ABSTRACT
Since mortality and suicide were found markedly increased in hospitalized psychiatric patients and may be predicted by treatment assignment, we developed a prospective investigation of treatment choice/mortality and suicide relationships in a well-assessed sample of these subjects. The overall psychiatric patients calling for inpatient care in a Geneva (Switzerland) 115,000 inhabitants catchment area within 2 months (N = 78) entered the study. During the second follow-up year, we found high Standardized Mortality Ratio (SMR respectively 10.5 for overall deaths and 257.7 for suicides). Increased number and crude rates of suicide were associated to emergency intervention only assignment at intake. Suicide risk was underestimated in subjects with acute psychiatric illness, and should be better investigated in the future.
Subject(s)
Cause of Death , Crisis Intervention , Mental Disorders/mortality , Suicide/statistics & numerical data , Adolescent , Adult , Female , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Male , Mental Disorders/psychology , Mental Disorders/therapy , Middle Aged , Prospective Studies , Psychiatric Status Rating Scales , Psychotherapy , Survival Rate , Switzerland/epidemiologyABSTRACT
We investigated whether process variables (therapeutic alliance and insight) measured at the termination of crisis intervention predict long-term treatment compliance and 2-year outcome. Thirty-seven consecutive depressed psychiatric patients assigned to outpatient crisis intervention (CCI) were assessed with both questionnaires and standardized instruments at intake, 1 week, and CCI termination (mean, 6 weeks). Thirty-one subjects (84%) were also evaluated at 1-year and 2-year follow-up. We found that working alliance and development of insight predicted positive global change and symptom improvement at 1 and 2 years' follow-up. Furthermore, the observed correlation between process measures and 2-year outcome was found to be independent of age, sex, symptoms severity at intake, improvement of symptoms at CCI termination, premorbid adjustment, DSM-III-R axis I/axis II diagnosis, and therapeutic alliance at intake.
Subject(s)
Crisis Intervention , Depressive Disorder/therapy , Outcome and Process Assessment, Health Care , Adult , Combined Modality Therapy , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , Interpersonal Relations , Male , Middle Aged , Patient Compliance/psychology , Personality Inventory , Prospective Studies , Psychiatric Status Rating ScalesABSTRACT
This is a preliminary study focusing on a 2 years follow-up of 78 patients addressed to psychiatric hospitalization and psychodynamically oriented crisis intervention. Relationship between psychopathological, clinical and interactional profile at first medical interview and clinical/social assessment at 1 and 2 years follow-up were studied, indicating different predictors for long-term treatment (DSM III R diagnosis and psychotic symptoms scores) and global improvement (age and sex) as well as poorer outcome for social functioning than for symptomatic measures. Comment is also provided on the observed high concordance between clinical predictions at crisis treatment completion and research staff assessments at 1 and 2 years follow-up. The evaluated crisis intervention model was found to provide a valuable setting to structure acute psychiatric episode treatment and long-term care, even though transition from clinical recovery to effective social-interpersonal reinvestments was observed to raise problems in the addressed psychiatric population.
