scholarly journals Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Wiens ◽  
Laura C. Rosella ◽  
Paul Kurdyak ◽  
Simon Chen ◽  
Tim Aubry ◽  
...  
Keyword(s):  
Mental Illness ◽  
Healthcare Costs ◽  
Service Use ◽  
Multinomial Logistic Regression ◽  
Service Planning ◽  
Inpatient Service ◽  
Homeless Adults ◽  
Targeted Interventions ◽  
Factors Associated ◽  
History Of

Abstract Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). Results Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort. Conclusions This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.

History of Forensic Mental Health Service Use Among Homeless Adults with Mental Illness

2017 ◽  
Vol 16 (1) ◽  
pp. 69-82 ◽  
Author(s):  
Alicia Nijdam-Jones ◽  
Tonia L. Nicholls ◽  
Anne G. Crocker ◽  
Laurence Roy ◽  
Julian M. Somers
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Health Service ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Forensic Mental Health ◽  
Homeless Adults ◽  
History Of

scholarly journals Admission to psychiatric hospital for mental illnesses 2 years prechildbirth and postchildbirth in Scotland: a health informatics approach to assessing mother and child outcomes

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016908 ◽  
Author(s):  
Julie Langan Martin ◽  
Gary McLean ◽  
Daniel Martin ◽  
Roch Cantwell ◽  
Daniel J Smith
Keyword(s):  
Mental Illness ◽  
Psychiatric Hospital ◽  
Potential Risk ◽  
Health Informatics ◽  
Psychiatric Admission ◽  
Affective Psychosis ◽  
Factors Associated ◽  
History Of ◽  
Depressive Episodes ◽  
The Impact

ObjectiveTo identify factors associated with: admission to a specialist mother and baby unit (MBU) and the impact of perinatal mental illness on early childhood development using a data linkage approach in the 2 years prechildbirth and postchildbirth.MethodsScottish maternity records (SMR02) were linked to psychiatric hospital admissions (SMR04). 3290 pregnancy-related psychiatric admissions for 1730 women were assessed. To investigate factors associated with MBU admission, the group of mothers admitted to an MBU were compared with those admitted to general psychiatric wards. To assess the impact of perinatal mental illness on early child development, a pragmatic indicator for ‘at potential risk of adversity’, defined as a child who was recorded as requiring intensive treatment at any time under the health plan indicators (HPI) and/or who had no record of completing three doses of the 5-in-1 vaccine by 12 months was generated. Logistic regression models were used to describe the association between each variable and the risk of admission between those with a history of prior psychiatric admission and those without.ResultsWomen admitted to an MBU were significantly more likely to be admitted with non-affective psychosis (OR=1.97, 95% CI 1.22 to 3.18), affective psychosis (OR=2.44, 95% CI 1.37 to 4.33) and non-psychotic depressive episodes (OR=1.93, 95% CI 1.42 to 2.63). They were less likely to come from deprived areas (OR=0.68 95% CI 0.49 to 0.93). Women with a previous history of psychiatric admission were significantly more likely to be located in the two most deprived quintiles. Almost one-third (29%) of children born to mothers with a pregnancy-related psychiatric admission were assessed as ‘at potential risk of adversity.’ConclusionsA health informatics approach has potential for improving understanding of social and clinical factors, which contribute to the outcomes of perinatal mental illness, as well as potential adverse developmental outcomes for offspring.

Prevalence of serious mental illness and mental health service use after a workplace injury: a longitudinal study of workers’ compensation claimants in Victoria, Australia

2020 ◽  
Vol 77 (3) ◽  
pp. 185-187
Author(s):  
Christa Orchard ◽  
Nancy Carnide ◽  
Cameron Mustard ◽  
Peter M Smith
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Health Service ◽  
Serious Mental Illness ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Workers Compensation ◽  
Factors Associated

ObjectivesSerious mental illness is common among those who have experienced a physical workplace injury, yet little is known about mental health service use in this population. This study aims to estimate the proportion of the workplace musculoskeletal injury population experiencing a mental illness, the proportion who access mental health services through the workers’ compensation system and the factors associated with likelihood of accessing services.MethodsA longitudinal cohort study was conducted with a random sample of 615 workers’ compensation claimants followed over three survey waves between June 2014 and July 2015. The primary outcome was receiving any type of mental health service use during this period, as determined by linking survey responses to administrative compensation system records for the 18 months after initial interview.ResultsOf 181 (29.4%) participants who met the case definition for a serious mental illness at one or more of the three interviews, 75 (41.4%) accessed a mental health service during the 18-month observation period. Older age (OR=0.96, 95% CI 0.93 to 0.99) and achieving sustained return to work (OR=0.27, 95% CI 0.11 to 0.69) were associated with reduced odds of mental health service use. Although not significant, being born in Australia was associated with an increased odds of service use (OR=2.23, 95% CI 0.97 to 5.10).ConclusionsThe proportion of injured workers with musculoskeletal conditions experiencing mental illness is high, yet the proportion receiving mental health services is low. More work is needed to explore factors associated with mental health service use in this population, including the effect of returning to work.

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital

Salud Mental ◽  
2017 ◽  
Vol 40 (6) ◽  
pp. 279-290
Author(s):  
Guillermo Alonso Castaño Pérez ◽  
◽  
Luz Angela Rojas Bernal ◽  
José Bareño Silva ◽  
Gloria María Sierra Hincapié
Keyword(s):  
Mental Illness ◽  
Health Resources ◽  
Cross Sectional Study ◽  
Secondary Source ◽  
Clinical Factors ◽  
Dual Disorders ◽  
Cross Sectional ◽  
Low Socioeconomic ◽  
Factors Associated ◽  
History Of

Introduction. Among patients with mental illness, dual disorders patients are characterized by a heterogeneous and more severe clinical presentation that is difficult to treat. Therefore, knowledge about the distribution of this disorder and the characteristics of these patients can be helpful to optimize and organize health resources. Objective. To explore the prevalence and socio-demographic and clinical factors associated with dual disorders patients who were hospitalized due to mental illness at a psychiatric unit in Colombia between January and June 2013; this data was collected and analyzed on the basis of the medical records of each patient. Method. Observational, quantitative, cross-sectional study of a secondary source. It included the analysis of 201 patients aged 18 to 65. Results. There were 201 patients analyzed; 45.3% had dual disorders, with a ratio of 2.24 men:women; there was a high frequency of single marital status (69.2%) and more than 90% had a low socioeconomic level. The factors significantly associated with dual disorders in order of importance were: age from 18 to 35 years (OR = 11.03; CI 95% [4.43, 27.46]), male (OR = 5.10, CI 95% [2.26, 11.50]), history of aggression (OR = 3.35; CI 95% [1.63, 6.91]), and readmission in the year after hospital discharge (OR = 2.23; CI 95% [1.08, 4.61]). Discussion and conclusion. Dual disorders prevalence in this study is similar to that found by other authors. The high prevalence of dual disorders requires specialized therapeutic programs for treatment. The more hospitals know about the associated variables in this study, the more they will be able to improve their approach to patients.

scholarly journals Socio-demographic and substance-related factors associated with mental distress among Wollo university students: institution-based cross-sectional study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Yosef Zenebe ◽  
Mogesie Necho
Keyword(s):  
Mental Illness ◽  
Logistic Regression ◽  
Associated Factors ◽  
Mental Distress ◽  
Current Cigarette Smoking ◽  
Cross Sectional ◽  
Factors Associated ◽  
Current Cigarette ◽  
History Of ◽  
Current Alcohol

Abstract Background The presence of mental distress among students affects their cognitive, emotional, physical, and interpersonal functioning. Besides, it predisposes to substance use problems and finally affects academic performance negatively. Therefore, this study was designed to estimate the magnitude and identify associated factors for the mental distress of students at Wollo University, Dessie, Ethiopia. Methods This institution-based cross-sectional survey assessed mental distress among 585 undergraduate students at Wollo University from April 10 to May 10/2019 using a multi-stage stratified sampling technique. Kessler-10 item scale was used to collect data about mental distress. Variables with p-value < 0.25 in bivariate logistic regression were pooled into a multi-variable logistic regression model and p-value < 0.05 in the multi-variable model was considered significant statistically. The strength of the relationship was interpreted using the odds ratio with 95% CI. The model adequacy in multi-variable regression was approved with Hosmer and Lemeshow goodness of fit test. Results Among 585 questionnaires distributed, 548 clear and completed questionnaires were included in the analysis with a response rate of 93.7%. The mental distress prevalence in the current study was 106 (19.3%). From this 65 (11.9%), 28 (5.1%), and 13 (2.4%) were found to be mild, moderate and severe mental distress respectively. Never attending a place of worship (AOR = 4.2, 95% CI 1.73, 10.39), family history of mental illness (AOR = 2.1, 95% CI 1.12, 3.95), current cigarette smoking (AOR = 3.2, 95% CI 1.69, 6.20), current alcohol use (AOR = 2.5, 95% CI 1.49, 4.25), and current cannabis use (AOR = 3.4, 95% CI 1.18, 9.57) were the associated factors for mental distress. Conclusion One in five students was affected by mental distress. Never attending a place of worship, family history of mental illness, current cigarette smoking, current alcohol use, and current cannabis use were the factors associated with it. Therefore, all stakeholders should be involved in overcoming this public health problem. Besides, clubs should be established in the university and have to play an active role in bringing behavioral change to substance use.

scholarly journals Methods women use for induced abortion and sources of services: insights from poor urban settlements of Accra, Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caesar Agula ◽  
Elizabeth G. Henry ◽  
Patrick O. Asuming ◽  
Charles Agyei-Asabere ◽  
Mawuli Kushitor ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Service Use ◽  
Multinomial Logistic Regression ◽  
Induced Abortion ◽  
Relative Risk Ratio ◽  
National Guidelines ◽  
Safe Abortion ◽  
Factors Associated ◽  
Medication Abortion ◽  
Urban Settlements

Abstract Background Increasing access to safe abortion methods is crucial for improving women’s health. Understanding patterns of service use is important for identifying areas for improvement. Limited evidence is available in Ghana on factors associated with the type of method used to induce abortion. This paper examined the methods and sources of services used for abortion by women living in poor urban settings of Accra. Methods Data are from a survey that was conducted in 2018 among 1233 women aged 16–44 years who reported ever having had an induced abortion. We estimated a multinomial logistic regression model to examine factors associated with the type of abortion methods women used. We further generated descriptive statistics for the source of abortion services. Results About 50% women used surgical procedures for their last abortion, 28% used medication abortion (MA), 12% used other pills, 3% used injection, and 7% used non-medical methods. However, nearly half (46%) of the women who terminated a pregnancy within the year preceding the survey used medication abortion (MA), 32% used surgical procedures, while 5% used non-medical methods. Women who terminated a pregnancy within three years preceding the survey had a 60% lower chance of using surgical procedures if they did not use MA compared to those who terminated a pregnancy more than 3 years before the survey (Relative Risk Ratio [RRR] 0.4; 95% CI 0.3–0.5). The vast majority (74%) of women who used MA obtained services from pharmacies. Conclusions The use of MA pills to terminate pregnancies has increased in recent years in Ghana and these pills are mostly accessed from pharmacies. This suggests a need for a review of the national guidelines to include pharmacists and chemists in the provision of MA services.

scholarly journals Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study

2018 ◽  
Vol 41 (2) ◽  
pp. 240-249 ◽  
Author(s):  
M Tong ◽  
L Tieu ◽  
C T Lee ◽  
C Ponath ◽  
D Guzman ◽  
...  
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Risk Groups ◽  
Population Based ◽  
Food Assistance ◽  
Homeless Population ◽  
Cross Sectional ◽  
Homeless Adults ◽  
Targeted Interventions ◽  
Factors Associated

Abstract Background The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. Methods We conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. We assessed food security and receipt of food assistance. We used multivariable logistic regression to examine factors associated with very low food security. Results The majority of the cohort was male and African American. Over half (55.4%) met criteria for food insecurity, 24.3% reported very low food security. Half (51.7%) reported receiving monetary food assistance. In the multivariable model, those who were primarily sheltered in the prior 6 months, (multi-institution users [AOR = 0.44, 95% CI: 0.22–0.86]) had less than half the odds of very low food security compared with those who were unsheltered. Depressive symptoms (AOR = 3.01, 1.69–5.38), oral pain (AOR = 2.15, 1.24–3.74) and cognitive impairment (AOR = 2.21, 1.12–4.35) were associated with increased odds of very low food security. Conclusions Older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

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