Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of the 1978 psychiatric reform.

A survey to analyse patients' characteristics and the care delivered to them was conducted in several psychiatric facilities, covering the whole range of care offered in the public sector in two regions of Southern Italy. A case-control method of analysis was chosen, and the relative risk estimates (RR), together with their 95% confidence intervals (CI), of being in custodial facilities were computed, comparing patients treated in custodial institutions ('cases') with those in community-based services ('controls') in respect of social and clinical variables. Factors more strongly associated with custodial treatment were: illiteracy (RR = 2.4), unmarried status (RR = 2.4), a history of prolonged illness (RR = 7.6), organic diagnosis (RR = 2.6), previous custodial treatment (RR = 3.9), and expected poor social functioning (RR = 2.4). The suitability and advantages of the case-control method of analysis in the field of psychiatric care evaluation are discussed.