[Long-term patients in supported housing after deinstitutionalisation--part V of the Berlin Deinstitutionalisation Study]. / Langzeitpatienten im Betreuten Wohnen nach der Enthospitalisierung--Teil V der Berliner Enthospitalisierungsstudie.

OBJECTIVE: In part IV of the Berlin Deinstitutionalisation Study, we reported a positive change in quality of life for 65 resettled patients one year after discharge. In this part, we investigated changes in a longer follow-up period. METHODS: A group of 66 patients discharged into supported housing was assessed one and five years after baseline. Quality of life, needs for care, patients' assessment of treatment, re-hospitalisation and characteristics of care were studied in a control-group design. RESULTS: After five years, 61 % of the patients continued to live in highly staffed settings (mean staff-patient-ratio: 1 : 3.5). Eleven percent had moved on to independent living and 16 % had returned into an institutional setting. Standard mortality ratios were 4.4 (all causes of death) and 62.5 (2 suicides only of schizophrenic patients). After one year patients (n = 20) showed a significant increase in satisfaction with their living situation and more social contacts. Over the longer period of time, there were also favourable changes, which failed to reach statistical significance (n = 24). Average length of inpatient stay per year of the illness was decreased significantly at both follow-ups. CONCLUSIONS: Interpretation of the findings is difficult because of the small sample size and selection effects. Most of the former long-stay patients appear able to live in the community with a significant decrease of time spent in hospital. Whilst patients were particularly satisfied with their accommodation at one year follow-up, this did not lead to a generalised improvement in subjective quality of life and other subjective criteria in the long term. In line with other recent studies on community mental health care one may conclude that small case loads alone do not have major beneficial effects. Further research should evaluate more systematic and targeted models of mental health care in the community in general and of supported housing in particular.

[Quality of life in the course of deinstitutionalisation-- part IV of the Berlin Deinstitutionalisation Study]. / Lebensqualiät im Verlauf der Enthospitalisierung-Teil IV der Berliner Enthospitalisierungsstudie.

As part of the Berlin Deinstitutionalisation Study, quality of life was assessed in 142 patients at two points of time. Discharged patients were reassessed one year after discharge. Patients who stayed in hospital were reinterviewed 1 1/2-2 years after the initial assessment. Discharged patients had more leisure activities, more often a "good friend", and more frequent social contacts. They were less often victim of a crime within the last year. In a cross-sectional comparison, they were significantly more satisfied with their life than patients who were still in hospital. In the latter group, only satisfaction with mental health improved significantly between first and second interview. Discharged patients became significantly more satisfied with their life in general, with leisure activities, with accommodation, and with mental health between initial assessment and follow-up. The findings demonstrate an improvement of quality of life in long-term hospitalised patients after discharge.

[Short assessment of subjective quality of life. Application and results of a short form of the Berliner Lebensqualitätprofil (BELP-KF)]. / Zur Kurzerfassung subjektiver Lebensqualität. Ergebnisse der Erprobung einer Kurzform des Berliner Lebensqualitätsprofils (BELP-KF).

The concurrent validity between the Berliner Lebensqualitätsprofil (BELP) and a new developed short form (BELP-KF) was tested in a sample of schizophrenia outpatients (N = 36) and turned out to be very high. The restriction to subjective quality of life questions did not lead to a greater halo-effect in the sense of an increasing similarity of single item values. Correlations with psychopathological symptoms were almost identical for both interview-versions. The same is true concerning the factorial structure of the satisfaction items which was nearly congruent. Two optional items on satisfaction with sexual life and with psychopharmacological treatment, which had been included into the short interview version, were attributable to an underlying general satisfaction dimension. Among 14 variables satisfaction with psychopharmacological treatment had the second highest factor-loading on the resulting general satisfaction factor.

[Discharge in inpatient care. Results of a survey. Postscript to part III of the Berlin Deinstitutionalization Study]. / Entlassungen in vollstationäre Einrichtungen. Ergebnisse einer Umfrage. Postskriptum zu Teil III der Berliner Enthospitalisierungsstudie.

PURPOSE: 42 percent long-term patients from the Berlin Deinstitutionalization Study sample have been discharged to full-time institutional settings. METHODS: The questionnaires of a mail-survey covered features of 58 different non-hospital full-time institutional settings and care for a group of 125 long-term mental patients. RESULTS: The return rate was more than 70 percent. For 78 percent of the discharged former long-term inpatients the political goal of complete psychiatric care in the patient's home area has been reached, but only 20 percent live in smaller institutions of up to 40 places. CONCLUSIONS: The significance of other data of the survey does not exceed that of stock-taking and certain indications because of the selective data and the limitations of the method. There is an urgent need for further research in examining the quality of non-hospital institutional care for psychiatric long-term patients.

[How does the quality of life of long-term hospitalized psychiatric patients change after their discharge into the community?]. / Wie verändert sich die Lebensqualität langzeithospitalisierter psychiatrischer Patienten nach ihrer Entlassung in die Gemeinde?

In the Berlin deinstitutionalisation study, quality of life in 134 long-term hospitalised psychiatric patients was examined twice: Discharged patients were interviewed again one year after their return to the community, whereas patients who continued to be hospitalised were reinterviewed after 1(1/2)-2 years after the first interview. Quality of life was assessed by the Berlin Quality of Life Profile. Four groups were distinguished in the analysis: 1. patients who continued as inpatients in the same hospital, 2. patients who had been referred to other hospitals, 3. patients who had been discharged after less than one year of continuous inpatient care, and 4. patients discharged after more then one year of hospital care. The four groups differed significantly in several sociodemographic and illness-related variables. Regarding the objective quality of life data, the four groups differed significantly in respect of the spheres leisure, social contacts and safety at follow-up. Discharged patients had more leisure activities, more often a "good friend", and more frequent social contacts within the last week. They had been less often victim to a crime. In a cross-sectional analysis, the four groups showed significant differences regarding subjective quality of life in the spheres accommodation and safety. In a longitudinal analysis, no group showed any significant negative changes. Positive changes were found in the group of patients formerly hospitalised for more than a year most often: satisfaction with leisure activities, with the financial situation, and with accommodation improved significantly during the follow-up period. Results show a marked and significant improvement in the objective and subjective quality of life indicators in formerly long-term hospitalised patients after discharge.

[Treatment prognosis and discharge 2 years later. III. Berlin Deinstitutionalization Study]. / Behandlerprognosen und Entlassungen nach zwei Jahren. Teil III der Berliner Enthospitalisierungsstudie.

In a two-year follow-up we report on discharges in a cohort of 422 middle-term and long-term inpatients and prognoses of their psychiatrists and psychologists concerning time of discharge and location, after 50% long-term patients with a present stay of more than two years and 82% of middle-term patients (stay: 6-24 months) had been discharged. More than one-third of the long-term patients could be placed in sheltered accommodation, but 42% are still referred to nursing homes. All together 68% are still in institutional settings--either as inpatients or in nursing homes. Prognoses were not very reliable concerning the time of discharge but substantial with regard to placement in sheltered accommodation. This can be interpreted as a result of successful co-operation between inpatient and community-based services.

Profiles of subjective quality of life in schizophrenic in- and out-patient samples.

For the use of subjective quality of life as an evaluation criterion, it should be known if measures are reliable, to what extent they are influenced by other variables and whether differences and similarities can be detected across treatment situations. Quality of life profiles (Berliner Lebensqualitatsprofil/Lancashire Quality of Life Profile) of 440 schizophrenic patients (from Berlin, Germany and from Wales, UK) were examined. Reliabilities differed between life domains and groups. The influence of other variables was moderate and varied between the groups. Several significant differences between subsamples could be shown between in-patients with a shorter present stay and out-patients. In addition, interesting similarities in profile patterns between in-patients with a longer stay (> or = 2 years) and out-patients can be found. Being admitted to a psychiatric hospital seems to have an influence on the level and structure of subjective quality of life for some time. Being in a psychiatric hospital for a longer time seems to coincide with a stabilization of level and structure of subjective quality of life. Future reports on subjective quality of life should include diagnostically homogeneous sampling and control the correlation with psychopathology. Further research is needed to clarify the impact of other variables (e.g. length of stay, cognitive variables, treatment features) on patients' satisfaction in different settings.

[Quality of life, needs and treatment evaluation of long-term hospitalized patients. Part II of the Berlin Deinstitutionalization Study]. / Lebensqualität, Bedürfnisse und Behandlungsbewertung langzeithospitalisierter Patienten. Teil II der Berliner Enthospitalisierungsstudie.

OBJECTIVE: Objective living situation, subjective quality of life, need for care, and assessment of treatment of long-term hospitalised patients were investigated. METHODS: 237 patients from 6 hospitals were examined using standardised instruments. RESULTS: Patients' satisfaction was generally relatively high, but varied greatly in subgroups and individuals. Patients were most satisfied with personal safety in the hospital and least satisfied with the expectation to live in the hospital for a long time. Therapists assessed clearly more needs for care in the patients than the patients did themselves. Statistical analysis revealed significant correlations between the subjective quality of life in different domains, the number of needs stated and plausible determining factors. CONCLUSIONS: Findings reflecting patients' living situation in the hospital are very heterogeneous. In respect of subjective evaluation criteria, there is little space for improvement in the future.

[Subjective quality of life of patients with chronic schizophrenia]. / Subjektive Lebensqualität bei Patienten mit chronischer Schizophrenie.

The main results of quality of life research in sociology and social psychology and the findings of psychiatric studies on subjective quality of life are summarized. The present study examined subjective quality of life in patients with chronic schizophrenia in different treatment settings (n = 318/ICD 10:F20). The satisfaction scales of the instrument used (Berliner Lebensqualitätsprofil) are shown to have adequate consistency coefficients. Psychopathological variables accounted for more variance than demographic and illness-related characteristics and features of objective quality of life. Negative schizophrenic symptoms were not of particular concern, and anxiety/depression scores did not interact with satisfaction ratings in different settings. Two of nine domains (living situation and mental health) and the total scores showed significant differences between patients in different settings. The degree of contrast between in- and out-patients seemed to be influenced by the current length of stay of the in-patients. In addition to cross-sectional studies, there is a need for further examination of differences in subjective quality of life and in treatment effects in longitudinal studies, which should make use of panel designs.

[Clinical characteristics of long-term hospitalized patients. Part I of the Berlin Deinstitutionalization Study]. / Klinische Merkmale Langzeithospitalisierter Patienten. Teil I der Berliner Enthospitalisierungsstudie.

The Berlin Deinstitutionalization Study investigates effects of the planned reduction of psychiatric hospital beds in Berlin prospectively. In the beginning cross-sectional survey all adult psychiatric patients from two and a half districts, who had been hospitalized for more than 6 months, were examined. The total sample was 422 patients. Treatment situation and needs for nursing care are reported. The primary diagnosis according to ICD-10 was organic disorder (incl. Korsakov's syndrome) in 70 patients and mental retardation in 61. Psychopathology and social disabilities were examined in 237 of the remaining 291 patients. On average, psychopathology and disabilities were moderate. A cluster analysis classified three groups. When patients should be discharged, special protective measures might be necessary only for the two smaller groups (together 31%).