Integrating mental health into primary care in Arkhangelsk County, Russia: the Pomor model in psychiatry.

BACKGROUND: Primary health care is still peripheral in the identification and treatment of mental health and substance use disorders in the Russian Federation. However, the development of primary health services has been given priority. A long-standing collaboration between Arkhangelsk County and northern Norway on mental health service development in Arkhangelsk has promoted the integration of mental health into primary care. AIM: To develop a model for mental health integration into primary care adapted to the conditions in Arkhangelsk County. METHODS: (a) Situational assessment, (b) development of a model for systematic cooperation between GPs and specialists, (c) initial evaluation of the model, (d) implementation and dissemination of the model. RESULTS: A local studies revealed major shortcomings in GPs' diagnostic and treatment skills and in their collaboration with specialists in psychiatry. In order to promote better communication between GPs and specialists in this desolate and sparsely populated geographical area, an information communication technology (ICT)-based competence centre was established at a specialised community mental health centre in Arkhangelsk city (APND). Through a network including APND and involved primary health care centres, GPs gained access to specialists' expertise when required in their work with psychiatric patients. GPs assess all patients' mental health condition and treatment responsibility for patients in need of mental health care is divided between GPs and specialists according to problem severity. APND has the formal responsibility for ensuring that this collaboration with the health centres is established and practiced. Training in diagnostics and conversation skills ensures basic professional competence in the GPs. Initial evaluation showed that patients, GPs and specialists were satisfied with their experiences. The model is currently under implementation in 50% of the districts of the county. CONCLUSION: Our cooperation has led to the development and implementation of a model for mental health care integration into primary care in an area with major geographical distances. Further improvements will be based on systematic evaluation of experiences with the model.

Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway.

BACKGROUND: More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures. METHODS: An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality. RESULTS: The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients. CONCLUSIONS: Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway.

BACKGROUND: We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. METHOD: All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics. RESULTS: Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. CONCLUSION: Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services ("dispensaries"). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

Psychometric evaluation of the Ward Atmosphere Scale in a Russian psychiatric hospital.

AIM: The aim of the study was to evaluate the psychometric properties of the 10 subscales of the Ward Atmosphere Scale (WAS) in a Russian psychiatric hospital. METHODS: A total of 212 patients and 96 staff members at five wards for acute psychiatric patients completed the WAS. We calculated Cronbach's alpha, the Corrected Item Total Subscale Correlation (CITC), and item-revised subscale intercorrelations. RESULTS: By removing a total of 32 items, the psychometric properties for all subscales except "Autonomy", reached an acceptable level for the patient scores. Although several of the revised subscales were highly intercorrelated, the specificity of the items of the revised scales appeared acceptable. CONCLUSIONS: The revised WAS version appeared applicable within this Russian psychiatric hospital context. Several of the items that were dropped appeared inapplicable because of differences between Russian and Western culture and psychiatry.

The effect of gender in diagnosing early schizophrenia--an experimental case simulation study.

BACKGROUND: Studies of diagnostic practice confirm that there is a diagnostic delay in diagnosing women with schizophrenia compared to diagnosing men. The aim of the present study was to investigate the diagnostic practice of Norwegian and Russian psychiatrists when it comes to early psychosis, emphasising gender differences. We wanted to study the association between patient gender as such and diagnostic decision-making among psychiatrists. MATERIALS AND METHODS: Psychiatrists in Norway and the Archangels region in Russia were invited to participate in a study of diagnostic practice, and received a written case description of a patient with early psychosis symptoms that could be interpreted as schizophrenia. They were, however, not informed that 50% of them received a female case description and 50% a male case description. Apart from the patient being described as "he" or "she" the stories were identical. Effects of patient gender, clinician gender, age and main area of interest were estimated using logistic regression analysis. RESULTS: A total of 467 psychiatrists answered the questionnaire. We found that schizophrenia diagnosis was given significantly more often to the male case than to the female case. Our finding remained significant after adjustment for country, clinician gender, age and main area of interest, and is unlikely to be explained by known biases. CONCLUSION: Patient gender in itself affects clinicians' diagnostic practice regarding schizophrenia, as schizophrenia diagnosis is given significantly more often to a male case description than to a female one, the descriptions being otherwise identical.