Mental hospital admission rates of immigrants in Switzerland

Purpose: This epidemiological study aims to assess the utilisation of inpatient psychiatric services by immigrants. Specifically, we address the question of gender-specific differences in immigrants and compare the population-based rates of males and females from different countries of origin. Methods: We analysed inpatient admission rates from a defined catchment area over a 6-year period by means of psychiatric register data. Poisson regression analysis was used to model effects of gender, age and country group (immigrants grouped into six categories according to their country of origin). Results: Of the total of 28,511 subjects consecutively referred to psychiatric inpatient treatment, 4,814 were foreign nationals (16.9%). Among immigrants the proportion of female inpatients (38.7%) was far lower than in the general population (45.6%; equal proportion of female-to-total among Swiss inpatients). Immigrants were 37.4years old on average at index admission (Swiss people: 46.3years), but there were considerable differences across country groups. We found three groups with particularly high admission rates: male immigrants originating from Turkey, Eastern European and ‘Other' countries (rates >6 per 1,000 population/year). These were admitted as inpatients at far higher rates than females from the same countries. In women, there was no immigrant group utilising inpatient treatment at a higher level than Swiss females. The rates of inpatient admission in males and females was almost equal among the Swiss (4.3 per 1,000), as was the case for immigrants from Southern, Western/Northern Europe and former Yugoslavia, although on a lower level (2.26-3.15 per 1,000). Regression analysis further suggests that country effects and age effects are different for males and females, and age effects are specific to the country of origin. Discussion: These gender- and interaction effects point to inequalities in psychiatric service use in people with different migration background. Further research is needed, particularly to understand the reasons for the markedly different gender-specific utilisation of psychiatric services by some immigrant group

Predictors of Compulsory Re-admission to Psychiatric Inpatient Care

Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT. Results: During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors. Conclusions: The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced

Patterns of inpatient care for immigrants in Switzerland: A case control study

Background: Migration has become a major political and social concern in West European societies. Methods: A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period. Results: Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients. Conclusions: Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countrie

Immunobiology of Carbohydrates: Implications for Novel Vaccine and Adjuvant Design Against Infectious Diseases

open5sìCarbohydrates are ubiquitous molecules expressed on the surface of nearly all living cells, and their interaction with carbohydrate-binding proteins is critical to many immunobiological processes. Carbohydrates are utilized as antigens in many licensed vaccines against bacterial pathogens. More recently, they have also been considered as adjuvants. Interestingly, unlike other types of vaccines, adjuvants have improved immune response to carbohydrate-based vaccine in humans only in a few cases. Furthermore, despite the discovery of many new adjuvants in the last years, aluminum salts, when needed, remain the only authorized adjuvant for carbohydrate-based vaccines. In this review, we highlight historical and recent advances on the use of glycans either as vaccine antigens or adjuvants, and we review the use of currently available adjuvants to improve the efficacy of carbohydrate-based vaccines. A better understanding of the mechanism of carbohydrate interaction with innate and adaptive immune cells will benefit the design of a new generation of glycan-based vaccines and of immunomodulators to fight both longstanding and emerging diseases.openStefanetti, Giuseppe; Borriello, Francesco; Richichi, Barbara; Zanoni, Ivan; Lay, LuigiStefanetti, Giuseppe; Borriello, Francesco; Richichi, Barbara; Zanoni, Ivan; Lay, Luig

Preventing compulsory admission to psychiatric inpatient care using psycho-education and monitoring: feasibility and outcomes after 12 months

The aim of this study was to evaluate an intervention programme for people with severe mental illness that targets the reduction in compulsory psychiatric admissions. In the current study, we examine the feasibility of retaining patients in this programme and compare outcomes over the first 12 months to those after treatment as usual (TAU). Study participants were recruited in four psychiatric hospitals in the Canton of Zurich, Switzerland. Patients were eligible if they had at least one compulsory admission during the past 24 months. Participants were assigned at random to the intervention or to the TAU group. The intervention programme consists of individualised psycho-education focusing on behaviours prior to illness-related crisis, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 (of 756 approached) inpatients were included in the trial. After 12 months, 80 (67.2 %) in the intervention group and 102 (85.7 %) in the TAU group were still participating in the trial. Of these, 22.5 % in the intervention group (35.3 % TAU) had been compulsorily readmitted to psychiatry; results suggest a significantly lower number of compulsory readmissions per patient (0.3 intervention; 0.7 TAU). Dropouts are characterised by younger age and unemployment. This interim analysis suggests beneficial effects of this intervention for targeted psychiatric patients

Sociodemographic and Clinical Predictors of the Length of Psychiatric Inpatient Stay of Immigrants in Switzerland

Immigrants with mental disorders have consistently been reported to spend shorter time in the psychiatric hospital compared to native patients. The aim of this study was to identify sociodemographic, clinical and migration-related predictors of a shorter length of psychiatric inpatient stay among immigrants in Switzerland. All patients of a foreign nationality admitted for inpatient treatment in the year 2016 (N = 279) were included in this study. The sample characteristics were drawn from the register of the psychiatric hospital. Within this sample, self-harm and substance use predicted a shorter inpatient treatment episode whereas disturbances of general psychosocial functioning were a predictor of a longer length of stay. As similar results were also reported for non-immigrant patients, the impact of these specific behavioral and social problems on the length of inpatient stay does not appear to be migrant-specific. Moreover, a country of origin outside Europe was a strong predictor of shorter length of stay pointing to inequalities of inpatient psychiatric treatment within the group of immigrants. Therefore, the cultural background and migrant history of immigrants in psychiatry need stronger consideration in order to eliminate disadvantages in mental health care

Patient-Level Predictors of Psychiatric Readmission in Substance Use Disorders

Repeated psychiatric readmissions are a particular challenge in the treatment of substance use disorders and are associated with substantial burden for patients and their associates and for healthcare providers. Factors affecting readmission rates are heterogeneous and need to be identified to better allocate resources. Within the Swiss healthcare system, such data on substance use disorder patients are largely missing. Understanding these factors might bear important implications for future healthcare planning. Thus here, we examine risk factors of inpatient readmission. We retrospectively analyzed all admissions to the hospital's department of addictive disorders in the year 2016. Patients included in the study were followed over a period of 1 year after discharge regarding readmissions to the clinic. Besides the demographic, social, and economic data, we extracted data concerning patient history, admission, and discharge as well as clinical data regarding type and number of substances abused and comorbid diagnoses. In order to describe severity of cases, we furthermore included the scores of the Health of the Nation Outcome Scale (HoNOS) at admission and at discharge as documented in the medical database. Of the 554 patients included in the study, 228 (41.2%) were readmitted within 12 months. Previous admissions, concomitant use of different substances, presence of psychosis or mania, and a higher severity score at discharge increased the likelihood of readmission. The odds for readmission were furthermore higher in patients not being married, living alone, and being unemployed. When all (bivariate) statistically significant factors are included into a logistic regression model, the previous number of admissions and the HoNOS clinical score at discharge significantly contributed to this model. Our findings stress that patients with higher symptom load at discharge are prone to be readmitted within 12 months. The same applies for patients with previous admissions. These findings suggest that the development of specific interventions to prevent premature discharge before satisfactory symptom remission, in particular in those patients with previous admissions in their patient history, might help to prevent readmissions

Predictors of Compulsory Re-admission to Psychiatric Inpatient Care

Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments.Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT.Results: During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors.Conclusions: The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced