Determinants of ambulatory mental health services use for school-age children and adolescents.

OBJECTIVE: To analyze a comprehensive multivariate model of the use of mental health-related ambulatory care services by children ages 6-17. STUDY SETTING: The 1987 National Medical Expenditure Survey, a national probability sample of the U.S. civilian noninstitutionalized population. STUDY DESIGN: A cross-sectional survey of a national probability sample of the U.S. population. Key independent variables include person-level mental health status, health care coverage, family income, and use of mental health services by other family members. DATA COLLECTION: Four in-person interviews were conducted during 1987 using structured questionnaires. A designated family respondent was used to answer questions for other family members, including children. PRINCIPAL FINDINGS: Children with poor mental health in high-income families were more than three times as likely to have a mental health-related visit than children with poor mental health in low-income families. The number of mental health-related visits and the likelihood of seeing a mental health specialist also increased along with family income. Mental health use by other family members was strongly associated with use. CONCLUSIONS: The results from this study provide strong evidence that the socioeconomic status of children is an important factor in explaining unmet need for mental health services.     

Determinants of vitamin D levels in nursing home residents

OBJECTIVE: To determine the effect of various doses of vitamin D(2) and D(3), as well as ambulatory status (a surrogate for sun exposure), on 25-OH-D levels. DESIGN: Cross-sectional study with multiple regression analysis. SETTING: A state veterans home for veterans and their spouses. PARTICIPANTS: Three hundred two of 609 eligible residents. MEASUREMENTS: Serum 25-OH-D and parathyroid hormone (PTH) level, supplemental dose of vitamins D(2) and D(3) per kilogram of body weight, and 3 levels of ambulatory status. RESULTS: The mean 25-OH-D level was 28.6 + 9.2 ng/mL; 6.6% of subjects had values of 16 ng/mL or below. Thirty-two percent of participants had 25-OH-D levels below 30 ng/mL and PTH elevation based on stage of kidney disease, evidence that the suboptimal 25-OH-D level had physiologic consequences. Residents unable to transfer independently had 25-OH-D levels 1.6 ng/mL lower than those able to transfer independently. A regression analysis performed in residents unable to transfer independently (less likely to be exposed to the sun) demonstrated that the average increase in 25-OH-D level per 100 IU of D(3) in a 70-kg resident was 2.1 ng/mL versus 1.8 ng/mL for vitamin D(2). CONCLUSION: Nursing home residents should receive at least 800-1000 IU of D(3) per day in an effort to maintain optimal vitamin D levels.     

Mental health services for nursing home residents: What will it cost?

The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered.     

Functional health status of relocated nursing home residents

This article presents the functional health status results of 49 nursing home residents who were involuntarily relocated from one institution to another. The purpose of the study was to determine whether there would be pre- to postmove changes in health status. Nursing personnel on both the day and evening shifts completed separate assessments of the residents' functional health status using the Long-Term Health Care Minimum Data Set instrument. These assessments were completed 2 to 3 months before and 3 to 4 months after the move. The interrater reliability was high; overall day-evening agreement was 82 percent. After the move, only receptive communication was rated higher; dressing, transferring, using the toilet, continence, and mobility were rated lower. Six functional activities showed no significant changes. Relocation does not appear to have a uniformly negative impact on functional status.     

Distance and the use of mental health services

The inverse relationship between distance from mental health services and their use has been noted over many decades and on several continents. Although many factors--diagnostic, socioeconomic, and nosocomial--may modify this correlation, its persistence is remarkable. As other barriers to use are diminished, distance remains a mutable variable for planning more effective use of many health care services.     

Boarding home residents: new underclass in the mental health system

Boarding homes have proliferated in recent times, spawned by the deinstitutionalization movement. This study explored the realities of living in these homes by using a quantified assessment procedure to examine their programs and policies. Findings suggest an absence of support and stimulation for the residents of homes and a need for outreach and advocacy on the part of social workers in community mental health practice.     

Demographic factors in the use of children's mental health services.

OBJECTIVES. This study was designed to (1) determine mental health service use by children of varying age, sex, socioeconomic status, and urbanicity of residence; (2) compare the prevalence of mental disorder in children in these groups; and (3) determine the extent to which differences in service use are consonant with the prevalence differences. METHODS. Data on psychiatric diagnoses and service use were taken from a random longitudinal sample of 760 children. Information was gathered by interviews of mothers and of youth aged 12 to 21. RESULTS. Significant lags in mental health service use were found for youth 18 to 21 years of age, for those living in rural and semirural areas, and for those in middle-income families. To some extent, these service use differences paralleled differences in diagnostic rates. However, when diagnostic differences were controlled, the same patterns of service use inequalities were present. CONCLUSIONS. Mental health service use rates for youth vary by age, urbanicity, and family income. The underservice of middle-income and rural children may reasonably be ascribed to access problems; we explore explanations for the underservice of older youth.     

Antipsychotic drug use among nursing home residents taking rivastigmine

OBJECTIVE: To evaluate whether or not rivastigmine use is associated with a decrease in the initiation of antipsychotic drug therapy among nursing home residents in the United States. METHODS: A retrospective analysis was performed using Minimum Data Set data and physician order files for newly admitted residents of 452 US nursing facilities from 2000 through 2002. The rivastigmine group included those who were diagnosed with Alzheimers disease (AD) and began rivastigmine treatment within 30 days of diagnosis. Patients were required to be on treatment for a minimum of 30 days. The control group included those who were diagnosed with AD, but did not receive a cholinesterase inhibitor. All subjects were antipsychotic drug-naive within 30 days of baseline (initiation of rivastigmine or initial AD diagnosis). A Cox proportional hazards model was used to estimate predicted risk of antipsychotic drug use. RESULTS: This study included 845 patients in the rivastigmine group and 517 patients in the control group. The rivastigmine group had fewer female patients, was younger, and had more verbal distress, sleep issues, sadness, loss of interest, and behavioral symptoms at baseline compared with the control group (P < .01). Overall initiation of antipsychotics was lower in the rivastigmine group (8.6%) compared with the control group (17.0%). Patients in the control group were almost 2 times more likely (relative risk = 1.86; P < .001) to take antipsychotics compared with patients taking rivastigmine, after adjusting for demographic covariates and mental health conditions or behavioral symptoms at baseline. Patients with baseline mental health conditions or behavioral symptoms were more likely to start antipsychotics than those without such conditions (P < .001). CONCLUSIONS: Study results suggest that nursing home residents with Alzheimers disease treated with rivastigmine have a reduced risk of initiating therapy with an antipsychotic drug compared with residents who do not receive cholinesterase inhibitor treatment.     

Costs and use of public mental health services by ethnicity

This paper used data obtained from Santa Clara County, California, to study the costs and use of public mental health services among ethnic populations (Asians, Blacks, Hispanics, and Whites). The study had access to 12,436 unduplicated users of services. The study found Whites had the highest per capita costs, while Asians incurred the lowest. However, after controlling for other demographic characteristics, Asians incurred higher costs than Whites. This reversal of Whites and Asians occurred because cost distributions are more skewed for Whites than Asians. Asians had the highest median costs and Hispanics the lowest. The top 5% of users incurred about 50% of the total public mental health costs. All are associated with the Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, the Western Consortium for Public Health. This study was supported by Grant MHR01-44753 from the National Institute of Mental Health. The opinions expressed are those of the authors alone, not of the authors’ affiliations.     

Life events, mental health functioning and the use of health care services by the elderly.

The association of life events and mental health impairment was studied in a community-based population of the elderly (n = 986). A crude estimate of the relative risk for mental health impairment given life events larger than or equal to 150 (as measured by the Schedule of Recent Events) was 2.14. A relative risk of 1.73 (p < .01) was estimated when a binary regression procedure was used, controlling for physical health, economic status, social support, and age. Increased life events were associated with health seeking behavior, even when physical and mental health functioning were controlled. The associations between increased life events and both mental health functioning and health seeking behavior were small, suggesting that life events, as measured by the Schedule of Recent Events may not be important risk factors for elderly living in the community.     

End-of-Life decision making for nursing home residents with dementia: a survey of nursing home social services staff

The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives, medical interventions, and comfort levels with withholding and withdrawing of treatment. Results showed a high degree of involvement in advance directive discussions, problems in the implementation of advance directives, and wide variation in comfort levels with treatment issues. Results of this study indicate areas of need for further research and training of nursing home social services staff.     

成都市敬老院老年人口腔健康认知、行为的调查分析

目的了解上海市松江区敬老院老年人口腔健康情况,为提高其口腔健康水平提供参考依据。方法通过对松江区15家敬老院共375名老年人问卷调查和口腔检查,分析其牙缺失、义齿修复、牙周状况及口腔卫生习惯等状况。结果375名老年人中失牙率达到94.13%,女性失牙率(96.09%)高于男性(91.03%)(P < 0.01);全口无牙颌率为28.27%,女性全口无牙颌比例(34.35%)明显多于男性(18.62%)(P < 0.05);全口义齿修复率为91.51%(97/106)。人均存牙数为11.54颗,男性人均存牙数(14.48颗/人)明显多于女性(9.70颗/人)(P < 0.05)。上、下颌牙的后牙的失牙率均显著高于其前牙失牙率(P < 0.01)。基本不刷牙的比例为20.53%,每天刷牙大于等于2次比例为33.33 %。结论目前松江区敬老院老年人口腔健康口腔状况不容乐观,需多部门联合加强辖区敬老院老人口腔保健的宣教力度,提升居民口腔保健意识,改善老年人的缺牙修复水平,提高其生活质量。     

Evaluating partnerships: a case study of integrated specialist mental health services

Partnerships are designed to facilitate the negotiation and delivery of public programmes cutting across the boundaries of a fragmented organisational landscape. This paper makes an empirical contribution to the study of the outcomes of partnership working, reporting results from a detailed United Kingdom case study of mental health services integration. It considers the county-wide establishment of a range of partnerships between a county council and multiple National Health Service organisations under Section 31 of the Health Act (1999), relating to mental health, learning disability, drug and alcohol, and child and adolescent mental health services. Arrangements included: integrated county-wide provision via a partnership trust; pooled commissioning and provision budgets; and joint commissioning arrangements between eight primary care trusts and the county council at a joint commissioning partnership board, supported by a joint commissioning team of officers. The evaluation explores the impact of integrated provision on service users, carers and team staff between 2002 and 2004. A multimethod approach incorporating qualitative and quantitative data was used: individual semistructured interviews and focus groups with staff, users and carers (2004); and questionnaires to team staff to explore role clarity and job satisfaction (2002 and 2004). While users and carers were largely positive towards the new provision, a range of alternative frames of reference towards inpatient episodes were identified, including notions of sanctuary and asylum, as well as lack of privacy and fears over safety. Similarly, there was some ambivalence over the dual focus of the teams on both users and carers. Small improvements overall in team staff scores for role clarity and job satisfaction masked variations between localities; such differences seem less to do with prior experience of partnership working than with recruitment difficulties. Additionally, the study raises methodological issues of relevance to the evaluation of complex social interventions. While partnership forms are themselves relatively easy to define, the attribution of improved outcomes to such arrangements is less straightforward - they are complex social interventions requiring enactment by individuals within specific contexts, typically involving many service changes against a turbulent policy background. Some implications for partnership evaluations are considered.     

Adolescent victimization and subsequent use of mental health counseling services.

PURPOSE: To test the extent to which adolescent victimization predicts subsequent use of mental health services in a prospectively assessed nationwide sample of high school students. METHODS: Data were analyzed from 4590 adolescents participating in Waves I and II of the National Longitudinal Survey of Adolescent Health. In-home self-report data were collected on four types of personal victimization, mental health service use, demographics, psychological symptoms/needs, and family connectedness. Using logistic regression analysis, adolescents' victimization and background variables at Wave I were entered as predictors of subsequent mental health service use, measured at Wave II. RESULTS: In this national sample, 19.6% of the respondents stated that they had experienced at least one of four forms of personal victimization in the prior year. Of those reporting personal victimization, 11.0% stated they had used mental health services at 1-year follow-up, as compared to 9.2% of those who did not report any personal victimization. After controlling for background variables in logistic regression analyses, however, adolescents' victimization reported at Wave I was associated with significantly lower odds of subsequent mental health service use at Wave II. CONCLUSIONS: Evidence does not indicate that adolescents' victimization prompts mental health service use, and rather indicates that in some instances victimization is associated with lower odds of subsequent mental health service use. These findings raise questions about the degree to which adolescents receive needed professional mental health supports in the wake of serious violence exposure.     

Determinants of the use of maternal health services in rural Bangladesh

Utilization of health services is a complex behavioral phenomenon. Empirical studies of preventive and curative services have often found that use of health services is related to the availability, quality and cost of services, as well as to social structure, health beliefs and personal characteristics of the users. In this paper an attempt is made to examine the factors associated with the use of maternal health care services in Bangladesh on the basis of data from a survey of maternal morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT). The results from both the bivariate and multivariate analyses confirmed the importance of mother's education in explaining the utilization of health care services. Female education retains a net effect on maternal health service use, independent of other women's background characteristics, household's socioeconomic status and access to healthcare services. The strong influence of mother's education on the utilization of health care services is consistent with findings from other studies. Women whose husbands are involved in business/services also positively influenced the utilization of modern health care services. However, the study results are inconclusive with respect to the influence of other predisposing and enabling factors, such as women's age, number of previous pregnancies and access to health facilities. Multivariate logistic regression estimates do not show any significant impact of these factors on the use of maternal health care. The influence of severity of disease condition in explaining the utilization of maternal health care appears to be significant. Multivariate analysis indicate that women having had a life-threatening condition are little over two times more likely to seek care from a doctor or nurse to treat their maternal morbidities.