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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024; 63:908-918. [PMID: 38280417 DOI: 10.1016/j.jaac.2023.09.554] [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: 01/08/2023] [Revised: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population. METHOD This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA. RESULTS Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85). PLAIN LANGUAGE SUMMARY This study utilized retrospective data from the National Inpatient Sample (2015 to 2019) to determine predictive factors for discharge against medical advice (DAMA) for youth, aged 10 to 19 years old, hospitalized for suicidal ideation or suicide attempt. Of 476,755 hospitalizations for suicidality, 3,825 (0.8%) were discharged against medical advice. Correlates of discharge against medical advice included age 16 to 19 years, self-pay status, admission to an urban non-teaching hospital, or a hospital located in the South or West Regions of the United States. Hispanic patients were less likely to be discharged against medical advice with no other racial/ ethnic differences observed. CONCLUSION Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
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Foster AA, Zabel M, Schober M. Youth Crisis: The Current State and Future Directions. Psychiatr Clin North Am 2024; 47:595-611. [PMID: 39122348 DOI: 10.1016/j.psc.2024.06.001] [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: 08/12/2024]
Abstract
The number of children and youth experiencing behavioral health crisis in the United States is substantially increasing. Currently, there are shortages to home-based and community-based services as well as psychiatric outpatient and inpatient pediatric care, leading to high emergency department utilization. This article introduces a proposed crisis continuum of care, highlights existing evidence, and provides opportunities for further research and advocacy.
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Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine, University of California, San Francisco, 550 16th Street, Box 0649, San Francisco, CA 94143, USA.
| | - Michelle Zabel
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
| | - Melissa Schober
- Innovations Institute, University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT 06103, USA
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Thomas GV, Camacho E, Masood FA, Huang Y, Valleru J, Bridge JA, Ackerman J. Development and Implementation of Postdischarge Text Messages to Adolescents With Suicidal Thoughts and Behaviors Through Caring Contacts: Implementation Study. JMIR Pediatr Parent 2024; 7:e51570. [PMID: 39137019 DOI: 10.2196/51570] [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: 08/03/2023] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Youth suicide is a pressing public health concern, and transitions in care after a suicidal crisis represent a period of elevated risk. Disruptions in continuity of care and emotional support occur frequently. "Caring contacts" validating messages post discharge have the potential to enhance connections with patients and have been shown to improve outcomes. More recently, positive outcomes have been noted using caring contact text messages (SMS and MMS), which hold promise for engaging patients in a pediatric setting, but there are few studies describing the large-scale implementation of such an approach. OBJECTIVE This study aims to describe the process of developing and implementing automated caring contacts within a quality improvement framework, using a standardized series of supportive texts and images, for adolescents discharged from high-acuity programs at a large midwestern pediatric hospital. We describe lessons learned, including challenges and factors contributing to success. METHODS We implemented the caring contacts intervention in 3 phases. Phase 1 entailed developing supportive statements and images designed to promote hope, inclusivity, and connection in order to create 2 sets of 8 text messages and corresponding images. Phase 2 included piloting caring contacts manually in the hospital's Psychiatric Crisis Department and Inpatient Psychiatry Unit and assessing the feasibility of implementation in other services, as well as developing workflows and addressing legal considerations. Phase 3 consisted of implementing an automated process to scale within 4 participating hospital services and integrating enrollment into the hospital's electronic medical records. Process outcome measures included staff compliance with approaching and enrolling eligible patients and results from an optional posttext survey completed by participants. RESULTS Compliance data are presented for 4062 adolescent patients eligible for caring contacts. Overall, 88.65% (3601/4062) of eligible patients were approached, of whom 52.43% (1888/3601) were enrolled. In total, 94.92% (1792/1888) of enrolled participants completed the program. Comparisons of the patients eligible, approached, enrolled, and completed are presented. Primary reasons for eligible patients declining include not having access to a mobile phone (686/1705, 40.23%) and caregivers preferring to discuss the intervention at a later time (754/1705, 44.22%). The majority of patients responding to the optional posttext survey reported that the texts made them feel moderately to very hopeful (219/264, 83%), supported (232/264, 87.9%), that peers would be helped by these texts (243/264, 92%), and that they would like to keep receiving texts given the option (227/264, 86%). CONCLUSIONS This study describes the successful implementation of automated postdischarge caring contacts texts to scale with an innovative use of images and demonstrates how a quality improvement methodology resulted in a more effective and efficient process. This paper also highlights the potential for technology to enhance care for at-risk youth and create more accessible, inclusive, and sustainable prevention strategies.
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Affiliation(s)
- Glenn V Thomas
- Behavioral Health Services, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Elena Camacho
- Behavioral Health Services, Nationwide Children's Hospital, Columbus, OH, United States
| | - Fatimah A Masood
- Behavioral Health Services, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jahnavi Valleru
- Patient Safety Education & Research, Ascension, St. Louis, MO, United States
| | - Jeffrey A Bridge
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, United States
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States
| | - John Ackerman
- Behavioral Health Services, Nationwide Children's Hospital, Columbus, OH, United States
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, United States
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Ferro RA, Edwards S, Coble K, Riddle M, Reinblatt SP, Ader C, Crosby Budinger M, Bettencourt AF. Children in Mental Health Crisis: Pediatric Primary Care Providers' Role in Bridging Treatment Following Higher Levels of Care. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10037-1. [PMID: 39096415 DOI: 10.1007/s10880-024-10037-1] [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] [Accepted: 07/01/2024] [Indexed: 08/05/2024]
Abstract
The current study examines the role of pediatric PCPs in bridging treatment for youth who have experienced mental health crises and the characteristics of these patients for whom PCPs sought psychiatric consultation and referral support from a child psychiatry access program, Maryland Behavioral Health Integration in Pediatric Primary Care. Psychiatric consultation and referral calls between 2012 and 2021 were included if a) the patient was recently seen in a higher level of care and b) the PCP was bridging treatment following the patient's discharge; 208 calls met criteria. The most common mental health concerns included depressed mood, suicidal thoughts/gestures, and anxiety. Acute concerns of aggression, suicide attempts, and hallucinations were also reported. Over half of the patients had two or more mental health diagnoses. At the time of the call, only one quarter of these patients had outpatient therapy services while about half were receiving medication treatment. Most of these patients were discharged from the higher level of care without a care plan. Pediatric PCPs are managing their patients' complex mental health concerns following receipt of higher levels of care. Improvements in collaboration and care coordination between pediatric PCPs and emergency department providers are needed.
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Affiliation(s)
- Rebecca A Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, 550 N Broadway, Room 907, Baltimore, MD, 21205, USA.
| | - Sarah Edwards
- School of Medicine, University of Maryland, 737 W Lombard St, Baltimore, MD, 21201, USA
| | - Kelly Coble
- School of Medicine, University of Maryland, 737 W Lombard St, Baltimore, MD, 21201, USA
| | - Mark Riddle
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, 550 N Broadway, Room 907, Baltimore, MD, 21205, USA
| | - Shauna P Reinblatt
- School of Medicine, University of Maryland, 737 W Lombard St, Baltimore, MD, 21201, USA
| | - Chelsie Ader
- School of Medicine, University of Maryland, 737 W Lombard St, Baltimore, MD, 21201, USA
| | | | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, 550 N Broadway, Room 907, Baltimore, MD, 21205, USA
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Koochakpour K, Nytrø Ø, Leventhal BL, Sverre Westbye O, Brox Røst T, Koposov R, Frodl T, Clausen C, Stien L, Skokauskas N. A review of information sources and analysis methods for data driven decision aids in child and adolescent mental health services. Int J Med Inform 2024; 188:105479. [PMID: 38761460 DOI: 10.1016/j.ijmedinf.2024.105479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/16/2023] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Clinical data analysis relies on effective methods and appropriate data. Recognizing distinctive clinical services and service functions may lead to improved decision-making. Our first objective is to categorize analytical methods, data sources, and algorithms used in current research on information analysis and decision support in child and adolescent mental health services (CAMHS). Our secondary objective is to identify the potential for data analysis in different clinical services and functions in which data-driven decision aids can be useful. MATERIALS AND METHODS We searched related studies in Science Direct and PubMed from 2018 to 2023(Jun), and also in ACM (Association for Computing Machinery) Digital Library, DBLP (Database systems and Logic Programming), and Google Scholar from 2018 to 2021. We have reviewed 39 studies and extracted types of analytical methods, information content, and information sources for decision-making. RESULTS In order to compare studies, we developed a framework for characterizing health services, functions, and data features. Most data sets in reviewed studies were small, with a median of 1,176 patients and 46,503 record entries. Structured data was used for all studies except two that used textual clinical notes. Most studies used supervised classification and regression. Service and situation-specific data analysis dominated among the studies, only two studies used temporal, or process features from the patient data. This paper presents and summarizes the utility, but not quality, of the studies according to the care situations and care providers to identify service functions where data-driven decision aids may be relevant. CONCLUSIONS Frameworks identifying services, functions, and care processes are necessary for characterizing and comparing electronic health record (EHR) data analysis studies. The majority of studies use features related to diagnosis and assessment and correspondingly have utility for intervention planning and follow-up. Profiling the disease severity of referred patients is also an important application area.
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Affiliation(s)
- Kaban Koochakpour
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Øystein Nytrø
- Department of Computer Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Computer Science, The Arctic University of Norway (UiT), Tromsø, Norway
| | | | - Odd Sverre Westbye
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway
| | | | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), The Arctic University of Norway (UiT), Tromsø, Norway
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Carolyn Clausen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Line Stien
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Boyd DT, Quinn CR, Durkee MI, Williams EDG, Constant A, Washington D, Butler-Barnes ST, Ewing AP. Perceived discrimination, mental health help-seeking attitudes, and suicide ideation, planning, and attempts among black young adults. BMC Public Health 2024; 24:2019. [PMID: 39075376 PMCID: PMC11285399 DOI: 10.1186/s12889-024-19519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/18/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Developing an understanding of the negative impact of discrimination is critical when examining the suicidality of Black young adults in the US. Suicide rates among Black young adults have increased at alarming rates. One of the reasons for this increase is the disparities related to access to mental health services, which has long-term health consequences. This study addresses a significant gap in the literature by examining associations between experiences of everyday discrimination, attitudes towards mental health help-seeking attitudes, on the outcomes suicide ideation, planning to die by suicide, and suicide attempts. METHODS The data came from a national study of the experiences of Black young adults regarding mental, physical, and sexual health. Participants were recruited from across the Midwestern region of the United States through Qualtrics Panels, an online survey delivery service used to recruit study participants. The total sample for this study was N = 362, and the average age of the sample was 21 (SD: 1.96). We used a logistic regression analysis to examine the role of everyday discrimination, mental health support-seeking attitudes, and covariates on the outcomes: suicide ideation, planning to die by committing suicide, and suicide attempts. RESULTS Black young adults with positive mental health help-seeking attitudes were 34% less likely to attempt suicide (OR = 0.66; 95% CI: 0.46, 0.96) and 35% less likely to experience suicide ideation (OR = 0.65; 95% CI: 0.47, 0.89). However, those young adults who experienced discrimination daily were more likely to report having attempted suicide (OR = 1.70; 95% CI: 1.34, 2.15). CONCLUSIONS Our findings offer valuable insights into the complex interplay between experiences of discrimination, attitudes toward seeking mental health support, and suicidal behaviors. However, our research also underscores how experiences of discrimination can significantly exacerbate feelings of isolation, hopelessness, and inadequacy, further contributing to suicidal behaviors in this population. By promoting positive mental health help-seeking behaviors, actively addressing discrimination, and applying an intersectional approach to suicide prevention efforts, we can take significant strides towards building a more supportive and inclusive society. This approach aims to empower individuals to seek help, reduce the risk of suicidal behaviors, and create a more welcoming environment for all members of our community.
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Affiliation(s)
- Donte T Boyd
- College of Social Work, The Ohio State University, 1047 College RD, #325K, Columbus, OH, 43215, USA.
- Center for Equitable Family & Community Well-Being, School of Social Work, University of Michigan, Ann Arbor, MI, USA.
| | - Camille R Quinn
- Center for Equitable Family & Community Well-Being, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Myles I Durkee
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | | | - Andrea Constant
- Department of Sociology, The Ohio State University, Columbus, OH, USA
| | | | | | - Aldenise P Ewing
- College of Public Health, The Ohio State University, Columbus, OH, USA
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Asada Y, Campbell LA, Grignon M, Hothi H, Stainton T, Kim SY. Importance of investigating vulnerabilities in health and social service provision among requestors of medical assistance in dying. LANCET REGIONAL HEALTH. AMERICAS 2024; 35:100810. [PMID: 38974806 PMCID: PMC11225022 DOI: 10.1016/j.lana.2024.100810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Yukiko Asada
- Department of Bioethics, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Leslie Anne Campbell
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, Nova Scotia B3H1V7, Canada
| | - Michel Grignon
- Department of Economics, Department of Health, Aging & Society, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4M4, Canada
| | - Harneet Hothi
- Department of Medicine, University of Toronto, 1 King’s College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Tim Stainton
- School of Social Work, Canadian Institute for Inclusion and Citizenship, University of British Columbia, 2080 West Mall, Vancouver, British Columbia V6T 1Z2, Canada
| | - Scott Y.H. Kim
- Department of Bioethics, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
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Hamilton JL, Torous J, Szlyk HS, Biernesser C, Kruzan KP, Jensen M, Reyes-Portillo J, Primack BA, Zelazny J, Weigle P. Leveraging Digital Media to Promote Youth Mental Health: Flipping the Script on Social Media-Related Risk. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2024; 11:67-75. [PMID: 39258150 PMCID: PMC11384282 DOI: 10.1007/s40501-024-00315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 09/12/2024]
Abstract
Purpose of Review Despite growing public concern about the negative impact of digital media for mental health problems, there are key ways in which digital media can be leveraged to prevent such outcomes. This article reviews research exploring the ways that digital media, particularly social media, can be used to prevent negative mental health outcomes and promote youth mental health and well-being. Recent findings Research indicates that media can be protective against mental health problems and promote mental health by enabling social support and destigmatizing mental illness, especially for youth with limited resources. Media also can be leveraged to identify those at risk, to educate, provide resources, and promote well-being, and to track symptoms and intervene to prevent or mitigate negative mental health outcomes. There is limited research on interventions designed to reduce the negative effects of digital media on mental health, especially those that harness media itself, a critical area of future research. Summary This article provides a summary of the current evidence on this topic, highlights key directions for future research, and provides evidence-based recommendations for adolescents, families, educators, clinicians, industry, and policy-makers to prevent mental health problems related to media.
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Affiliation(s)
- Jessica L Hamilton
- Rutgers University, New Brunswick, NJ, USA
- Department of Psychology, Rutgers University, 53 Avenue E, Piscataway, NJ 08854, USA
| | | | | | | | | | | | | | | | | | - Paul Weigle
- University of Connecticut School of Medicine, Farmington, CT, USA
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Adrian M, Twohy E, Babeva K, Jenness J, Gurtovenko K, Blossom JB, King S, McCartney L, McCauley E. A unique model of care for youth in crisis: A pilot open trial. Psychol Serv 2024; 21:388-397. [PMID: 37428791 PMCID: PMC10776799 DOI: 10.1037/ser0000778] [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: 07/12/2023]
Abstract
Suicide is the second leading cause of death for those ages 10-24 years in the United States, and emergency department (ED) visits due to youth self-injurious thoughts and behaviors (SITB) and increased substantially between 2016 and 2021. Although ED services are essential for an effective system of care, the ED setting is typically not well-suited for the comprehensive, collaborative, and therapeutic evaluation of SITB; treatment planning; and care coordination that youth in a suicidal crisis need. As a result, an urgent care model for mental health designed to provide comprehensive crisis triage and intervention services is needed within outpatient psychiatry. This pilot trial examined the feasibility, acceptability, and preliminary clinical outcomes of a brief, urgent care model, the Behavioral Health Crisis Care Clinic (CCC), designed to provide comprehensive outpatient triage and intervention services aimed at reducing suicide risk for youth in crisis. Participants were 189 youth (ages 10-20; 62.4% females; 58% Caucasian) who had past-week suicidal ideation or behavior and their caregivers. The results demonstrated the CCC model exceeded feasibility and acceptability benchmarks based on the Service Satisfaction Scale (M score > 3.00). CCC care was associated with significant decreases in self-reported suicide risk based on the Collaborative Assessment and Management of Suicidality Suicide Status Form with low levels of ED usage during CCC care (7.7%) and 1-month posttreatment (11.8%). Over 88% of patients without established outpatient care at the time of referral were connected to care during CCC treatment, almost all of whom (95%) continued with ongoing mental health care 1 month after ending CCC care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Molly Adrian
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Eileen Twohy
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Kalina Babeva
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | | | | | | | - Sophie King
- Seattle Children's Child Psychiatry and Behavioral Medicine
| | - Leah McCartney
- Seattle Children's Child Psychiatry and Behavioral Medicine
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Carson NJ, Yang X, Mullin B, Stettenbauer E, Waddington M, Zhang A, Williams P, Rios Perez GE, Cook BL. Predicting adolescent suicidal behavior following inpatient discharge using structured and unstructured data. J Affect Disord 2024; 350:382-387. [PMID: 38158050 PMCID: PMC10923087 DOI: 10.1016/j.jad.2023.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The objective was to develop and assess performance of an algorithm predicting suicide-related ICD codes within three months of psychiatric discharge. METHODS This prognostic study used a retrospective cohort of EHR data from 2789 youth (12 to 20 years old) hospitalized in a safety net institution in the Northeastern United States. The dataset combined structured data with unstructured data obtained through natural language processing of clinical notes. Machine learning approaches compared gradient boosting to random forest analyses. RESULTS Area under the ROC and precision-recall curve were 0.88 and 0.17, respectively, for the final Gradient Boosting model. The cutoff point of the model-generated predicted probabilities of suicide that optimally classified the individual as high risk or not was 0.009. When applying the chosen cutoff (0.009) to the hold-out testing set, the model correctly identified 8 positive cases out of 10, and 418 negative cases out 548. The corresponding performance metrics showed 80 % sensitivity, 76 % specificity, 6 % PPV, 99 % NPV, F-1 score of 0.11, and an accuracy of 76 %. LIMITATIONS The data in this study comes from a single health system, possibly introducing bias in the model's algorithm. Thus, the model may have underestimated the incidence of suicidal behavior in the study population. Further research should include multiple system EHRs. CONCLUSIONS These performance metrics suggest a benefit to including both unstructured and structured data in design of predictive algorithms for suicidal behavior, which can be integrated into psychiatric services to help assess risk.
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Affiliation(s)
- Nicholas J Carson
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA.
| | - Xinyu Yang
- Parexel, 275 Grove St., Suite 101C, Newton, MA 02466, USA
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | | | - Marin Waddington
- Division of Gastroenterology at Brigham and Women's Hospital, Resnek Family Center for PSC Research, 75 Francis Street, Boston, MA 02115, USA
| | - Alice Zhang
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Peyton Williams
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Gabriel E Rios Perez
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
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Kim C, Jin H, Kang G, Dusing GJ, Chum A. Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea. J Affect Disord 2024; 350:313-318. [PMID: 38237869 DOI: 10.1016/j.jad.2024.01.089] [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: 07/06/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. METHODS Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. RESULTS Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. CONCLUSION The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Hyunju Jin
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China; Seoul National University Institute of Sport Science, Seoul, South Korea
| | - Goneui Kang
- Department of Economics, Korea University, Seoul, South Korea
| | | | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Zhu JM, Eisenberg M. Administrative Frictions and the Mental Health Workforce. JAMA HEALTH FORUM 2024; 5:e240207. [PMID: 38517421 PMCID: PMC11203202 DOI: 10.1001/jamahealthforum.2024.0207] [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] [Indexed: 03/23/2024] Open
Abstract
This Viewpoint describes the administrative barriers experienced by mental health professionals and recommends strategies to address these barriers.
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Affiliation(s)
- Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland
| | - Matthew Eisenberg
- Center for Mental Health and Addiction Policy, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Rubenson MP, Gurtovenko K, Simmons SW, Thompson AD. Systematic Review: Patient Outcomes in Transdiagnostic Adolescent Partial Hospitalization Programs. J Am Acad Child Adolesc Psychiatry 2024; 63:136-153. [PMID: 37271333 DOI: 10.1016/j.jaac.2023.03.022] [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: 09/27/2022] [Revised: 03/02/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Partial hospitalization programs (PHPs) are designed to help stabilize patients with acute mental health problems and are considered more cost-effective than inpatient care for patients who do not require 24-hour monitoring. Many PHPs treat transdiagnostic adolescents to reduce suicidality, self-harm, and other high-risk behaviors; however, the effectiveness of such programs is unknown. We aimed to review the existing evidence for the effects of PHPs on adolescent mental health symptoms and functioning. METHOD We retrieved peer-reviewed evaluations of PHPs treating adolescents with a range of disorders that reported quantitative clinical outcomes. We followed PRISMA guidelines for systematic reviews and included studies published since 2000. RESULTS Fifteen studies of 10 PHPs in North America, Europe, Asia, and Australia met inclusion criteria, 5 of which used comparison groups. Most participants were White and female with depressive disorders. All studies found improvements in adolescents' functioning and mental health from admission to discharge; however, only 1 study tested PHP relative to other levels of care, and only 1 study included follow-up data. Dialectical behavior therapy (DBT) may be an effective theoretical orientation for PHP settings, but evidence is limited. CONCLUSION Evidence for effectiveness of PHPs relative to other models is limited. Currently available research suggests that many high-risk transdiagnostic adolescents tend to improve during PHP treatment; however, controlled studies with follow-up data are needed to determine whether partial hospitalization is effective and, if so, how effective, and whether treatment gains persist after discharge.
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Affiliation(s)
- Miriam P Rubenson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington.
| | - Kyrill Gurtovenko
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Shannon W Simmons
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
| | - Alysha D Thompson
- Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington
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14
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Kraus CK, Ferry J. Emergency Department Care of the Patient with Suicidal or Homicidal Symptoms. Emerg Med Clin North Am 2024; 42:31-40. [PMID: 37977751 DOI: 10.1016/j.emc.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Patients frequently present to the emergency department (ED) with acute suicidal and homicidal thoughts. These patients require timely evaluation, with determination of disposition by either voluntary or involuntary hospitalization or discharge with appropriate outpatient follow-up. Safety concerns should be prioritized for patients as well as ED staff. Patient dignity and autonomy should be respected throughout the process.
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Affiliation(s)
- Chadd K Kraus
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, Allentown, PA, USA; University of South Florida Morsani College of Medicine.
| | - James Ferry
- Department of Emergency Medicine, Geisinger, Danville, Pennsylvania, USA
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15
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Kudinova AY, Brick LA, Armey M, Nugent NR. Micro-sequences of anger and shame and non-suicidal self-injury in youth: an ecological momentary assessment study. J Child Psychol Psychiatry 2024; 65:137-147. [PMID: 37525367 PMCID: PMC10828100 DOI: 10.1111/jcpp.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Non-suicidal self-injury (NSSI) is a significant mental health concern with the highest prevalence among adolescents. NSSI has been conceptualized as one of the maladaptive strategies to cope with challenging affect or a form of self-punishment. Although characterizing moment-to-moment associations between shame and NSSI in individuals' real-world environment and partitioning between- and within-person effects is critical for mobile and timely interventions, most studies examined habitual experiences of negative affective states and focused on adults. METHOD In this study, we focused on in vivo anger at self and others and shame and NSSI among 158 adolescents 3 weeks following their psychiatric hospitalizations using ecological momentary assessment (EMA) technology. RESULTS We found that greater between-person levels of anger at self and others were linked to a higher number of subsequent NSSI occurrences within a day. These findings remained primarily unchanged when we statistically adjusted for participants' age, sex assigned at birth, the number of current psychiatric diagnoses, EMA response rates, and youth lifetime history of SI. Within-person increases in NSSI were linked to increased anger at self over and beyond between-person average levels of NSSI. CONCLUSIONS These findings highlight the potential regulatory role of NSSI to decrease negative affective states and point to the clinical utility of assessing and early mobile interventions targeting challenging affect in youth.
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Affiliation(s)
- Anastacia Y Kudinova
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Child Psychiatry, Bradley Hospital, Providence, RI, USA
| | - Leslie A Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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Ojo S, Okoye TO, Olaniyi SA, Ofochukwu VC, Obi MO, Nwokolo AS, Okeke-Moffatt C, Iyun OB, Idemudia EA, Obodo OR, Mokwenye VC, Okobi OE. Ensuring Continuity of Care: Effective Strategies for the Post-hospitalization Transition of Psychiatric Patients in a Family Medicine Outpatient Clinic. Cureus 2024; 16:e52263. [PMID: 38352099 PMCID: PMC10863747 DOI: 10.7759/cureus.52263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
In healthcare, continuity of care is a crucial element, especially for patients in the field of psychiatry who have recently been discharged from a hospital. The shift from inpatient to outpatient care poses challenges for patients and healthcare providers, including openness to treatment, competing priorities, financial insecurity, concerns and dilemmas faced by patients regarding their post-hospitalization life after improvements in symptoms, lack of social support, poor patient-doctor relationships, lack of insight, and stigma associated with mental illness. Therefore, it is vital to employ effective strategies to ensure patients receive the required care and support during this transition. This review delves into the significance of continuity of care for psychiatric patients post-hospitalization, effective strategies for the transition, and the challenges and barriers to implementation from the perspective of a family medicine practice. To analyze physicians' role in managing psychiatric patients post-hospitalization, we developed a comprehensive search strategy. This involved extracting relevant data, updates, guidelines, and recommendations. Our search spanned various online repositories, such as PubMed and Google Scholar, specifically focusing on US-based guidelines aligned with our objectives. The search was conducted using medical subject headings (MeSH) and combinations of "OR," "AND," and "WITH." We crafted keywords to optimize our search strategy, including psychiatric illness, post-hospitalization, follow-up, follow-up care, primary care follow-up, and guidelines. Exploring online repositories yielded 132 articles, and we identified some guidelines that addressed our objectives. We established inclusion and exclusion criteria for our review and reviewed 21 papers. Post-hospitalization follow-up is a critical facet of psychiatric care, aligning with guidelines from the American Psychiatric Association and other relevant sources. Emphasizing continuity of care ensures a smooth transition from inpatient to outpatient settings, sustaining therapeutic momentum and minimizing the risk of relapse. This comprehensive approach involves careful medication management, regular mental health assessments, education on condition-specific coping strategies, and coordinated care between healthcare providers. It includes conducting risk assessments, safety planning, building social support and community integration, prompt post-hospitalization follow-up, and tailored treatment plans. Together, these measures enhance overall wellness for recently discharged patients. This holistic strategy tackles pressing short-term needs while facilitating long-term stability, promoting resilience and successful community reintegration, reducing readmission likelihood, and ultimately supporting sustained recovery.
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Affiliation(s)
- Soji Ojo
- Psychiatry, University of Texas Health Science Center at Houston, Dallas, USA
| | | | - Seyi A Olaniyi
- Medicine and Surgery, Obafemi Awolowo University, Ile-Ife, NGA
| | - Victor C Ofochukwu
- Medicine, Ebonyi State University, Abakaliki, NGA
- Medicine and Surgery, Hospital Corporation of America (HCA) Houston Healthcare Pearland, Pearland, USA
| | - Maureen O Obi
- General Practice, Federal Teaching Hospital, Owerri, NGA
| | | | - Chinwe Okeke-Moffatt
- Psychiatry and Behavioral Sciences, Washington University School of Health Sciences, San Pedro, BLZ
| | - Oluwatosin B Iyun
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, ZAF
| | - Etinosa A Idemudia
- Psychiatry and Behavioral Sciences, North Vista Hospital, Las Vegas, USA
| | | | - Violet C Mokwenye
- General Practice, University of Uyo, Uyo, NGA
- General Practice, National Hospital Abuja, Abuja, NGA
| | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical center, Belle Glade, USA
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Moe AM, Llamocca E, Wastler HM, Steelesmith DL, Brock G, Oluwoye O, Fontanella CA. Racial and Ethnic Disparities in the Diagnosis and Early Treatment of First-Episode Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae019. [PMID: 39206276 PMCID: PMC11350282 DOI: 10.1093/schizbullopen/sgae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background Despite recognition that early intervention for first-episode psychosis (FEP) improves outcomes, Black youth with FEP continue to experience critical disparities in care. A historical lack of scientific focus on racial and ethnic factors in the study of psychosis and scant investigations among publicly insured (ie, Medicaid-enrolled) youth hinder our ability to understand and address factors that contribute to disparities in early FEP care. Strategies for improving FEP services for Black youth are reliant on more precise identification of who faces disparities and when during the early course of illness disparities are experienced. Study Design A retrospective longitudinal analysis of Ohio Medicaid claims data was performed for 987 982 youth aged 15-24 years between 2010 and 2020 to examine: (1) the likelihood of FEP diagnosis, (2) the type of psychotic disorder diagnosis received, and (3) receipt of treatment following psychosis onset. Study Results Non-Hispanic Black (NHB) youth, relative to non-Hispanic White (NHW) peers, were more likely to be diagnosed with a psychotic disorder and were further more likely to receive a diagnosis of schizophrenia relative to an affective psychotic disorder. In the first year following FEP diagnosis, NHB youth were also less likely to receive psychotherapy than NHW youth; this disparity was no longer present when examined at 2 years following FEP. Conclusions In this study, Black youth experienced disparities in both the diagnosis and early treatment of FEP. Additional efforts are needed to understand and address these observed disparities and to promote equitable access to FEP care during the critical early illness phases.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Elyse Llamocca
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI
| | - Heather M Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH
| | - Danielle L Steelesmith
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH
- Center for Suicide Prevention and Research, The Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
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Lengvenyte A, Giner L, Jardon V, Olié E, Perez V, Saiz P, Gonzalez Pinto A, Courtet P. Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023:S2950-2853(23)00113-8. [PMID: 38158127 DOI: 10.1016/j.sjpmh.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical guidelines for the assessment and management of suicidal crises. MATERIALS AND METHODS Utilizing the Delphi methodology, 80 suicide clinician and research experts agreed on a series of recommendations. The process involved two iterative rounds of surveys to assess agreement with drafted recommendations, inviting panellists to comment and vote, culminating in 43 consensus recommendations approved with at least 67% agreement. These consensus recommendations fall into three main categories: clinical assessment, immediate care, and long-term approaches. RESULTS The panel formulated 43 recommendations spanning suicidal crisis recognition to continuous long-term care. These guidelines underscore systematic proactive suicide risk screening, in-depth medical and toxicological assessment, and suicide risk appraisal considering personal, clinical factors and collateral information from family. The immediate care directives emphasize a secure environment, continuous risk surveillance, collaborative decision-making, including potential hospitalization, sensible pharmacological management, safety planning, and lethal means restriction counselling. Every discharge should be accompanied by prompt follow-up care incorporating proactive case management and multi-modal approach involving crisis lines, brief contact, and psychotherapeutic and pharmacological interventions. CONCLUSIONS This study generated comprehensive guidelines addressing care for individuals in suicidal crises, covering pre- to post-discharge care. These practical recommendations can guide clinicians in managing patients with suicidal thoughts and behaviours, improve patient safety, and ultimately contribute to the prevention of future suicidal crises.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France; Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| | - Vincent Jardon
- CHU Lille, Hôpital Fontan, Service de Psychiatrie Adulte, Lille, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Victor Perez
- Institute of Neuropsychiatry and Addiction (Institut de Neuropisiquiatria i Addiccions), Parc de Salut Mar, Barcelona, Spain; CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain
| | - Pilar Saiz
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Ana Gonzalez Pinto
- CIBERSAM (Mental Health Networking Biomedical Research Centre), Spain; Department of Psychiatry, BIOARABA, Araba University Hospital, University of the Basque Country, Vitoria, Spain; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
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Che SE, Gwon YG, Kim KH. Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness. JAMA Netw Open 2023; 6:e2336767. [PMID: 37812420 PMCID: PMC10562943 DOI: 10.1001/jamanetworkopen.2023.36767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/27/2023] [Indexed: 10/10/2023] Open
Abstract
Importance Although early outpatient follow-up after psychiatric inpatient discharge may prevent suicide, the association between early follow-up care and a reduced risk of suicide after discharge has not been fully explored. Objectives To investigate outpatient follow-up care after psychiatric inpatient discharge and determine whether the timing of the first outpatient follow-up is associated with a reduced risk of suicide. Design, Setting, and Participants This population-based, retrospective cohort study used the National Health Claim Database from 2017 to 2018 in Korea. Patients were observed until December 31, 2021, to confirm the occurrence of suicide. The study population included all patients aged 18 years or older who were newly admitted to hospitals with psychiatric illness except for dementia from January 1, 2017, to December 31, 2018. Statistical analysis was performed from January to May 2023. Exposure The timing of the first mental health outpatient care follow-up within 30 days after discharge. Main Outcomes and Measures The outcome of interest was suicide after hospital discharge. The timing of the first follow-up visit was observed within 30 days after discharge. The Cox proportional hazard model was used to explore the association between the risk of suicide and the timing of outpatient follow-up. Results Of the 76 462 patients admitted to hospitals from 2017 to 2018, 225 (52.6%) were male; 21 313 (27.9%) had a primary diagnosis of substance use disorder, 17 608 (23.0%) had schizophrenia, and 15 018 (19.6) had depression; mean (SD) age was 46.4 (16.3) years. A total of 49 319 patients (64.5%) received follow-up outpatient care within 30 days of discharge. The mean (SD) follow-up period was 30.8 (20.2) months, and 1536 patients died of suicide during the study period. The hazard ratio for suicide risk in patients who received outpatient care within 7 days compared with those who did not receive any care within 30 days after discharge was 0.82 (95% CI, 0.80-0.83). The earlier the time of outpatient follow-up care, the lower the risk of suicide for those with substance use disorder, schizophrenia, bipolar disorder, and depression. Conclusions and Relevance In this cohort study of patients with psychiatric illness, early follow-up outpatient care after discharge was associated with a lower risk of suicide. These results suggest that those at high risk of suicide during hospitalization need intensive follow-up immediately after discharge.
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Affiliation(s)
- Song Ee Che
- Review and Assessment Research Institute, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Yeong Geun Gwon
- Review and Assessment Research Institute, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Kyoung-Hoon Kim
- Department of Health Administration, Kongju National University, Gongju, South Korea
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Delaney KR. The Future of the Psychiatric Mental Health Nursing Workforce: Using Our Skill Set to Address Incongruities in Mental Health Care Delivery. Issues Ment Health Nurs 2023; 44:933-943. [PMID: 37734065 DOI: 10.1080/01612840.2023.2252498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
The USA is dealing with well-documented issues around mental health and its treatment. The Psychiatric Mental Health (PMH) workforce is growing and practicing in a variety of roles within the mental health system. How will PMH nurses address instances when the structure of services does not meet the mental health needs of the population? In this piece, I argue that to some degree the future of the PMH workforce will be determined by how well we use our capacity and capabilities to address incongruities in service structure and population needs. Five areas of concern with mental health services are outlined; they all involve factors that can be addressed with innovative approaches and optimum utilization of the PMH workforce. Included are suggestions on how PMH nurses might direct efforts toward these service issues, particularly by using their skill set and presence in the mental health system. Strategies include forging a tighter connection between the work of advanced practice and registered nurses in delivering care. Broadly, these efforts should be directed at building models of patient-centered care that address the needs of populations, reducing disparities, and demonstrating how engagement is a critical lever of effective inpatient and community-based care.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community Mental Health and Systems, Rush College of Nursing, Chicago, Illinois, USA
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Simmons S, Noble C, Arquette K, Thompson AD. Bridging the Gap: Impact of dedicated post-discharge services on readmission rates and emergency department visits for psychiatrically hospitalized youth. Clin Child Psychol Psychiatry 2023; 28:1257-1265. [PMID: 36075261 DOI: 10.1177/13591045221125634] [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: 11/16/2022]
Abstract
BACKGROUND For psychiatrically hospitalized youth, discharge care coordination can reduce suicide risk and rehospitalization, but studies on effective interventions or programs are sparse. This study aimed to examine the impact of a dedicated post-discharge bridging service including case management and therapeutic supports on readmissions and emergency department presentations. METHODS This retrospective cohort study compared emergency department mental health visits (EDMH) and psychiatric hospitalizations in the 60 days before the hospitalization which included referral to the bridging service, and in the 60 days post-hospitalization. RESULTS This diagnostically heterogeneous group of 238 youth had a mean age of 14 years and were of similar racial and ethnic background as the broader inpatient population. There was a nominal decrease in hospitalizations (p = 0.251), and a significant decrease in EDMH (p < 0.001) in the 60 days following referral to this program compared to the 60 days prior. Further, the proportion of patients with at least one EDMH or hospitalization decreased significantly before and after linkage with this service from 42.4% to 27.3% (p < 0.001). CONCLUSION Dedicated post-discharge bridging services including family-centered, flexible case management and therapeutic supports can reduce EDMH visits and potentially lower readmission for children and adolescents.
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Affiliation(s)
- Shannon Simmons
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, WA, USA
| | | | | | - Alysha D Thompson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Seattle Children's Hospital, Seattle, WA, USA
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23
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Vance MM, Gryglewicz K, Nam E, Richardson S, Borntrager L, Karver MS. Exploring Service Use Disparities among Suicidal Black Youth in a Suicide Prevention Care Coordination Intervention. J Racial Ethn Health Disparities 2023; 10:2231-2243. [PMID: 36100810 DOI: 10.1007/s40615-022-01402-7] [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: 04/26/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study is to examine service utilization disparities among Black youth participating in Linking Individuals Needing Care (LINC), a 90-day research-informed suicide care coordination intervention. METHODS An open trial pilot was conducted to examine the effectiveness of LINC in increasing access to and engagement in mental health and non-mental health services among suicidal youth (N = 587). Other variables of interest included service use facilitators and service use barriers. Generalized linear mixed models with binomial distribution and logit link were performed to ascertain if service use facilitators and barriers were associated with service utilization and if disparities in service use and engagement existed between Black and White suicidal youth through a comparative analysis. RESULTS Service utilization differences were found between Black and White youth. While Black and White youth were both likely to engage in individual therapy (OR = 1.398, p < .001) and non-mental health services (OR = 1.289, p < .001), utilization rates for mental health and medication management services were lower for Black (55.1% to 60.6%) youth compared to White (66.0% to 71.0%) youth. Specifically, Black youth were significantly less likely than Whites to receive medication management (OR = .466, p = .002). Systemic barriers such long waitlists for care (OR = 1.860, p = .039) and poor relationship with providers (OR = 7.680, p = .028) increased odds of engagement in non-mental health services. Clinical disorders and engagement in suicide-related behaviors increased the likelihood of obtaining care from both medication management and non-mental health services. CONCLUSION Care coordination services for suicidal youth can increase access and engagement in mental health and non-mental health services. Culturally adapted models attending to cultural and social assets of Black families are needed to reduce disparities and suicide risk among Black youth.
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Affiliation(s)
- Michelle M Vance
- Department of Social Work & Sociology, North Carolina Agricultural & Technical State University, Greensboro, NC, USA.
| | - Kim Gryglewicz
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Eunji Nam
- School of Social Welfare, Incheon National University, Incheon, South Korea
| | - Sonyia Richardson
- School of Social Work, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Lisa Borntrager
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Grazier KL, Grupp-Phelan J, Brent D, Horwitz A, McGuire TC, Casper TC, Webb MW, King CA. The Cost of Universal Suicide Risk Screening for Adolescents in Emergency Departments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6843. [PMID: 37835113 PMCID: PMC10573004 DOI: 10.3390/ijerph20196843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
Suicide is the second leading cause of death among adolescents. As nearly 20% of adolescents visit emergency departments (EDs) each year, EDs have an opportunity to identify previously unrecognized suicide risk. A novel Computerized Adaptive Screen for Suicidal Youth (CASSY) was shown in a multisite study to be predictive for suicide attempts within 3 months. This study uses site-specific data to estimate the cost of CASSY implementation with adolescents in general EDs. When used universally with all adolescents who are present and able to participate in the screening, the average cost was USD 5.77 per adolescent. For adolescents presenting with non-behavioral complaints, the average cost was USD 2.60 per adolescent. Costs were driven primarily by time and personnel required for the further evaluation of suicide risk for those screening positive. Thus, universal screening using the CASSY, at very low costs relative to the cost of an ED visit, can facilitate services needed for at-risk adolescents.
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Affiliation(s)
- Kyle L. Grazier
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (A.H.); (C.A.K.)
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA;
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
- Department of Psychiatry, University of Pittsburgh Medical Center Western Psychiatric Hospital, Pittsburgh, PA 15213, USA
| | - Adam Horwitz
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (A.H.); (C.A.K.)
| | - Taylor C. McGuire
- Department of Psychology, Harvard University, Cambridge, MA 02138, USA;
| | - T. Charles Casper
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (T.C.C.); (M.W.W.)
| | - Michael W. Webb
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (T.C.C.); (M.W.W.)
| | - Cheryl A. King
- Department of Psychiatry, School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA; (A.H.); (C.A.K.)
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Feng YR, Valuri GM, Morgan VA, Preen DB, O’Leary CM, Crampin E, Waterreus A. Secondary mental health service utilisation following emergency department contact for suicidal behaviour: A systematic review. Aust N Z J Psychiatry 2023; 57:1208-1222. [PMID: 37161341 PMCID: PMC10466987 DOI: 10.1177/00048674231172116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours. METHODS A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'. RESULTS Studies in young people (n = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies (n = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%. CONCLUSION This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.
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Affiliation(s)
- YR Feng
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - GM Valuri
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - DB Preen
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Colleen M O’Leary
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - E Crampin
- Office of the Chief Psychiatrist, Perth, WA, Australia
| | - A Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Shields MC, Hollander MAG, Busch AB, Kantawala Z, Rosenthal MB. Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad017. [PMID: 38756837 PMCID: PMC10986256 DOI: 10.1093/haschl/qxad017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2024]
Abstract
Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.
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Affiliation(s)
- Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Mara A G Hollander
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard University, Harvard Medical School, Boston, MA 02115, United States
- McLean Hospital, Belmont, MA 02478, United States
| | - Zohra Kantawala
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard University, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
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Skovira CM, Pfoh E, Thompson A, Rish J. Closing the Mental Health Access Gap Through Novel Analytics. Cureus 2023; 15:e42093. [PMID: 37602116 PMCID: PMC10435285 DOI: 10.7759/cureus.42093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Depression and anxiety are associated with substantial morbidity, including physical deterioration. Connecting individuals to timely care improves outcomes. Unfortunately, significant gaps remain between the demand for behavioral healthcare and the supply of care. Further, estimates of demand are based on retrospective and/or non-localized measures, which impedes planning. This poses an opportunity to rethink how to close this gap. Health systems are better positioned than ever to do so, given novel technologies, data, and community integration. By developing more localized, real-time models of depression and anxiety demand and healthcare supply, health systems can better prioritize resource deployment and partnerships to proactively meet patient needs.
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Affiliation(s)
- Christine M Skovira
- Department of Medicine, Michigan State University College of Human Medicine, Grand Rapids, USA
- Department of Clinical Transformation, Cleveland Clinic Foundation, Cleveland, USA
| | - Elizabeth Pfoh
- Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, USA
| | - Amy Thompson
- Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, USA
| | - Julie Rish
- Department of Clinical Transformation, Cleveland Clinic Foundation, Cleveland, USA
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Yu SH, Kodish T, Bear L, O’Neill JC, Asarnow JR, Goldston D, Cheng KK, Wang X, Vargas SM, Lau AS. Leader and Provider Perspectives on Implementing Safe Alternatives for Teens and Youth - Acute (SAFETY-A) in Public School Districts Serving Racial/ethnic Minoritized Youth. SCHOOL MENTAL HEALTH 2023; 15:583-599. [PMID: 37622166 PMCID: PMC10449380 DOI: 10.1007/s12310-023-09572-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
Racial/ethnic minoritized (REM) youth represent a high-risk group for suicide, yet there are striking disparities in their use of mental health services (MHS) even after risk is identified in schools. Prior research suggests that school-based risk assessments and hospitalization encounters can be negatively experienced by REM youth and families, thus deterring likelihood of seeking follow-up care. The Safe Alternatives for Teens and Youth-Acute (SAFETY-A) is a brief, strengths-based, cognitive-behavioral family intervention demonstrated to increase linkage to MHS when implemented in emergency departments. With its focus on strengths and family engagement, SAFETY-A may cultivate a positive therapeutic encounter suited to addressing disparities in MHS by enhancing trust and family collaboration, if appropriately adapted for schools. Thirty-seven school district leaders and frontline school MHS providers from districts serving primarily socioeconomically disadvantaged REM communities participated in key informant interviews and focus groups. First, interviews were conducted to understand usual care processes for responding to students with suicidal thoughts and behaviors, and perspectives on the strengths and disadvantages of current practices. An as-is process analysis was used to describe current practices spanning risk assessment, crisis intervention, and follow-up. Second, focus groups were conducted to solicit perceptions of the fit of SAFETY-A for these school contexts. Thematic analysis of the interviews and focus groups was used to identify multilevel facilitators and barriers to SAFETY-A implementation, and potential tailoring variables for implementation strategies across school districts.
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Affiliation(s)
- Stephanie H. Yu
- Department of Psychology, University of California, Los Angeles, CA
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles, CA
| | | | - J. Conor O’Neill
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Joan R. Asarnow
- Department of Psychiatry, Child, and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - David Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Karli K. Cheng
- Department of Neurology, Phoenix Children’s Hospital, Phoenix, AZ
| | - Xinran Wang
- Department of Psychology, University of California, Los Angeles, CA
- Department of Psychology and Human Development, Vanderbilt University, TN
| | - Sylvanna M. Vargas
- Department of Psychology, University of California, Los Angeles, CA
- Department of Psychiatry, Child, and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, CA
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Hurd NM, Young AS. Introduction to the Special Issue: Advancing Racial Justice in Clinical Child and Adolescent Psychology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:311-327. [PMID: 37141558 PMCID: PMC10213141 DOI: 10.1080/15374416.2023.2202255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Relative to White youth, racially and ethnically marginalized youth in the U.S. are less likely to initiate treatment, stay in treatment, and receive adequate care. This special issue attends to racial injustice in clinical child and adolescent psychology. While numerous factors drive these racial disparities, this special issue focuses specifically on opportunities and responsibilities we have as mental health providers, teachers, mentors, researchers, and gatekeepers to make our field more racially just. In this introduction to the special issue, we review barriers and solutions across multiple contexts including structural, institutional, and practice-based. We also discuss challenges and opportunities to diversify our field and increase the representation of racially and ethnically marginalized practitioners and scholars in clinical child and adolescent psychology. We then briefly review the special issue articles and make final recommendations for how to move the field forward.
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Affiliation(s)
| | - Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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30
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Alon N, Perret S, Segal R, Torous J. Clinical Considerations for Digital Resources in Care for Patients With Suicidal Ideation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:160-165. [PMID: 37201138 PMCID: PMC10172563 DOI: 10.1176/appi.focus.20220073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Smartphone apps offer accessible new tools that may help prevent suicide and that offer support for individuals with active suicidal ideation. Numerous smartphone apps for mental health conditions exist; however, their functionality is limited, and evidence is nascent. A new generation of apps using smartphone sensors and integrating real-time data on evolving risk offers the potential of more personalized support, but these apps present ethical risks and currently remain more in the research domain than in the clinical domain. Nevertheless, clinicians can use apps to benefit patients. This article outlines practical strategies to select safe and effective apps for the creation of a digital toolkit that can augment suicide prevention and safety plans. By creating a unique digital toolkit for each patient, clinicians can help ensure that the apps selected will be most relevant, engaging, and effective.
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Affiliation(s)
- Noy Alon
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sarah Perret
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Rebecca Segal
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - John Torous
- Division of Digital Psychiatry (Alon, Perret, Torous) and mental health services consultant (Segal), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Ketabchi B, Hoffmann JA. Supporting Youths During Mental Health Boarding: It's About Time. J Pediatr 2023; 255:8-11. [PMID: 36460080 PMCID: PMC10121726 DOI: 10.1016/j.jpeds.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Bijan Ketabchi
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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32
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Melhem N, Moutier CY, Brent DA. Implementing Evidence-Based Suicide Prevention Strategies for Greatest Impact. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:117-128. [PMID: 37201145 PMCID: PMC10172552 DOI: 10.1176/appi.focus.20220078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Suicide remains a leading cause of death in the United States and globally. In this review, epidemiological trends in mortality and suicide risk are presented, with consideration given to the impact of the COVID-19 pandemic. A public health model of suicide prevention with a community and clinical framework, along with advances in scientific discovery, offer new solutions that await widespread implementation. Actionable interventions with evidence for reducing risk for suicidal behavior are presented, including universal and targeted strategies at community, public policy, and clinical levels. Clinical interventions include screening and risk assessment; brief interventions (e.g., safety planning, education, and lethal means counseling) that can be done in primary care, emergency, and behavioral health settings; psychotherapies (cognitive-behavioral, dialectical behavior, mentalization therapy); pharmacotherapy; and systemwide procedures for health care organizations (training, policies, workflow, surveillance of suicide indicators, use of health records for screening, care steps). Suicide prevention strategies must be prioritized and implemented at scale for greatest impact.
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Affiliation(s)
- Nadine Melhem
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - Christine Yu Moutier
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - David A Brent
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
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33
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Che SE, Geun GY, Lee JY, Lee H, Yun K, Sim B, Kim KH. Trends in patient suicide rate after psychiatric discharge in Korea from 2010 to 2018: A nationwide population-based study. J Affect Disord 2023; 323:860-865. [PMID: 36526113 DOI: 10.1016/j.jad.2022.12.009] [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: 05/12/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is limited quantitative evidence to investigate short-term suicide rates although the risk of suicide in psychiatric patients is exceptionally high in the early post-discharge period. This study aimed to explore the trends of the 30 days suicide rate after discharge using population-based data from Korea. METHODS This study was conducted on psychiatric patients aged 15 years or older discharged between 2010 and 2018. Patients were extracted from the National Health Insurance Claim Database (NHICD) and information on suicide was obtained from the National Statistical Office. Age-standardized suicide rate (ASR) and Standardized Mortality Ratio (SMR) within 30 days after discharge was estimated and tested using joinpoint regression. RESULTS Of the 1,576,028 patients discharged from hospitals from 2010 to 2018, 53.9 % were male and 47.9 % were aged between 40 and 59 years. The 30 days ASRs for psychiatric patients after discharge varied from 174.9 to 218.0 per 100,000 patients with no clear trend excluding patients with schizophrenia and anxiety disorder. The SMR for suicide within 30 days after discharge was 66.8 in 2016-2018, and patients aged 20 to 39, female, and patients with depression had high SMRs compared to other groups. LIMITATIONS Factors that may impact the suicide were not considered in this study. Since the NHICD data is collected for payment of medical expenses, there may be scope for inaccuracies. CONCLUSIONS The 30 days suicide rate after psychiatric discharge has failed to decrease between 2010 and 2018. This study recommends early interventions after discharge and intensive interventions for patient groups who may be vulnerable to suicide.
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Affiliation(s)
- Song Ee Che
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Gwon Yeong Geun
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Jin Yong Lee
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea; Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea; Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyejin Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kookhoe Yun
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Boram Sim
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea
| | - Kyoung-Hoon Kim
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju, South Korea.
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Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS, Rea M, Cwik MF, Shenoi RP, Fein JA, Mahabee-Gittens EM, Patel SJ, Mistry RD, Duffy S, Melzer-Lange MD, Rogers A, Cohen DM, Keller A, Hickey RW, Page K, Casper TC, King CA. Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA Netw Open 2023; 6:e2255986. [PMID: 36790810 PMCID: PMC9932829 DOI: 10.1001/jamanetworkopen.2022.55986] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
IMPORTANCE Screening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool. OBJECTIVE To compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata. DESIGN, SETTING, AND PARTICIPANTS The Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023. MAIN OUTCOMES AND MEASURES This study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY's continuous outcome is the predicted probability of an SA. RESULTS Of 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively). CONCLUSIONS AND RELEVANCE This study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.
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Affiliation(s)
- David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Lisa M. Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | | | - Jeffrey A. Bridge
- The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Robert Gibbons
- Department of Medicine, The University of Chicago, Chicago, Illinois
- Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
- Department of Comparative Human Development, The University of Chicago, Chicago, Illinois
| | - Lauren S. Chernick
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Margaret Rea
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California
| | - Mary F. Cwik
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rohit P. Shenoi
- Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Joel A. Fein
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shilpa J. Patel
- Division of Pediatric Emergency Medicine, Children’s National Hospital, Washington, DC
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Susan Duffy
- Hasbro Children’s Hospital, Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island
| | | | - Alexander Rogers
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Daniel M. Cohen
- Division of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Allison Keller
- Department of Pediatric Emergency Medicine, University of Utah and Primary Children’s Hospital, Salt Lake City
| | - Robert W. Hickey
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kent Page
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Cheryl A. King
- Department of Psychiatry, Michigan Medicine, Ann Arbor
- Injury Prevention Center, The University of Michigan, Ann Arbor
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Comtois KA, Hendricks KE, DeCou CR, Chalker SA, Kerbrat AH, Crumlish J, Huppert TK, Jobes D. Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality. J Affect Disord 2023; 320:656-666. [PMID: 36162692 DOI: 10.1016/j.jad.2022.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study compared the "next day appointment" (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction. METHODS Participants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment. RESULTS Participants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline. LIMITATIONS The study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. CONCLUSIONS All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.
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Affiliation(s)
- Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America.
| | - Karin E Hendricks
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Christopher R DeCou
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Samantha A Chalker
- Department of Psychology, Catholic University of America, United States of America
| | - Amanda H Kerbrat
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - Jennifer Crumlish
- Department of Psychology, Catholic University of America, United States of America
| | - Tierney K Huppert
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States of America
| | - David Jobes
- Department of Psychology, Catholic University of America, United States of America
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Gryglewicz K, Peterson A, Nam E, Vance MM, Borntrager L, Karver MS. Caring Transitions - A Care Coordination Intervention to Reduce Suicide Risk Among Youth Discharged From Inpatient Psychiatric Hospitalization. CRISIS 2023; 44:7-13. [PMID: 34128700 DOI: 10.1027/0227-5910/a000795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicide risk following youth psychiatric hospitalization is of significant concern. This study evaluated Linking Individuals Needing Care (LINC), a theory-driven, comprehensive care coordination approach for youth discharged from crisis services. Aims: To pilot LINC's potential effectiveness in increasing service utilization and decreasing suicide risk. Method: Participants were 460 youth patients who received LINC for approximately 90 days following discharge from crisis services. Service utilization, depressive symptoms, and suicide-related variables were measured at baseline and 30, 60, and 90 days after baseline. Results: Patients significantly increased the use of various beneficial, least restrictive services (individual therapy, medication management, and non-mental health supports) over the 90-day intervention. Significant decreases were observed in depressive symptoms, suicide ideation, and engagement in suicide-related behaviors. Limitations: Absence of a comparison group and nonparticipating families limit causal conclusions and generalizability. Conclusions: LINC may be a promising new approach following inpatient hospitalization that can engage and retain youth in services, likely resulting in improved treatment outcomes. This approach was designed emphasizing patient engagement, suicide risk assessment and management, safety planning, community networking, referral/linkage monitoring, coping and motivational strategies, and linguistic/culturally responsive practices to meet service and support needs of high-risk suicidal youth.
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Affiliation(s)
- Kim Gryglewicz
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Amanda Peterson
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Eunji Nam
- Department of Social Welfare, Incheon National University, Incheon, South Korea
| | - Michelle M Vance
- Department of Social Work & Sociology, North Carolina A&T State University, Greensboro, NC, USA
| | - Lisa Borntrager
- School of Social Work, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Hugunin J, Davis M, Larkin C, Baek J, Skehan B, Lapane KL. Established Outpatient Care and Follow-Up After Acute Psychiatric Service Use Among Youths and Young Adults. Psychiatr Serv 2023; 74:2-9. [PMID: 36223162 PMCID: PMC9812848 DOI: 10.1176/appi.ps.202200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study explored follow-up after hospitalization and emergency room (ER) use for mental health among youths and young adults with private insurance. METHODS The IBM MarketScan commercial database (2013-2018) was used to identify people ages 12-27 with a mental health hospitalization (N=95,153) or ER use (N=108,576). Factors associated with outpatient mental health follow-up within 7 and 30 days of discharge were determined via logistic models with generalized estimating equations that accounted for state variation. RESULTS Of those hospitalized, 42.7% received follow-up within 7 days (67.4% within 30 days). Of those with ER use, 28.6% received follow-up within 7 days (46.4% within 30 days). Type of established outpatient care predicted follow-up after hospitalization and ER use. Compared with people with no established care, the likelihood of receiving follow-up within 7 days was highest among those with mental health and primary care (hospitalization, adjusted odds ratio [AOR]=2.81, 95% confidence interval [CI]=2.68-2.94; ER use, AOR=4.06, 95% CI=3.72-4.42), followed by those with mental health care only (hospitalization, AOR=2.57, 95% CI=2.45-2.70; ER use, AOR=3.48, 95% CI=3.17-3.82) and those with primary care only (hospitalization, AOR=1.20, 95% CI=1.15-1.26; ER use, AOR=1.22, 95% CI=1.16-1.28). Similar trends were observed within 30 days of discharge. CONCLUSIONS Follow-up rates after acute mental health service use among youths and young adults were suboptimal. Having established mental health care more strongly predicted receiving follow-up than did having established primary care. Improving engagement with outpatient mental health care providers may increase follow-up rates.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Maryann Davis
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Celine Larkin
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Jonggyu Baek
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Brian Skehan
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
| | - Kate L Lapane
- Clinical and Population Health Research doctoral program, Morningside Graduate School of Biomedical Sciences (Hugunin, Davis, Larkin, Baek, Lapane); Department of Psychiatry (Davis, Larkin, Skehan); Department of Emergency Medicine (Larkin); Department of Population and Quantitative Health Sciences (Baek, Lapane); and Department of Pediatrics (Skehan), University of Massachusetts Chan Medical School, Worcester
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Housing Status as a Predictor for Outpatient Care Following an Emergency or Urgent Care Encounter with a Behavioral Health Diagnosis: A Multivariable Analysis. Community Ment Health J 2022; 59:826-833. [PMID: 36454478 DOI: 10.1007/s10597-022-01063-0] [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: 05/11/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
Individuals without stable housing experience high rates of mental illness and seek behavioral health care in emergency care settings. Little is known about the effect of homelessness on outpatient follow-up after utilizing emergency or urgent care for behavioral health care. Patient encounters with behavioral health diagnoses among 7 emergency department (ED) or urgent care (UC) locations over 4 years were used to determine the correlation between housing status and outpatient follow-up within 90 days. Of 1,160,386 visits by 269,615 unique patients, 55,738 (23%) encounters included a behavioral health diagnosis. Patients with stable housing were twice as likely to follow up with a primary care provider (PCP) and with an outpatient behavioral health provider than patients without housing (aOR 2.60; aOR 2.00, p < 0.0001). Homelessness is associated with difficulty in accessing follow-up behavioral health care. UCs and EDs may use specific interventions to improve outpatient follow-up.
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Chen BC, Lui JHL, Benson LA, Lin YJR, Ponce NA, Innes-Gomberg D, Lau AS. After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022; 52:360-375. [DOI: 10.1080/15374416.2022.2127103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Joyce H. L. Lui
- Department of Psychology, University of California
- Department of Psychology, University of Maryland
| | | | | | | | | | - Anna S. Lau
- Department of Psychology, University of California
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Rodwin AH, Shimizu R, Travis R, James KJ, Banya M, Munson MR. A Systematic Review of Music-Based Interventions to Improve Treatment Engagement and Mental Health Outcomes for Adolescents and Young Adults. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 40:1-30. [PMID: 36407676 PMCID: PMC9666939 DOI: 10.1007/s10560-022-00893-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Mental health disorders and suicidality are rising among adolescents and young adults (A-YA) while rates of treatment engagement remain notoriously low. Emerging research supports the potential of music-based interventions to improve mental health, but their efficacy remains unclear for A-YA. This systematic review evaluates the evidence on music-based psychosocial interventions to improve engagement in treatment and/or mental health outcomes among A-YA. This review was prospectively registered with PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-six studies were extracted. There was heterogeneity of designs, populations, measures, and outcomes. A typology of music-based interventions emerged, which is characterized by combinations of three broad categories: 1) Somatosensory, 2) Social-Emotional, and 3) Cognitive-Reflective. Most interventions are Socio-Cognitive and Holistically Integrated (combines all three) followed by Socio-Somatic. All interventions involved Social-Emotional processes. Results indicate that most studies report significant effects for mental health outcomes related to social and emotional improvements and reductions of internalizing symptoms for adolescents. Few studies targeted young adults and effects on engagement were rarely measured. There is a need for more studies that use rigorous methods. This review illuminated a need for interventions that are developmentally and culturally tailored to subgroups. Finally, the field is ripe from more studies that apply experimental therapeutics to conceptualize, operationalize, and test mechanisms of change to improve the understanding of how and for whom music-based interventions work. Recommendations for embedding these innovative strategies into research and practice for A-YA are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10560-022-00893-x.
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Affiliation(s)
- Aaron H. Rodwin
- Silver School of Social Work, New York University, New York, NY USA
| | - Rei Shimizu
- School of Social Work, University of Alaska, Anchorage, AK USA
| | - Raphael Travis
- School of Social Work, Texas State University, San Marcos, TX USA
| | - Kirk Jae James
- Silver School of Social Work, New York University, New York, NY USA
| | - Moiyattu Banya
- Silver School of Social Work, New York University, New York, NY USA
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Hung P, Probst JC, Shih Y, Ranganathan R, Brown MJ, Crouch E, Eberth JM. Rural-Urban Disparities in Quality of Inpatient Psychiatric Care. Psychiatr Serv 2022; 74:446-454. [PMID: 36321319 DOI: 10.1176/appi.ps.20220277] [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: 03/08/2023]
Abstract
OBJECTIVE Rural residents have higher rates of serious mental illness than urban residents, but little is known about the quality of inpatient psychiatric care available to them locally or how quality may have changed in response to federal initiatives. This study aimed to examine differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals. METHODS This national retrospective study of 1,644 facilities examined facility-level annual quality-of-care data from the Inpatient Psychiatric Facility Quality Reporting program, 2015-2019. Facility location was categorized as urban, large rural, or small or isolated rural on the basis of zip code-level rural-urban commuting area codes. Generalized regression models were used to assess rural-urban differences in care quality (five continuity-of-care and two patient experience measures) and changes over time. RESULTS Rural inpatient psychiatric units performed better than urban units in nearly all domains. Improvements in quality of care (excluding follow-up care) were similar in rural and urban units. Rates of 30- and 7-day postdischarge follow-up care decreased in all hospitals but faster in rural units. Timely transmission of transition records was more frequent in small or isolated rural versus urban units (mean marginal difference=22.5, 95% CI=6.3-38.8). Physical restraint or seclusion use was less likely in rural than in urban units (OR=0.6, 95% CI=0.5-0.8). CONCLUSIONS Rural psychiatric units had better care quality at baseline (better follow-up care, better timely transmission of transition records, and lower rates of physical restraint use) than urban units, but during 2015-2019, follow-up care performance decreased overall and more in rural than urban units.
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Affiliation(s)
- Peiyin Hung
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Janice C Probst
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Yiwen Shih
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Radhika Ranganathan
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Monique J Brown
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Elizabeth Crouch
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
| | - Jan M Eberth
- Rural and Minority Health Research Center (Hung, Probst, Ranganathan, Brown, Crouch, Eberth), Department of Health Services Policy and Management (Hung, Probst, Shih, Crouch), and Department of Epidemiology and Biostatistics (Ranganathan, Brown, Eberth), University of South Carolina Arnold School of Public Health, Columbia; Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia (Eberth)
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Demyttenaere K. The temporal experience in depression: from slowing down and delayed help seeking to the emergency setting and length of treatment. Int Rev Psychiatry 2022; 34:693-698. [PMID: 36786108 DOI: 10.1080/09540261.2022.2141103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The present paper discusses the 'time' dimension in depression, from the phenomenological experience to the diagnostic criteria, from delayed help seeking to the emergency room, from a (non) timely follow-up to (non) adherence to treatment. The temporal experience is fundamentally disturbed in depression and recent neurophenomenological findings help in better understanding this dimension. The duration of symptoms needed to fulfil diagnostic criteria are somewhat arbitrary. Depression dramatically decreases life expectancy mainly through increased non-suicidal mortality. The time from help seeking to getting treatment (between delayed help seeking and the emergency room) is contradictory and the length of treatment (from too short to too long) suggests that taking better account of these phenomena could improve depression treatment.
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Affiliation(s)
- Koen Demyttenaere
- Department of Neurosciences, Faculty of Medicine, University of Leuven, University Hospital Gasthuisberg, University Psychiatric Center KU Leuven, Leuven, Belgium
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Riblet NB, Varela M, Ashby W, Zubkoff L, Shiner B, Pogue J, Stevens SP, Wasserman D, Watts BV. Spreading a Strategy to Prevent Suicide After Psychiatric Hospitalization: Results of a Quality Improvement Spread Initiative. Jt Comm J Qual Patient Saf 2022; 48:503-512. [PMID: 35382976 PMCID: PMC9445104 DOI: 10.1016/j.jcjq.2022.02.009] [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: 01/07/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Suicide after psychiatric hospitalization is a major concern. Poor treatment engagement may contribute to risk. The World Health Organization Brief Intervention and Contact (BIC) Program is an evidence-based practice shown to prevent suicide after psychiatric discharge in international trials. There have been no efforts to implement BIC into routine practice in US populations. METHODS The authors conducted a 12-month quality improvement (QI) collaborative at six US Department of Veterans Affairs (VA) medical centers serving a large rural population. Sites had low to moderate performance on a VA quality measure of mental health postdischarge care; a measure assessing the proportion of discharged patients who achieve the required number of visits ≤ 30 days. Sites received programmatic support to implement BIC locally. Implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS Overall, teams had high participation in programmatic activities and enrolled 85% of eligible patients that they approached. Among 70 enrolled patients, 81.4% achieved the VA quality measure of mental health postdischarge care, suggesting good treatment engagement. On average, patients rated BIC as excellent. Team members agreed that BIC was easy to use, implementable, possible, and doable. Factors facilitating implementation included standardized operating procedures to standardize processes. Barriers included insufficient staffing and loss to follow-up. Most sites plan to continue to enroll patients and to expand BIC to other areas. CONCLUSION A QI collaborative can facilitate implementation of BIC in six VA facilities that provide inpatient psychiatric treatment. BIC may appeal to patients and providers and may improve treatment engagement.
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Kodish T, Lau AS, Belin TR, Berk MS, Asarnow JR. Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A. Psychiatr Serv 2022; 74:419-422. [PMID: 36128694 DOI: 10.1176/appi.ps.20220129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated the effects of Safe Alternatives for Teens and Youths-Acute (SAFETY-A), a brief strengths-based, cognitive-behavioral family intervention, on racial-ethnic minority youths receiving emergency department (ED) treatment for suicidal episodes. METHODS Participants were 105 racial-ethnic minority youths enrolled in a randomized controlled trial evaluating SAFETY-A versus enhanced usual care for youths receiving ED treatment for suicidal episodes. Analyses examined group effects on care linkage after discharge and adequate treatment dose. A sample of 55 White youths was included for comparison. RESULTS Racial-ethnic minority youths who received SAFETY-A had higher treatment linkage rates than those receiving usual care. Adequate treatment dose rates did not differ by group. CONCLUSIONS Racial-ethnic minority youths receiving SAFETY-A had higher treatment linkage rates after discharge than those receiving usual care. SAFETY-A is a promising approach to enhance care continuity and mental health equity for racial-ethnic minority youths at risk for suicide.
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Affiliation(s)
- Tamar Kodish
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Anna S Lau
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Thomas R Belin
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Michele S Berk
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
| | - Joan R Asarnow
- Department of Psychology (Kodish, Lau), Department of Biostatistics (Belin), and Department of Psychiatry and Biobehavioral Sciences (Asarnow), University of California, Los Angeles, Los Angeles; Department of Psychiatry, Stanford University School of Medicine, Stanford (Berk)
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Chavez LJ, Steelesmith DL, Bridge JA, Fontanella CA. Predictors of substance use disorder treatment initiation and engagement among adolescents enrolled in Medicaid. Subst Abus 2022; 43:1260-1267. [PMID: 35670769 DOI: 10.1080/08897077.2022.2074603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Adolescents with substance use disorders (SUD) should receive timely access to treatment to improve lifelong outcomes. The Healthcare Effectiveness Data and Information Set (HEDIS) initiation and engagement in treatment (IET) performance measure was intended to promote quality improvement for patients with SUD. Yet, few studies have assessed predictors of measure performance among adolescents or other engagement in mental health services, which is critical to understanding disparities in treatment quality or opportunities for targeted improvement strategies. The present study reports the rates and predictors of IET among adolescents with SUD, as well as receipt of any mental health services. Methods: The sample included adolescents enrolled in Medicaid in 14 states who had a qualifying diagnosis for SUD (2009-2013) and met HEDIS IET performance measure eligibility criteria. Three outcomes were assessed, including initiation of SUD treatment within 14 days of qualifying diagnosis, engagement in SUD treatment (2 or more encounters) within 30 days of initiation, and receipt of any mental health services (1 or more encounters) within 30 days of initiation. Logistic regression was used to identify demographic and clinical characteristics associated with outcomes. Results: Among 20,602 adolescents who met eligibility criteria, 49.5% initiated SUD treatment, 48.5% engaged in SUD treatment, and 70% received any mental health service. Adolescents with higher levels of clinical need (e.g., medical complexity, mental health comorbidity, and multiple SUD diagnoses) had significantly higher odds of initiating, but lower odds of engaging in treatment or receiving any mental health service. Conclusions: To increase the delivery of SUD treatment, efforts should target adolescents with co-occurring mental health needs, many of whom are receiving mental health services after SUD diagnosis. Integrating addiction and mental health services could address these missed opportunities.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Danielle L Steelesmith
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jeffrey A Bridge
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Cynthia A Fontanella
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, USA
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Follow-up Psychiatric Care and Risk of Readmission in Patients with Serious Mental Illness in State Funded or Operated Facilities. Psychiatr Q 2022; 93:499-511. [PMID: 34694533 PMCID: PMC9046324 DOI: 10.1007/s11126-021-09957-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
Receipt of outpatient treatment within 30 days of discharge from psychiatric hospitalization is an established quality indicator; however, there is scant, mixed evidence as to whether it reduces the risk of readmission. We evaluated this question in patients hospitalized for schizophrenic, bipolar or depressive disorders using the Mental Health Treatment Episode Data Set (MH-TEDS), comprising patients in state-funded or -operated facilities and programs. We performed a 6-month, retrospective longitudinal cohort study including 44,761 patients with schizophrenic disorders, 45,413 patients with bipolar disorders, and 74,995 patients with depressive disorders with an index hospitalization between 2014 and 2018, stratified by whether they had at least one outpatient treatment admission in the first 30 days post-discharge. We used multivariable logistic regression to assess risk of readmission during days 31-180. We found that less than 10 percent of patients in the three cohorts received the recommended follow-up outpatient care. Furthermore, we found that schizophrenic and bipolar patients who did receive such care were no less likely to be readmitted than those not receiving such care (AOR = 0.96, 95% CI 0.87-1.06; AOR 1.06, 955 CI 0.98-1.14), and patients with depressive disorders receiving such care were more likely to be readmitted (AOR = 1.14, 95% CI 1.07-1.22). Thus, few patients received follow-up outpatient care within 30 days of discharge. When it occurred, such outpatient care was either not linked to reduced readmissions or was associated with increased readmissions. These findings suggest the need for more effective care processes in state-funded or -operated facilities.
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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Dickson KS, Sklar M, Chen SZ, Kim B. Characterization of multilevel influences of mental health care transitions: a comparative case study analysis. BMC Health Serv Res 2022; 22:437. [PMID: 35366865 PMCID: PMC8976965 DOI: 10.1186/s12913-022-07748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts. METHODS A comparative multiple case study design was used to characterize transition practices within the literature examining children's, non-VA adult, and VA adult service contexts. Andersen's (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems. RESULTS Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity. CONCLUSIONS Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
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Affiliation(s)
- Kelsey S. Dickson
- Department of Child and Family Development, San Diego State University, San Diego, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Marisa Sklar
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California, San Diego, San Diego, CA USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, San Diego, CA USA
| | - Serena Z. Chen
- Harvard South Shore Psychiatry Residency Training Program, Harvard Medical School / VA Boston Healthcare System, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Bo Kim
- Harvard South Shore Psychiatry Residency Training Program, Harvard Medical School / VA Boston Healthcare System, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA USA
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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Parast L, Burkhart Q, Bardach NS, Thombley R, Basco WT, Barabell G, Williams DJ, Mitchel E, Machado E, Raghavan P, Tolpadi A, Mangione-Smith R. Development and Testing of an Emergency Department Quality Measure for Pediatric Suicidal Ideation and Self-Harm. Acad Pediatr 2022; 22:S92-S99. [PMID: 35339249 PMCID: PMC8969171 DOI: 10.1016/j.acap.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. METHODS Based on a conceptual framework, evidence review, and a modified Delphi process, we developed a quality measure assessing whether youth 5 to 17 years old evaluated for suicidal ideation or self-harm in the ED and discharged to home had a follow-up mental health care visit within 7 days. The measure was tested in 4 geographically dispersed states (California, Pennsylvania, South Carolina, Tennessee) using Medicaid administrative data. We examined measure feasibility of implementation, variation, reliability, and validity. To test validity, adjusted regression models examined associations between quality measure scores and subsequent all-cause and same-cause hospital readmissions/ED return visits. RESULTS Overall, there were 16,486 eligible ED visits between September 1, 2014 and July 31, 2016; 53.5% of eligible ED visits had an associated mental health care follow-up visit within 7 days. Measure scores varied by state, ranging from 26.3% to 66.5%, and by youth characteristics: visits by youth who were non-White, male, and living in an urban area were significantly less likely to be associated with a follow-up visit within 7 days. Better quality measure performance was not associated with decreased reutilization. CONCLUSIONS This new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, future work is needed to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
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Affiliation(s)
- Layla Parast
- RAND Corporation, Statistics Group (L Parast, Q Burkhart, A Tolpadi), Santa Monica, Calif.
| | - Q Burkhart
- RAND Corporation, Statistics Group (L Parast, Q Burkhart, A Tolpadi), Santa Monica, Calif
| | - Naomi S Bardach
- University of California San Francisco (NS Bardach), San Francisco, Calif
| | - Robert Thombley
- UCSF, Institute for Health Policy Studies (R Thombley), San Francisco, Calif
| | - William T Basco
- The Medical University of South Carolina (WT Bosco), Charleston, SC
| | | | - Derek J Williams
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr. Children's at Vanderbilt (DJ Williams), Nashville, Tenn
| | - Ed Mitchel
- Department of Health Policy, Vanderbilt University School of Medicine (E Mitchel), Nashville, Tenn
| | - Edison Machado
- Kaiser Permanente Washington Health Research Institute (E Machado, R Mangione-Smith), Seattle, Wash
| | | | - Anagha Tolpadi
- RAND Corporation, Statistics Group (L Parast, Q Burkhart, A Tolpadi), Santa Monica, Calif
| | - Rita Mangione-Smith
- Kaiser Permanente Washington Health Research Institute (E Machado, R Mangione-Smith), Seattle, Wash
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