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Change in prevalence and retention of patients in Canadian psychiatric institutions, 1955-1960. Kennedy, Margaret Josephine

Abstract

The 75,000 patients in mental institutions are only a fraction of the mentally ill in Canada. All of these hospitalized patients have passed through several phases of a complicated selective process. Interpersonal relations, group and community attitudes, and hospital policy, are some of the interacting factors in this process. The hospitalized population is a conglomerate of recent admissions and patients remaining from the admissions of many previous years. Changes in various hospital and societal factors affect the nature of these cohorts. For these reasons, the composition of the hospital population merits consideration of itself, rather than as an index of the amount of mental illness in the total population. The purpose of this thesis was (a) to review the characteristics of psychiatric patients under institutional care in Canada in 1960 and compare them with those of other populations reported in the literature, (b) to assess the changes which have taken place in this population between 1955 and 1960, and (c) to elucidate some of the reasons for this change and to suggest areas of further enquiry. The results show that, in 1960, seventy per cent of the 75,000 patients had been under continuous hospital care for over two years. The proportion of the population under hospital care increased with age. Schizophrenia was the most frequent diagnosis for patients over 20, and mental deficiency the most frequent for those under 20. Statistically significant changes occurred between 1955 and 1960 in the number and characteristics of patients under hospital care. The following variables were affected: (a) Age groups: there were fewer patients between the ages of 20 and 59, and more younger and older patients. (b) Diagnostic categories: Schizophrenia decreased and mental deficiency increased. c) Length of stay: there were more recently-admitted patients, and a decrease in the number of patients hospitalized-for from two to five years. Although a smaller proportion of the patients admitted in 1958 was retained continuously than of those admitted in 1955, there were still approximately 4,000 patients remaining for more than two years from the cohorts of each of these years. Changes in the retention ratios are associated with changes in the composition of the patient population between 1955 and 1960. Some suggestions from other studies regarding the causes of current changes were rejected. These suggestions included (a) the changing age distribution of the population, (b) separation of a large cohort of patients who were admitted between 1933 and 1937, and (c) a decline in syphilitic brain syndrome, and (d) increased use of tranquillizers. Publications of the Dominion Bureau of Statistics were discussed, and suggestions made for additional tabulations. Implications for other studies on hospitalized patients were presented.

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