[Also a reform effect? An explorative analysis of increasing hospitalization due to mental disorders]

The present prospective longitudinal study describes and explores the impact of demographic change and political reforms on the growing risk of suffering from mental disorders and subsequent hospitalization. The statistical analysis is based on all insured individuals who were 50 years and older during the years 1993 to 2003 (n = 453 609) from a statutory sickness fund, the Gmünder Ersatzkasse. Event-history analyses show no linear but a rather u-shaped relationship between age and the risk to be given in-patient treatment for mental disorders. However, the age effect shrinks significantly when the number of previous hospital stays, the proximity to death, and the marital status are statistically controlled. On the other hand, the number of psychic disorders as a minor diagnosis has grown robustly after the legal requirement for fully documenting hospital cases according to section sign 301 SGB V and after the legal decision to introduce DRG refunding in 2000. Since the risk of in-hospital treatment of a psychic minor diagnosis increases most in somatic and not in psychiatric clinics, we suspect an up-grading effect.