Abstract
First admission rates to Canadian mental hospitals have been analysed by age, sex diagnosis and method of admission, for the years 1932 to 1953 inclusive.
This 22 year period was divided by the war into three periods of approximately equal duration— a pre-war era of high but gradually falling unemployment, the war years, and a post-war period of economic expansion with continued low unemployment.
Overall age standardized rates showed a definite time relationship with figures for unemployment up till the end of the war, but subsequently rose rapidly in the absence of economic stress.
There was a continuous excess of male rates over female in most age groups and diagnoses, but this excess was least or reversed towards the end of the war, when female unemployment exceeded male.
Rates for the youngest age group showed considerable fluctuation, and those for the oldest age group showed an increasing trend throughout the 22 year period. In the intermediate age groups there was a cyclical tendency corresponding with the overall trend, more marked for male than female, and most pronounced for the age group 30 to 39.
Age sex specific rates for thirteen selected diagnoses, and their estimated yearly trends, have been examined.
Rates for C.N.S. syphilis underwent a marked decline, particularly in the post-war period. Rates for psychoses with mental deficiency and with psychopathic personality also showed slight decreases. Manic depressive psychosis and paranoid states maintained relatively stable rates, while mental deficiency without psychosis showed considerable fluctuation but no overall change. Rates for the organic psychoses of senility increased throughout (for the age group 70 years and over), while rates for the remaining diagnoses all increased during the post-war period, alcoholism without psychosis showing the most rapid rise.
Rates for admission on medical certificates showed relative equality between the sexes and tended to follow the overall trend up till the end of the war, but the post-war increase was less marked and less consistent than that for the overall rates. Voluntary rates remained fairly constant until the last five years of the study and then increased rapidly. Rates for admission on warrant showed a consistent male predominance, with slight initial increases followed by declines to lower levels than initially, although male rates showed slight upward movement at the end of the period under examination.
It has been concluded that first admission rates do not simply reflect either the incidence of individual diagnoses or the aggregate incidence of all mental disorders, but that a number of factors influence these rates.
The influence of the following factors on first admission rates has been discussed: —(i) reliability of data and calculations, (ii) social judgement of mental abnormality, (iii) social demand for mental hospital care, (iv) availability of mental hospital accommodation, (v) availability of alternative psychiatric facilities, (vi) diagnostic criteria, (vii) incidence, (viii) economic stress, (ix) war, (x) immigration, (xi) age and sex.
It has been concluded that the marked post-war increases in rates for “minor” disorders (psychoneuroses, psychopathic personality and alcoholism without psychosis) is largely attributable to increased social awareness and demand, in the presence of available accommodation.
While the decline in rates for C.N.S. syphilis apparently represents a true decline in incidence, the multiplicity of factors influencing these rates renders it impossible to attribute observed increases in rates to definite increases in incidence. However, some increase in incidence is considered probable for alcoholism and alcoholic psychoses, and possible for certain other diagnoses (e.g. schizophrenia and the organic psychoses of senility).
The influence of economic stress, war and immigration upon rates would appear to be complex, involving particularly consideration of both social demand and incidence, while age and sex distribution represent the product of all other factors affecting first admission rates.