Reciprocal association between social support and psychological distress in chronic physical health conditions: A random intercept cross-lagged panel model.

The onset of a chronic physical health condition (CHC) can highly impact individuals' well-being and mental health. Social support has been shown to help people rebound after the onset of a CHC. Nonetheless, little is known about the longitudinal pattern of social support and its reciprocal association with mental health in CHC. This study aimed to illustrate the longitudinal pattern of perceived social support and to examine the reciprocal association between perceived social support and psychological distress across 6 years. Two random intercept cross-lagged panel models were conducted, one for emotional and one for practical support, using yearly assessments of 582 Swiss Household Panel's participants reporting a CHC. A reciprocal association was found, with psychological distress 1 year after the onset being linked to less emotional support in the following year and vice versa, more emotional support being linked to less psychological distress the following year. A unidirectional association was found for practical support, with more psychological distress 1 year before the CHC onset being linked to more practical support at the onset year. This study underlines the importance of involving the social environment of individuals living with a CHC, especially around the first year after the onset.

Social disparities in unplanned 30-day readmission rates after hospital discharge in patients with chronic health conditions: A retrospective cohort study using patient level hospital administrative data linked to the population census in Switzerland.

Unplanned readmissions shortly after discharge from hospital are common in chronic diseases. The risk of readmission has been shown to be related both to hospital care, e.g., medical complications, and to patients' resources and abilities to manage the chronic disease at home and to make appropriate use of outpatient medical care. Despite a growing body of evidence on social determinants of health and health behaviour, little is known about the impact of social and contextual factors on readmission rates. The objective of this study was to analyse possible effects of educational, financial and social resources of patients with different chronic health conditions on unplanned 30 day-readmission risks. The study made use of nationwide inpatient hospital data that was linked with Swiss census data. The sample included n = 62,109 patients aged 25 and older, hospitalized between 2012 and 2016 for one of 12 selected chronic conditions. Multivariate logistic regressions analysis was performed. Our results point to a significant association between social factors and readmission rates for patients with chronic conditions. Patients with upper secondary education (OR = 1.26, 95% CI: 1.11, 1.44) and compulsory education (OR = 1.51, 95% CI: 1.31, 1.74) had higher readmission rates than those with tertiary education when taking into account demographic, social and health status factors. Having private or semi-private hospital insurance was associated with a lower risk for 30-day readmission compared to patients with mandatory insurance (OR = 0.81, 95% CI: 0.73, 0.90). We did not find a general effect of social resources, measured by living with others in a household, on readmission rates. The risk of readmission for patients with chronic conditions was also strongly predicted by type of chronic condition and by factors related to health status, such as previous hospitalizations before the index hospitalization (+77%), number of comorbidities (+15% higher probability per additional comorbidity) as well as particularly long hospitalizations (+64%). Stratified analysis by type of chronic condition revealed differential effects of social factors on readmissions risks. Compulsory education was most strongly associated with higher odds for readmission among patients with lung cancer (+142%), congestive heart failure (+63%) and back problems (+53%). We assume that low socioeconomic status among patients with chronic conditions increases the risk of unplanned 30-day readmission after hospitalisation due to factors related to their social situation (e.g., low health literacy, material deprivation, high social burden), which may negatively affect cooperation with care providers and adherence to recommended therapies as well as hamper active participation in the medical process and the development of a shared understanding of the disease and its cure. Higher levels of comorbidity in socially disadvantaged patients can also make appropriate self-management and use of outpatient care more difficult. Our findings suggest a need for increased preventive measures for disadvantaged populations groups to promote early detection of diseases and to remove financial or knowledge-based barriers to medical care. Socially disadvantaged patients should also be strengthened more in their individual and social resources for coping with illness.

Social inequalities, length of hospital stay for chronic conditions and the mediating role of comorbidity and discharge destination: A multilevel analysis of hospital administrative data linked to the population census in Switzerland.

Social factors are recognized determinants of morbidity and mortality and also have an impact on use of medical services. The objective of this study was to assess the associations of educational attainment, social and financial resources, and migration factors with length of hospital stays for chronic conditions. In addition, the study investigated the role of comorbidity and discharge destination in mediating these associations. The study made use of nationwide inpatient data that was linked with Swiss census data. The study sample included n = 141,307 records of n = 92,623 inpatients aged 25 to 84 years, hospitalized between 2010 and 2016 for a chronic condition. Cross-classified multilevel models and mediation analysis were performed. Patients with upper secondary and compulsory education stayed longer in hospital compared to those with tertiary education (ß 0.24 days, 95% CI 0.14-0.33; ß 0.37, 95% CI 0.27-0.47, respectively) when taking into account demographic factors, main diagnosis and clustering on patient and hospital level. However, these effects were almost fully mediated by burden of comorbidity. The effect of living alone on length of stay (ß 0.60 days, 95% CI 0.50-0.70) was partially mediated by both burden of comorbidities (33%) and discharge destination (30.4%). (Semi-) private insurance was associated with prolonged stays, but an inverse effect was observed for colon and breast cancer. Allophone patients had also prolonged hospital stays (ß 0.34, 95% CI 0.13-0.55). Hospital stays could be a window of opportunity to discern patients who need additional time and support to better cope with everyday life after discharge, reducing the risks of future hospital stays. However, inpatient care in Switzerland seems to take into account rather obvious individual needs due to lack of immediate support at home, but not necessarily more hidden needs of patients with low health literacy and less resources to assert their interests within the health system.

Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland.

If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03-1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09-1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53-1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37-0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.

The longitudinal impact of a chronic physical health condition on subjective well-being.

OBJECTIVE: Chronic health conditions (CHC) can have severe impacts on an individual's life, affecting well-being and mental health. Nonetheless, individuals can show different response patterns of psychological adaptation following a CHC onset. This study aimed to identify profiles of subjective well-being (SWB) at 1 year before (T - 1), 1 year after (T + 1), and 4 years after (T + 4) the onset of a physical CHC using seven indicators (health satisfaction, life satisfaction, energy, joy, worry, sadness, anger), examine transitions between the identified profiles, and determine predicting factors of these transitions. METHOD: Latent profile analysis and latent transition analysis was conducted using a sample of 357 participants reporting a physical CHC drawn from the Swiss Household Panel dataset. RESULTS: Three profiles were identified at T - 1: low, high, and very high SWB. At T + 1 and T + 4, a fourth vulnerable profile emerged. Transition analysis showed that, overall, the most probable transition was to stay in similar profiles across time. However, recovery toward higher SWB profiles and delayed reaction toward lower SWB profiles appeared between 1 and 4 years following the CHC onset. Factors predicting recovery patterns from low to high SWB are better health status, fewer negative life events, and financial scarcity, whereas lower emotional stability was related to a delayed reaction from high to low SWB. CONCLUSION: This study underlines the importance of personal factors in the adaptation following CHC onset. Routine assessment of personality traits would enable identifying individuals at greater risk of lower SWB following the onset of a CHC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological distress trajectories in chronic physical health conditions.

OBJECTIVE: The onset of a chronic health condition (CHC) can have a severe impact on an individual's life, affecting mental and physical health. This study's goal was to investigate psychological distress trajectories starting from 1 year before to 4 years after the onset of a physical CHC. The specific aims were to identify the number and shape of longitudinal psychological distress trajectories and to test health-related, psychological, social, and demographic factors predicting these trajectories. METHOD: Two samples were drawn from the Swiss Household Panel data set: a CHC sample (n = 361) and a 1-to-1 matched comparison sample of healthy individuals. Latent growth mixture modeling was used to identify psychological distress trajectories over 6 years. Factors predicting trajectories were then tested using multinomial logistic regression. RESULTS: Four psychological distress trajectories were identified in the CHC sample: resilience (53.9%), chronic (22.2%), delayed (15.0%), and recovery (8.9%). In the comparison sample, two trajectories were identified: low psychological distress (90%) and elevated psychological distress (10%). Protective factors associated with resilient trajectory membership in the CHC sample were higher emotional stability, higher relationship satisfaction, and male gender. CONCLUSION: Individuals living with a CHC had an increased risk of vulnerability compared with a sample of healthy individuals. This advocates awareness of mental health issues following the onset of a CHC. In this regard, biopsychosocial factors (gender, emotional stability, and relationship satisfaction) offer prevention and intervention opportunities for more vulnerable individuals. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perinatal mental disorders in Switzerland: prevalence estimates and use of mental-health services.

BACKGROUND: Perinatal mental disorders (PMDs) are the most common complication of pregnancy and the first postpartum year. Since PMD prevalence and use of mental-health services by perinatal women in Switzerland are unknown, we analysed existing health statistics. METHODS: We used statistics from a large health insurance company, hospitals and freelance midwives. We assessed the annual rates of mental-healthcare use in perinatal women (n = 13 969). We ascertained the annual rates of PMD treatment in obstetric inpatients (n = 89 699), and annual rates of PMD records by freelance midwives (n = 57 951). In 15 104 women who gave birth in 2012 or 2013, we assessed use of mental healthcare before and during pregnancy, and in the postpartum year. For the same sample, we determined proportions of medication and consultation treatments. We used multiple regression analysis to estimate the influence of PMD on overall healthcare costs of mandatory health insurance. RESULTS: The annual rate of mental-healthcare use by perinatal women was 16.7%. The annual rate of PMD treatment in obstetric inpatients was 1.1%. The annual rate of PMD records in the midwifery care setting was 2.9%. Women with PMD use mental health services mainly in non-obstetric outpatient settings. Medication was the most frequent treatment. Primary care providers and mental health specialists contributed almost equally to consultation treatments. PMD during pregnancy raised overall costs of healthcare in the postpartum year by 1214 Swiss francs. CONCLUSIONS: Health-system research and perinatal healthcare should take into consideration the high prevalence of PMD. Real PMD prevalence may be even higher than our data suggest and could be assessed with a survey using our model of PMD prevalence.