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This cross-sectional study identifies and quantifies state-level shortages in community-based perinatal psychiatry care in the US.

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INTRODUCTION: There is a need for effective, strengths-based parenting supports for diverse parent populations. We conducted a quasi-experimental study to investigate whether a 12-week parenting program delivered in the community decreases perceived parenting stress and improves parent-reported outcomes. METHOD: Parents in the intervention group participated in Parenting Journey, a curriculum designed to increase resilience and support nurturing family relationships. Parents who were eligible for Parenting Journey but did not enroll were included in the concurrent comparison group. Participants completed the Parenting Stress Index and the Parenting Journey Survey at baseline and follow-up. We conducted bivariate and multivariate analyses to evaluate differences between groups. RESULTS: We enrolled 244 parents, 123 in the intervention group and 121 in the comparison group. The majority of participants in the intervention and comparison groups were female, identified as Black or Latino, and reported an annual household income of less than $20,000. At baseline, intervention participants reported higher total parenting stress than comparison participants (mean percentile 70.7 vs. 55.8, p = .002). At follow-up, intervention participants' mean total parenting stress score decreased by 14.1 points, while comparison participants' score increased by 3.0 points (difference-in-difference p < .0001). Intervention participants were significantly more likely to demonstrate improvement in 4 or more of the 7 constructs measured by the Parenting Journey Survey (adjusted OR = 2.2, 95% CI [1.2, 4.1], p = .01). DISCUSSION: Participation in Parenting Journey is associated with decreased perceived parenting stress and improvement in parent-reported outcomes. Future work should evaluate the longitudinal impact on parental mental health and child socioemotional development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Caseload and daily volume requirements present clinical and administrative challenges in organized settings primarily serving the public sector. These challenges are examined through lenses of systems-level fiscal viability, population health, and patient experience. Framed by previous efforts in caseload methodology, illustrative data collected from members of the American Association of Community Psychiatrists are discussed, with consideration of issues of professional effort and burnout. A systematic effort is needed to develop guidelines for caseload and volume expectations that support recovery outcomes, account for practitioner skills, and promote high-quality clinical encounters.

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BACKGROUND: The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women. METHODS: Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis. RESULTS: Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56-6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22-0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31-9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68-5.22) but not in men. CONCLUSIONS: Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.

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OBJECTIVE: We aim to determine psychiatrists' identified factors associated with suitability of discharging patients on long-acting injectable antipsychotics (LAI) from specialist to primary care. METHOD: We undertook a retrospective observational study utilising case file reviews. A questionnaire was developed specifically for this including sociodemographic information, clinical characteristics of the patients and clinical opinion on suitability of discharge to primary care. RESULTS: In total, 72 case files (51 men, 21 women) were included in the study. The most common diagnosis was schizophrenia (71%) and Risperidone was the most often used LAI (71%). Fourteen (19%) of the patients were deemed suitable for discharge to primary care. A minimum period of 1 year of stability, having good cognitive function and insight, and absence of high-risk history were associated with suitability for discharge. CONCLUSIONS: Treating psychiatrists consider only a minority of patients on long-acting injection antipsychotics as suitable for discharge to primary care.

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OBJECTIVE: Involuntary psychiatric admissions under the Mental Health Act increased significantly nationwide. Little is known, however, about the influencing factors of this phenomenon. METHODS: The aim of this regional cross-sectional study in North Rhine-Westphalia was to compare voluntary and involuntary psychiatric admissions (under the PsychKG NRW) regarding personal, institutional, social-psychiatric and demographic characteristics. A retrospective analysis of hospital admission registers over a period of 6 years with over 200 000 cases was conducted. RESULTS: Elderly patients with dementia were most frequently involuntarily admitted. The existence of a locked ward in hospitals did not per se increase involuntary admissions, whereas the scope and quality of local social-psychiatric services had a major impact. CONCLUSION: Social-psychiatric services and home-treatment must be strengthened to achieve lower involuntary admission rates and to further improve the quality of mental health care all over Germany.

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The Italian Psychiatric Reform of 1978 is reviewed here in terms of national/regional mental health (MH) policies and with the help of epidemiological data. The reform law was essentially a framework one, and Italy's 21 regions were called to draft detailed organizational norms and to implement their systems. This explains a relevant interregional variability, despite several national MH plans. In a recent survey, compliance with national standards found homogeneous implementation on structural parameters but quite a variable one on functional parameters (continuity, coordination, accessibility, specialization). Epidemiological data show the impact of regional variability on the quality of treatment provided. Because of discrepancies among regional information systems, we analyze data from six Italian regions, where regional case registers have long been implemented, focusing on adult population prevalence and incidence rates and outpatient-inpatient care. Indicators of service use and some national MH documents are discussed in relation to the system's future prospects.

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With the help of a structured quality report (SQR) the first assessment on the quality of task fulfillment in the 12 social psychiatric services (SPS) in Berlin was carried out. 102 standardised questions in 10 dimensions were posed. The results show that in the important dimensions which depict the core tasks of the SPS, in general a good quality was documented. At the same time deficiencies and deficits were mentioned (e. g., lack of check-lists, poor cooperation with the clinics, inadequate supervision). For the further development of SQR an adaptation to the Berlin situation as well as progress documentation in the individual SPS will be of major importance. Furthermore, a modification for other services in the public health-care system such as, e. g., child and adolescent health care should be considered.

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The gap times between recurrent events are often of primary interest in medical and epidemiology studies. The observed gap times cannot be naively treated as clustered survival data in analysis because of the sequential structure of recurrent events. This paper introduces two important building blocks, the averaged counting process and the averaged at-risk process, for the development of the weighted risk-set (WRS) estimation methods. We demonstrate that with the use of these two empirical processes, existing risk-set based methods for univariate survival time data can be easily extended to analyze recurrent gap times. Additionally, we propose a modified within-cluster resampling (MWCR) method that can be easily implemented in standard software. We show that the MWCR estimators are asymptotically equivalent to the WRS estimators. An analysis of hospitalization data from the Danish Psychiatric Central Register is presented to illustrate the proposed methods.

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OBJECTIVE: Are assessment instruments used for social psychiatry research in German-language countries in agreement with international scientific standards? METHODS: Analysis of assessment instruments mentioned in publications of two German-language journals. RESULTS: Most studies concerning social psychiatry used assessment instruments developed previously and for the majority data about their validity and reliability are available. The fact that most of the instruments were originally published in English indicates that they are internationally used. CONCLUSIONS: Most assessment instruments mentioned in German-language papers meet with international scientific standards.

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R. Baron and D. A. Kenny's (1986) paper introducing mediation analysis has been cited over 9,000 times, but concerns have been expressed about how this method is used. The authors review past and recent methodological literature and make recommendations for how to address 3 main issues: association, temporal order, and the no omitted variables assumption. The authors briefly visit the topics of reliability and the confirmatory-exploratory distinction. In addition, to provide a sense of the extent to which the earlier literature had been absorbed into practice, the authors examined a sample of 50 articles from 2002 citing R. Baron and D. A. Kenny and containing at least 1 mediation analysis via ordinary least squares regression. A substantial proportion of these articles included problematic reporting; as of 2002, there appeared to be room for improvement in conducting such mediation analyses. Future literature reviews will demonstrate the extent to which the situation has improved.

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Research in social psychiatry has partly neglected the problem of comparatively disturbed persons, who are characterized by a shift from the regular social psychiatric care system into homelessness, closed psychiatric treatment or other desintegrated areas. Against this background in Mecklenburg-Vorpommern, an evaluation of all clinical and complementary institutions engaged in psychiatry was realized. 83.5 % of the institutions took part in the study and 137 (5.21 %) persons were identified as critical. 59.4 % of the institutions, especially therapeutic living groups, remarked that they had treated critical persons during the last year. Sociodemographically, the critical persons could be characterized by comparatively limited interpersonal relationships und a high unemployed status. A factor analysis has resulted in 4 factors characterizing the problematical behaviour: (i) aggression, low social adjustment and impulsivity; (ii) suicidal behaviour; (iii) delinquency and substance use; (iv) manipulative behaviour and pestering. Defining a comparatively high of disturbed behaviour, 51 persons could be identified.

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BACKGROUND: People with schizophrenia comprise the majority of patients with severe mental illness recruited to recent mental health service studies of new teams (e.g. assertive outreach, crisis resolution). Reduction in hospitalisation has been the most consistent outcome measure in these studies, but results are inconsistent. AIMS: To understand inconsistency of results from studies using hospitalisation as an outcome measure. METHOD: The advantages and disadvantages of hospitalisation are explored, including the ways in which it is recorded. Regional variation in outcomes and the impact of control services are reviewed. RESULTS: Hospitalisation has face validity as an outcome but translates poorly between differing healthcare contexts. These variations can be exploited positively to distinguish potentially effective ingredients in community care (outreach, combined health and social care, team structure) from redundant components. CONCLUSIONS: Hospitalisation is a good proxy outcome measure in schizophrenia care in randomised controlled trials, but the dangers of extrapolating to new contexts require care.

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BACKGROUND: Mind-body medicine (MBM) approaches to many health problems have been well documented in the literature, including through multiple meta-analyses. Efficacy has been well demonstrated in conditions such as headache, irritable bowel syndrome, anxiety, fibromyalgia, hypertension, low back pain, depression, cancer symptoms, and postmyocardial infarction. However, an apparent disconnect (ie, translational block) prevents more widespread adoption of such therapies into practice. Biofeedback, relaxation therapy, hypnosis, guided imagery, cognitive behavioral therapy, and psychoeducational approaches are the domain of MBM we examined in assessing physician attitudes, beliefs, and practices. METHODS: Using a Web-based survey, we obtained responses from 74 faculty and resident physicians in the Department of Family Medicine and the Department of Psychiatry. Our response rate was 69%. We conducted descriptive statistics, bivariate analysis, and multivariate analysis using a logistic regression model. Various statistics were chosen depending on the nature of analyzed variables. Synoptic tables are presented. RESULTS: Comparing these cohorts, we found little difference between physicians in the two specialties, but substantial reports that barriers to the use of MBM were largely based on lack of training, inadequate expertise, and insufficient clinic time. Lack of expertise and insufficient clinic time were higher among family physicians than among psychiatrists. There was a high interest in both groups in learning relaxation techniques and meditation and lower interest in biofeedback and hypnosis. Female physicians were significantly more likely to use MBM, both with patients and for their own self-care, and were less likely to be concerned that recommending these therapies would make patients feel that their symptoms were being discounted. Female physicians also had significantly higher beliefs about the benefits of MBM on health disorders in several of the conditions examined, with a consistent though nonsignificant trend in others.

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Caring for psychiatric patients, Social Psychiatric Services (SpDi) carry out advising and therapeutic tasks and give medical opinions. They also participate in the management of the community psychiatric care system. The services differ widely in giving priorities to these tasks. In Germany there are no standards concerning quality and quantity of individual help being offered by SpDis. Evaluation of this individual client related help is essential for quality management. Besides rates, which partly describe the utilisation of the service, such parameters are of interest that hint at the psycho-social risk. Furthermore, figures indicating continuity or discontinuity of help are of importance. The statistics of the documentation in 1999 and 2000 of the SpDi Wolfsburg serve as an example for such an evaluation.

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AIM OF THE STUDY: Scientists and politicians currently pin great hopes on preventive activities in order to increase the health of particular target populations and to reduce illness related costs. This also holds true for mental disorders, which often show a chronic course of disease. The aim of the present study is to analyse the importance of prevention in social-psychiatric research. METHODS: Including 60 journals, listed in the Science Citation Index or the Social Science Citation Index for the psychosocial field, a systematic literature analysis was done for the year 2004. RESULTS: Only 14 percent of social-psychiatric original research paid attention to prevention. 39 percent of the prevention related publications refer to primary prevention, further 39 percent to secondary prevention, 22 percent focused on tertiary prevention. Research activities concentrated on prevention of substance related disorders as well as early detection or rehabilitation of schizophrenia. CONCLUSIONS: Social psychiatry has only partly responded to the growing importance of prevention in health care. Because many social-psychiatric questions are important for prevention research, social psychiatry should use their competences to facilitate prevention-studies. This holds particularly true for depressive disorders and dementia, which are conditions with high prevalence and substantial illness related costs.

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OBJECTIVE: Due to the lack of adequate data on the need of psychiatric and psychotherapeutic care in the community, an evidence-based goal directed development of treatment systems in socioeconomically poorer regions in former Eastern Germany is not feasible. METHOD: A community sample from the Study of Health in Pomerania (N = 4310) was investigated with the "Beschwerdenliste" from von Zerssen. The met and the unmet need of care were estimated. RESULTS: 3.1 % of all subjects were treated at least once by a mental health professional during the last 12 months. 12 % of the subjects, currently not in treatment, were estimated to be highly distressed by psychopathological symptoms and were considered to be potentially in need of mental health care. From this follows a treatment rate of 20 %. Subjects with high mental stress consulted their GP's, internists, orthopedics and neurologists significantly more often than subjects with low mental stress. CONCLUSION: A considerable need of psychiatric and psychotherapeutic treatment facilities has to be faced. Besides the improvement of psychiatric and psychotherapeutic treatment facilities, psychosocial networks should be established in order to provide an integrative and interdisciplinary approach to mental problems in the community.

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