[Long-term service-dependent patients in mental health care: connection to urbanisation]

In view of the increased rate of psychiatric morbidity in urban areas there is likely to be a relation between urbanisation and the extent to which patients use the care services. It is not yet known whether this relation is particularly strong in the case of long-term service-dependent patients with mental health problems.

To investigate the possible relation between the prevalence of long-term service-dependent patients and the degree of urbanisation and to find out if there are differences in the strength of this relation in the case of different types of long-term patients and between these patients and other psychiatric patients.

Data were collected from three psychiatric case registers and from the Statistics Netherlands (cbs). Distinctions were made between three types of long-term patients: 'long stay', 'residential & outpatient' and 'outpatient'. The population was divided into five categories according to the degree of urbanisation in the area of residence. Data were analysed using Poisson regression analysis, corrected for differences in age, sex, marital status and the amount of care available.

The incidence rate ratios for the categories 'long stay', 'residential & outpatient' and 'outpatient' and for other patients were significantly higher for each category of urbanisation than for non-urbanised municipalities. There was also a significant positive linear relation. For long stay patients no significant relation was found with the degree of urbanisation. The total ratios for long-term patients were higher than the ratios for other types of patients. The ratios for residential and outpatient were higher than the ratios for outpatient.

The prevalence of long-term service-dependent patients in mental health care increases with the degree of urbanisation and this increase is stronger than the increase observed for other patients. Furthermore, the relation with urbanisation for the category residential and outpatient is stronger for the category residential and outpatient than for the long-term outpatients.