• R Kaltiala-Heino, P Laippala, and M Joukamaa.
• Tampere School of Public Health and Tampere University Hospital, 33014 University of Tampere, Tampere, Finland. merihe@uta.fi
• J Affect Disord. 2003 Sep 1;76(1-3):31-7.

ObjectiveTo analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions.MethodA register study of all inpatient treatment due to psychiatric disorders from four health care districts in Northern Finland, with a population of more than 600,000. Treatment undertaken by psychiatric hospitals and wards, primary care wards and medical and surgical wards in general hospitals are distinguished.ResultsInpatient treatment for mood disorders increased vastly in all kinds of health care institutions. The increase was due to growing inpatient treatment of depression.LimitationsThe National Discharge Register does not include treatment episodes in private nursing homes or details about the contents of the treatment.ConclusionEven during explicit active de-institutionalisation, other policies may have a greater impact on hospital use, resulting in unexpected changes in patient populations and service utilisation. In Finland, de-institutionalisation failed concerning mood disorders. The depression awareness policies during the 1990s increased inpatient use of depression across institutions.

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