Abstract
Background
Both perceived job insecurity and unemployment has been associated with an increased risk of developing mental ill health. It has, moreover, been proposed that an insecure ...employment may be as detrimental as unemployment itself.
Objective
To estimate incidence rate ratios (RRs) of (i) redeemed prescriptions for psychotropic drugs and (ii) psychiatric hospital treatment due to mood, anxiety, or stress-related disease, among fixed-term contract workers (as an operationalization of insecure job) vs. unemployed, in the general population of Denmark.
Methods
Data on baseline employment status were drawn from the Danish Labor Force Surveys in the years 2001–2013. Participants (10,265 fixed-term contract workers and 7926 unemployed) were followed for up to 5 years in national registers (2439 cases of psychotropic drug use, 71,516 person years; 311 cases of psychiatric hospital treatment, 86,790 person years). Adjusted RRs were obtained by Poisson regression. We aspired to minimize health selection effects by (i) exclusion of survey participants who received sickness benefits, social security cash benefits, psychiatric hospital treatment or a prescription for psychotropic drugs, within 1-year prior to baseline (
n
= 11,693), (ii) adjustment for age, gender, level of education, calendar year, disposable family income and maternity/paternity benefits within 1-year prior to baseline.
Results
The adjusted RR for fixed-term contract workers vs. unemployed was 0.98 (99.5% CI: 0.87—1.11) for psychotropic drugs and 0.93 (99.5% CI: 0.67—1.30) for psychiatric hospital treatment.
Conclusion
The present study did not find significant differences in the risk of developing mental ill health between fixed-term contract workers and unemployed, and thus suggests that fixed-term contracts may be as detrimental as unemployment.
Trial registration
International Registered Report Identifier (IRRID): DERR2-10.2196/24392.
Individuals with psychiatric disorders have higher early mortality rates than the general population, and all types of mental disorders are associated with a short life expectancy. In this context, ...assessment of the mortali-ties of both natural and unnatural causes in psychiatric inpatients is of critical importance in terms of mortality epidemiology, which provides data that can help improve the quality and planning of psychiatric care. The popu-lation of this study retrospective, cross-sectional study consisted of inpatients that died in Manisa Mental Health and Diseases Hospital between May 2002 and December 2022. Of the 120 inpatients that died, 119 patients, 63.9% male, and 36.1% female, were included in the study sample. The mortality rate decreased from 3.2% to 0.22% during the period covered by the study. The difference between mortality rates before 2013, when qua-lity and accreditation processes started, and after 2013 has decreased from 74.8% to 25.2%. Of the natural deaths, 45.4% were caused by cardiac arrest, whereas 100% of the unnatural deaths occurred due to suicides. Short hospital stays and close follow-up in the first week of hospitalization are essential in reducing mortality rates in psychiatric inpatients. In addition, increasing the quality of health care in accordance with the national and international quality and accreditation criteria will further reduce the mortality rates in psychiatric inpati-ents.
Ruhsal bozukluğu olan bireylerin genel nüfusa göre daha yüksek erken ölüm oranlarına sahip olduğu ve tüm ruhsal bozukluk türlerinin kısa yaşam beklentisi ile ilişkili olduğu bilinmektedir. Bu bağlamda, psikiyatrik yatan hastalarda hem doğal hem de doğal olmayan nedenlerden kaynaklanan ölümlerin değerlendirilmesi, psikiyatrik bakımın kalitesini ve planlamasını iyileştirmeye yardımcı olabilecek veriler sağlayan mortalite epidemiyolojisi açısından kritik öneme sahiptir. Bu retrospektif, kesitsel çalışmanın evrenini Mayıs 2002-Aralık 2022 tarihleri arasında Manisa Ruh Sağlığı ve Hastalıkları Hastanesi'nde yatarak tedavi gören ve ölen hastalar oluşturmaktadır. Yatarak tedavi gören 120 hastadan %63,9'u erkek, %36,1'i kadın olmak üzere 119 hasta çalışma örneklemine dahil edilmiştir. Çalışmanın kapsadığı dönem boyunca ölüm oranı %3,2'den %0,22'ye düşmüştür. Kalite ve akre-ditasyon süreçlerinin başladığı yıl olan 2013 öncesi ölüm oranları ile 2013 sonrası fark ise %74.8’den %25.2’ye gerilemiştir. Doğal ölümlerin %45,4'ü kardiyak arrest nedeniyle gerçekleşirken, doğal olmayan ölümlerin %100'ü intihar nedeniyle meydana gelmiştir. Kısa hastanede kalış süreleri ve hastaneye yatışın ilk haftasında yakın takip, psikiyatrik yatan hastalarda ölüm oranlarını azaltmada esastır. Ayrıca, ulusal ve uluslararası kalite ve akreditasyon kriterlerine uygun olarak sağlık bakım kalitesinin artırılması, psikiyatrik yatan hastalarda ölüm oranlarını daha da azaltacaktır.
Purpose
Psychiatric hospitals or mental asylums grew across the world in the colonial era. Despite concerns over quality of care and human rights violations, these hospitals continue to provide the ...majority of mental health care in most low- and middle-income countries (LMICs). We sought to review the evidence of reform of mental hospitals and associated patient outcomes.
Methods
We adopted an integrative review methodology by including experimental and non-experimental research. The review protocol was registered on PROSPERO (CRD42019130399). A range of databases and systematic hand searches were conducted by two independent reviewers. Research conducted between 1980 and May 2019, that focused on any aspect of reform in mental hospitals for adults (age 18 and upwards) with severe mental illness and published in English, were considered.
Results
16 studies were included in the review. 12 studies met inclusion criteria, and four additional reports emerged from the hand search. Studies covered—India, China, South Africa, Grenada, Georgia, Sri Lanka, Argentina and Brazil. Key findings emphasise the role of judicial intervention as a critical trigger of reform. Structural reform composed of optimisation of resources and renovations of colonial structures to cater to diverse patient needs. Process reforms include changes in medical management, admission processes and a move from closed to open wards. Staff engagement and capacity building have also been used as a modality of reform in mental hospital settings.
Conclusion
There is some documentation of reform in psychiatric hospitals. However, poor methodological quality and variation in approach and outcomes measured, make it challenging to extrapolate specific findings on process or outcomes of reform. Despite being integral service providers, psychiatric hospitals still do not adopt patient centric, recovery-oriented processes. Hence, there is an urgent need to generate robust evidence on psychiatric reform and its effect on patient outcomes.
Psychiatric inpatients constitute a population at considerably increased risk for suicide. Identifying those at imminent risk is still a challenging task for hospital staff. This retrospective ...case-control study focused on clinical risk factors related to the course of the hospital stay.
Inpatient suicide cases were identified by linking the Tyrol Suicide Register with the registers of three psychiatric hospitals in the state. Control subjects were patients who had also been hospitalized in the respective psychiatric unit but had not died by suicide. Matching variables included sex, age, hospital, diagnosis, and admission date. The study period comprised 7 years. Data were analyzed by the appropriate two-sample tests and by logistic regression.
A total of 30 inpatient suicide cases and 54 control patients were included. A number of factors differentiated cases from controls; after correction for multiple testing, the following retained significance: history of aborted suicide, history of attempted suicide, history of any suicidal behavior/threats, suicidal ideation continuing during hospitalization, no development of prospective plans, no improvement of mood during the hospital stay, and leaving ward without giving notice. Logistic regression identified the latter three variables and history of attempted suicide as highly significant predictors of inpatient suicide.
Preventive measures during hospitalization include thorough assessment of suicidal features, an emphasis on the development of future perspectives, and a review of hospital regulations for patients who want to leave the ward.
Psychiatric hospitals are increasingly being digitalised. Digitalisation often requires changes at work for health professionals. A positive attitude from health professionals towards technology is ...crucial for a successful and sustainable digital transformation at work. Nevertheless, insufficient attention is being paid to the health professionals' sentiments towards technology.
This study aims to identify the implemented technologies in psychiatric hospitals and to describe the health professionals' sentiments towards these implemented technologies.
A text-mining analysis of semi-structured interviews with nurses, physicians and psychologists was conducted. The analysis comprised word frequencies and sentiment analyses. For the sentiment analyses, the SentimentWortschatz dataset was used. The sentiments ranged from -1 (strongly negative sentiment) to 1 (strongly positive sentiment).
In total, 20 health professionals (nurses, physicians and psychologists) participated in the study. When asked about the technologies they used, the participating health professionals mainly referred to the computer, email, phone and electronic health record. Overall, 4% of the words in the transcripts were positive or negative sentiments. Of all words that express a sentiment, 73% were positive. The discussed technologies were associated with positive and negative sentiments. However, of all sentences that described technology at the workplace, 69.4% were negative.
The participating health professionals mentioned a limited number of technologies at work. The sentiments towards technologies were mostly negative. The way in which technologies are implemented and the lack of health professionals' involvement seem to be reasons for the negative sentiments.
Background: Medical care for psychosomatic patients in Austria differs from Germany. Besides treatment in psychiatric wards, there are also inpatient programs for psychosomatic patients integrated in ...internal medical departments. Such an integrated ward in Lower Austria operates for more than 35 years and treats internal-psychosomatic and gastroenterological patients. However, its effectiveness was not yet evaluated. Objective: The aim of the current study was to evaluate the effectiveness of an inpatient program for psychosomatic patients. Method: In total, 184 patients participated in the naturalistic study and filled in questionnaires at admission and discharge from inpatient treatment. Primary endpoint was the difference in global symptom burden, as well as symptom burden in the areas of somatization, anxiety, and depression as measured with the Brief Symptom Inventory (BSI) between admission and discharge. Secondary endpoints were body image (FKB-20) and subjective therapeutic success (BVB-2000). The predictive power of the Structure of Personality (OPD-SF) and adverse childhood experiences (ACE-D) was also investigated. A smaller sample of 59 patients also participated in a four-month follow up assessment. Results: The inpatient treatment was associated with improvement in the primary endpoints that can be interpreted as large effects. The effects were also small to large for the secondary endpoints, however, the improvement was smaller at the follow up time point. Patients with deficits in the dimensions regulation of relationships and internal emotional communication showed less improvement. Discussion: Symptoms improve over the course of the evaluated inpatient treatment program. Specific dimension of the structure of personality predict treatment response and should be considered in treatment planning. Conclusion: This study provides initial evidence for the presented internal-psychosomatic inpatient program. The program might act as model for psychosomatic medical care in Austrian hospitals. Z Psychosom Med Psychother 67/2021 Key words Inpatient Psychotherapy - Internal-Psychosomatic Treatment - Integrated Psychosomatic Approach - Effectiveness - Internal Medicine Hintergrund: Die Versorgung psychosomatischer Patienten in Österreich unterscheidet sich von der in Deutschland. Neben den psychiatrisch geführten Therapieangeboten gibt es in Österreich auch stationäre Konzepte zur Behandlung psychosomatischer Beschwerden, die an Abteilungen für Innere Medizin angesiedelt sind. Die Station für Internistische Psychosomatik eines Akutkrankenhauses in Niederösterreich mit gastroenterologischem Schwerpunkt bietet seit über 35 Jahren stationäre Behandlung für psychosomatische Beschwerden an, die Wirksamkeit wurde bisher aber nicht systematisch überprüft. Fragestellung: Ziel der Studie war es, die Wirksamkeit eines psychosomatischen Behandlungs-settings zu überprüfen. Material und Methoden: Insgesamt wurden im Rahmen einer naturalistischen Studie 184 Personen bei Aufnahme in die stationäre Behandlung und bei Entlassung befragt. Der primäre Endpunkt war der Unterschied in der globalen Symptombelastung sowie in den Bereichen Somatisierung, Ängstlichkeit und Depressivität, gemessen mit dem Brief Symptom Inventory (BSI) zwischen Aufnahme und Entlassung. Sekundäre Endpunkte waren die weiteren Symptomskalen des BSI, das Körperbild (FKB-29) und der subjektive Therapieerfolg (BVB2000). Die Persönlichkeitsstruktur (OPD-SF) und aversive Kindheitserfahrungen (ACE-D) wurden als Prädiktoren für den Therapieerfolg untersucht. Eine kleinere Stichprobe von 59 Personen nahm auch an einer Vier-Monats-Katamnese teil. Ergebnisse: Die Aufnahme führte zu einer Verbesserung in den primären Endpunkten, die als großer Effekt gewertet werden kann. Der Effekt zeigte sich in verschieden großem Ausmaß ebenfalls in den sekundären Endpunkten. Personen mit geringer integrierter Struktur in den Bereichen Regulierung des Objektbezugs und emotionale Kommunikation nach innen zeigten geringeren Therapieerfolg. Die kleinere Vier-Monats-Katamnese gab erste Hinweise auf die zeitliche Stabilität der Effekte. Diskussion: Die stationäre Versorgung psychosomatischer Patienten scheint in der evaluierten Station erfolgreich zu gelingen. Die Persönlichkeitsstruktur liefert einen Hinweis auf den zu erwartenden Therapieerfolg und sollte in der Behandlung berücksichtigt werden. Schlussfolgerungen: Es gibt Hinweise auf die Wirksamkeit des Behandlungskonzepts. Dieses Konzept könnte ein Modell für die Integration von psychosomatischen Behandlungsangeboten im Akutkrankenhaus in Österreich darstellen.
Abstract
Study Objectives
Blue-depleted lighting reduces the disruptive effects of evening artificial light on the circadian system in laboratory experiments, but this has not yet been shown in ...naturalistic settings. The aim of the current study was to test the effects of residing in an evening blue-depleted light environment on melatonin levels, sleep, neurocognitive arousal, sleepiness, and potential side effects.
Methods
The study was undertaken in a new psychiatric hospital unit where dynamic light sources were installed. All light sources in all rooms were blue-depleted in one half of the unit between 06:30 pm and 07:00 am (melanopic lux range: 7–21, melanopic equivalent daylight illuminance M-EDI range: 6–19, photopic lux range: 55–124), whereas the other had standard lighting (melanopic lux range: 30–70, M-EDI range: 27–63, photopic lux range: 64–136), but was otherwise identical. A total of 12 healthy adults resided for 5 days in each light environment (LE) in a randomized cross-over trial.
Results
Melatonin levels were less suppressed in the blue-depleted LE (15%) compared with the normal LE (45%; p = 0.011). Dim light melatonin onset was phase-advanced more (1:20 h) after residing in the blue-depleted LE than after the normal LE (0:46 h; p = 0.008). Total sleep time was 8.1 min longer (p = 0.032), rapid eye movement sleep 13.9 min longer (p < 0.001), and neurocognitive arousal was lower (p = 0.042) in the blue-depleted LE. There were no significant differences in subjective sleepiness (p = 0.16) or side effects (p = 0.09).
Conclusions
It is possible to create an evening LE that has an impact on the circadian system and sleep without serious side effects. This demonstrates the feasibility and potential benefits of designing buildings or hospital units according to chronobiological principles and provide a basis for studies in both nonclinical and clinical populations.
Introduction and Aim: Psychotic and mood disorders are associated with significant functional impairment, premature mortality, physical morbidity, and great social and economic burden. The aim of ...this study is to evaluate the effectiveness of psychosocial, psychological, and rehabilitative interventions implemented in an Italian psychiatric inpatient facility, with a focus on patients with schizophrenia spectrum versus those with mood disorders. Methods: A retrospective observational study was conducted in the psychiatric hospital Villa Maria Pia in Rome, Italy, during 2022. Patients with an established diagnosis of schizophrenia spectrum and mood disorder (ICD-9-CM) were assessed on admission (TO) and at the end of treatment (T1), using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Interventions involved a multidisciplinary team and included individual and group activities. The t-test for independent samples was used to compare continuous variables between groups and Spearman correlation coefficient to calculate correlations between variables. Results: The study sample consisted of 141 patients, the majority of them being adults (51.3 years + or - 12.4) men (F/M= 68/73). Among them, 85 patients (60.3%) actively engaged in psychosocial and rehabilitative interventions and, compared to non-participating individuals, they showed lower functioning and symptoms at discharge (delta GAF was significantly higher among patients who had taken part in the psychosocial activities, t = -2.095; p = 0.038). Considering the index computed (n of interventions/days of hospitalization), the number of psychosocial activities was positively correlated with the improvement in patients' functioning in the sample taking part in activities (r = 0.272, p = 0.012), especially with psychotherapy and support groups (r = 0.202, p = 0.017 and r = 0.188, p = 0.025, respectively). Splitting the total sample into schizophrenia-spectrum disorder (N = 37) and mood disorder (N = 48) groups, the positive correlations between GAF improvement and participation in psychosocial activities were confirmed only in the schizophrenia-spectrum group. These correlations were not significant for symptomatology (BPRS) either in the total or the individual group. Conclusion: Evidence from our study suggests that inpatient rehabilitation can be effective and useful for people with severe mental disorders. Further investigations are needed to better understand its effectiveness on improving quality of life and social functioning in the long term. Keywords: psychosis, schizophrenia, psychiatric rehabilitation, psychosocial intervention, mental health rehabilitation
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