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To do the complexity of being a caregiver of a psychiatric inpatient justice, it is imperative to broaden the lopsided perspective of the burden of caregivers in research studies to the also existing rewards of caregiving.
Semi-structured interviews with ever 15 caregivers of patients with schizophrenia, depression, bipolar disorders and personality disorders were analysed by using a summarizing content analysis. The interviews focus on negative and positive aspects of providing care for a family member. Furthermore, the coping strategies of the caregivers were analysed by using the Freiburg Questionnaire on Coping with Illness (FQCI).
The burden of the relatives (n=60) are many-sided (787 individual statements are named), but the rewards are surprisingly numerous, too. 413 individual statements of rewards could be summarized in 23 global statements, which were assigned to six categories: “Appreciation for providing care from the patient and others and satisfaction about providing care” (30.3%), “Gain in personality and experience of life” (22.8%), “Gain in successful coping strategies” (13.6%), “Increase of cohesion and relationship within the family” (13.1%), “Changes of attitudes and opinions” (12.1%) and “Experiences of support by others” (8.2%). The most frequent coping strategies of the relatives are “Active problem-oriented coping” (mean value 3.5), “Distraction and building self-esteem” (2.7) and “Religiousness and search for meaning” (2.7).
Results demonstrate the relevance and variety of both positive and negative aspects of caregiving and targets for intervention in psychoeducation programmes as well as in self-help groups to encourage relatives in their skills and resources.
Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare. In Germany, until now no such intervention has been implemented, let alone subjected to a clinical trial.
“Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM) is a multicentre RCT conducted in five psychiatric hospitals in Germany (Günzburg, Düsseldorf, Regensburg, Greifswald, and Ravensburg). Subjects asked to provide informed consent to participate have to be of adult age with a primary diagnosis of schizophrenia or affective disorder, and a defined high utilisation of psychiatric care during two years prior to the current admission. Subjects are asked to provide detailed outcome data at four measurement points during a period of 18 months. Recruitment (which started in April 06) is still ongoing. Thus, baseline data of about 350 participants will be presented.
Recruitment has been quite successful and the study has been generally well accepted by participating patients and their clinicians in in- and outpatient treatment settings. Subjects showed substantial initial impairment on outcome measures (e.g. needs, psychopathology, quality of life, and level of functioning) and high utilisation of mental health care. Further results on conduct and feasibility of the trial will be presented.
The first phase of this mulicentre trial was promising. The potential of this study to strengthen the integration of mental health care provision in Germany will be discussed.
Aim of this contribution is to describe the intervention used in the study “Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services” (NODPAM). This intervention applies principles of needs-led care and focusses on the inpatient-outpatient transition. The NODPAM intervention manual includes a range of predefined standardised options based on number and type of needs.
For the intervention group, a trained intervention worker provides a coherent package of needs-oriented discharge planning and monitoring focussing on the care process. He or she emphasises continuity of the care process vis-à-vis both patient and clinician (and carers if possible) via providing two manualised intervention sessions): (a) A discharge planning session takes place just before discharge with the patient and responsible clinician at the inpatient service; (b) A monitoring session takes place three months after discharge with the patient and outpatient clinician (office-based or public outpatient mental health service-based). A written treatment plan is signed by and forwarded to all participants after each session.
Acceptance of the intervention by patients and clinicians has been high so far. Further results on duration, participant characteristics, and participants' appraisal of the NODPAM intervention will be presented.
These first results indicate that the NODPAM intervention is feasible in inpatient mental health services in Germany. Discussion will focus on its applicability in other service systems.
The study aimed at exploring prevalence and risk factors of attempted suicide and suicidal thoughts before hospital admission.
40.451 episodes of inpatient care from 1995 to 2004 were included. Last admission of each patient (n=20.543) was extracted to investigate attempted suicide and suicidal thoughts before admission, which were recorded by the German Basic Documentation System (BADO). Univariate analyses and multivariate logistic regression analyses were performed to explore predictors of suicidality before hospital admission.
3.643 (17.7%) of 20.543 inpatients attempted suicide or had suicidal thoughts before admission. 1.478 (7.2%) attempted suicide before admission. Most had diagnoses F43 (36.5%), F32/33 (19.2%) or F60/61 (8.8%). According to regression analysis risk of attempted suicide increases with life time suicide attempt, diagnosis F43, admission due to doctor´s recommendation, diagnosis F32/33, diagnosis F60/61 and period of onset of present episode less than one week. 2.165 (10.5%) had suicidal thoughts before admission without concomitant suicide attempt. Most frequent diagnoses were F43 (23.5%), F32/33 (22.7%) and F10 (11.7%). Risk of suicidal thoughts increases with diagnosis F43, diagnosis F32/33, life time suicide attempt, diagnosis F60/61, supportive psychotherapy before admission, period of onset of present episode less than one week, being younger and being not rehospitalized.
Basic rate of suicidality before admission of psychiatric inpatients is high. Therefore, risk of suicide should be carefully examined at admission but also during inpatient care. Especially, inpatients with adjustment disorder and depression seem to be a high risk groups regarding suicidality before admission and require special attention.
Elaborate studies have found sex ratio of patients with depressive disorder tends to decline with increasing age. The aim of this study was to evaluate if the sex ratio of depressed inpatients in Bavaria corresponds with the sex ratio found in epidemiological studies.
Based on AGATE – due date census for inpatients 2000 – 2004 in Bavaria, we examine the relationship between sex and age on depressive episode (ICD-10: F 32 or F 33). The drug safety program AGATE is supported by 28 psychiatric hospitals in Bavaria. Overall 41,699 patients on 10 target days during 5 years were evaluated. Spearman-correlation was conducted with SPSS.
A total of 7,487 patients were rated as “depressive episode” according to ICD-10. The sex-ratio F/M was 1.9. In the 5. and 6. decade of life the sex-ratio was 1.7. It climbed to a sex-ratio of 2.2 in the 7. decade of life and to 2.6 in the 8. decade of life. The Spearman coefficient of correlation was 0.731 (p=0.018).
Differently from epidemiological studies the predicted reduction of sex differences with increasing age was not found.
The study aimed to evaluate if and how online self-help forums are used by patients with bipolar affective disorders, their relatives and by professionals.
2400 postings in two German language forums for patients with bipolar affective disorders, their relatives and professionals were qualitatively and quantitatively analysed. Interrater-reliability was 0,84 (Cohen's Kappa). Chi-squared tests with Bonferroni correction were performed and exploratory factor analyses were conducted.
94% of all postings were written by patients, 4% were written by relatives, and 2% by professionals. “Disclosure” (44% of all postings), “friendship” (23%), “online-group cohesion” (22%), “empathy and support” (18%), and “provision of information” (15%) were the main self-help mechanisms. The topics most discussed were the “social network” of the patients (27%), the “symptoms of the illness” (22%), “medication” (14%), “professionals” (12%), and “diagnoses” (11%). The item “provision of information” was significantly more often named by professionals (chi(2)=32,30; p<0,001), whereas the item “gratitude” was significantly more often named by relatives (chi(2)=34,91; p<0,001). Factor analysis revealed three factors according to self-help mechanisms: “group cohesion”, “emotional support”, and “exchange of information”. Also according to fields of interest factor analysis yielded three factors: “illness related aspects”, “social aspects”, and “financial and legal issues”.
We infer that the main interest in participating in online forums for patients with bipolar affective disorders and their relatives is to share emotions. Our study also reveals that the social network is very important for patients coping with bipolar affective disorders. Psychoeducative programmes should focus on those aspects.
Attempts to reduce high utilisation of mental health inpatient care by targeting the critical time of hospital discharge are rare. In this study, we test the effect of a needs-oriented discharge planning intervention on number and duration of psychiatric inpatient treatment episodes (primary), as well as on outpatient service use, needs, psychopathology, depression and quality of life (secondary).
Four hundred and ninety-one adults with a defined high utilisation of mental health care gave informed consent to participate in a multicentre RCT carried out at five psychiatric hospitals in Germany (Düsseldorf, Greifswald, Regensburg, Ravensburg and Günzburg). Subjects allocated to the intervention group were offered a manualised needs-led discharge planning and monitoring intervention with two intertwined sessions administered at hospital discharge and 3 months thereafter. Outcomes were assessed at four measurement points during a period of 18 months following discharge.
Intention-to-treat analyses showed no effect of the intervention on primary or secondary outcomes.
Process evaluation pending, the intervention cannot be recommended for implementation in routine care. Other approaches, e.g. team-based community care, might be more beneficial for people with persistent and severe mental illness.
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