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Int J Nurs Stud. 2019 Mar;91:119-127. doi: 10.1016/j.ijnurstu.2018.12.015. Epub 2019 Jan 2.

The association between Open Dialogue to young Danes in acute psychiatric crisis and their use of health care and social services: A retrospective register-based cohort study.

Author information

1
Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; St. Vincent's Hospital Sydney, Australia; St. Vincent's Private Hospital Sydney, Australia; Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. Electronic address: niels.buus@sydney.edu.au.
2
Department of Psychiatry, Research Unit, University of Southern Denmark, Odense, Region of Southern Denmark, Denmark.
3
The Department of Child and Adolescent Mental Health Services in Southern Jutland, Psychiatric Hospital Region of Southern Denmark, Denmark.
4
Center for Psychosis Research, Aalborg University Hospital, Psychiatric Hospital, Region of North Denmark, Denmark.
5
Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Denmark; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Maryland, USA.

Abstract

BACKGROUND:

Although most mental disorders have their onset in early life, the mental health needs of young people are often not addressed adequately. Open Dialogue is a need-adapted approach that mobilizes psychosocial resources in a crisis struck person's social network. Open Dialogue is organised as a series of network meetings and seeks to promote collaborative integrated care, and a non-directive psychotherapeutic stance. Its effectiveness for young people has not previously been assessed.

OBJECTIVES:

The aim of the study was to examine whether a Danish Open Dialogue approach directed at young people, who sought help from Child and Adolescent Mental Health Services, reduced their utilisation of psychiatric and other health services, compared to peers receiving usual psychiatric treatment.

DESIGN:

A retrospective register-based cohort study.

METHODS:

Using clinical and national register data, a cohort of patients aged 14-19 years (n = 503) enrolled from one region during 2000 to 2015 were compared to a matched comparison group from two other regions using propensity scores. Utilisation of psychiatric health services, GP services, and social markers were assessed after 1, 2, 5 and 10 year of follow-up using logistic and Poisson regression models.

RESULTS:

Patients receiving Open Dialogue intervention had more psychiatric outpatient treatments at one year of follow-up (RR = 1.2, CI: 1.1-1.4) than the comparison group, but not at subsequent follow-ups. Recipients of the intervention had fewer emergency psychiatric treatments (1 year follow-up: RR = 0.2, CI: 0.1-0.5; 10 years follow-up: RR = 0.5, CI: 0.3-0.8) and less use of general practitioner services (1 year follow-up: RR = 0.90, CI: 0.82-0.99; 10 years follow-up: RR = 0.85, CI: 0.78-0.92). There was no significant reduction in the number of psychiatric hospitalisation contacts or treatment days.

CONCLUSIONS:

Open Dialogue was significantly associated with some reduced risks of utilising health care services. These mixed results should be tested in a randomized design.

KEYWORDS:

Delivery of health care, integrated; Mental health services; Psychosocial support systems; Psychotherapy; Retrospective studies

PMID:
30682632
DOI:
10.1016/j.ijnurstu.2018.12.015
[Indexed for MEDLINE]

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