Page 98 - Demo

Chapter 496Strengths and limitationsAn important strength of this study is the unique focus on people with MID. By linking the SN-MH service database with the SN-MID database, we were able to identify and include people with MID who were not recorded as such in MH services. This fills a blind spot regarding the large number of people with MID who would have been overlooked without data linkage. The use of databases containing routinely collected (health) data, however, also comes with some limitations. Firstly, the MH service database has limited details of diagnoses and treatments, as the main purpose of the data is to enable proper functioning of the health insurance system. Therefore, only information about the prevalence of main diagnostic groups could be determined, not allowing precise comparisons with international evidence. Secondly, we excluded patients whose MH trajectory end date was missing or whose trajectory was not completed within the period observed in this study. Potentially, this concerned patients with more chronic MH disorders and additional care needs, which might be more prevalent among patients with MID. However, the MID prevalence was lower in the excluded patient group compared to the included patient group (1.9 vs 2.3%; Figure 1). Therefore, we do not think that this has led to a disproportionate exclusion of MID patients and consequently an underestimation of the care provided to those patients in comparison to patients without ID. Thirdly, the SN-MID database is composed mostly of users of work-related social services, resulting in an underrepresentation of children and older people. Therefore, we had to restrict our study population to 18-to-75-year-olds. Finally, the SNMID database contains no exact information on individual-level intellectual and adaptive functioning, so it cannot be ruled out that some people with more severe ID or borderline intelligence were part of our MID group. However, the SN-MID database is currently the best source available in the Netherlands to identify people with MID. This makes this study unique and valuable, as it is the first population-based database study to focus on the care for people with MID in MH services. ConclusionIn conclusion, we can say that MID is very often not registered in MH services and most likely insufficiently taken into account in the trajectories in MH Katrien Pouls sHL.indd 96 24-06-2024 16:26