The influence of age on the female/male ratio of treated incidence rates in depression

BACKGROUND: Poor data exist on the influence of psychosocial variables on the female/male ratio of depression because of the small number of cases and the resulting limited numbers of variables available for investigation. For this investigation a large number of first admitted depressed patients (N = 2599) was available which offered the unique opportunity to calculate age specific sex ratios for different marital and employment status categories. METHODS: Age and sex specific population based depression rates were calculated for first ever admissions for single year intervals. Moving averages with interpolated corrections for marginal values in the age distribution were employed. RESULTS: For the total group the female/male ratio of depression showed an inverted U-shape over the life-cycle. This pattern was influenced by the group of married persons, which showed a sex-ratio of 3:1 between the age of 30–50, but ratios of around 1:1 at younger and older ages. For not married persons the female/male ratio was already around 2:1 at the age of 18 and rose to 2.5:1 in mid-life and declined to 1 at around 55. The almost parallel decline of depression rates in employed men and women resulted in a female/male ratio of about 2:1 from age 18 to age 50 and became 1 after the age of 60. The female/male ratio among the not employed was about 1, in mid-life it became negative. CONCLUSIONS: Our analyses show that the gender-gap in first admitted depressed patients is age dependent and that psychosocial factors modify the sex ratio

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

Modern medicine and the onesizefitsall approach : A clinician's comment to Alexandra Pârvan's “Mind Electric” article

As a clinician, I can easily agree with the author that a person's own reality of being healthy is independent of physical evidence or clinical categories and that this perspective should be considered to improve clinical care. However, I cannot follow the assumptions about the nature and working of modern medicine and psychiatry as typically using “black box” and onesizefitsall treatments in daily practice. I outline several working contexts of doctors where this criticism does only marginally apply or not at all and wonder whether the author might wish, if possible at all from a philosophical viewpoint, to differentiate her concepts with regard to these different contexts. In addition, I think that ill health in the field of psychiatry might have to be dealt with differently than physical ill health.(VLID)339842

Journal of Evaluation in Clinical Practice / Psychiatry's contribution to the public stereotype of schizophrenia : Historical considerations

The public stereotype of schizophrenia is characterized by craziness, a split personality, unpredictable and dangerous behaviour, and by the idea of a chronic brain disease. It is responsible for delays in helpseeking, encourages social distance and discrimination, and furthers selfstigmatization. This paper discusses the circumstances of the origins of the idea of a chronic brain disease (Emil Kraepelin, 18561926), of the split personality concept derived from the term “schizophrenia” (Eugen Bleuler, 18571939), and the craziness idea reflected in the “first rank symptoms”, which are all hallucinations and delusions (Kurt Schneider, 18871967). It shows how Emil Kraepelin's scientific search for homogenous groups of patients with a common aetiology, symptom pattern, and prognosis materialized in the definition of “dementia praecox” as a progressing brain disease; how Eugen Bleuler's life and professional circumstances facilitated an “empathic” approach to his patients and prompted him to put in the foreground incoherence of cognitive and affective functioning, and not the course of the disease; finally, how Kurt Schneider in his didactic attempt to teach general practitioners how to reliably diagnose schizophrenia, neglected what Emil Kraepelin and Eugen Bleuler had emphasized decades earlier and devised his own criteria, consisting exclusively of hallucinations and delusions. In a strange conglomerate, the modern operational diagnostic criteria reflect all three approaches, by claiming to be NeoKraepelinean in terms of defining a categorical disease entity with a suggestion of chronicity, by keeping Bleuler's ambiguous term schizophrenia, and by relying heavily on Kurt Schneider's hallucinations and delusions. While interrater reliability may have improved with operational diagnostic criteria, the definition of schizophrenia is still arbitrary and has no empirical validitybut induces stigma.(VLID)339842

Sociology and Psychiatry.

Sociology and psychiatry have a longstanding, albeit intermittently, conflicting relationship. During the mental health care reforms from the 1950s to the 1980s, mainstream sociology has supported psychiatry with both basic and applied research. Currently, the sociological perspective has become more critical. From a sociological point of view, several so-called mental disorders are nothing but medicalized behavioral features (e.g., grief reactions as depression). Further issues addressed are the current countermovement against medicalization ('recovery') as well as the ongoing stigmatization and social exclusion of persons who are diagnosed with a mental disorder

An automated tool for a uniform decentralized quality control and data analysis in multicenter studies with health care registry data

ABSTRACT Objectives The EU FP7 funded project CEPHOS-LINK investigates hospital re-admissions of patients with a psychiatric disorder in 6 European countries by using linked health care registry data. In addition to the problems of different healthcare, payment and data collection systems, coordinating quality control, data analysis, and statistical modeling of sensitive data with six partners is challenging. For this purpose we have designed a secure online data analysis tool to diminish the time necessary to get results and incremental adaptions of reports as well as decreasing the chance and effects of misunderstandings between national and linguistic boundaries. Approach A comprehensive study protocol clearly defining variables to be obtained and methods to be applied has been put together. The protocol is based on a thorough investigation of the different healthcare systems and related registries. It became clear that nonetheless misconceptions occur and the incremental improvements consumed vast amounts of available resources. Therefore a system which automatically creates the required reports including all tables, graphics and statistical models including data preparation based on a defined data structure has been developed. The report system is based on the statistical environment R and the document markup language LaTeX, tightly integrated with R's package “knitr”.As this highly flexible solution is not straight forward to apply and implies various technical dependencies, a secure online platform hiding all technical details from the users has been developed. Utilizing state of the art software containers based on Linux and docker, a customized VPN solution, authentication and SSL encryption were put together. The web application itself is developed with R's “shiny” package and allows users to simply upload a dataset in the predefined format, interactively explore the contents, apply filters and generate the customizable, standardized report. Additionally, an offline version of the application is available for all major (desktop) operating systems. Results The new platform advances data analysis and reporting in a situation where several partners are involved in analyzing local datasets, as is the case of the CEPHOS-LINK project. Integrating new features, graphics and research topics can be managed centrally while users can update their results and reports in nearly no time. Conclusion The additional effort spent on developing a customized platform for quality control, data analysis and reporting has been worth the effort. Benefits include quick detection of implausible results, unifying the layout and graphics often depending on the software utilized and an established common data structure