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Tijdschrift voor Psychiatrie 61 (2019) 7, 445 - 454


Social isolation, source of income and healthcare consumption for psychiatric patients with and without severe mental illness

L.F.M. van der Post, J.F. Koenders, J.J.M. Dekker, A.T.F. Beekman

background The more severe the psychiatric illness the more patients are dependent on social support and informal care. However, research showed that patients with severe mental illness (smi) have smaller networks than healthy controls.
aim To examine the relationship between network size and perceived social support on the one hand and healthcare consumption on the other.
method A group of 252 patients who got a crisis consultation in Amsterdam, was divided into patients with and without smi on the basis of two years of observation. Mental healthcare consumption was then measured over a period of three years. Bi- and multivariate analyses were used to determine which variables predict levels of mental healthcare consumption.
results Both patient groups did not show any change in level of care consumption during the three follow-up years. In both smi patients and other patients, mental healthcare consumption increased with smaller network size (or 0,85; 95% ci 0,75-0,96). Patients with smi showed a more than threefold higher care consumption compared to non-smi patients (or 3.19; 95% ci 1.82-5.61) independent of network size and living situation.
conclusion smi patients live in conditions that undermine self-reliance: they have a small social network, they often live alone and they usually depend on welfare benefits. They also consume considerably more care than patients with milder disorders and this level of consumption did not decline during the three years of follow-up. A development of new social interventions will be needed to make this patient group more self-reliant and less dependent on care.

keywords care consumption, follow-up research, severe mental illness, smi, social network, social support