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Shrier LA, McCaskill NH, Smith MC, O'Connell MM, Gluskin BS, Parker S, Everett V, Burke PJ, Harris SK. Telehealth counseling plus mHealth intervention for cannabis use in emerging adults: Development and a remote open pilot trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 166:209472. [PMID: 39111371 DOI: 10.1016/j.josat.2024.209472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/27/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION To improve treatment access for emerging adults with cannabis use disorder (CUD), we developed a telehealth counseling-plus-mHealth intervention and remotely conducted a single-arm open pilot study to preliminarily evaluate its feasibility in primary care. METHODS A multidisciplinary team including youth developed the intervention using the structure of the MOMENT intervention: two weekly counselor-delivered Motivational Enhancement Therapy (MET) sessions, then two weeks of smartphone surveys (4 prompted/day) querying socioemotional contexts and cannabis use, with pre-programmed messages on report of personal triggers for use (Ecological Momentary Intervention; EMI). The team adapted the MET for virtual delivery; created material to enhance self-reflection, plan behavior change, and anticipate withdrawal; shortened the sessions; and tested them with five youth actors. EMI messages were created to align with the MET and programmed to minimize repetition. Patients aged 18-25 using recreational cannabis ≥3 days/week were recruited from an urban medical practice. Participants received the intervention and responded to surveys on satisfaction and burden. At baseline, post-intervention, and two months, participants reported behavior change readiness/importance/confidence and cannabis use. EMI engagement was calculated as % days with ≥1 phone survey completed. RESULTS Fourteen eligible patients enrolled; 79 % used cannabis daily/near-daily and 100 % reported use problems. All completed both MET sessions and responded to EMI surveys. All agreed/strongly agreed that they felt respected by, comfortable with, and trust for the counselor and that the activities and discussion were helpful; all rated the MET sessions as very good/excellent. Technical issues were infrequent and minor. Median EMI engagement was 100 % (≥1 report/day) in each week. Behavior change confidence was higher post-intervention and importance and confidence were higher at two months vs. baseline. By two months, 11 participants had started to change cannabis use; median percent days of use in the past 30 days declined by 27 % and average times of use per use day declined by 28 %. All rated intervention quality as good, very good, or excellent. CONCLUSIONS Emerging adults were highly satisfied and engaged with a telehealth MET counseling-plus-mHealth EMI intervention for cannabis use and reported higher motivation to change cannabis use and less use post-intervention and at 2-month follow-up.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Nicholas H McCaskill
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madeline C Smith
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Madison M O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Brittany S Gluskin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Veronica Everett
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Kassa MA, Anbesaw T, Nakie G, Melkam M, Azmeraw M, Semagn EG, Abate BB. Investigating war trauma, its effects, and associated risk factors on anxiety among high school students in Woldia town, northeast Ethiopia, 2022. Front Psychiatry 2024; 15:1368285. [PMID: 39056017 PMCID: PMC11270624 DOI: 10.3389/fpsyt.2024.1368285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background Anxiety symptoms are the most frequent mental health problems in the world, and it is a serious public health concern, especially among adolescents, because if left untreated, adolescent anxiety can have a number of detrimental effects, including lower academic performance, strained relationships with friends and family, substance addiction, thoughts of suicide and homicide, and trouble finding work. While this vulnerability is concerning in all situations, it is particularly critical in armed conflict areas. Ethiopia is one of the most recent war-affected countries, but to the best of our knowledge, limited studies focused on adolescents in this context. Therefore, this study assessed the experience of war trauma and its effects on anxiety symptoms among high school students in Woldia town, Ethiopia. Objective We assessed the experience of war trauma and its effects on anxiety among high school students, as well as associated risk factors, in war-affected areas in Woldia town, northeast Ethiopia. Methods A cross-sectional study design was conducted from May 23 to June 08 2022. Data were collected from high school students in Woldia town. Bivariable and multivariable logistic regression analyses were used to identify independent factors associated with anxiety. Results A total of 624 out of 660 students participated in the study (94.5% response rate). The prevalence of anxiety among high school students in Woldia town was 39.7%. In the multivariable analysis, having depression (AOR = 9.24, 95% CI: 6.27, 13.64), witnessing the murder of family/friends (AOR = 1.93, 95% CI: 1.05, 3.57), being of female sex (AOR=1.59, 95% CI: 1.08, 2.36), and having a family history of mental illness (AOR=1.69, 95% CI: 1.00, 2.85) were factors significantly associated with anxiety. Conclusions and recommendations The prevalence of anxiety in this study was approximately two in five high school students. Therefore, we recommend that the Ministry of Education collaborate with the Ministry of Health to expand and implement mental health services in high schools to promote the wellbeing of students for the prevention of anxiety.
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Affiliation(s)
- Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Azmeraw
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Elsabet Gezmu Semagn
- Department of Veterinary Parasitology, College of Veterinary Medicine, Wollo University, Dessie, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Wang D, Martin K, Hogg-Johnson S, Papaconstantinou E, Côté P. Prevalence of problematic psychological symptoms in samples of Canadian postsecondary students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-16. [PMID: 38713863 DOI: 10.1080/07448481.2024.2342343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES To estimate the one-month prevalence of problematic psychological symptoms among Canadian postsecondary students, and to compare the prevalence by student characteristics. PARTICIPANTS Three samples of students from two postsecondary institutions. METHODS In a cross-sectional study conducted in 2017, we measured self-reported problems related to symptoms of depression, anxiety, and stress using questions from the functioning module of the WHO Model Disability Survey. We used modified Poisson regression modeling to compute prevalence ratios (95%CI) to compare the prevalence by student characteristics. RESULTS Our study included 1392 students (participation rate 35%-77%). Across samples, the one-month prevalence of moderate-extreme problems ranged from 50.8%-64.7% for anxiety, 41.2%-60.8% for stress, and 29.4%-43.6% for depression. Such problems were consistently more prevalent among females, poor-quality sleepers, students with food insecurity and those with insufficient social support. CONCLUSIONS Significant burden of problems related to psychological symptoms exists within the postsecondary student population and varies by student characteristics.
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Affiliation(s)
- Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Canadian Memorial Chiropractic College, Toronto, Canada
| | - Krystle Martin
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
| | - Sheilah Hogg-Johnson
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Canadian Memorial Chiropractic College, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Efrosini Papaconstantinou
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Gonçalves Pacheco JP, Kieling C, Manfro PH, Menezes AMB, Gonçalves H, Oliveira IO, Wehrmeister FC, Rohde LA, Hoffmann MS. How much or how often? Examining the screening properties of the DSM cross-cutting symptom measure in a youth population-based sample. Psychol Med 2024:1-12. [PMID: 38639338 DOI: 10.1017/s0033291724000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
BACKGROUND The DSM Level 1 Cross-Cutting Symptom Measure (DSM-XC) allows for assessing multiple psychopathological domains. However, its capability to screen for mental disorders in a population-based sample and the impact of adverbial framings (intensity and frequency) on its performance are unknown. METHODS The study was based on cross-sectional data from the 1993 Pelotas birth cohort in Brazil. Participants with completed DSM-XC and structured diagnostic interviews (n = 3578, aged 22, 53.6% females) were included. Sensitivity, specificity, positive (LR+), and negative (LR-) likelihood ratios for each of the 13 DSM-XC domains were estimated for detecting five internalizing disorders (bipolar, generalized anxiety, major depressive, post-traumatic stress, and social anxiety disorders) and three externalizing disorders (antisocial personality, attention-deficit/hyperactivity, and alcohol use disorders). Sensitivities and specificities >0.75, LR+ > 2 and LR- < 0.5 were considered meaningful. Values were calculated for the DSM-XC's original scoring and for adverbial framings. RESULTS Several DSM-XC domains demonstrated meaningful screening properties. The anxiety domain exhibited acceptable sensitivity and LR- values for all internalizing disorders. The suicidal ideation, psychosis, memory, repetitive thoughts and behaviors, and dissociation domains displayed acceptable specificity for all disorders. Domains also yielded small but meaningful LR+ values for internalizing disorders. However, LR+ and LR- values were not generally meaningful for externalizing disorders. Frequency-framed questions improved screening properties. CONCLUSIONS The DSM-XC domains showed transdiagnostic screening properties, providing small but meaningful changes in the likelihood of internalizing disorders in the community, which can be improved by asking frequency of symptoms compared to intensity. The DSM-XC is currently lacking meaningful domains for externalizing disorders.
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Affiliation(s)
- João Pedro Gonçalves Pacheco
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Mental Health Epidemiology Group, Santa Maria, Rio Grande do Sul, Brazil
| | - Christian Kieling
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Psychiatry and Legal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro H Manfro
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Isabel O Oliveira
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Fernando C Wehrmeister
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
- Rady Faculty of Health Sciences, Institute for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Luis Augusto Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
- UniEduK, Indaiatuba, São Paulo, Brazil
| | - Maurício Scopel Hoffmann
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Mental Health Epidemiology Group, Santa Maria, Rio Grande do Sul, Brazil
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
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Shrier LA, O'Connell MM, Torres A, Shone LP, Fiks AG, Plumb JA, Maturo JL, McCaskill NH, Harris D, Burke PJ, Felt T, Murphy ML, Sherritt L, Harris SK. Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55039. [PMID: 38530346 PMCID: PMC11005433 DOI: 10.2196/55039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. OBJECTIVE This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. METHODS We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. RESULTS The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. CONCLUSIONS Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. TRIAL REGISTRATION ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55039.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Madison M O'Connell
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Laura P Shone
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
- Shone Sciences, DBA, Lowville, NY, United States
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Julia A Plumb
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jessica L Maturo
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Nicholas H McCaskill
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Donna Harris
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States
| | - Pamela J Burke
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Thatcher Felt
- Yakima Valley Farm Workers Clinic, Grandview, WA, United States
| | | | - Lon Sherritt
- Cornerstone Systems Northwest, Lynden, WA, United States
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Venkatesh U, Aparnavi P, Mogan K, Durga R, Pearson J, Kishore S, Joshi HS, Nair NS, Nisha B, Agrawal R, Vidusha K, Chenkual CV, Nath B, Epari VR, Kumari R, Goyal P, Ahamed F, Baruah M, Anil R, Swami AA, Kamble BD, Sharma GA, Sharma A, Bera OP, Grover A, Verma SK. Determinants of substance use among young people attending primary health centers in India. Glob Ment Health (Camb) 2024; 11:e23. [PMID: 38572250 PMCID: PMC10988150 DOI: 10.1017/gmh.2024.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/14/2023] [Accepted: 01/24/2024] [Indexed: 04/05/2024] Open
Abstract
Background Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10-24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.
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Affiliation(s)
- U. Venkatesh
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | - P. Aparnavi
- Kovai Medical Center and Hospital Institute of Health Sciences and Research, Coimbatore, India
| | - K.A. Mogan
- South Asia Field Epidemiology and Technology Network, Inc., Metro Manila, Philippines
| | - R. Durga
- Department of Dentistry, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - Surekha Kishore
- All India Institute of Medical Sciences (AIIMS), Gorakhpur, India
| | - Hari Shanker Joshi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India
| | | | - B. Nisha
- Saveetha Medical College and Hospital, Kuthambakkam, India
| | | | | | | | - Bhola Nath
- All India Institute of Medical Sciences, Raebareli, India
| | | | | | - Pooja Goyal
- Employment State Insurance Corporation Medical College and Hospital, Faridabad, India
| | - Farhad Ahamed
- All India Institute of Medical Sciences, Kalyani, India
| | | | - R. Anil
- PES Institute of Medical Sciences and Research, Beggilipalle, India
| | | | | | | | - Akash Sharma
- Department of Medicine, University at Buffalo – Catholic Health System, Buffalo, NY, USA
| | | | - Ashoo Grover
- Indian Council of Medical Research, New Delhi, India
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Takada S, Seamans MJ, Javanbakht M, Bone C, Ijadi-Maghsoodi R, Shoptaw S, Gelberg L. Nativity and the risk of opioid use disorder among Hispanic/Latinx women in primary care in Los Angeles, CA. J Ethn Subst Abuse 2024:1-15. [PMID: 38327151 PMCID: PMC11303597 DOI: 10.1080/15332640.2023.2297392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND While rates of opioid use disorder (OUD) are lower among women compared to men, nativity may have disproportionate impacts on OUD risk among Hispanic/Latinx women but remain understudied. OBJECTIVE To assess the association between country of birth and reported OUD risk among low-income Hispanic/Latinx women in primary care in Los Angeles, CA. METHODS This was a cross-sectional study of 1189 non-pregnant, Hispanic/Latinx women attending two federally qualified health centers in Los Angeles between March and July 2013. OUD risk was assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and moderate-to-high risk was defined as ASSIST score ≥ 4. RESULTS Overall, 4.2% of women (n = 49) were at moderate-to-high risk for OUD. Risk for OUD was higher among US-born women compared to foreign-born women (6.7 vs. 1.7%; p < .01), those who reported 2+ chronic medical conditions (p < .01), and those who were at moderate-to-high risk for other substance use disorders (p < .01). In multivariable logistic regression analyses, being U.S.-born was independently associated with being at moderate-to-high risk for OUD among Hispanic/Latinx women as compared to those who were foreign-born (AOR = 2.8; 95% CI 1.2-6.8). CONCLUSION Among low-income Hispanic/Latinx women presenting to primary care, one in twenty patients is at-risk for OUD. The odds of moderate-high risk of OUD were three times as high in US-born compared to foreign-born women, and higher among those with chronic medical conditions and those at risk of other substance use disorders. Gender-specific and culturally-tailored screening for OUD may inform overdose prevention interventions for US-born Hispanic/Latinx women.
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Affiliation(s)
- Sae Takada
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Marissa J Seamans
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Curtis Bone
- Department of Family and Community Medicine, Penn State Milton Hershey Medical Center, Hershey, Pennsylvania
| | - Roya Ijadi-Maghsoodi
- Department of Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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Mitchell MM, G Mitchell S, Brooks JH, Akinwolere OG, Dusek K, O'Grady KE, Schwartz RP, Gryczynski J. The Relationship between Vaping Cannabis and Frequency of Cannabis Use and Cannabis-Related Problems among Urban High School Students. Subst Use Misuse 2024; 59:329-335. [PMID: 38063201 DOI: 10.1080/10826084.2023.2269573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Background: Vaping, including vaping cannabis, is increasing among adolescents. In this longitudinal study, we examined the relationship between vaping cannabis and frequency of cannabis use and related problems over 6 months among adolescents. Material and Methods: Data were from 233 participants (46.8% male, 93.1% African American, mean age = 16.4 years) reporting cannabis use. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) assessed frequency of past 30-day cannabis use and cannabis-related problems at baseline, 3- and 6-months post-baseline. We used latent growth curve modeling to compare vaping to non-vaping adolescents on trends in cannabis use frequency and ASSIST cannabis scores. Results: Adolescents who vaped cannabis (11.7%) had higher past 30-day frequency (mean = 17.89 days, SD = 10.49) of cannabis use at baseline compared to adolescents who had not vaped (mean = 12.1 days, SD = 10.93), but reported a significantly sharper decline in frequency of cannabis use (b = -0.34, p = 0.017). A significantly steeper decrease existed in the mean cannabis ASSIST scores for the vaping group than for the non-vaping group (b = -0.34, p = 0.014). Mean ASSIST scores on the cannabis subscale between the two groups were significantly different at 6-month follow-up (Vape mean = 6.00, SD = 8.12 vs. Non-vape mean = 9.6, SD = 9.39; p < 0.021). Conclusions: In a sample of cannabis-using adolescents, adolescents with experience vaping cannabis, compared to adolescents without vaping experience, on average reported sharper decreases in frequency of cannabis use and cannabis-related problems such as health or social problems.
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Affiliation(s)
| | | | | | | | - Kristi Dusek
- Friends Research Institute, Baltimore, Maryland, USA
| | - Kevin E O'Grady
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Arrington-Sanders R, Galai N, Falade-Nwulia O, Hammond C, Wirtz A, Beyrer C, Arteaga A, Celentano D. Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study. Subst Use Misuse 2024; 59:317-328. [PMID: 38146133 DOI: 10.1080/10826084.2023.2267655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.Trial Registration: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Renata Arrington-Sanders
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia Perelman School of Medicine, University of Pennsylvania
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Oluwaseun Falade-Nwulia
- Department of Medicine, Division of Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher Hammond
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Aubrey Arteaga
- Department of Pediatrics, Division of Adolescent & Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Boness CL, Carlos Gonzalez J, Sleep C, Venner KL, Witkiewitz K. Evidence-Based Assessment of Substance Use Disorder. Assessment 2024; 31:168-190. [PMID: 37322848 PMCID: PMC11059671 DOI: 10.1177/10731911231177252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.
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Affiliation(s)
- Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | | | - Chelsea Sleep
- Cincinnati VA Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | - Kamilla L Venner
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
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11
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Psychiatr Clin North Am 2023; 46:749-760. [PMID: 37879836 DOI: 10.1016/j.psc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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12
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Myerson JT, Thomas JK, Rufino KA, Noor N, Patriquin MA. Relationship between parental attachment styles and suicide in adolescents and adults admitted to an inpatient psychiatric hospital. J Affect Disord 2023; 341:170-175. [PMID: 37633528 DOI: 10.1016/j.jad.2023.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Suicide is among one of the leading causes of death in the United States affecting individuals of all ages. METHODS We examined the relationship between suicide risk and parental attachment among an inpatient psychiatric sample of 690 adolescents and 1000 adults. Participants completed self-report measures of suicide risk and attachment. RESULTS We found that both adolescents and adults with insecure (i.e., preoccupied, dismissive, fearful) maternal and paternal attachment are at a significantly higher risk of suicide compared to those with secure maternal and paternal attachment. Adolescents who endorsed a previous suicide attempt (27.2 %) were less likely to have a secure maternal attachment, while adults who endorsed a previous suicide attempt (28.9 %) were less likely to have secure paternal attachment. LIMITATIONS Our sample had limited racial and ethnic diversity which may limit the generalizability of the results to a broader population. CONCLUSIONS The present study provides evidence of the importance of parental attachment styles as a predictor of suicide-related behaviors across both adolescents and adults who are admitted inpatient. This suggests the importance of utilizing family-based interventions in order to reduce the risk of suicide.
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Affiliation(s)
| | | | - Katrina A Rufino
- The Menninger Clinic, Houston, TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; The University of Houston Downtown, Houston, TX 77002, USA
| | - Nausheen Noor
- The Menninger Clinic, Houston, TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michelle A Patriquin
- The Menninger Clinic, Houston, TX 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA; Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
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13
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Romero-Acosta K, Verhelst S, Lowe GA, Lipps GE, Restrepo J, Fonseca L. Association Between Suicidal Behaviour and Cannabis and Tranquilizer use, Depression, Aggression and Other Borderline Personality Traits Among Students in Sincelejo, Colombia. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2023; 52:225-235. [PMID: 37923416 DOI: 10.1016/j.rcpeng.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/29/2021] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This objective of this study is to examine the association between suicidal behaviour and substance use, depression, aggressiveness and borderline personality traits among adolescents from Sincelejo, a rural city in the north of Colombia. METHODS This cross sectional study included 352 participants selected by purposive sampling, from a public and a private school located in Sincelejo, Sucre district, in the north of Colombia. Students ages ranged from 12 to 18 years old (mean, 15.09±1.82). The participants completed three screening tools: a socio-demographic questionnaire, a screening instrument to collect information related to the frequency of use of some substances, such as tobacco and cannabis, and a self-report inventory to assess various personality and psychopathology domains. A series of t-tests, ANOVA and linear regression analyses were conducted. RESULTS Physical aggression (t=7.74; p <0.01), cognitive depression (t=5.03; p <0.01), affective depression (t=8.24; p <0.01), affective instability (t=3.46; p <0.01), few social relationships (t=3.36; p <0.01), self-harm (t=3.45; p<.01), cannabis and tranquilizer use (t=2.83; p <0.05; and t=2.37; p <0.05) had a significant independent relationship with suicidal behaviour. Aggression (t=2.59; p <0.05), components of depression (t=9.03; p <0.01) and borderline personality traits (t=4.12; p <0.01) also predicted suicidal behaviour. CONCLUSIONS More longitudinal studies are needed in this area to identify the causal relations between the factors studied and the suicidal behaviour of young people in Sincelejo.
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Affiliation(s)
- Kelly Romero-Acosta
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia.
| | - Salomón Verhelst
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
| | - Gillian A Lowe
- Department of Community Health and Psychiatry, The University of the West Indies - Mona, Kingston, Jamaica
| | - Garth E Lipps
- Department of Sociology, Psychology and Social Work, The University of the West Indies - Mona, Kingston, Jamaica
| | - José Restrepo
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
| | - Leodanis Fonseca
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
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14
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Bunting AM, Schwartz RP, Wu LT, Wahle A, Kline M, Subramaniam G, McNeely J. A Brief Screening and Assessment Tool for Opioid Use in Adults: Results from a Validation Study of the Tobacco, Alcohol, Prescription Medication, and Other Substances Tool. J Addict Med 2023; 17:471-473. [PMID: 37579113 PMCID: PMC10404299 DOI: 10.1097/adm.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This secondary analysis evaluated opioid-specific validation results of the Tobacco, Alcohol, Prescription Medication, and Other Substances (TAPS) tool for screening in primary care. METHODS This study is a secondary data analysis of the TAPS validation study. Performance of the TAPS tool for screening for unhealthy opioid use (with a score of 1+ for heroin and/or prescription opioids representing a positive screen) was evaluated. Discriminative ability was examined in comparison with reference standard measures across the spectrum of unhealthy opioid use: timeline follow-back with and without oral fluid testing identifying past-month use and the modified Composite International Diagnostic Interview for past-year problem use, opioid use disorder (OUD), and moderate-severe OUD. RESULTS In a sample of 2000 primary care patients, 114 screened positive for opioids on the TAPS tool. With a TAPS cutoff equal to 1+, the TAPS accurately identified past-month use, problem use, any OUD, and moderate-severe OUD (sensitivities = 68%-85%, specificities = 97%-98%, area under the curve = 0.80-0.91). When past-month use was expanded to include timeline follow-back with oral fluid testing, accuracy declined (52% sensitivity [95% confidence interval, 43%-60%], 98% specific [95% confidence interval, 97%-98%]). CONCLUSIONS While further testing in a larger population sample may be warranted, given their brevity, simplicity, and accuracy when self-administered, the TAPS opioid items can be used in primary care settings for a spectrum of unhealthy opioid use; however, self-disclosure remains an issue in primary care settings.
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Affiliation(s)
- Amanda M Bunting
- From the New York University Grossman School of Medicine, New York, NY (AMB, JM); Friends Research Institute, Baltimore, MD (RPS); Duke University School of Medicine, Durham, NC (L-TW); The Emmes Company, Rockville, MD (AW, MK); and National Institute on Drug Abuse, Rockville, MD (GS)
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15
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Kassa MA, Srahbzu M, Nakie G, Mekuria K, Feleke SF, Tesfa NA, Getnet B. Suicidal ideation and attempts among high school students of war- affected area at Woldia town, Northeast, Ethiopia, 2022. BMC Psychiatry 2023; 23:384. [PMID: 37259028 DOI: 10.1186/s12888-023-04889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Suicidal ideation and attempts usually occur during adolescence time, and living in war- affected area make the problem more predominate and severe. To the best of our knowledge, there were no studies done among high school students who live in war affected areas in Ethiopia. OBJECTIVE We assessed the prevalence and factors associated with suicide ideation and suicide attempts among high school students of war- affected area at Woldia town, Northeast, Ethiopia. METHODS School based cross-sectional study was conducted from May 23 to June 08, 2022.Data were collected from high school students in Woldia town, Ethiopia. Pretested, self-administered Amharic-language questionnaire was used to collect the data. Bivariable and multivariable logistic regression was used to identify the independent factors associated with suicide ideation and attempt. RESULTS A total of 668 of the 707 sampled students participated in the study (94.5% response rate). The prevalence of suicidal ideation and attempts among high school students in Woldia town was 16.29% and 12.87%, respectively. In the multivariable analysis, poor social support(AOR = 2.86, 95% CI:1.49, 5.46), posttraumatic stress disorder (AOR = 2.15, 95% CI:1.20, 3.85), family history of suicide(AOR = 3.94, 95% CI:2.21, 7.04), anxiety(AOR = 3.45, 95% CI:1.72, 6.89), and depression (AOR = 2.31, 95% CI:1.24, 4.33) were factors significantly associated with suicide ideation, and poor social support(AOR = 2.75, 95% CI:1.38, 5.47), depression (AOR = 4.27, 95% CI:2.10, 8.67) and being a female sex (AOR = 2.12, 95% CI:1.22, 3.69) were factors significantly associated with suicidal attempt. CONCLUSIONS AND RECOMMENDATIONS This study revealed that at least one in six and one in eight of the students had suicidal ideation and attempt, respectively. Therefore, we recommend that Ministry of Education shall work with Ministry of Health to extend and implement mental health services in high schools and provide social support to those students who need the services in order for the prevention of suicidal ideation and attempts.
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Affiliation(s)
- Mulat Awoke Kassa
- Department of Nursing, College of Health Sciences, Woldia University, P. O. Box: 400, Woldia, Ethiopia.
| | - Mengesha Srahbzu
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindie Mekuria
- Department of Nursing, College of Health Sciences, Woldia University, P. O. Box: 400, Woldia, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Berhanie Getnet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bershteyn A, Richard E, Zhou Q, Khan MR, Scheidell JD, Manandhar-Sasaki P, Ban K, Crystal S, Gordon AJ, Justice AC, Bryant KJ, Braithwaite RS. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study. Lancet HIV 2023; 10:e118-e125. [PMID: 36731986 DOI: 10.1016/s2352-3018(22)00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alcohol use, tobacco use, and other substance use often co-occur with depression, anxiety, and chronic pain, forming a constellation of alcohol, substance, and mood-related (CASM) conditions that disproportionately affects people with HIV in the USA. We used a microsimulation model to evaluate how alternative screening strategies accounting for CASM interdependence could affect life expectancy in people with HIV in the USA. METHODS We augmented a microsimulation model previously validated to predict US adult life expectancy, including in people with HIV. Using data from the Veterans Aging Cohort Study, we incorporated CASM co-occurrence, inferred causal relationships between CASM conditions, and assessed the effects of CASM on HIV treatment and preventive care. We simulated an in-care HIV cohort exposed to alternative CASM screening and diagnostic assessment strategies, ranging from currently recommended screenings (alcohol, tobacco, and depression, with diagnostic assessments for conditions screening positive) to a series of integrated strategies (screening for alcohol, tobacco, or depression with additional diagnostic assessments if any screened positive) to a maximal saturation strategy (diagnostic assessments for all CASM conditions). FINDINGS The saturation strategy increased life expectancy by 0·95 years (95% CI 0·93-0·98) compared with no screening. Recommended screenings provided much less benefit: 0·06 years (0·03-0·09) gained from alcohol screening, 0·08 years (0·06-0·11) from tobacco screening, 0·10 years (0·08-0·11) from depression screening, and 0·25 years (0·22-0·27) from all three screenings together. One integrated strategy (screening alcohol, tobacco, and depression with diagnostic assessment for all CASM conditions if any screened positive) produced near-maximal benefit (0·82 years [0·80-0·84]) without adding substantial screening burden, albeit requiring additional diagnostic assessments. INTERPRETATION Primary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Emma Richard
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Qinlian Zhou
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kaoon Ban
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA; Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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17
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Tang F, Li K, Rauktis ME, Buckley TD, Chi I. Immigration Experience and Cognitive Function Trajectories Among Older Chinese Immigrants. J Gerontol B Psychol Sci Soc Sci 2023; 78:124-135. [PMID: 35988160 PMCID: PMC9890920 DOI: 10.1093/geronb/gbac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/18/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Although a number of studies have documented cognitive health among older immigrants in the United States, little is known about how the life-course immigration experiences are associated with cognitive trajectories among older Chinese immigrants. We assess patterns of cognitive functioning and change over time and examine whether age at migration, reasons for migration, acculturation, perceived discrimination, and preferred dialects are related to cognitive trajectories. METHODS The sample comprised 2,075 participants from the Population Study of Chinese Elderly (PINE), who completed a battery of cognitive tests at four time points (2011-2019). Latent class growth analysis and multinomial logistic regression were utilized. RESULTS Three latent classes of cognitive trajectories were identified: the low functioning with the fastest decline (LCF, 12%), the moderate functioning with a medium decline rate (MCF, 39%), and the high functioning with the slowest decline (HCF, 48%). Perceiving more discrimination reduced, whereas speaking Taishanese increased the odds of being in the LCF and MCF. High acculturation only distinguished MCF from HCF after controlling for the known factors of cognitive health such as age, education, and social engagement. DISCUSSION This study identifies a group of older Chinese immigrants who are especially vulnerable to cognitive impairment and indicates that the risk of cognitive decline appears to be elevated with lower levels of acculturation and unidentified racial discrimination. More research is needed to fully understand the underlying mechanisms that link the life-course immigration experiences to cognitive health outcomes in later life.
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Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ke Li
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary E Rauktis
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tommy D Buckley
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, Southern California, USA
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18
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Calihan JB, Levy S. Substance Use Screening, Brief Intervention, and Referral to Treatment in Pediatric Primary Care, School-Based Health Clinics, and Mental Health Clinics. Child Adolesc Psychiatr Clin N Am 2023; 32:115-126. [PMID: 36410898 DOI: 10.1016/j.chc.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adolescent cannabis use is a modifiable health behavior with potential adverse developmental, cognitive, psychological, and health effects. Over the last 2 decades, work to promote implementation of screening, brief intervention, and referral to treatment has improved screening, use of validated screening tools, and preventive messaging. Current intervention strategies for cannabis use are associated with modest, short-term effects, and referral to treatment is limited by availability of resources for adolescent substance use. This article provides an update on the evidence base for screening, brief intervention, referral to treatment, and the current state of implementation focused on management of cannabis use disorder.
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Affiliation(s)
- Jessica B Calihan
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
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19
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Ramirez D, Rufino KA, Rech ME, Poa E, Patriquin MA. Increased symptom severity in adults and adolescents admitting to an inpatient psychiatric hospital during the COVID-19 pandemic. Psychiatry Res 2022; 316:114758. [PMID: 35944372 PMCID: PMC9338827 DOI: 10.1016/j.psychres.2022.114758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022]
Abstract
While the negative effects of Coronavirus Disease-2019 (COVID-19) on general mental health are well-established, less is known about the impact on those with severe mental illness. Thus, this study examined symptom severity among psychiatric inpatients admitted prior to versus during the COVID pandemic. Self-reported anxiety (GAD-7), depression (PHQ-9), emotional dysregulation (DERS-SF), sleep quality (PSQI), nightmares (DDNSI), and suicidal ideation (SBQ-R) were examined in 470 adults (n = 235 admitted pre-pandemic) and 142 children and adolescents (n = 65 admitted pre-pandemic) at admission. Adults also completed measures of disability (WHODAS) and substance use (WHOASSIST). Adults admitted during the COVID pandemic reported significantly higher levels of anxiety [p < .001, partial η2=0.18], depression [p < .001, partial η2=0.06], emotion dysregulation [p < .001, partial η2=0.05], nightmares [p = .013, partial η2=0.01], and disability [p < .001, partial η2=0.04] compared to adults admitted pre-COVID. Levels of anxiety [p = .005, partial η2=0.05], depression [p = .005, partial η2=0.06], and sleep quality [p = .011, partial η2=0.05] were significantly higher among adolescents admitted during COVID compared to pre-COVID. The findings help identify areas of prioritization for future mental health prevention/intervention efforts for future disease outbreaks.
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Affiliation(s)
| | - Katrina A. Rufino
- The Menninger Clinic, Houston, TX 77035, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 12301 Main St, Houston, TX 77030, USA,The University of Houston Downtown, Houston, TX 77002, USA
| | | | - Edward Poa
- The Menninger Clinic, Houston, TX 77035, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 12301 Main St, Houston, TX 77030, USA
| | - Michelle A. Patriquin
- The Menninger Clinic, Houston, TX 77035, USA,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 12301 Main St, Houston, TX 77030, USA,Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA,Corresponding author at: Menninger Department of Psychiatry and Behavioral Sciences, The Menninger Clinic, Baylor College of Medicine, 12301 Main St, Houston, TX 77035, USA
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Examining the Effectiveness of the FaCES Adolescent SBIRT Intervention. J Adolesc Health 2022; 71:S41-S48. [PMID: 36122968 DOI: 10.1016/j.jadohealth.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/15/2022] [Accepted: 04/26/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE The Facilitating Change for Excellence in SBIRT (FaCES) is a service package for adolescent primary care that was developed based on best practices and evidence, but was empirically untested. The aim of this study is to compare the FaCES intervention to treatment as usual (TAU) for rural adolescent primary care patients. METHODS In this modified cluster-randomized stepped wedge design, providers who completed at least 20 adolescent TAU visits received training in the FaCES package in random order. Adolescent patients (N = 1,226) waiting for appointments were continuously recruited into the study and completed a baseline assessment before their scheduled appointment and an on-line 3-month follow-up. Participants received either FaCES or TAU, depending on whether their provider had been trained in FaCES. Due to COVID-19 disruptions, only 14 of the 29 providers were trained before study recruitment activities ceased. RESULTS More than 80% of the sample indicated no prior use of tobacco, alcohol, or marijuana at study entry. The Arm × Time interaction failed to reach significance for the substance use outcomes considered. In the FaCES condition, the group with no prior use had an increased probability of substance use at 3-month follow-up, while the group reporting prior use had a decreased probability of use at follow-up. Participants who reported no use at baseline had an increased probability of use at follow-up, whether they received the FaCES intervention or TAU. DISCUSSION This study was unable to demonstrate the effectiveness of FaCES. Findings suggest some natural movement in substance use risk over time.
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21
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Coronavirus disease pandemic and adolescent substance use. Curr Opin Pediatr 2022; 34:334-340. [PMID: 35836392 DOI: 10.1097/mop.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Substance use is common in adolescence and has distinct developmental, cognitive, and health consequences. Over the last 2 years, the coronavirus disease 2019 pandemic has isolated adolescents, disrupted typical developmental milestones, and caused pervasive stress and anxiety. Healthcare providers can help by recognizing and addressing these effects on adolescent mental health and substance use. This update reviews the immediate effects of the pandemic on adolescent substance use, potential future implications, and opportunities to use new strategies to improve care for adolescents with problematic use. RECENT FINDINGS Initial findings suggest that fewer teens started using substances during the pandemic. This was likely influenced by stay at home orders that reduced opportunities for social use. However, increased time at home was not beneficial for all adolescents. Furthermore, adolescents who used substances prepandemic, experienced material hardship, or reported higher pandemic-related stress tended to intensify substance use during this time. SUMMARY The adverse effects of pandemic isolation, anxiety, and developmental disruption will likely have consequences for adolescent substance use for many years to come. To comprehensively address adolescent health, healthcare providers can be sensitive to these realities and use existing screening and brief intervention strategies to address use. Innovative telehealth strategies that allow for the expansion of substance use treatment offer promising opportunities to improve care for adolescents with substance use disorder.
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22
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Yin L, Dinasarapu AR, Borkar SA, Chang KF, De Paris K, Kim-Chang JJ, Sleasman JW, Goodenow MM. Anti-inflammatory effects of recreational marijuana in virally suppressed youth with HIV-1 are reversed by use of tobacco products in combination with marijuana. Retrovirology 2022; 19:10. [PMID: 35642061 PMCID: PMC9151353 DOI: 10.1186/s12977-022-00594-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Marijuana's putative anti-inflammatory properties may benefit HIV-associated comorbidities. How recreational marijuana use affects gene expression in peripheral blood cells (PBC) among youth with HIV-1 (YWH) is unknown. APPROACH YWH with defined substance use (n = 54) receiving similar antiretroviral therapy (ART) were assigned to one of four analysis groups: YWH with detectable plasma HIV-1 (> 50 RNA copies/ml) who did not use substances (H+V+S-), and YWH with undetectable plasma HIV-1 who did not use substances (H+V-S-), or used marijuana alone (H+V-S+[M]), or marijuana in combination with tobacco (H+V-S+[M/T]). Non-substance using youth without HIV infection (H-S-, n = 25) provided a reference group. PBC mRNA was profiled by Affymetrix GeneChip Human Genome U133 Plus 2.0 Array. Differentially expressed genes (DEG) within outcome groups were identified by Significance Analysis of Microarrays and used for Hierarchical Clustering, Principal Component Analysis, and Ingenuity Pathways Analysis. RESULTS HIV-1 replication resulted in > 3000 DEG involving 27 perturbed pathways. Viral suppression reduced DEG to 313, normalized all 27 pathways, and down-regulated two additional pathways, while marijuana use among virally suppressed YWH resulted in 434 DEG and no perturbed pathways. Relative to H+V-S-, multiple DEG normalized in H+V-S+[M]. In contrast, H+V-S+[M/T] had 1140 DEG and 10 dysregulated pathways, including multiple proinflammatory genes and six pathways shared by H+V+S-. CONCLUSIONS YWH receiving ART display unique transcriptome bioprofiles based on viral replication and substance use. In the context of HIV suppression, marijuana use, alone or combined with tobacco, has opposing effects on inflammatory gene expression.
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Affiliation(s)
- Li Yin
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, 50 South Dr., Bethesda, MD, 20814, USA.
| | | | - Samiksha A Borkar
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, 50 South Dr., Bethesda, MD, 20814, USA
| | - Kai-Fen Chang
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, 50 South Dr., Bethesda, MD, 20814, USA
| | - Kristina De Paris
- Department of Microbiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julie J Kim-Chang
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - John W Sleasman
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Maureen M Goodenow
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, 50 South Dr., Bethesda, MD, 20814, USA
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Venturo-Conerly KE, Johnson NE, Osborn TL, Puffer ES, Rusch T, Ndetei DM, Wasanga CM, Mutiso V, Musyimi C, Weisz JR. Long-term health outcomes of adolescent character strength interventions: 3- to 4-year outcomes of three randomized controlled trials of the Shamiri program. Trials 2022; 23:443. [PMID: 35614514 PMCID: PMC9132569 DOI: 10.1186/s13063-022-06394-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents in low- and middle-income countries in need of mental health care often do not receive it due to stigma, cost, and lack of mental health professionals. Culturally appropriate, brief, and low-cost interventions delivered by lay-providers can help overcome these barriers and appear effective at reducing symptoms of depression and anxiety until several months post-intervention. However, little is known about whether these interventions may have long-term effects on health, mental health, social, or academic outcomes. METHODS Three previous randomized controlled trials of the Shamiri intervention, a 4-week, group-delivered, lay-provider-led intervention, have been conducted in Kenyan high schools. Shamiri teaches positively focused intervention elements (i.e., growth mindset and strategies for growth, gratitude, and value affirmation) to target symptoms of depression and anxiety and to improve academic performance and social relationships, by fostering character strengths. In this long-term follow-up study, we will test whether these mental health, academic, social, and character-strength outcomes, along with related health outcomes (e.g., sleep quality, heart-rate variability and activity level measured via wearables, HIV risk behaviors, alcohol and substance use), differ between the intervention and control group at 3-4-year follow-up. For primary analyses (Nanticipated = 432), youths who participated in the three previous trials will be contacted again to assess whether outcomes at 3-4-year-follow-up differ for those in the Shamiri Intervention group compared to those in the study-skills active control group. Multi-level models will be used to model trajectories over time of primary outcomes and secondary outcomes that were collected in previous trials. For outcomes only collected at 3-4-year follow-up, tests of location difference (e.g., t-tests) will be used to assess group differences in metric outcomes and difference tests (e.g., odds ratios) will be used to assess differences in categorical outcomes. Finally, standardized effect sizes will be used to compare groups on all measures. DISCUSSION This follow-up study of participants from three randomized controlled trials of the Shamiri intervention will provide evidence bearing on the long-term and health and mental health effects of brief, lay-provider-delivered character strength interventions for youth in low- and middle-income countries. TRIAL REGISTRATION PACTR Trial ID: PACTR202201600200783 . Approved on January 21, 2022.
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Affiliation(s)
- Katherine E Venturo-Conerly
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Natalie E Johnson
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Tom L Osborn
- Shamiri Institute, Nairobi, Kenya.
- Shamiri Institute, Allston, MA, USA.
| | - Eve S Puffer
- Global Health Institute, Duke University, Durham, NC, USA
| | - Thomas Rusch
- Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
| | - David M Ndetei
- African Mental Health Research & Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Victoria Mutiso
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Pautrat M, Pierre Lebeau J, Laporte C. Identifying available addictive disorder screening tests validated in primary care: A systematic review. Addict Behav 2022; 126:107180. [PMID: 34864478 DOI: 10.1016/j.addbeh.2021.107180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Substance use disorders and non-substance addictive behaviors are major, growing health concerns. Efficient screening primary care settings encouraged but its widespread implementation is restricted without an appropriate screening approach for clinical practice or guidance for practitioners choose an appropriate screening test. This study aims to identify addictive disorder screening tests which are validated in primary care and suggest steps to help practitioners select the appropriate test. METHOD A systematic review of the literature through Pubmed, PsycINFO and The Cochrane Library was performed from database inception to December 21, 2020. The search strategy included three research topics: screening, addictive disorders, and primary care. Selection criteria included published studies evaluating the validity of an addictive disorder screening test in primary care settings. RESULTS 8638 papers were selected, and 50 studies were included. Seventeen questionnaires validated in primary care covered the main substance use disorders, but none screened for non-substance addictive behaviors. Tests such as ASSIST, S2BI, SUBS and TAPS screen for a variety of substance use disorders while others such as TICS and CAGE-AID only have a few questions to improve feasibility. However, some shorter tests had weaker psychometric properties. CONCLUSIONS Seventeen addictive disorder screening tests validated in primary care are available. The feasibility and acceptability in primary care of the shorter tests needs to be assessed. A transversal screening test, adapted to the constraints of primary care, that enables clinicians to detect substance use disorders and non-substance addictive behaviors is needed.
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Affiliation(s)
- Maxime Pautrat
- Department of General Practice, University of Tours, France; University of Tours, EA7505 Education Ethique Santé, France.
| | - Jean Pierre Lebeau
- Department of General Practice, University of Tours, France; University of Tours, EA7505 Education Ethique Santé, France
| | - Catherine Laporte
- University of Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, F-63000 Clermont-Ferrand, France
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25
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Levy S, Fuller A, Kelly S, Lunstead J, Weitzman ER, Straus JH. A Phone Consultation Call Line to Support SBIRT in Pediatric Primary Care. Front Psychiatry 2022; 13:882486. [PMID: 35633788 PMCID: PMC9130490 DOI: 10.3389/fpsyt.2022.882486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Screening Brief Intervention Referral to Treatment (SBIRT) is recommended as a routine part of pediatric primary care, though managing patients with positive screens is challenging. To address this problem, the state of Massachusetts created a call line staffed by pediatric Addiction Medicine specialists to provide consultations to primary care providers and access to a behavioral health provider specially trained in managing adolescent substance use. OBJECTIVE To describe the uptake and outcomes of a consultation call line and virtual counseling for managing substance use disorders (SUD) in pediatric primary care. METHODS Service delivery data from consultations and counseling appointments were captured in an electronic database including substance, medication recommendations, level of care recommendations and number of counseling appointments completed for each patient. Summary data is presented here. RESULTS In all, there were 407 encounters to 108 unique families, including 128 consultations and 279 counseling visits in a one-year period. The most common substances mentioned by healthcare providers were cannabis (64%), nicotine (20%), alcohol (20%), vaping (9%) and opioids (5%). Management in primary care was recommended for 87 (68%) of the consultations. Medications for SUD treatment were recommended for 69 (54%) consultations including two for opioid use disorder. CONCLUSION We found that both a statewide consultation call line and virtual counseling to support SBIRT in pediatric primary care were feasible. The majority of consultations resulted in recommendations for treatment in primary care.
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Affiliation(s)
- Sharon Levy
- Department of Pediatrics, Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Alyssa Fuller
- Department of Pediatrics, Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, MA, United States
| | - Shawn Kelly
- Department of Pediatrics, Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, MA, United States
| | - Julie Lunstead
- Department of Pediatrics, Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, MA, United States
| | - Elissa R Weitzman
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - John H Straus
- Massachusetts Child Psychiatry Access Program, Beacon Health Options, Boston, MA, United States
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26
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Anthoine E, Caillon J, Deparis X, Blanche M, Lebeaupin M, Brochard MA, Venisse JL, Moret L. Assessing the Acceptability and Feasibility of a Web-Based Screening for Psychoactive Substance Users Among a French Sample of University Students and Workers: Mixed Methods Prospective Study. JMIR Form Res 2021; 5:e15519. [PMID: 34596571 PMCID: PMC8520132 DOI: 10.2196/15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Early detection in the prevention of addictive behaviors remains a complex question in practice for most first-line health care workers (HCWs). Several prevention measures have successfully included a screening stage followed by a brief intervention in case of risk-related use or referral to an addiction center for problematic use.
Whereas early detection is highly recommended by the World Health Organization, it is not usually performed in practice. Objective The aim of this study was to assess the acceptability and feasibility of a web-based app, called Pulsio Santé, for health service users and first-line prevention HCW and to carry out an exhaustive process of early detection of psychoactive substance use behaviors. Methods A mixed methods prospective study was conducted in 2 departments:
HCWs from the regional occupational health department and from the university department of preventive medicine dedicated to students were invited to participate.
Participants 18 years or older who had been seen in 2017 by a HCW from one of the departments were eligible.
The study procedure comprised 5 phases: (1) inclusion of the participants after a face-to-face consultation with an HCW; (2) reception of a text message by participants on their smartphone or by email; (3) self-assessment by participants regarding their substance use with the Pulsio Santé app; (4) if participants agreed, transfer of the results to the HCW; and (5) if participants declined, a message to invite them to get in touch with their general practitioner should the assessment detect a risk. Several feasibility and acceptability criteria were assessed by an analysis of a focus group with the HCW that explored 4 themes (usefulness and advantages, problems and limitations, possible improvements, and finally, integration into routine practice). Results A total of 1474 people were asked to participate, with 42 HCWs being involved. The percentage of people who agreed to receive a text message or an email, which was considered as the first level of acceptability, was 79.17% (1167/1474). The percentage of participants who clicked on the self-assessment link, considered as the second level of acceptability, was 60.24% (703/1167).
The percentage of participants who completed their self-evaluation entirely, which was considered as the first level of feasibility, was 76.24% (536/703). The percentage of participants who shared the results of their evaluation with the HCWs, considered as the second level of feasibility, was 79.48% (426/536).
The qualitative study showed that there were obstacles on the side of HCWs in carrying out the recommended interventions for people at risk based on their online screening, such as previous training or adaptations in accordance with specific populations. Conclusions Quantitative results showed good acceptability and feasibility of the Pulsio Santé app by users and HCWs. There is a need for further studies more directly focused on the limitations highlighted by the qualitative results.
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Affiliation(s)
- Emmanuelle Anthoine
- PHU11 Public Health Department, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Julie Caillon
- Addictions Department, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | - Xavier Deparis
- Service de Santé au Travail de la Région Nantaise, Nantes, France
| | - Michel Blanche
- Service de Santé des Étudiants (SUMPPS), University of Nantes, Nantes, France
| | - Maxime Lebeaupin
- PHU11 Public Health Department, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
| | | | | | - Leïla Moret
- PHU11 Public Health Department, Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France.,UMR 1246 SPHERE (Methods in Patient-Centered Outcomes and Health Research), University of Nantes and Tours, Nantes, France
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Friso F, Saucedo G, Villanueva J, Politi M. Administration of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among high school students in the Peruvian Amazon. J Ethn Subst Abuse 2021:1-11. [PMID: 34348077 DOI: 10.1080/15332640.2021.1956393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article reports on results of the administration of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to 500 high school students (aged 16-19) in the Peruvian Amazon. Results indicate 68.6% of the sample reported consumption of alcohol in the past three months. One out of four students reported high risk involvement with at least one substance while 1 out of 3 reported moderate risk. This is one of the few instances in which ASSIST was administered to adolescents and offers possibilities for further reflection on drug use at early ages.
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Affiliation(s)
- Fabio Friso
- Center for Drug Addiction Treatment and Research on Traditional Medicines - Takiwasi, Tarapoto, Peru
| | - Gary Saucedo
- Center for Drug Addiction Treatment and Research on Traditional Medicines - Takiwasi, Tarapoto, Peru
| | - Josué Villanueva
- Center for Drug Addiction Treatment and Research on Traditional Medicines - Takiwasi, Tarapoto, Peru
| | - Matteo Politi
- Center for Drug Addiction Treatment and Research on Traditional Medicines - Takiwasi, Tarapoto, Peru.,University of Chieti-Pescara, Chieti Scalo, Italy
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28
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Rabbitts JA, Zhou C, de la Vega R, Aalfs H, Murray CB, Palermo TM. A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPal TM): study protocol for a multisite randomized controlled trial. Trials 2021; 22:506. [PMID: 34330321 PMCID: PMC8325315 DOI: 10.1186/s13063-021-05421-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. METHODS Adolescents 12-18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. DISCUSSION Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. TRIAL REGISTRATION NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020.
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Affiliation(s)
- Jennifer A. Rabbitts
- Center for Clinical and Translational Research (CCTR), Seattle Children’s Hospital, 4800 Sand Point Way NE MB.11.500.3, Seattle, WA 98105 USA
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Chuan Zhou
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Rocio de la Vega
- Department of Psychology, University of Málaga, Campus de Teatinos, s/n, 29071 Málaga, Spain
| | - Homer Aalfs
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Caitlin B. Murray
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
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Romero-Acosta K, Verhelst S, Lowe GA, Lipps GE, Restrepo J, Fonseca L. Association Between Suicidal Behaviour and Cannabis and Tranquilizer use, Depression, Aggression and Other Borderline Personality Traits Among Students in Sincelejo, Colombia. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00106-2. [PMID: 34246472 DOI: 10.1016/j.rcp.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 05/19/2021] [Accepted: 05/29/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This objective of this study is to examine the association between suicidal behaviour and substance use, depression, aggressiveness and borderline personality traits among adolescents from Sincelejo, a rural city in the north of Colombia. METHODS This cross sectional study included 352 participants selected by purposive sampling, from a public and a private school located in Sincelejo, Sucre district, in the north of Colombia. Students ages ranged from 12 to 18 years old (mean, 15.09±1.82). The participants completed three screening tools: a socio-demographic questionnaire, a screening instrument to collect information related to the frequency of use of some substances, such as tobacco and cannabis, and a self-report inventory to assess various personality and psychopathology domains. A series of t-tests, ANOVA and linear regression analyses were conducted. RESULTS Physical aggression (t=7.74; p <0.01), cognitive depression (t=5.03; p <0.01), affective depression (t=8.24; p <0.01), affective instability (t=3.46; p <0.01), few social relationships (t=3.36; p <0.01), self-harm (t=3.45; p<.01), cannabis and tranquilizer use (t=2.83; p <0.05; and t=2.37; p <0.05) had a significant independent relationship with suicidal behaviour. Aggression (t=2.59; p <0.05), components of depression (t=9.03; p <0.01) and borderline personality traits (t=4.12; p <0.01) also predicted suicidal behaviour. CONCLUSIONS More longitudinal studies are needed in this area to identify the causal relations between the factors studied and the suicidal behaviour of young people in Sincelejo.
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Affiliation(s)
- Kelly Romero-Acosta
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia.
| | - Salomón Verhelst
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
| | - Gillian A Lowe
- Department of Community Health and Psychiatry, The University of the West Indies - Mona, Kingston, Jamaica
| | - Garth E Lipps
- Department of Sociology, Psychology and Social Work, The University of the West Indies - Mona, Kingston, Jamaica
| | - José Restrepo
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
| | - Leodanis Fonseca
- Department of Psychological Research, House 9, Corporación Universitaria del Caribe CECAR, Sincelejo, Colombia
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Basedow LA, Kuitunen-Paul S, Eichler A, Roessner V, Golub Y. Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients. Front Psychol 2021; 12:678819. [PMID: 34149570 PMCID: PMC8212997 DOI: 10.3389/fpsyg.2021.678819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023] Open
Abstract
Background A common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients. Methods N = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated. Results A two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70). Conclusion This is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.
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Affiliation(s)
- Lukas A Basedow
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sören Kuitunen-Paul
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Yulia Golub
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Kaswa R. Primary healthcare approach to substance abuse management. S Afr Fam Pract (2004) 2021; 63:e1-e4. [PMID: 34082558 PMCID: PMC8378164 DOI: 10.4102/safp.v63i1.5307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/04/2022] Open
Abstract
Substance abuse is common amongst patients attending primary healthcare settings. Despite the substantial impact on one’s health, substance abuse is often underdiagnosed by primary care providers owing to a lack of training and time for screening. Self-reported screening tools are easy to administer and efficient to make a substance abuse diagnosis in primary care settings. Comorbid mental illness and intimate partner violence are common amongst patients presenting with substance abuse in primary care. An early diagnosis and a brief behavioural change counselling are effective in managing substance abuse before it develops into dependency. A brief motivational communication rather than a confrontation during substance abuse screening, counselling and treatment is important to achieve optimum patient outcomes.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Walter Sisulu University, Mthatha.
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Gilbert PA, Kava CM, Afifi R. High-School Students Rarely Use E-Cigarettes Alone: A Sociodemographic Analysis of Polysubstance Use Among Adolescents in the United States. Nicotine Tob Res 2021; 23:505-510. [PMID: 32052052 DOI: 10.1093/ntr/ntaa037] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/10/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Most adolescents reporting e-cigarette use have also used combustible tobacco; however, the extent to which they use other substances is less clear. This study assessed e-cigarette use with tobacco, alcohol, or cannabis and quantified the risk of polysubstance use among adolescents overall and by sociodemographic characteristics. AIMS AND METHODS Using 2017 Youth Behavioral Risk Factor Surveillance System data from adolescents (grades 9-12) with complete substance use information (n = 11 244), we examined e-cigarette poly-use status (none [referent], e-cigarettes only, or e-cigarettes + other substances). We estimated the prevalence of substance use and modeled odds of e-cigarette use, alone or with other substances, by several sociodemographic characteristics. Analyses were completed in Stata version 15.1 using survey procedures to account for the complex survey design. RESULTS Approximately 12% of adolescents reported past 30-day e-cigarette use. Almost all (93%) e-cigarette users also reported other substance use; alcohol appeared most frequently in combinations. Odds of e-cigarette single use and e-cigarette poly-use (vs. no use) were higher for males and adolescents with lower grades (odds ratios [ORs] = 1.44-2.31). Racial/ethnic minorities had lower odds of e-cigarette poly-use than White peers (ORs = 0.18-0.61), and bisexual (vs. straight) adolescents were more likely to be e-cigarette poly-users (OR = 1.62). E-cigarette use increased from 9th grade (7%) to 12th grade (16%). CONCLUSIONS Polysubstance use is highly prevalent among adolescents who use e-cigarettes. Therefore, e-cigarette screening should include the assessment of other substances, especially alcohol. Early and comprehensive prevention efforts to reduce e-cigarette and other substance use could have a substantial beneficial impact on population health over time. IMPLICATIONS This study extends knowledge about e-cigarette use among adolescents by exploring its use with alcohol, cannabis, and other tobacco products. We found that e-cigarettes were very rarely used alone, and our analysis identified several sociodemographic factors associated with greater odds of e-cigarette polysubstance use. In response, we recommend that prevention interventions address multiple substances concurrently, screen repeatedly to detect new initiation as age increases, focus on e-cigarette use as a less stigmatized entry point to discussions of substance use, and target priority population subgroups.
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Affiliation(s)
- Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA
| | - Christine M Kava
- Health Promotion Research Center, Department of Health Services, University of Washington, Seattle, WA
| | - Rima Afifi
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA
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Brief Mental Health Disorder Screening Questionnaires and Use with Public Safety Personnel: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073743. [PMID: 33916659 PMCID: PMC8038412 DOI: 10.3390/ijerph18073743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
Brief mental health disorder screening questionnaires (SQs) are used by psychiatrists, physicians, researchers, psychologists, and other mental health professionals and may provide an efficient method to guide clinicians to query symptom areas requiring further assessment. For example, annual screening has been used to help identify military personnel who may need help. Nearly half (44.5%) of Canadian public safety personnel (PSP) screen positive for one or more mental health disorder(s); as such, regular mental health screenings for PSP may be a valuable way to support mental health. The following review was conducted to (1) identify existing brief mental health disorder SQs; (2) review empirical evidence of the validity of identified SQs; (3) identify SQs validated within PSP populations; and (4) recommend appropriately validated brief screening questionnaires for five common mental health disorders (i.e., generalized anxiety disorder (GAD), major depressive depression (MDD), panic disorder, posttraumatic stress disorder, alcohol use disorder). After reviewing the psychometric properties of the identified brief screening questionnaires, we recommend the following four brief screening tools for use with PSP: the Patient Health Questionnaire-4 (screening for MDD and GAD), the Brief Panic Disorder Symptom Screen—Self-Report, the Short-Form Posttraumatic Checklist-5, and the Alcohol Use Disorders Identification Test-Consumption.
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Comparing substance use and mental health among sexual and gender minority and heterosexual cisgender youth experiencing homelessness. PLoS One 2021; 16:e0248077. [PMID: 33705446 PMCID: PMC7951876 DOI: 10.1371/journal.pone.0248077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/18/2021] [Indexed: 11/20/2022] Open
Abstract
Youth homelessness has been demonstrated to disproportionately affect sexual and gender minority (SGM) youth compared to heterosexual cisgender peers. In this context, we aimed to compare health risks between service-seeking SGM and heterosexual cisgender youth experiencing homelessness, including harmful risks stemming from substance use and severity of symptoms of mental health disorders. We recruited 100 racially diverse, unstably housed participants aged 18-24 who access services at an urban non-profit organization in San Francisco, CA. Data analysis included 56 SGM participants who identified as gay, lesbian, bisexual, pansexual, unsure, transgender, and nongender, and 44 heterosexual cisgender participants. In contrast to previous studies reporting significantly higher frequency of substance use and more severe symptoms of depression, generalized anxiety, and post-traumatic stress disorder among SGM youth compared to heterosexual cisgender peers, many of these health disparities were not observed in our diverse study population of service-seeking youth. Furthermore, with the exception of methamphetamine, SGM participants did not exhibit greater harmful risks resulting from substance use, such as health, social, financial, and legal complications. We discuss the reduced burden of health disparities between SGM and heterosexual cisgender youth in our service-seeking study population within the context of gender- and sexuality-affirming programming offered at the partnering community organization. We conclude that longitudinal data on these tailored community-level interventions are needed to further explore the reduced burden of health disparities observed among service-seeking SGM youth experiencing homelessness in San Francisco in order to continue supporting pathways out of homelessness for youth of all sexual and gender identities nationwide.
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Mulat N, Gutema H, Wassie GT. Prevalence of depression and associated factors among elderly people in Womberma District, north-west, Ethiopia. BMC Psychiatry 2021; 21:136. [PMID: 33685419 PMCID: PMC7938572 DOI: 10.1186/s12888-021-03145-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression is a common mental disorder that suffers many elderly people who are neglected, their problems are overlooked, and no efforts are made to mitigate their suffering. It is a mental health problem which is both underdiagnosed and under treated in primary care settings. This study was aimed to assess the prevalence and associated factors of depression among elderly people in Womberma District, Ethiopia. METHODS A community based cross-sectional study was conducted from March 10/2020 - April 08/2020. From a 2269 study population, 959 study participants were selected by using computer-generated simple random sampling techniques from selected kebeles. Data were collected using Geriatric depression scale item 15 through face-to-face interviews. Then, entered into EpiData version 3.1 and then exported to SPSS version 23.0 for analyses. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of depression. An adjusted odds ratio with 95% confidence interval was reported and statistical significance was declared at P-values < 0.05. RESULTS The prevalence of depression among elderly people was 45% [95% CI: 41.7-48.5%]. Being female [AOR = 1.60, 95% CI [(1.15-2.23)], (age > =75 years [AOR = 7.95, 95% CI (4.98-12.68)], age 70-74 years [AOR = 5.52, 95% CI (3.52-8.66)], age 65-69 years [AOR = 2.39,95% CI (1.54-3.70)]; divorced [AOR = 2.53, 95% CI (1.59-4.03)], widowed [AOR = 2.65, 95% CI (1.61-4.34)]; poor social support [AOR = 3.32, 95% CI (1.77-6.23)] and presence of known chronic disease [AOR = 1.91, 95% CI (1.30-2.81)] were significantly associated factors with depression. CONCLUSIONS In this study, the prevalence of depression among elderly people was high compared with previous studies done in other parts of Ethiopia. Older age, being female, marital loss, presence of known chronic disease, and poor social support were contributing factors for depression among elders. Early screening and co-morbidity management of depression should be comprised in basic primary health care packages. And also, ensuring adequate social support by establishing the Geriatrics care center could play a crucial role to mitigate the suffering of the elders from marital loss provoked loneness and depression.
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Affiliation(s)
- Nebiyu Mulat
- Womberma District Health Office, Dembecha, Amhara Region Ethiopia
| | - Hordofa Gutema
- grid.442845.b0000 0004 0439 5951Department of Health promotion and Behavioral sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Erinfolami A, Olagunju A, Akije A, Ogunsemi O. Mitigating the risk of alcohol use among university students: Examining the feasibility and effects of screening and brief intervention - A quasi-experimental study. JOURNAL OF CLINICAL SCIENCES 2021. [DOI: 10.4103/jcls.jcls_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Computer- vs. nurse practitioner-delivered brief intervention for adolescent marijuana, alcohol, and sex risk behaviors in school-based health centers. Drug Alcohol Depend 2021; 218:108423. [PMID: 33307377 DOI: 10.1016/j.drugalcdep.2020.108423] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study examined approaches to delivering brief interventions (BI) for risky substance use and sexual behaviors in school-based health centers (SBHCs). METHODS 300 Adolescents (ages 14-18; 54 % female) with risky marijuana and/or alcohol use identified via CRAFFT screening (scores >1) were recruited from two SBHCs and randomized to computer-delivered BI (CBI) or nurse practitioner-delivered BI (NBI). Both BIs included motivational and didactic content targeting marijuana, alcohol, and risky sexual behaviors. Assessments at baseline, 3-month, and 6-month follow-up included past 30-day frequency of marijuana use, alcohol use, binge drinking, unprotected sex, and sex while intoxicated; marijuana and alcohol problems; and health-related quality-of-life (HRQoL). A focused cost-effectiveness analysis was conducted. An historical 'assessment-only' cohort (N=50) formed a supplementary quasi-experimental comparison group. RESULTS There were no significant differences between NBI and CBI on any outcomes considered (e.g., days of marijuana use; p=.26). From a cost-effectiveness perspective, CBI was 'dominant' for HRQoL and marijuana use. Participants' satisfaction with BI was significantly higher for NBI than CBI. Compared to the assessment-only cohort, participants who received a BI had lower frequency of marijuana (3-months: Incidence Rate Ratio [IRR] = .74 [.57, .97], p=.03), alcohol (3-months: IRR = .43 [.29, .64], p<.001; 6-months: IRR = .58 [.34, .98], p = .04), alcohol-specific problems (3-months: IRR = .63 [.45, .89], p=.008; 6-months: IRR = .63 [.41, .97], p = .04), and sex while intoxicated (6-months: IRR = .42 [.21, .83], p = .013). CONCLUSIONS CBI and NBI did not yield different risk behavior outcomes in this randomized trial. Supplementary quasi-experimental comparisons suggested potential superiority over assessment-only. Both NBI and CBI could be useful in SBHCs.
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Alderson H, Kaner E, McColl E, Howel D, Fouweather T, McGovern R, Copello A, Brown H, McArdle P, Smart D, Brown R, Lingam R. A pilot feasibility randomised controlled trial of two behaviour change interventions compared to usual care to reduce substance misuse in looked after children and care leavers aged 12-20 years: The SOLID study. PLoS One 2020; 15:e0238286. [PMID: 32898141 PMCID: PMC7478815 DOI: 10.1371/journal.pone.0238286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers. AIM The SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care. METHODS We recruited young people in care aged 12-20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up). RESULTS Of 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions. CONCLUSION By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Paul McArdle
- Child and Adolescent, Mental Health Services, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, United Kingdom
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Rebecca Brown
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children’s Health, University New South Wales, Randwick, Australia
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Alderson H, Kaner E, Brown R, Howel D, McColl E, Smart D, Copello A, Fouweather T, McGovern R, Brown H, McArdle P, Lingam R. Behaviour change interventions to reduce risky substance use and improve mental health in children in care: the SOLID three-arm feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Looked-after children and care leavers (henceforth children in care) are young people placed under the care of local authorities, often because of a history of family abuse and/or neglect. These young people have significantly increased risk of substance use and mental health problems compared with peers.
Aim
The Supporting Looked After Children and Care Leavers In Decreasing Drugs, and alcohol (SOLID) trial aimed to investigate the feasibility of a definitive randomised controlled trial comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) in and improve the mental health of children in care aged 12–20 years.
Methods
The study consisted of two phases: (1) a formative phase that adapted the motivational enhancement therapy and social behaviour and network therapy interventions for use with children in care and (2) a three-arm pilot randomised controlled trial (comparing motivational enhancement therapy, social behaviour and network therapy and usual care), and a linked process and economic (return on investment) evaluation. Trial feasibility was compared with prespecified STOP/GO criteria.
Setting
Six local authority areas in the north-east of England.
Participants
Children in care (aged 12–20 years) who screened positive for drug and/or alcohol use within the last 12 months were eligible for the trial. The formative and process evaluations included children in care, carers, social workers, and drug and alcohol workers.
Outcome measures
The primary outcomes were recruitment and retention rates at 12 months’ follow-up. Baseline and 12-month follow-up questionnaires measured self-reported drug and alcohol use, mental health and health-related quality of life. The process evaluation considered acceptability and engagement with the interventions and trial procedures.
Results
Formative findings (n = 65) highlighted the need for interventions to increase the emphasis on therapeutic relationships, use creative methods of engagement and support the identification of treatment goals wider than substance misuse. Within the randomised controlled trial, of 860 participants screened, 211 (24.5%) met the inclusion criteria. One hundred and twelve (53%) of the 211 eligible children were recruited and randomised. Just 15 of the 76 (20%) participants allocated to intervention attended any of the motivational enhancement therapy of social behaviour and network therapy sessions, and 60 (54%) participants completed the 12-month follow-up. The screening and recruitment of children in care required significantly more time and resource investment by researchers and children’s services than planned. The process evaluation (n = 116) demonstrated that, despite participants engaging in risky substance use, they did not often acknowledge this nor felt that they needed help. Children in care had complex, chaotic lives and children’s services departments were less research mature and extremely stretched; this, coupled with the multiple steps in the intervention pathway and study protocol, resulted in low adherence to the intervention and the trial.
Conclusions
The SOLID trial demonstrated successful engagement with children in care to adapt the motivational enhancement therapy and social behaviour and network therapy interventions. However, the pilot randomised controlled trial found that a definitive trial is not feasible. The current screen, refer and treat pathway for children in care did not work. There is an urgent need to radically rethink how we deliver therapeutic services for children in care. A pragmatic evaluation design, coupled with additional research resource for children’s services, is needed to evaluate these novel models of care at scale.
Trial registration
This study is registered as PROSPERO CRD42018098974 and Current Controlled Trials ISRCTN80786829.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hayley Alderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Smart
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Copello
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Tony Fouweather
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Paul McArdle
- Child and Adolescent Mental Health Services, Tyne and Wear NHS Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, UK
| | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
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Borillo CJ, Tamanal JM, Kim CH. Determining the Cut Off Score of the Healthy Lifestyle Screening Tool among High School Students. J Lifestyle Med 2020; 10:92-101. [PMID: 32995336 PMCID: PMC7502896 DOI: 10.15280/jlm.2020.10.2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/27/2022] Open
Abstract
Background Several lifestyle factors such as not smoking, drinking alcohol in moderation, eating healthily, regular exercise, and maintaining a normal weight have been known to play an important role in optimal health. A screening tool that has a standardized score that indicates healthy or risky lifestyle behaviors is needed for health promotion. However, such a tool that focuses on lifestyle behaviors have not incorporated scores to summarize the results. The purpose of this study is to develop the cut-off points of the Healthy Lifestyle Screening tool. Methods Data collection in this study was done from 198 Filipino high school students utilizing the Healthy Lifestyle Screening Tool. Results Receiver Operating Curve (ROC) results indicated cut-off score of 98 to separate into low and high score groups. The mean scores for all subcomponents were significantly different in between two groups. The general population fell in the high score category with a mean total score of 105.61 in which 81.31% were categorized in the high score group and 18.61% in the low score group. Subjects in general obtained low mean scores in specific subscale components such as rest (2.46) water (2.66) and exercise (2.78). Conclusion Increasing the total score by working on low scoring components will be beneficial in achieving a healthy lifestyle. This study reinforced the importance of holistic approach regarding health and well-being among high school students.
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Affiliation(s)
- Carmela Jeanette Borillo
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
| | - Jerre Mae Tamanal
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
| | - Cheong Hoon Kim
- Department of Addiction Science, College of Health Science and Social Welfare, Sahmyook University Graduate School, Seoul, Korea
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Patnode CD, Perdue LA, Rushkin M, Dana T, Blazina I, Bougatsos C, Grusing S, O'Connor EA, Fu R, Chou R. Screening for Unhealthy Drug Use: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:2310-2328. [PMID: 32515820 DOI: 10.1001/jama.2019.21381] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Illicit drug use is among the most common causes of preventable morbidity and mortality in the US. OBJECTIVE To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019. STUDY SELECTION Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use. DATA EXTRACTION AND SYNTHESIS Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drug use and other health, social, and legal outcomes. RESULTS Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, -0.49 day in the last 7 days [95% CI, -0.85 to -0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, -35% [95% CI, -67% to -3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, -18% [95% CI, -26% to -10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events. CONCLUSIONS AND RELEVANCE Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Sara Grusing
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University, Portland
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
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Beaudequin D, Schwenn P, McLoughlin LT, Parker MJ, Broadhouse K, Simcock G, Boyes A, Kannis-Dymand L, Wood A, Lagopoulos J, Hermens DF. Using measures of intrinsic homeostasis and extrinsic modulation to evaluate mental health in adolescents: Preliminary results from the longitudinal adolescent brain study (LABS). Psychiatry Res 2020; 285:112848. [PMID: 32062518 DOI: 10.1016/j.psychres.2020.112848] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022]
Abstract
Adolescence is a period when complex interactions occur between mental health risk factors. The Longitudinal Adolescent Brain Study (LABS) commenced in 2018, to monitor environmental and psychosocial factors thought to influence mental health in 500 young people. Participants commence at 12 years of age, via a community-based recruitment model, and data is collected at 15 time-points over five years. This study examines demographic and psychosocial self-report data from time-point 1, for the first 50 participants. Here we investigate associations between environmental and psychosocial factors, considered as measures of intrinsic homeostasis and extrinsic modulation. Numerous strong correlations were found. Findings indicate that sleep dysfunction and social connectedness were strongly associated external modulators of intrinsic homeostasis in this sample of 12-year old participants. To successfully address the increase in mental health problems in young people, comprehensive evaluation of lifestyle and environmental risk factors is recommended in addition to medicalised approaches. Interventions to promote mental health wellbeing in young adolescents should include a focus on sleep quality and patterns and the positive and negative aspects of social connectedness.
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Affiliation(s)
- Denise Beaudequin
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia.
| | - Paul Schwenn
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Larisa T McLoughlin
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Marcella J Parker
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Kathryn Broadhouse
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Gabrielle Simcock
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Amanda Boyes
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Lee Kannis-Dymand
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Andrew Wood
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
| | - Daniel F Hermens
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya 4575, Australia
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Oni HT, Buultjens M, Blandthorn J, Davis D, Abdel-Latif M, Islam MM. Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives' experience. Midwifery 2019; 81:102595. [PMID: 31838337 DOI: 10.1016/j.midw.2019.102595] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/08/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience. AIM The study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs. DESIGN/SETTING A semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data. FINDINGS Of the seven themes identified under barriers, five could be categorised as "institution and provider-related", namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as 'client-related', namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were "institution and provider-related." They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE To the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives' willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.
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Affiliation(s)
- Helen Tosin Oni
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Melissa Buultjens
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, Royal Women's Hospital, Melbourne, VIC 3052, Australia
| | - Deborah Davis
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | - Mohamed Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, ACT 2605, Australia
| | - M Mofizul Islam
- Department of Public Health, Health Sciences Building 1, La Trobe University, Melbourne, VIC 3086, Australia
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Hattangadi N, Vogel E, Carroll LJ, Côté P. Is Food Insecurity Associated with Psychological Distress in Undergraduate University Students? A Cross Sectional Study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2019.1658679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- N Hattangadi
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - E Vogel
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - LJ Carroll
- School of Public Health, University of Alberta, Edmonton, Canada
| | - P. Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
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Identifying Problematic Substance Use in a National Sample of Adolescents Using Frequency Questions. J Am Board Fam Med 2019; 32:550-558. [PMID: 31300575 PMCID: PMC7043279 DOI: 10.3122/jabfm.2019.04.180284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brief substance use screening questions for tobacco, alcohol, cannabis, and other drugs need further validation in adolescents. In particular, optimal age-specific screening cut-points are not known, and no study has been large enough to evaluate screening questions for noncannabis illicit drug use. METHODS Adolescent respondents to an annual national household survey were included (2008 to 2014; n = 169,986). Days of tobacco use in the past month, and days of alcohol, cannabis, other illicit drug use in the past year, were assessed as brief screens for tobacco dependence and DSM-IV alcohol (AUD), cannabis (CUD), and other illicit drug use disorders (DUD). Areas under receiver operating characteristics curves (AUCs), sensitivity and specificity were estimated separately by age group (12-15-, 16-17-, and 18-20-year-olds) and cut-points that maximized combined values of sensitivity and specificity were considered optimal. RESULTS The prevalence of tobacco dependence, AUD, CUD, and DUD was 5.8%, 7.1%, 4.5%, and 2.0%, respectively. AUCs ranged 0.84 to 0.99. The optimal cut-points for screening for tobacco dependence and DUDs was the same for all age groups: ≥1 day. The optimal cut-points for alcohol and cannabis varied by age: ≥3 days for 12-15-year-olds and ≥12 days for older adolescents. CONCLUSIONS Brief measures of past-year use, or past-month use for tobacco, accurately identified adolescents with problematic substance use. However, health systems should use age-specific screening cut-points for alcohol and cannabis to optimize screening performance.
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O'Connor EA, Perdue LA, Senger CA, Rushkin M, Patnode CD, Bean SI, Jonas DE. Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2018; 320:1910-1928. [PMID: 30422198 DOI: 10.1001/jama.2018.12086] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Unhealthy alcohol use is common, increasing, and a leading cause of premature mortality. OBJECTIVE To review literature on the effectiveness and harms of screening and counseling for unhealthy alcohol use to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through October 12, 2017; literature surveillance through August 1, 2018. STUDY SELECTION Test accuracy studies and randomized clinical trials of screening and counseling to reduce unhealthy alcohol use. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction by 2 reviewers. Counseling trials were pooled using random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, drinks per week, exceeding recommended limits, heavy use episodes, abstinence (for pregnant women), and other health, family, social, and legal outcomes. RESULTS One hundred thirteen studies (N = 314 466) were included. No studies examined benefits or harms of screening programs to reduce unhealthy alcohol use. For adolescents (10 studies [n = 171 363]), 1 study (n = 225) reported a sensitivity of 0.73 (95% CI, 0.60 to 0.83) and specificity of 0.81 (95% CI, 0.74 to 0.86) using the AUDIT-C (Alcohol Use Disorders Identification Test-Consumption) to detect the full spectrum of unhealthy alcohol use. For adults (35 studies [n = 114 182]), brief screening instruments commonly reported sensitivity and specificity between 0.70 and 0.85. Two trials of the effects of interventions to reduce unhealthy alcohol use in adolescents (n = 588) found mixed results: one reported a benefit in high-risk but not moderate-risk drinkers, and the other reported a statistically significant reduction in drinking frequency for boys but not girls; neither reported health or related outcomes. Across all populations (68 studies [n = 36 528]), counseling interventions were associated with a decrease in drinks per week (weighted mean difference, -1.6 [95% CI, -2.2 to -1.0]; 32 studies [37 effects; n = 15 974]), the proportion exceeding recommended drinking limits (odds ratio [OR], 0.60 [95% CI, 0.53 to 0.67]; 15 studies [16 effects; n = 9760]), and the proportion reporting a heavy use episode (OR, 0.67 [95% CI, 0.58 to 0.77]; 12 studies [14 effects; n = 8108]), and an increase in the proportion of pregnant women reporting abstinence (OR, 2.26 [95% CI, 1.43 to 3.56]; 5 studies [n = 796]) after 6 to 12 months. Health outcomes were sparsely reported and generally did not demonstrate group differences in effect. There was no evidence that these interventions could be harmful. CONCLUSIONS AND RELEVANCE Among adults, screening instruments feasible for use in primary care are available that can effectively identify people with unhealthy alcohol use, and counseling interventions in those who screen positive are associated with reductions in unhealthy alcohol use. There was no evidence that these interventions have unintended harmful effects.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie A Perdue
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan Rushkin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Carrie D Patnode
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Kiburi SK, Molebatsi K, Obondo A, Kuria MW. Adverse childhood experiences among patients with substance use disorders at a referral psychiatric hospital in Kenya. BMC Psychiatry 2018; 18:197. [PMID: 29914409 PMCID: PMC6007077 DOI: 10.1186/s12888-018-1780-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/07/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Substance use disorders are a major cause of health and social problems worldwide. Research evidence shows a strong graded relationship of adverse childhood experiences and substance use in adulthood. This study aimed at determining the prevalence of adverse childhood experiences and their association with substance use among patients with substance use disorders. METHOD The study used a descriptive cross-sectional design. A total of 134 patients aged 18 years and above receiving inpatient treatment for substance use disorders were recruited into the study. A mental state exam was done to rule out active psychopathology. Data on socio demographic variables, adverse childhood experiences (ACEs) and substance use was collected using Adverse Childhood Experiences International Questionnaire and The Alcohol, Smoking and Substance Involvement Screening Test respectively. Data was analysed using statistical package for social sciences (SPSS) version 20 for windows. RESULTS Males accounted for the majority of the study participants (n = 118, 88.1%). Only 43.3% (n = 58) of the participants had a family history of substance use disorder. The most frequently used substance was alcohol which was reported by 82.1% of the participants. Nearly 93% of the respondents had experienced at least one ACE and the most prevalent ACE was one or no parent which was reported by half of the respondents. The adverse childhood experiences significantly associated with current problematic substance use were; emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect. Emotional abuse significantly predicted tobacco (A.O.R = 5.3 (1.2-23.9)) and sedative (A.O.R = 4.1 (1.2-14.2)) use. Childhood exposure to physical abuse was associated with cannabis use [A.O.R = 2.9 (1.0-7.9)]. Experiencing five or more ACEs was associated with increased risk of using sedatives. CONCLUSION There is a high prevalence of adverse childhood experiences among patients with substance use disorders. Experiencing emotional abuse, having someone with mental illness in the household, physical abuse and physical neglect in childhood are risk factors of substance use disorders. ACEs screening and management should be incorporated in substance abuse prevention programs and policies.
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Affiliation(s)
- Sarah Kanana Kiburi
- Department of Psychiatry, Mbagathi Hospital, Nairobi County, Nairobi, P.O. BOX 20725-00202, Kenya.
| | - Keneilwe Molebatsi
- 0000 0004 0635 5486grid.7621.2Department of Psychiatry, University of Botswana, Private Bag, 00713 Gaborone, Botswana
| | - Anne Obondo
- 0000 0001 2019 0495grid.10604.33Department of Psychiatry, University of Nairobi, Nairobi, P.O. BOX 19676-00202 Kenya
| | - Mary W. Kuria
- 0000 0001 2019 0495grid.10604.33Department of Psychiatry, University of Nairobi, Nairobi, P.O. BOX 19676-00202 Kenya
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Gray KM, Squeglia LM. Research Review: What have we learned about adolescent substance use? J Child Psychol Psychiatry 2018; 59:618-627. [PMID: 28714184 PMCID: PMC5771977 DOI: 10.1111/jcpp.12783] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adolescence is a critical biological, psychological, and social developmental stage involving heightened risk for substance use and associated adverse consequences. This review, synthesizing emerging findings on this complex topic, is intended to inform research and clinical care focused on adolescents. METHODS Literature searches were conducted using PubMed, yielding a cross-section of observational and interventional studies focused on adolescent substance use. Findings were organized and categorized to cover key areas of epidemiology, neurobiology, prevention, and treatment. FINDINGS Adolescent substance-related attitudes and use patterns have evolved over time, informed by adult and peer behaviors, public policy, media messaging, substance availability, and other variables. A number of risk and resiliency factors contribute to individual differences in substance use and related consequences. Advances in observational techniques have provided enhanced understanding of adolescent brain development and its implications for substance use. Prevention efforts have yielded mixed results, and while a number of adolescent-targeted evidence-based treatments for substance use disorders have been developed, effect sizes are generally modest, indicating the need for further research to enhance prevention and treatment outcomes. CONCLUSIONS Substance use in adolescence is heterogeneous, ranging from normative to pathological, and can lead to significant acute and long-term morbidity and mortality. Understanding risk and resiliency factors, underlying neurobiology, and optimal developmentally sensitive interventions is critical in addressing substance-associated problems in adolescence.
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Affiliation(s)
- Kevin M. Gray
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston SC USA
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Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics. J Addict Med 2018; 11:350-356. [PMID: 28590392 DOI: 10.1097/adm.0000000000000327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services. METHODS We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up. RESULTS In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01). CONCLUSIONS SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.
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Howells FM, Temmingh HS, Hsieh JH, van Dijen AV, Baldwin DS, Stein DJ. Electroencephalographic delta/alpha frequency activity differentiates psychotic disorders: a study of schizophrenia, bipolar disorder and methamphetamine-induced psychotic disorder. Transl Psychiatry 2018; 8:75. [PMID: 29643331 PMCID: PMC5895848 DOI: 10.1038/s41398-018-0105-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
Abstract
Electroencephalography (EEG) has been proposed as a neurophysiological biomarker to delineate psychotic disorders. It is known that increased delta and decreased alpha, which are apparent in psychosis, are indicative of inappropriate arousal state, which leads to reduced ability to attend to relevant information. On this premise, we investigated delta/alpha frequency activity, as this ratio of frequency activity may serve as an effective neurophysiological biomarker. The current study investigated differences in delta/alpha frequency activity, in schizophrenia (SCZ), bipolar I disorder with psychotic features and methamphetamine-induced psychosis. One hundred and nine participants, including individuals with SCZ (n = 28), bipolar I disorder with psychotic features (n = 28), methamphetamine-induced psychotic disorder (MPD) (n = 24) and healthy controls (CON, n = 29). Diagnosis was ascertained with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition disorders and current medication was recorded. EEG was undertaken in three testing conditions: resting eyes open, resting eyes closed and during completion of a simple cognitive task (visual continuous performance task). EEG delta/alpha frequency activity was investigated across these conditions. First, delta/alpha frequency activity during resting eyes closed was higher in SCZ and MPD globally, when compared to CON, then lower for bipolar disorder (BPD) than MPD for right hemisphere. Second, delta/alpha frequency activity during resting eyes open was higher in SCZ, BPD and MPD for all electrodes, except left frontal, when compared to CON. Third, delta/alpha frequency activity during the cognitive task was higher in BPD and MPD for all electrodes, except left frontal, when compared to CON. Assessment of EEG delta/alpha frequency activity supports the delineation of underlying neurophysiological mechanisms present in psychotic disorders, which are likely related to dysfunctional thalamo-cortical connectivity. Delta/alpha frequency activity may provide a useful neurophysiological biomarker to delineate psychotic disorders.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Hendrik S Temmingh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jennifer H Hsieh
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Andrea V van Dijen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - David S Baldwin
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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