Montemagni Cristiana, Frieri Tiziana, Villari Vincenzo, Rocca Paola
Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSD), Department of Neuroscience and Mental Health A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
Psychiatr Danub. 2018 Jun;30(2):207-215. doi: 10.24869/psyd.2018.207.
The purpose of the study was to identify homogenous subgroups, based upon achievement of two functional milestones (marriage and employment) and Global Assessment of Functioning (GAF) score in a sample of 848 acute patients admitted to the Psychiatric Emergency Service (PES) of the Città della Salute e della Scienza di Torino, during a 24-months period.
A two-step cluster-analysis, using GAF total score and the achievements in the two milestones as input data was performed. In order to examine whether the identified subgroups differed in external variables that were not included in the clustering process, and consequently to validate the found functional profiles, chi-square tests for categorical variables and analyses of variance (ANOVA) for continuous variables were performed.
Five clusters were found. Employed patients (Clusters 4 and 5) had more years of education, less illness chronicity (shorter duration of illness and lower proportion of previous voluntary hospitalizations), lower use of mental health resources in the last year yet higher treatment adherence, larger network size, and higher ordinary discharge. Married inpatients (Clusters 3 and 5) had lower frequencies of substance abuse.
The remarkably high rate of unemployment in this inpatients' sample, and the evidence of associations between unemployment and poorer functioning, argue for further research and development of evidence-based supported employment programs, that put forth diligent effort in helping people obtain work quickly and sustain; they may also help to reduce health care service use among that clientele.
本研究旨在根据婚姻和就业这两个功能里程碑的达成情况以及功能总体评定量表（GAF）得分，在都灵市健康与科学城精神科急诊服务（PES）收治的848例急性患者样本中，识别出同质亚组，研究为期24个月。
采用两步聚类分析，将GAF总分和两个里程碑的达成情况作为输入数据。为了检验所识别的亚组在聚类过程中未包含的外部变量上是否存在差异，从而验证所发现的功能概况，对分类变量进行卡方检验，对连续变量进行方差分析（ANOVA）。
发现了五个聚类。就业患者（聚类4和5）受教育年限更长，疾病慢性程度更低（病程更短且既往自愿住院比例更低），过去一年心理健康资源使用更少但治疗依从性更高，社交网络规模更大，正常出院比例更高。已婚住院患者（聚类3和5）药物滥用频率更低。
该住院患者样本中极高的失业率，以及失业与功能较差之间存在关联的证据，表明有必要进一步研究和开发基于证据的支持性就业项目，这些项目应努力帮助人们快速获得并维持工作；它们也可能有助于减少该群体的医疗服务使用。
