To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Physical activity is a modifiable risk factor for several physical and mental health conditions. It is well established that people with severe mental illness have increased risk of physical health complications, particularly cardiovascular disease. They are also more likely to be physically inactive, contributing to the elevated cardiovascular and metabolic risks, which are further compounded by antipsychotic medication use. Interventions involving physical activity are a relatively low risk and accessible way of reducing physical health problems and weight in people with severe mental illness. They also have wider benefits for mental health symptoms and quality of life. However, many barriers still exist to the widespread implementation of physical activity interventions in the treatment of severe mental illness. A more concerted effort is needed to facilitate their translation into routine practice and to increase adherence to activity interventions.
For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone.
We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs.
We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick–Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale).
We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54–1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4–3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4–2.1, P = 0.004), and lower depression scores (−1.7, 95% CI −2.7 to −0.8, P < 0.001), than CRT participants.
Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
Policies addressing the physical health of people with mental disorders have historically focused on those with severe mental illness (SMI), giving less prominence to the more prevalent common mental disorders (CMDs). Little is known about the comparative physical health outcomes of these patient groups. We aimed to first compare the: (a) number of past-year chronic physical conditions and (b) recent physical health service utilization between CMDs vs. SMI, and secondly compare these outcomes between people with CMDs vs. people without mental disorders.
We analyzed cross-sectional data from the third Adult Psychiatric Morbidity Survey, a representative sample of the English population. We determined the presence of physical conditions and health service utilization by self-report and performed logistic regression models to examine associations of these outcomes between participant groups.
Past-year physical conditions were reported by the majority of participants (CMDs, n = 815, 62.1%; SMI = 27, 63.1%) with no variation in the adjusted odds of at least one physical condition between diagnoses (odds ratio [OR] = 0.96, 95% confidence intervals [CI] 0.42–1.98, p = 0.784). People with CMDs were significantly more likely to be recently hospitalized relative to with those with SMI (OR = 6.33, 95% CI 5.50–9.01, p < 0.05). Having a CMD was associated with significantly higher odds of past-year physical conditions and recent health service utilization (all p < 0.001) compared with the general population.
People with CMDs experience excess physical health morbidities in a similar pattern to those found among people with SMI, while their somatic hospitalization rates are even more elevated. Findings highlight the importance of recalibrating existing public health strategies to bring equity to the physical health needs of this patient group.
Potentially modifiable risk factors for developing dementia have been identified. However, risk factors for increased mortality in patients with diagnosed dementia are not well understood. Identifying factors that influence prognosis would help clinicians plan care and address unmet needs.
To investigate diagnosed depression and sociodemographic factors as predictors of mortality in patients with dementia in UK secondary clinical care services.
We conducted a cohort study of patients with a dementia diagnosis in an electronic health records database in a UK National Health Service mental health trust.
In 3374 patients with 10 856 person-years of follow-up, comorbid depression was not associated with mortality (adjusted hazard ratio 0.94; 95% CI 0.71–1.24). Single patients had higher mortality than those who were married (adjusted hazard ratio 1.25; 95% CI 1.03–1.50). Patients of Asian ethnicity had lower mortality rates than White British patients (adjusted hazard ratio 0.50; 95% CI 0.34–0.73).
Clinically diagnosed depression does not increase mortality in patients with dementia. Patients who are single are a potential high-mortality risk group. Lower mortality rates in Asian patients with dementia that have been reported in the USA also apply in the UK.
Bipolar disorder and schizophrenia are associated with increased mortality relative to the general population. There is an international emphasis on decreasing this excess mortality.
To determine whether the mortality gap between individuals with bipolar disorder and schizophrenia and the general population has decreased.
A nationally representative cohort study using primary care electronic health records from 2000 to 2014, comparing all patients diagnosed with bipolar disorder or schizophrenia and the general population. The primary outcome was all-cause mortality.
Individuals with bipolar disorder and schizophrenia had elevated mortality (adjusted hazard ratio (HR) = 1.79, 95% CI 1.67–1.88 and 2.08, 95% CI 1.98–2.19 respectively). Adjusted HRs for bipolar disorder increased by 0.14/year (95% CI 0.10–0.19) from 2006 to 2014. The adjusted HRs for schizophrenia increased gradually from 2004 to 2010 (0.11/year, 95% CI 0.04–0.17) and rapidly after 2010 (0.34/year, 95% CI 0.18–0.49).
The mortality gap between individuals with bipolar disorder and schizophrenia, and the general population is widening.
This article summarises internet-mediated approaches to conducting quantitative and qualitative cross-sectional mental health research, and describes aspects of research design to consider for optimising scientific rigour and validity as well as response. Rapid adoption of internet-mediated approaches risks compromising the quality of the methods used. Not only can it cause distress to participants, but methodological problems may lead to inappropriate inferences being made from research findings. In this article the advantages of using internet communication for research purposes are balanced against the disadvantages, using examples of recent internet-mediated research (IMR) studies to illustrate good practice.
High-quality evidence on morale in the mental health workforce is
To describe staff well-being and satisfaction in a multicentre UK
National Health Service (NHS) sample and explore associated factors.
A questionnaire-based survey (n = 2258) was conducted in
100 wards and 36 community teams in England. Measures included a set of
frequently used indicators of staff morale, and measures of perceived job
characteristics based on Karasek's demand–control–support model.
Staff well-being and job satisfaction were fairly good on most
indicators, but emotional exhaustion was high among acute general ward
and community mental health team (CMHT) staff and among social workers.
Most morale indicators were moderately but significantly intercorrelated.
Principal components analysis yielded two components, one appearing to
reflect emotional strain, the other positive engagement with work. In
multilevel regression analyses factors associated with greater emotional
strain included working in a CMHT or psychiatric intensive care unit
(PICU), high job demands, low autonomy, limited support from managers and
colleagues, age under 45 years and junior grade. Greater positive
engagement was associated with high job demands, autonomy and support
from managers and colleagues, Black or Asian ethnic group, being a
psychiatrist or service manager and shorter length of service.
Potential foci for interventions to increase morale include CMHTs, PICUs
and general acute wards. The explanatory value of the
demand–support–control model was confirmed, but job characteristics did
not fully explain differences in morale indicators across service types
World Mental Health Survey data demonstrate that a high proportion of people
who are suicidal receive no treatment and that, contrary to previous
assumptions, attitudes to treatment constitute greater barriers to
help-seeking than do stigma or structural/financial constraints. We explore
how suicide-prevention policy-makers might respond to Bruffaerts et
Alternatives to traditional in-patient services may be associated with a better experience of admission.
To compare patient satisfaction, ward atmosphere and perceived coercion in the two types of service, using validated measures.
The experience of 314 patients in four residential alternatives and four standard services were compared using the Client Satisfaction Questionnaire (CSQ), the Service Satisfaction Scale – Residential form (SSS–Res), the Ward Atmosphere Scale (WAS) and the Admission Experience Scale (AES).
Compared with standard wards, service users from alternative services reported greater levels of satisfaction (mean difference CSQ 3.3, 95% CI 1.8 to 4.9; SSS–Res 11.4, 95% CI 5.0 to 17.7). On the AES, service users in alternatives perceived less coercion (mean difference –1.3, 95% CI –1.8 to –0.8) and having more ‘voice’ (mean difference 0.9, 95% CI 0.6 to 1.2). Greater autonomy, more support and less anger and aggression were revealed by WAS scores. Differences in CSQ and AES scores remained significant after multivariable adjustment, but SSS–Res results were attenuated, mainly by detention status.
Community alternatives were associated with greater service user satisfaction and less negative experiences. Some but not all of these differences were explained by differences in the two populations, particularly in involuntary admission.
Little is known about the preferences and experiences of people with mental illness in relation to residential alternatives to hospital.
To explore patients' subjective experiences of traditional hospital services and residential alternatives to hospital.
In-depth interviews were conducted with 40 purposively selected patients in residential alternative services who had previously experienced hospital in-patient stays. Transcripts were coded and analysed for thematic content.
Patients reported an overall preference for residential alternatives. These were identified as treating patients with lower levels of disturbance, being safer, having more freedom and decreased coercion, and having less paternalistic staff compared with traditional in-patient services. However, patients identified no substantial difference between their relationships with staff overall and the care provided between the two types of services.
For patients who have acute mental illness but lower levels of disturbance, residential alternatives offer a preferable environment to traditional hospital services: they minimise coercion and maximise freedom, safety and opportunities for peer support.
The quest for alternatives to traditional psychiatric wards has a long history but methodological difficulties have limited research into their benefits. Two UK studies suggest that community-based residential alternatives are valued by service users and may be cost-effective. Establishing and/or maintaining such services, where they function as an integrated component of local acute care pathways, is a justifiable decision. However, our findings do not provide compelling evidence that they should be seen as essential in every catchment area. Quality of therapeutic relationships appears central to service user experiences, and future research should explore how this may be improved in both hospital and community settings.
Residential alternatives to standard psychiatric admissions are associated with shorter lengths of stay, but little is known about the impact on readmissions.
To explore readmissions, use of community mental health services and costs after discharge from alternative and standard services.
Data on use of hospital and community mental health services were collected from clinical records for participants in six alternative and six standard services for 12 months from the date of index admission.
After discharge, the mean number and length of readmissions, use of community mental health services and costs did not differ significantly between standard and alternative services. Cost of index admission and total 12-month cost per participant were significantly higher for standard services.
Shorter lengths of stay in residential alternatives are not associated with greater frequency or length of readmissions or greater use of community mental health services after discharge.