RESUMEN
BACKGROUND: Intimate partner sexual violence (IPSV) is a common but often overlooked form of intimate partner violence (IPV) that may have unique consequences for those who experience it. We aimed to explore how outcomes associated with IPSV differ from outcomes associated with other forms of intimate partner and sexual violence. METHODS: We conducted a narrative review of the English-language literature, including original research studies and reports that focused on outcomes associated with IPSV. We aimed to quantify the risk for health outcomes associated with exposure to IPSV in comparison with exposure to other forms of interpersonal violence or nonexposure to interpersonal violence. RESULTS: Twenty-eight publications were reviewed, most were small observational studies focused on women exposed to IPSV. Reported outcomes were related to mental health (n = 20 studies), physical and sexual health (n = 19 studies), and health of children with a parent exposed to IPSV (n = 1 study). Compared with other forms of interpersonal violence, exposure to IPSV was associated with greater risk for posttraumatic stress disorder and depressive symptoms, problematic substance use, suicidality, pain and other somatic symptoms, adverse sexual health problems, specific physical injuries including strangulation, and death by homicide. Children with an exposed parent were at higher risk for internalizing symptoms such as depression, anxiety, and somatization. CONCLUSIONS: Sexual violence in intimate partner relationships is common and has distinct consequences compared with other forms of interpersonal violence including elevated risks for suicidality and death by homicide. It should be given special consideration within the assessment and management of interpersonal violence.
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Violencia de Pareja/psicología , Delitos Sexuales/psicología , Víctimas de Crimen/psicología , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , NarraciónRESUMEN
BACKGROUND: Diabetes is common among individuals with chronic psychotic illness, yet they receive lower quality of diabetes care than those without psychosis. Men usually receive higher quality diabetes care than women, but whether this holds true in chronic psychotic illness populations is unknown. We aimed to determine whether quality of diabetes care differs between men and women with chronic psychotic illness. METHODS: This population-based cohort study used Ontario health administrative data to compare women and men with comorbid chronic psychotic illness and diabetes mellitus (2011-2013). The primary outcome was adherence to diabetes monitoring guidelines, defined as ≥1 retinal exam, ≥4 hemoglobin A1c (HbA1c) tests, and ≥1 dyslipidemia test during a 2-year period. Logistic regression models compared women to men to generate adjusted odds ratios (aOR) and confidence intervals (95% CI), adjusting for potential confounding variables. RESULTS: Women with chronic psychotic illness (n = 13,972) were slightly more likely to receive guideline-adherent diabetes monitoring than men (n = 12,287) (25.2% vs. 23.0%; aOR 1.20, 95% CI 1.10-1.30), including a greater likelihood of receiving ≥1 retinal exam (aOR 1.13, 95% CI 1.08-1.19) and ≥4 HbA1c tests (aOR 1.06, 95% CI 1.01-1.12). There was no difference in receipt of ≥1 dyslipidemia test (aOR 1.04, 95% CI 0.99-1.11). CONCLUSIONS: Quality of diabetes monitoring is similarly poor in women and men with chronic psychotic illness, with women receiving only marginally more optimal monitoring than men. This differs from patterns in the general population, and could have implications when designing and implementing interventions to improve diabetes care in women and men with chronic psychotic illness.
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Diabetes Mellitus/terapia , Adhesión a Directriz , Trastornos Mentales/epidemiología , Calidad de la Atención de Salud , Factores Sexuales , Adulto , Anciano , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Ontario , Factores de Riesgo , Factores SocioeconómicosRESUMEN
PURPOSE: Psychiatric readmission is a common negative outcome. Predictors of readmission may differ by sex. This study aimed to derive and internally validate sex-specific models to predict 30-day psychiatric readmission. METHODS: We used population-level health administrative data to identify predictors of 30-day psychiatric readmission among women (n = 33,353) and men (n = 32,436) discharged from all psychiatric units in Ontario, Canada (2008-2011). Predictor variables included sociodemographics, health service utilization, and clinical characteristics. Using derivation data sets, multivariable logistic regression models were fit to determine optimal predictive models for each sex separately. Results were presented as adjusted odds ratios (aORs) and 95% confidence intervals (CI). The multivariable models were then applied in the internal validation data sets. RESULTS: The 30-day readmission rates were 9.3% (women) and 9.1% (men). Many predictors were consistent between women and men. For women only, personality disorder (aOR 1.21, 95% CI 1.03-1.42) and positive symptom score (aOR 1.41, 95% CI 1.09-1.82 for score of 1 vs. 0; aOR 1.44, 95% CI 1.26-1.64 for ≥ 2 vs. 0) increased odds of readmission. For men only, self-care problems at admission (aOR 1.20, 95% CI 1.06-1.36) and discharge (aOR 1.44, 95% CI 1.26-1.64 for score of 1 vs. 0; aOR 1.79, 95% CI 1.17-2.74 for 2 vs. 0), and mild anxiety rating (score of 1 vs. 0: aOR 1.30, 95% CI 1.02-1.64, derivation model only) increased odds of readmission. Models had moderate discriminative ability in derivation and internal validation samples for both sexes (c-statistics 0.64-0.65). CONCLUSIONS: Certain key predictors of psychiatric readmission differ by sex. This knowledge may help to reduce psychiatric hospital readmission rates by focusing interventions.
Asunto(s)
Hospitales Psiquiátricos/estadística & datos numéricos , Trastornos Mentales/terapia , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Enfermedad Aguda , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Ontario , Trastornos de la Personalidad/terapia , Factores Sexuales , Factores de TiempoRESUMEN
Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.