Trends in Psychiatric Inpatient Rates from 1991–1995 in the State of Washington: The Effect of Insurance Type on Utilization

This study examined whether there have been changes in inpatient psychiatric use among publicly and privately insured patients by analyzing trends in adult psychiatric hospitalizations from 1991 through 1995 in the State of Washington. A state-wide Comprehensive Hospital Abstract Reporting System (CHARS) was used to track psychiatric hospital utilization patterns. The results show a significant growth in psychiatric hospitalizations among the publicly insured patients due to their high proportion of severe and persistent mental illness. There was a flat trend in psychiatric hospitalizations suggesting that private insurers aggressively monitor the costly use of hospitalizations for mentally ill patients.     

Increased risk for complications following diagnostic cerebral angiography in older patients: Trends from the Nationwide Inpatient Sample (1999–2009)

The full utility of diagnostic cerebral angiography, an invasive cerebrovascular imaging technique, is currently debated. Our goal was to determine trends in diagnostic cerebral angiography utilization and associated complications from 1999 through 2009. The National Inpatient Sample (NIS) was used to identify patients who received primary cerebral angiography from 1999–2009 in the United States. We observed trends in discharge volume, total mean charge, and post-procedural complications for this population. Data was based on sample projections and analyzed using univariate and multivariate regression. There were a total of 424,105 discharges indicating primary cerebral angiography nationwide from 1999–2009. The majority of these cases (65%) were in patients older than 55 years. Embolic stroke was the most frequent complication, particularly in the oldest age bracket, occurring in 16,304 patients. The risk for complications increased with age (p < 0.0001) and with other underlying health conditions. Pulmonary, deep vein thrombosis, and renal associated comorbidities resulted in the greatest risk for developing post-procedural complications. Throughout the study period case volume for cerebral angiography remained constant while total charge per patient increased from $17,365 in 1999 to $45,339 in 2009 (p < 0.001). While the overall complication rate for this invasive procedure is relatively low, the potential risk for embolic stroke in older patients is significant. It is worth considering less invasive diagnostic techniques for an older and at risk patient population.     

Suicide Trends in Singapore: 1955–2004

The objective of this study was to investigate suicide trends in Singapore between 1955 and 2004. Suicide cases were identified from the Registry of Birth and Death, Singapore, and analyzed using Poisson regression. Overall, suicide rates in Singapore remained stable between 9.8–13.0/100,000 over the last 5 decades. Rates remain highest in elderly males, despite declines among the elderly and middle-aged males in recent years. Rates in ethnic Chinese and Indians were consistently higher than in Malays. While the rates among female Indians and Chinese have declined significantly between 1995 and 2004, some increase was noted in female Malays. Although there was no increase in overall suicide rates, risk within certain population segments has changed over time.     

Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units?

Youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates. Though specialized psychiatric units are effective, few specialized units exist. The ASD Care Pathway (ASD-CP) was developed as a scalable approach to improving care in general psychiatric units through staff training and a package of autism-specific intervention strategies. An evaluation of the effectiveness of the ASD-CP in a public hospital child psychiatric service compared 18 months (n?=?17) versus 18 months (n?=?20) post implementation. Average length of hospital stay decreased 40% (22.4–13.4 days) and use of crisis interventions decreased 77% (holds/restraints; 0.65/day to 0.15/day), though each result only approached statistical significance (p?=?0.07; 0.057). This study provides preliminary evidence for improved outcomes after implementation of an ASD-CP.     

Inpatients’ and Providers’ Experiences with User Involvement in Inpatient Care

A qualitative study of inpatients’ perspectives on what it means to be involved in their own care, and providers’ experiences with encouraging user involvement in care planning and service provision is reported. Twenty semi-structured interviews with inpatients, fourteen log reports from providers and sixteen sets of written minutes from staff meetings constitute the study data. Differences were found between inpatient and provider perspectives. Inpatients reported few opportunities to have meaningful input in the decision-making regarding their care, while providers reported difficulty engaging inpatients into discussions or care planning. Although participants described providers as nice, understanding and supportive, these qualities did not always translate into their feeling seen and heard as unique individuals. When experiencing difficulty in engaging inpatients in existing forms of treatment, providers reported being aware of few options for them to try in increasing user involvement. Such different perspectives will need to be addressed in future efforts to increase service user involvement in inpatient care.     

Trends in Autism Spectrum Disorder Diagnoses: 1994–2007

We analyzed predictors of parent-reported initial diagnosis (autistic disorder [AD], pervasive developmental disorder-not otherwise specified [PDD-NOS], pervasive developmental disorder [‘PDD’] and autism spectrum disorder [‘ASD’], and Asperger syndrome [AS]), among 6,176 individuals with autism spectrum disorders diagnosed from 1994 through 2007. Overall, distribution of diagnoses was influenced by a secular time trend factor; other significant factors included ethnicity, white race, geographic location, urbanicity, and initial evaluator. Since 2001, most initial diagnoses of AD and AS have remained steady while ‘PDD’ and PDD-NOS have decreased. ‘ASD’ diagnoses have increased, especially among school-based teams; AS diagnoses also increased uniquely among these evaluators. Findings from this study suggest that current diagnostic guidelines may not be meeting all community evaluator needs.

Trends in non-help-seeking for mental disorders in Germany between 1997–1999 and 2009–2012: a repeated cross-sectional study

Purpose

This study sought to examine trends in non-help-seeking for mental disorders among persons with a prevalent mental disorder (12-month prevalence) in Germany between 1997–1999 and 2009–2012.

Methods

We examined data from 1909 persons aged 18–65 years who participated in two independent, repeated cross-sectional surveys (German National Interview and Examination Study 1997–1999, German Health Interview and Examination Survey for Adults 2009–2012) conducted 12 years apart. Prevalent mental disorders (12-month prevalence) were determined using the Composite International Diagnostic Interview, which included information on lifetime help-seeking for mental health problems. Correlates of self-reported help-seeking were analyzed according to Andersen’s Behavioral Model. Multivariable Poisson regression models were used to assess time trends in the directly standardized and model-adjusted prevalence of non-help-seeking across strata of socio-economic and clinical variables.

Results

The proportion of people with a prevalent mental disorder who have never sought help in their lifetime decreased significantly from 62% (95% CI 58.7–64.7) to 57% (95% CI 52.2–60.9) between 1997–1999 and 2009–2012 in adults aged 18–65 years in Germany. Downward trends in non-help-seeking occurred in all investigated strata and reached statistical significance in women, in people who were living alone, people with medium educational level, people living in middle-sized communities, people with non-statutory health insurance, smokers, and people with co-existing somatic conditions.

Conclusion

Despite a downward trend over the course of 12 years, a large proportion of people suffering from mental disorders are still not seeking treatment in Germany. Further efforts to increase uptake of help-seeking for mental disorders in hard-to-reach groups are warranted to continue this trend.

     

Medicaid Spending Differences for Child/Youth Community-Based Care in California’s Decentralized Public Mental Health System

This study evaluated spending differences across counties during the decade after California decentralized its public mental health system. Medicaid data for 0–25 year olds using mental health services were collapsed to the county-year level (n = 627). Multivariate models with county fixed effects were used to predict per capita spending for community-based mental health care. While counties increased their spending over time, those with relatively low initial expenditures per user continued to spend less than counties with historically higher spending levels. Spending differences per user were most noticeable in counties with larger racial/ethnic minority populations that also had historically lower spending levels.     

Trends in New York State secure care patients: 1980–1982

Demographic and clinical characteristics of patients in special security units in New York State psychiatric centers are examined over time. The percentage of recently dangerous patients increased dramatically over the first three years of official operation. In addition, there were increases in the percentages of patients with physical problems, alcohol/drug problems, and mental retardation diagnoses.I would like to express my appreciation to Henry J. Steadman for comments and suggestions on earlier drafts.     

Gambling Trends in the State of New Mexico: 1996–1998

New Mexico experienced a surge in the gaming industry during the mid-1990s with the initiation of a state lottery and other new gaming opportunities, as well as the development of many Indian gaming establishments. This paper explores patterns associated with gambling in two random samples of the adult population (N = 2674) in the entire State of New Mexico in 1996 and 1998. Specifically, the purpose of this paper is to describe the relationship between gambling and such variables as age, gender, and ethnicity. Overall, an increase occurred in the number of people who reported having ever gambled, from 86.4% in 1996 to 92.5% in 1998. From 1996 to 1998, respondents’ reports of their past month gambling showed that certain forms of gambling (e.g., playing cards and betting on animals for money) decreased, while other forms of gambling either remained unchanged or increased in frequency (e.g., sports and investment gambling). The relationship of gender and age to gambling was also examined. Survey results indicated that while males and females reported many similar gambling habits, there are gender differences, particularly with regard to investment gambling. Specifically, females show a greater increase in investment gambling from 1996 to 1998, than do males. Overall results indicate a small positive correlation between age and dollar amount spent on gambling in the past month. In addition, ethnicity and age-specific patterns for certain forms of gambling are described.