Barbara Lay1, Wulf Rössler. 1. Psychiatrische Universitätsklinik Zürich, Forschungsbereich Klinische und Soziale Psychiatrie. barbara.lay@bli.uzh.ch
Abstract
OBJECTIVE: The study addresses changes in the use of inpatient psychiatric treatment during the life course in various mental disorders. METHODS: We analysed inpatient admissions from a defined catchment area (1.3 mill. people) over a 1-year period by means of register data. All patients aged 15-80 referred to a psychiatric hospital in the Canton of Zurich were included in the study (9'637 inpatient admissions). To model effects of age, gender and diagnostic group we used Poisson regression analysis. RESULTS: In terms of the absolute number of psychiatric admissions, results suggest a peak in middle aged people (30-40 years). Nevertheless, the risk of inpatient psychiatric admission in terms of treatment prevalence (1.6 per 10'000 population) remains rather stable over the life course in both genders. On the level of specific mental disorders (ICD-10 main categories), treatment prevalence varies significantly over the life course in all diagnostic groups and, except for organic mental disorders, between both genders. From a life course perspective, data strongly suggest specific profiles of inpatient use in any mental disorder whatsoever, not only in disorders of childhood and adolescence or of ageing. In males with psychotic disorder for instance, use of inpatient treatment decreases significantly (from 6.1 to 1.0 per 10'000) after the age of 30. Only in psychotic disorders there was a significant age-by-gender interaction effect regarding the use of inpatient psychiatric treatment. CONCLUSIONS: Neither the specific profiles of inpatient use across the life span nor the gender differences can be traced back to the morbidity rates of corresponding disorders at the respective ages, not even in serious chronic mental disorders. The findings there fore bear important implications for both clinical practice and health policy. They accentuate the need for efforts to ensure adequate treatment and continuity of care particularly for those patients at the more severe end of the spectrum of mental disorders.
OBJECTIVE: The study addresses changes in the use of inpatient psychiatric treatment during the life course in various mental disorders. METHODS: We analysed inpatient admissions from a defined catchment area (1.3 mill. people) over a 1-year period by means of register data. All patients aged 15-80 referred to a psychiatric hospital in the Canton of Zurich were included in the study (9'637 inpatient admissions). To model effects of age, gender and diagnostic group we used Poisson regression analysis. RESULTS: In terms of the absolute number of psychiatric admissions, results suggest a peak in middle aged people (30-40 years). Nevertheless, the risk of inpatient psychiatric admission in terms of treatment prevalence (1.6 per 10'000 population) remains rather stable over the life course in both genders. On the level of specific mental disorders (ICD-10 main categories), treatment prevalence varies significantly over the life course in all diagnostic groups and, except for organic mental disorders, between both genders. From a life course perspective, data strongly suggest specific profiles of inpatient use in any mental disorder whatsoever, not only in disorders of childhood and adolescence or of ageing. In males with psychotic disorder for instance, use of inpatient treatment decreases significantly (from 6.1 to 1.0 per 10'000) after the age of 30. Only in psychotic disorders there was a significant age-by-gender interaction effect regarding the use of inpatient psychiatric treatment. CONCLUSIONS: Neither the specific profiles of inpatient use across the life span nor the gender differences can be traced back to the morbidity rates of corresponding disorders at the respective ages, not even in serious chronic mental disorders. The findings there fore bear important implications for both clinical practice and health policy. They accentuate the need for efforts to ensure adequate treatment and continuity of care particularly for those patients at the more severe end of the spectrum of mental disorders.