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1.
Drug Alcohol Depend ; 229(Pt B): 109158, 2021 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-34784556

RESUMEN

AIM: We examined prevalence and factors associated with receiving perceived helpful alcohol use disorder (AUD) treatment, and persistence in help-seeking after earlier unhelpful treatment. METHODS: Data came from 27 community epidemiologic surveys of adults in 24 countries using the World Health Organization World Mental Health surveys (n = 93,843). Participants with a lifetime history of treated AUD were asked if they ever received helpful AUD treatment, and how many professionals they had talked to up to and including the first time they received helpful treatment (or how many ever, if they had not received helpful treatment). RESULTS: 11.8% of respondents with lifetime AUD reported ever obtaining treatment (n = 9378); of these, 44% reported that treatment was helpful. The probability of obtaining helpful treatment from the first professional seen was 21.8%; the conditional probability of subsequent professionals being helpful after earlier unhelpful treatment tended to decrease as more professionals were seen. The cumulative probability of receiving helpful treatment at least once increased from 21.8% after the first professional to 79.7% after the seventh professional seen, following earlier unhelpful treatment. However, the cumulative probability of persisting with up to seven professionals in the face of prior treatments being unhelpful was only 13.2%. CONCLUSION: Fewer than half of people with AUDs who sought treatment found treatment helpful; the most important factor was persistence in seeking further treatment if a previous professional had not helped. Future research should examine how to increase the likelihood that AUD treatment is found to be helpful on any given contact.

2.
Artículo en Inglés | MEDLINE | ID: mdl-34639847

RESUMEN

Evidence suggests that changes in alcohol consumption during the first months of the COVID-19 pandemic were unevenly distributed over consumer groups. We investigated possible inter-country differences in how changes in alcohol consumption are contingent on initial consumption (before or at the start of the pandemic), and how changes in consumption translate into possible changes in the prevalence of heavy drinking. We used data from the European Survey on Alcohol use and COVID-19 (ESAC) conducted in Czechia, Denmark, Finland, Germany, Norway, Poland, Spain, and the UK (N = 31921). Past-year alcohol consumption and changes in consumption were measured by AUDIT-C. Drinking habits were compared according to percentiles of pre-pandemic consumption levels, below versus above the 90th percentile. Across countries, drinkers in the highest 10% for pre-pandemic consumption increased their drinking during the pandemic, whereas absolute changes among those initially drinking below this level were modest. The percentage of people reporting >28 alcohol units/week increased significantly in seven of eight countries. During the first months of the COVID-19 pandemic, alcohol consumption in the upper decile of the drinkers increased as did the prevalence of heavy drinkers, in contrast with a declining consumption in other groups in the sample.


Asunto(s)
Intoxicación Alcohólica , COVID-19 , Consumo de Bebidas Alcohólicas/epidemiología , Humanos , Pandemias , SARS-CoV-2
3.
BMC Psychiatry ; 21(1): 392, 2021 08 09.
Artículo en Inglés | MEDLINE | ID: mdl-34372811

RESUMEN

BACKGROUND: Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. METHODS: Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. RESULTS: The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. CONCLUSIONS: The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.


Asunto(s)
Trastornos de Ansiedad , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/terapia , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Encuestas Epidemiológicas , Humanos , Prevalencia , Encuestas y Cuestionarios
4.
J Affect Disord ; 288: 199-209, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-33940429

RESUMEN

BACKGROUND: Although randomized trials show that specific phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey. METHODS: Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. RESULTS: 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments. LIMITATIONS: Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. CONCLUSIONS: Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.


Asunto(s)
Trastornos Mentales , Trastornos Fóbicos , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Aceptación de la Atención de Salud , Trastornos Fóbicos/terapia , Estudios Retrospectivos , Encuestas y Cuestionarios
5.
Soc Psychiatry Psychiatr Epidemiol ; 56(11): 1957-1965, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34031702

RESUMEN

PURPOSE: Providing effective treatment for immigrants is an increasing challenge for mental health services across Europe. Yet, little is known as to whether current practice is associated with different outcomes in migrant and non-migrant patients. We compared outcomes of inpatient psychiatric treatment for migrants and non-migrants in a sample from five European countries. METHODS: Patients with psychotic disorders, affective disorders or anxiety/somatisation disorders admitted to routine psychiatric inpatient treatment were assessed in hospitals in Belgium, Germany, Italy, Poland and the United Kingdom. Treatment outcomes were satisfaction with care during hospitalisation, length of stay, readmission to hospital (any and, specifically, involuntary re-hospitalisation), as well as untoward incidents in a 1-year follow-up period. Outcomes were compared between patients born inside (non-migrants) and outside (migrants) the country of treatment, through mixed regression models. RESULTS: Across all sites, 985 migrant patients and 6298 non-migrant patients were included. After accounting for the influence of confounding patient characteristics, migrants reported significantly lower treatment satisfaction, but there were no significant differences for length of stay and re-hospitalisations, in general and involuntary ones. Migrants had a lower rate of suicide attempts, but there was no significant difference in other types of untoward incidents in the year following the index admission. CONCLUSION: The study suggests that migrants are less satisfied with their hospital treatment, there is no evidence that routine inpatient care as currently provided results overall in poorer objective outcomes for migrants than in non-migrant populations.


Asunto(s)
Servicios de Salud Mental , Trastornos Psicóticos , Migrantes , Alemania , Hospitales Psiquiátricos , Humanos , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapia
6.
Int J Occup Med Environ Health ; 34(5): 591-602, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-33847309

RESUMEN

OBJECTIVES: The following analysis covers the role of the occupational structure in the prevalence of alcohol use disorders (AUDs). The authors investigated whether the occupational position affected the prevalence of AUDs among men and women, and how this relationship varied in lifetime and past year periods. MATERIAL AND METHODS: Data were taken from the General Population Survey on Mental Health in Poland (EZOP) utilizing the Composite International Diagnostic Interview questionnaire (N = 2806). Binary and multiple regression models were employed to assess the risk of AUDs adjusted for the occupational structure and socio-demographic variables. RESULTS: The occupational position affects the prevalence of AUDs in men, while it has no impact on AUDs in women. Skilled and non-skilled workers suffer from AUDs to a greater extent than those in higher occupational positions. However, the risk of alcohol harm in women seems to be equally distributed across the occupational structure. CONCLUSIONS: The uneven pattern of alcohol harm in men and women can be possibly explained by shifting working conditions and work environments, as well as traditional gender roles affecting alcohol behaviors. The findings of the study support further development of the occupational position concept in alcohol research. The problem of harmful alcohol drinking in women across the occupational structure warrants a more in-depth inquiry. Int J Occup Med Environ Health. 2021;34(5):591-602.


Asunto(s)
Alcoholismo , Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Femenino , Humanos , Masculino , Salud Mental , Polonia/epidemiología , Encuestas y Cuestionarios
7.
Addiction ; 116(8): 2016-2025, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33464658

RESUMEN

BACKGROUND AND AIMS: In recent decades, alcohol drinking in the European Union has been characterized by increasing homogenization of levels of drinking coupled with an overall decrease. This study examined whether we can still distinguish distinct practices of drinking by addressing two research questions: (1) are drinking practices still characterized by the choice of a certain alcoholic beverage; and (2) how do drinking practices vary across countries? DESIGN: Cross-sectional study: latent-class analyses of drinking variables and fractional response regression analyses of individual characteristics for individual-level class endorsement probabilities, respectively. SETTING: Nineteen European countries and one autonomous community. PARTICIPANTS: A total of 27 170 past-year drinkers aged 18-65 years in 2015. MEASUREMENTS: Data were collected through the Standardized European Alcohol Survey included frequency of past-year drinking, pure alcohol intake per drink day, occurrence of monthly risky single-occasion drinking and preferred beverage, together with socio-demographic data. FINDINGS: Three latent classes were identified: (1) light to moderate drinking without risky single-occasion drinking [prevalence: 68.0%, 95% confidence interval (CI) = 66.7-69.3], (2) infrequent heavy drinking (prevalence: 12.6%, 95% CI = 11.5-13.7) and (3) regular drinking with at least monthly risky single-occasion drinking (prevalence: 19.4%, 95% CI = 18.1-20.9). Drinking classes differed considerably in beverage preference, with women reporting a generally higher share of wine and men of beer drinking. Light to moderate drinking without risky single-occasion drinking was the predominant drinking practice in all locations except for Lithuania, where infrequent heavy drinking (class 2) was equally popular. Socio-demographic factors and individual alcohol harm experiences (rapid alcohol on-line screen) explained up to 20.5% of the variability in class endorsement. CONCLUSIONS: Beverage preference appears to remain a decisive indicator for distinguishing Europeans' drinking practices. In most European countries, multiple drinking practices appear to be present.


Asunto(s)
Consumo de Bebidas Alcohólicas , Bebidas Alcohólicas , Consumo de Bebidas Alcohólicas/epidemiología , Cerveza , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino
8.
J Affect Disord ; 279: 191-202, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33059222

RESUMEN

BACKGROUND: Most research on mental illness stigma has involved people with psychosis; less information is available for people with affective and anxiety disorders. We aimed to compare experienced and anticipated discrimination among people with schizophrenia, and affective and anxiety disorders. METHODS: People with schizophrenia (n=773), affective (n=1010) and anxiety disorders (n=372) were recruited during psychiatric admission across 5 EU countries. The Discrimination and Stigma Scale (DISC-12) was used. Multivariate mixed effect logistic regression models with a random effect for hospital and country were performed to explore patient characteristics associated with experienced and anticipated discrimination. RESULTS: With anxiety disorders, there were more reports of experiences of discrimination in social life (35%), intimate relationships (23.5%), and physical healthcare (19%); in schizophrenia, in relations with neighbours (23.6%) and mental health staff (21.7%); and in affective disorders, in parental role (22.8%). In multivariate analyses, anxiety was associated with increased likelihood of experiencing discrimination in police interactions (OR=1.675; p=0.038) and physical healthcare (OR=1.816; p=0.003), and reduced likelihood when starting a family (OR=0.474; p=0.01) as compared with schizophrenia. Affective (OR=1.367; p=0.004) and anxiety disorders (OR=1.354; p=0.034) were associated with increased likelihood of concealing a diagnosis compared with schizophrenia. LIMITATIONS: As patients with affective and anxiety disorders were recruited from hospital inpatient units, their experiences may not be representative of all people with these disorders. CONCLUSIONS: In a sample of people receiving inpatient treatment, experienced and anticipated discrimination are perceived, at least in some life domains, as more of a burden for people with affective and anxiety disorders than those with schizophrenia.


Asunto(s)
Esquizofrenia , Trastornos de Ansiedad/epidemiología , Europa (Continente) , Humanos , Salud Mental , Esquizofrenia/epidemiología , Estigma Social
9.
PLoS One ; 15(11): e0241433, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33201885

RESUMEN

In most epidemiological literature, harmful drinking-a drinking pattern recognized as closely linked to alcohol-attributable diseases-is recorded using the measure risky single-occasion drinking (RSOD), which is based on drinking above a certain quantity. In contrast, subjective intoxication (SI) as an alternative measure can provide additional information, including the drinker's subjective perceptions and cultural influences on alcohol consumption. However, there is a lack of research comparing both. The current article investigates this comparison, using data from the Standardized European Alcohol Survey from 2015. We analysed the data of 12,512 women and 12,516 men from 17 European countries and one region. We calculated survey-weighted prevalence of SI and RSOD and compared them using Spearman rank correlation and regression models. We examined the role of the required quantity of alcohol needed for the drinker to perceive impairments and analysed additional demographic and sociodemographic characteristics as well as drinking patterns. In the most locations, the prevalence of SI was lower or equal to the prevalence of RSOD. Both prevalence estimates were highly correlated. Almost 8% of the variance in the difference between the individual-level frequencies of the SI and RSOD measures was explained by the individual quantity of alcohol needed to perceive impairments. Sociodemographic characteristics and drinking patterns explained less than 20% in the adjusted perceived quantity of alcohol needed. In conclusion, our results indicated that subjective measures of intoxication are not a preferable indicator of harmful drinking to the more conventional measures of RSOD.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Adulto , Europa (Continente)/epidemiología , Femenino , Humanos , Modelos Lineales , Masculino , Prevalencia , Asunción de Riesgos , Tamaño de la Muestra
10.
Alcohol Alcohol ; 55(5): 554-563, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32491170

RESUMEN

AIMS: The aims of the article are (a) to estimate coverage rates (i.e. the proportion of 'real consumption' accounted for by a survey compared with more reliable aggregate consumption data) of the total, the recorded and the beverage-specific annual per capita consumption in 23 European countries, and (b) to investigate differences between regions, and other factors which might be associated with low coverage (prevalence of heavy episodic drinking [HED], survey methodology). METHODS: Survey data were derived from the Standardised European Alcohol Survey and Harmonising Alcohol-related Measures in European Surveys (number of surveys: 39, years of survey: 2008-2015, adults aged 20-64 years). Coverage rates were calculated at the aggregated level by dividing consumption estimates derived from the surveys by alcohol per capita estimates from a recent global modelling study. Fractional response regression models were used to examine the relative importance of the predictors. RESULTS: Large variation in coverage across European countries was observed (average total coverage: 36.5, 95% confidence interval [CI] [33.2; 39.8]), with lowest coverage found for spirits consumption (26.3, 95% CI [21.4; 31.3]). Regarding the second aim, the prevalence of HED was associated with wine- and spirits-specific coverage, explaining 10% in the respective variance. However, neither the consideration of regions nor survey methodology explained much of the variance in coverage estimates, regardless of the scenario. CONCLUSION: The results reiterate that alcohol survey data should not be used to compare or estimate aggregate consumption levels, which may be better reflected by statistics on recorded or total per capita consumption.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Anciano , Bebidas Alcohólicas/estadística & datos numéricos , Sesgo , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
11.
Soc Psychiatry Psychiatr Epidemiol ; 55(11): 1425-1438, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32409885

RESUMEN

PURPOSE: Long lengths of stay (LoS) in psychiatric hospitals or repeated admission may affect the social integration of patients with psychiatric disorders. So far, however, studies have been inconclusive. This study aimed to analyse whether long LoS or repeated admissions in psychiatric wards were associated in different ways with changes in the social integration of patients. METHODS: Within a prospective cohort study, data were collected on 2181 patients with a main ICD-10 diagnosis of psychotic, affective, or anxiety disorder, hospitalised in the UK, Italy, Germany, Poland, and Belgium in 2015. Social integration was measured at baseline and 1 year after admission using the SIX index, which includes four dimensions: employment, housing, family situation, and friendship. Regression models were performed to test the association between LoS, the number of admissions, and the change in social integration over the study period, controlling for patients' characteristics (trial registration ISRCTN40256812). RESULTS: A longer LoS was significantly associated with a decrease in social integration (ß = - 0.23, 95%CI - 0.32 to - 0.14, p = 0.03), particularly regarding employment (OR = 2.21, 95%CI 1.18-3.24, p = 0.02), housing (OR = 3.45, 95%CI 1.74-5.16, p < 0.001), and family situation (OR = 1.94, 95%CI 1.10-2.78, p = 0.04). In contrast, repeated admissions were only associated with a decrease in friendship contacts (OR = 1.15, 95CI% 1.08-1.22, p = 0.03). CONCLUSIONS: Results suggest that a longer hospital LoS is more strongly associated with a decrease in patients' social integration than repeated admissions. Special attention should be paid to helping patients to find and retain housing and employment while hospitalised for long periods.


Asunto(s)
Hospitales Psiquiátricos , Trastornos Mentales , Bélgica , Europa (Continente) , Alemania , Humanos , Italia , Tiempo de Internación , Trastornos Mentales/terapia , Polonia , Estudios Prospectivos , Integración Social
12.
Eur Addict Res ; 26(6): 316-325, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32114584

RESUMEN

INTRODUCTION: Unrecorded alcohol, that is, alcohol not reflected in official statistics of the country where it is consumed, contributes markedly to overall consumption of alcohol. However, empirical data on unrecorded alcohol consumption are scarce, especially in high-income countries. This study measures the contribution of unrecorded alcohol in 7 member states of the European Union. METHODS: Two categories of unrecorded consumption were assessed in general population surveys (reducing alcohol related harm Standardized European Alcohol Survey; n = 11,224): home-made alcohol and cross-border shopping. Country-specific logistic regressions were used to link respondent characteristics to odds of acquisition of unrecorded alcohol. Total per capita alcohol consumption was estimated under different assumptions of calculating unrecorded alcohol consumption. RESULTS: Individuals with higher drinking levels were more likely to acquire unrecorded alcohol in all 7 countries. In some countries, male sex and more affluent social class were also positively linked to acquisition of unrecorded alcohol. There was a substantial contribution of unrecorded alcohol to overall consumption in 5 out of 7 member states (Croatia, Finland, Greece, Hungary, Portugal), but not in Poland or Spain. In Greece, up to two-thirds of all alcohol consumed was estimated to be unrecorded. CONCLUSION: Unrecorded alcohol contributes to overall consumption even in high-income countries, and thus needs to be monitored. In monitoring, as many categories of unrecorded alcohol as possible should be clearly defined (e.g., surrogate alcohol) and included in future surveys.


Asunto(s)
Consumo de Bebidas Alcohólicas , Bebidas Alcohólicas , Consumo de Bebidas Alcohólicas/epidemiología , Bebidas Alcohólicas/estadística & datos numéricos , Unión Europea , Humanos , Encuestas y Cuestionarios
14.
Psychol Med ; 50(2): 284-292, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-30696510

RESUMEN

BACKGROUND: Patient satisfaction is a key indicator of inpatient care quality and is associated with clinical outcomes following admission. Different patient characteristics have been inconsistently linked with satisfaction. This study aims to overcome previous limitations by assessing which patient characteristics are associated with satisfaction within a large study of psychiatric inpatients conducted across five European countries. METHODS: All patients with a diagnosis of psychotic (F2), affective (F3) or anxiety/somataform (F4) disorder admitted to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and the UK were included. Data were collected from medical records and face-to-face interviews, with patients approached within 2 days of admission. Satisfaction with inpatient care was measured on the Client Assessment of Treatment Scale. RESULTS: Higher satisfaction scores were associated with being older, employed, living with others, having a close friend, less severe illness and a first admission. In contrast, higher education levels, comorbid personality disorder and involuntary admission were associated with lower levels of satisfaction. Although the same patient characteristics predicted satisfaction within the five countries, there were significant differences in overall satisfaction scores across countries. Compared to other countries, patients in the UK were significantly less satisfied with their inpatient care. CONCLUSIONS: Having a better understanding of patient satisfaction may enable services to improve the quality of care provided as well as clinical outcomes for all patients. Across countries, the same patient characteristics predict satisfaction, suggesting that similar analytical frameworks can and should be used when assessing satisfaction both nationally and internationally.


Asunto(s)
Pacientes Internos/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/normas , Satisfacción del Paciente , Adulto , Estudios Transversales , Europa (Continente) , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad
15.
Soc Psychiatry Psychiatr Epidemiol ; 55(2): 205-216, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31493010

RESUMEN

BACKGROUND: The current debate on organisation of the mental health care raises a question whether to prioritise specialisation of clinical teams or personal continuity of care. The article explores the experiences of patients and clinicians regarding specialisation (SC) and personal continuity (PCC) of care in five European countries. METHODS: Data were obtained via in-depth, semi-structured interviews with patients (N = 188) suffering from mental disorders (F20-49) and with clinicians (N = 63). A maximum variation sampling was applied to assume representation of patients and of clinicians with different characteristics. The qualitative data from each country were transcribed verbatim, coded and analysed through a thematic analysis method. RESULTS: Many positive experiences of patients and clinicians with the PCC approach relate to the high quality of therapeutic relationship and the smooth transition between hospital and community care. Many positive experiences of patients and clinicians with the SC approach relate to concepts of autonomy and choice and the higher adequacy of diagnosis and treatment. Clinicians stressed system aspects of providing mental health care: more effective management structure and higher professionalization of care within SC approach and the lower risk of disengagement from treatment and reduced need for coercion, restraint, forced medication or involuntary admission within PCC. CONCLUSIONS: Neither the PCC, nor the SC approach meets the needs and expectations of all patients (and clinicians). Therefore, future reforms of mental health services should offer a free choice of either approach, considering that there is no evidence of differences in patient outcomes between PCC and SC approaches.


Asunto(s)
Continuidad de la Atención al Paciente/organización & administración , Trastornos Mentales/psicología , Servicios de Salud Mental/organización & administración , Aceptación de la Atención de Salud/psicología , Especialización , Adulto , Actitud del Personal de Salud , Europa (Continente) , Femenino , Humanos , Masculino , Investigación Cualitativa , Proyectos de Investigación
16.
Addict Behav ; 102: 106128, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31865172

RESUMEN

BACKGROUND: Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities. METHODS: Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0. RESULTS: Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence. CONCLUSIONS: Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Trastornos Mentales/epidemiología , Salud Poblacional , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Prevalencia , Organización Mundial de la Salud
17.
Artículo en Inglés | MEDLINE | ID: mdl-31766281

RESUMEN

Alcohol policy endorsements have changed over time, probably interacting with the implementation and effectiveness of alcohol policy measures. The Standardized European Alcohol Survey (SEAS) evaluated public opinion toward alcohol policies in 20 European locations (19 countries and one subnational region) in 2015 and 2016 (n = 32,641; 18-64 years). On the basis of the SEAS report, we investigated regional differences and individual characteristics related to categories of alcohol policy endorsement. Latent class analysis was used to replicate cluster structure from the SEAS report and to examine individual probabilities of endorsement. Hierarchical quasi-binomial regression models were run to analyze the relative importance of variables of interest (supranational region, gender, age, educational achievement, and drinking status) on class endorsement probability, with random intercepts for each location. The highest support for alcohol control policies was recorded in Northern countries, which was in contrast to the Eastern countries, where the lowest support for control policies was found. Across all locations, positive attitudes toward control policies were associated with the female gender, older age, and abstaining from alcohol. Our findings underline the need to communicate alcohol-related harm and the implications of alcohol control policies to the public in order to increase awareness and support for such policies in the long run.


Asunto(s)
Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Consumo de Bebidas Alcohólicas/psicología , Adolescente , Adulto , Actitud , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Opinión Pública , Política Pública , Encuestas y Cuestionarios , Adulto Joven
18.
Alcohol Alcohol ; 54(3): 279-286, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-30989164

RESUMEN

AIMS: Treatment of patients with comorbidity of mental health problems and alcohol use disorder (AUD) constitutes a challenge in many countries. The article aimed at exploration of personal experiences of clinicians and patients with the comorbidity regarding its assessment, treatment and organization of care in Poland and the UK. METHODS: Data were collected via in-depth, semi-structured interviews with clinicians (N = 28) and patients (N = 81) in both countries, according to a unified study protocol. Maximum variation sampling was applied to both study groups. All interviews' transcripts were coded (CAQDA) and the consistency of coding across centres was assessed. Data analysis was performed according to the principles of thematic analysis. RESULTS: Our data show that most patients with AUD admitted at the psychiatric wards-apart from assessment which is a standard procedure during admission-receive only minimal support during their hospital stay. This is the consequence of two factors: lack of trained staff prepared to help those patients and a priority given to self-referrals by AUD units. At the same time, it is recognized by clinicians and patients that more support is needed to encourage the utilization of AUD services and to prevent the drop-out. CONCLUSIONS: In order to improve the system response, the use of screening instruments in the process of the assessment of AUD and establishment of special procedures supporting motivation and adherence to treatment and preventing drop-out merits consideration. Moreover, the psychiatric wards and the AUD services could possibly profit from formalization of the collaboration between services.


Asunto(s)
Alcoholismo/epidemiología , Alcoholismo/psicología , Actitud del Personal de Salud , Trastornos Mentales/epidemiología , Aceptación de la Atención de Salud/psicología , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Reino Unido/epidemiología
19.
Rocz Panstw Zakl Hig ; 70(4): 385-391, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31961101

RESUMEN

Background: A study reveals ­ against to common beliefs ­less support between rural area residents in comparison to town-dwellers and significantly higher support for healthy, not for poor health research participants. Objectives: The aim of our paper was comparing support from spouse/partner, relatives, friends and strangers among people with good and ill physical health. A next purpose was to find differences of social support and experience of social undermining in urban and rural residential settings. Material and methods: The study "Epidemiology of Mental Disorders and Access to Mental Health Care, EZOP ­ Poland" was carried out on random sample of 24 000 of Poland residents and a 50,4% response rate, 10 081 computerassisted personal interviews. Of those respondents, 4 000 constituted a sub-sample asked to complete the social networks and support section of the questionnaire. Data were analyzed by age, gender, residential setting and marital status for statistically significant differences in the percentage of functional and structural social support being reported, using the chi-squared test with a significance level of 0.05 used to reject the null hypothesis (H0 = lack of relationship between variables). Results: A majority of respondents maintain that in difficult life situations, family and a close network of friends and acquaintances make it possible to openly discuss problems and obtain help. However, respondents who rate their health as "poor" or "very poor" significantly less often than healthy individuals experience support coming from their relatives, friends, or strangers. In comparison to urban areas, the extent of social support in rural areas is significantly limited. The rural setting offers less support and even less opportunities for interaction with relatives, friends, acquaintances and strangers. Negative social factors­ low levels of trust, isolation from friends and family, lack of a social life, lack of a helpful neighborhood ­ are conditions significantly more often found in the countryside than in urban areas. Conclusions: Results obtained from the EZOP study shows that amount of social support received is higher in urban areas and among those who enjoy better physical health.


Asunto(s)
Estado de Salud , Características de la Residencia/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Red Social , Apoyo Social , Población Urbana/estadística & datos numéricos , Adulto , Femenino , Amigos , Conductas Relacionadas con la Salud , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Satisfacción Personal , Polonia , Adulto Joven
20.
Neuropsychopharmacol Hung ; 21(4): 152-163, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32015192

RESUMEN

BACKGROUND: The recent decade witnessed growing prevalence of novel psychoactive substances (NPS) among young people in Europe and elsewhere. The study, conducted in 2011 as part of the EU-funded ReDNet project, aimed at better understanding of motives behind the demand for NPS among youth as well as at their information needs in this regard. In addition to historical values, the lessons learned during the legal status of NPS may contribute to a more general understanding of use of new drugs and to current drug policies. METHOD: A self-administered anonymous questionnaire on NPS was completed via internet among young people from Hungary, Poland, the United Kingdom and the United States (N=1353) when NPS in general still enjoyed legal status. RESULTS: The majority of respondents (82%) used NPS in the last 12 months and approximately half of them experienced adverse effects from these substances. The most frequent motives behind NSP use were willingness to experiment with new substances. However, sense of security and confidence in their composition as legal products were also important drivers of their consumption. Desired psychoactive effects and risks associated with their use were rated as the two most vital pieces of information to improve their knowledge about NPS. CONCLUSIONS: There were some differences between participants representing different countries, however, the study also revealed many similarities, suggesting emergence of global youth consumption cultures, including NPS use. Provision of information on NPS, including their positive and negative effects, should play an important role in drug policies. Since the time of the study some qualities of NPS (such as confidence in their composition as well as quality and sense of security) may have deteriorated after delegalisation. On the other hand, opinions of NPS users suggest that delegalisation may have a deterrent effect for one third of their consumers while would not affect majority of them.


Asunto(s)
Consumidores de Drogas , Adolescente , Humanos , Hungría , Drogas Ilícitas , Polonia , Psicotrópicos , Reino Unido , Estados Unidos
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