EPISODES OF CARE FOR FIRST-EVER PSYCHIATRIC-PATIENTS - A LONG-TERM CASE-REGISTER EVALUATION IN A MAINLY URBAN AREA

Background. Psychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of 'survival analysis ' have rarely been used for assessing such data. Method. A longitudina l study was conducted over 10 years (1 January 1982 to 31 December 199 1) on 1423 first-ever psychiatric patients, using the PCR of South Ver ona, Italy. The product-limit method, the log-rank test, the Cox regre ssion model and the Poisson regression analysis were used to analyse e pisodes of care and relapses. Results. The duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one incre ased consistently from the second to the sixth episode. The only varia ble significantly associated with the length of the first episode of c are was diagnosis (highest probability of having longer episodes for s chizophrenic patients), while the length of the breaks following the f irst episode of care was associated with diagnosis, sex and occupation al status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorde rs, for males, and for unemployed patients). The probability of openin g a new episode of care decreased with time since last contact and inc reased with number of previous contacts. Conclusions. The community ps ychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chro nic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.