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Wu Y, Fan L, Xia F, Zhou Y, Wang H, Feng L, Xie S, Xu W, Xie Z, He J, Liu D, He S, Xu Y, Deng J, Wang T, Chen L. Global, regional, and national time trends in incidence for depressive disorders, from 1990 to 2019: an age-period-cohort analysis for the GBD 2019. Ann Gen Psychiatry 2024; 23:28. [PMID: 39095916 PMCID: PMC11297615 DOI: 10.1186/s12991-024-00513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Even with advances in primary health care, depressive disorders remain a major global public health problem. We conducted an in-depth analysis of global, regional and national trends in depressive disorders incidence over the past 30 years. METHODS Data on the incidence of depressive disorders were obtained by sex (female, male, and both), location (204 countries), age (5-84 years), year (1990-2019) from the Global Burden of Disease Study (GBD) 2019. Further, age-period-cohort modeling was used to estimate the net drift, local drift, age, period and cohort effects between 1990 and 2019. RESULTS In 2019, although the incidence of depressive disorders has increased by 59.3% to 290 million (95% UI: 256, 328), the age-standardized incidence rate has decreased by 2.35% to 3588.25 per 100,000 people (3152.71, 4060.42) compared to 1990. There was an emerging transition of incidences from the young and middle-aged population to the old population. From 1990 to 2019, the net drift of incidence rate ranged from -0.54% (-0.61%, -0.47%) in low-middle Socio-demographic Index (SDI) regions to 0.52% (0.25%, 0.79%) in high SDI regions. Globally, the incidence rate of depressive disorders increases with age, period effects showing a decreasing risk and cohort effects beginning to decline after the 1960s. CONCLUSIONS Our current findings reflect substantial health disparities and potential priority-setting of depressive disorders incidence in the three dimensions of age, period and cohort across SDI regions, countries. The scope of healthcare to improve the progression of depressive disorders events can be expanded to include males, females of all ages.
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Affiliation(s)
- Yuhang Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Luying Fan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Fan Xia
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yunzhe Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Haiyan Wang
- Department of Dermatology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lijuan Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530000, Guangxi Province, China
| | - Shudong Xie
- Transplantation Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wendi Xu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiqin Xie
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital of Nanchang University, Nanchang, 330052, Jiangxi, People's Republic of China
| | - Jing He
- Department of Obstetrics, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Dan Liu
- Prehospital Emergency Department of Xiangtan Central Hospital, Xiangtan, China
| | - Sui He
- Department of Clinical Laboratory, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Yuting Xu
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, 410013, People's Republic of China
| | - Jing Deng
- Hunan Academy of Traditional Chinese Medicine Affiliated Hospital, Changsha, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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Barbato A, D'Avanzo B, Corrao G, Di Fiandra T, Ferrara L, Gaddini A, Jarach CM, Monzio Compagnoni M, Saponaro A, Scondotto S, Tozzi VD, Lora A. Allocation of Users of Mental Health Services to Needs-Based Care Clusters: An Italian Pilot Study. Community Ment Health J 2024; 60:494-503. [PMID: 37882894 PMCID: PMC10912259 DOI: 10.1007/s10597-023-01200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
In Italy, despite strong community-based mental health services, needs assessment is unsatisfactory. Using the Mental Health Clustering Tool (MHCT) we adopted a multidimensional and non-diagnosis dependent approach to assign mental health services users with similar needs to groups corresponding to resources required for effective care. We tested the MHCT in nine Departments of Mental Health in four Italian regions. After a brief training, 318 professionals assessed 12,938 cases with a diagnosis of schizophrenia, depression, bipolar disorder and personality disorder through the MHCT. 53% of cases were 40-59 years, half were females, 51% had a diagnosis of schizophrenia, 48% of cases were clinically severe. Clusters included different levels of clinical severity and diagnostic groups. The largest cluster was 11 (ongoing recurrent psychosis), with 18.9% of the sample, followed by cluster 3 (non-psychotic disorders of moderate severity). The MHCT could capture a variety of problems of people with mental disorders beyond the traditional psychiatric assessment, therefore depicting service population from a different standpoint. Following a brief training, MHCT assessment proved to be feasible. The automatic allocation of cases made the attribution to clusters easy and acceptable by professionals. To what extent clustering provide a sound base for care planning will be the matter of further research.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Quality Assessment of Care and Services, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Quality Assessment of Care and Services, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Teresa Di Fiandra
- Psychologist, previously General Directorate for Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University), Milan, Italy
| | | | - Carlotta Micaela Jarach
- Laboratory of Lifestyle Epidemiology, Department of Environment and Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy.
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Psychologist, previously General Directorate for Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Tozzi VD, Banks H, Ferrara L, Barbato A, Corrao G, D'avanzo B, Di Fiandra T, Gaddini A, Compagnoni MM, Sanza M, Saponaro A, Scondotto S, Lora A. Using big data and Population Health Management to assess care and costs for patients with severe mental disorders and move toward a value-based payment system. BMC Health Serv Res 2023; 23:960. [PMID: 37679722 PMCID: PMC10483754 DOI: 10.1186/s12913-023-09655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Mental health (MH) care often exhibits uneven quality and poor coordination of physical and MH needs, especially for patients with severe mental disorders. This study tests a Population Health Management (PHM) approach to identify patients with severe mental disorders using administrative health databases in Italy and evaluate, manage and monitor care pathways and costs. A second objective explores the feasibility of changing the payment system from fee-for-service to a value-based system (e.g., increased care integration, bundled payments) to introduce performance measures and guide improvement in outcomes. METHODS Since diagnosis alone may poorly predict condition severity and needs, we conducted a retrospective observational study on a 9,019-patient cohort assessed in 2018 (30.5% of 29,570 patients with SMDs from three Italian regions) using the Mental Health Clustering Tool (MHCT), developed in the United Kingdom, to stratify patients according to severity and needs, providing a basis for payment for episode of care. Patients were linked (blinded) with retrospective (2014-2017) physical and MH databases to map resource use, care pathways, and assess costs globally and by cluster. Two regions (3,525 patients) provided data for generalized linear model regression to explore determinants of cost variation among clusters and regions. RESULTS Substantial heterogeneity was observed in care organization, resource use and costs across and within 3 Italian regions and 20 clusters. Annual mean costs per patient across regions was €3,925, ranging from €3,101 to €6,501 in the three regions. Some 70% of total costs were for MH services and medications, 37% incurred in dedicated mental health facilities, 33% for MH services and medications noted in physical healthcare databases, and 30% for other conditions. Regression analysis showed comorbidities, resident psychiatric services, and consumption noted in physical health databases have considerable impact on total costs. CONCLUSIONS The current MH care system in Italy lacks evidence of coordination of physical and mental health and matching services to patient needs, with high variation between regions. Using available assessment tools and administrative data, implementation of an episodic approach to funding MH could account for differences in disease phase and physical health for patients with SMDs and introduce performance measurement to improve outcomes and provide oversight.
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Affiliation(s)
- Valeria D Tozzi
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Helen Banks
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy
| | - Lucia Ferrara
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management - Bocconi University, Via Sarfatti, 10, Milan, 20136, Italy.
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Barbara D'avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | | | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano- Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Services, AUSL Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Antonio Lora
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Monzio Compagnoni M, Caggiu G, Allevi L, Barbato A, Carle F, D'Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Giordani C, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Corrao G, Lora A. Assessment and Monitoring of the Quality of Clinical Pathways in Patients with Depressive Disorders: Results from a Multiregional Italian Investigation on Mental Health Care Quality (the QUADIM Project). J Clin Med 2023; 12:jcm12093297. [PMID: 37176737 PMCID: PMC10179491 DOI: 10.3390/jcm12093297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Ensuring adequate quality of care to patients with severe mental disorders remains a challenge. The implementation of clinical indicators aimed at assessing the quality of health care pathways delivered is crucial for the improvement of mental health services (MHS). This study aims to evaluate the quality of care delivered to patients who are taken-into-care with depressive disorders by MHS. Thirty-four clinical indicators concerning accessibility, appropriateness, continuity, and safety were estimated using health care utilization databases from four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). A total of 78,924 prevalent patients treated for depressive disorders in 2015 were identified, of whom 15,234 were newly engaged by MHS. During the year of follow-up, access to psychotherapeutic interventions was low, while the intensity was adequate; 5.1% of prevalent patients received at least one hospitalization in a psychiatric ward (GHPW), and 3.3% in the cohort of newly engaged in services. Five-out-of-10 patients had contact with community services within 14 days after GHPW discharge, but less than half of patients were persistent to antidepressant drug therapy. Furthermore, prevalent patients showed an excess of mortality compared to the general population (SMR = 1.35; IC 95%: 1.26-1.44). In conclusion, the quality of health care is not delivered in accordance with evidence-based mental health standards. Evaluation of health interventions are fundamental strategies for improving the quality and equity of health care.
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Affiliation(s)
- Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, 60121 Ancona, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Teresa Di Fiandra
- Psychologist, Previously General Directorate for Health Prevention, Ministry of Health, 00144 Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | | | - Cristina Giordani
- Department of Health Planning, Italian Health Ministry, 00144 Rome, Italy
| | - Michele Sanza
- Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, 48121 Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, 40127 Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, 90145 Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, 20100 Milan, Italy
| | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, 23900 Lecco, Italy
- Consultant for General Directorate for Welfare, 20124 Milan, Italy
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Cognitive insight in individuals at ultra-high risk for psychosis compared to patients with first-episode psychosis and non-psychotic help-seeking youths. Asian J Psychiatr 2022; 73:103107. [PMID: 35461034 DOI: 10.1016/j.ajp.2022.103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Defective insight is a hallmark of schizophrenia. Less is known about insight in emerging psychosis. In this study a widely used measure of cognitive insight, the Beck Cognitive Insight Scale (BCIS), has been applied to a sample including patients with first-episode psychosis (FEP), at ultra-high risk (UHR) for psychosis, and help-seeking youths without psychotic symptoms. METHODS The Comprehensive Assessment of At-Risk Mental State (CAARMS) interview was used to classify patients. Enrolled patients were assessed with the General Health Questionnaire-12 (GHQ-12), the Prodromal Questionnaire-16 (PQ-16), the Social and Occupational Functioning Assessment Scale (SOFAS), and the BCIS. RESULTS The sample included 212 participants (58%) with non-psychotic mental distress, 131 participants (36%) were UHR, and 22 (6%) were with FEP. Males and females were in equal proportion, mean age was 19.2 ± 2.6 years old (range: 15-25 years). Reliability (Cronbach's alpha) was good for clinical scales (>0.7) and acceptable (around 0.6) for the two BCIS subscales. The self-certainty subscale of the BCIS was more reproducible in factor analysis than the self-reflectiveness scale. Youths devoid of psychotic symptoms scored lower than UHR and FEP participants on the GHQ-12 and the PQ-16 and had better psychosocial functioning as measured by the SOFAS. Levels of cognitive insight did not differ between groups. CONCLUSION People in the early stages of psychosis may be still accessible to self-reflectiveness and more hesitant about the certainty of their beliefs than patients at more advanced stages of the illness, as those with fully displayed schizophrenia.
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The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases. Epidemiol Psychiatr Sci 2022; 31:e15. [PMID: 35156603 PMCID: PMC8851066 DOI: 10.1017/s2045796022000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. RESULTS A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. CONCLUSIONS The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.
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Ostinelli EG, D’Agostino A, Pesce L, Zangani C, Miragoli P, Durbano F, Biffi G, Mencacci C, Scarone S, Gambini O. Mental health services and the city: a neighbourhood-level epidemiological study. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bülow P, Topor A, Andersson G, Denhov A, Stefansson CG. The Stockholm Follow-up Study of Users Diagnosed with Psychosis (SUPP): A 10-year Follow-up 2004-2013. Community Ment Health J 2021; 57:1121-1129. [PMID: 33191458 PMCID: PMC8217026 DOI: 10.1007/s10597-020-00740-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022]
Abstract
Since the 1970s, psychiatric care in the western world has undergone fundamental changes known as de-institutionalisation. This has changed the living conditions for people with severe mental illness. The purpose of this study was to investigate the living conditions and utilisation of care and social services for a group of people in Sweden with diagnosis of psychosis over a 10-year period, 2004-2013. During this period, psychiatric care decreased at the same time as interventions from the social services increased. Half of the persons in the studied group did not have any institutional care, that is, neither been hospitalised nor dwelling in supported housing, during the last 5 years, and just over 20% had no contact with either psychiatry or the municipality's social services during the last 2 years of the investigated period.
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Affiliation(s)
- Per Bülow
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Regional Forensic Psychiatric Hospital, Vadstena, Sweden.
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway.,Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Gunnel Andersson
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Mortality in mental health patients of the Emilia-Romagna region of Italy: A registry-based study. Psychiatry Res 2021; 296:113702. [PMID: 33418461 DOI: 10.1016/j.psychres.2020.113702] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022]
Abstract
Evidence from previous research demonstrated a gap in mortality between patients with mental disorders and the general population. However, a more exhaustive assessment is required to address this public health issue. The aim of this study was to provide comprehensive analysis of mortality examining all causes of death and all psychiatric diagnoses. We conducted a 10-year retrospective cohort study, including all in and out patients registered in the Mental Health Registry of Emilia-Romagna, Italy. Standardized mortality ratios (SMRs) were calculated. The cohort consisted of 137,351 patients 11,236 of whom died during the study period and the overall SMR was 1.99. 85.9 % of excess mortality was attributable to a broad range of natural causes. Diseases of circulatory and respiratory systems as well as neoplasms were the principal contributors to the mortality gap. All psychiatric conditions led to a higher risk of death. The greatest excess was due to neoplasms in depressed and neurotic patients and to cardiovascular diseases in patients with schizophrenia and personality disorders. Our results highlight the need for close collaboration between mental and primary health care services with the aim of reducing excess mortality as a result of medical diseases among all patients suffering from psychiatric condition.
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Mental Health Disorders and Summer Temperature-Related Mortality: A Case Crossover Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239122. [PMID: 33297344 PMCID: PMC7731125 DOI: 10.3390/ijerph17239122] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
Identifying the most vulnerable subjects is crucial for the effectiveness of health interventions aimed at limiting the adverse consequences of high temperatures. We conducted a case crossover study aimed at assessing whether suffering from mental health disorders modifies the effect of high temperatures on mortality. We included all deaths occurred in the area of Bologna Local Health Trust during the summers 2004-2017. Subjects with mental disorders were identified by using the local Mental Health Registry. A conditional logistic model was applied, and a z-test was used to study the effect modification. Several models were estimated stratifying by subjects' characteristics. For every 1 °C above 24 °C, mortality among people without mental disorders increased by 1.9% (95% CI 1.0-2.6, p < 0.0001), while among mental health service users, mortality increased by 5.5% (95% CI 2.4-8.6, p < 0.0001) (z-test equal to p = 0.0259). The effect modification varied according to gender, residency and cause of death. The highest probability of dying due to an increase in temperature was registered in patients with depression and cognitive decline. In order to reduce the effects of high temperatures on mortality, health intervention strategies should include mental health patients among the most vulnerable subjects taking account of their demographic and clinical characteristics.
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Meneghelli A, Barbera S, Meliante M, Monzani E, Preti A, Cocchi A, Percudani M. Outcome at 2-year of treatment in first-episode psychosis patients who were enrolled in a specialized early intervention program. Psychiatry Res 2020; 291:113200. [PMID: 32535510 DOI: 10.1016/j.psychres.2020.113200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023]
Abstract
Treatment in early intervention services (EIS) seems superior to treatment as usual on several outcomes, but the extent of heterogeneity in response is unclear. In this study, treatment response trajectories up to 2 years in first-episode psychosis (FEP) patients enrolled in an Italian early intervention service (EIS) have been quantified. The 24-item Brief Psychiatric Rating Scale (BPRS) was used to quantify treatment response up to 2 years in 129 participants. Conditional growth modeling and latent class growth analysis were used to test changes over time in the BPRS and separation into independent classes over time. Group differences were tested on socio-demographic and clinical variables known to be related to outcome in psychosis. Scores on the BPRS showed a statistically significant decrease in overall scores across all tested models. Four trajectories were identified across 2 years. Most patients showed a progressive decrease in the BPRS scores; a scant fraction showed a more stepped decrease from very high levels of psychopathology. No potential predictor was statistically related to the time course of BPRS scores. Most patients that undergo treatment within an EIS are characterized by amelioration, but patients that have higher baseline scores of psychopathology require more intensive treatment.
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Affiliation(s)
- Anna Meneghelli
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Simona Barbera
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Maria Meliante
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Emiliano Monzani
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Antonio Preti
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy.
| | - Angelo Cocchi
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy
| | - Mauro Percudani
- Programma2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, ASST Niguarda Hospital, Milan, Italy.
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Parabiaghi A, Confalonieri L, Magnani N, Lora A, Butteri E, Prato K, Vaggi M, Percudani ME. Integrated Programs for Early Recognition of Severe Mental Disorders: Recommendations From an Italian Multicenter Project. Front Psychiatry 2019; 10:844. [PMID: 31803086 PMCID: PMC6874055 DOI: 10.3389/fpsyt.2019.00844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023] Open
Abstract
The onset of mental disorders often occurs in adolescence or young adulthood, but the process of early diagnosis and access to timely effective and appropriate services can still be a challenge. The goal of this paper is to describe a pilot case of implementation of the ultra-high-risk (UHR) paradigm in six Italian departments of mental health employing an integrated approach to address clinical practice and service organization for youth in a broader preventive perspective. This approach entailed the integration of the UHR paradigm with a service provision model which prioritizes prevention and the promotion of local community coalitions to improve youth service accessibility. The multicenter Italian project "Integrated programs for recognition and early treatment of severe mental disorders in youths" funded by the National Centre for Disease Prevention and Control (CCM2013 Project) implemented in three Italian regions will be described. As a result of synergic actions targeting accessibility of young individuals to innovative youth mental health teams, a total of 376 subjects aged 15-24 years were recruited by integrated youth services within 12 months. Subjects have been screened by integrated multidisciplinary mental health youth teams employing standardized procedure and evidence-based clinical assessment instruments for at-risk mental states in young subjects [e.g., Comprehensive Assessment of At-Risk Mental States (CAARMS)]. Considering the three UHR categories included in CAARMS, the percentage of UHR subjects was 35% (n = 127) of the sample. In conclusion, future strategies to improve the organization of youth mental health services from a wider preventive perspective will be proposed.
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Affiliation(s)
- Alberto Parabiaghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Linda Confalonieri
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy
| | - Nadia Magnani
- Department of Mental Health, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - Antonio Lora
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Emanuela Butteri
- Department of Mental Health and Addiction Services, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Katia Prato
- Department of Mental Health and Addiction Services, ASST Rhodense, Milan, Italy
| | - Marco Vaggi
- Department of Mental Health and Addiction Services, ASL 3 Genova, Genova, Italy
| | - Mauro Emilio Percudani
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy
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13
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Cocchi A, Cavicchini A, Collavo M, Ghio L, Macchi S, Meneghelli A, Preti A. Implementation and development of early intervention in psychosis services in Italy: a national survey promoted by the Associazione Italiana Interventi Precoci nelle Psicosi. Early Interv Psychiatry 2018; 12:37-44. [PMID: 26416725 DOI: 10.1111/eip.12277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
AIM This is the first comprehensive, nationwide survey aimed at collecting evidence about the process of implementation and development of early intervention in psychosis (EIP) services (EIPs) in Italy, following the establishment of the pilot program 'Programma 2000' in 1999 and the publishing of the Italian National Guidelines in 2007. This survey covers all the Departments of Mental Health (DMHs) operating in Italy in 2013. METHODS Using a purpose-designed form to assess EIP implementation, all directors of public mental health services for adults throughout Italy (n = 216) were asked to provide information about the activities of EIP-relevant local services. The initial delivery was followed by a request for a prompt response. RESULTS Out of 216 enquired DMHs, 103 provided computable answers to the survey (response rate = 48%). Among responders, 45 (44%) reported the implementation of EIP (one out of five DMHs operating in Italy). About a half of the active EIPs also targeted patients at ultra-high risk of psychosis (n = 27). Strict application of guidelines related to drug prescription was reported in 35% of EIPs. Conversely, 90% provided some kind of structured psychotherapy and psychoeducation. Among EIPs, a minority reported willingness to provide initial assessment/contact at the patient's home. CONCLUSION Albeit slowly, the implementation of EIP is spreading throughout the Italian public network of mental health. There is still a wide variability in the distribution of EIP services across the Italian territory. Further efforts are necessary to stimulate policy endorsement and resource allocation, as well as to support the poorest zones.
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Affiliation(s)
- Angelo Cocchi
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Anna Cavicchini
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Marzia Collavo
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Genoa, Italy
| | - Sara Macchi
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Anna Meneghelli
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Preti
- Programma 2000 - Center for Early Detection and Intervention in Psychosis, Department of Mental Health, Niguarda Ca' Granda Hospital, Milan, Italy.,Psychiatry Branch, Genneruxi Medical Center, Cagliari, Italy.,Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
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14
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Lora A, Monzani E, Ibrahim B, Soranna D, Corrao G. Routine quality care assessment of schizophrenic disorders using information systems. Int J Qual Health Care 2017; 28:728-733. [PMID: 27578632 DOI: 10.1093/intqhc/mzw096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 07/19/2016] [Indexed: 12/18/2022] Open
Abstract
Objective To assess the quality of mental healthcare provided to patients with schizophrenic disorders in the Italian region of Lombardy. Design Forty-one clinical indicators were applied to Lombardy's healthcare databases containing data on mental health treatments, hospital admissions, somatic health treatments and pharmaceutical prescriptions. Setting All public departments of mental health and private residential facilities in Lombardy. Participants All 28 227 patients with schizophrenic disorders that were under the care of Lombardy mental health services in 2009. Interventions N/A. Main outcome measures N/A. Results The care that was delivered to patients and family members was more frequent for first-episode cases than for prevalent ones. Seven out of ten patients made use of continuing care and, after hospitalization, more than half of the discharged patients received a follow-up visit by community mental health centre staff within 2 weeks of their discharge. Psychotherapeutic and psychoeducative treatments, such as employment and independent living support, were not widespread among these discharged patients. Antipsychotic drug dosage was usually within the recommended range. The adherence of first-episode patients to antipsychotic treatment was lower than that of prevalent patients, and the monitoring of metabolic side effects was not always consistent. Inappropriateness of hospital care, in terms of longer admission, readmission, compulsory admission and restraint, was limited. Mortality during the period was significant. Conclusions Clinical indicators demonstrate the strengths and weaknesses of the mental health system in Lombardy and they can be useful tools in the routine assessment of mental healthcare quality.
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Affiliation(s)
- Antonio Lora
- Department of Mental Health, Azienda Ospedaliera della Provincia di Lecco, Via dell'Eremo 9/11, 23900 Lecco, Italy
| | - Emiliano Monzani
- Department of Mental Health, Azienda Ospedaliera Niguarda Ca Granda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, Italy
| | - Bussy Ibrahim
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy
| | - Davide Soranna
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy.,Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Via BIcocca degli Arcinboldi 8, 20126 Milano, Italy
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15
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Lora A, Lesage A, Pathare S, Levav I. Information for mental health systems: an instrument for policy-making and system service quality. Epidemiol Psychiatr Sci 2017; 26:383-394. [PMID: 27780495 PMCID: PMC6998623 DOI: 10.1017/s2045796016000743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022] Open
Abstract
AIMS Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward. METHODS Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries. RESULTS Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models. CONCLUSIONS Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited application of information. Corrective action is needed to upgrade data collection in outpatient facilities, to improve data quality, to establish clear rules and norms, to access adequate information technology equipment and to train health care personnel in data collection. Moreover, it is necessary to shift from mere administrative data collection to analysis, dissemination and use by relevant stakeholders and to develop a "culture of information" to dismantle the culture of intuition and mere tradition. Clinical directors, mental health managers, patient and family representatives, as well as politicians should be educated to operate with information and not just intuition.
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Affiliation(s)
- A. Lora
- Department of Mental Health - Manzoni Hospital, Lecco, Italy
| | - A. Lesage
- Centre de recherche de l'Institut Universitaire en Santé Mentale, Université de Montréal, Montreal, Canada
| | - S. Pathare
- Centre for MH Law & Policy, Indian Law Society, Pune, India
| | - I. Levav
- Department of Community Mental Health, Faculty of Welfare and Health Sciences, University of Haifa, Israel
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16
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Community residential facilities in mental health services: A ten-year comparison in Lombardy. Health Policy 2017; 121:623-628. [PMID: 28400127 DOI: 10.1016/j.healthpol.2017.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/24/2017] [Accepted: 03/20/2017] [Indexed: 11/21/2022]
Abstract
Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.
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17
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Dell'Osso B, Cremaschi L, Grancini B, De Cagna F, Benatti B, Camuri G, Arici C, Dobrea C, Oldani L, Palazzo MC, Vismara M, Altamura AC. Italian patients with more recent onset of Major Depressive Disorder have a shorter duration of untreated illness. Int J Clin Pract 2017; 71. [PMID: 28090727 DOI: 10.1111/ijcp.12926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/09/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Previous investigation on the duration of untreated illness (DUI) in patients with Major Depressive Disorder (MDD) revealed a different latency to first antidepressant treatment, with adverse consequences in terms of outcome for individuals with a longer DUI. Recent reports, moreover, documented a reduced DUI, as observed with the passage of time, in patients with different psychiatric disorders. Hence, the present study was aimed to assess DUI and related variables in a sample of Italian patients with MDD as well as to investigate potential differences in subjects with onset before and after 2000. METHODS An overall sample of 188 patients with MDD was assessed through a specific questionnaire investigating DUI and other variables related to the psychopathological onset and latency to first antidepressant treatment, after dividing them in two different subgroups on the basis of their epoch of onset. RESULTS The whole sample showed a mean DUI of approximately 4.5 years, with patients with more recent onset showing a significantly shorter latency to treatment compared with the other group (27.1±42.6 vs 75.8±105.2 months, P<.05). Other significant differences emerged between the two subgroups, in terms of rates of onset-related stressful events and benzodiazepine prescription, respectively, higher and lower in patients with more recent onset. CONCLUSIONS Our findings indicate a significant DUI reduction in MDD patients whose onset occurred after vs before 2000, along with other relevant differences in terms of onset-related correlates and first pharmacotherapy. Further studies with larger samples are warranted to confirm the present findings in Italy and other countries.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA, USA
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca De Cagna
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Camuri
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Arici
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Dobrea
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Carlotta Palazzo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Vismara
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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18
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Barbato A, Vallarino M, Rapisarda F, Lora A, Parabiaghi A, D'Avanzo B, Lesage A. Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. Int J Soc Psychiatry 2016; 62:334-44. [PMID: 26896028 DOI: 10.1177/0020764016631368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. AIMS This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. METHOD Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. RESULTS A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. CONCLUSION Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy
| | - Martine Vallarino
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- Mental Health Department, Lecco Hospital, Lecco, Italy
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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Dell'Osso B, Oldani L, Camuri G, Benatti B, Grancini B, Arici C, Cremaschi L, Palazzo M, Spagnolin G, Dobrea C, Altamura AC. Reduced duration of untreated illness over time in patients with schizophrenia spectrum, mood and anxiety disorders. Psychiatry Clin Neurosci 2016; 70:202-10. [PMID: 26821781 DOI: 10.1111/pcn.12380] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/27/2022]
Abstract
AIMS Psychiatric disorders represent highly impairing conditions, often underdiagnosed and undertreated, with a conspicuous duration of untreated illness (DUI). Given that social and cultural factors influence the DUI and assuming that progress in diagnosis and treatment determines a reduced latency to pharmacotherapy, we assessed and compared DUI and related variables in a large sample of psychiatric patients (n = 562) whose onset occurred within three different a priori-defined epochs. METHODS Two temporal cut-offs were established - the year 1978, when Law 180 (redefining standards for mental care) was introduced in Italy, and the year 2000 - in order to divide patients into three subgroups: onset before 1978, onset 1978-2000 and onset after 2000. RESULTS A significant difference in terms of age at onset, age at first diagnosis and age at first treatment was observed in patients with onset 1978-2000 and in those with onset after 2000. In addition, a significant reduction of the DUI was found across epochs (onset before 1978: 192.25 ± 184.52 months; onset 1978-2000: 77.00 ± 96.63 months; and onset after 2000: 19.00 ± 31.67 months; P < 0.001). Furthermore, the proportion of patients with onset-related stressful events, use of benzodiazepines and neurological referral was found to be significantly different between the three epochs (χ(2) = 23.4, P < 0.001; χ(2) = 9.92, P = 0.007; χ(2) = 16.50, P = 0.011). CONCLUSIONS Present data indicate a progressive, statistically significant reduction of latency to treatment and other related changes across subsequent epochs of onset in patients with different psychiatric disorders. Future studies will assess specific changes within homogeneous diagnostic subgroups.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Bipolar Disorders Clinic, Stanford Medical School, Stanford University, California, USA
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Camuri
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Grancini
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Arici
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariacarlotta Palazzo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gregorio Spagnolin
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Dobrea
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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20
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Corrao G, Soranna D, Merlino L, Monzani E, Viganò C, Lora A. Do patterns of mental healthcare predict treatment failure in young people with schizophrenia? Evidence from an Italian population-based cohort study. BMJ Open 2015; 5:e007140. [PMID: 26041489 PMCID: PMC4458586 DOI: 10.1136/bmjopen-2014-007140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Little is known about the practice of predicting community-based care effectiveness of patients affected by schizophrenic disorders. We assessed predictors of treatment failure in a large sample of young people affected by schizophrenia. METHODS A cohort of 556 patients aged 18-35 years who were originally diagnosed with schizophrenia during 2005-2009 in a Mental Health Service (MHS) of the Italian Lombardy Region was identified. Intensity of mental healthcare received during the first year after index visit (exposure) was measured by patients' regularity in MHS attendance and the length of time covered with antipsychotic drug therapy. Patients were followed from index visit until 2012 for identifying hospital admission for mental disorder (outcome). A proportional hazards model was fitted to estimate the HR and 95% CIs for the exposure-outcome association, after adjusting for several covariates. A set of sensitivity analyses were performed in order to account for sources of systematic uncertainty. RESULTS During follow-up, 144 cohort members experienced the outcome. Compared with patients on low coverage with antipsychotic drugs (≤ 4 months), those on intermediate (5-8 months) and high (≥ 9 months) coverage, had HRs (95% CI) of 0.94 (0.64 to 1.40) and 0.69 (0.48 to 0.98), respectively. There was no evidence that regular attendance at the MHS affected the outcome. CONCLUSIONS Patients in the early phase of schizophrenia and their families should be cautioned about the possible consequences of poor antipsychotic adherence. Physicians and decision makers should increase their contribution towards improving mental healthcare.
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Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy
| | - Emiliano Monzani
- Department of Mental Health, Cà Granda Niguarda Hospital, Milan, Italy
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milano, Milan, Italy
| | - Antonio Lora
- Department of Mental Health, Lecco Hospital, Lecco, Italy
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Conti V, Venegoni M, Cocci A, Fortino I, Lora A, Barbui C. Antipsychotic drug exposure and risk of pulmonary embolism: a population-based, nested case-control study. BMC Psychiatry 2015; 15:92. [PMID: 25924683 PMCID: PMC4423096 DOI: 10.1186/s12888-015-0479-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/23/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Only three observational studies investigated whether exposure to antipsychotics is associated with an increased risk of pulmonary embolism, with conflicting results. This study was therefore carried out to establish the risk of pulmonary embolism associated with antipsychotic drugs, and to ascertain the risk associated with first- and second-generation antipsychotic drugs, and with exposure to individual drugs. METHODS We identified 84,253 adult individuals who began antipsychotic treatment in a large Italian health care system. Cases were all cohort members who were hospitalized for non-fatal or fatal pulmonary embolism during follow-up. Up to 20 controls for each case were extracted from the study cohort using incidence density sampling and matched by age at cohort entry and gender. Each individual was classified as current, recent or past antipsychotic user. The occurrence non-fatal or fatal pulmonary embolism was the outcome of interest. RESULTS Compared to past use, current antipsychotic use more than double the risk of pulmonary embolism (odds ratio 2.31, 95% confidence interval 1.16 to 4.59), while recent use did not increase the risk. Both conventional and atypical antipsychotic exposure was associated with an increase in risk, and the concomitant use of both classes increased the risk of four times (odds ratio 4.21, 95% confidence interval 1.53 to 11.59). CONCLUSIONS Adding the results of this case-control study to a recent meta-analysis of three observational studies substantially changed the overall estimate, which now indicates that antipsychotic exposure significantly increases the risk of pulmonary embolism.
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Affiliation(s)
- Valentino Conti
- Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy.
| | - Mauro Venegoni
- Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy.
| | - Alfredo Cocci
- Regional Centre for Pharmacovigilance, Lombardy Region, Milano, Italy.
| | - Ida Fortino
- Unit of Community Health Services, Regional Health Ministry, Lombardy Region, Milan, Italy.
| | | | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy.
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Cocchi A, Balbi A, Corlito G, Ditta G, Di Munzio W, Nicotera M, Meneghelli A, Pisano A, Preti A. Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies. Early Interv Psychiatry 2015; 9:163-71. [PMID: 24673891 DOI: 10.1111/eip.12135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/05/2014] [Indexed: 11/29/2022]
Abstract
AIM In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. METHODS The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). RESULTS Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. CONCLUSIONS Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.
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Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma 2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
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Abstract
The Italian Psychiatric Reform of 1978 is reviewed here in terms of national/regional mental health (MH) policies and with the help of epidemiological data. The reform law was essentially a framework one, and Italy's 21 regions were called to draft detailed organizational norms and to implement their systems. This explains a relevant interregional variability, despite several national MH plans. In a recent survey, compliance with national standards found homogeneous implementation on structural parameters but quite a variable one on functional parameters (continuity, coordination, accessibility, specialization). Epidemiological data show the impact of regional variability on the quality of treatment provided. Because of discrepancies among regional information systems, we analyze data from six Italian regions, where regional case registers have long been implemented, focusing on adult population prevalence and incidence rates and outpatient-inpatient care. Indicators of service use and some national MH documents are discussed in relation to the system's future prospects.
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Abstract
Filling an alarming gap in evidence-based data on the post-1978 reformed Italian psychiatric system, two turn-of-millennium nationwide projects, Progetto Residenze (PROGRES) and PROGRES-Acute, provided detailed qualitative-quantitative information about care facilities. In 2000, there were 2.9 residential beds per 10,000 inhabitants, hospital care being delivered through small (15-bed) psychiatric units. Private inpatient facilities had proliferated, private inpatient beds per 10,000 inhabitants outnumbering public beds. In 2002, there were 1.7 acute inpatient beds per 10,000 inhabitants, one of Europe's lowest current ratios. The PROGRES and other subsequent projects showed marked nationwide variation in the provision of residential inpatient and outpatient care, grounds for concern about the quality of such care, and an uneven service use pattern. Although the Italian reform law produced a broad network of facilities to meet diverse mental health care needs, the present overview article confirms that further efforts are required to improve quality, balance public and private sectors, and coordinate resources and agencies.
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Abstract
The psychiatric reform in 1978 assigned the regions the task of implementing community mental health (MH) services; 30 years on in Italy, there are as many MH systems as there are Italian regions and all completely differentiated. Three Italian regions (Lombardy, Emilia-Romagna, and Campania) in different geographic areas are here chosen as representing three different models of community care implementation as well as certain similarities and differences at a regional level. For each region, the article focuses on MH policy, financing, the network of community health facilities, service provision, MH staff, and the information system.
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Cocchi A, Cerati G, Lora A, Meneghelli A, Monzani E, Percudani M, Petrovich L, Mirabella F, Picardi A, Preti A. Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment. Clin Pract Epidemiol Ment Health 2014; 10:1-8. [PMID: 24600479 PMCID: PMC3942866 DOI: 10.2174/1745017901410010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/20/2014] [Accepted: 01/22/2014] [Indexed: 11/22/2022]
Abstract
Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.
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Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giorgio Cerati
- Dipartimento di Salute Mentale, Azienda Ospedaliera Ospedale Civile di Legnano, Italy
| | - Antonio Lora
- Dipartimento Salute Mentale, Azienda Ospedaliera della Provincia di Lecco, Italy
| | - Anna Meneghelli
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emiliano Monzani
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Mauro Percudani
- Dipartimento di Salute Mentale - A.O. "G. Salvini", Garbagnate Milanese, Italy
| | - Lorenzo Petrovich
- Comitato Tecnico per le Innovazioni in Salute Mentale. Direzione Generale Sanità - Regione Lombardia, Milan, Italy
| | - Fiorino Mirabella
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Picardi
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Preti
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
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Use of antipsychotic drugs and mood stabilizers in women of childbearing age with schizophrenia and bipolar disorder: epidemiological survey. Epidemiol Psychiatr Sci 2013; 22:355-61. [PMID: 23369654 PMCID: PMC8367338 DOI: 10.1017/s2045796013000012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims. To determine the prevalence of women of childbearing age with schizophrenia and bipolar disorder exposed to antipsychotic (AP) drugs and mood stabilizers (MS) in Lombardy, a European region of 10 million inhabitants and 1 752 285 women of childbearing age. Methods. The data concerning psychiatric care, drug treatments and pregnancy outcomes were retrieved from local administrative databases during a 12-month census period. Results. During a 12-month census period, 2893 women of childbearing age with schizophrenia (74.8% of all women of childbearing age with schizophrenia) and 918 with bipolar disorder (80.1% of all women of childbearing age with bipolar disorder) were exposed to AP drugs or MS, yielding a prevalence of exposure for women with schizophrenia of 1.65 (95% confidence interval (CI) 1.59-1.71) per 1000 female inhabitants, and for women with bipolar disorder of 0.52 (95% CI 0.49-0.55) per 1000 female inhabitants. Persistent exposure to potentially teratogenic medications accounted for one in every 1000 women of childbearing age. Of the 57 pregnancies in women with schizophrenia, normal delivery was recorded in 23 (40%) cases; of the 26 pregnancies in women with bipolar disorder, normal delivery was recorded in 10 (38%) cases. Conclusions. In women of childbearing age with severe mental disorders, exposure to psychotropic drugs is substantial, which suggests that the issue of reproductive health is epidemiologically relevant and a major public health concern.
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Patterns of referral in first-episode schizophrenia and ultra high-risk individuals: results from an early intervention program in Italy. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1905-16. [PMID: 23832100 DOI: 10.1007/s00127-013-0736-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study set out to investigate the patterns of referral in a sample (n = 206) of patients having first-time access to an Italian comprehensive program that targets the early detection of and early intervention on subjects at the onset of psychosis. The primary goal of the study was to investigate the duration of untreated illness (DUI) and/or the duration of untreated psychosis (DUP) in the sample since the implementation of the program. METHOD Data on pathways of referrals prospectively collected over a 11-year period, from 1999 to 2010; data referred to patients from a defined catchment area, and who met ICD-10 criteria for a first episode of a psychotic disorder (FEP) or were classified to be at ultra-high risk of psychosis (UHR) according to the criteria developed by the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne. Changes over time in the DUI and DUP were investigated in the sample. RESULTS Referrals increased over time, with 20 subjects enrolled per year in the latter years of the study. A large majority of patients contacted a public or private mental health care professional along their pathway to treatment, occurring more often in FEP than in UHR patients. FEP patients who had contact with a non-psychiatric health care professional had a longer DUP. Over time, DUP and DUI did not change in FEP patients, but DUI increased, on average, in UHR patients. CONCLUSIONS The establishment of an EIP in a large metropolitan area led to an increase of referrals from people and agencies that are not directly involved in the mental health care system; over time, there was an increase in the number of patients with longer DUI and DUP than those who normally apply for psychiatric services.
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Loukidou E, Mastroyannakis A, Power T, Thornicroft G, Craig T, Bouras N. Evaluation of Greek psychiatric reforms: methodological issues. Int J Ment Health Syst 2013; 7:11. [PMID: 23537115 PMCID: PMC3622561 DOI: 10.1186/1752-4458-7-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/21/2013] [Indexed: 11/29/2022] Open
Abstract
Over the last three decades significant efforts have been made in many European countries to move away from a mental health system dominated by institutional care towards one whereby the main emphasis is on providing care and support within the community. Although the time of starting the reforms, their pace, the political context, and the exact objectives varies substantially across Europe, practically all countries have been undergoing such major reforms aimed at establishing services in the community to replace institutional based care. Each country makes its own decisions about the necessary mental health services taking into account a range of factors including population needs, level of resources, flexibility and coordination of organizational structures, as well as local culture. These factors become an integral element of a national mental health policy and action plan, closely linked with national public health strategies.Greece has been modernizing an outdated mental health system, which was based on institutional care, over the last 20 years, by developing community-based mental health care. This article describes the methodology used for the evaluation of the Psychargos programme of the mental health reforms in Greece. Various forms of community-based mental health services have been developed including supported living facilities, community mental health centres and employment opportunities.
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Affiliation(s)
| | | | - Tracey Power
- Maudsley International, King’s College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
| | - Graham Thornicroft
- Health Service and Population Research Department, King’s College London, Institute of Psychiatry, England, UK
| | - Tom Craig
- King’s College London, Institute of Psychiatry, England, UK
| | - Nick Bouras
- Maudsley International, King’s College London, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK
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Dezetter A, Briffault X, Bruffaerts R, De Graaf R, Alonso J, König HH, Haro JM, de Girolamo G, Vilagut G, Kovess-Masféty V. Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems. Soc Psychiatry Psychiatr Epidemiol 2013; 48:137-49. [PMID: 22644000 DOI: 10.1007/s00127-012-0522-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate patterns of use of general practitioners (GPs) and/or mental health professionals (MHPs) for mental health reasons, across six European countries, and the extent to which these patterns of use are associated with differences in mental health-care delivering systems. METHODS Data are based on the European Study of the Epidemiology of Mental Disorders (ESEMeD): a cross-sectional survey of a representative sample of 8,796 non-institutionalized adults from six European countries, conducted between 2001 and 2003 using computer-assisted interviews with the CIDI-3.0. Countries were classified into: MHP- for countries where access to medical professionals tends to predominate (Belgium, France, Italy), and MHP+ where access to non-medical MHPs predominates (Germany, Spain, The Netherlands). RESULTS Among respondents consulting GPs and/or MHPs in the past year (n = 1,019), respondents from the MHP- group more often consulted GPs (68 vs. 55 % in MHP+ group), GPs and psychiatrists (23 vs. 14 %). People from the MHP+ group more often used MHPs only (45 vs. 32 %), GPs and non-medical MHPs (16 vs. 8 %). GPs from the MHP+ group were more inclined to refer patients to MHPs. Factors associated with use of GPs versus MHPs were: being over 49 years, not highly educated, lower income and suffering from mood or severe mental disorders. CONCLUSIONS Differences in the use of GPs versus MHPs are markedly linked to individual as well as organizational factors. Interventions are needed, in countries fostering medical access, to reimburse sessions with non-medical MHPs and improve cooperation between professionals to obtain better practice in access to care.
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Affiliation(s)
- Anne Dezetter
- EA4069 Ecole des Hautes Etudes en Santé Publique (EHESP), Hôtel Dieu, Paris Descartes University, Sorbonne Paris Cité, 1 place du parvis de Notre-Dame, 75181, Paris Cedex 04, France.
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de Belvis AG, Ferrè F, Specchia ML, Valerio L, Fattore G, Ricciardi W. The financial crisis in Italy: Implications for the healthcare sector. Health Policy 2012; 106:10-6. [DOI: 10.1016/j.healthpol.2012.04.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/10/2012] [Accepted: 04/02/2012] [Indexed: 11/24/2022]
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Conti V, Lora A, Cipriani A, Fortino I, Merlino L, Barbui C. Persistence with pharmacological treatment in the specialist mental healthcare of patients with severe mental disorders. Eur J Clin Pharmacol 2012; 68:1647-55. [PMID: 22573134 DOI: 10.1007/s00228-012-1298-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 04/18/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to measure persistence with pharmacological treatment in the specialist mental healthcare of patients with schizophrenia, bipolar disorder, and unipolar depression in Lombardy, a region of 10 million inhabitants located in the northernmost part of Italy. METHODS The data concerning psychiatric care used in this study were retrieved from the regional Psychiatric Information System, while information on drug treatment was retrieved from the regional administrative database. Time to lack of persistence with initial pharmacological treatment was the outcome measure. RESULTS A total of 11,797 patients, followed in the specialist mental healthcare system, started a new pharmacological treatment for depression, schizophrenia, or bipolar disorder during 2007. Overall, 8,500 patients (72.1%) discontinued treatment during the 12 month follow-up, with a median duration of 101 days. Very similar discontinuation rates were observed in patients with unipolar depression, schizophrenia, and bipolar disorder. In the multivariate analysis, operational definitions of continuity and intensity of care were the most robust determinants of persistence with drug treatment in each of the three cohorts of psychiatric diagnoses. CONCLUSIONS High rates of treatment discontinuation were found in a population of patients with severe mental disorders followed in the specialist mental healthcare system of an Italian region, with no differences among patients with unipolar major depression, schizophrenia, and bipolar disorder. These findings corroborate the notion that the problem of treatment discontinuation in psychiatric disorders is a factor related to the capacity of the mental health system to assure and maintain continuity and intensity of care.
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Affiliation(s)
- Valentino Conti
- Regional Centre for Pharmacovigilance, Lombardy Region, via Rosellini 17, 20124, Milan, Italy.
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Gigantesco A, Lega I, Picardi A. The Italian SEME Surveillance System of Severe Mental Disorders Presenting to Community Mental Health Services. Clin Pract Epidemiol Ment Health 2012; 8:7-11. [PMID: 22435071 PMCID: PMC3293155 DOI: 10.2174/1745017901208010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 10/30/2011] [Accepted: 10/30/2011] [Indexed: 11/24/2022]
Abstract
Mental health is recognized worldwide as a major public health priority for the twenty-first century. Different actions are needed, including developing or strengthening national mental health information systems, based on standardized indicators that allow national and international monitoring. In 2008, the national Centre for Disease prevention and Control of the Italian Ministry of Health and the Mental Health Unit of the Italian National Institute of Health (INIH) jointly launched a mental health information system named SEME (an Italian acronym meaning ‘mental health epidemiological surveillance’) based upon data collected from trained psychiatrists working in 22 selected sentinel community mental health centers distributed across Italy and covering a total population of 1,941,853 inhabitants, in order to collect and report site-level information on first-contact patients suffering from specific severe mental disorders (schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, bipolar I disorder, anorexia nervosa, major depressive episode with psychotic symptoms or suicide attempt). Strengths of the system are the high reliability of diagnoses and the use of a web-based technique for data collection with data entry forms designed for ease of completion. During the first year of implementation of this system, a total of 343 first-contact patients met criteria for one of the severe mental disorders under surveillance. As the system includes standardized instruments to measure psychiatric symptoms and psychosocial functioning, it may facilitate health services research based on longitudinal measurements aimed at evaluating the continuity of psychiatric care and the effectiveness of innovative therapeutic and rehabilitative programs.
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Affiliation(s)
- Antonella Gigantesco
- Mental Health Unit, National Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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