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R Gater

Publications and source records attributed to R Gater.

26 records · Page 2Linked to original sources
PubMed1995

A comparison of community-based care for schizophrenia in south Verona and south Manchester.

BACKGROUND: The community-oriented mental illness services providing care to defined populations in south Verona, Italy (17,628 adults) and south Manchester, England (12,021 adults) have been compared to explore relationships between service organisation and patterns of service use. METHOD: The composition and function of the two services and the sociodemographic characteristics of the two centres are described and related to epidemiological data on service use in the community, out-patient clinic, day hospital and in-patient care. RESULTS: Treated incidence of all psychiatric diagnoses and of schizophrenia were significantly higher in south Manchester than south Verona, indicating that the referral filter between primary and secondary care is more permeable in Manchester. Patients known to the service were more likely to be admitted and to have shorter in-patient stays in south Verona, indicating that the filter between in-patient care and the community is more permeable in Verona than Manchester. CONCLUSIONS: The organisation of services in Verona results in a smaller load on the mental health service; the shorter hospital stays can be related to better integration between hospital and community resources. The organisation of services in Manchester provides care for a greater proportion of the population, but would be likely to require increased resources for the mental health services over time.

Adolescent↗
PubMed1994

Psychiatric disorders in a paediatric primary care clinic.

BACKGROUND: The proportion of children with psychiatric disorders treated in primary care is not known in most developing countries. METHOD: In a two-stage epidemiological study, 990 children aged between 7 and 14 years were screened with the parents' version of the Rutter scale. Of these, a stratified sample of 227 was interviewed jointly with their mothers, using the children's version of the Schedule for Affective Disorders and Schizophrenia (K-SADS). RESULTS: We obtained a weighted prevalence of 19.6 +/- 2.5% for the presence of one or more DSM-III-R disorders. Depressive disorders were present in 6.0%, anxiety-related disorders in 4.7%, and conduct disorders in 6.1%. CONCLUSION: Psychiatric disorders in children are common in primary care. Doctors working at this level of care need the skills to detect and treat them.

Adolescent↗
PubMed1993

A new community mental health team based in primary care. A description of the service and its effect on service use in the first year.

A new community multidisciplinary team based in primary care is described and the experience of the first year discussed. The effect the team has had on the use of psychiatric services in its first year was studied. There was a threefold increase in the rate of inception to care, leading to a doubling in the prevalence of treated psychiatric disorder. There has been a reduction in the demands made on the hospital out-patient services, but no change in the use of in-patient resources or emergency contacts.

Adult↗
PubMed1993

Effects of a community mental health service on the practice and attitudes of general practitioners.

Recent years have seen closer links developing between general practitioners and mental health specialists. A study was undertaken in Manchester to determine the effects of a new community mental health service on the practice and attitudes of general practitioners. Ten doctors had access to the community based psychiatric team over a three year period while another 10 doctors continued to use hospital services. Those with access to the team were significantly more satisfied with the specialist support services, and were more likely to give high priority to community psychiatric nurses and psychiatric social workers working as part of a primary health care team than those without access to the service. Those with access were more willing than those without access to share with psychiatrists the care of patients with chronic neurotic disorders. The community mental health team was considered particularly helpful in reducing the burden posed by patients with neurotic and psychosocial problems, but this resulted in the general practitioners doing less counselling themselves. The study did not find that the new service had an effect on the general practitioners' ability to detect or manage psychiatric illness.

Community Mental Health Services↗
PubMed1991

The pathways to psychiatric care: a cross-cultural study.

This paper describes the referral pathways taken by 1554 patients newly referred to the mental health services in 11 countries, and documents factors associated with delays in referral. The pathways in centres relatively well provided with psychiatric staff were dominated by general practitioners and to a lesser extent hospital doctors: the relatively less well resourced centres showed a variety of pathways with native healers often playing an important part. Delays were remarkably short in all centres regardless of psychiatric resources, but in some centres we found longer delays on pathways involving native healers. Somatic problems were a common presentation in all centres, and in some centres there was a tendency for patients presenting with somatic problems to have longer delays than those with symptoms of depression or anxiety. The implications of these findings are discussed in the context of an ongoing programme of WHO research activities aimed at improving the quality of mental illness care available in community settings.

Adult↗
PubMed1991

Pathways to psychiatric care in South Manchester.

Of 250 patients newly referred to the mental illness services of South Manchester, almost two-thirds were referred directly by their GPs; a further third were referred by hospital doctors. Non-medical sources of referral accounted for only 2% of new cases. Patients with somatic problems had the longest interval between seeking care and referral to the psychiatric services. Being employed was associated with a longer delay before seeking care; among women, those living with their husbands or children had longer total intervals between the onset of the problem and arrival at the psychiatric services.

Adolescent↗
PubMedDate not supplied

Somatic symptoms of distress: an international primary care study.

The objective of this study was to examine cross-national differences in somatic symptoms associated with psychological distress. Data from the World Health Organization (WHO) collaborative study of psychological problems in general health care (5438 patients at 15 sites) were used to examine somatic symptoms associated with psychological distress. At each site, a stratified random sample of consecutive primary care patients completed the 28-item General Health Questionnaire (GHQ) and the Composite International Diagnostic Interview (CIDI). At all sites, the number of current CIDI somatic symptoms (whether medically explained or not) was strongly associated with current psychological distress (measured by selected GHQ-28 items). Pearson correlation of somatic symptom count with psychological distress score was .42 for all sites and ranged from .20 to .58 (p < .0001 at all sites). Across all sites, anxiety and depressive symptoms showed roughly the same association with somatic symptom counts, and specific somatic symptoms or symptom clusters did not show differential association with anxiety or depression. Although somatic symptoms did cluster into meaningful groups (gastrointestinal, neurological/conversion, autonomic, and musculoskeletal), these symptom groups did not show differential association with psychological distress. Examination of individual somatic symptoms and symptom clusters across sites did not reveal clear patterns of association according to geography or level of economic development. These data show a strong association between somatic symptoms and psychological distress, which did not vary across disparate cultures and levels of economic development. Cultural factors, however, may influence the meaning attached to symptoms or the likelihood of presentation for health care.

Adolescent↗