Intimate partner violence among reproductive-age women with chronic mental illness attending a psychiatry outpatient department: cross-sectional facility-based study, Addis Ababa, Ethiopia

ObjectiveTo determine the prevalence of intimate partner violence (IPV), and associated factors, in reproductive-aged women attending psychiatric outpatient departments.DesignCross-sectional facility-based study.SettingOutpatient psychiatric clinics of public hospitals in Addis Ababa.ParticipantsReproductive aged women with chronic mental illness (CMI) who attended follow-up in psychiatric outpatient clinics.Primary and secondary outcome measuresThe data were collected using a multi-culturally validated instrument from randomly sampled women with CMI. Multiple logistic regression was used to identify factors independently associated with IPV.ResultFour hundred and twenty-two women who were attending the psychiatric outpatient clinics took part in the study. The majority of participants 62.0% (95% CI 56.1 to 68.8) experienced IPV at least once in their lifetime. The most common form of IPV experienced by women was emotional violence (60%; 95% CI 55.0 to 64.7). One hundred and eighty-six (44.1%; (95% CI 39.3 to 48.8)) respondents experienced physical or sexual violence during the last year. A history of divorce (Adjusted Odds Ratio [AOR]=5.64; 95% CI 2.75 to 11.56) and having a mental illness for more than 5 years (AOR=2.23; 95% CI 1.26 to 3.93) were associated with any form of IPV.ConclusionThe high prevalence of IPV among women attending psychiatric outpatient services highlights the need to routinely inquire about IPV and develop effective strategies to prevent it among this vulnerable group.

Gender Differences in Psychiatric Outpatients: A Before and During COVID-19 Pandemic Study in General Hospitals From China

BackgroundLittle is known about the gender characteristics and the Corona Virus Disease 2019(COVID-19) impact on psychiatric department outpatients in general hospitals in China. MethodsWe retrospectively collected 225,947 outpatient clinic records before and during COVID-19 pandemic from January 1, 2019 to December 31, 2020 in the psychiatric clinic of 3 general hospitals, gender composition of patients was analyzed in different five age groups and nine diagnostic categories at three levels: total patient visits, number of patients and number of first-visit patients. ResultsThe total male-to-female ratio of psychiatric outpatient records in 3 general hospitals from 2019 to 2020 was 1:1.69. Women were more common in all age groups and the male-to-female ratio of 2020 was expanded compared to that of 2019, especially in age group below 34 years old and anxiety disorders category. Most mental disorders showed higher demands for females than that for males except Mental and behavioral disorders due to psychoactive substance use with the male-to-female ratio was 1:0.05. Compared to 2019, the proportions of women were expanded especially in age group below 34 years old, and anxiety disorder and undetermined diagnosis categories were significantly increased in 2020. ConclusionsThe demand for female psychiatric outpatient services is obviously higher than that for males. It is necessary to pay more attention to explore targeted mechanism or psychosocial service strategy for female patients with mental disorders. Trial registration: ChiCTR2100044894, March 31,2021 retrospectively registered.

Non-attendance at psychiatric outpatient clinics: comparison of clinical, risk and demographic factors between attenders and non-attenders

AimsWith an overarching aim of decreasing the incidence of non-attendance in psychiatric outpatient clinics, this service evaluation was intended to explore the profile of non-attenders. Specifically, the clinical, risk and demographic features of patients who did not attend their psychiatric outpatient appointments were compared with those of attenders. The outcome of patients who did not attend was also studied.MethodAll the consecutive non-attenders (n = 32) in November 2020 in a psychiatric outpatient clinic were compared with 32 consecutive attenders. The groups were compared based on clinical features (diagnosis, medical treatment, psychological treatment, care programme approach, first contact), risk profile (self or others) and demographic features (age, gender, ethnicity, accommodation, occupation, benefits). The non-attender sample was also analysed to consider the outcome after their missed appointment, following local Trust protocols.ResultThe overall rate of patients who did not attend their appointment was 22%. There was a statistically significant difference between the age and gender of non-attenders. Males were less likely to attend their appointment than females (p = 0.024). The mean age of patients who did not attend their appointment was 36.4 compared with 44.8 years in the attenders (p = 0.005). There were a few clinically relevant findings. Around one third (34%) of patients who did not attend their appointments had a history of risk of self-harm noted in previous appointments. The results also showed that 75% of individuals who did not attend their outpatient appointments were unemployed. There were no significant differences based on the type of treatments (depot injections, lithium, clozapine, antipsychotics or antidepressants) patients received. Patients who did not attend were more likely to have a mood disorder (59% compared with 40%), and less likely to have a psychotic disorder (25% compared with 44%). Of the patients who did not attend, all were appropriately contacted as per the local Trust guidelines via a letter, and were provided with appointments where appropriate; 34% of non-attenders were discharged from services.ConclusionNon-attendance at psychiatric outpatient appointments is a concern, particularly for younger and male patients. Considering the clinical risks associated with this patient population, efforts need to be taken to improve their engagement with mental health services. Future studies may explore patients’ perspectives of non-attendance and how to ameliorate any hindrances to attending.

Abstract 060: Cardiovascular Disease Burden In A Psychiatric Outpatient Population

Objective: To understand the burden of cardiovascular diseases (CVDs) in a psychiatric outpatient population. Methods: We used baseline data from the ongoing Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry, which is comprised of adult patients who were seen at a psychiatric outpatient clinic affiliated with the Department of Psychiatry and Behavioral Health and the Penn State Milton S. Hershey Medical Center. The Electronic Medical Record (EMR) data from 3,024 patients who sought psychiatric care between 02/17/2015 and 09/18/2019 were included in this report. We compared the prevalence of CVDs and the mean levels of major CVD risk factors in our sample with that reported in the 2013-2016 National Health and Nutrition Examination Survey (NHANES). Results: The mean age of the study population was 42.7 (16.7) years, with 63% female and 85% Caucasians. The most common psychiatric diagnoses at baseline were Major Depressive Disorder [ICD-10: F32 & F33] (45%), Generalized Anxiety Disorder [ICD-10: F41.1] (20%), and Bipolar Disorder [ICD-10: F31] (12%). Eighteen percent of patients reported using tobacco products and 1.7% reported using alcohol. The prevalence (%) of CVDs, type 2 diabetes, hypertension, and dyslipidemia in our sample were 9.1, 20, 48, and 41%, respectively (all significantly higher than the NHANES reports, all p < 0.0001). The baseline means (mg/dl) of total cholesterol (C), LDL-C, HDL-C, and triglycerides (TG) were 186, 108, 48, and 156, respectively (all are significantly lower than that reported from the NHANES, except for TG, which was higher than that of the NHANES, all p < 0.0001), while 22% of all patients had prescriptions for lipid-lowering medications. Baseline mean level of glucose and HbA1C were 111 mg/dl and 6.2% (both significantly higher than that from the NHANES, p < 0.0001). Conclusions: In this systematic registry of psychiatric outpatients from a mid-Atlantic academic medical center, the baseline CVD burden as measured by common cardiovascular diseases, comorbidities and risk factors are significantly higher than the CVD burden in the general US population. Considering that the mean age of this patient population is 5 years younger than that of the NHANES population, our data underscores the need for control and prevention of CVD in patients with psychiatric conditions, and suggests the potential of integrating mental and physical health care in this type of special population.

The use of ‘my side telling’ during history taking in psychiatric consultations

Using the method of conversation analysis, this article examines an interactional practice through which psychiatric practitioners exhibit knowledge about their patients’ problems, symptoms, or experiences in psychiatric outpatient consultations. This practice is referred to as ‘my side telling’. The data were from audio recordings of 55 psychiatric outpatient visits to four psychiatrists in China. In the data, the psychiatrists employ ‘my side telling’ within larger sequences of talk where psychiatrists solicit their patients to elaborate on their problems or experiences, treating prior answers of the patients as unsatisfactory. Based on empirical study of the data, it is argued that ‘my side telling’ in psychiatry is not merely used to elicit information. Rather, through facing patients with facts or evidence which the psychiatrists got from other sources, it acquires a confrontative function and may be employed as a tool to test the patients’ sense of reality and willingness to talk about their experiences. Thus, it is shown to work towards assessing patients for possible psychiatric conditions and forming diagnostic hypotheses. I further argue that ‘my side telling’ allows the psychiatrists to achieve a balance between respecting the patients’ rights to report their own experiences and influencing the directions in which the information is reported.