Page 95 - Demo

A database study in Dutch mental health services934DiscussionThis is the first population-based database study to focus on patients with MID in advanced MH services. Patients with MID, compared to patients without ID, were diagnosed with different MH disorders and more often received treatment in specialised MH service settings, such as forensic or addiction care. The MH trajectories were shorter, and the MH service professionals performed fewer diagnostic and treatment activities in patients with MID, in particular in those cases in which the ID was unregistered, while conducting significantly more indirect patient care activities. At the same time, crisis interventions and MH hospital admissions were more frequent in patients with MID. These findings are indications of undertreatment in patients with MID, which is likely to result in poor MH outcomes. A total of 60% of the patients with MID had no ID registration in their MH service files. Through linkage with information on MID registration from other sources, we were able to include them in this study.Comparison with existing literatureThe observed differences in the prevalence of MH disorders in patients with MID compared to patients with no ID, including ‘Schizophrenia and other psychotic disorders’ (10.9 vs 5.2%), ‘Depressive disorders’ (10.7 vs 22.6%), and ‘Personality disorders’ (7.1 vs 13.7%), are consistent with other research in MH services. 7, 15-17 There are several possible explanations for these prevalence differences, including an etiological origin. However, misinterpretation or mis-categorisation of symptoms by referring health professionals, such as the general practitioner and MH service professionals, most likely contribute to differences in prevalence; impaired communication and symptom presentation can make it more difficult to categorise using the DSM. 18 The high prevalence of ‘No or unknown diagnosis’ in patients with MID (37.4%) is an extra indication in this respect.Adequate recognition of MID also appeared difficult in MH care. The underregistration of MID in our data, which was also found in other research, 7, 15can be seen as a clear indication of under-recognition of MID in MH services. The presence of an MID should be taken into account during the whole MH trajectory, as it is considered a significant risk factor for developing Katrien Pouls sHL.indd 93 24-06-2024 16:26