Predictors of frequent recourse to health professionals by people with severe mental disorders.

摘要: Despite deinstitutionalization and the introduction of mental health services in community during last decades, few people with SMDs continue to be repeatedly admitted specialized hospital services.1 The disproportionate use by frequent users (or heavy, high, or repeat users) has long been focus studies.2,3 Some researchers have stressed that 5% 18% between 27% 63% services.4–8 Other studies state 30% 35% such patients account for 75% 80% psychiatric inpatient service costs.9,10 Numerous 2 decades looked at factors overuse emergency,2,4,6,7,11 multiple readmission care (the revolving-door phenomenon),3,12–15 patterns general16 SMDs. leading variables identified as predictors high this clientele include sex,7 age,7,17 marital status,4 unemployment,4,6,15 education,12,13 schizophrenia,4,6,15 schizophrenia spectrum disorders,13,15 substance disorders,18 lack social support.6,7,12 However, used a conceptual framework try understand relative importance those regarding prevalence use. The Behavioral Model Health Services Use structured Andersen19 is most common theoretical identify use. According Andersen’s theory, can explained 3 categories (predisposing, enabling, need factors). Predisposing are individual characteristics, age, sex, level education, could prompt someone services. Enabling systemic, organizational, structural assets facilitate use, example, insurance, family income, employment. Finally, diagnoses other clinical (such severity symptoms, chronicity, perceived needs) might justify decision seek help.8 Clinical Implications People who more rarely professionals likely younger, married relationship, live autonomous accommodations, sources income than welfare. Among may lead participants frequently support schizophrenia, disorders, adjustment and, marginally, multiplicity disorders. Mental should prioritize interventions address modifiable factors, unemployment, correlate use. Limitations There differences definitions infrequent according studies. Results not apply geographical areas. Results pertinent having no SMD. In health, behavioural model served primarily determinants reasons among suffering mostly from disorders (anxiety minor depressions).8,20–27 sole relation SMDs, our knowledge, medication use28,29 predict homeless SMDs.30,31 All studies—with exception Lemming Calsyn30 Rosenheck Lam31—applied logistic regression found were key Hierarchical analysis seems suitable method mutually linked—compared isolated—variables explicate why some find it necessary regularly professionals. main purpose article thus determine blocks explain compared services, based on model.