The five-year evolution of a mixed psychiatric and somatic care unit: a European experience.

BACKGROUND: There are virtually no reported experiences of mixed medical/psychiatry inpatient units in Europe. Such a program was created in Geneva, Switzerland, in 1999. OBJECTIVE: The authors retrospectively analyzed clinical data from its first 5 years of operation. METHOD: These data represent 1,380 hospitalizations. A descriptive analysis was carried out on all collected data for each year of activity. RESULTS: The severity of physical disorders increased with time. The number of medical comorbidities, length of hospital stay, and compulsory admissions increased. The proportion of mood disorders decreased, whereas the proportion of psychotic and adjustment disorders increased. CONCLUSION: Patients with comorbid medical and psychiatric disorders are often refused admission to both medical and psychiatric wards. Once they are admitted, they are often released prematurely or transferred to another ward too quickly because of behavioral management difficulties. Physicians who refer patients to the unit recognize the complex nature of these cases and refer them because the unit is capable of offering acute psychiatric and medical treatments and provides an environment that encourages patient cooperation and treatment adherence.

Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees.

Refugees and asylum seekers have a high risk of developing mental health problems and appropriate screening in people from diverse origins remains a challenge. The aim of this study was to validate a structured diagnostic interview, adapted from the Major Depressive Episode (MDE) and Posttraumatic Stress Disorder (PTSD) sections of the Mini International Neuropsychiatric Interview, to detect these disorders among newly arrived asylum seekers. The adapted questionnaire was administered by nurses in a primary care context and its performance was judged against the expert opinion of a mental health specialist. One hundred one subjects were included in the study (mean age: 30; origin: Africa 58%, Europe: 37%, Asia: 5%). MDE and PTSD were diagnosed among 33% and 30% of them respectively. The questionnaire demonstrated moderate sensitivity (MDE: 79%; PTSD: 69%), but high specificity (MDE: 95%; PTSD: 94%). These characteristics remained stable despite cultural differences and use of interpreters. This instrument could be used for systematic screening of MDE and PTSD in refugees from various origins.

Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context.

OBJECTIVE: To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers. METHOD: A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist). Second, we submitted the reworded and original versions of the MINI to 14 interpreters' who tested for general and cultural acceptability. Each diagnostic criterion was rated according to interpreters' comments on a 4-point Likert scale (1 = an item good for translation and 4 = an unusable or completely inadequate item). In the third step, we rephrased the most problematic items identified by the interpreters. RESULTS: Some original items were considered particularly ill-adapted for this context, and 4 had to be dropped. This final rewording took into account cultural inadequacies and lack of structure (including temporal organization) of the everyday life of newly arrived asylum seekers. CONCLUSION: The reworded MINI was successfully tested, and its items are presented in the final part of the study.