Community health services and risk of readmission in public psychiatric hospitals of Belo Horizonte, Brazil, 2005-2011.

INTRODUCTION: The readmission phenomenon in psychiatry not only reflects the severity and chronicity of the underlying disorders, but also indicates the quality of mental healthcare. In the context of the Brazilian mental healthcare reform, no study has included the availability of outpatient care among the potential determinants for psychiatric readmission. OBJECTIVE: To correlate the availability of community healthcare resources at the place of residence with the risk of psychiatric readmission. METHODS: All admission records from 2005 to 2011 in the two public psychiatric hospitals of Belo Horizonte were included (n=19,723). Variables related to patients and characteristics of hospitalization were collected, and indicators of community healthcare coverage were calculated for each place of residence yearly. The outcome of interest was early (<7 days), medium-term (8-30 days) and late (31-365 days) readmissions. The analysis was based on Cox regressions. RESULTS: The coverage of basic health units and of psychiatrists was associated with lower readmission risks. Coverage of specialized centers for psychosocial attention (Centros de Atenção Psicossocial [CAPS]) and psychologists did not show any protective effects. Young, male patients and those residing outside the capital had greater risk of early readmission. Compared to other psychotic disorders, mood disorders and neurotic disorders were seen as protective factors for readmission. CONCLUSION: Regionalized attention offered by the CAPS did not result in reduced readmission risks.

Community health services and risk of readmission in public psychiatric hospitals of Belo Horizonte, Brazil, 2005-2011 / Cobertura de serviços extra-hospitalares e risco de reinternação nos hospitais psiquiátricos públicos de Belo Horizonte, 2005 a 2011

Abstract Introduction The readmission phenomenon in psychiatry not only reflects the severity and chronicity of the underlying disorders, but also indicates the quality of mental healthcare. In the context of the Brazilian mental healthcare reform, no study has included the availability of outpatient care among the potential determinants for psychiatric readmission. Objective To correlate the availability of community healthcare resources at the place of residence with the risk of psychiatric readmission. Methods All admission records from 2005 to 2011 in the two public psychiatric hospitals of Belo Horizonte were included (n=19,723). Variables related to patients and characteristics of hospitalization were collected, and indicators of community healthcare coverage were calculated for each place of residence yearly. The outcome of interest was early (<7 days), medium-term (8-30 days) and late (31-365 days) readmissions. The analysis was based on Cox regressions. Results The coverage of basic health units and of psychiatrists was associated with lower readmission risks. Coverage of specialized centers for psychosocial attention (Centros de Atenção Psicossocial [CAPS]) and psychologists did not show any protective effects. Young, male patients and those residing outside the capital had greater risk of early readmission. Compared to other psychotic disorders, mood disorders and neurotic disorders were seen as protective factors for readmission. Conclusion Regionalized attention offered by the CAPS did not result in reduced readmission risks.

Resumo Introdução O fenômeno da reinternação psiquiátrica reflete não apenas a gravidade e cronicidade da doença de base, mas também a qualidade dos serviços de saúde. Ainda não há estudos incluindo a disponibilidade de recursos assistenciais extra-hospitalares como preditor da readmissão psiquiátrica, no contexto da reforma da assistência à saúde mental brasileira. Objetivo Correlacionar a disponibilidade de recursos de assistência extra-hospitalar das localidades de residência com o risco de readmissão psiquiátrica. Métodos Foram analisados todos os registros de internações ocorridas de 2005 a 2011 nos dois hospitais psiquiátricos públicos de Belo Horizonte (n=19.723). Foram coletadas variáveis relativas aos pacientes e às características da internação, e calculados indicadores de cobertura em saúde extra-hospitalar para cada localidade de residência e ano. O desfecho de interesse foi a reinternação precoce (<7 dias), de médio prazo (8-30 dias) e tardia (31-365 dias). A análise se deu por regressões de Cox. Resultados A cobertura de unidades básicas de saúde e de psiquiatras se associou a menores riscos de reinternação. A cobertura de Centros de Atenção Psicossocial (CAPS) e de psicólogos não apresentou efeitos protetores. Pacientes jovens e do sexo masculino, assim como os residentes fora da capital, tiveram risco maior de reinternação precoce. Em comparação com outros transtornos psicóticos, os transtornos de humor e os transtornos neuróticos se apresentaram como fatores protetores para a reinternação. Conclusão A atenção regionalizada oferecida pelos CAPS não resultou em riscos reduzidos de reinternação.

Further evidence of seasonality of mania in the tropics.

BACKGROUND: Findings from various temperate regions have quite consistently shown a spring/summer peak for the occurrence of manic episodes, but inconsistencies can still be found in results from tropical regions. The present study was designed to investigate the seasonal distribution of mania and its correlations to climatic variables, in a large sample of patients visiting the emergency psychiatric room. METHODS: A hospital registry of 5172 emergency psychiatric visits for mania, 2000-2007, at a public psychiatric hospital at Belo Horizonte, Brazil (latitude 19 degrees 55' S), was analyzed. Seasonality was assessed with Cosinor Analysis. Correlations of the rate of admissions for mania to climatic variables were performed, including lagged and differenced data. RESULTS: A minor, but significant seasonal pattern was evidenced, with a late winter/spring peak and the nadir in February (late summer). The regression model including secular and seasonal components explained 44.4% of the variance of visits for mania. The rate of emergency visits for mania was negatively correlated to relative humidity and rainfall. Altogether, climatic variables explained 8.1% of the variance in the rate of emergency visits for mania. LIMITATIONS: Using hospital registry data may have led to misclassification of diagnosis. The ecologic design does not account for seasonal evolution of individual cases. CONCLUSION: Emergency psychiatric visits for mania were more frequent in late winter/spring, corresponding to the drier seasons of Belo Horizonte. Seasonality of mania in the tropics was corroborated by these results.