RESUMO
Background: There is evidence suggesting racial disparities in diagnosis and treatment in bipolar disorder (BD) and schizophrenia (SZ). The purpose of this study is to compare psychiatric diagnoses and psychotropic use preceding a first episode of mania (FEM) or psychosis (FEP) in racially diverse patients. Methods: Using a comprehensive medical records linkage system (Rochester Epidemiology Project, REP), we retrospectively identified individuals diagnosed with BD or SZ and a documented first episode of mania or psychosis. Illness trajectory before FEP/FEM were characterized as the time from first visit for a mental health complaint to incident case. Pathways to care and clinical events preceding FEP/FEM were compared based on subsequent incident case diagnosis (BD or SZ) and self-reported race (White vs. non-White). Results: A total of 205 (FEM = 74; FEP = 131) incident cases were identified in the REP. Duration of psychiatric antecedents was significantly shorter in non-White patients, compared to White patients (2.2 ± 4.3 vs. 7.4 ± 6.6 years; p < 0.001) with an older age at time of first visit for a mental health complaint (15.7 ± 6.3 vs. 11.1 ± 6.0 years; p = 0.005). There were no significant differences by race in FEM pathway to care or age of first seeking mental health. Overall non-White patients had lower rates of psychotropic use. Conclusion: These data are unable to ascertain reasons for shorter duration of psychiatric antecedents and later age of seeking care, and more broadly first age of initial symptom presentation. If symptoms are confirmed to be earlier than first time seeking care in both groups, it would be important to identify barriers that racial minorities face to access timely psychiatric care and optimize early intervention strategies.
RESUMO
RESUMEN Objetivo Definir el perfil psicosocial de adultos mayores de 65 años hospitalizados por fractura de cadera secundaria a caída. Métodos Se realizó un estudio de prevalencia, descriptivo, cuantitativo; reclutándose 55 sujetos mayores de 65 años hospitalizados de marzo 2017 a febrero 2018. Los datos fueron recolectados a través de un cuestionario socioeconómico y el índice de Barthel para Actividades de la Vida Diaria. Resultados El promedio de edad fue de 80,8 años, de los cuales 76,36% eran mujeres. El 58,2% de pacientes eran viudos; 61,8% habían cursado solo la educación primaria y 29,1% no contaban con estudios. El 69,1% de la muestra se encontraba desempleada y 56,36% subsistía con un ingreso mensual menor a US$101,77, dependiendo de programas de apoyo social gubernamental como fuente de ingreso. Los hallazgos en las condiciones de vivienda fueron homogéneos entre la población estudiada. El 67.3% de la muestra presentaba un grado variable de dependencia en las actividades cotidianas. Discusión Los resultados permiten generar la hipótesis de que el riesgo de complicaciones médicas y socioeconómicas durante el periodo de recuperación puede ser mayor en nuestra población debido a las condiciones premórbidas descritas.(AU)
ABSTRACT Objective To define the psychosocial profile of elders hospitalized for fall-related hip fracture. Methods A quantitative, descriptive, prevalence study was performed by evaluating 55 individuals aged 65 years old or more, from March 2017 through February 2018. Data were collected using a socioeconomic questionnaire and the Barthel Index for Activities of Daily Living. Results The mean age was 80.8 years and 76.36% of the sample was made up of women. Most patients were widowed (58.2%). Regarding educational attainment, 61.8% had completed primary education and 29.1% were uneducated. Unemployment prevailed among the sample (69.1%) and 56.36% had a monthly income below 101,77 USD and reported social support as their main source of income. Household conditions were homogenous across the sample. A variable degree of loss of autonomy in activities of daily living was reported in 67.3% of the sample. Discussion The findings allow hypothesizing that the risk for medical and socioeconomic complications during the recovery period could be higher in the study population due to the reported psychosocial vulnerabilities.(AU)
OBJETIVO Definir o perfil psicossocial de adultos acima de 65 anos internados por fratura de quadril secundária à queda. MÉTODOS Foi realizado um estudo quantitativo descritivo de prevalência; recrutamento de 55 indivíduos com mais de 65 anos internados no período de março de 2017 a fevereiro de 2018. Os dados foram coletados através de um questionário socioeconômico e do índice de Barthel para Atividades da Vida Diária. RESULTADOS A idade média foi de 80,8 anos, dos quais 76,36% eram mulheres. 58,2% dos pacientes eram viúvos; 61,8% tinham apenas o ensino fundamental completo e 29,1% não tinham estudos. 69,1% da amostra estavam desempregados e 56,36% mantinham uma renda mensal inferior a US $ 101,77, dependendo dos programas governamentais de apoio social como fonte de renda. Os achados nas condições de moradia foram homogêneos entre a população estudada. 67,3% da amostra possuía um grau variável de dependência das atividades diárias. DISCUSSÃO Os resultados permitem gerar a hipótese de que o risco de complicações médicas e socioeconômicas durante o período de recuperação pode ser maior em nossa população devido às condições pré-mórbidas descritas.(AU)
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Saúde do Idoso , Idoso Fragilizado/estatística & dados numéricos , Assistência Integral à Saúde/organização & administração , Fraturas do Quadril/epidemiologia , Classe Social , Epidemiologia Descritiva , Prevalência , México/epidemiologiaRESUMO
OBJECTIVE: To define the psychosocial profile of elders hospitalized for fall-related hip fracture. METHODS: A quantitative, descriptive, prevalence study was performed by evaluating 55 individuals aged 65 years old or more, from March 2017 through February 2018. Data were collected using a socioeconomic questionnaire and the Barthel Index for Activities of Daily Living. RESULTS: The mean age was 80.8 years and 76.36% of the sample was made up of women. Most patients were widowed (58.2%). Regarding educational attainment, 61.8% had completed primary education and 29.1% were uneducated. Unemployment prevailed among the sample (69.1%) and 56.36% had a monthly income below 101,77 USD and reported social support as their main source of income. Household conditions were homogenous across the sample. A variable degree of loss of autonomy in activities of daily living was reported in 67.3% of the sample. DISCUSSION: The findings allow hypothesizing that the risk for medical and socioeconomic complications during the recovery period could be higher in the study population due to the reported psychosocial vulnerabilities.
OBJETIVO: Definir el perfil psicosocial de adultos mayores de 65 años hospitalizados por fractura de cadera secundaria a caída. MÉTODOS: Se realizó un estudio de prevalencia, descriptivo, cuantitativo; reclutándose 55 sujetos mayores de 65 años hospitalizados de marzo 2017 a febrero 2018. Los datos fueron recolectados a través de un cuestionario socioeconómico y el índice de Barthel para Actividades de la Vida Diaria. RESULTADOS: El promedio de edad fue de 80,8 años, de los cuales 76,36% eran mujeres. El 58,2% de pacientes eran viudos; 61,8% habían cursado solo la educación primaria y 29,1% no contaban con estudios. El 69,1% de la muestra se encontraba desempleada y 56,36% subsistía con un ingreso mensual menor a US$101,77, dependiendo de programas de apoyo social gubernamental como fuente de ingreso. Los hallazgos en las condiciones de vivienda fueron homogéneos entre la población estudiada. El 67.3% de la muestra presentaba un grado variable de dependencia en las actividades cotidianas. DISCUSIÓN: Los resultados permiten generar la hipótesis de que el riesgo de complicaciones médicas y socioeconómicas durante el periodo de recuperación puede ser mayor en nuestra población debido a las condiciones premórbidas descritas.