The paper reviewed here is ‘A Comparison of Psychiatric Consultation-Liaison Services Between Hospitals in the United States and Japan’ by Kishi and colleagues and freely available here. As the title suggest, the researchers make a comparison of consultation-liaison services in Japan and the United States and in the abstract there are a number of conclusions drawn. They begin with an introduction to their study. The researchers briefly describe some of their expectations of a comparison between the services in the two countries in this section.
The researchers describe their method in the next section. The researchers selected hospitals in Minnesota, USA and Kanagawa, Japan for the study. They write that cultural differences between the two countries might be reflected by the patterns of referrals to liaison services. They also state that the period of study was related to a change in the reimbursement fees for consultations although I wasn’t sure of the temporal relationship between the study period and this change. The catchment area of the Minnesota hospital was 3 million and in the Kanagawa hospital was 1 million. The researchers describe the data that was recorded during the study period. The researchers justify their use of an adjusted Length of Stay (LOS) figure which incorporates the timing of the consultation.
In the results section, there were significantly more men in the Minnesota sample (p=0.040), significantly more of the subjects were married in the Kanagawa sample – indeed almost twice as many proportionally (p<0.001) and significantly more employed in the latter sample (p=0.001). Surgical referrals seemed to be proportionally much higher in the Kanagawa sample than the Minnesota sample while the reverse was true for intensive care referrals although chi-squared and p-values weren’t displayed in the table for these figures. Interestingly almost twice as many referrals (proportionally) in the Minnesota sample had a past psychiatric history and this was highly significant (p<0.001). ‘Chemical dependency’ was the most common cause of referral in the Minnesota sample and ‘evaluation’ in the Kanagawa sample and both were significantly different from their counterpart values (i.e. in the other cities). Delirium was the most common diagnosis in the Kanagawa sample and depression in the Minnesota sample and again both proportions were significantly higher than those in the counterpart populations.
In the discussion, the authors suggest that cultural factors might not play a role in the differences in prevalence of depression between East Asian countries and western countries (however an interesting study is reviewed here). They then suggest that in Japanese culture there is a focus on the collective rather than the individual and that this may influence interactions with mental health services. They also comment on referrals from physicians to psychiatrists for ‘psychosocial issues’ which was a frequent finding in referrals. In their discussion the authors note a number of limitations to the study including the lack of controls which would be helpful in better understanding the cultural differences. Additionally they note that the selected hospitals may not be representative of other teaching hospitals in the respective countries.
As this was a comparison of retrospective data and they were interested in characteristics, the absence of primary outcome measures meant that in effect this was an exploratory analysis and adjustments may help to clarify which are the most interesting findings. It would be interesting to explore the findings with regards to referrers and diagnoses using a different paradigm e.g. case-controlled registry-based studies.
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