Psychiatr Prax 2011; 38 - OP07_EC
DOI: 10.1055/s-0031-1277811

Social environment and utilization of community-based psychiatric services

V Donisi 1, F Tedeschi 1, D Salazzari 1, M Percudani 2, A Fiorillo 3, C De Rosa 3, M Tansella 1, F Amaddeo 1
  • 1Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Italy
  • 2Department of Mental Health, Hospital „G. Salvini“, Garbagnate Milanese, Milan, Italy
  • 3Department of Psychiatry, Second University of Naples, Italy

Background/Objectives: The main aim of this study was to assess how the utilisation of community-based psychiatric services varies according to the social environment of the area of residence, considering spatial proximity and patients’ socio-demographic and clinical characteristics.

Methods: All patients with an ICD-10 psychiatric diagnosis, who had at least one contact between January and June 2009 with three Italian Community-based Mental Health Service in Italy were included (n=2759). General treated prevalence and incidence as well as specific indicators of inpatient, day-care, outpatient and home-based service utilisation were calculated. At an ecological level, socio-economic status (SES) index using nine census variables at census block level (n=336.788) and other characteristics such as land characteristics, public services’ supply and population density were calculated. Clinical, socio-demographic patients’ characteristics and indicators of social network were collected by using clinical records, questionnaires and information systems. Spatial proximity between patients and facilities’ locations were measured along the street network.

Results: Treated prevalence and incidence increased in the most deprived census blocks; differences among categories of community services, diagnostic groups and centres resulted. With regard to length of stay, in general the days spent in an acute inpatient ward increased with an increase in distance. Poisson hierarchical regression models, using as independent variables individual socio-demographic and clinical patients’ characteristics and ecological factors, were able to explain around 20% of the variance in utilization.

Discussion/Conclusions: Although social environment seems to be a control variable rather than a main predictor, a significant relation among ecological factors and utilisation of services emerged, with different patterns among diagnosis. The social environment alongside individual's characteristics may be used as useful measures to inform planners on the local utilisation of services and for organising mental health services.

Funding: Italian Ministry of Health (grant no. RF-VEN-2006–357034).

Keywords: Process evaluation, socio-economic factors, evaluation of mental health services.