Johannes Wancata

The criterion validity of the Geriatric Depression Scale: a systematic review

Objective:  The objective was to provide a systematic review of the screening accuracy of both versions of the Geriatric Depressions Scale (GDS‐30, GDS‐15).

Prevalence of dementia in the elderly in Europe

Dementia is an important public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality. This review on dementia is restricted to European Union countries where the overwhelming majority of studies have been undertaken, and will also refer to the EURODEM publications which may be considered to be the principal European reference point in this area. In subjects aged over 65, crude prevalence rates for dementia varied between 5.9% and 9.4%. We discuss the major problems limiting the use of these estimations, limits which may differ according to the area of application, be it etiological research or care provision.

Ascertaining late-life depressive symptoms in Europe: An evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project

The reported prevalence of late‐life depressive symptoms varies widely between studies, a finding that might be attributed to cultural as well as methodological factors. The EURO‐D scale was developed to allow valid comparison of prevalence and risk associations between European countries. This study used Confirmatory Factor Analysis (CFA) and Rasch models to assess whether the goal of measurement invariance had been achieved; using EURO‐D scale data collected in 10 European countries as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 22,777). The results suggested a two‐factor solution (Affective Suffering and Motivation) after Principal Component Analysis (PCA) in 9 of the 10 countries. With CFA, in all countries, the two‐factor solution had better overall goodness‐of‐fit than the one‐factor solution. However, only the Affective Suffering subscale was equivalent across countries, while the Motivation subscale was not. The Rasch model indicated that the EURO‐D was a hierarchical scale. While the calibration pattern was similar across countries, between countries agreement in item calibrations was stronger for the items loading on the affective suffering than the motivation factor. In conclusion, there is evidence to support the EURO‐D as either a uni‐dimensional or bi‐dimensional scale measure of depressive symptoms in late‐life across European countries. The Affective Suffering sub‐component had more robust cross‐cultural validity than the Motivation sub‐component. Copyright

The Consequences of Non-Cognitive Symptoms of Dementia in Medical Hospital Departments

Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes. Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used. Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables. Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Does psychiatric comorbidity increase the length of stay in general hospitals

Several studies reported that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well. But their methods are often limited because other predictors of length of stay were excluded from statistical analyses. Using the Clinical Interview Schedule, research psychiatrists interviewed 993 patients of medical, surgical, gynecological, and rehabilitation departments in Austria. Using several multiple regression analyses, the influence of psychiatric comorbidity and other variables on length of stay was analyzed. 32.2% of all patients suffered from psychiatric morbidity. Of all psychiatric cases, 6.2% received more than one psychiatric diagnosis. Presence of psychiatric disorders, age, a diagnosis of neoplasms, number of all somatic diagnoses, and the number of previous non-psychiatric hospital admissions predicted length of stay. Patients with dementia, with substance abuse disorders, and with alcohol- and drug-related psychiatric disorders showed a significantly increased length of stay, while other psychiatric diagnoses did not differ from the mentally well. Even after controlling for confounding variables, dementia and substance related diagnoses increase the length of hospital stay. It is important to investigate interventions for early recognition and treatment of these disorders.

Fighting stigma of mental illness in midsize European countries.

PurposeStigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.MethodsThe review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.ResultsThe anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.ConclusionsAlthough much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Non-cognitive symptoms of dementia in nursing homes: frequency, course and consequences

Since most studies concerning the frequency of non-cognitive symptoms of dementia are based on samples of psychiatric services, the results of these studies may be influenced by their selection procedure. For this reason, we investigated the frequency of non-cognitive dementia symptoms based on an epidemiological nursing home study. The sample consisted of 249 nursing home residents in Austria who were interviewed with the Clinical Interview Schedule within 2 weeks after admission (T1) and again 6 months later (T2). For the analyses of the non-cognitive symptoms among the demented, only manifest clinical abnormalities observed during the interview were included. Further, mobility and impaired self-care were assessed. At admission, dementia was found in 63.9% of the sample. At T1, 38%, and at T2, 36.1% of the demented suffered from any non-cognitive symptoms. Flattened or incongruous affect, suspiciousness or aggressiveness, and anxiety were found most frequently. Multiple regression analyses showed that non-cognitive symptoms increase the risk for impaired self-care. Despite the fact that the frequency of several non-cognitive symptoms found in our survey is lower than reported from studies based on psychiatric samples, a high proportion of the demented in nursing homes suffer from such symptoms. Non-cognitive symptoms of dementia increase the risk for an impaired self-care, which supports the assumption that they raise the costs of caring.

Prevalence and course of psychiatric disorders among nursing home admissions

Abstract Several studies have shown that psychiatric disorders are common in nursing homes, but information on the course of psychiatric morbidity shortly after admission is still lacking. Therefore, we interviewed 262 residents of Austrian nursing homes within 2 weeks following admission, and a second time after 6 months. Using the Clinical Interview Schedule and its case criteria, prevalence was 76.3% at admission, and 69.9% 6 months later. In the intervening period, the mortality rate was markedly higher among psychiatric cases, and the incidence of new psychiatric cases (5.9%) was slightly lower than the rate of remission (8.6%). At both assessments, organic mental illness was the most frequent diagnosis. Nursing home residents suffering from psychiatric disorders were treated predominantly by general practitioners applying a psychotropic drug regimen.

The "carers' needs assessment for Schizophrenia": an instrument to assess the needs of relatives caring for schizophrenia patients.

ObjectiveFor the purpose of service planning, an instrument was developed for the systematic assessment of interventions needed by the caregivers of schizophrenia patients.MethodThe development of this instrument was based on in-depth interviews and focus groups. It consists of 18 areas describing common problems of schizophrenia caregivers. For each of these problem areas several possible interventions are offered. Concurrent validity, inter-rater and retest reliability were tested among 50 caregivers.ResultsThe kappa values for the inter-rater reliability are predominantly excellent (kappa > 0.75). The values for the retest reliability show a wide range between excellent (kappa > 0.75) and fair agreement (kappa 0.40–0.60). The significant correlations found between summary scores of this new instrument and several sub-scales of the Family Problem Questionnaire support the assumption that the concurrent validity is satisfactory.ConclusionThese results suggest that this instrument is both valid and reliable.

Psychiatric disorders in gynaecological, surgical and medical departments of general hospitals in an urban and a rural area of Austria.

A total of 728 patients admitted to the medical, gynaecological and surgical departments of one urban and one rural general hospital in Austria were investigated for psychiatric morbidity. Using the Clinical Interview Schedule and its case criteria, the prevalence of psychiatric morbidity was found to be highest in medical departments (38.2%), followed by surgical departments (32.5%), and lowest in gynaecological departments (20.7%). Among medical and surgical patients, dementia and substance abuse disorders were the most frequent psychiatric categories, while in gynaecological departments neurotic disorders showed the highest frequency. For the sample as a whole, single status (i.e. unmarried, widowed or divorced), lower social class and rural catchment area of the general hospital predicted a high prevalence of psychiatric morbidity in a logistic regression analysis, while complications of childbirth, pregnancy or the puerperium, and diseases of the skin or the musculoskeletal system showed a negative association with psychiatric illness.