Stahler Gerald J, Mennis Jeremy, Cotlar Rachel, Baron David A
Department of Geography and Urban Studies, Temple University, Philadelphia, PA 19122, USA.
Am J Psychiatry. 2009 Nov;166(11):1258-68. doi: 10.1176/appi.ajp.2009.08111667. Epub 2009 Oct 1.
Environmental contingencies inherent in neighborhoods and communities have been shown to affect individual behavior. The authors analyzed neighborhood and individual factors predicting initial outpatient treatment attendance and rehospitalization within 1 year among patients who were dually diagnosed with at least one mental disorder and a substance use disorder and discharged from an acute psychiatric inpatient care unit.
Stepwise-forward logistic regression modeling and a geographic information system were utilized to assess data extracted from the medical records of 380 patients who, upon hospital admission, had one or more mental health disorders and a positive urine drug screen for prototypical illicit drugs. Geographic data on patients' neighborhood environment were obtained from public sources. Outcome variables were whether a patient attended the first outpatient treatment appointment within 30 days of hospital discharge and whether a patient was readmitted to the inpatient unit within 1 year of discharge. Predictor variables were features relating to individual-level patient characteristics and features associated with neighborhood environment.
Factors that decreased the likelihood of attending the initial outpatient treatment were returning home following hospitalization (versus returning to an institutional setting), residing in an area with a high vacant housing rate, residing in an area far from an Alcoholics Anonymous meeting location, having the chief complaint of bizarre behavior (i.e., grossly inappropriate behavior), and having a urine drug screen positive for heroin. The likelihood of being rehospitalized within 1 year was greater for Hispanic patients, patients who had at least one prior hospital admission, and patients who lived in close proximity to a Narcotics Anonymous meeting location. Patients living in areas with higher educational attainment had a reduced likelihood of rehospitalization.
A more explicit focus on the neighborhood and community context represents an important area in psychiatry, in terms of both research and clinical practice, which can potentially enhance long-term care and treatment planning for psychiatric patients. Future research is needed to better understand the influence of the neighborhood environment to help predict important clinical outcomes.
研究表明，社区和邻里环境中的各种因素会影响个体行为。作者分析了社区和个体因素，这些因素预测了同时被诊断患有至少一种精神障碍和物质使用障碍并从急性精神科住院治疗单元出院的患者在1年内首次门诊治疗的就诊情况和再次住院情况。
采用逐步向前逻辑回归模型和地理信息系统，对380例患者的病历数据进行评估。这些患者入院时患有一种或多种精神健康障碍，且尿液药物筛查显示存在典型非法药物阳性。患者邻里环境的地理数据来自公共资源。结果变量包括患者在出院后30天内是否参加首次门诊治疗预约，以及患者在出院后1年内是否再次入住住院单元。预测变量包括与个体层面患者特征相关的特征以及与邻里环境相关的特征。
降低首次门诊治疗就诊可能性的因素包括：住院后回家（而非返回机构环境）、居住在空置房屋率高的地区、居住在远离戒酒互助会会议地点的地区、主要诉求为怪异行为（即严重不当行为）以及尿液药物筛查显示海洛因阳性。西班牙裔患者、至少有一次既往住院史的患者以及居住在匿名戒毒会会议地点附近的患者在1年内再次住院的可能性更大。居住在教育程度较高地区的患者再次住院的可能性降低。
无论是在研究还是临床实践方面，更明确地关注社区和邻里环境是精神病学的一个重要领域，这可能会加强对精神科患者的长期护理和治疗规划。需要进一步研究以更好地理解邻里环境的影响，从而有助于预测重要的临床结果。
