Outcomes following hip fracture surgery in adults with schizophrenia in Ontario, Canada: A 10-year population-based retrospective cohort study.

OBJECTIVE: To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia. METHODS: Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models. RESULTS: In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year. CONCLUSIONS: Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.

Effects of the Implementation of a Patient-Oriented Discharge Summary (PODS) on Pre- and Postdischarge Outcomes.

A patient-oriented discharge summary (PODS) is a patient-facing process to provide best practices in discharge planning. The PODS process was implemented in phases in 22 units of a large, publicly funded psychiatric hospital in Canada. The authors studied 7,624 discharges. Sustained implementation of the PODS process attained an ongoing PODS completion rate of 86.5%. Rates of medication reconciliation, patient-centered medication education, follow-up appointment scheduling, and medical discharge summary completion within 48 hours of discharge significantly improved over the implementation phase. Despite high uptakes of these best practices, more distal outcomes (e.g., follow-up appointment attendance and hospital readmission) did not improve.

Diabetic Ketoacidosis and Mortality in People With Type 1 Diabetes and Eating Disorders.

OBJECTIVE: To determine the risk of diabetic ketoacidosis (DKA) and all-cause mortality among adolescents and young adults with type 1 diabetes with and without an eating disorder. RESEARCH DESIGN AND METHODS: With use of population-level health care administrative data covering the entire population of Ontario, Canada, all people with type 1 diabetes aged 10-39 years as of January 2014 were identified. Individuals with a history of eating disorders were age- and sex-matched 10:1 with individuals without eating disorders. All individuals were followed for 6 years for hospitalization/emergency department visits for DKA and for all-cause mortality. RESULTS: We studied 168 people with eating disorders and 1,680 age- and sex-matched people without eating disorders. Among adolescents and young adults with type 1 diabetes, 168 (0.8%) had a history of eating disorders. The crude incidence of DKA was 112.5 per 1,000 patient-years in people with eating disorders vs. 30.8 in people without eating disorders. After adjustment for baseline differences, the subdistribution hazard ratio for comparison of people with and without eating disorders was 3.30 (95% CI 2.58-4.23; P < 0.0001). All-cause mortality was 16.0 per 1,000 person-years for people with eating disorders vs. 2.5 for people without eating disorders. The adjusted hazard ratio was 5.80 (95% CI 3.04-11.08; P < 0.0001). CONCLUSIONS: Adolescents and young adults with type 1 diabetes and eating disorders have more than triple the risk of DKA and nearly sixfold increased risk of death compared with their peers without eating disorders.

Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders.

The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimer's disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., within-group meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a trans-diagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.

Depression and Anxiety in Adults With Hidradenitis Suppurativa: A Systematic Review and Meta-analysis.

IMPORTANCE: Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors' knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric comorbidities in this population. OBJECTIVE: To assess the prevalence and odds for depression and anxiety in patients with HS. DATA SOURCES: From July 25 to September 30, 2018, observational studies investigating the prevalence and odds for depression and anxiety in adults with HS were systematically searched without language restriction from the inception of each database to July 25, 2018, in PubMed/MEDLINE, Embase, and PsycINFO databases. Searches used various configurations of the terms hidradenitis suppurativa; acne inversa; depressive disorder; depression; anxiety; anxiety disorders; phobia, social; suicide; and suicide, attempted. In addition, the reference lists of included references were screened manually. STUDY SELECTION: Two investigators independently screened references that measured prevalence rates and odds for depressive and anxiety symptoms in patients with HS. Of 136 unique references, 10 ultimately met inclusion criteria. DATA EXTRACTION AND SYNTHESIS: Relevant data were extracted from eligible references. Authors were contacted to provide further information when necessary. Methodological quality of included studies was assessed through a modified version of the Newcastle-Ottawa Scale. Random-effects models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES: Prevalence rates and ORs for depression and anxiety in adults with HS were the primary outcome measures. Heterogeneity across studies was assessed with the I2 statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. RESULTS: Ten studies comprising 40 307 participants with HS met inclusion criteria. The overall prevalence of depression was 16.9% (95% CI, 9.9%-27.2%). Heterogeneity was large. In the subgroup of studies that considered a clinical criteria-based diagnosis of depression, the prevalence of depression was 11.9% (95% CI, 4.9%-26.2%), compared with 26.8% (95% CI, 20.4%-34.5%) in studies that used a screening instrument. The methodological quality of included studies moderated those findings. The OR for depression in individuals with HS compared with individuals without HS was 1.84 (95% CI, 1.57-2.15). The prevalence of anxiety was 4.9% (95% CI, 1.7%-13.2%); there were insufficient data to determine an odds ratio for anxiety in persons with HS because 2 studies included a comparison group. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis indicates that depression and anxiety are common comorbid conditions in patients with HS. Results suggest that the development of strategies to recognize and treat those psychiatric comorbidities in patients with HS is warranted.

Cannabis use and suicide attempts among 86,254 adolescents aged 12-15 years from 21 low- and middle-income countries.

BACKGROUND: Evidence suggests that cannabis use may be associated with suicidality in adolescence. Nevertheless, very few studies have assessed this association in low- and middle-income countries (LMICs). In this cross-sectional survey, we investigated the association of cannabis use and suicidal attempts in adolescents from 21 LMICs, adjusting for potential confounders. METHOD: Data from the Global school-based Student Health Survey was analyzed in 86,254 adolescents from 21 countries [mean (SD) age = 13.7 (0.9) years; 49.0% girls]. Suicide attempts during past year and cannabis during past month and lifetime were assessed. Multivariable logistic regression analyses were conducted. RESULTS: The overall prevalence of past 30-day cannabis use was 2.8% and the age-sex adjusted prevalence varied from 0.5% (Laos) to 37.6% (Samoa), while the overall prevalence of lifetime cannabis use was 3.9% (range 0.5%-44.9%). The overall prevalence of suicide attempts during the past year was 10.5%. Following multivariable adjustment to potential confounding variables, past 30-day cannabis use was significantly associated with suicide attempts (OR = 2.03; 95% CI: 1.42-2.91). Lifetime cannabis use was also independently associated with suicide attempts (OR = 2.30; 95% CI: 1.74-3.04). CONCLUSION: Our data indicate that cannabis use is associated with a greater likelihood for suicide attempts in adolescents living in LMICs. The causality of this association should be confirmed/refuted in prospective studies to further inform public health policies for suicide prevention in LMICs.

Different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms among older adults in Ireland: A prospective community-based study.

BACKGROUND: The associations of different patterns of alcohol consumption and the incidence and persistence of depressive and anxiety symptoms in older age remain unclear. METHODS: Data on 6095 adults aged ≥ 50 years old from the Irish Longitudinal Study on Aging (TILDA) was analyzed. Participants completed the CAGE instrument to screen for problematic alcohol use at baseline between October 2009 and February 2011. Outcomes were incident (assessed by the CES-D scale) and anxiety (assessed by the Hospital Anxiety and Depressive scale) symptoms after a two-year follow-up as well as persistence of probable depression and anxiety among those with a positive screen for those disorders at baseline. Associations were adjusted for potential confounders through multivariable models. RESULTS: In the overall sample, problem drinking did not predict incident and persistent depression and anxiety in this sample. Among females, problem drinking increased the risk for incident depression (OR = 2.11; 95%CI = 1.12-4.00) and anxiety (OR = 2.22; 95%CI = 1.01-4.86). In addition, problem drinking increased the risk of persistent depressive symptoms (OR = 2.43; 95%CI = 1.05-5.06) among females. CONCLUSION: Problem drinking may increase the risk of incident probable depression and anxiety among older females. Furthermore, problem drinking led to a higher likelihood of persistent depressive symptoms in older female participants. Interventions targeting problem drinking among older females may prevent the onset and persistence of depression in this population, while also decreasing the incidence of anxiety symptoms.

Trends in standardized mortality among individuals with schizophrenia, 1993-2012: a population-based, repeated cross-sectional study.

BACKGROUND: We examined mortality time trends and premature mortality among individuals with and without schizophrenia over a 20-year period. METHODS: In this population-based, repeated cross-sectional study, we identified all individual deaths that occurred in Ontario between 1993 and 2012 in persons aged 15 and over. We plotted overall and cause-specific age- and sex-standardized mortality rates (ASMRs), stratified all-cause ASMR trends by sociodemographic characteristics, and analyzed premature mortality using years of potential life lost. Additionally, we calculated mortality rate ratios (MRRs) using negative binomial regression with adjustment for age, sex, income, rurality and year of death. RESULTS: We identified 31 349 deaths among persons with schizophrenia, and 1 589 902 deaths among those without schizophrenia. Mortality rates among people with schizophrenia were 3 times higher than among those without schizophrenia (adjusted MRR 3.12, 95% confidence interval 3.06-3.17). All-cause ASMRs in both groups declined in parallel over the study period, by about 35%, and were higher for men, for those with low income and for rural dwellers. The absolute ASMR difference also declined throughout the study period (from 16.15 to 10.49 deaths per 1000 persons). Cause-specific ASMRs were greater among those with schizophrenia, with circulatory conditions accounting for most deaths between 1993 and 2012, whereas neoplasms became the leading cause of death for those without schizophrenia after 2005. Individuals with schizophrenia also died, on average, 8 years younger than those without schizophrenia, losing more potential years of life. INTERPRETATION: Although mortality rates among people with schizophrenia have declined over the past 2 decades, specialized approaches may be required to close the persistent 3-fold relative mortality gap with the general population.

Perinatal suicide in Ontario, Canada: a 15-year population-based study.

BACKGROUND: Death by suicide during the perinatal period has been understudied in Canada. We examined the epidemiology of and health service use related to suicides during pregnancy and the first postpartum year. METHODS: In this retrospective, population-based cohort study, we linked health administrative databases with coroner death records (1994-2008) for Ontario, Canada. We compared sociodemographic characteristics, clinical features and health service use in the 30 days and 1 year before death between women who died by suicide perinatally, women who died by suicide outside of the perinatal period and living perinatal women. RESULTS: The perinatal suicide rate was 2.58 per 100 000 live births, with suicide accounting for 51 (5.3%) of 966 perinatal deaths. Most suicides occurred during the final quarter of the first postpartum year, with highest rates in rural and remote regions. Perinatal women were more likely to die from hanging (33.3% [17/51]) or jumping or falling (19.6% [10/51]) than women who died by suicide non-perinatally (p = 0.04). Only 39.2% (20/51) had mental health contact within the 30 days before death, similar to the rate among those who died by suicide non-perinatally (47.7% [762/1597]; odds ratio [OR] 0.71, 95% confidence interval [CI] 0.40-1.25). Compared with living perinatal women matched by pregnancy or postpartum status at date of suicide, perinatal women who died by suicide had similar likelihood of non-mental health primary care and obstetric care before the index date but had a lower likelihood of pediatric contact (64.5% [20/31] v. 88.4% [137/155] at 30 days; OR 0.24, 95% CI 0.10-0.58). INTERPRETATION: The perinatal suicide rate for Ontario during the period 1994-2008 was comparable to international estimates and represents a substantial component of Canadian perinatal mortality. Given that deaths by suicide occur throughout the perinatal period, all health care providers must be collectively vigilant in assessing risk.

Physician Warnings in Psychiatry and the Risk of Road Trauma: An Exposure Crossover Study.

OBJECTIVE: To determine if physician warnings to psychiatric patients alter the subsequent frequency of a motor vehicle crash. A secondary objective was to determine if physician warnings change the subsequent frequency of psychiatric hospitalization. METHODS: Exposure crossover design of 23,145 psychiatric patients diagnosed with ICD-9 schizophrenia (code 295), mood disorder (296), personality disorder (301), or substance use disorder (303, 304) and warned by their physician about driving safety between April 1, 2006, and March 31, 2011. Each patient was followed for 4 years before the warning and 1 year after the warning. Patients living outside the region or lacking a valid health card number were excluded. RESULTS: Patients' motor vehicle crash frequency decreased from 11.78 to 8.17 events per 1,000 patients per year after a physician warning, which corresponded to a relative risk of 0.69 (95% CI, 0.59-0.81; P < .001). Psychiatric hospitalization frequency increased from 147 to 289 events per 1,000 patients per year corresponding to a relative risk of 1.97 (95% CI, 1.91-2.03; P < .001). CONCLUSIONS: Physician warnings are associated with a subsequent decreased frequency of motor vehicle crashes and increased frequency of psychiatric hospitalization. This result suggests that physician warnings are an effective intervention for reducing road trauma but need to be weighed against potential adverse psychiatric health.

Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia.

BACKGROUND: Almost 50% of women with schizophrenia become pregnant. Little is known about their psychiatric service use patterns during or shortly after pregnancy. METHODS: Using health administrative data, we identified 1,433 women in Ontario, Canada, with schizophrenia (ICD-9, ICD-10, or DSM-IV-TR) who had a live birth delivery from January 2003 through March 2011 and described their use of acute psychiatric care services including hospitalizations, emergency department visits not requiring hospitalization, and self-harm-related emergency department visits during pregnancy and in the first year postpartum. Incidence rates of psychiatric hospitalization during pregnancy, and also within 1 year postpartum, were each compared to the incidence rate of psychiatric hospitalization in the 1-year period before conception. Results are presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Similar comparisons were made for psychiatric emergency department visits not requiring hospitalization, as well as for self-harm-related emergency department visits. RESULTS: About 12% of the women had at least 1 psychiatric hospitalization during pregnancy, and 19% in the first year postpartum. About 10% had at least 1 psychiatric emergency department visit without hospitalization during pregnancy, and 16% had at least 1 emergency department visit postpartum. Self-harm-related emergency department visits were rarer, affecting only about 1% of the women in each time period. Relative to that in the 1-year period before conception (50 per 100 person-years), the incidence rate of psychiatric hospitalizations was lower during pregnancy (25 per 100 person-years), which is equivalent to an IRR of 0.50 (95% CI, 0.43-0.60). While the IRR of psychiatric hospitalizations was lower over the entire 1-year period postpartum (0.66; 95% CI, 0.57-0.76), it was transiently higher in the first 9 days postpartum (3.59; 95% CI, 2.74-4.69) and then waned by days 10 to 29 postpartum (0.87; 95% CI, 0.56-1.24). Emergency department visits for psychiatric and self-harm reasons were consistently lower during pregnancy and postpartum compared to the year before conception. CONCLUSIONS: Psychiatric hospitalizations and emergency department visits are not uncommon for women with schizophrenia during pregnancy and the postpartum period. However, except for a brief period after delivery, women with schizophrenia are at relatively lower risk of requiring acute psychiatric inpatient and emergency care during and 1 year after pregnancy compared to the 1-year period prior to conception. This is key prognostic information for women with schizophrenia, their families, and providers who counsel them regarding pregnancy, motherhood, and management of schizophrenia. Identifying women at risk of requiring acute psychiatric services in the perinatal period warrants further investigation.

Prescription Stimulant Use and Hospitalization for Psychosis or Mania: A Population-Based Study.

Small studies suggest that prescription stimulants can precipitate psychosis and mania. We conducted a population-based case-crossover study to examine whether hospitalization for psychosis or mania was associated with initiation of stimulant therapy. Between October 1, 1999 and March 31, 2013, we studied 12,856 young people who received a stimulant prescription and were subsequently hospitalized for psychosis or mania. Of these, 183 commenced treatment during 1 of 2 prespecified 60-day intervals (defined as the "risk interval" and "control interval," respectively) prior to admission. We found that stimulant initiation was associated with an increased risk of hospitalization for psychosis or mania in the subsequent 60 days (odds ratio, 1.86; 95% confidence interval, 1.39-2.56). The risk was marginally higher in patients treated with antipsychotic drugs (odds ratio, 2.06; 95% confidence interval, 1.38-3.28), but remained in patients with no such history (odds ratio, 1.66; 95% confidence interval, 1.09-2.66). One third of subjects received another stimulant prescription after hospital discharge. Of these, 45% were readmitted with psychosis or mania shortly thereafter. We conclude that initiation of prescription stimulants is associated with an increased risk of hospitalization for psychosis or mania. Resumption of therapy is common, which may reflect a lack of awareness of the potential causative role of these drugs.

READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units.

Our aim was to create a clinically useful risk index, administered prior to discharge, for determining the probability of psychiatric readmission within 30 days of hospital discharge for general psychiatric inpatients. We used population-level sociodemographic and health administrative data to develop a predictive model for 30-day readmission among adults discharged from an acute psychiatric unit in Ontario, Canada (2008-2011), and converted the final model into a risk index system. We derived the predictive model in one-half of the sample (n = 32,749) and validated it in the other half of the sample (n = 32,750). Variables independently associated with 30-day readmission (forming the mnemonic READMIT) were: (R) Repeat admissions; (E) Emergent admissions (i.e. harm to self/others); (D) Diagnoses (psychosis, bipolar and/or personality disorder), and unplanned Discharge; (M) Medical comorbidity; (I) prior service use Intensity; and (T) Time in hospital. Each 1-point increase in READMIT score (range 0-41) increased the odds of 30-day readmission by 11% (odds ratio 1.11, 95% CI 1.10-1.12). The index had moderate discriminative capacity in both derivation (C-statistic = 0.631) and validation (C-statistic = 0.630) datasets. Determining risk of psychiatric readmission for individual patients is a critical step in efforts to address the potentially avoidable high rate of this negative outcome. The READMIT index provides a framework for identifying patients at high risk of 30-day readmission prior to discharge, and for the development, evaluation and delivery of interventions that can assist with optimizing the transition to community care for patients following psychiatric discharge.

Fertility rate trends among adolescent girls with major mental illness: a population-based study.

OBJECTIVE: Fertility rates among adolescents have decreased substantially in recent years, yet fertility rates among adolescent girls with mental illness have not been studied. We examined temporal trends in fertility rates among adolescent girls with major mental illness. METHODS: We conducted a repeated annual cross-sectional study of fertility rates among girls aged 15 to 19 years in Ontario, Canada (1999-2009). Girls with major mental illness were identified through administrative health data indicating the presence of a psychotic, bipolar, or major depressive disorder within 5 years preceding pregnancy (60,228 person-years). The remaining girls were classified into the comparison group (4,496,317 person-years). The age-specific fertility rate (number of live births per 1000 girls) was calculated annually and by using 3-year moving averages for both groups. RESULTS: The incidence of births to girls with major mental illness was 1 in 25. The age-specific fertility rate for girls with major mental illness was 44.9 per 1000 (95% confidence interval [CI]: 43.3-46.7) compared with 15.2 per 1000 (95% CI: 15.1-15.3) in unaffected girls (rate ratio: 2.95; 95% CI: 2.84-3.07). Over time, girls with major mental illness had a smaller reduction in fertility rate (relative rate: 0.86; 95% CI: 0.78-0.96) than did unaffected girls (relative rate: 0.78; 95% CI: 0.76-0.79). CONCLUSIONS: These results have key clinical and public policy implications. Our findings highlight the importance of considering major mental illness in the design and implementation of pregnancy prevention programs as well as in targeted antenatal and postnatal programs to ensure maternal and child well-being.

Within-hospital readmission: an indicator of readmission after discharge from psychiatric hospitalization.

OBJECTIVE: Readmission after psychiatric hospitalization is widely used as a quality of care indicator by government funding agencies, policy-makers, and hospitals deciding on clinical priorities. Readmission rates are calculated accurately to allow these varied groups to correctly translate the knowledge into appropriate, tangible outcomes. We aimed to assess how well hospital readmission rates, calculated using only readmissions to the discharging institution, can approximate actual readmission rates. METHOD: We used administrative data sources to identify patients with a mental health discharge in the province of Ontario (2008-2011). We identified mental health readmissions within 30 and 90 days of discharge occurring to the hospital from which the patient was discharged (within-hospital readmissions), and compared readmission rates using only within-hospital admissions with actual readmission rates. RESULTS: The percentage of readmissions occurring to the discharging institution ranged from 39% to 89% (median 73%) and from 37% to 86% (median 70%) for 30- and 90-day readmissions, respectively. Using only within-hospital readmissions to rank hospitals by their readmission rates, only 56% of hospitals for 30-day readmissions and 50% for 90-day readmissions were ranked in the same quartile as when actual readmission rates were used. CONCLUSIONS: These findings highlight the importance of measuring psychiatric readmissions at the system level, particularly for hospitals with lower discharge volumes. As well, the high likelihood that multiple hospitals are involved in the hospital-based care of people who require readmission requires consideration at clinical and policy levels.

Objectif : La réhospitalisation après une hospitalisation psychiatrique est largement utilisée comme indicateur de la qualité des soins par les organismes gouvernementaux subventionnaires, les décideurs, et les hôpitaux qui décident des priorités cliniques. Les taux de réhospitalisation sont calculés avec précision pour permettre à ces divers groupes de traduire correctement ce savoir en résultats appropriés, tangibles. Nous visions à évaluer dans quelle mesure les taux de réhospitalisation, calculés seulement à l'aide des réhospitalisations à l'institution ayant donné le congé, peuvent s'approcher des taux réels de réhospitalisation. Méthode : Nous avons utilisé des sources de données administratives pour identifier les patients ayant obtenu leur congé de santé mentale dans la province de l'Ontario (2008­2011). Nous avons identifié les réhospitalisations en santé mentale dans les 30 à 90 jours suivant le congé qui ont lieu à l'hôpital même duquel le patient avait obtenu son congé (réhospitalisations au même hôpital), et comparé les taux de réhospitalisation au même hôpital seulement avec les taux de réhospitalisation réels. Résultats : Le pourcentage des réhospitalisations à l'institution ayant donné le congé jouait entre 39 % et 89 % (moyenne 73 %) et entre 37 % et 86 % (moyenne 70 %) pour des réhospitalisations après 30 et 90 jours, respectivement. En utilisant seulement les réhospitalisations au même hôpital pour classer les hôpitaux par taux de réhospitalisation, seulement 56 % des hôpitaux pour les réhospitalisations après 30 jours et 50 % pour les réhospitalisations après 90 jours étaient classés dans le même quartile que celui des taux réels de réhospitalisation. Conclusions : Ces résultats soulignent l'importance de mesurer les réhospitalisations psychiatriques au niveau du système, particulièrement pour les hôpitaux dont les volumes de congés sont plus faibles. De même, la probabilité élevée que de multiples hôpitaux participent aux soins en milieu hospitalier de gens qui nécessitent une réhospitalisation demande un examen au niveau clinique et politique.

Transitional interventions to reduce early psychiatric readmissions in adults: systematic review.

BACKGROUND: Up to 13% of psychiatric patients are readmitted shortly after discharge. Interventions that ensure successful transitions to community care may play a key role in preventing early readmission. AIMS: To describe and evaluate interventions applied during the transition from in-patient to out-patient care in preventing early psychiatric readmission. METHOD: Systematic review of transitional interventions among adults admitted to hospital with mental illness where the study outcome was psychiatric readmission. RESULTS: The review included 15 studies with 15 non-overlapping intervention components. Absolute risk reductions of 13.6 to 37.0% were observed in statistically significant studies. Effective intervention components were: pre- and post-discharge patient psychoeducation, structured needs assessments, medication reconciliation/education, transition managers and in-patient/out-patient provider communication. Key limitations were small sample size and risk of bias. CONCLUSIONS: Many effective transitional intervention components are feasible and likely to be cost-effective. Future research can provide direction about the specific components necessary and/or sufficient for preventing early psychiatric readmission.

Temporal trends in general and age-specific fertility rates among women with schizophrenia (1996-2009): a population-based study in Ontario, Canada.

PURPOSE: There is substantial evidence that women with schizophrenia in many parts of the world have fewer children than their peers. Our objective was to analyze recent trends in general and age-specific fertility rates among women with schizophrenia in Ontario, Canada. METHODS: We conducted a repeated cross-sectional population-based study from 1996 to 2009 using population-based linked administrative databases for the entire province of Ontario. Women aged 15-49 years were classified into schizophrenia and non-schizophrenia groups in each successive 12-month period. Annual general and age-specific fertility rates were derived. RESULTS: The general fertility rate (GFR) among women with schizophrenia was 1.16 times higher in 2007-2009 than in 1996-1998 (95% confidence interval [CI] 1.04-1.31). The annual GFR ratio of women with vs. without schizophrenia was 0.41 (95% CI 0.36-0.47) in 2009, which was slightly higher than the same ratio in 1996 of 0.30 (95% CI 0.25-0.35). Annual age-specific fertility rates (ASFR) increased over time among women with schizophrenia aged 20-24, 25-29, 35-39 and 40-44 years, but the increase was not always statistically significant. Among women aged 20-24 years, the ASFR ratio in women with vs. without schizophrenia was not significant by the end of the study period (0.93, 95% CI 0.70-1.22). CONCLUSIONS: The general fertility rate among women with schizophrenia appears to have increased modestly over the past 13 years. Clinical care and health policy should consider new strategies that focus on the mental health of women with schizophrenia as new mothers, while optimizing healthy pregnancies and child rearing.

Using the Johns Hopkins Aggregated Diagnosis Groups (ADGs) to predict mortality in a population-based cohort of adults with schizophrenia in Ontario, Canada.

Administrative health care databases are increasingly used for health services and comparative effectiveness research. When comparing outcomes between different treatments, interventions and exposures, the ability to adjust for differences in the risk of the outcome occurring between treatment groups is important. There is a paucity of validated methods to ascertain comorbidities for risk-adjustment in ambulatory populations of subjects with schizophrenia using administrative health care databases. Our objective was to examine the ability of th\e Johns Hopkins' Aggregated Diagnosis Groups (ADGs) to predict 1-year mortality in a population-based cohort of subjects with schizophrenia. We used a retrospective cohort constructed using population-based administrative data that consisted of all 94,466 residents of Ontario, Canada between the ages of 20 and 100years who were alive on January 1, 2007 and who had been diagnosed with schizophrenia prior to this date. Subjects were randomly divided into derivation and validation samples. A logistic regression model consisting of age, sex, and indicator variables for 14 of the 32 ADG categories had excellent discrimination: the c-statistic (equivalent to the area under the ROC curve) was 0.845 and 0.836 in the derivation and validation samples, respectively. Furthermore, the model demonstrated very good calibration.