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Graham Thornicroft

Publications and source records attributed to Graham Thornicroft.

51 records · Page 3Linked to original sources
PubMed2002

Gender differences in living with schizophrenia. A cross-sectional European multi-site study.

The EPSILON project (European Psychistric Services: Inputs Linked to Outcomes and Needs) is a cross-sectional study of the clinical and social characteristics, needs, satisfaction with services, quality of life, and service utilisation and costs for people with schizophrenia in five European sites (Amsterdam, Copenhagen, London, Santander, and Verona). This study examined five hypotheses: (1) Men will have more total needs and more unmet needs for: 'accommodation', 'substance misuse', 'psychotic symptoms', 'harm to others', and 'sexual expression', whereas women will have more total needs and more unmet needs in the domains of 'childcare' and 'harm to self'. (2) Caregivers of male patients will show higher rates of psychological distress, and higher scores for 'supervision' and 'urging' than caregivers of female patients. (3) Male and female patients will show similar levels of satisfaction with services, both in total scores and subscores. (4) Male patients will show lower objective quality of life, but similar subjective quality of life compared with women. (5) Service utilization for men and women will differ, and patterns will vary by site. The results confirmed hypotheses 1 (in part) and 3, but failed to support hypotheses 2, 4 and 5. Graphical models were used to generate hypotheses for future research. The implications for planning separate services for male and female schizophrenic patients are discussed.

Adult↗
PubMed2002

Poverty, poor services, and compulsory psychiatric admission in England.

BACKGROUND: Compulsory admission is a central feature of psychiatric systems internationally but the factors determining its use within different legal systems are not understood. Numbers of compulsory psychiatric admissions vary widely between areas in England. We examined the hypothesis that variation in rates of detention is related to social deprivation and also to the functioning of local mental health services. METHODS: Rates of detention under sections 2 and 3 of the Mental Health Act (1983) in 1998/9 were obtained in 34 mental health sectors in eight Trusts in England. Measures of socio-economic deprivation and measures of service function were used to conduct an ecological analysis. RESULTS: Compulsory admission is associated with measures of deprivation but there is unexplained variation. The range in rates is higher than allowed for by the resource allocation formula. Some indicators of service quality are independently associated with rates of detention. CONCLUSIONS: Variation in detention rates and its relation to service function need further explanation if the use of compulsion is to be reduced.

Adolescent↗
PubMed2002

Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

OBJECTIVE: To compare service utilization and cost profiles of people with schizophrenia living in Europe in order to understand differences in treatment and care costs. METHOD: Cross-sectional samples were taken of people with schizophrenia in five European locations. Sociodemographic, clinical and service use data were collected via interviewer-administered questionnaires. Site-specific unit costs were obtained, transformed subsequently into a single currency (UK pound). Multiple regression analyses were conducted. RESULTS: There were widespread and considerable differences between sites in service utilization patterns and associated costs. Higher needs, greater symptom severity and longer psychiatric history are associated with higher costs: quality of life and service satisfaction are not. Few differences were found between sites in patterns of association with cost. CONCLUSION: Comparative analyses of the use and cost of mental health services can highlight existing variations helpfully in service provision and uptake. Methodological consistency is required if meaningful conclusions are to be drawn from such comparative data.

Adult↗
PubMed2002

The general fertility rate in women with psychotic disorders.

OBJECTIVE: This study determined the general fertility rate and age-specific fertility rates for women with psychotic disorders. METHOD: This historical matched-cohort study of patient records from a primary care database (the General Practice Research Database) was carried out for women of childbearing age (15-44 years) with psychotic disorders. RESULTS: The women with psychotic disorders (N=7,936) had a lower overall general fertility rate than the normal comparison subjects (N=23,023), although fertility was only significantly lower in the women aged 25 and above. This lower fertility rate was less marked in women with affective psychoses. There was no evidence that treatment with neuroleptics influenced the fertility rate in women with non-affective psychoses. CONCLUSIONS: This study found markedly lower fertility rates in women with psychotic disorders than in matched normal comparison subjects, particularly in women with non-affective disorders. Knowledge of fertility rates in women with psychotic disorders is fundamental for clinicians and researchers, since it has implications for family planning services, prevention of obstetric complications, child-care support, and hypotheses about the etiology of these disorders.

Adolescent↗
PubMed2002

Dropping out of care: inappropriate terminations of contact with community-based psychiatric services.

BACKGROUND: Few studies have investigated factors which predict inappropriate terminations (drop-out) of clinical contact with mental health services. AIMS: To identify patient and treatment characteristics associated with dropping out of contact with community-based psychiatric services (CPS). METHOD: A 3-month cohort of patients attending the CPS was followed up for 2 years, to identify drop-outs. RESULTS: We identified 495 patients who had had at least one psychiatric contact of whom 261 had complete ratings for the Global Assessment of Functioning and the Verona Service Satisfaction Scale. In the year after the index contact, 70 terminated contact with the CPS; of these, 44 were rated as having inappropriate terminations (the "drop-out" group) and 26 had appropriate terminations of contact. Drop-outs were younger, less likely to be married and their previous length of contact with services was shorter. No drop-outs had a diagnosis of schizophrenia. Multivariate analysis revealed predictors of dropping out. CONCLUSIONS: In a CPS targeted to patients with severe mental illnesses, those who drop out of care are younger patients without psychoses who are generally satisfied with their treatment.

Adolescent↗
PubMedDate not supplied

Main determinants of Global Assessment of Functioning score in schizophrenia: a European multicenter study.

BACKGROUND: The Global Assessment of Functioning (GAF) scale is a measure widely used to assess the outcome of patients with schizophrenia. However, little is known about the importance of clinical and psychosocial variables in determining its final score. The aim of this paper is to identify which factors predict GAF scores of patients with schizophrenia and their variability in 5 different European settings. METHOD: A representative sample of 404 patients with schizophrenia was assessed with the GAF. A multiple regression analysis was performed to identify predictors of the GAF scores. RESULTS: Clinical factors are the main determinants of GAF score. However, the analysis also showed that social and functioning factors were also significantly associated with GAF scores. Finally, the study showed the presence of intercenter differences in the factors, mainly in social functioning. CONCLUSIONS: The GAF is a useful and easy-to-apply measure of global functioning, independent of cross-cultural differences. Clinical factors are the main determinants of its score, although social functioning variables also have a lesser effect.

Adult↗
PubMedDate not supplied

Growing recognition of the importance of service user involvement in mental health service planning and evaluation.

Service user involvement in the planning and provision of mental health services has been growing over the last two decades, especially in countries and areas where institutional service provision has been changed to a community-orientated model of care. However, the material involvement of service users in mental health research is still in its infancy. The aim of this paper is to attempt to place these developments in a conceptual context, to summarise the ethics-based and evidence-based reasons why it has to be considered as necessary, and to illustrate some of the emerging evidence which shows the advantages to be gained from it. In particular the results of recent studies are briefly reported, showing that outcomes data rated by service users in some cases are more important than those rated by staff. The reduction in patient-rated unmet needs in the social domain was the strongest predictor of an increase in subjective quality of life. The importance of including service user preferences within the content of the research questions is exemplified by the results of a recent study that showed that joint crisis plans can significantly reduce the use of compulsory admission during crises and by a review that demonstrated that the use of an explicit service user perspective produced distinctive insights into the long-term effects of Electro-Convulsive Therapy (ECT).

Attitude to Health↗
PubMedDate not supplied

Does meeting needs improve quality of life?

BACKGROUND: This study investigated the relationship between patient-rated unmet needs and subjective quality of life using routine outcome data. METHODS: 265 mental health service patients from South Verona were assessed using the Camberwell Assessment of Need, the Lancashire Quality of Life Profile, and other standardised assessments of symptoms, disability, function and service satisfaction. At 1-year follow-up, 166 patients were still in contact, of whom 121 patients (73%) were re-assessed. RESULTS: Higher baseline quality of life was associated with being male, a diagnosis of psychosis, higher disability, higher satisfaction with care, fewer staff-rated or patient-rated unmet needs, and fewer patient-rated met needs (accounting for 40% of the variance). Specifically, fewer baseline patient-rated unmet needs were cross-sectionally associated with a higher quality of life (B = -0.08, 95% CI -0.12 to -0.04). Apart from its baseline value, the only baseline predictor of follow-up QoL was patient-rated unmet need (B = -0.08, 95% CI -0.21 to -0.09), accounting for 58% of the variance in follow-up quality of life. Graphical chain modelling confirmed this association. CONCLUSIONS: The association between high numbers of unmet needs and low subjective quality of life appears increasingly robust across several studies. Future research will need to investigate whether changes in needs precede changes in quality of life. This study provides further evidence that a policy of actively assessing and addressing patient-rated unmet needs may lead to improved quality of life.

Disability Evaluation↗