scholarly journals Inequalities in psychiatric service use and mortality by migrant status following a first diagnosis of psychotic disorder: a Swedish cohort study of 1.3m people

2021 ◽  
Author(s):  
Dafni Katsampa ◽  
Syeda F Akther ◽  
Anna-Clara Hollander ◽  
Henrik Dal ◽  
Christina Dalman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychotic Disorder ◽  
Service Use ◽  
Psychiatric Service ◽  
Mental Healthcare ◽  
Migrant Status ◽  
Region Of Origin ◽  
Icd 10 ◽  
Sub Saharan ◽  
First Diagnosis

Abstract It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality (including by major causes of death); (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people born 1984-1997 and living in Sweden from 1st January 1998, followed from their 14 th birthday or arrival to Sweden, until death, emigration, or 31 December 2016.People with ICD-10 psychotic disorder (F20-33; N=9,399) were 6.7 (95%CI: 5.9-7.6) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). This mortality gap was most pronounced for suicide (adjusted hazard ratio [aHR]: 12.2; 95% CI: 10.4-14.4), but persisted for deaths from other external (aHR: 5.1; 95%CI: 4.0-6.4) and natural causes (aHR: 2.3; 95%CI: 1.6-3.3). Non-refugee (adjusted odds ratio [aOR]: 1.4, 95%CI: 1.2-1.6) and refugee migrants (aOR: 1.4, 95%CI: 1.1-1.8) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (adjusted sub-HR: 1.2; 95%CI: 1.1-1.4). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

scholarly journals Inequalities in psychiatric service use and mortality by migrant status following a first diagnosis of psychotic disorder: a Swedish cohort study of 1.3m people

2021 ◽  
Author(s):  
Dafni Katsampa ◽  
Syeda Akther ◽  
Anna-Clara Hollander ◽  
Henrik Dal ◽  
Christina Dalman ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Psychotic Disorder ◽  
Service Use ◽  
Psychiatric Service ◽  
Mental Healthcare ◽  
Survival Models ◽  
Migrant Status ◽  
Region Of Origin ◽  
Sub Saharan ◽  
First Diagnosis

It is unclear whether inequalities in mental healthcare and mortality following the onset of psychosis exist by migrant status and region-of-origin. We investigated whether (i) mortality; (ii) admission type (in- or out-patient), and; (iii) in-patient length of stay at first diagnosis for psychotic disorder presentation, and; (iv) time-to-readmission for psychotic disorder differed for refugees, non-refugee migrants and by region-of-origin. We established a cohort of 1,335,192 people aged up to 33 years old, born 1984-1997, and living in Sweden from 1st January 1998, followed from their 14th birthday or arrival to Sweden, until death, emigration, or 31 December 2016. The cohort included 9,399 individuals first diagnosed with ICD-10 psychotic disorder (F20-33) during follow-up. Logistic, linear and competing risks regression survival models were used to estimate disparities in outcomes by migrant status or region-of-origin, adjusted for covariates. People with psychotic disorder were 6.70 (95%CI: 5.93-7.58) times more likely to die than the general population, but this did not vary by migrant status (p=0.15) or region-of-origin (p=0.31). Non-refugee (odds ratio [OR]: 1.40, 95%CI: 1.21-1.61) and refugee migrants (OR: 1.42, 95%CI: 1.09-1.84) were more likely to receive inpatient care at first diagnosis. No differences in inpatient length of stay at first diagnosis were observed. Sub-Saharan African migrants with psychotic disorder were readmitted more quickly than their Swedish-born counterparts (sub-Hazard ratio: 1.19; 95% CI: 1.05-1.35). Our findings highlight the need to understand the drivers of disparities in psychosis treatment and the mortality gap experienced by all people with disorder, irrespective of migrant status or region-of-origin.

scholarly journals Migrant status and risk of compulsory admission at first diagnosis of psychotic disorder: a population-based cohort study in Sweden

2020 ◽  
pp. 1-10
Author(s):  
J. Terhune ◽  
J. Dykxhoorn ◽  
E. Mackay ◽  
A.-C. Hollander ◽  
J. B. Kirkbride ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Middle Eastern ◽  
Population Based ◽  
Compulsory Admission ◽  
Migrant Status ◽  
Region Of Origin ◽  
Increased Risk ◽  
National Register Data ◽  
Sub Saharan ◽  
First Diagnosis

Abstract Background Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation. Methods By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates. Results Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26–1.73] or child of a migrant (OR 1.27; 95% CI 1.10–1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51–2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17–1.81), non-Nordic European (OR 1.27; 95% CI 1.01–1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03–1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06–1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02–1.24). Conclusions Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.

scholarly journals Policy initiative to improve access to psychological services for people with affective and anxiety disorders: population-level analysis

2011 ◽  
Vol 198 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Meredith G. Harris ◽  
Philip M. Burgess ◽  
Jane E. Pirkis ◽  
Tim N. Slade ◽  
Harvey A. Whiteford
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Service Use ◽  
Social Inequalities ◽  
Mental Healthcare ◽  
Population Level ◽  
Epidemiological Data ◽  
Psychological Services ◽  
Service Users ◽  
Icd 10

BackgroundIn 2006, Australia introduced new publicly funded psychological services for people with affective and anxiety disorders (the Better Access programme). Despite massive uptake, it has been suggested that Better Access is selectively treating socioeconomically advantaged people, including some who do not warrant treatment, and people already receiving equivalent services.AimsTo explore potential disparities in Better Access treatment using epidemiological data from the 2007 National Survey of Mental Health and Wellbeing.MethodLogistic regression analyses examined patterns and correlates of service use in two populations: people who used the new psychological services in the previous 12 months; and people with any ICD–10 12-month affective and anxiety disorder, regardless of service use.ResultsMost (93.2%) Better Access psychological services users had a 12-month ICD–10 mental disorder or another indicator of treatment need. Better Access users without affective or anxiety disorders were not more socioeconomically advantaged, and received less treatment than those with these disorders. Among the population with affective or anxiety disorders, non-service users were less likely to have a severe disorder and more likely to have anxiety disorder, without a comorbid affective disorder, than Better Access users. Better Access users comprised more new allied healthcare recipients than other service users. A substantial minority of non-service users (13.5%) had severe disorders, but most did not perceive a need for treatment.ConclusionsBetter Access does not appear to be overservicing individuals without potential need or contributing to social inequalities in mental healthcare. It appears to be reaching people who have not previously received psychological care. Treatment rates could be improved for some people with anxiety disorders.

scholarly journals Patterns of Primary Care Use Prior to a First Diagnosis of Nonaffective Psychotic Disorder in Ontario, Canada: Modèles d’utilisation des soins de première ligne avant un premier diagnostic de trouble psychotique non affectif en Ontario, Canada

2020 ◽  
pp. 070674372096173
Author(s):  
Nicole Schoer ◽  
Rebecca Rodrigues ◽  
Jennifer Reid ◽  
Bridget L. Ryan ◽  
Daniel J. Lizotte ◽  
...  
Keyword(s):  
Primary Care ◽  
General Population ◽  
Psychotic Disorder ◽  
Service Use ◽  
Latent Class ◽  
Care Service ◽  
Primary Care Service ◽  
Contact Frequency ◽  
Pathway To Care ◽  
First Diagnosis

Background: Many people experience early signs and symptoms before the onset of psychotic disorder, suggesting that there may be help-seeking prior to first diagnosis. The family physician has been found to play a key role in pathways to care. This study examined patterns of primary care use preceding a first diagnosis of psychotic disorder. Methods: We used health administrative data from Ontario (Canada) to construct a population-based retrospective cohort. We investigated patterns of primary care use, including frequency and timing of contacts, in the 6 years prior to a first diagnosis of psychosis, relative to a general population comparison group matched on age, sex, geographic area, and index date. We used latent class growth modeling to identify distinct trajectories of primary care service use, and associated factors, preceding the first diagnosis. Results: People with early psychosis contacted primary care over twice as frequently in the 6 years preceding first diagnosis (RR = 2.22; 95% CI, = 2.19 to 2.25), relative to the general population, with a sharp increase in contacts 10 months prior to diagnosis. They had higher contact frequency across nearly all diagnostic codes, including mental health, physical health, and preventative health. We identified 3 distinct service use trajectories: low-, medium-, and high-increasing usage. Discussion: We found elevated patterns of primary care service use prior to first diagnosis of psychotic disorder, suggesting that initiatives to support family physicians in their role on the pathway to care are warranted. Earlier intervention has implications for improved social, educational, and professional development in young people with first-episode psychosis.

scholarly journals Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049721
Author(s):  
Ioannis Bakolis ◽  
Robert Stewart ◽  
David Baldwin ◽  
Jane Beenstock ◽  
Paul Bibby ◽  
...  
Keyword(s):  
Mental Health ◽  
Inpatient Care ◽  
Service Use ◽  
Regression Discontinuity ◽  
Mental Healthcare ◽  
Service Level ◽  
Community Services ◽  
Mental Health Service Use ◽  
Healthcare Data ◽  
Early Intervention In Psychosis

ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participantsMental healthcare data were extracted from 10 UK providers.Outcome measuresDaily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.ResultsPooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.ConclusionsMH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

Placental weight in first generation migrant mothers in Germany. Do the length of stay, acculturation or migrant status play a role?

Placenta ◽  
2021 ◽  
Vol 108 ◽  
pp. 103-108
Author(s):  
Larry Hinkson ◽  
Matthias David ◽  
Charlotte Bauman ◽  
Theda Borde ◽  
Wolfgang Henrich ◽  
...  
Keyword(s):  
Length Of Stay ◽  
First Generation ◽  
Placental Weight ◽  
Migrant Status ◽  
Generation Migrant

scholarly journals Mental health service use, depression, panic disorder and life events among Swedish young adults in 2000 and 2010: a repeated cross-sectional population study in Stockholm County, Sweden

2017 ◽  
Vol 27 (5) ◽  
pp. 510-518 ◽  
Author(s):  
A. Lundin ◽  
Y. Forsell ◽  
C. Dalman
Keyword(s):  
Young Adults ◽  
Panic Disorder ◽  
Life Events ◽  
Service Use ◽  
Psychiatric Service ◽  
Psychiatric Services ◽  
Mental Health Service Use ◽  
Stockholm County ◽  
Cross Sectional ◽  
Psychiatric Service Use

Aims.The use of specialised psychiatric services for depression and anxiety has increased steadily among young people in Sweden during recent years. It is not known to what extent this service use is due to an increase in psychiatric morbidity, or whether other adversities explain these trends. The aim of this study is to examine if there is increased use of psychiatric services among young adults in Sweden between 2000 and 2010, and if so, to what extent this increase is associated with differences in depression, anxiety and negative life events.Methods.This is a repeated cross-sectional study of 20–30-year old men and women in Stockholm County in 2000 and 2010 (n = 2590 and n = 1120). Log-binomial regression analyses were conducted to compare the prevalence of service use, depression and panic disorder between the two cohorts. Self-reported life events were entered individually and as a summary index, and entered as potential mediators. Different effects of life events on service use were examined through interaction analysis. We report prevalence proportion ratios (PPR) with 95% confidence intervals.Results.Specialised psychiatric service use, but also depression and panic disorder was more common in the younger cohort (current service use 2.4 and 5.0%). The younger cohort did not report more life events overall or among those with depression or anxiety. Neither depression, panic disorder nor life events could explain the increased use of psychiatric services in the younger cohort (Fully adjusted model PPR = 1.70, 1.20–2.40 95% CI). There was no significant interaction between cohort and life events in predicting psychiatric service use.Conclusion.This study provides initial support for an increase in service use among young adults compared with 10 years earlier. The increased service use cannot be explained with increasing worse life situations.

Amphetamine use and psychiatric admissions: a 10-year perspective

2021 ◽  
pp. 103985622110142
Author(s):  
Jai Nathani ◽  
Richard W Morris ◽  
Nicholas Glozier ◽  
Grant Sara
Keyword(s):  
Cohort Study ◽  
Psychotic Disorder ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Service Use ◽  
Psychotic Disorders ◽  
Multivariate Tests ◽  
Psychiatric Admissions ◽  
Amphetamine Treatment ◽  
Amphetamine Use

Objective: We aimed to (i) describe the 10-year trend in admissions associated with amphetamine use, (ii) describe the distinguishing characteristics of people with an amphetamine-related diagnosis (ARD) and (iii) examine predictors of repeated admissions among people with an ARD. Method: We conducted a retrospective cohort study. We (i) counted the number of admissions with an ARD and evaluated any trends, and using univariate and multivariate tests, (ii) compared those who had an ARD with those who did not and (iii) compared those with an ARD who had one, two to four, and five or more admissions. Results: Admissions associated with amphetamine use increased between 2009 and 2015. Those with an ARD had significant differences in demographics, diagnosis and pattern of service use relative to those without an ARD. Amongst those with an ARD, a higher number of admissions was positively associated with a schizophrenia diagnosis but inversely associated with a transient psychotic disorder diagnosis. Conclusions: The increase in admissions associated with amphetamine use indicates that people with an ARD posed major demands on inpatient services. Targeting amphetamine treatment to those with psychotic disorders, both schizophrenia and transient psychotic disorders, may reduce hospital-related costs and re-admissions.

The course of depression in the elderly: a longitudinal community-based study in Australia

1997 ◽  
Vol 27 (1) ◽  
pp. 119-129 ◽  
Author(s):  
A. S. HENDERSON ◽  
A. E. KORTEN ◽  
P. A. JACOMB ◽  
A. J. MACKINNON ◽  
A. F. JORM ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Decline ◽  
Service Use ◽  
Community Sample ◽  
The Elderly ◽  
Activity Levels ◽  
Sample Attrition ◽  
Poor Social Support ◽  
Icd 10 ◽  
Depressive States

Background. We report the outcome of depressive states after 3-4 years in a community sample of the elderly.Methods. A sample of 1045 persons aged 70+ years in 1990–1 was re-interviewed after 3·6 years.Results. Mortality (21·7%) and refusal or non-availability (10·4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990–1, 13% retained that diagnosis. Of those who were not depressed initially only 2·5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia.Conclusions. Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.

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