the disease.

16.2 Associations Between Mental and Physical Illness Comorbidity and Hospital Utilization Among Adolescents and Young Adults

This presentation will characterize the prevalence of chronic mental and physical illnesses and their comorbidity among adolescents and young adults (AYAs) and assess the association of comorbidity on hospital utilization.

Coping Styles, Psychological Resilience and Mental Health Status of Nurses Working in The Regional Mental Health and Illness Hospital

Amaç: Bu çalışmanın amacı bölge ruh sağlığı ve hastalıkları hastanesinde çalışan hemşirelerin psikolojik dayanıklılıkları, başa çıkma tarzları ve ruhsal durumlarının değerlendirilmesidir.Yöntem: Tanımlayıcı araştırmadır. Çalışmanın evrenini, bir bölge ruh sağlığı ve hastalıkları hastanesinde çalışan 130 hemşire oluşurmuştur. Çalışma 97 hemşire ile tamamlanmıştır. Veriler 2 Nisan 2016- 15 Ağustos 2016 tarihleri arasında Tanıtıcı bilgiler formu, Yetişkinler için Psikolojik Dayanıklılık Ölçeği, Stresle Başa Çıkma Tarzları Ölçeği ve Kısa Semptom Envanteri kullanılarak toplanmıştır. Araştırmanın yapılabilmesi için etik kurul izni alınmıştır. İstatistiksel değerlendirmede; Student-t testi, Mann Whitney U testi, tek yönlü varyans analizi, Kruskall Wallis, Pearson Korelasyon ve Çoklu regresyon analizi kullanılmıştır.Bulgular: Çalışmaya katılan hemşirelerin %76.3’ü kadın olup yaş ortalaması 39.26±7.63’tür. Hemşirelerin Stresle Başa Çıkma Tarzları Ölçeği kendine güvenli yaklaşım alt boyutu puan ortalaması 2.30±0.45 olup en yüksek alt boyut puanıdır. Yetişkinler için psikolojik dayanıklılık ölçeği alt boyutlarından sosyal kaynaklar alt boyut puan ortalaması 28.55±4.94’tür. Yetişkinler için Psikolojik Dayanıklılık Ölçeği alt boyutları içinde en yüksek puandır. Kısa Semptom Envanteri rahatsızlık ciddiyet indeksi skoru 0.10±0.10 (medyan=0.07)’dur. Stresle Başa çıkma Tarzları Ölçeği kendine güvenli yaklaşım alt boyut puanına Yetişkinler için Psikolojik Dayanıklılık ölçeği alt boyut puanlarının etkilerini regresyon analizi ile değerlendirildiğinde; modelin ileri düzeyde anlamlı (p:0.007; p&amp;lt;0.01) bulunmuştur ve R square değeri 0.419 olarak saptanmıştır.Sonuç: Araştırmaya katılan hemşireler başa çıkma tarzları içinde en fazla kendine güvenli yaklaşım ve iyimser yaklaşımı kullanmaktadırlar. Orta düzeyde psikolojik dayanıklılığa sahiptirler. Gösterdikleri ruhsal belirtiler hastalık düzeyinde değildir.

Investigation of the Motivation of Nurses Working in a Mental Health and Psychiatry Hospital to Approach or Avoid Emotion Inducing Situations in Terms of Some Parameters

Objective: This study aims to investigate the motivation of nurses, who are working in a mental health and illness hospital, to approach or avoid emotion inducing situations in terms of some parameters.Methods: This descriptive study was conducted with 101 nurses who worked in Samsun Mental Health and Illness Hospital between June 2017 and July 2017 and met the inclusion criteria. In the study, the “Demographic Information Sheet” and “Need for Affect Scale” were used as a data collection tool.Results: The nurses who thought that they were capable of recognizing their feelings had a low score from the avoidance sub-scale (p&amp;lt;0.05). The nurses who thought that they were capable of expressing their feelings had a high score from the approach sub-scale but a low score from the avoidance sub-scale (p&amp;lt;0.05). The nurses, who expressed that they partially abstain from participating in emotionally intense environments in their social lives, had a higher score from the avoidance sub-scale (p&amp;lt;0.05).Conclusion: It was concluded that for the nurses working in the mental health and illness hospital where the study was conducted, the parameter of thinking to be capable of expressing their feelings affected the motivation to approach emotion-inducing situations; while the parameters of thinking to be capable of recognizing feelings, of abstaining from participating in emotionally intense environments in social life, of thinking that individuals with mental illness are dangerous and having difficulty when working with them affected the avoidance motivation.

Association between long-term hospitalization for mental illness and locomotive syndrome

BackgroundPatients in psychiatric care wards face serious problems in terms of declining physical function due to aging and long-term hospitalization. This study aimed to determine the current status of locomotive syndrome (LS) in long-term inpatients in psychiatric care wards and to clarify the factors associated with LS risk severity. MethodsThe study included 84 patients admitted to psychiatric care wards who underwent the LS stage test. We investigated the participants’ age, length of stay, antipsychotic drug use, body mass index, and activities of daily living were assessed and analyzed the correlations between the LS stage test and each assessment item. ResultsThe participants' mean age was 60.0 ± 13.6 years, with those aged ≥60 years comprising nearly 60% of the sample. The participants’ mean length of stay was 10.5 ± 12.0 years, and over half of the patients stayed >5 years: 17.9% stayed between 5 and 10 years, while 36.9% stayed ≥10 years. Nearly 90% of participants stayed for >1 year. The LS stage test showed that 60.7% of the participants were stage 3, 21.4% were stage 2, 14.3% were stage 1, and 3.6% had no risk. The results of the LS stage indicated significant correlations with age, length of stay, and the Barthel Index scores. ConclusionsPatients who stay in a psychiatric care unit for a long period experience declining physical function, which is associated with aging and long-term hospitalization and might affect their activities of daily living.

Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 years and older: shorter-stay versus longer-stay.

As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI. In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N=118) and longer stays (N=117). After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced 're-institutionalization' to another care setting, as opposed to living independently. The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life.

Behavioral Health Care Quality Among Marketplace Insurers in 2019.

Using 2019 Centers for Medicare and Medicaid Services data, the authors analyzed performance on behavioral health care quality measures among 168 marketplace insurers offering 185 products and investigated whether performance differed by insurer attributes. The authors considered four quality measures: antidepressant medication management, follow-up care for children prescribed attention-deficit hyperactivity disorder medication, follow-up care within 7 days after hospitalization for mental illness, and initiation and engagement of alcohol and other drug dependence treatment. Multivariate regression was used to determine whether performance varied by insurers' nonprofit ownership, Blue Cross-Blue Shield affiliation, Medicaid-managed care participation, and preferred provider organization status. Performance levels were highest for management with antidepressant medication and lowest for initiation and engagement of drug dependence treatment. Systematic differ-ences were observed by ownership status and Medicaid-managed care plan status. Increasing the transparency of health plan quality information is important for aiding enrollee decision making and encouraging quality improvement among providers and insurers.

Incidence of Type 2 Diabetes in People With a History of Hospitalization for Major Mental Illness in Scotland, 2001-2015: A Retrospective Cohort Study.

To determine the incidence of type 2 diabetes in people with a history of hospitalization for major mental illness versus no mental illness in Scotland by time period and sociodemographics. We used national Scottish population-based records to create cohorts with a hospital record of schizophrenia, bipolar disorder, or depression or no mental illness and to ascertain diabetes incidence. We used quasi-Poisson regression models including age, sex, time period, and area-based deprivation to estimate incidence and relative risks (RRs) of diabetes by mental illness status. Estimates are illustrated for people aged 60 years and in the middle deprivation quintile in 2015. We identified 254,136 diabetes cases during 2001-2015. Diabetes incidence in 2015 was 1.5- to 2.5-fold higher in people with versus without a major mental disorder, with the gap having slightly increased over time. RRs of diabetes incidence were greater among women than men for schizophrenia (RR 2.40 [95% CI 2.01, 2.85] and 1.63 [1.38, 1.94]), respectively) and depression (RR 2.10 [1.86, 2.36] and 1.62 [1.43, 1.82]) but similar for bipolar disorder (RR 1.65 [1.35, 2.02] and 1.50 [1.22, 1.84]). Absolute and relative differences in diabetes incidence associated with mental illness increased with increasing deprivation. Disparities in diabetes incidence between people with and without major mental illness appear to be widening. Major mental illness has a greater effect on diabetes risk in women and people living in more deprived areas, which has implications for intervention strategies to reduce diabetes risk in this vulnerable population.

Pengaruh Pemilihan Anti-Psikotik Pada Pasien Depresi Tanpa dan Dengan Gejala Psikotik Terhadap Lama Hari Rawat Inap

Antipsychotic therapy is given frequently to the patient with depressive symptoms. Antipsychotics are used to enhance the effects of antidepressants in the depressive patients. The aim of this study was to evaluate the length of stay of antipsychotic therapy selection in the depressive patient without/with psychosis symptoms. This study was conducted by quantitative method, multicenter, non-experimental approach, and cohort design study. Data were collected from medical records of 187 patients diagnosed with depression without/with psychosis symptoms from the various mental-illness hospital in Central Java Province. There was a significant difference (p 0.05) in the length of stay with the selection of antipsychotic agents in depressive patients without/with psychotic symptoms. Keywords— Length of stay, depression, without/with psychosis symptoms, antipsychotic