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Pattern of patients recovered in psychiatric rehabilitation services: defining homogeneous groups. Multivariate analysis of a sample
Published online by Cambridge University Press: 11 October 2011
Summary
Objective – To provide a multidimensional description about the pattern of patients recovered in some Psychiatric Rehabilitation Sevices, as emerging from identification of similar groups regarded the total severity. Design and Setting – A cross-sectional survey has been conducted on patients recovered in 4 Northern-Italy Psychiatric Rehabilitation Services. A statistical bottom-up analysis (Principal Components and Cluster Analysis) has been performed. Main outcome measures – Any patient has been evaluated using a questionnaire with well-known rating scales (BPRS-psychiatric rating, Katx index and IADL index, IDS index of comorbidity) together with informations on sex, age, social and economic state, psychiatic history, therapeutic devices and staff involvement. Results – We analyzed 455 patients. 267 (58.7%) male and the mean age is 58.517.9. After statistical analysis, 4 clusters of patients has been found: the first group (106 patients) is younger, descrided as not seriuosly compromised, mostly with psychotic problems; the second (96 patients, most of them woman with diagnosis of demetia) is much older, with serious problems of indipendency and comorbidity. The third (82 patients) and fourth (171 patients) group show intermediate patterns. The level of care requested by these groups has been provided. Conclusions – Our results show the usefulness of sophisticated statistical methods to describe patients recovered in psychiatric rehabilitation services. Moreover, our findings could be useful as good proposal to the people involved in this field, planning an active intervention in this area.
Riassunto
Scopo – Fornire un quadro della tipologia multidimensionale dei pazienti ricoverati in alcune strutture di Riabilitazione Psichiatrica, attraverso la identificazione di gruppi omogenei per gravita globale. Disegno e Setting – É stata condotta un'indagine epidemiologica trasversale sui ricoverati in quattro strutture di riabilitazione del Nord Italia. I pazienti sono stati analizzati e descritti con procedura bottom-up attraverso l'Analisi delle Componenti Principali e la Cluster Analysis. Principali misure utilizzate – Un questionario contenente dati relativi a scale di valutazione (gravità dei sintomi: BPRS, autonomia: KATZ e IADL, comorbidità: IDS), insieme ad informazioni su sesso, età, stato socioeconomico, anamnesi psichiatrica, presidi terapeutici utilizzati e impegno degli operatori. Risultati – Il campione è costituito da 455 soggetti, di cui 267 (58.7%) maschi. L'età media complessiva è di 58.5 anni (DS = 17.9). L'analisi multivariata ha permesso di identificare quattro gruppi: un gruppo di 106 soggetti meno gravi, più giovani, psicotici, si contrappone ad un gruppo di 96 soggetti più gravi, non autonomi, molto anziani, per lo più donne con demenza e alto livello di comorbidità. Gli altri due gruppi, di 82 e 171 pazienti rispettivamente, sono in situazioni intermedie. Vengono infine analizzati gli impegni assistenziali richiesti dai quattro gruppi. Conclusioni – Lo studio dimostra come sia possibile descrivere in maniera multidimensionale e multivariata complesse realtà come quella dell'utenza degli Istituti di Riabilitazione Psichiatrica, proponendo nel contempo agli operatori un possibile strumento per un intervento operativo all'interno di queste strutture.
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References
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