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Biomedical subjects

L Appleby

Publications and source records attributed to L Appleby.

At least 73 records · Page 4Linked to original sources
PubMed1996

Length of inpatient stay and recidivism among patients with schizophrenia.

OBJECTIVE: The study examined whether length of hospital stay is related to recidivism among psychiatric patients. A quasi-experimental approach was used to address limitations of controlled and epidemiological research. METHODS: Three matched groups, each consisting of 55 inpatients with schizophrenia, were selected from public psychiatric units with different mean lengths of stay. Regression models were used to compare the groups on three variables: time to first readmission (survival analysis), number of readmissions (ordinal logit regression), and total time in the community in the postdischarge year (multiple linear regression). RESULTS: An analysis based on the units with different lengths of stay, which was similar to that typically used in controlled studies, found no differences in the three outcome measures. However, a second analysis that examined data for all patients irrespective of their unit assignment found that inpatients treated for 30 days or less relapsed sooner than those with stays longer than 30 days. The disparity in results was largely due to overlapping quasi-experimental conditions: many patients on the short-stay units had a long lengths of stay, and vice versa. The first analysis supports an administrative policy of short stays. The second reinforces previous findings that a group of patients, primarily young males with onset of illness at an early age and multiple previous hospitalizations, is at greater risk of relapse with short-term treatment. CONCLUSIONS: The apparent contradiction between a unit- or patient-based analysis suggests that unit-based results should be interpreted with caution when used to make clinical or utilization review decisions.

Adult↗
PubMed1996

General practitioners and young suicides: a preventive role for primary care.

BACKGROUND: The suicide rate in young men, but not young women, is rising. One possible route to suicide prevention is through general practice but recent evidence suggests that young suicides are not likely to attend GP surgeries prior to death. METHOD: We carried out a retrospective examination of general practice contacts by a 2-year sample of suicides under 35 years of age in the 12 health districts of Greater Manchester. In the 61 young suicides who were known to attend a GP in the three months before death, we recorded (a) the number of consultations each week in the three months before suicide; (b) sex differences in rates of and reasons for consultation; (c) frequency of recorded risk assessment at the last GP visit before suicide. RESULTS: The number of GP visits increased significantly before death. A monthly increase was more evident in males, but the increase in the week before death was more marked in females. There was no sex difference in the rate of GP visits before suicide; both sexes were most likely to attend for psychological reasons. Significant suicide risk had been noted at none of the final GP visits. CONCLUSIONS: There remains a potential role for GPs in preventing suicides by young people of both sexes. The recent increase in suicide by young males does not appear to be related to a lower rate of GP attendance before death. Future training of GPs in this area should focus on risk assessment.

Adult↗
PubMed1996

Demographic and obstetric risk factors for postnatal psychiatric morbidity.

BACKGROUND: Postnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks. METHOD: The Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (> 12) were determined and entered stepwise into a regression model. RESULTS: Four independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors. CONCLUSIONS: Although a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.

Adolescent↗
PubMed1995

Parasuicide in the first postnatal year.

Data were collected on a consecutive 6 month sample of women aged 15-44 years attending their catchment area Casualty Department because of parasuicide. Information included age and childbirth within the previous year. Using this information and catchment area data on population size and births, an odds ratio for parasuicide in postnatal as compared to non-postnatal women was calculated. Five of 131 study subjects had delivered a baby in the previous 12 months. The odds ratio was calculated to 0.43 (95% confidence interval 0.17-0.95). These findings suggest that the rate of parasuicide in the first postnatal year is low despite the high rate of psychiatric morbidity at this time. The result supports previous findings on suicide and suggests that postnatal women, despite their high rates of psychiatric disorder, are protected against fatal and non-fatal self harm. The implications for postnatal and suicide prevention services are discussed.

Adolescent↗
PubMed1994

Screening women for high risk of postnatal depression.

A ten-item screening questionnaire was constructed from previous reports on risk factors for postnatal depression, and its ability to predict antenatally the development of postnatal depression was tested. Women attending an antenatal clinic at 36 wk gestation completed the questionnaire and, at 8 wk postpartum, were assessed for the presence of depression using the Edinburgh Postnatal Depression Scale (EPDS). Although antenatal questionnaire scores correlated significantly with postnatal EPDS scores, this was largely because the questionnaire was able to identify correctly those who would not become depressed. Neither the questionnaire as a whole, nor groups of items, was able to discriminate well between women who later did or did not become depressed. However, women who reported previous or current treatment for depression were at a threefold greater risk of becoming or remaining depressed postnatally. Possible reasons for the negative results are discussed, including the heterogeneity of depression occurring in the postnatal period.

Adult↗
PubMed1993

Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients.

OBJECTIVE: Psychiatric beds in public hospitals have decreased 80% since 1955, but admissions have risen correspondingly, largely because of high recidivism rates. Decreases in numbers of beds have been partly achieved by shortening the length of stay, which lessened by half between 1970 and 1980. This study was undertaken to determine whether duration of hospital treatment affects the rate and rapidity of relapse among schizophrenic patients. METHOD: Data on 1,500 patients from 10 state hospitals were gathered for 18 months after initial discharge. Predictor variables included age, sex, marital status, race, number of previous admissions, location of the facility, and length of stay. Data were analyzed by survival analysis with a Cox regression model for two times to initial relapse: 30 days and 18 months (outcome). RESULTS: Length of stay was significantly related to each time to relapse after the effects of number of previous admissions and age were partialed out. Facility location was not predictive, but intrahospital effects were tested by examining the data on the largest facility; again, length of stay significantly predicted relapse. CONCLUSIONS: Although the magnitude of the effect was small, the clinical significance of the findings is the greater likelihood that brief-stay patients will be rehospitalized within 30 days after discharge than will patients treated for longer periods. Brief hospitalization seems generally applicable to psychiatric populations, but there may be a small but important group of seriously mentally ill patients for whom other alternatives are possibly more appropriate and should be explored.

Adult↗
PubMed1992

Diagnostic criteria in schizophrenia: accentuate the positive.

In a recent article, Andreasen and Flaum (Schizophrenia Bulletin, Vol. 17, No. 1, 1991) argued that greater emphasis should be placed on negative symptoms in the diagnosis of schizophrenia, leading to a less important role for positive symptoms. This article presents a counter-argument to this view. Positive symptoms are common and reliable and therefore highly useful diagnostically. First-rank symptoms, although not specific to schizophrenia, show good discriminability. No other type of symptom or investigative method can make such claims to usefulness. Although positive symptoms do not predict outcome, this is not a necessary function of diagnostic criteria. The predictive power of negative symptoms is, in any case, based largely on studies of patients with chronic disorder. Premorbidly impaired social development may interact with schizophrenia, worsening the prognosis. We believe positive symptoms have always been the essence of psychiatric disorder and should remain so. Increasing the diagnostic weight given to negative symptoms risks restricting the definition of schizophrenia excessively.

Activities of Daily Living↗