Psychiatric consequences of a father’s leave policy by nativity: a quasi-experimental study in Sweden

BackgroundParental leave use has been found to promote maternal and child health, with limited evidence of mental health impacts on fathers. How these effects vary for minority populations with poorer mental health and lower leave uptake, such as migrants, remains under-investigated. This study assessed the effects of a Swedish policy to encourage fathers’ leave, the 1995 Father’s quota, on Swedish-born and migrant fathers’ psychiatric hospitalisations.MethodsWe conducted an interrupted time series analysis using Swedish total population register data for first-time fathers of children born before (1992–1994) and after (1995–1997) the reform (n=198 589). Swedish-born and migrant fathers’ 3-year psychiatric hospitalisation rates were modelled using segmented negative binomial regression, adjusting for seasonality and autocorrelation, with stratified analyses by region of origin, duration of residence, and partners’ nativity.ResultsFrom immediately pre-reform to post-reform, the proportion of fathers using parental leave increased from 63.6% to 86.4% of native-born and 37.1% to 51.2% of migrants. Swedish-born fathers exhibited no changes in psychiatric hospitalisation rates post-reform, whereas migrants showed 36% decreased rates (incidence rate ratio (IRR) 0.64, 95% CI 0.47 to 0.86). Migrants from regions not predominantly consisting of Organisation for Economic Cooperation and Development countries (IRR 0.50, 95% CI 0.19 to 1.33), and those with migrant partners (IRR 0.23, 95% CI 0.14 to 0.38), experienced the greatest decreases in psychiatric hospitalisation rates.ConclusionThe findings of this study suggest that policies oriented towards promoting father’s use of parental leave may help to reduce native–migrant health inequalities, with broader benefits for family well-being and child development.

Police Encounters, Agitation, Diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment Patients During a Psychiatric Crisis

Objective: This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT).Methods: This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are “sociodemographic”, “social engagement”, “diagnosis and psychopathology”, “aggression”, “substance use”, “mental health services” and “quality of life”. Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD).Results: Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to “psychopathology and care” was between 0.34 and 0.08. The “aggression” domain explained the highest proportion (R2 = 0.34) of the variance in hospitalisation. “Quality of life” had the lowest explained proportion of variance (R2 = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10–51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02–7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74–284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01–0.63; ARD = −0.28; RR = 0.66).Conclusion: IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.

Hospital-treated deliberate self-poisoning in the older adult: Identifying specific clinical assessment needs

Background: Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. Objective: To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45–64 years) during an index episode of hospital-treated deliberate self-poisoning. Methods: A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003–2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. Results: There were ( n = 157) older-aged and ( n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. Conclusion: Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.

Homelessness at discharge and its impact on psychiatric readmission and physician follow-up: a population-based cohort study

Aims A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care. Methods This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge. Results There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26–1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68–2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40–0.53)). Conclusion Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.