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Suicide and attempted suicide among older adults in Western Australia

PSYCHOLOGICAL MEDICINE 2000年第4期30卷 813-821页

作者： Lawrence, D Almeida, OP Hulse, GK Jablensky, AV Holman, CDJ Univ Western Australia Dept Psychiat & Behav Sci Queen Elizabeth II Med Ctr Perth WA 6009 Australia Univ Western Australia Dept Publ Hlth Perth WA 6009 Australia

Background. Suicide rates are high in later life. Risk factors include male sex and depressive illness. This study investigated the relationship between suicidal behaviour and contact with mental health services among the elderly in Western Australia. Methods. Record linkage was used to obtain records of hospital admissions and mental health service contacts for all suicide attempts and deaths in the period 1980-95. Standardized incidence ratios were calculated for the elderly, general population and people with mental health service contacts. Cox regression was used to evaluated potential risk factors for elderly people who were in contact with mental health services. Results. People over 60 years of age accounted for 15 % of suicides and 4.6 % of attempted suicides. Suicide rates were 3.3 times higher in males and 4.4 times higher in females when compared to the general population of elderly people. For attempted suicide, the rate was 5.8 times higher in males and 6.6 times higher in females with prior contact with mental health services. Highest risk of suicide was found in patients with diagnoses of affective psychoses (RR = 3.7), adjustment reaction (RR = 3.2) or depressive disorder (RR = 2.8). The diagnosis of cancer was associated with decreased risk of suicide (RR = 3.6) and attempted suicide (RR = 1.9). Conclusions. Suicide rates are high among the elderly in Western Australia. Suicide is significantly associated with the diagnosis of mood disorder. Suicide attempts are less common, and are associated most strongly with mood and personality disorders. The decreased risk of self-harm behaviour among patients with cancer warrants further investigation.

关键词：年龄分布社区精神卫生服务/统计学和数值数据老年人保健服务/统计学和数值数据发病率情绪障碍/流行病学情绪障碍/心理学肿瘤/流行病学肿瘤/心理学人格障碍/流行病学人格障碍/心理学人群监测比例危险度模型危险危险因素性别分布自杀/心理学自杀/统计学和数值数据自杀未遂/心理学自杀未遂/统计学和数值数据西澳大利亚/流行病学老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Consequences of anxiety in older persons: its effect on disability, well-being and use of health services

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PSYCHOLOGICAL MEDICINE 1999年第3期29卷 583-593页

作者： de Beurs, E Beekman, ATF van Balkom, AJLM Deeg, DJH van Dyck, R van Tilburg, W Vrije Univ Amsterdam Dept Psychiat NL-1075 BG Amsterdam Netherlands Vrije Univ Amsterdam Inst Res Extramural Med NL-1075 BG Amsterdam Netherlands

Background. Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources. Methods, Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables. Results. Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low. Conclusions. Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

关键词：衰老/生理学焦虑症/诊断焦虑症/心理学社区精神卫生服务/统计学和数值数据残疾人/心理学健康状况荷兰精神病状态评定量表老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Homeless youth in London: II. Accommodation, employment and health outcomes at 1 year

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PSYCHOLOGICAL MEDICINE 2000年第1期30卷 187-194页

作者： Craig, TKJ Hodson, S St Thomas Hosp Div Psychiat & Psychol London SE1 7EH England

Background. While there is considerable evidence of a high prevalence of psychiatric disorder among homeless youth, much less is known about its long-term course or the impact it may have on accommodation outcomes. Method. A random sample of 161 homeless people 16-21 years of age were recruited from consecutive attendees at two of London's largest facilities for homeless young people. These young people were traced and re-interviewed a year later to examine accommodation, occupation and health outcomes. Results. A total of 107 (67%) people were successfully re-interviewed. Psychiatric disorder was identified in 55% at follow up. Two thirds of those with a psychiatric disorder at index interview remained symptomatic at follow-up. Persistence of psychiatric disorder was associated with adverse childhood experiences and rough sleeping. Satisfactory accommodation outcomes were achieved by 45 subjects (42 %). Better accommodation outcomes were associated with three variables measured at the index assessment: ethnic minority status;educational achievement;and, the presence of accommodation plans negotiated through a resettlement agency. While psychiatric disorder at index interview was not associated with accommodation outcome, persistent substance use in the follow-up year was associated with poor accommodation outcome. Over half of the young people had been involved in petty crime and just under a third had been convicted for more serious criminal activity. Offending and antisocial behaviour in the follow-up year were related to a history of conduct disorder, persistent substance abuse and poor accommodation outcomes. Conclusions. Young homeless people are characterized try multiple social and medical needs. Successful resettlement of this population may depend upon integrated services that address problems of persisting substance use and mental illness as well as the immediate housing need.

关键词：青少年保健服务/统计学和数值数据社区精神卫生服务/统计学和数值数据罪行/心理学就业无家可归青少年/心理学精神障碍/病因学精神障碍/治疗治疗结果职业指导青少年成年人女(雌)性人类男(雄)性

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Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women

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COMMUNITY MENTAL HEALTH JOURNAL 1999年第6期35卷 515-530页

作者： Alvidrez, J Univ Calif San Francisco Dept Psychiat 401 Parnassus AveBox CPT 0984 San Francisco CA 94143 USA

This study examines the predictors of mental health service use among patients in an ethnically diverse public-care women's clinic. While waiting for their clinic appointments, 187 Latina, African American, and White women were interviewed about their attitudes towards mental illness and mental health services. White women were much more likely to have made a mental health visit in the past than the ethnic minority women. Having a substance use problem, use of mental health services by family or friends, and beliefs about causes of mental illness were all predictors of making a mental health visit.

关键词：非洲裔美国人/心理学健康态度社区精神卫生服务/统计学和数值数据文化特征人种群欧洲大陆世系人群/心理学预测西班牙裔美国人/心理学贫困偏见物质相关性障碍青少年成年人女(雌)性人类

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A risk-adjusted measure of hospitalization rates for evaluating community mental health program performance

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1999年第4期26卷 269-279页

作者： Banks, SM Pandiani, JA Schacht, L Gauvin, L Vermont Dept Dev & Mental Hlth Serv Waterbury VT 05671 USA

The authors describe the use of risk-adjusted hospitalization rates to measure community mental health treatment outcomes. The risk adjustment involves comparing rates of hospitalization subsequent to treatment with rates of hospitalization prior to treatment. The research uses a probabilistic methodology that reliably estimates caseload overlap by comparing the distribution of the dates of birth observed in data sets to the distribution of dates of birth in the general population. Findings indicate that risk-adjusted hospitalization rates are substantially different than unadjusted rates. Half of the community programs in one state consistently achieved positive outcomes in four consecutive years;other programs had mixed results or no change.

关键词：社区精神卫生服务/标准社区精神卫生服务/统计学和数值数据置信区间住院/统计学和数值数据结果评价(卫生保健)/方法概率方案评价/方法风险调节佛蒙特成年人女(雌)性人类男(雄)性中年人

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Criminal behavior and emotional disorder: Comparing youth served by the mental health and juvenile justice systems

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第2期27卷 227-237页

作者： Rosenblatt, JA Rosenblatt, A Biggs, EE Univ Calif San Francisco Child Serv Res Grp San Francisco CA 94104 USA

This study explored whether youth involved in joint service systems differed from single-agency users in terms of types of crimes committed and clinical functioning. Data from 4, 924 youth involved in one county's public mental health and juvenile justice service systems were examined. Twenty percent of those youth receiving mental health services had recent arrest records, and 30% of youth arrested received mental health services. Of all youth arrested in the county, mental health service users had more arrests than non-mental health service users. A subsample of 94 mental health service users with arrests was matched on demographics with 94 mental health service users without arrests. Youth with arrests had a higher frequency of conduct disorder higher Child Behavior Checklist Externalizing and Total Problem Scale scores, and more functional impairment on the Child and Adolescent Functional Assessment Scale as compared to youth without arrests. Implications for behavioral health service delivery were discussed.

关键词：加利福尼亚/流行病学病例对照研究社区精神卫生服务/组织和管理社区精神卫生服务/统计学和数值数据罪行/人种学罪行/心理学罪行/统计学和数值数据体内外控制青少年犯罪/人种学青少年犯罪/心理学青少年犯罪/统计学和数值数据精神障碍/并发症精神障碍/流行病学精神障碍/人种学精神障碍/心理学患病率精神病状态评定量表青少年儿童女(雌)性人类男(雄)性中年人

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Mental health services in the county jail: A critical partnership?

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PSYCHOLOGICAL REPORTS 1999年第3期84卷 1099-1104页

作者： Muzekari, LH Lonigan, CJ Hatton, AY Rowe, C Lexington Cty Community Mental Hlth Ctr W Columbia SC 29169 USA Florida State Univ Tallahassee FL 32306 USA Osawatomie State Hosp Osawatomie KS USA

This study was designed to provide a description of individuals incarcerated in a county jail and referred for mental health services. A standardized intake form was completed for 598 inmates who had contact with the mental health counselor. Analysis of the mental health status of inmates suggests that the presence of a counselor in the jail may serve an important function. Specifically, inmates referred ro the counselor were not in acute distress. This suggests they may be better served by an on-site counselor rather than through the traditional method of being transported to the hospital emergency room or community mental health center for evaluation.

关键词：社区精神卫生服务/统计学和数值数据合同业务/统计学和数值数据横断面研究卫生服务需求/统计学和数值数据精神障碍/诊断精神障碍/流行病学囚犯/心理学囚犯/统计学和数值数据转诊和会诊/统计学和数值数据南卡罗来纳/流行病学成年人女(雌)性人类男(雄)性

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Assessing behavioral health outcomes in outpatient programs: Reliability and validity of the BASIS-32

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第1期26卷 5-17页

作者： Eisen, SV Wilcox, M Leff, HS Schaefer, E Culhane, MA Harvard Univ McLean Hosp Sch Med Dept Mental Hlth Serv Res Belmont MA 02478 USA

The Behavior and Symptom Identification Scale (BASIS-32) was developed to assess mental health outcomes among patients with severe illness treated on inpatient programs. However;its applicability and utility to those treated in outpatient programs has not been determined The objective of this study war;to assess reliability, validity, and sensitivity to change of the BASIS-32 among mental health consumers treated in outpatient programs. A total of 407 outpatients completed the BASIS-32 and the Short Form Health Status Profile (SF-36) at the beginning of a treatment episode and again 30 to 90 days later Outpatients reported less difficulty at intake than did inpatients, and the BASIS-32 detected statistically significant changes 30 To 90 days after beginning outpatient treatment. Factor structure and construct validity were partially confirmed on this sample of outpatient consumers. Analyses of data from a wide range of facilities and samples would add to validation efforts and to further refinement of the BASIS-32.

关键词：门诊医疗/心理学门诊医疗/统计学和数值数据行为疗法/统计学和数值数据社区精神卫生服务/统计学和数值数据随访研究精神障碍/心理学精神障碍/康复结果与过程评价(卫生保健)/统计学和数值数据门诊部医院/统计学和数值数据个性量表/统计学和数值数据心理测定学结果可重复性青少年成年人老年人女(雌)性人类男(雄)性中年人

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Are school based mental health services effective? Evidence from 36 inner city schools

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COMMUNITY MENTAL HEALTH JOURNAL 1999年第6期35卷 493-504页

作者： Armbruster, P Lichtman, J Yale Univ Sch Med Ctr Child Study New Haven CT 06520 USA Yale Univ Sch Med Dept Neurol New Haven CT 06510 USA

In an effort to bridge the gap between service need and service utilization, an urban based, university-affiliated children's psychiatric outpatient clinic implemented a program which provides mental health services in inner city schools. Since impressions of school and mental health personnel affirmed the effectiveness of such services, an evaluation of this program was conducted, despite the difficulties inherent in implementing research in "naturalistic settings." A clinic sample of children (N = 220) was compared with a sample served in the urban schools (N = 256). The findings revealed that both sets of children showed improvement as indicated by the Children's Global Assessment Scale (C-GAS) and Global Assessment of Functioning Scale (GAF). The improvement was comparable, even though the school children were seen for a slightly shorter period of time (an average of 5 versus 8 months) but had an equally frequent level of service (3 sessions per month in each setting). This finding may have important implications for the managed care environment. These results indicate that school based mental health services show improvement comparable to the clinic-based services, and have the potential for bridging the gap between need and utilization by reaching disadvantaged children who would otherwise not have access to these services.

关键词：儿童行为社区精神卫生服务/标准社区精神卫生服务/统计学和数值数据卫生服务易得程度精神障碍/治疗结果评价(卫生保健) 贫困方案评价中小学生卫生保健服务/标准中小学生卫生保健服务/统计学和数值数据市区人口青少年儿童儿童学龄前女(雌)性人类男(雄)性

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