Diagnostic differences in psychogeriatric patients in Toronto, New York and London, England.
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National statistics on psychiatric illness in the elderly patient from Canada, the United States and the United Kingdom suggest great differences in morbidity in these three centres. The present study shows that these differences stem mainly from different diagnostic habits in the three countries, but also there were more alcoholics in the Canadian sample. In particular, the diagnostic bias of the New York psychiatrists towards diagnosing most elderly patients as senile was not shared by their Toronto colleagues. Some patients were psychiatrically well, in spite of receiving a psychiatric diagnosis, and could have been helped without hospitalization. In addition, some depressed patients were labelled senile. Recommendations include improvement of catchment and treatment facilities for the elderly alcoholic and the provision of psychogeriatric diagnostic centres. (+info)
Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach: The South Verona Outcome Project 4.
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BACKGROUND: Both subjective and objective information is necessary to assess quality of life (QOL). AIMS: To explore the role of subjective and objective QOL dimensions and their cross-sectional and longitudinal predictors. METHOD: The relationship between QOL, as measured by the Lancashire Quality of Life Profile (LQL), and demographic variables, diagnosis, psychopathology, disability, functioning, affect balance, self-esteem, service use and service satisfaction was investigated at two points in time, using factor analysis and multiple regression techniques. RESULTS: One subjective and two objective LQL factors with strong face validity were identified. Cross-sectional predictors of the subjective factor were primarily subjective measures; longitudinally, few predictors of this factor were identified. The cross-sectional and longitudinal predictors of the objective factors were primarily demographic and observer-rated measures. CONCLUSIONS: Subjective and objective data are distinct types of information. Objective measures may be more suitable in detecting treatment effects. Subjective information is necessary to complete the QOL picture and to enhance the interpretation of objective data. (+info)
Psychiatric morbidity and its recognition by doctors in patients with cancer.
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Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. (+info)
Patterns of mental health utilization and costs among children in a privately insured population.
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OBJECTIVE: To examine trends in mental health service use and cost among privately insured children. DATA SOURCES: Inpatient and outpatient claims from the MarketScan database, a collection of health care claims for a national sample of over seven million privately insured individuals. Claims were analyzed for all users of mental health services 17 years of age and under from 1993 to 1996. STUDY DESIGN: The proportion of children receiving mental health services and annual costs and treatment days per treated child were compared across diagnostic groups over time. PRINCIPLE FINDINGS: The proportion of covered children receiving any mental health services fell substantially (-30.0 percent). Inpatient mental health costs per treated child fell $4,587 (-46.9 percent) during the period, driven by decreases in the number of hospital days per treated child per year (-22.9 percent) and per diem costs (-14.5 percent). Outpatient mental health costs also fell during the period due to a 5.1 percent decline in the number of treatment days and a 25.9 percent fall in costs per day. Children whose primary diagnosis was hyperactivity experienced the largest decrease in inpatient costs per treated patient, those diagnosed with schizophrenia experienced the smallest decrease, and those diagnosed with substance abuse disorders experienced large increases. CONCLUSIONS: Changes in mental health service delivery have resulted in substantially reduced access to mental health care among children and significant declines in service use and costs among those who do receive services. (+info)
Factors that influence the cost of caring for patients with severe psychotic illness: report from the UK 700 trial.
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BACKGROUND: Many factors influence the type and quantity of services received by patients and, thus, the total cost of care. Knowledge of these factors can aid budgetary and service-planning decisions. AIMS: To investigate factors that influence the cost of caring for patients with severe psychotic illness. METHOD: Univariate and multivariate analyses were used to examine associations between baseline characteristics and subsequent 2-year total direct costs in 667 patients from the UK 700 case management trial. RESULTS: Significantly more money was spent on younger patients, those with longer duration of illness, those who had spent less time living independently and those who had spent longer in hospital for psychiatric reasons. CONCLUSIONS: Total costs of caring for patients with severe psychotic illness appear to be influenced to a large extent by age, duration of illness and past levels of dependence on statutory services. The strength of these relationships is greater than the impact of illness severity. (+info)
Racial/ethnic differences in attitudes toward seeking professional mental health services.
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OBJECTIVES: This study examined racial/ethnic differences in attitudes toward seeking mental health services. METHODS: Data from the National Comorbidity Survey, which administered a structured diagnostic interview to a representative sample of the US population (N = 8098), were analyzed. Multiple logistic regression was used, and data were stratified by need for mental health services. RESULTS: African Americans with depression were more likely than Whites with depression to "definitely go" (odds ratio [OR] = 1.8, P < .001) seek mental health services. African Americans with severe psychiatric disorders were less likely to be "somewhat embarrassed if friends knew they sought care" (OR = 0.3, P < .001) than were their White counterparts. CONCLUSIONS: African Americans reported more positive attitudes toward seeking mental health services than did Whites. (+info)
Politically correct labels and schizophrenia: a rose by any other name?
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This study investigated the role of politically correct labels in emotional reactions, attributions regarding illness, behavioral intentions, and knowledge of schizophrenia symptoms. Two samples, undergraduate students and community members, were asked to rate a target individual on various scales using one of four labels varying in "political correctness": consumer of mental health services, person with severe mental illness, person with schizophrenia, and schizophrenic. Results showed that the label "consumer of mental health services" was associated with less negative reactions and was considered to be reflective of a condition more likely to change relative to the other, less politically correct labels. However, this label did not result in greater behavioral intention to interact with persons with a psychiatric disorder. Furthermore, participants receiving this label identified fewer symptoms associated with DSM-IV criteria of schizophrenia and were more likely to attribute responsibility for the condition to the target person, relative to the other labels. (+info)
Understanding AIDS-risk behavior among adolescents in psychiatric care: links to psychopathology and peer relationships.
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OBJECTIVE: Severely mentally ill youths are at elevated risk for human immunodeficiency virus infection, but little is known about acquired immunodeficiency syndrome (AIDS) risk behavior in adolescents who seek outpatient mental health services or about the links between psychiatric problems and particular high-risk behaviors. This pilot study used structural equation modeling to conduct a path analysis to explore the direct and indirect effects of adolescent psychopathology on risky sex, drug/alcohol use, and needle use. METHOD: Ethnically diverse youths (N = 86) and their caregivers who sought outpatient psychiatric services in Chicago completed questionnaires of adolescent psychopathology. Youths reported their relationship attitudes, peer influence, sexual behavior, and drug/alcohol use. RESULTS: Different AIDS-risk behaviors were associated with distinct forms of adolescent psychopathology (e.g., delinquency was linked to drug/alcohol use, whereas aggression was related to risky sexual behavior), and peer influence mediated these linkages. Some patterns were similar for caregiver- and adolescent-reported problems (e.g., peer influence mediated the relation between delinquency and drug/alcohol use), but others were different (e.g., caregiver-reported delinquency was associated with risky sex, whereas adolescent-reported delinquency was not). CONCLUSIONS: Findings underscore the complexity of factors (types of informants and dimensions of psychopathology) that underlie AIDS risk in troubled youths, and they offer specific directions for designing and implementing uniquely tailored AIDS prevention programs, for example, by targeting delinquent behavior and including high-risk peers and important family members in interventions. (+info)