A retrospective cohort study describing six months of admissions under Section 136 of the Mental Health Act; the problem of alcohol misuse

BackgroundVeteran suicides have increased despite mental health investments by the Veterans Health Administration (VHA).ObjectiveTo examine relationships between suicide and acute inpatient psychiatric bed occupancy and other community, hospital and patient factors.MethodsRetrospective cohort study using administrative and publicly available data for contextual community factors. The study sample included all veterans enrolled in VHA primary care in 2011–2016 associated with 111 VHA hospitals with acute inpatient psychiatric units. Acute psychiatric bed occupancy, as a measure of access to care, was the main exposure of interest and was categorised by quarter as per cent occupied using thresholds of ≤85%, 85.1%–90%, 90.1%–95% and >95%. Hospital-level analyses were conducted using generalised linear mixed models with random intercepts for hospital, modelling number of suicides by quarter with a negative binomial distribution.ResultsFrom 2011 to 2016, the national incidence of suicide among enrolled veterans increased from 39.7 to 41.6 per 100 000 person-years. VHA psychiatric bed occupancy decreased from a mean of 68.2% (IQR 56.5%–82.2%) to 65.4% (IQR 53.9%–79.9%). VHA hospitals with the highest occupancy (>95%) in a quarter compared with ≤85% had an adjusted incident rate ratio (IRR) for suicide of 1.10 (95% CI 1.01 to 1.19); no increased risk was observed for 85.1%–90% (IRR 0.96; 95% CI 0.89 to 1.03) or 90.1%–95% (IRR 0.96; 95% CI 0.89 to 1.04) compared with ≤85% occupancy. Of hospital and community variables, suicide risk was not associated with number of VHA or non-VHA psychiatric beds or amount spent on community mental health. Suicide risk increased by age categories, seasons, geographic regions and over time.ConclusionsHigh VHA hospital occupancy (>95%) was associated with a 10% increased suicide risk for veterans whereas absolute number of beds was not, suggesting occupancy is an important access measure. Future work should clarify optimal bed occupancy to meet acute psychiatric needs and ensure adequate bed distribution.

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Trends in Emergency Department Visits for Mental Health Disorder Diagnoses Before and During the COVID-19 Pandemic: A Retrospective Cohort Study 2016-2021

SSRN Electronic Journal ◽

10.2139/ssrn.3920909 ◽

2021 ◽

Author(s):

Majed Ramadan ◽

Alaa Fallatah ◽

Yara Batwa ◽

Ziyad Saifaddin ◽

Mohammed S. Mirza ◽

...

Keyword(s):

Mental Health ◽

Emergency Department ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Mental Health Disorder ◽

Emergency Department Visits

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Does screening shorten delays to care for post-deployment mental disorders in military personnel? A longitudinal retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-037853 ◽

2020 ◽

Vol 10 (8) ◽

pp. e037853

Author(s):

David Boulos ◽

Bryan Garber

Keyword(s):

Mental Health ◽

Cohort Study ◽

Mental Disorders ◽

Mental Disorder ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Health Concern ◽

Military Population

ObjectiveTo determine whether post-deployment screening is associated with a shorter delay to diagnosis and care among individuals identified with a deployment-related mental disorder.DesignRetrospective cohort study.SettingCanadian military population.ParticipantsThe cohort consisted of personnel (n=28 460) with a deployment within the 2009 to 2014 time frame. A stratified random sample (n=3004) was selected for medical chart review. We restricted our analysis to individuals who had an opportunity to undergo screening and were subsequently diagnosed with a mental disorder that a clinician indicated was deployment-related (n=1157).InterventionsPost-deployment health screening.Main outcome measureThe outcome was delay to diagnosis and care, the latency from individuals’ deployment return to their mental disorder diagnosis date. Cox proportional hazards regression assessed screening’s influence on this outcome.Results74.4% of the study population had screened. Overall, the median delay to care was 766 days, 578 days among screeners and 928 days among non-screeners—a 350-day difference. Cox regression indicated that screeners had a significantly shorter delay to care (adjusted HR (aHR), 1.43 (95% CI, 1.11 to 1.86)). Screening findings had a substantial influence on delay to care. Identification of a mental health concern, whether a ‘major’ concern (aHR, 3.36 (95% CI, 2.38 to 4.73)) or a ‘minor’ concern (aHR, 1.46 (95% CI, 1.08 to 1.99)), and a recommendation for mental health services follow-up (aHR, 2.35 (95% CI, 1.73 to 3.21)) were strongly associated with shorter delays to care relative to non-screeners.ConclusionsReduced delays to care are anticipated to lead to beneficial outcomes for both the individual and military organisation. We found that screening was associated with a shortened delay to care for mental disorders that were deployment-related. Future work will further explore this screening’s components and optimisation strategies.

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