Long-stay patients in a psychiatric hospital in Southern Brazil

OBJECTIVE: To describe the demographic profile, social functioning, and quality of life of a population of long-stay care patients in a psychiatric hospital. METHODS: A study was carried out in Porto Alegre, Southern Brazil, in 2002. A total of 584 (96%) long-stay patients were assessed by means of the following instruments: the World Health Organization Quality of Life, the Social Behavior Schedule, the Independent Living Skills Survey, the Brief Psychiatric Rating Scale and another instrument for assessing disability (Questionnaire for Assessing Physical Disability). RESULTS: The average hospital stay was 26 years (SD: 15.8) and 46.6% of inpatients had no physical disability. Patients had their social functioning skills and autonomy largely impaired. Few of them (27.7%) answered the instrument for assessing quality of life, and showed significant impairments in all domains. The Brief Psychiatric Rating Scale evidenced a low prevalence of positive symptoms in this population. CONCLUSIONS: The institutionalized population studied presented significantly impaired social functioning, autonomy, and quality of life. These aspects need to be taken into consideration while planning for their deinstitutionalization.     

What is a Psychiatric Disability?

This article aims to clarify the notion of a psychiatric disability. The article uses conceptual analysis, examining and applying established definitions of (general) disability to psychiatric disabilities. This analysis reveals that disability as inability to perform according to expectations or norms is related to impairment as deviation from the (statistical) norm, while disability as inability to achieve (personal) goals is related to impairment as deviation from the (personal) ideal. These two views of impairment and disability are distinct from the self-organization view of impairment as disrupted self-creation or disrupted self-repair and of disability as disrupted whole person self-compensation (in relation to an impairment). All these three views of disability pertain to psychiatric disability. Although there is nothing necessarily psychiatric about psychiatric disability other than the psychiatric impairment related to it, the life course and life circumstances typical of many people with (severe) psychiatric disorders may lead to disability and may thus confer some (psychiatric) specificity on this disability. This analysis may facilitate research on specific psychiatric disabilities and a broader scope for psychiatric rehabilitation.     

The mental health of Australian mothers and fathers of young children at risk of disability

OBJECTIVES: To: (1) determine the strength of the relationship between risk of child disability and parental mental health in a nationally representative sample of Australian families with young children; (2) estimate the contribution of distress among parents of children at risk of disability to overall parental psychiatric morbidity; and (3) explore the extent to which between-group differences in parental mental health may be attributable to differences in exposure to other risk factors. METHOD: Secondary analysis of cross-sectional data collected in Wave 1 of the Longitudinal Study of Australian Children (n=4,983; 6.5% of children identified as being at risk of disability). RESULTS: Elevated rates of psychological distress indicative of serious mental illness were found among mothers (OR=5.1, 95% CL 3.5-7.6), but not fathers (OR=1.4, 95% CL 0.5-3.4) of children at risk of disability. Psychological distress among mothers of children at risk of disability accounted for 23% of estimated total maternal psychiatric morbidity. Approximately 50% of the elevated risk of distress for mothers was accounted for by increased rates of poverty among children at risk of disability and their families, an association possibly mediated by increased exposure to adverse life events, poorer maternal health and reduced personal-social capital. CONCLUSIONS: The association between risk of child disability and maternal mental health is strongly confounded by increased rates of poverty among children at risk of disability. Any residual risk appears to be related to the poorer social, emotional and behavioural development of children at risk of disability. Social and health policy responses need to focus on poverty reduction, enhancing the personal social capital of mothers living in poverty and on improving the social, emotional and behavioural development of the children.     

Psychiatric rehabilitation and community care: resettlement from a North Wales Hospital

The Health Services Research Unit, University College of North Wales, Bangor is evaluating the care provision and outcomes for a cohort of 63 long-stay psychiatric patients from the North Wales Hospital, Denbigh. Hospital closure is being phased in up to 1995 with reprovision of mental health services in the community. The paper reports on the care process in two specially designed community living schemes and assesses the outcomes for 34 patients from the cohort 12 months after discharge from hospital. The results show some positive outcomes with the majority resettled in well-resourced care settings. Levels of client dependency show significant improvement in these schemes, with increases in social activity, community skills and speech skills. The majority of clients have reacted well to changes in care provision and report a number of improvements in their quality of life. It is concluded that long-stay hospital clients need continuing high levels of support if care in community settings is to be successful.     

无锡市社区严重精神障碍患者体检率调查及其影响因素分析

目的 了解无锡市社区严重精神障碍患者健康体检率及其影响因素,为提高对社区患者的健康体检服务质量提出相关建议。方法 采用分层整群随机抽样方法,对无锡市1 220名社区严重精神障碍患者及其监护人进行问卷调查,描述性分析患者健康体检状况,并探讨影响患者健康体检的因素。结果 无锡市社区严重精神障碍患者的健康体检率为50.82%。logistic回归分析显示,居住城区(OR=2.756,95%CI=1.985-3.825)、服药(规律OR=1.974,95%CI=1.380-2.823;间断OR=1.948,95%CI=1.238-3.067)、有体检意识(必要OR=5.757,95%CI=4.054-8.177;无所谓OR=1.584,95%CI=1.053-2.382)及监护人为父母(OR=2.359,95%CI=1.367-4.069)或夫妻(OR=1.860,95%CI=1.036-3.339)是患者参加体检的积极因素,而家庭经济贫困(OR=0.614,95%CI=0.444-0.849)、病程≤10年(OR=0.662,95%CI=0.461-0.949)、未曾住精神专科医院(OR=0.704,95%CI=0.514-0.963)、GAS评分≤50分(OR=0.248,95%CI=0.166-0.371)或51-60分(OR=0.500,95%CI=0.340-0.734)是影响患者体检的消极因素。结论 无锡市社区严重精神障碍患者体检率有待提高,应通过加强健康宣教改善患者对体检的认知,关注农村及贫困家庭及督促服药、稳定病情等措施提高体检率。     

The cost effectiveness of specialised facilities for service users with persistent challenging behaviours

Little systematic research relates specifically to the last people to leave a psychiatric hospital at the end of a closure programme. The long-running evaluation of the reprovision of services from Friern Hospital in North London allowed a special study to be made of such a group (67 people in all), whose range of problem behaviours made placement in community settings most difficult. The patients were relatively young, with a shorter length of stay than the remainder of the former long-stay hospital population. They were assessed three times: before leaving Friern, and one and 5 years after relocation. The social and clinical characteristics of each person were measured, and the full costs of their care calculated. The "difficult-to-place" patients moved to four highly staffed rehabilitation facilities, where the total cost of their care was, on average, 1230 UK pounds per week. There was no overall change in their psychiatric state over the 5 years after they left Friern Hospital although, in the longer-term, they gained skills in several areas of daily functioning. Most importantly, there was a fall of almost 50% in the number of challenging behaviours exhibited by the study group. At the five-year follow-up point, the cost of care had fallen, on average, by 170 UK pounds per week, and 24 people had been able to move to more independent accommodation arrangements. Study participants had gained a new network of community service contacts, and used services provided by a greater variety of agencies. The indicators suggest that high expenditure on alternative care was justified retrospectively by overall long-term outcomes. An important policy lesson from the Friern Hospital reprovision study is that adequate funds should be reserved until the end of the closure programme to allow the investment of resources in provision for patients with the most severe problem behaviours.     

南京市重性精神疾病患者生命质量及影响因素研究

目的 分析重性精神疾病患者生命质量的主要影响因素,为提高其生命质量提供科学依据。方法 采用简明健康调查问卷（the MOS 36-item short form health survey,SF-36）,当面询问调查重性精神疾病患者,共679人纳入分析。结果 重性精神疾病患者生理总分（physical component summary, PCS）、心理总分（mental component summary, MCS）的平均水平分别为（48.64±10.62）分、（37.86±14.66）分。经多元线性模型分析结果显示: 低年龄者、受教育程度高、无伴发躯体疾病、无药物不良反应、社会功能无缺陷者PCS较高（均有P<0.05）;无精神病症状、危险性分级低风险、社会功能无缺陷者MCS较高（均有P<0.05）。结论 重性精神疾病严重损害患者的心理健康,同时对生理健康也有一定程度的损害。在对重性精神疾病患者的干预中,要重点治疗精神病症状、控制危险性、改善社会功能,以提高患者的心理健康。同时,关注患者有无伴发躯体疾病、药物不良反应,并积极缓解,以提高患者生理健康。     

Exploring the health of women with mobility impairments

This study examined health surveys of 109 midwestern women (mean age 44.6 +/- 8.2 years) with impaired mobility to determine whether mobility impairment severity was related to self-reported health, health care use, and engaging in health behaviors. The study also assessed which health factors were associated with pain. Women with severe mobility impairments reported poorer physical functioning, but better mental health than less severely impaired women after controlling for age, disability duration, and/or bodily pain. Degree of mobility impairment level was not significantly related to health behaviors, except having a checkup in the past year; more moderately impaired women reported these visits than mildly impaired women. Furthermore, pain was significantly associated with social functioning, general health, and secondary conditions. The findings suggest that factors beyond impairment level, such as pain, age, and disability duration, are related to the health of mobility-impaired women.     

Demoralisation, distress and pain in older Western Australians

OBJECTIVE: To assess the relationship of psychiatric morbidity, morale, physical activity and the presence of pain in older people. METHOD: Older people attending senior citizens' clubs were administered the 28-item General Health Questionnaire (GHQ-28), the Revised Philadelphia Geriatric Centre Scale (RPGCS) and five self-report questions from the Brief Disability Questionnaire. They also rated the presence of pain on a five-point scale. Multiple and logistic regression were used to adjust for socio-demographic factors and identify variables independently associated with psychological status and morale. RESULTS: Of 112 people approached, 86% agreed to take part (n = 96). The sample showed a wide range in total GHQ scores (mean = 2.9, range = 0-19) and RPGCS scores (mean = 2.3, range = 1.1-3.0). Twenty-one per cent had psychological distress as defined by a score of > or = 6 on the GHQ-28 (n = 19). Fifty-four respondents (56%) reported low morale as defined by a score < 2 on the RPGCS. There was a close relationship between psychological distress, low morale on the RPGCS (OR = 5.5 [1.5-20.5]) and moderate to severe pain (OR = 5.3 [1.8-15.9]). When adjusted odds ratios were calculated to control for confounding factors, moderate to severe pain remained independently associated with psychological distress (OR = 1.6 [1.3-2.4] p = 0.02), and limitations in daily activities with low morale (OR = 3.64 (1.001-8.4) p = 0.05). CONCLUSIONS: There is a close relationship between physical disability, low morale and psychological distress. IMPLICATIONS: An increased index of suspicion for psychological distress is warranted in all older people with physical disability, particularly in the presence of moderate to severe pain.     

Risk factors for disability among U.S. adults with arthritis.

This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.     

Domestic violence and abuse, health status, and social functioning

BACKGROUND: Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. METHODS: We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. RESULTS: Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. CONCLUSIONS: Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.     

Uptake of screening for breast cancer in patients with mental health problems

OBJECTIVES: Mental illness is associated with physical illness and mortality from a variety of causes including cancer. There is little information on screening attendance among the mentally ill population. An audit was conducted of a breast screening service in inner London to determine uptake rates in women with mental illness. DESIGN: Cross sectional data linkage study of the local screening register and patients of the local psychiatric units. Screening uptake rates in all patients, those with a history of multiple detention in hospital, and those with psychosis were compared with the local reference population. SETTING: Women in three inner London boroughs. PARTICIPANTS: Screening records for 933 psychiatric patients and 44 195 women without mental health problems aged 50 to 64 years. MAIN RESULTS: Overall, psychiatric patients were as likely as the reference group to attend breast screening. Patients with a history of multiple detention were significantly less likely to attend (OR = 0.40, 0.29 to 0.55; p<0.001), as were patients with a diagnosis of psychosis (OR = 0.33, 0.18 to 0.61; p<0.01). Increasing age, a history of detention in hospital, and social deprivation remained independent predictors for non-attendance. CONCLUSION: Women with severe mental health problems may be less likely to attend national screening programmes such as breast screening, and action should be taken to overcome the barriers to attendance.     

Disadvantage as a measure of handicap: a paired sibling study of disabled adults in Lebanon.

In 1980 WHO defined disability as a functional limitation due to impairment, and handicap as the psychosocial disadvantage consequent to disability. This study was designed to investigate the advent of handicap in a group of adults physically disabled by poliomyelitis in childhood by comparing them to their age- and sex-matched siblings. An area survey was conducted in West Beirut and its Southern Suburb and 240 such disabled people and their siblings were identified and interviewed. Handicap was defined as disadvantage in six areas, namely, education, work, income, marital status, housing, and mental well-being. The differences between each disabled person and his/her sex-matched sibling were assessed. Significant differences were noted in employment (Odds ratio (OR) = 4.20, confidence interval (CI): 1.38-15.26), social class (OR = 2.67, CI: 1.11-6.79), income (OR = 2.88, CI: 5.57-113.3) and marital status for both the disabled people compared with their elder siblings (OR = 20.00, CI: 5.57-113.30) and for those disabled compared with their younger siblings (OR = 4.60, CI: 1.53-16.55). Multivariate analyses of the explanatory factors for each of these six areas of disadvantage among the disabled group showed that educational discrepancies cut across social class differences (OR = 1.90, CI: 1.00-3.61), income differences (OR = 1.44, CI: 0.97-2.14), and symptoms of depression (OR = 2.33, CI: 1.42-3.84). Marital-status disadvantage was related to lower income groups and disabled women (OR = 1.66, CI: 1.10-2.49; OR = 1.60, CI: 1.07-2.39).(ABSTRACT TRUNCATED AT 250 WORDS)     

Mobility disability and the urban built environment

Research on the effects of the built environment in the pathway from impairment to disability has been largely absent. Using data from the Chicago Community Adult Health Study (2001-2003), the authors examined the effect of built environment characteristics on mobility disability among adults aged 45 or more years (n = 1,195) according to their level of lower extremity physical impairment. Built environment characteristics were assessed by using systematic social observation to independently rate street and sidewalk quality in the block surrounding each respondent's residence in the city of Chicago (Illinois). Using multinomial logistic regression, the authors found that street conditions had no effect on outdoor mobility among adults with only mild or no physical impairment. However, among adults with more severe impairment in neuromuscular and movement-related functions, the difference in the odd ratios for reporting severe mobility disability was over four times greater when at least one street was in fair or poor condition (characterized by cracks, potholes, or broken curbs). When all streets were in good condition, the odds of reporting mobility disability were attenuated in those with lower extremity impairment. If street quality could be improved, even somewhat, for those adults at greatest risk for disability in outdoor mobility, the disablement process could be slowed or even reversed.     

Exploring the Health of Women with Mobility Impairments

ABSTRACT

This study examined health surveys of 109 midwestern women (mean age 44.6 ± 8.2 years) with impaired mobility to determine whether mobility impairment severity was related to self-reported health, health care use, and engaging in health behaviors. The study also assessed which health factors were associated with pain. Women with severe mobility impairments reported poorer physical functioning, but better mental health than less severely impaired women after controlling for age, disability duration, and/or bodily pain. Degree of mobility impairment level was not significantly related to health behaviors, except having a checkup in the past year; more moderately impaired women reported these visits than mildly impaired women. Furthermore, pain was significantly associated with social functioning, general health, and secondary conditions. The findings suggest that factors beyond impairment level, such as pain, age, and disability duration, are related to the health of mobility-impaired women.     

Burmese political dissidents in Thailand: trauma and survival among young adults in exile.

OBJECTIVES: This study assessed the self-reported mental health, physical health, and social functioning of young adult political exiles and relates their psychiatric symptoms to their trauma and survival strategies. METHODS: A 1992/93 survey of Burmese who fled to Bangkok, Thailand, after participating in a 1988 uprising against Burma''s government elicited information on employment, education, disability, trauma, survival strategies, and depressive and posttraumatic stress symptoms. RESULTS: The 104 participants reported a mean of 30 trauma events, including interrogation (89%), imprisonment (78%), threats of deportation (70%), and torture (38%). Many reported poor health and lack of social supports, but few reported substantial social disability. The prevalence of elevated symptom scores was 38% for depressive symptoms and 23% for criterion symptoms of posttraumatic stress disorder. Symptoms of avoidance and of increased arousal were the most strongly related to cumulative trauma. Two survival strategies, camaraderie and a Buddhist concept of self-confidence (weria), were associated with somewhat reduced levels of both classes of symptoms. CONCLUSIONS: Burmese political exiles in Thailand are young adults adversely affected by severe trauma. Their psychosocial well-being may deteriorate further without legal protections to reduce the continuing stress and violence.     

Patient psychoeducation: the therapeutic use of knowledge for the mentally ill.

Psychoeducation has been used successfully with families of patients with psychiatric illness for over the past two decades. Modifying this model for use with mentally ill patients has demonstrated to both patients and staff the positive impact that knowledge can have on patients' functioning and attitudes. The model described has three objectives: (1) to impart information about psychiatric illness, medication and treatment regimens as a way of increasing patients' understanding, (2) to provide a forum which facilitates the integration of this information through group discussions with other patients and (3) to teach and model some specific management skills for patients as they deal with their illnesses.     

Predictors of occupational low back disability: implications for secondary prevention

Over the past decade, studies have identified a combination of demographic, physical/medical, ergonomic, and psychosocial factors in the development of work disability related to occupational low back pain. Using such data on disability risk factors, investigators have begun to develop risk identification and disability prevention programs. As part of an ongoing effort to develop a secondary prevention program, the present case-control study identified the relative contribution of demographic, physical demand, physical fitness, as well as occupational and individual psychosocial variables to back-related work disability in the US Army. Soldiers (n = 174) diagnosed with a lumbosacral strain and medically discharged from the Army were compared with non-disabled controls (n = 173). Dependent measures were obtained from the US Army Health Risk Appraisal (HRA). For cases, these data pre-dated disability determination by 1 to 3 years. For controls, the HRA was completed during the same time period. Significant predictors of low back disability were: age (odds ratio [OR] = 1.13 per year), lower rank (E2/E3) (OR = 4.08/OR = 3.02), infrequent aerobic exercise (OR = 2.2), higher work stress (OR = 2.71), worries (OR = 2.17), and lower social support (OR = 5.07). The model correctly classified 73.13% of all subjects. These results highlight the importance of considering age, status level in the organization, frequency of aerobic exercise, occupational stress, general worries, and social support for the early detection of soldiers at increased risk for back-related disability. Additionally, the findings support past research indicating the multivariate nature of work disability and emphasize the importance of considering such factors in future secondary prevention efforts.