Nuevas tendencias en la investigación en salud mental / Recent trends in mental health research

Debido a que el modelo de atención en salud mental ha cambiado desde una orientación hospitalaria a una comunitaria, la orientación de los investigadores ha cambiado también. La nueva tendencia es investigar prestando mayor atención a la prevención, la cronicidad, la colaboración entre salud mental y atención primaria, y el entorno de los sujetos en estudio (AU)

Because the orientation in mental health care changed from hospitalbased to communitybased, the orientation of researchers had to change as well. The new tendency is research with more atention paid to prevention, to chronicity, to the collaboration between mental health and primary health care and the involvement of users in research (AU)

[Day-care and day-treatment in psychogeriatrics. Changes in the characteristics of users in the course of a year]. / Dagverzorging en dagbehandeling in de psychogeriatrie. Veranderingen in de kenmerken van gebruikers in de loop van een jaar.

Users of day-treatment had a different need for care than users of day-care. The behaviour measured by the GIP was different on the cognitive and social scales: 100 users of day-treatment showed more disturbed behaviour than 63 users of day-care. Geronte also showed that they were in need of more help than users of day-care: at the start and also after twelve months with respect to their mental, physical and social functions as well as in home keeping. Users who left the facility within one year showed a lower level of selfcontainment at the start compared with users still visiting the facility after one year. The need profile of users leaving day-care resembled that of the users that started day-treatment. Fifteen percent of users who left day-care directly started day-treatment.

[Instrument for determination and planning of care]. / Een instrument ter bepaling en visualisering van zorgbehoefte.

Geronte is a French instrument to assess and visualize the need of care of elderly people. In 1995 Geronte was translated into Dutch. In order to be able to determine differences in the need of care, it was investigated whether the Dutch Geronte is able to discriminate between the users of different care-providing institutions. Five groups of fifteen elderly people in five different situations were examined: residents with predominantly psycho-geriatric impairment, residents with predominantly somatic impairment and residents of a home for the elderly, elderly people living at home with home help and elderly people living at home without any assistance. The Dutch Geronte proved to be able to reveal differences between the users of the different types of care, with the exception of residents of the home for the elderly and elderly people living at home with home help. The Dutch Geronte proved to be useful in the assessment and visualization of the need of care of elderly people.

The reliability of diagnostic coding in psychiatric case registers.

In total, 103 cases were randomly selected from the Groningen, Nottingham and South Verona registers. Six raters (two in each of the register areas) were involved in coding these cases according to the ICD-9. In general, interrater agreement was satisfactory when codes were grouped into a limited number of categories. Nevertheless, considerable variation in agreement rates was found. We distinguished three steps in the diagnostic process. The selected logistic model showed that reliability is significantly affected in each step, but only substantial in the first where clinicians formulate a diagnosis.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study.

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.

Use of mental health services in south Verona and Groningen. A comparative case-register study.

A comparison was made of the utilization of mental health services in a psychiatric case register area in Italy (south Verona) and one in the Netherlands (Groningen). All residents living in these areas who contacted a mental health service in 1982 were traced and followed for a period of one year. The year prevalence rates differed considerably (110/10,000 in south Verona and 329/10,000 in Groningen). Rates of single consulters were similar in both areas, while those of chronic inpatients were more than 11 times higher in Groningen than in south Verona. After excluding both single consulters and chronic inpatients, when comparing service consumption according to fixed classes of scores, the category of highest service use accounted for 60% of care provided in Groningen as compared with less than 30% in south Verona. The proportion of total service consumption due to inpatient care was about the same in both areas, but brief admissions were more common in south Verona. Moreover, when service use was considered as a relative construct, about 10% of patients in both areas could be called high users. Finally, long-term patients were more prevalent in Groningen (26%) than in south Verona (13%).

A cross-cultural comparison of mental health care delivery in Athens and Groningen.

Until recently mental health care in Greece was mainly delivered by old traditional mental hospitals and few outpatient services. In order to induce the process of change the University of Athens started to experiment with a community mental health service. In order to study what has been achieved in a relatively short time, data relating to the delivery of care cohorts of patients from a pilot area in Athens and from an area in the north of the Netherlands were compared. The overall new contact rate was much higher in the Groningen area, except for the category of psychoneuroses and personality disorders. Patients with a psychosis received more intensive treatment and left the services at a later stage in Athens. Differences of patterns of care in other diagnostic and age groups are discussed.

Patterns of care in the field of mental health. Conceptual definition and research methods.

The concept "patterns of care" plays a central role in research focusing on the evaluation of mental health care. It is a concept encompassing a number of dimensions. The primary ingredients are the type, the setting, the intensity and the duration of care. In this paper, a critical survey is provided of a total of 7 classifications or scales of patterns of care. An argument is advanced for developing a more systematic working method within this research area, in which new scales of patterns of care are developed, building on the methodology already in existence. Standardization is urgently needed if comparative research is to yield better results than it has in the past.

Patterns of mental health care in two European areas: Mannheim, Federal Republic of Germany; and Groningen, The Netherlands.

All consecutive cases entering the mental health services cooperating with the cumulative psychiatric case register of Mannheim between 1-31 July 1976 were followed up until the end of June 1978 and compared with the consecutive cases entering the mental health services cooperating with the psychiatric case register of Groningen between 1 January and 1 May 1979. Patterns of in-, day- and outpatient care delivered to these 2 cohorts of patients, who were greater than or equal to 15 years of age, and who had not been in contact with one of the services for at least 6 months prior to entry, were compared by diagnostic category. The most common episode of care was the relatively brief outpatient one. Mixed types of care and chronic cases were more common among patients with a psychosis or an addiction than in other diagnostic categories. Between 6 and 24 months after first contact 76% of the patients in Mannheim and 43% of the patients in Groningen had no more contacts. Between 18 and 24 months after the first contact the percentages had increased to 90 and 72% (respectively). In Groningen a higher percentage of patients received outpatient care only. Although a larger percentage of patients in Mannheim received inpatient care, the accumulation of "new chronic" patients was larger in Groningen, as a result of a greater length of stay in Groningen.

[Culture specific or universal depressive diseases? Comparison of depressive symptoms of WHO/SADD (Standardized Assessment of Depressive Disorders) in Mannheim, West Germany and Addis Abeba, Ethiopia]. / Kulturspezifische oder universelle depressive Erkrankungen? Vergleich der depressiven Symptomatik des WHO/SADD in Mannheim/BRD und Addis Abeba/Athiopien.

In an international comparative study the symptomatology of depressive patients from psychiatric services in Addis Ababa, Ethiopia (N = 52) and in Mannheim, Federal Republic of Germany (N = 136) was investigated with the WHO Schedule for Standardized Assessment of Depressive Disorders (WHO/SADD). Controlled for differences in the sex-, age- and diagnostic-distribution of the two samples, depressive patients in Addis Ababa showed significantly more somatic symptoms, hypochondrias, psychomotor restlessness and delusions of reference and persecution, but markedly less feelings of guilt. Nevertheless, the same core of symptomatology was found to build in both samples the first and most important factor of 17, mainly psychological complaints. Only "feelings of guilt" did not belong to this core in Addis Ababa. In contrast to what is often believed to be the case in African patients, the more frequently expressed somatic complaints came in addition to, but did not replace the core-psychological symptomatology. The investigators stress the importance of a separate analysis of the frequencies of symptoms and of dimensions these symptoms build.

Determination of the optimum period of interview for retrospective collection of data. An empirical study based on reported and documented outpatient contacts of depressive patients.

On the basis of reported and documented data on outpatient contacts of depressive patients, the reliability of data on the use of services, and the possibilities and sources of errors in the retrospective collection of data are presented and discussed. The results show an increase in errors the longer the period of inquiry is removed from the time of interview. The retrospective collection of data about ambulatory care more than 6 months ago has to be questioned from a reliability point of view. The correct dating of outpatient contacts succeeds substantially more reliably when questioned about periods of 3 months than about monthly periods, which leads to implications for the definition of patterns of care.

Uses of a psychiatric case register. Evaluation studies.

The Groningen case register, modelled after the Camberwell register, was initiated with a point prevalence count on the 31st of December 1973, and accumulates since data on contacts with psychiatric services of all people in a small town in the north of the Netherlands, with a population of 43,783 inhabitants. It has been running smoothly for the past twelve years with increasing interest and involvement on the part of the field workers and policy makers. Examples are given of the use of the register in evaluating new services, patterns of care, continuity of care and deinstitutionalization, in which it has proved its value as a tool for evaluation.

The elderly in the mental health services of twenty-one European pilot study areas.

In a WHO project: Mental Health Services in Pilot Study Areas, 21 centers in 16 European countries collected a cohort of 200 consecutive new out-, day- and inpatients in 1979/1980 and followed them up for a period of 2 years. Since in most countries the elderly constitute a rapidly growing proportion of the population, with increasing demands on the mental health services, the collected data concerning the elderly were examined in detail. The results show that it is possible to study elderly people in care with data from a more general study. There are considerable differences among the elderly in the use of mental health services in the various areas, which can only be partly explained by differences in the age distribution of the various populations. The diagnostic distribution of elderly patients, and the type and amount of care delivered within the same diagnostic group, differ widely from area to area. Trieste offers a good example of day care as an alternative to inpatient care, even for elderly patients with organic psychosis.

The feasibility of cost-benefit studies of mental health care. An attempt with a Dutch Case Register.

A cohort of 928 people, aged 20 to 60 years, were entered in a Dutch Case Register for the first time as outpatients during the period from 1974 to 1977. They were each followed up for 1 year in order to identify patterns of care and calculate their cost. The latter was calculated for groups of patients, according to diagnosis and type of service at entry. This approach required registering face-to-face contacts for each patient, and close collaboration with the services involved, to calculate costs.

Patterns of mental health care for the elderly. A cohort study in a Dutch register area.

Four cohorts of patients of 65 years or more who had contact with a mental health service in the first 3 months of 1975, 1977, 1979 and 1981 were followed for 1 year to study their pattern of care. Data were collected in a psychiatric case register covering a town of approximately 45,000 inhabitants in the north of the Netherlands. Patterns of care were analysed for various diagnostic groups. Findings suggest that the socially determined age of retirement of 65 years, makes less sense from a psychiatric point of view. Typical disorders of the aged, such as dementia manifest themselves in significant numbers at a much older age.

[Day care for psychogeriatric nursing home patients in 1979]. / Dagbehandleing voor psychogeriatrische patiënten in verpleeghuizen anno 1979.

Recently day care facilities are available for psychogeriatric patients. With a national survey we tried to get insight into how and where in 1979 the day care facilities for psychogeriatric patients in The Netherlands were functioning. The data collected revealed that this type of care is yet only on a small scale -- and not evenly spread out over the country -- available. The ratio of nursing home beds and of day-care places per thousand of the population of 65 years and older varies from province to province. A description is given of the organization of the day-care facility, the staffing and the coordination of the treatment offered. About half of the patients who finished the day-treatment in 1979 after a period of five to six months of care, were admitted to an intramural health service. We have tried to find reasons for this. Poor contact between the staff of the day-care facility and others like the general practitioner and the social psychogeriatric outpatient service might be a reason, the capacity of nursing home beds another.

Mental illness, neuroticism and life events in a Dutch village sample: a follow-up.

In a 5-year follow-up of 32 patients identified during a survey of a Dutch village in 1969, approximately two-thirds were found to have recovered. This result was reflected in the scores on a self-reporting questionnaire. A control group showed little change over those years. The persistence of psychiatric problems was related to life experience, as measured by a life-event interview.