'If we would change things outside we wouldn't even need to go in ' supporting recovery via community-based actions: A focus group study on psychiatric rehospitalization.

BACKGROUND: Psychiatric rehospitalization is a complex phenomenon in need of more person-centred approaches. The current paper aimed to explore how community-based actions and daily life influence mental health and rehospitalization. DESIGN, SETTING AND PARTICIPANTS: The qualitative study included focus group data from six European countries including 59 participants. Data were thematically analysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health. RESULTS: Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (complementing services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning). DISCUSSION: Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal recovery. By articulating the value of these facilitators, we highlight benefits of a person-centred and recovery-focused approach also within the context of psychiatric rehospitalization. CONCLUSIONS: This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilitators, acknowledging the social determinants of mental health and personal recovery. PATIENT OR PUBLIC CONTRIBUTION: The current study included participants with experience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study.

Using national electronic health care registries for comparing the risk of psychiatric re-hospitalisation in six European countries: Opportunities and limitations.

Psychiatric re-hospitalisation rates have been of longstanding interest as health care quality metric for planners and policy makers, but are criticized for not being comparable across hospitals and countries due to measurement unclarities. The objectives of the present study were to explore the interoperability of national electronic routine health care registries of six European countries (Austria, Finland, Italy, Norway, Romania, Slovenia) and, by using variables found to be comparable, to calculate and compare re-hospitalisation rates and the associated risk factors. A "Methods Toolkit" was developed for exploring the interoperability of registry data and protocol led pilot studies were carried out. Problems encountered in this process are described. Using restricted but comparable data sets, up to twofold differences in psychiatric re-hospitalisation rates were found between countries for both a 30- and 365-day follow-up period. Cumulative incidence curves revealed noteworthy additional differences. Health system characteristics are discussed as potential causes for the differences. Multi-level logistic regression analyses showed that younger age and a diagnosis of schizophrenia/mania/bipolar disorder consistently increased the probability of psychiatric re-hospitalisation across countries. It is concluded that the advantage of having large unselected study populations of national electronic health care registries needs to be balanced against the considerable efforts to examine the interoperability of databases in cross-country comparisons.

The Role of Attitudes to, and the Frequency of, Domestic Violence Encounters in the Healthcare Professionals' Handling of Domestic Violence Cases.

BACKGROUND: Domestic violence is recognized as a public health problem with a high prevalence in the general population. Healthcare professionals play an important role in the recognition and treatment of domestic violence. Hence, conducting research on factors that facilitate or inhibit appropriate actions by healthcare professionals is of the upmost importance. The objective of the study was to examine the relationship between healthcare professionals' attitudes toward the acceptability of domestic violence and their responses when dealing with victims of domestic violence. METHODS: The sample consisted of 322 healthcare professionals (physicians, dentists, nursing staff and other healthcare workers; 85.2% female), who completed a questionnaire, assessing their attitudes towards domestic violence, experience, behaviour and perceived barriers in recognizing and treating domestic violence in the health care sector. The study was cross-sectional and used availability sampling. RESULTS: The results showed no significant differences in domestic violence acceptability attitudes when comparing groups of healthcare professionals who reported low or high frequency of domestic violence cases encounters. Furthermore, we found that domestic violence acceptability attitudes were negatively associated with action taking when the frequency of encounters with domestic violence cases was high and medium. However, the attitudes were not associated with action taking when the frequency of encounters with domestic violence cases was low. CONCLUSIONS: The results highlight the important role of attitudes in action taking of healthcare professionals when it comes to domestic violence. This indicates the need for educational interventions that specifically target healthcare professionals' attitudes towards domestic violence.

Psychiatric readmissions and their association with physical comorbidity: a systematic literature review.

BACKGROUND: Comorbidity between mental and physical disorder conditions is the rule rather than the exception. It is estimated that 25% of adult population have mental health condition and 68% of them suffer from comorbid medical condition. Readmission rates in psychiatric patients are high and we still lack understanding potential predictors of recidivism. Physical comorbidity could be one of important risk factors for psychiatric readmission. The aim of the present study was to review the impact of physical comorbidity variables on readmission after discharge from psychiatric or general inpatient care among patients with co-occurring psychiatric and medical conditions. METHODS: A comprehensive database search from January 1990 to June 2014 was performed in the following bibliographic databases: Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. An integrative research review was conducted on 23 observational studies. RESULTS: Six studies documented physical comorbidity variables only at admission/discharge and 17 also at readmission. The main body of studies supported the hypothesis that patients with mental disorders are at increased risk of readmission if they had co-occurring medical condition. The impact of physical comorbidity variables on psychiatric readmission was most frequently studied in in patients with affective and substance use disorders (SUD). Most common physical comorbidity variables with higher probability for psychiatric readmission were associated with certain category of psychiatric diagnoses. Chronic lung conditions, hepatitis C virus infection, hypertension and number of medical diagnoses were associated with increased risk of readmission in SUD; Charlson Comorbidity Index, somatic complaints, physical health problems with serious mental illnesses (schizophrenia, schizoaffective disorder, personality disorders); not specified medical illness, somatic complaints, number of medical diagnoses, hyperthyroidism with affective disorders (depression, bipolar disorder). Co-occurring physical and mental disorders can worsen patient's course of illness leading to hospital readmission also due to non-psychiatric reasons. CONCLUSIONS: The association between physical comorbidity and psychiatric readmission is still poorly understood phenomenon. Nevertheless, that physical comorbid conditions are more common among readmitted patients than single admission patients, their association with readmission can vary according to the nature of mental disorders, characteristics of study population, applied concept of comorbidity, and study protocol.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study.

BACKGROUND: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). METHODS: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or "Basic Stable Input of Care" (BSIC), coded by its principal function or "Main Type of Care" (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). RESULTS: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. CONCLUSION: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Psychometric properties of the Slovenian version of temperament evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A): temperament profiles in Slovenian university students.

BACKGROUND: TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a self-rated instrument that measures five affective temperaments: depressive, cyclothymic, hyperthymic, irritable, and anxious. The aim of our study was to examine the psychometric characteristics of the Slovenian TEMPS-A and to ascertain if temperament profile is related to the professions chosen by Slovenian students. METHODS: 892 Slovenian university students in six different professional fields (economics, geography, engineering, law, sports pedagogy and nursing) were included in our study. RESULTS: Cronbach's reliability coefficients denoted acceptable internal consistency of the subscales. Principal component analysis revealed relatively good internal structure of the instrument. Nursing and geography students scored the highest on depressive temperament. Sports pedagogues as well as engineers demonstrated the most firm personality structure with distinctive hyperthymic temperament. Law students revealed the most irritable temperament, while nursing and law students scored the highest on anxious temperament. LIMITATIONS: Sample of Slovenian students is not representative for general population. The structure of the sample was crucial as well, as it comprised mainly of younger students who just started their study. CONCLUSIONS: The Slovenian version of the TEMPS-A proved to have relatively good internal consistency and internal structure. The questionnaire verified as a reliable and valid instrument and generally in line with previous studies. This study strengthens the perspective that professional areas could be associated with distinct affective temperament profile that could influence career decisions. The findings in students of economics, geography, and sport pedagogy are new as they have not been previously investigated by TEMPS researchers. The results open new possibilities for future research.

Comorbid anxiety in patients with psychosis.

A diagnosis of psychosis has tended to discount the considerable degree of emotional disorder associated with it, in a manner that may also inform psychological treatment options. Depression and anxiety are often associated with schizophrenia. Up to 40% of people have clinical levels of depression and anxiety symptoms could occur in 60% of patients with chronic psychotic disorder. Among emotional problems depression and depressive symptoms are well recognised and treated with success, whereas anxiety is a less known phenomenon and has not been studied as much as depression. Comorbid anxiety disorders or symptoms (social phobia, panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder) occur in patients with psychosis in the same way as in patients who have only anxiety disorder. This comorbidity adversely affects outcome, and it may also reflect on processes underlying the development of psychotic symptoms. The present review highlights some major characteristics of anxiety and psychosis and also some aspects of coping and treatment strategies for anxiety in patients with psychosis.

Assessment of mental health services in Slovenia with The European Service Mapping Schedule.

The aim of our study was to examine availability and utilization of mental health services in the 12 Slovenian statistical regions by using the The European Service Mapping Schedule (ESMS) methodology. 251 mental health services were mapped according to their type as presented in schema of ESMS service tree. Marked differences between regions were noticed in patterns of service provision and utilization. In contrast with the scarcity of mental health services in the Zasavska and Notranjsko-kraska region, the Central-Slovenian region offered the most diverse and abundant choice of services of all statistical regions. We lack day and structured activity services offering work or work-related activities. Out-patient and community services are mainly medium intensity non-mobile services that offer continuing care.

A preliminary report on the implementation of the European Service and Mapping Schedule (ESMS) in Slovenia to map preventive and promotion activities in mental health.

OBJECTIVE: Mental health promotion and mental disorder prevention can reduce the risk for mental and behavioural disorders and decreased social welfare and health costs. The aim of the present study was to map and analyse prevention and promotion activities and programmes in the mental health area in Slovenia. SUBJECTS: The selection of services for a study was performed using the database of the Agency of the Republic of Slovenia for Public Legal Records and Related Services, internet and other accessible sources METHODS: The Slovenian translation of ESMS was used for mapping the services in the mental health area. RESULTS: The initial sample from above mentioned sources contained 84 services working in the mental health area in 12 Slovenian statistical regions. At present 516 services were contacted and 172 did not comply with inclusion criteria. The 162 services from all 12 Slovenian statistical geographical regions have been mapped and their activities and characteristics analysed. CONCLUSIONS: The analysis of the approaches to mental disorder prevention revealed that the most frequent approaches were selective primary prevention in 27.9% and tertiary prevention in 28.2% of cases.

Behavioural inhibition system (BIS) and behavioural activation system (BAS) as predictors of emotional and cognitive deficits observed in alcohol abstainers.

OBJECTIVE: The purpose of the present study was to determine which aspects of motivational, cognitive and emotional functioning were impaired in a group of alcoholics after 8 weeks of abstinence. We also examined the clinical applicability of the BIS/BAS Scales (Carver & White 1994) used in order to identify a potential association between behavioural inhibition / activation tendencies and emotional and cognitive deficits in alcohol abstainers. SUBJECTS AND METHODS: 33 right- handed middle- aged (mean age 45.0 years) male alcohol inpatients in treatment and 36 healthy volunteers without a previous drinking history, matched for age, education and handedness participated in the study. Both groups were assessed with the composite of tests in the following domains: motivation, attention, emotional processing, visuospatial functioning and working memory. RESULTS: Alcohol abstainers revealed heightened BAS sensitivity, more pronounced depressive symptoms and attentional deficits compared to controls, while working memory and visuospatial abilities did not significantly differ between the groups. Elevated BAS sensitivity correlated with the length of abstinence, whereas BIS sensitivity associated with the presence of suicidal history and with selective attention difficulties. CONCLUSIONS: Our research confirmed several previous studies that some cognitive and visuospatial deficits could improve during alcohol abstinence, while motivational tendencies, attentional and emotional functioning take longer to recover. Application of the BIS/BAS Scales proved a useful instrument for assessment of the alcohol abstainers' rehabilitation process. In this regard, when planning treatment programmes for alcoholics, approach and withdrawal motivational tendencies, neuropsychological dysfunctions and psychiatric comorbidity should be considered.

Survey of domestic violence among young adolescents in Slovenia.

OBJECTIVE: It has been estimated that domestic violence is wide spread in Slovenia, but the lack of empirical data of domestic violence prevalence and its consequences, aggravate the precise knowledge on the extension of the phenomenon. The aim of the study was to assess the extensiveness and characteristics of domestic violence in the group of Slovenian adolescents. SUBJECTS: 1297 young adolescents (age 13-15 years) from 65 Slovenian primary schools participated in the study. METHODS: A questionnaire for domestic violence experience and help seeking screening, McMaster Family Functioning Scale, Buss/Perry Aggression Questionnaire and Trauma Symptom Checklist for Children (TSCC) have been applied. RESULTS: 18.7% of participants experienced violence in their own family (38.3% males and 61.7% females). Different patterns of verbal violence, irritability and indirect violence predominated. In the most cases of domestic violence the adolescent's parents were involved as perpetrators and their close relatives (brothers, sisters). Victims displayed a significant profile that could be linked with their violence experience: dysfunctional family environmental, aggressiveness, anxiety, depression, anger and posttraumatic stress symptoms. CONCLUSIONS: Presented study confirmed that the phenomenon of domestic violence and abused adolescents is quite widespread in Slovenia and that in the future more attention on research and policy making level should be given to this phenomenon. Particularly the perceived gap between attitudes towards support and the actually given help could be the orientation for developing a better prevention strategies and screening procedures for domestic violence. A proper intervention and protection of the adolescent victims could effectively prevent the outburst of depression, suicide, behavioural problems and, spreading the aggressive behaviour patterns to the future generations.