johanna cresswell-smith

Purpose: To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health.
Methods: Systematic reviews, controlled trials and realist evaluations of the last 10 years are reviewed, without age or geographical restrictions.
Results: Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level
interventions, such as poverty alleviation or youth guarantee, is quite restricted.
Conclusions: The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but
it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.

Civil society in general is widely recognised as having an important role in addressing the social determinants of health. Non-governmental organisations (NGOs) have a long history of mental health actions, ranging from mental health promotion and advocacy to volunteer work and service provision. An explicit focus on the social determinants of mental health is a more recent development. In this article we review relevant literature on NGO actions on key social determinants of mental health: family; friends and communities; education and skills; good work; money and resources; housing; and surroundings. Searching of relevant bibliographic databases was combined with searching for relevant grey literature to identify relevant evidence and practice on the work of NGOs in this field. We reflect on the inherent tensions involved in understanding the role of NGOs in taking action on the social determinants of mental health and the critical questions raised as a result. Our review highlights a lack of documented evidence of NGO actions, and underscores the significant untapped potential of civil society to contribute to the Mental Health in All Policies (MHiAP) agenda.

Objective: The aim of this study is to identify and appraise existing instruments to evaluate mental well-being in old age.

Method: Systematic literature searches in PubMed, PsycINFO, ProQuest Research Library, AgeLine and CINAHL databases were performed. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline was used to assess the measurement properties, reported according to the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) statement. For each measurement property, results were classified as positive, negative or indeterminate. The quality level of evidence was rated as high, moderate, low or very low following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results: A total of 28 instruments were found. Most instruments evaluated different dimensions of mental well-being, including various subscales. The quality was adequate overall. Six instruments showed high quality (Perceived Well-Being Scale-PWB, Salamon-Conte Life Satisfaction in the Elderly Scale-SCLSES, Herth Hope Scale-HHS, Life Satisfaction Index Third Age-LSITA, Meaning in Life Scale-MLS, and SODdisfazione dell’Anziano-SODA), and other six a moderate level (Scale of Happiness of the Memorial University of Newfoundland-MUNSH, Six Scales of Psychological Well-Being-PWBS, Valuation Of Life-VOL, Life Satisfaction Scale for Chinese Elders-LSS-C, Meaningful Activity Participation Assessment-MAPA and Will To Life-WTL).

Conclusion: This review provides the first comprehensive synthesis of instruments assessing mental well-being in older populations. The PWB, SCLSES, HHS, LSITA, MLS and SODA were the most appropriated instruments. An instrument that specifically measures mental well-being in the oldest old age group (aged 80 plus) and that considers its multidimensional nature is needed.

Purpose The aims of our study are: to explore rehospitalization in mental health services across Italian regions, Local Health Districts (LHDs), and hospitals; to examine the predictive power of different clinical and organizational factors. Methods The data set included adult patients resident in Italy discharged from a general hospital episode with a main psychiatric diagnosis in 2012. Independent variables at the individual, hospital, LHD, and region levels were used. Outcome variables were individual-level readmission and LHD-level readmission rate to any hospital at 1-year follow-up. The association with readmission of each variable was assessed through both single-and multi-level logistic regression; descriptive statistics were provided to assess geographical variation. Relevance of contextual effects was investigated through a series of random-effects regressions without covariates. Results The national 1-year readmission rate was 43.0%, with a cross-regional coefficient of variation of 6.28%. Predictors of readmission were: admission in the same LHD as residence, psychotic disorder, higher length of stay (LoS), higher rate of public beds in the LHD; protective factors were: young age, involuntary admission, and intermediate number of public healthcare staff at the LHD level. Contextual factors turned out to affect readmission only to a limited degree. Conclusions Homogeneity of readmission rates across regions, LHDs, hospitals, and groups of patients may be considered as a positive feature in terms of equity of the mental healthcare system. Our results highlight that readmission is mainly determined by individual-level factors. Future research is needed to better explore the relationship between readmission and LoS, discharge decision, and resource availability.

[ENGLISH ABSTRACT BELOW]
Lähtökohdat
Psykiatrisen sairaalahoidon toistuminen riippuu potilaasta ja hoitojärjestelmästä. Selvitimme sairaalaan palaamisen esiintyvyyttä ja yhteyttä paluuta edeltävään avohoitoon sairaanhoitopiireittäin.

Menetelmät
Rekisteritutkimusaineisto kattaa 16 814 potilasta (18–97 v), jotka olivat psykiatrisista syistä osastohoidossa v. 2012. Heidän perusterveydenhuollon ja erikoissairaanhoidon käyttöään seurattiin 12 kk:n ajan uloskirjauksesta.

Tulokset
Potilaista 40 % palasi psykiatriseen sairaalahoitoon. Sairaanhoitopiirien erot olivat suuret (28–53 %). Terveydenhuollon avohoitokäynti viikon kuluessa uloskirjauksesta oli 51 %:lla potilaista (34–69 %). 8 %:lla ei ollut avohoitokäyntejä sairaalajakson jälkeen, ja heillä riski palata sairaalahoitoon oli suurin.

Päätelmät
Alueellinen vaihtelu paluussa sairaalaan voi selittyä osin hoidon järjestämisestä ja toteutumisesta uloskirjauksen jälkeen. Jo yksi avohoitokäynti liittyi merkitsevästi pienempään paluuriskiin. Sairaalaan palaavien osuus ja avohoito uloskirjauksen jälkeen kuvaavat palvelujärjestelmän laatua.

ENGLISH ABSTRACT
Background. Psychiatric re-hospitalisation is dependent on patient level factors as well as health system level factors. Low re-hospitalisation rates are often considered a positive quality indicator in terms of mental health services. This study sets out to investigate psychiatric re-hospitalisation and its predictors on hospital district level in Finland.

Methods. The register-based study consisted of nationwide data on 16,814 adult patients (18–97 years of age) hospitalised with a psychiatric diagnosis (ICD-10 categories F2–F6) for a minimum period of 24 hours in the year 2012. Health service use was followed for 12 months, starting from date of discharge. Data were obtained from the Care Register for Health Care (Hilmo) and the Register of Primary Health Care Visits (AvoHilmo). Specialised and primary care outpatient contacts were examined. Statistical analysis was performed as frequency analysis and logistic regression with re-hospitalisation as the dependent variable.

Results. A total of 40% of patients were re-hospitalised into psychiatric inpatient care within a year (re-hospitalisation rate varying between hospital districts from 28–53%). Altogether 51% of patients received an outpatient appointment within one week from hospital discharge, while 8% received no outpatient contact at all during the 12-month follow-up. Typically, those who received outpatient care had 2.3 visits per month. The rate of psychiatric re-hospitalisation was highest for those who received no outpatient contact at all.

Conclusions Regional differences in psychiatric re-hospitalisation rates can to some extent be explained by health service organisation. Health services should direct more attention to the early weeks following hospital discharge. Even one contact with outpatient services resulted in a decreased risk of re-hospitalisation. Low levels of unplanned psychiatric re-hospitalisation rates, together with a seamless transition to outpatient services following discharge are both promising health service quality indicators. These indicators could benefit from regular regional follow-up.