Pathways to psychiatric care in south-Verona, Italy.

This paper compares the pathway to psychiatric care of patients contacting the South-Verona Community Psychiatrics Service (CPS) with the pathways described in other countries, using the method of the WHO cross-cultural study of pathways in psychiatric care. One hundred and sixteen South-Verona residents starting new episodes of care were traced and included in the study. The first port of call for 92% of patients was a doctor.

Are social deprivation and psychiatric service utilisation associated in neurotic disorders? A case register study in south Verona.

Measures of service utilisation from the South Verona psychiatric case register in North-East Italy for the years 1983, 1986 and 1989 were used to identify possible associations with sociodemographic variables from the 1981 census for neurotic disorders. There were no consistent patterns of associations between local social and demographic predictors and rates of psychiatric service utilisation. This contrasts markedly with the associations found previously in England (for all psychiatric admissions) and in Italy (for various measures of service utilisation concerning contacts both in and outside hospital for schizophrenic as well as for all psychiatric patients) where social deprivation factors proved to be strong predictors of service use.

Validity and test-retest reliability of the Italian version of the 12-item General Health Questionnaire in general practice: a comparison between three scoring methods.

Validity coefficients of the 12-item General Health Questionnaire (GHQ-12) were established against the Clinical Interview Schedule (CIS) in a sample of primary care patients. Comparison between the conventional scoring method, Likert scoring, and the revised scoring procedure proposed by Goodchild and Duncan-Jones (C-GHQ) showed very similar screening properties: sensitivity ranged between 71% and 75%, and specificity ranged between 73% and 76%. The test-retest reliability of the GHQ-12, as expressed by Pearson's r and intraclass correlation coefficient, was satisfactory irrespective of the scoring method used, even though mean scores on the second test tended to be significantly lower than the corresponding mean scores on the first test.

Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy.

Service utilization measures from the psychiatric case registers for urban South-Verona and rural Portogruaro in North East Italy for the period 1983-9 were used to identify associations with socio-demographic variables from the 1981 census in schizophrenia and related disorders as well as in all diagnoses. The patterns of service use were broadly similar, except that Portogruaro has significantly more community contacts, and has about twice the treated incidence and prevalence of schizophrenia. The census data showed that unmarried and unemployed people were more likely to live alone in the urban than in the rural area.

Comprehensive community care without long stay beds in mental hospitals: trends from an Italian good practice area.

Despite the scientific evidence that long stays in mental hospitals are clinically deleterious, inhumane and probably not cost-effective, this practice still occurs in most Western countries. The continued use of long stay beds in mental hospitals is a policy decided by many authorities, including psychiatrists. Alternatives to the mental hospital exist and may limit the use of hospital beds through comprehensive community care that also includes proper residential provisions.

[En epidemiologic approach for the analysis of the demand and supply of psycho-psychiatric care in general medicine and in specialized services].

In this paper we present data collected in the area of Verona concerning indicators of demand and of supply of care in two settings, the general practice and the South-Verona Community Psychiatric Service. These data, obtained from the epidemiological studies conducted by our research group during the past ten years, emphasize similarities and differences existing in the two levels of care. In general practice the demand for care for psychological disorders is difficult to identify, because of the frequent somatic expression of these disorders; moreover at the level of psychiatric services the demand is frequently aspecific.

Trends in the prescription of antidepressants in urban and rural general practices.

Antidepressant drug (AD) prescriptions written in the period 1983-1988 by all GPs working in Verona, Italy were analyzed. The data were provided by a local drug information system and calculated as Defined Daily Dose (DDD). The area was divided in 25 districts, classified on the urban-rural continuum according to population density.

Provision of mental health care in general practice in Italy.

The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identify the best model of collaboration between psychiatric services and general practice services is becoming increasingly urgent.

The Interval General Health Questionnaire and its relationship with psychiatric disorder in community and general practice samples.

This paper contrasts the usual scoring of the GHQ-30 with scoring based upon a criterion approach applied to only 12 of the GHQ items that takes account of the 'diagnostic significance' of the chosen items. Repeat assessments with this shorter form of the questionnaire (the I-GHQ), coupled with procedures to assess change, can be used to provide summary measures of symptom course in those research situations where available interview time precludes the use of more formal assessment methods.

Measuring the treatment environment of a psychiatric ward and a community mental health center after the Italian reform.

In 1978 a major psychiatric reform drastically changed the Italian psychiatric system by the closing of admissions to mental hospitals and the development of psychiatric units in general hospitals and of alternative services in the community. The paper presents the results of a study in which two treatment environments set up according to the reform, i.e.

Psychiatric morbidity in general practice in Italy. A point-prevalence survey in a defined geographical area.

Psychiatric morbidity among 505 attenders on a single day at 32 general practices in South Verona was assessed using the General Health Questionnaire (GHQ-30) and recordings of practitioners' evaluations. The usual GHQ scoring system with a cut-off point of 5/6 resulted in 52% of high-scorers while the scoring system for longstanding psychological distress conditions (C-GHQ) yielded 37% of high-scorers (cut-off point 11/12). General practitioners identified 28% of attenders as cases.

Patterns of care for chronic patients after the Italian psychiatric reform. A longitudinal case register study.

A comprehensive and well-integrated community-based system of psychiatric services has been developed in South-Verona since the Italian psychiatric reform. Using the South-Verona Psychiatric Case Register, we identified chronic psychiatric patients in the community over a 6-year period after the reform. Six first-contact sociodemographic variables (sex, age, marital status, living situation, education, occupational status) and two clinical variables (ICD-9 diagnosis and past history of state psychiatric hospital admission) were studied for these patients.

Mobility of schizophrenic patients, non-psychotic patients and the general population in a case register area.

This preliminary study attempts to evaluate the effect of a community psychiatric service on residential mobility by comparing a cohort of schizophrenic patients over a 5-year period with that of non-psychotic and general population control groups in South Verona, a case register area in Northern Italy. No significant differences were found between the groups for different types of movement (within South Verona/outside catchment area of South Verona/outside City of Verona), except for movements within South Verona between the schizophrenic group and neurotic group. The former tended to move less than the latter.

The spectrum of psychiatric morbidity in a defined geographical area.

The concept of 'the pathway to psychiatric care' as described by Goldberg & Huxley (1980) using a scheme of five 'levels' and four 'filters', has provided a useful framework in investigating referral processes in places where health services are organized in a way similar to the British National Health Service. Previous estimates of psychiatric morbidity at each of the levels of this model have been calculated, based upon data obtained from diverse geographical areas and over different time frames. The value of these estimates for service planning is therefore limited by the heterogeneity of the data sources.

Gender, marital status and treated affective disorders in South Verona: a case register study.

Data from the South Verona Psychiatric Case Register were used to test hypotheses about the relationship between age, gender, marital status and the incidence of treated affective disorders. Analysis of the 5-year period 1983-1987 yielded overall rates of affective disorder per 10(5) of 57.7 for males and 78.

Use of mental health services in south Verona and Groningen. A comparative case-register study.

A comparison was made of the utilization of mental health services in a psychiatric case register area in Italy (south Verona) and one in the Netherlands (Groningen). All residents living in these areas who contacted a mental health service in 1982 were traced and followed for a period of one year. The year prevalence rates differed considerably (110/10,000 in south Verona and 329/10,000 in Groningen).

The demand for extramural psychiatric intervention in a community-based service.

Using a psychiatric case register, patients who had extramural contacts with the South-Verona Community Psychiatric Service in 1983 (N = 549) were selected for this study and followed-up for 3 years, from the date of their first 1983 contact. Out of the total number of extramural contacts made in 3 years (N = 12,429) 16% were unplanned (drop-in) contacts. A linear-logistic model was used to investigate the joint effects of sociodemographic and clinical variables on the frequency of unplanned extramural contacts.