0 5 10 15 20 25 30 35 40

0 200 400 600 800 1000 1200 1400 1600 1800

0

20

40

60

80

90

92

94

96

98

100

Number of Episodes

Number of Days

Pe

rce

nti

le o

f S

am

ple

*

FIGURE 1: DISTRIBUTION OF DAYS AND EPISODES IN HOSPITAL OVER 5 YEARS FOLLOWING INDEX

ADMISSION

# of Days # of episodes

65% of individuals did not have additional inpatient

episodes or days in hospital during the 5 years

following their index admission

DESIGN

Prospective cohort: Secondary analysis of population & clinical data.

• Linked Via Forward Sortation Area (FSA)

• Cohort: index admissions between 2006 and 2009.

• First psychiatric admission

• Follow-up: 5 years

• Total number of subsequent episodes since index

• Total number of subsequent days in hospital since index

SAMPLE (N=29,938)

Exclusion Criteria

• Forensic designation

• No Ontario FSA

• Individuals with lifetime exposure not captured by OMHRS

• Short stay episodes which occur prior to index admission

DATABASES

• RAI-Mental Health (RAI-MH) data from the Ontario Mental Health

Reporting System (OMHRS).

• Ontario Marginalization index (On-MARG)

• Developed by systematic review and factor analysis

• Derived from 2006 census, geographically focussed measure

• Describes four dimensions of geographic areas, including

residential instability

INDEPENDENT VARIABLES

Residential instability

• Consists of 9 dimensions, for example, proportion of population living

alone, and proportion of dwellings in an area that are not owned

• Reported as ordinal quintiles:

• 1= least unstable, 5=most unstable.

Diagnoses

• Primary diagnoses as determined by clinicians upon discharge

OUTCOME VARIABLES

• Number of days spent in hospital since index admission

• Number of episodes since index admission

NEIGHBOURHOOD LIVING ENVIRONMENT AND MENTAL HEALTH

SERVICE USE: USING INTERRAI TO IMPROVE RIGORKYLE ROGERS, M.SC CANDIDATE

CHRIS PERLMAN, PH.D

BACKGROUND

A review of mental health service use research has identified several

gaps in the literature:

1. Socio-environmental factors have received limited attention.

• This stands in contrast to the body of knowledge examining the

relationship between mental illness and socio-environmental factors.

2. Much of the research utilizes binary measures to capture service use

(e.g. Used in past 12 months, yes/no?)

Residential instability is one such socio-environmental factor that

describes the transience of the population living in an area.

• Aspects of residential instability been previously associated with

increased mental health service use.

Research that combines rich data from the RAI-MH with existing socio-

environmental data provides the opportunity to complement existing

research by:

1. Investigating the association between socio-environmental factors,

individual factors and inpatient service use.

2. Examining more nuanced measures of service use that go beyond

yes/no binary operationalizations

DISCUSSION• 65% of individuals who have an index admission between 2006 and

2009 did not have further contact with inpatient services for 5 years.

• There is an association between residential instability and the pattern

of service use, with a slight increasing trend in both number of

episodes and days in hospital as residential instability increases.

• Individuals with schizophrenia have extensive variation in their

patterns of service use at both episode and number of day levels.

• Individuals with dementia have some variation in their pattern of

service use in terms of days in hospital, but less in the number of

episodes.

• Individuals with concurrent mental illness have patterns of increased

number of visits to hospital, while number of days in hospital was not

shown to be statistically significant.

• There is a greater proportion of individuals with schizophrenia and

substance use in areas with the highest degree of residential

instability.

• There is a lower proportion of individuals with mood disorders and

dementia in areas with the highest degree of instability

ACKNOWLEDGEMENTS AND THANKS• interRAI and CIHI for providing access to OMHRS

• Sebastian Rios for providing feedback throughout the development of the

poster

• Jonathan Chen for his help developing the final dataset for analysis

IMPLICATIONS• Combining OMHRS data with the On-MARG allows researchers to develop

a nuanced consideration of inpatient mental health service that considers

both individual and socio-environmental factors.

• Further consideration of other individual and socio-environmental factors

available in the combined dataset may establish an understanding of

what drives inpatient service use.

• Multivariate multi-level modelling is needed to better understand the role

of residential instability in MHSU when compared against individual

aspects.

0% 20% 40% 60% 80% 100%

Quintile 1 (Lowest Instability)

Quintile 2

Quintile 3

Quintile 4

Quintile 5 (Highest instability)

FIGURE 2: DAYS IN HOSPITAL OVER 5 YEARS FOLLOWING INDEX ADMISSION BY RESIDENTIAL INSTABILITY QUINTILES

0 Days 1-14 Days 15-30 Days 31-90 Days 90+ Days

0% 20% 40% 60% 80% 100%

Quintile 1 (Lowest instability)

Quintile 2

Quintile 3

Quintile 4

Quintile 5 (Highest instability)

FIGURE 3: SUBSEQUENT EPISODES 5 YEARS FOLLOWING INDEX ADMISSION BY RESIDENTIAL INSTABILITY QUINTILES

0 episodes 1-2 episodes 3+ episodes

0% 20% 40% 60% 80% 100%

Concurrent Substance Abuse (27%)

Eating Disorders (1%)

Substance Use (17%)

Mood (45%)

Dementia (9%)

Schizophrenia (17%)

FIGURE 4: DAYS IN HOSPITAL OVER 5 YEARS FOLLOWING INDEX ADMISSION BY DIAGNOSIS

0 Days 1-14 Days 15-30 Days 31-90 Days 90+ Days

0% 20% 40% 60% 80% 100%

Concurrent Mental Illness (38%)

Concurrent Substance use (27%)

Substance Use ( 17%)

Dementia (9%)

Schizophrenia (17%)

FIGURE 5: SUBSEQUENT EPISODES 5 YEARS FOLLOWING INDEX ADMISSION BY DIAGNOSIS

No episodes 1-2 episodes 3+ episodes

…

…

*y axis percentile distribution jumps to accommodate extreme observations

36

5 d

ay

s

Greatest instability

associated with sum of

days greater than a

month

Greater instability

associated with

subsequent episodes

Schizophrenia has great

variation with days in

hospital following index

admission

Schizophrenia has

great variation in

subsequent episodes

Dementia does not

0% 20% 40% 60% 80% 100%

Concurrent Mental Illness (38%)

Concurrent Substance use (27%)

Eating Disorders (1%)

Substance use( 17%)

Mood (45%)

Anxiety (4%)

Dementia (10%)

Schizophrenia (17%)

FIGURE 6: PRIMARY DIAGNOSIS BY RESIDENTIAL INSTABILITY QUARTILES

Quintile 1 (Lowest instability) Quintile 2 Quintile 3 Quintile 4 Quintile 5 (Highest instability)

TABLE 1: NUMBER OF DAYS SPENT IN HOSPITAL BY

SUBSEQUENT DAYS

REFERENCESBabitsch B, Gohl D, Lengerke T von. Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic

review of studies from 1998–2011. GMS Psycho-Social-Medicine. German Medical Science; 2012;9.

Twomey CD, Baldwin DS, Hopfe M, Cieza A. A systematic review of the predictors of health service utilisation by

adults with mental disorders in the UK. BMJ open. British Medical Journal Publishing Group; 2015;5(7):e007575.

Fleury M, Ngui AN, Bamvita J, Grenier G, Caron J. Predictors of healthcare service utilization for mental health

reasons. International journal of environmental research and public health 2014;11(10):10559-10586.