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There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
– In the health sector, anywhere in the world nurses are one of the most exposed groups to violence. However, it is not obvious that psychiatric nurses (PNs) are more exposed to aggression and burnout.
– To determine the nature and effects of aggressive acts towards nursing staff in psychiatric and other medical services in Poland.
– Various questionnaires (Stress at Work Scale, General Health Questionnaire, Maslach Burnout Inventory, Work Satisfaction Scale), were distributed among psychiatric (N = 78) and non-psychiatric nurses (N-PNs) (N = 335). A 92.6% response rate was achieved.
– Significant differences were found between PNs and non-psychiatric counterparts with respect to their experiences of violence. The most frequently reported incident was verbal abuse, followed by threats and physical assault. Patients were significantly more frequent perpetrators in psychiatric wards than in others. The level of intra-staff aggression did not significantly vary between groups, neither did the level of work satisfaction and absenteeism.
– The frequency of violent acts and stress related to them point out the strong need for the development of preventive programs to address the issue of violence at work.
Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient’s psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients.
Subject and methods
After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory.
Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed.
High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients’ emotional distress, medical and economic costs.
The aim of the study was to compare a clinical course and treatment results of depression occurring as the first depressive episode, the second depressive episode or the third or further depressive episode. The study was 1-year, prospective, naturalistic observation made by Polish psychiatrists.
One-hundred and seventy-nine patients with the first depressive episode (group I), 170 patients with the second episode (group II) and 183 patients with the third or further episode of depression (group III) were compared. The main analysed variable was remission, defined as the score of ≤7 points on 17-item Hamilton depression rating scale (HDRS), after 6 and 12 months of observation.
The groups of patients studied did not initially differ as to age, proportion of gender and intensity of depression. The percentages of remission after 6 months of observation in groups I.III were: 49%, 41% and 32%, and after 12 months 69%, 60% and 50%, respectively.
The results obtained indicate that the course of subsequent depressive episodes is less favourable compared to the first depressive episode. The percentages of remission obtained in individual groups studied may have implications regarding duration of pharmacological treatment of depressive episode.
The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication.
The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders’ representatives. The national recommendations have been subsequently summarized into a European shared document.
Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients’ dignity, privacy and safety shall be preserved at all times.
The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.
Legislation and practice of involuntary hospital admission vary
substantially among European countries, but differences in outcomes have
not been studied.
To explore patients' views following involuntary hospitalisation in
different European countries.
In a prospective study in 11 countries, 2326 consecutive involuntary
patients admitted to psychiatric hospital departments were interviewed
within 1 week of admission; 1809 were followed up 1 month and 1613 3
months later. Patients' views as to whether the admission was right were
the outcome criterion.
In the different countries, between 39 and 71% felt the admission was
right after 1 month, and between 46 and 86% after 3 months. Females,
those living alone and those with a diagnosis of schizophrenia had more
negative views. Adjusting for confounding factors, differences between
countries were significant.
International differences in legislation and practice may be relevant to
outcomes and inform improvements in policies, particularly in countries
with poorer outcomes.
– En el sector sanitario, el personal de enfermería es uno de los grupos más expuestos a la violencia en todo el mundo. Sin embargo, no es obvio que el personal de enfermería psiquiátrica (PEP) esté más expuesto a la agresión y el agotamiento laboral (burnout).
– Determinar la naturaleza y los efectos de los actos agresivos hacia el personal de enfermería en los servicios psiquiátricos y otros servicios médicos en Polonia.
– Se distribuyó diversos cuestionarios (Escala de Estrés en el Trabajo, Cuestionario de Salud General, Inventario de Agotamiento Laboral de Maslach, Escala de Satisfacción Laboral) entre miembros del personal de enfermería psiquiátrica (PEP, n = 78) y no psiquiátrica (PENP, n = 335). Se alcanzó una tasa de respuesta del 92,6%.
– Se encontraron diferencias significativas entre el PEP y el PENP con respecto a sus experiencias de violencia. El incidente comunicado con más frecuencia era el abuso verbal, seguido por las amenazas y la agresión física. Los pacientes eran los autores de manera significativamente más frecuente en las salas psiquiátricas que en las otras salas. El nivel de agresión entre el personal no variaba significativamente entre los grupos, ni tampoco el nivel de satisfacción laboral y de absentismo.
– La frecuencia de los actos violentos y el estrés relacionado con ellos señala la gran necesidad del desarrollo de programas preventivos para abordar la cuestión de la violencia en el trabajo.
The aim was to evaluate the prevalence of psychiatric morbidity in Polish population.
Subjects and methods:
The national health interview survey was based on entire non-institutionalized Polish population by means of randomized, stratified (urban and rural census tracks) two-stage method (over 39 000 respondents). Prevalence of psychiatric morbidity was based on General Health Questionnaire-12.
Psychiatric morbidity was noted in almost 1/4 of women and 1/5 of men in Poland, with small differences between urban and rural population. Every 10th woman reported such complaints at the age up to 25 years and every second above 75 years of age. Divorced and widowed respondents, irrespective of gender, have psychiatric disorders more frequently than compared groups. Higher prevalence of psychiatric morbidity was noted in out of work and especially disabled persons. The higher the level of education, the lower the frequency of psychiatric morbidity was observed.
Presented survey enabled to evaluate prevalence of psychiatric morbidity in Polish representative sample. Findings should trigger more extended epidemiological studies. The requirement for epidemiological investigations increases in reform-awaiting health care system in Poland, for at least one reason that the improvement of the quality of services is closely associated with a detailed recognition of the problem.
El propósito del estudio era comparar el curso clínico y los resultados del tratamiento de la depresión que se producia como primer episodio depresivo, segundo episodio depresivo, o tercer o posteriores episodios depresivos. El estudio era una observacion prospectiva naturalista de 1 año realizada por psiquiatras polacos.
Se comparó 179 pacientes con primer episodio depresivo (grupo I), 170 pacientes con segundo episodio (grupo II) y 183 pacientes con tercer o posteriores episodios de depresión (grupo III). La principal variable analizada era la remisión, definida como la pun- tuación de ≤7 puntos en la Escala de Evaluación de la Depresión de Hamilton de 17 elementos (HDRS), después de 6 y 12 meses de observación.
Los grupos de pacientes estudiados no diferían inicialmente en cuanto a la edad, la proporción de géneros y la intensidad de la depresión. Los porcentajes de remisión después de 6 meses de observación en los grupos I-III fueron: 49%, 41% y 32%, y después de 12 meses: 69%, 60% y 50%, respectivamente.
Los resultados obtenidos indican que el curso de los episodios depresivos posteriores es menos favorable co con el primer episodio. Los porcentajes de remisión obtenidos en los grupos individuals estudiados pueden tener implicaciones con respecto a la duración del tratamiento farmacológico del episodio depresivo.
Apart from insomnia, poor quality of sleep, decreased sleep duration, tiredness after awakening and frequency of using sleeping drugs are important indicators of sleep problems.
The aim of this study was to assess the prevalence of indicators of sleep disturbance, such as quality of sleep, sleep duration, feeling of restfulness in the morning and drug utilization in a randomly selected Polish adult population.
A stratified scheme of sampling involving two steps was used. A representative Polish population sample of 47 924 non-institutionalized adults was interviewed. Assessments of sleep-related problems were based on six questions. Standardized prevalence ratios (SPRs and their 95% confidence intervals) were calculated.
Almost one-tenth of Polish inhabitants usually slept badly or very badly, a problem that was more common among women than men. Quality of sleep decreased together with ageing and this process was more rapid in women than in men over 40 years of age. Highly educated respondents had the highest quality of sleep. Up to one-fifth of the general Polish population usually woke up tired in the morning. Mean sleep duration was 7.7 h, with no gender differences. Usage of over-the-counter (OTC) medications was significantly lower than usage of those prescribed by the physician (5 vs. 16%). Women used OTC drugs twice as often as men.
It would appear to be necessary to introduce educational programmes for the community as well as for general practitioners in order to correct improper attitudes.
La cirugía cardíaca es un factor que provoca respuestas emocionales y fisiológicas específicas de un paciente. A pesar de los efectos somáticos positivos de la cirugía, la depresión y la ansiedad pueden persistir o aparecer por primera vez después de la intervención quirúrgica, empeorando el funcionamiento psicosocial y la calidad de vida del paciente. El propósito de este estudio es ofrecer una visión prospectiva sobre la incidencia y el curso de los autoinformes de depresión y ansiedad en pacientes con derivación aortocoronaria (DAC).
Sujetos y métodos
Después del consentimiento informado, 53 pacientes que se propusieron para DAC fueron examinados unos días antes y después de la intervención y 3 meses después de ella. Los pacientes rellenaron el Cuestionario de Ansiedad de Spielberger y el Inventario de Depresión de Beck.
El 55% aproximadamente de los pacientes tenía un nivel alto de ansiedad preoperatoria. Poco después de la intervención, el 34% de los pacientes y, después de 3 meses, el 32% de ellos tenían un nivel clínicamente relevante de ansiedad. El 32% de los pacientes antes de la intervención, el 28% inmediatamente después de la DAC y el 26% en el seguimiento estaban deprimidos.
Las puntuaciones preoperatorias altas de depresión, ansiedad como estado y ansiedad como rasgo parecen ser predictoras de la evolución psicológica posoperatoria. La evaluación preoperatoria puede identificar a los pacientes con riesgo de niveles clínicos de ansiedad y depresión posoperatorias. El consejo preventivo psicológico y la intervención psiquiátrica pueden reducir el sufrimiento emocional de los pacientes, y los costes médicos y los económicos.
Cryotherapy has a long tradition in somatic medicine. Yet we know very little about its impact on psyche and mood disturbances in particular. Therefore there is a real need for scientific investigations into this problem.
The study reported here was an initial approach to whole-body cryotherapy (WBCT) as a potential treatment modality for depression and was expected to provide rough data helping to design a future project with extended methodology, larger sample groups and longer follow-up.
Twenty-three patients aged 37–70 years gave informed consent to participate in the study. Ten WBCT procedures (160 s, −150°C) were applied within 2 weeks. Participants were recruited from depressed day hospital patients. Antidepressive medication was not ceased. Symptoms were rated at the beginning and end of this intervention using the 21-item Hamilton Depression Rating Scale (HDRS). Changes in scores were analyzed in the group of patients for every item separately as well as for the sum of all items for each patient.
Almost for each individual HDRS item, the overall score for all patients together was significantly lower after WBCT. This means that all symptoms, except for day–night mood fluctuations, were presumably positively influenced by cryotherapy. The HDRS sum-score for each patient after WBCT was lower than that of the baseline and reached statistical significance in a paired samples t-test. Every patient was therefore considerably relieved after WBCT.
It appears that WBCT helps in alleviating depression symptoms. Should this be confirmed in the extended study we are currently implementing, WBCT may become an auxiliary treatment in depression.
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