Acta psychiatrica Scandinavica
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Acta Psychiatr Scand · Aug 1990
Comparative StudyA psychiatric study of suicide among urban Swedish women.
A total of 104 suicides among women were investigated by means of a modified psychological autopsy, including interviews with survivors and a review of somatic and psychiatric records. Diagnosis according to Research Diagnostic Criteria (RDC) showed that 35% were suffering from a major depressive disorder during their final month and another 24% were also depressed; 12% were substance abusers and 14% had adjustment disorders. Two thirds had attempted suicide and another 23% had communicated suicidality in other ways. ⋯ Fifty-seven percent had been psychiatric inpatients or outpatients during the final year of life. An increasing number of life events occurred during the final 6 months. In most cases the depressed women had been treated ineffectively with antidepressant drugs.
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Acta Psychiatr Scand · Aug 1990
From community mental health services to specialized psychiatry: the effects of a change in policy on patient accessibility and care utilization.
In 1975, a community mental health (CMH) centre with most of its resources channelled to outpatient services was set up in a defined catchment area of 75,000 inhabitants near Stockholm. In 1981, the CMH centre was allocated 3 inpatient wards of its own. An outpatient unit to treat long-term psychotic patients was also built up from existing resources. ⋯ The number of compulsory admissions increased by 20% (still being far below the mean number in Stockholm). The decrease in the patient population is attributed to the reduction in accessibility to the CMH centre at a time when primary care services in the area were undergoing a sizeable expansion. The increased care utilization is the result of an internal redistribution of resources in favour of resource-demanding, long-term psychotic patients.