Readmission rate is considered an indicator of the mental health care quality. Previous studies have examined a number of factors that are likely to influence readmission. The main objective of this ...systematic review is to identify the studied pre-discharge variables and describe their relevance to readmission among psychiatric patients.
Studies on the association between pre-discharge variables and readmission after discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management and OpenGrey. Relevant publications published between January 1990 and June 2014 were included. For each variable, the number of papers that considered it as a predictor of readmission and that found a significant association was recorded, together with the association direction and whether it was found respectively in bivariate and in multivariate analyses.
Of the 734 articles identified in the search, 58 papers were included in this review, mainly from the USA and concerning patients with severe mental disorders. Analysed variables were classified according to the following categories: patients' demographic, social and economic characteristics; patients' clinical characteristics; patients' clinical history; patients' attitude and perception; environmental, social and hospital characteristics; and admission and discharge characteristics. The most consistently significant predictor of readmission was previous hospitalisations. Many socio-demographic variables resulted as influencing readmission, but the results were not always homogeneous. Among other patients' clinical characteristics, diagnosis and measures of functional status were the most often used variables. Among admission characteristics, length of stay was the main factor studied; however, the results were not very consistent. Other relevant aspects resulted associated with readmission, including the presence of social support, but they have been considered only in few papers. Results of quality assessment are also reported in the review. The majority of papers were not representative of the general psychiatric population discharged from an inpatient service. Almost all studies used multivariate analytical methods, i.e., confounders were controlled for, but only around 60% adjusted for previous hospitalisation, the variable most consistently considered associated to readmission in the literature.
The results contribute to increase knowledge on pre-discharge factors that could be considered by researchers as well as by clinicians to predict and prevent readmissions of psychiatric patients. Associations are not always straightforward and interactions between factors have to be considered.
Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among ...hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy.
All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes.
A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic.
The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health.
Aims: The aim was to analyse and describe cases of delirium in hospitalized patients for whom a psychiatric consultation was requested during 2017. Methods: Patients personal and clinical data were ...retrospectively reviewed from hospital files and clinical data records. We investigated possible risks and precipitating factors using as outcomes length of stay, deaths, falls and institutionalization after discharge. Features of delirium were collected during the consultation-liaison contacts. Results: During 2017, 78 requests for consultations to our Unit have resulted in a diagnosis of delirium. In most cases, requests arrived when behavioural disorders were uncontrollable or undermine the adherence to medical treatments. Units which required more consultations were Internal Medicine (41 pts) and Surgical Units (20 pts). Consultations were requested on average 4 days after symptoms onset (range from 0 to 28 days). The majority consisted of hyperkinetic delirium (81%). In total, we examined 26 women and 52 men with an average age of 77 years; only 2 patients were younger than 60 years: one with delirium tremens and one with symptoms of opioid withdrawal. Around 41% of patients had dementia, while 29% had a psychiatric history. One-third had a previous admission in an Intensive Care Unit. Regarding outcomes. 18 people died during the index admission where consultation was requested and 6 died in a subsequent admission. The length of stay was on average 30 days. 16 patients were rehospitalized within a month, 12 were discharged to long-term care or to rehabilitation facilities, 12 had falls and 4 developed decubitus ulcers. Statistics about risks and precipitating factors will be presented. Conclusion: Literature estimates that delirium is unrecognized in 33-66% cases with serious clinical implications and consequences. We also found that our colleagues were not able to identify signs and symptoms of delirium as in most cases the diagnosis was done during the consultation. For this reason, a project with the aim to raise awareness and train colleagues was implemented, the Confusion Assessment Method questionnaire was piloted in three clinical units in order to obtain earlier diagnosis and better management of delirium. Preliminary results will be presented.
Purpose
The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of ...different clinical and organizational factors.
Methods
The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single- and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates.
Results
The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree.
Conclusions
Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.
WHO declared that mental health care should be considered one essential health service to be maintained during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to describe the effect ...of lockdown and restrictions due to the COVID-19 pandemic in Italy on mental health services' utilisation, by considering psychiatric diagnoses and type of mental health contacts.
The study was conducted in the Verona catchment area, located in the Veneto region (northeastern Italy). For each patient, mental health contacts were grouped into: (1)
, (2)
, (3)
, (4)
, (5)
. A 'difference in differences' approach was used: difference in the number of contacts between 2019 and 2020 on the weeks of lockdown and intermediate restrictions was compared with the same difference in weeks of no or reduced restrictions, and such difference was interpreted as the effect of restrictions. Both a global regression on all contacts and separate regressions for each type of service were performed and Incidence Rate Ratios (IRRs) were calculated.
In 2020, a significant reduction in the number of patients who had mental health contacts was found, both overall and for most of the patients' characteristics considered (except for people aged 18-24 years for foreign-born population and for those with a diagnosis of schizophrenia. Moreover, in 2020 mental health contacts had a reduction of 57 096 (-33.9%) with respect to 2019; such difference remained significant across the various type of contacts considered, with rehabilitation interventions and day care showing the greatest reduction. Negative Binomial regressions displayed a statistically significant effect of lockdown, but not of intermediate restrictions, in terms of reduction in the number of contacts. The lockdown period was responsible of a 32.7% reduction (IRR 0.673;
-value <0.001) in the overall number of contacts. All type of mental health contacts showed a reduction ascribable to the lockdown, except social and supportive interventions.
Despite the access to community mental health care during the pandemic was overall reduced, the mental health system in the Verona catchment area was able to maintain support for more vulnerable and severely ill patients, by providing continuity of care and day-by-day support through social and supportive interventions.
Aims: The interplay between physical and mental illness in migrants has arisen a high degree of concern in the European countries. In spite of this, few studies have compared the health of migrant ...and natives. In this paper, we aim to describe differences in physical comorbidities between natives and migrants seeking psychiatric care in the catchment area of Verona, an affluent city located on the north of Italy. Methods: Using the Psychiatric Case Register covering the catchment area of Verona, all individuals with a first ever psychiatric contact with the mental health services from 2000 to 2015 were identified and data were extracted. T and Chi-square tests (p<0.05) were applied for comparisons. Results: Data on physical comorbidities were available for 16.335 patients. Differences between natives and migrants were found for age (52.2 vs 36.5) and psychiatric diagnosis (psychotic disorders: 4.0% vs 10.0%), while no difference was found for sex (males: 40.6% vs 42.6%). 35.9% natives and 59.3% migrants had no physical comorbidities. Concerning physical illnesses, no differences were found in the frequencies and specific patterns, with the exception of cardiovascular disorders (16.0% vs 4.9%), infectious diseases (1.9% vs 4.0%) and multiple comorbidities (12.9% vs 3.9%). In the group below 30 years 70.8% natives and 74.5% migrants had no physical comorbidities. The profile of physical illnesses confirmed a difference only in infectious diseases (0.9% natives vs 4.3% migrants). In the group above 30 years, 28.9% natives and 51.3% migrants had no physical comorbidities. The profile of physical illnesses showed differences in cardiovascular disorders (18.7% natives vs 6.9% migrants) and multiple comorbidities (15.1% natives vs 5.4% migrants). Conclusion: This study shows a picture of the balance of physical and mental health that seems different from the perception of the local communities. It seems clear that environmental factors have a role in modulating the health of the migrants, as shown by the higher rate of psychosis and the susceptibility to infectious diseases, in front of an overall physical health that seems even better in migrants than in natives. These findings might help to devise more targeted interventions in these disadvantaged subjects.
Most mortality studies of psychiatric patients published to date have been conducted in hospital-based systems of care. This paper describes a study of the causes of death and associated risk factors ...among psychiatric patients who were followed up over a 20-year period in an area where psychiatric care is entirely provided by community-based psychiatric services.
All subjects in contact with the South Verona Community-based Mental Health Service (CMHS) over a 20-year period with an ICD-10 psychiatric diagnosis were included. Of these 6956 patients, 938 died during the study period. Standardized mortality ratios (SMRs) and Poisson multiple regressions were used to assess the excess of mortality in the sample compared with the general population.
The overall SMR of the psychiatric patients was 1.88. Mortality was significantly high among out-patients SMR 1.71, 95% confidence interval (CI) 1.6-1.8, and higher still following the first admission (SMR 2.61, 95% CI 2.4-2.9). The SMR for infectious diseases was higher among younger patients and extremely high in patients with diagnoses of drug addiction (216.40, 95% CI 142.5-328.6) and personality disorders (20.87, 95% CI 5.2-83.4).
This study found that psychiatric patients in contact with a CMHS have an almost twofold higher mortality rate than the general population. These findings demonstrate that, since the closure of long-stay psychiatric hospitals, the physical health care of people with mental health problems is often neglected and clearly requires greater attention by health-care policymakers, services and professionals.
The first aim of this study is to compare involuntary admissions across the Veneto Region in Italy. The second aim is to explore the relation between mental health services provision, characteristics ...of population, individual factors and involuntary admissions.
For 21 Mental Health Departments (MHDs) in the Veneto Region (Italy), the average population prevalence rate of involuntary admissions between 2000 and 2007 and the percentage of involuntary admissions were calculated. Chi-square tests for equality of proportions were used to test hypotheses. Variables at the individual, contextual and organisational levels were used in multiple regressions, with the involuntary admission data as dependent variables.
The average prevalence rate of involuntary commitment was 12.75 ranging from 1.96 to 27.59 across MHDs . About 75% of the involuntary admissions referred to psychotic patients, and almost half of patients were aged 25-44. Significant differences among MHDs emerged; higher percentages of involuntary admissions were generally found in densely populated areas. Higher ageing indices and rates of social workers were found as predictors of the prevalence rate. In the multilevel regression, being males and psychotic significantly increased involuntary admissions, while the percentage of singles in population decreased it.
This study contributes to define the specific contribution of each factor predicting the use of involuntary admission, even within areas under the same legislation. It shows how the inclusion of both individual and contextual factors may lead to better predictions and provides precious data for the services improvement.
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