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      Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis

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          Abstract

          Background

          Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders.

          Methods

          This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records.

          Results

          The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).

          Conclusions

          As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.

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          Most cited references31

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          Schizophrenia and employment - a review.

          Little is known about the extent to which work contributes to the recovery of people with schizophrenia. There is increasing interest in the subject because of new service models and the economic cost of unemployment in people with severe mental illness. A literature search was carried out with the aim of investigating: a). employment rates in schizophrenia and first-episode psychosis and the extent to which they have changed over time; b). the barriers to work; c). the factors associated with being employed among people with schizophrenia; and d). whether employment influences other outcomes in schizophrenia. There are wide variations in reported employment rates in schizophrenia. Most recent European studies report rates between 10 % and 20%, while the rate in the US is less clear. There is a higher level of employment among first-episode patients. The employment rate in schizophrenia appears to have declined over the last 50 years in the UK. Barriers to getting employment include stigma,discrimination, fear of loss of benefits and a lack of appropriate professional help. The most consistent predictor of employment is previous work history. Working is correlated with positive outcomes in social functioning, symptom levels, quality of life and self esteem, but a clear causal relationship has not been established. Very low employment rates are not intrinsic to schizophrenia, but appear to reflect an interplay between the social and economic pressures that patients face, the labour market and psychological and social barriers to working.
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            Multiple imputation: current perspectives.

            This paper provides an overview of multiple imputation and current perspectives on its use in medical research. We begin with a brief review of the problem of handling missing data in general and place multiple imputation in this context, emphasizing its relevance for longitudinal clinical trials and observational studies with missing covariates. We outline how multiple imputation proceeds in practice and then sketch its rationale. We explore the problem of obtaining proper imputations in some detail and distinguish two main classes of approach, methods based on fully multivariate models, and those that iterate conditional univariate models. We show how the use of so-called uncongenial imputation models are particularly valuable for sensitivity analyses and also for certain analyses in clinical trial settings. We also touch upon other forms of sensitivity analysis that use multiple imputation. Finally, we give some open questions that the increasing use of multiple imputation has thrown up, which we believe are useful directions for future research.
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              Quality of life in patients with schizophrenia in five European countries: the EPSILON study.

              To compare subjective quality of life (QOL) and objective QOL indicators in patients with schizophrenia from five European sites: Amsterdam, Copenhagen, London, Santander and Verona. A representative sample of 404 patients with schizophrenia, in contact with mental health services, was randomly selected and evaluated with the Lancashire Quality of Life Profile (EU). The level of satisfaction in certain domains, religion, family and social relations appears to be associated with local style of living and culture while work, finances, and safety were more independent from local variations. In addition to the severity of symptoms, frequency of contacts with family, friendship and age appear as predictors of QOL, all of them influenced by the characteristics of the surroundings. The centres participating in the study presented differences in subjective measures of QOL, objective indicators and also in service provision and styles of living.
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                Author and article information

                Journal
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central
                1472-6963
                2011
                7 October 2011
                : 11
                : 257
                Affiliations
                [1 ]Research Unit Distrito Sanitario Malaga, IMABIS Fundation. Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Spain. (Research network "redIAPP", "SAMSERAP" group
                [2 ]Psychiatric Service, University Hospital Carlos Haya, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group
                [3 ]Psychiatric Service, University Hospital Carlos Haya, Malaga, Spain
                [4 ]Community Mental Health Centre "Guadalmedina". University Hospital Carlos Haya, Malaga, Spain (Research network "redIAPP", "SAMSERAP" group
                [5 ]Community Mental Health Centre "Centro". University Hospital Carlos Haya, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group
                [6 ]Research Unit Distrito Sanitario Malaga, IMABIS Foundation, Malaga, Spain, (Research network "redIAPP", "SAMSERAP" group
                [7 ]Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain, (Research network "redIAPP", "SM-SJ de Déu" group
                [8 ]Health Centre El Palo. Research Unit Distrito Sanitario Málaga (Research network "redIAPP", "SAMSERAP" group). Department of Preventive Medicine, University of Malaga, Spain
                Article
                1472-6963-11-257
                10.1186/1472-6963-11-257
                3210099
                21982430
                ef4c5477-bfe6-4d7d-a99e-5d193f5497c0
                Copyright ©2011 Moreno et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 March 2011
                : 7 October 2011
                Categories
                Research Article

                Health & Social care
                Health & Social care

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