计量经济分析 = Econometric analysis

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Social class and mental illness: a community study

Seasonality and bipolar disorder: a systematic review, from admission rates to seasonality of symptoms.

Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care

Event History Analysis.

Seasonal variation in suicides and in admissions to hospital for mania and depression.

Objective. To assess the effects of choosing different time-intervals of observation when using unplanned readmissions as an outcome indicator. 

Design. A conceptual model was developed based on the risk curve. The model assigned readmissions above a background level as ‘related’ to the earlier episode of illness. The characteristics of the hazard curve were used to estimate how the rates of related and unrelated readmissions varied with time. 

Setting. Patients living in a region of Middle Norway served by eight acute-care hospitals and discharged in the year 1996. 

Main outcome measure. The conditional risk (hazard rate) of having an unplanned readmission. The information gathered allowed inclusion of readmissions to all hospitals in the area, and to make risk corrections for deaths. 

Results. The identified proportion of readmissions judged as related to the earlier episode of illness was found to be very sensitive to changes in the time interval. With the commonly used interval of 30 days, 0.5 of all related readmissions were identified, while 0.7 of the readmissions included at this time were estimated as related ones (‘true positives’). The hazard curve was different for medical and surgical patients, but the corresponding proportions of related and unrelated readmissions were relatively similar. Adjusting for deaths in the observation period did not result in significantly different risk curves. 

Conclusion. When unplanned readmissions are used as an outcome indicator, the measure is susceptible to the choice of time interval. The operative characteristics must be interpreted in the context of where it is intended that the indicator should be used.

Measuring readmissions: focus on the time factor.

Explore if a multi-dimensional analytic approach to routinely registered data provides a comprehensive way to characterise utilisation patterns, and to test if the patients’ functional status is a predictor for the use of services. We linked register contact data during a two-year period, including all types of specialised mental health services, in the population of a Norwegian county. Cox regression was applied in the models for prediction of admission and readmission. Great variability and complexity in patterns of utilisation were found, including multiple transitions between in-patient and out-patient statuses. The distribution of services was characterised by a small group of patients receiving a disproportionally large amount of resources. A majority of 77% appeared as out-patients only. Severity of symptoms as well as of dysfunction, as assessed by the split GAF-score, differentiated amongst utilisation groups. Both dimensions were significant predictors for admission. In contrast, only the severity of dysfunction predicted readmission. Multi-dimensional data architecture and analytical perspectives can be applied to routine data, and should be used to analyse the diverse patterns of utilisation. Risk populations could be predicted by routinely registered information on functional status.

Patterns of mental health care utilisation: distribution of services and its predictability from routine data

Background: Adverse media coverage of isolated incidents affects the public perception of the risk of violent behavior among people with mental illness. However, the risk of violence is studied most frequently among inpatients, which falsely exaggerates the prevalence of people with mental illness because the majority of individuals receive treatment as outpatients.Aim: To estimate the prevalence of the risk of violence among inpatients and outpatients in psychiatric treatment, as well as the associations with gender, age, socio-economic status and co-morbid substance use disorders in all major diagnostic categories.Methods: We conducted a national census of patients in specialist mental health services in Norway, which included 65% of all inpatients (N = 2,358) and 60% of all outpatients (N = 23,124).Results: The prevalence of the risk of violence was 32% among inpatients and 8% among outpatients, where 80% of the patients in specialist mental health services were outpatients. If we weight the pr...

Risk of violence among patients in psychiatric treatment : Results from a national census

Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes.We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation.The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends.Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services. 

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Solfrid E. Lilleeng

Papers

Seasonal variation in suicides and in admissions to hospital for mania and depression.

Measuring readmissions: focus on the time factor.

Patterns of mental health care utilisation: distribution of services and its predictability from routine data

Risk of violence among patients in psychiatric treatment : Results from a national census

Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway