PSYCHOTROPIC DRUG USE AND EXPENDITURES AMONG MEDICAID BENEFICIARIES WITH AND WITHOUT OTHER MENTAL HEALTH OR SUBSTANCE ABUSE SERVICES

Deze studie vergelijkt het zorg‐ en psychofarmacagebruik omwille van psychische klachten van gescheiden personen (met een nieuwe partner of alleenstaand) met gehuwden. Binnen het theoretisch kader van de crowding‐in/out hypothesen, stellen wij ons de vraag of de beschikbaarheid van informele steun professioneel zorggebruik aanmoedigt of substitueert. Logistische regressieanalyses werden uitgevoerd afzonderlijk voor mannen (N=3020) en vrouwen (N=3450) met het contacteren van een huisarts, psychiater, psycholoog en psychofarmacagebruik als afhankelijke variabelen. Gescheiden alleenstaanden rapporteren het hoogste zorg‐ en psychofarmacagebruik. Gescheiden vrouwen (en vooral alleenstaande) contacteren vaker een huisarts, psychiater en psycholoog, ongeacht hun mentale gezondheid, informele steun en sociaaleconomische achtergrond. Vrouwen die kunnen rekenen op emotionele steun van familie en niet‐familieleden zijn meer geneigd om een huisarts te contacteren. Bij mannen beïnvloedt de aanwezigheid van emotionele steun van leden buiten de familie het contacteren van elk type van zorgverlener. Deze bevindingen zijn in lijn van de crowding‐in hypothese. Abstract : This study compares mental health care and psychotropic drug use of the divorced (re‐partnered or single) to the married. Within the theoretical framework of crowding in/out thesis, we question whether the availability of informal support, facilitates or substitutes formal care seeking. Logistic regression analyses were performed for women (N=3450) and men (N=3020) to determine the correlates of contacting a GP, a psychiatrist, a psychologist and taking psychotropic drugs. Divorced singles report the highest mental health care and psychotropic drug use. Divorced women (especially singles) contact more often each type of health care provider, regardless of their mental health, informal support and socio‐economic background. Women who can rely on the support of family and non‐family members are more inclined to contact a GP. With regard to men, informal support of non‐family members positively influences each type of care seeking. These findings are in line with the crowding‐in thesis.

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Current Issues within the Perinatal Mental Health Care System in Japan: A Cross-Sectional Questionnaire Survey

10.21203/rs.3.rs-117649/v1 ◽

2020 ◽

Author(s):

Kei Fujita ◽

Tomomi Kotani ◽

Yoshinori Moriyama ◽

Takafumi Ushida ◽

Kenji Imai ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Drug Use ◽

Mental Health Care ◽

Health Care System ◽

Psychotropic Drug ◽

Maternity Care ◽

Perinatal Mental Health ◽

Mental Health Care System ◽

Psychotropic Drug Use

Abstract Background: Mental illness commonly occurs in reproductive age, and its adverse effects on mothers and children are a major public health concern. However, the extent to which the perinatal mental health care system in Japan is functioning adequately remains unexplored. This study aimed to identify the issues that exist within the perinatal mental health care system in Japan. Methods: A cross-sectional survey was conducted across medical facilities in Aichi prefecture in central Japan. Questionnaires were mailed to the head physicians of all 128 maternity care units, 21 neonatal intensive care units (NICUs), and 40 assisted reproductive technology (ART) units. The following data were collected: the number of admissions to mental health care units and admissions of neonates born to mothers with mental illness during the perinatal period between 2016 and 2018. Perspectives on psychotropic drug use during pregnancy were compared across different types of maternity care units, including maternal-fetal (MF) centers and private clinics by Fisher’s exact test. The multidisciplinary team system was also compared across different types of maternity care units by Fisher’s exact test. Results: The number of admissions to mental health care units was 82 (52.8 per 10 000 births), and 158 (1.0 per 1000 births) neonates born to mothers with mental illness were admitted to NICUs during the aforementioned period. With regard to the multidisciplinary team system, 84 (71.1 %) and 76 (64.4 %) maternity care units did not have any psychiatrists or social workers. Moreover, only 5 % of the head physicians in MF centers endorsed the discontinuation of psychotropic drug use during pregnancy. The corresponding figures were 20–35 % among those in general hospitals, private clinics, and ART units. Conclusions: Multidisciplinary system resources were perceived to be limited. Perspectives on psychotropic drug use during pregnancy differed significantly based on the type of units in which the doctors were working. There is a need for resources that will facilitate the admission of perinatal women with mental illnesses to mental health care units in Japan.

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