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Stewart RE, Cardamone NC, Shen L, Dallard N, Comeau C, Mandell DS, Bowen J, Rothbard A. Effect of Providing Evidence-Based Mental Health Treatment on Retention in Care Among Medicaid-Enrolled Youths. Psychiatr Serv 2024:appips20240066. [PMID: 39091172 DOI: 10.1176/appi.ps.20240066] [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: 08/04/2024]
Abstract
OBJECTIVE Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not. METHODS Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503). RESULTS Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01). CONCLUSIONS These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.
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Affiliation(s)
- Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Nicholas C Cardamone
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Lisa Shen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Natalie Dallard
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Carrie Comeau
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Jill Bowen
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
| | - Aileen Rothbard
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Stewart, Cardamone, Shen, Mandell, Rothbard); Community Behavioral Health, Philadelphia (Dallard, Comeau); Department of Behavioral Health and Intellectual disAbility Services, Philadelphia (Bowen)
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Boyer L, Llorca PM, Fond G. Call for action to address premature mortality due to physical illness in individuals with severe mental disorders. Acta Psychiatr Scand 2024; 150:53-55. [PMID: 38923517 DOI: 10.1111/acps.13722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Laurent Boyer
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Fondation FondaMental, Créteil, France
| | | | - Guillaume Fond
- CEReSS - Health Service Research and Quality of Life Center, UR3279, Aix-Marseille University, Marseille, France
- Fondation FondaMental, Créteil, France
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Hargraves JL, Cosenza C, Cleary PD. Measuring Access to Mental Health Services Among Primary Care Patients. Med Care 2024; 62:559-566. [PMID: 38842445 PMCID: PMC11226347 DOI: 10.1097/mlr.0000000000002029] [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: 06/07/2024]
Abstract
BACKGROUND The lifetime risk of mental health disorders is almost 50% and, in any year, about 25% of the population have a psychiatric disorder. Many of those people are cared for in primary care settings. RESEARCH OBJECTIVE Measure access to mental health services, such as getting counselling or prescription mental health medications, using new patient survey questions that can be added to Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. STUDY DESIGN Surveys were conducted with a stratified probability sample of patients receiving primary care services in a single state in 2018-2019. Medicaid and privately insured patients were surveyed by mail or telephone, respectively. RESULTS Approximately 14% of sampled patients responded to a survey. More than 10% of privately insured respondents and about 20% of Medicaid respondents got or tried to get appointments for mental health care. About 15% of privately insured respondents and 11% of Medicaid respondents reported problems getting appointments with counselors. Only 8%-9% of respondents seeking mental health medicines reported problems getting appointments for prescriptions. A composite measure combining access to counselors and prescribers of mental health medicines evidenced adequate internal consistency reliability. Group level reliability estimates were low. CONCLUSIONS Many respondents got or tried to get mental health services and a substantial number reported problems getting appointments or getting mental health prescriptions. The tested questions can be combined into an Access to Mental Health Care measure, which can be included in patient experience surveys for ambulatory care to monitor access to behavioral health care.
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Affiliation(s)
- J. Lee Hargraves
- Center for Survey Research, University of Massachusetts Boston, 100 William T. Morrissey Blvd. Boston, MA 02125-3393
| | - Carol Cosenza
- Center for Survey Research, University of Massachusetts Boston, 100 William T. Morrissey Blvd. Boston, MA 02125-3393
| | - Paul D. Cleary
- Yale School of Public Health, 60 College St, New Haven, CT 06510
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Sreeram A, Nair R, Rahman MA. Efficacy of educational interventions on improving medical emergency readiness of rural healthcare providers: a scoping review. BMC Health Serv Res 2024; 24:843. [PMID: 39061016 PMCID: PMC11282721 DOI: 10.1186/s12913-024-11116-7] [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: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers' knowledge, skills, and confidence to meet patients' emergency needs. Rural healthcare professionals' medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers' emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers' medical emergency readiness. OBJECTIVES This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers' medical emergency readiness globally. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data. RESULTS From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers' emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers' medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally. CONCLUSION The review concluded that rural healthcare providers' medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions' behavioural outcomes, especially among rural healthcare providers in low to middle-income countries.
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Affiliation(s)
- Anju Sreeram
- Federation University Australia, Mt Helen Campus, Ballarat, Australia.
| | - Ram Nair
- JeevaRaksha Trust, Bangalore, India.
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick campus, Berwick, Australia
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Fossum SØ, Moen ØL, Gonzalez MT, Schröder A, Skundberg-Kletthagen H. Investigating the Associations between Patient-Reported Quality of Care and Perceived Coercion: A Norwegian Cross-Sectional Study. Issues Ment Health Nurs 2024:1-10. [PMID: 38976249 DOI: 10.1080/01612840.2024.2361336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Patient perspectives on the quality of care received are fundamental to mental health care. This study aimed to investigate the association between patient-reported mental health care quality, perceived coercion, and various demographic, clinical, and ward-related factors. Using a cross-sectional design, data were collected from 169 patients in Norwegian mental health wards using the quality in psychiatric care-inpatient (QPC-IP) instrument and experienced coercion scale (ECS). The analysis revealed a consistent pattern in which patients with higher perceived coercion consistently rated lower quality on all QPC-IP dimensions. The significant findings of the multiple regression models further supported this association. Beyond coercion, the factors influencing quality ratings include self-reported treatment results, participation in treatment planning, and knowledge of complaint procedures. Emphasizing the pivotal role of coercion in enhancing mental health care quality, these findings contribute to a nuanced understanding of patient experiences and underscore the importance of patient participation in mental health care improvement efforts.
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Affiliation(s)
- Siri Ødegaard Fossum
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Øyfrid Larsen Moen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Marianne Thorsen Gonzalez
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Agneta Schröder
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Faculty of Health and Social Sciences, Institute of Nursing and Health Sciences, University of South-Eastern Norway (USN), Drammen, Norway
| | - Hege Skundberg-Kletthagen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Horwitz AG, McCarthy K, Sen S. A review of the peak-end rule in mental health contexts. Curr Opin Psychol 2024; 58:101845. [PMID: 39018885 DOI: 10.1016/j.copsyc.2024.101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
The peak-end rule, a memory heuristic in which the most emotionally salient part of an experience (i.e., peak) and conclusion of an experience (i.e., end) are weighted more heavily in summary evaluations, has been understudied in mental health contexts. The recent growth of intensive longitudinal methods has provided new opportunities for examining the peak-end rule in the retrospective recall of mental health symptoms, including measures often used in measurement-based care initiatives. Additionally, principles of the peak-end rule have significant potential to be applied to exposure-based therapy procedures. Additional research is needed to better understand the contexts in which, and persons for whom, the peak-end rule presents a greater risk of bias, to ultimately improve assessment strategies and clinical care.
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Affiliation(s)
- Adam G Horwitz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA.
| | - Kaitlyn McCarthy
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA
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McCluskey A, Watson C, Nugent L, O'Connor T, Moore Z, Molloy L, Patton D. 'Sometimes You Have No Choice but to Give Them Medication': Experiences of Nurses Caring for People With Auditory Hallucinations in an Acute Unit. Int J Ment Health Nurs 2024. [PMID: 38965712 DOI: 10.1111/inm.13380] [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: 02/09/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/06/2024]
Abstract
The aim of this study was to explore psychiatric nurse's experiences of caring for people with auditory hallucinations in an acute unit. A qualitative study was conducted using thematic analysis. The study involved semi-structured interviews with 18 acute unit nurses all of whom provided interventions to patients with auditory hallucinations. Overall, participants identified their role in the management of risk within an acute unit, the importance of their therapeutic role and a perceived over-reliance on medication administration as a primary nursing intervention. These findings thus demonstrate the personal and professional conflict that nurses face when working in an acute unit with patients who experience auditory hallucinations. Nurses are in a prime position to provide effective interventions and assistance for people with auditory hallucinations in an acute unit. The findings of this study indicate that mental health nurses may require additional support and education to provide care in a truly recovery-based manner, with training in specific interventions and engagement skills for people who hear voices. Due to an unpredictable environment and sometimes high-risk workplace, nurses may also benefit from organisational assistance in this area.
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Affiliation(s)
- Anita McCluskey
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chanel Watson
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Tom O'Connor
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Lida Institute, Shanghai, China
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Zena Moore
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Lida Institute, Shanghai, China
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourbe, Victoria, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- University of Wales, Cardiff, UK
| | - Luke Molloy
- Department of Medicine and Health, School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Declan Patton
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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8
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Fleury MJ, Cao Z, Grenier G, Rahme E. Profiles of quality of outpatient care among individuals with mental disorders based on survey and administrative data. J Eval Clin Pract 2024. [PMID: 39031622 DOI: 10.1111/jep.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
RATIONALE Though it is crucial to contribute to patient recovery through access, diversity, continuity and regularity of outpatient care, still today most of these are deemed nonoptimal. Identifying patient profiles based on outpatient service use and quality of care indicators might help formulate more personalized interventions and reduce adverse outcomes. AIMS AND OBJECTIVES This study aimed to identify profiles of individuals with mental disorders (MDs) patterned after their outpatient care use and quality of care received, and to link those profiles to individual characteristics and subsequent outcomes. METHODS A cohort of 5669 individuals with MDs was considered based on data from the 2013-2014 and 2015-2016 Canadian Community Health Survey, which were linked to administrative data from the Quebec health insurance registry. Latent class analysis generated profiles based on service use over the 12 months preceding each respondent's interview, and comparative analyses were used to associate profiles with sociodemographic and clinical characteristics, and health outcomes over the three following months. RESULTS Four profiles were identified. Profile 1 (P-1) was labelled 'Low service use'; P-2 'Moderate general practitioner (GP) care and continuity and regularity of care'; P-3 'High GP care, continuity and regularity of care, and low psychiatrist care'; and P-4 'High psychiatrist care and regularity of care, and low GP care'. Profiles 3 and 4 (~50% of the cohort) were provided with better care, but showed worse outcomes, mainly acute care use due to more complex conditions and unmet needs. Profiles 1 and 2 had better outcomes as they showed fewer risk factors such as being younger and having better social conditions. CONCLUSION Intensity, diversity and regularity of care were higher in profiles with more complex MDs, chronic physical illnesses, and worse perceived health conditions. Adapting specific interventions for each profile, such as assertive community treatment or intensive case management for Profile 4, is recommended.
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Affiliation(s)
| | - Zhirong Cao
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Skliarova T, Pedersen H, Holsbrekken Å, Pedersen SA, Mandal A, De Las Cuevas C, Havnen A, Gråwe R, Lara-Cabrera ML. Psychoeducational group interventions for adults diagnosed with attention-deficit/ hyperactivity disorder: a scoping review of feasibility, acceptability, and outcome measures. BMC Psychiatry 2024; 24:463. [PMID: 38902683 PMCID: PMC11191191 DOI: 10.1186/s12888-024-05908-8] [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: 02/03/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Although psychoeducational group interventions are increasingly used for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), a comprehensive review focused on the feasibility and acceptability indicators of these interventions remains lacking. Furthermore, although previous research has explored various aspects of psychoeducation for ADHD, such as its definition and approaches, limited research has focused on the synthesis for outcome measures and patients' experiences related to these interventions. Therefore, this scoping review aims to map the existing evidence reported on psychoeducational group interventions for adults diagnosed with ADHD. The objective is to provide a comprehensive overview of feasibility indicators, acceptability, and outcome measures used in psychoeducational group interventions. METHOD A comprehensive structured literature search on the topic was performed in seven bibliographic databases, and the resulting records were independently screened, and their data extracted by two reviewers. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-S) to ensure the transparency and rigor of this scoping review. RESULTS The searches yielded 7510 records. Eight studies met the inclusion criteria. These included studies were conducted in European countries and the United States. Among these, six studies used a randomized control design, one an open feasibility trial, and one a pre-post intervention design. All the studies reported some feasibility and acceptability indicators. While all the studies reported on the severity of symptoms of ADHD as an outcome measure, some also reported on outcomes related to psychological or mental-health problems, quality of life, changes in knowledge regarding ADHD, or the level of self-esteem, functioning, and impairment. CONCLUSION This scoping review revealed that psychoeducational group interventions are generally acceptable for patients in terms of patient satisfaction with the group intervention. All included studies reported some feasibility indicators, with some reporting good attendance and relatively low dropout rates. Most studies reported positive effects on ADHD and mental health symptoms, suggesting that these interventions are beneficial for adults with ADHD. However, several gaps exist regarding the reporting on the feasibility indicators, acceptability, and outcome measures employed across studies.
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Affiliation(s)
- Tatiana Skliarova
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Henrik Pedersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Nidaros Community Mental Health Center, St. Olavs University Hospital, Trondheim, Norway
| | - Åshild Holsbrekken
- Division of Psychiatry, Nidaros Community Mental Health Center, St. Olavs University Hospital, Trondheim, Norway
| | - Sindre Andre Pedersen
- Library Section for Research Support, Data and Analysis, NTNU University Library, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Arthur Mandal
- Vårres Regional User-Led Center Mid-Norway, Trondheim, Norway
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, San Cristóbal de La Laguna, Canary Islands, Spain
| | - Audun Havnen
- Library Section for Research Support, Data and Analysis, NTNU University Library, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Rolf Gråwe
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Mental Healthcare, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mariela Loreto Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Mental Healthcare, Nidelv Community Mental Health Center, St. Olavs University Hospital, Trondheim, Norway
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10
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Deane AE, Elmore JS, Mayes TL, Robinson S, AlZubi Y, Wakefield SM, Trivedi MH. Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01715-0. [PMID: 38896285 DOI: 10.1007/s10578-024-01715-0] [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] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.
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Affiliation(s)
- Amber E Deane
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Skylar Robinson
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Yasmin AlZubi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA.
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11
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Triplett NS, Mbwayo A, Kiche S, Sackey E, AlRasheed R, Okoth DA, Nyaboke OA, Amanya C, Dorsey S. "A problem shared is a problem solved:" integrating human-centered design and implementation science to optimize lay counselor supervision in Western Kenya. SSM - MENTAL HEALTH 2024; 5:100319. [PMID: 38938452 PMCID: PMC11210373 DOI: 10.1016/j.ssmmh.2024.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Implementation science and human-centered design (HCD) offer useful frameworks and methods for considering and designing for individuals' needs and preferences when implementing new interventions or technologies in global health. When used in tandem, the two approaches may blend creative and partnered research methods with a focus on the factors necessary to design, implement, and sustain interventions. However, research is needed that describes the process of blending these two approaches and explores the experiences of community partners. This study builds from a stepped-wedge cluster-randomized trial in Western Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy (TF-CBT). Mobile phones emerged as a tool to supervise lay counselors from afar; however, their use was characterized by unique challenges. Informed by human-centered design and implementation science, we first engaged lay counselors (n = 24) and supervisors (n = 3) in individual semi-structured interviews then hosted an in-person participatory workshop to "co-design" solutions to optimize the use of mobile phone supervision. Lay counselors participated in focus group discussions regarding their experiences in the workshop. Focus group transcripts were analyzed using thematic analysis. We describe our approach as well as focus group discussion results. Counselors felt the workshop was a valuable experience to learn new strategies from their colleagues, and they enjoyed the "collaborative spirit" that emerged as they worked together. Counselors felt that varying small and large group discussions fostered participation by creating opportunities for more people to engage and share their thoughts. Counselors suggested the approach be improved by providing more tangible materials (e.g., hand-outs) and more closely following a schedule of activities. It is important to also center stakeholders' experiences as partners in the research process. Though counselors largely expressed positive sentiments, they also shared valuable suggestions for how to improve participatory research practices in the future.
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Affiliation(s)
- Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Enoch Sackey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | | | | | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Aldis R, Rosenfeld LC, Mulvaney-Day N, Lanca M, Zona K, Lam JA, Asfour J, Meltzer JC, Leff HS, Fulwiler C, Wang P, Progovac AM. Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition. Learn Health Syst 2024; 8:e10416. [PMID: 38883875 PMCID: PMC11176570 DOI: 10.1002/lrh2.10416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. Methods This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Results Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. Conclusions There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
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Affiliation(s)
- Rajendra Aldis
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Lisa C Rosenfeld
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Margaret Lanca
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Kate Zona
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Jeffrey A Lam
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Julia Asfour
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - Jonah C Meltzer
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - H Stephen Leff
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Carl Fulwiler
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Philip Wang
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Ana M Progovac
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
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13
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Armoon B, Grenier G, Fleury MJ. Perceived Higher Unmet Care Needs among Adults in Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01390-2. [PMID: 38819494 DOI: 10.1007/s10488-024-01390-2] [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: 05/21/2024] [Indexed: 06/01/2024]
Abstract
This study is original in that it assesses various types of care needs, barriers to care, and factors associated with higher unmet needs among 308 permanent supportive housing (PSH) residents in Quebec (Canada). Data from structured interviews that featured the Perceived Need for Care Questionnaire were collected from 2020 to 2022, controlling for the COVID-19 pandemic period. Eight types of care (e.g., information, counseling) were accounted for. Based on the Behavioral Model for Vulnerable Populations, predisposing, need, and enabling factors associated with higher unmet care needs were assessed using a negative binomial regression model. The study found that 56% of adult PSH residents, even those who had lived in PSH for 5 + years, had unmet care needs. Twice as many unmet needs were due to structural (e.g., care access) rather than motivational barriers. Living in single-site PSH, in healthier neighborhoods, having better quality of life and self-esteem, and being more satisfied with housing and outpatient care were associated with fewer unmet care needs. PSH residents with co-occurring mental disorders (MD) and substance use disorders (SUD), and with moderate or severe psychological distress were likely to have more unmet needs. Better access to care, counseling and integrated treatment for co-occurring MD-SUD might be improved, as well as access to information on user rights, health and available support. Welfare benefits could be increased, with more peer support and meaningful activities, especially in single-site PSH. The quality of the neighborhoods where PSH are located might also be better monitored.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montréal, Québec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montréal, Québec, Canada.
- Department of Psychiatry, McGill University, Montréal, Québec, Canada.
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montréal, QC, H4H 1R3, Canada.
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Horgan S, Prorok J, Ellis K, Mullaly L, Cassidy KL, Seitz D, Checkland C. Optimizing Older Adult Mental Health in Support of Healthy Ageing: A Pluralistic Framework to Inform Transformative Change across Community and Healthcare Domains. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:664. [PMID: 38928911 PMCID: PMC11203904 DOI: 10.3390/ijerph21060664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 06/28/2024]
Abstract
This paper describes a pluralistic framework to inform transformative change across community and healthcare domains to optimize the mental health of older adults in support of healthy ageing. An extensive review and analysis of the literature informed the creation of a framework that contextualizes the priority areas of the WHO Decade of Health Ageing (ageism, age-friendly environments, long-term care, and integrated care) with respect to older adult mental health. The framework additionally identifies barriers, facilitators, and strategies for action at macro (social/system), meso (services/supports), and micro (older adults) levels of influence. This conceptual (analytical) framework is intended as a tool to inform planning and decision-making across policy, practice, education and training, research, and knowledge mobilization arenas. The framework described in this paper can be used by countries around the globe to build evidence, set priorities, and scale up promising practices (both nationally and sub-nationally) to optimize the mental health and healthy ageing trajectories of older adults as a population.
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Affiliation(s)
- Salinda Horgan
- Departments of Rehabilitation Therapy & Psychiatry, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Jeanette Prorok
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Katie Ellis
- Mental Health Commission of Canada, Ottawa, ON K1R 1A4, Canada; (K.E.); (L.M.)
| | - Laura Mullaly
- Mental Health Commission of Canada, Ottawa, ON K1R 1A4, Canada; (K.E.); (L.M.)
| | - Keri-Leigh Cassidy
- Department of Psychiatry, Dalhousie University, Dalhousie, NS B3H 2E2, Canada;
| | - Dallas Seitz
- Departments of Psychiatry & Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Claire Checkland
- Canadian Coalition for Seniors’ Mental Health, Markham, ON L3R 9X9, Canada;
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15
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D'Aunno T, Neighbors CJ. Innovation in the Delivery of Behavioral Health Services. Annu Rev Public Health 2024; 45:507-525. [PMID: 37871139 DOI: 10.1146/annurev-publhealth-071521-024027] [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: 10/25/2023]
Abstract
Several factors motivate the need for innovation to improve the delivery of behavioral health services, including increased rates of mental health and substance use disorders, limited access to services, inconsistent use of evidence-based practices, and persistent racial and ethnic disparities. This narrative review identifies promising innovations that address these challenges, assesses empirical evidence for the effectiveness of these innovations and the extent to which they have been adopted and implemented, and suggests next steps for research. We review five categories of innovations: organizational models, including a range of novel locations for providing services and new ways of organizing services within and across sites; information and communication technologies; workforce; treatment technologies; and policy and regulatory changes. We conclude by discussing the need to strengthen and accelerate the contributions of implementation science to close the gap between the launch of innovative behavioral health services and their widespread use.
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Affiliation(s)
- Thomas D'Aunno
- Wagner Graduate School of Public Service, New York University, New York, NY, USA;
| | - Charles J Neighbors
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
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16
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Baandrup L, Dons AM, Bartholdy KV, Holm KO, Hageman I. Changing prescribing practice for rapid tranquillization-a quality improvement project based on the Plan-Do-Study-Act method. Soc Psychiatry Psychiatr Epidemiol 2024; 59:781-788. [PMID: 36943451 PMCID: PMC10029773 DOI: 10.1007/s00127-023-02461-9] [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: 08/14/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE It is unclear how the evidence from clinical trials best translates into complex clinical settings. The aim of this quality improvement (QI) project was to change prescribing practice for rapid tranquillization in inpatient mental health care services examining the effectiveness of the Plan-Do-Study-Act (PDSA) method. METHODS A prospective QI project was conducted to ensure that intramuscular (IM) diazepam was substituted with IM lorazepam for benzodiazepine rapid tranquillization in inpatient mental health care. We monitored the prescription and administration of medication for rapid tranquillization before (N = 371), during (N = 1130) and after (N = 364) the QI intervention. Seven iterative PDSA cycles with a multiple-component intervention approach were conducted to gradually turn the prescribing practice in the desired direction. Simultaneously, a standard monitoring regimen was introduced to ensure patient safety. RESULTS Lorazepam administrations gradually replaced diazepam during the intervention period which was sustained post-intervention where lorazepam comprised 96% of benzodiazepine administrations for rapid tranquillization. The mean dose of benzodiazepine administered remained stable from pre (14.40 mg diazepam equivalents) to post (14.61 mg) intervention phase. Close to full compliance (> 80%) with vital signs monitoring was achieved by the end of the observation period. CONCLUSION It was possible to increase the quality of treatment of acute agitation in a large inpatient mental health care setting using a stepwise approach based on iterative PDSA cycles and continuous data feedback. This approach might be valuable in other prescribing practice scenarios with feedback from local stakeholders and opinion leaders.
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Affiliation(s)
- Lone Baandrup
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark.
- Mental Health Centre Copenhagen, Tuborgvej 235, 2400, Copenhagen NV, Denmark.
| | - Anne Mette Dons
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katja Vu Bartholdy
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katrine Overballe Holm
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ida Hageman
- The Mental Health Services of the Capital Region in Denmark, Copenhagen University Hospital, Copenhagen, Denmark
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17
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Wangel AM, Persson K, Duerlund S, Fhager J, Mårdhed E, Sjögran L, Sjöström K, Glantz A, Örmon K, Sunnqvist C. The Core Elements of Psychiatric and Mental Health Nursing: Time, Honest Engagement, Therapeutic Relations, Professional Nursing and Lifetime-Perspective. Issues Ment Health Nurs 2024; 45:399-408. [PMID: 38363803 DOI: 10.1080/01612840.2024.2305934] [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: 02/18/2024]
Abstract
Defining psychiatric and mental health nursing has been a challenge for decades, and it is still difficult to find a comprehensive definition. We have identified a possibility to clarify psychiatric and mental health nursing based on humanistic philosophy in a general psychiatric care context. The aim was therefore to identify and synthesize the theoretical frameworks from which psychiatric and mental health nursing models are developed. We systematically collected and evaluated articles based on Grounded Theory (GT) methodology regarding psychiatric or mental health nursing. The PRISMA statement for systematic reviews was used and the formal process of synthesis, as a three-step process of identifying first -, second - and third-order themes following the examples of Howell Major and Savin-Baden. The synthesis resulted in a model describing five core elements of psychiatric and mental health nursing: 'professional nursing', 'therapeutic relationships' and 'honest engagement', with time as the all-encompassing theme, including the patients' 'lifetime perspective'. Psychiatric and mental health nursing is a caring support towards recovery, where the patient's lifetime perspective must be in focus during the caring process with a relationship built on an honest engagement. Time is therefore essential for psychiatric and mental health nursing.
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Affiliation(s)
- Anne-Marie Wangel
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Persson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Sara Duerlund
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Johan Fhager
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Emma Mårdhed
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Lotta Sjögran
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Karin Sjöström
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Andreas Glantz
- Department of Nursing, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Götaland Region Competence Centre on Intimate Partner Violence, Gothenburg, Sweden
| | - Charlotta Sunnqvist
- The Region Skåne Committee on Psychiatry, Habilitation and Technical Aids, Lund, Sweden
- Department of Clinical Sciences Psychiatry, Lund University, Lund, Sweden
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18
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DeSimone J, Hansen BR. The Impact of Measurement-Based Care in Psychiatry: An Integrative Review. J Am Psychiatr Nurses Assoc 2024; 30:279-287. [PMID: 37264644 DOI: 10.1177/10783903231177707] [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: 06/03/2023]
Abstract
BACKGROUND The quality of mental health treatment has not progressed to the same extent as physical health treatment. Suboptimal mental health outcomes may be attributed to the lack of a systematic approach to tracking and measuring patient progress. In psychiatry, Measurement-Based Care (MBC) offers an objective, systematic approach to monitor clinical progress, evaluate treatment efficacy, and inform clinical decisions, yet remains seldom used in daily practice. AIMS To identify the clinical impact of using MBC in psychiatry. METHODS Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query, "What is the clinical impact of Measurement-Based Care when treating patients with mental illness?" RESULTS A total of nine articles met the inclusion criteria for this integrative review. The articles ranged from 2008 to 2021. The following themes were identified from the analysis of these articles: (1) the clinical impact of MBC, (2) provider attitudes about MBC, and (3) barriers to MBC implementation. CONCLUSIONS MBC, augmenting usual standard care, provides an objective, systematic approach using quantifiable data to monitor symptom severity and treatment effectiveness. This review highlights the clinical benefits of MBC, including increased remission rates, lower risk of relapse, improved medication adherence, and strengthening the therapeutic alliance. Although this review provides an overview of the benefits of MBC in psychiatry, there remains a substantial practice gap warranting further investigation. Strategies must be developed to address barriers at the individual and organizational levels which impede the successful adoption of MBC.
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Affiliation(s)
- Janine DeSimone
- Janine DeSimone, MSN, PMHNP-BC, Johns Hopkins University, Baltimore, MD, USA; Stony Brook University, Stony Brook, NY, USA
| | - Bryan R Hansen
- Bryan R. Hansen, PhD, RN, APRN-CNS, ACNS-BC, Johns Hopkins University, Baltimore, MD, USA
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19
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Dimitropoulos G, Lindenbach D, Potestio M, Mogan T, Richardson A, Anderson A, Heintz M, Moskovic K, Gondziola J, Bradley J, LaMonica HM, Iorfino F, Hickie I, Patten SB, Arnold PD. Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures. JMIR Res Protoc 2024; 13:e51667. [PMID: 38506921 PMCID: PMC10993112 DOI: 10.2196/51667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/13/2024] [Accepted: 02/09/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. OBJECTIVE The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. METHODS This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. RESULTS This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. CONCLUSIONS This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/51667.
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Affiliation(s)
- Gina Dimitropoulos
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - David Lindenbach
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | | | - Tom Mogan
- Alberta Health Services, Edmonton, AB, Canada
| | | | - Alida Anderson
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | - Madison Heintz
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Scott B Patten
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Paul D Arnold
- Mathison Centre for Mental Health & Education, University of Calgary, Calgary, AB, Canada
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20
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Dopp AR, Hindmarch G, Osilla KC, Meredith LS, Manuel JK, Becker K, Tarhuni L, Schoenbaum M, Komaromy M, Cassells A, Watkins KE. Mis-implementation of evidence-based behavioural health practices in primary care: lessons from randomised trials in Federally Qualified Health Centers. EVIDENCE & POLICY : A JOURNAL OF RESEARCH, DEBATE AND PRACTICE 2024; 20:15-35. [PMID: 38911233 PMCID: PMC11192460 DOI: 10.1332/17442648y2023d000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. "Mis-implementation" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange. Aims and objectives We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs). Methods We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors. Findings Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic. Discussion and conclusion Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
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21
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Thompson E, Senek M, Ryan T. Analysis of a nursing survey: Reasons for compromised quality of care in inpatient mental health wards. Int J Ment Health Nurs 2024; 33:52-61. [PMID: 37654077 DOI: 10.1111/inm.13216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality.
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Affiliation(s)
- Elissa Thompson
- Division of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Michela Senek
- University of Sheffield, Sheffield University/Strategic Research Alliance, Sheffield, UK
| | - Tony Ryan
- University of Sheffield, Sheffield University/Strategic Research Alliance, Sheffield, UK
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22
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Dergaa I, Fekih-Romdhane F, Hallit S, Loch AA, Glenn JM, Fessi MS, Ben Aissa M, Souissi N, Guelmami N, Swed S, El Omri A, Bragazzi NL, Ben Saad H. ChatGPT is not ready yet for use in providing mental health assessment and interventions. Front Psychiatry 2024; 14:1277756. [PMID: 38239905 PMCID: PMC10794665 DOI: 10.3389/fpsyt.2023.1277756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024] Open
Abstract
Background Psychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry. Objective Our study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients. Methods Three imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations. Results In case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient's clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient's management. Conclusion As for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.
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Affiliation(s)
- Ismail Dergaa
- Primary Health Care Corporation (PHCC), Doha, Qatar
- Research Unit Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Instituto de Psiquiatria, Universidade de Sao Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | | | | | - Mohamed Ben Aissa
- Department of Human and Social Sciences, Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
| | - Nizar Souissi
- Research Unit Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
| | - Noomen Guelmami
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Helmi Ben Saad
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, University of Sousse, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, University of Sousse, Sousse, Tunisia
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Iversen HH, Haugum M, Ellingsen-Dalskau LH, Bjertnaes O. Reliability and validity of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). BMC Health Serv Res 2024; 24:26. [PMID: 38178069 PMCID: PMC10768463 DOI: 10.1186/s12913-023-10506-7] [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: 05/30/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Inpatient experiences with interdisciplinary treatment for substance dependence and mental health care are measured using continuous electronic measurements in Norway. Major changes in data collection from cross-sectional surveys to continuous measurements necessitated the revalidation of the instrument. The main purpose of the present study was to determine the psychometric properties of the Patient Experiences Questionnaire for Interdisciplinary Treatment for Substance Dependence - Continuous Electronic Measurement (PEQ-ITSD - CEM). We also aimed to develop a short version of this tool, since completing the original version can be burdensome for some patients. METHODS The study included adult inpatients (aged ≥ 16 years) who received substance-dependence treatment at 102 different sections in Norway during 2020-2022 (n = 2,850). Factor structure and item performance were assessed. A short version was developed based on the psychometric testing results that included item response theory analysis. RESULTS The PEQ-ITSD - CEM comprised three empirically based scales with good internal consistency, reliability and validity, which covers treatment and personnel (14 items), milieu (6 items) and outcome (5 items). The results supported a seven-item short version, with three items selected for the treatment and personnel scale, two items for the milieu scale and two items for the outcome scale. CONCLUSIONS The PEQ-ITSD - CEM can be recommended for future assessments of patient experiences with interdisciplinary treatment for substance dependence in Norway and in other countries with similar healthcare systems. This short-form version can be applied when respondent burden is a crucial issue.
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Affiliation(s)
| | - Mona Haugum
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
| | | | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 222 Skoyen, Oslo, 0213, Norway
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24
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Pallikkuth R, Manoj Kumar T, Dictus CT, Bunders-Aelen JFG. Design and Evaluation of Peer Supervision for Community Mental Health Workers: A Task-Shifting Strategy in Low-Resource Settings. Community Ment Health J 2024; 60:131-147. [PMID: 37679654 PMCID: PMC10799819 DOI: 10.1007/s10597-023-01161-7] [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: 09/06/2022] [Accepted: 06/17/2023] [Indexed: 09/09/2023]
Abstract
The use of Lay Mental Health Workers (LMHWs) to tackle the treatment gap in low-resource settings is well established, and although they often receive training, the potential of proper supervision to improve outcomes remains untapped. Indeed, given the strain on expert resources, peer-supervision models based on supervisors' seniority of work experience have significant potential especially in relation to community knowledge and embedding of LMHWs. This study summarizes the evaluation of a pilot program for peer supervision on the basis of Social Cognitive Theories of Self-Efficacy for LMHWs in Kerala, India. Two experienced LMHWs worked as supervisors for a total of 12 LMHWs over the course of a year. These participants were subsequently interviewed to analyze their experiences in order to evaluate the potential of peer supervision and distil relevant information to improve future training of LMHWs. The findings include improved performance and emotional support for the participants.
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Affiliation(s)
- Rekha Pallikkuth
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - T Manoj Kumar
- Department of Clinical Psychology, Mental Health Action Trust, Calicut, India
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Claudia T Dictus
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands.
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals. J Psychiatr Ment Health Nurs 2023; 30:1231-1244. [PMID: 37409521 DOI: 10.1111/jpm.12951] [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: 10/27/2022] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.
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Affiliation(s)
- Karel Desmet
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- AZ Damiaan, Ostend, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Peter J J Goossens
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Dimence Mental Health Center for Bipolar Disorder, Deventer, the Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, VIVES University College, Roeselare, Belgium
- Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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26
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Arias de la Torre J, Vilagut G, Ronaldson A, Bakolis I, Dregan A, Navarro-Mateu F, Pérez K, Szücs A, Bartoll-Roca X, Molina AJ, Elices M, Pérez-Solá V, Martín V, Serrano-Blanco A, Valderas JM, Alonso J. Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health. JMIR Public Health Surveill 2023; 9:e48138. [PMID: 37995112 PMCID: PMC10704303 DOI: 10.2196/48138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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Affiliation(s)
- Jorge Arias de la Torre
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Gemma Vilagut
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Alex Dregan
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fernando Navarro-Mateu
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Katherine Pérez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Anna Szücs
- Department of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Antonio J Molina
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Matilde Elices
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Víctor Pérez-Solá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Vicente Martín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Antoni Serrano-Blanco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | - Jordi Alonso
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medical and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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27
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Dallison S, Jenkinson C, Davey A, O'Mahen H. Overcoming training bottlenecks: mixed-methods evaluation of digital training for non-specialists in postnatal depression self-help treatment. J Reprod Infant Psychol 2023:1-20. [PMID: 37986141 DOI: 10.1080/02646838.2023.2280714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES This mixed-methods study evaluated the feasibility, acceptability and preliminary effectiveness of an interactive digital training programme for non-specialist supporters providing a guided self-help intervention for postnatal depression (PND). METHODS A total of 49 non-specialist trainees participated. Six digital training modules were flexibly delivered over a 5-week period. Training included a chatroom, moderated by a supervised assistant psychologist. Quantitatively, feasibility was assessed via participation and retention levels; acceptability was examined using course evaluation questionnaires; and effectiveness was measured pre-test-post-test quantitatively using a self-report questionnaire and pre-post using scenario questions. Participant focus groups explored feasibility, acceptability and effectiveness. RESULTS The training was feasible; 41 completed the course and 42 were assessed at follow-up. Quantitative course evaluation and thematic analysis of focus group feedback demonstrated high training acceptability. RANOVAs indicated training significantly improved knowledge and confidence pre- to post-test. There were demonstrable increases in specific skills at post-test as assessed via clinical scenarios. CONCLUSION This training is a feasible, acceptable and effective way to upskill non-specialists in supporting treatment for PND, however supervised practice is recommended to ensure participants embed knowledge competently into practice. The training offers an effective first step in upskilling non-specialist supporters to support women with PND treatment at scale.
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Affiliation(s)
- Sophie Dallison
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Caroline Jenkinson
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Antoinette Davey
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
| | - Heather O'Mahen
- Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
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28
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Du W, Chung Y. Discovering risk patterns in people with affective disorder-induced disabilities associated with their healthcare delay. Int Health 2023; 15:723-733. [PMID: 36960797 PMCID: PMC10629950 DOI: 10.1093/inthealth/ihad020] [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: 09/01/2022] [Revised: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND People with affective disorder-induced disabilities (ADIDs) often experience complex needs that delay their healthcare. Discovering hidden patterns in these people for real-world use of health services is essential to improve healthcare delivery. METHODS A cross-sectional study population (2501 adults with ADIDs) was obtained from the Australian national representative survey of disability in 2015, including 21 demographic, health and social characteristics and healthcare delay information in general practice, specialist and hospital services. The Self-Organising Map Network was used to identify hidden risk patterns associated with healthcare delay and investigate potential predictors of class memberships by means of simple visualisations. RESULTS While experiencing disability avoidance showed across different healthcare delays, labour force appeared not to have any influence. Approximately 30% delayed their healthcare to general practice services; these were young, single females in great need of psychosocial support and aids for personal activities. Those who delayed their healthcare commonly presented a lack of social connections and a need for contact with family or friends not living in the same household. CONCLUSIONS The pattern evidence provides an avenue to further develop integrated care strategies with better targeting of people with ADIDs, considering social participation challenges facing them, to improve health service utilisation.
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Affiliation(s)
- Wei Du
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Australian Capital Territory, Australia
| | - Younjin Chung
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Australian Capital Territory, Australia
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29
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Malgaroli M, Hull TD, Zech JM, Althoff T. Natural language processing for mental health interventions: a systematic review and research framework. Transl Psychiatry 2023; 13:309. [PMID: 37798296 PMCID: PMC10556019 DOI: 10.1038/s41398-023-02592-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Neuropsychiatric disorders pose a high societal cost, but their treatment is hindered by lack of objective outcomes and fidelity metrics. AI technologies and specifically Natural Language Processing (NLP) have emerged as tools to study mental health interventions (MHI) at the level of their constituent conversations. However, NLP's potential to address clinical and research challenges remains unclear. We therefore conducted a pre-registered systematic review of NLP-MHI studies using PRISMA guidelines (osf.io/s52jh) to evaluate their models, clinical applications, and to identify biases and gaps. Candidate studies (n = 19,756), including peer-reviewed AI conference manuscripts, were collected up to January 2023 through PubMed, PsycINFO, Scopus, Google Scholar, and ArXiv. A total of 102 articles were included to investigate their computational characteristics (NLP algorithms, audio features, machine learning pipelines, outcome metrics), clinical characteristics (clinical ground truths, study samples, clinical focus), and limitations. Results indicate a rapid growth of NLP MHI studies since 2019, characterized by increased sample sizes and use of large language models. Digital health platforms were the largest providers of MHI data. Ground truth for supervised learning models was based on clinician ratings (n = 31), patient self-report (n = 29) and annotations by raters (n = 26). Text-based features contributed more to model accuracy than audio markers. Patients' clinical presentation (n = 34), response to intervention (n = 11), intervention monitoring (n = 20), providers' characteristics (n = 12), relational dynamics (n = 14), and data preparation (n = 4) were commonly investigated clinical categories. Limitations of reviewed studies included lack of linguistic diversity, limited reproducibility, and population bias. A research framework is developed and validated (NLPxMHI) to assist computational and clinical researchers in addressing the remaining gaps in applying NLP to MHI, with the goal of improving clinical utility, data access, and fairness.
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Affiliation(s)
- Matteo Malgaroli
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY, 10016, USA.
| | | | - James M Zech
- Talkspace, New York, NY, 10025, USA
- Department of Psychology, Florida State University, Tallahassee, FL, 32306, USA
| | - Tim Althoff
- Department of Computer Science, University of Washington, Seattle, WA, 98195, USA
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30
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Boyer L, Fernandes S, Brousse Y, Zendjidjian X, Cano D, Riedberger J, Llorca PM, Samalin L, Dassa D, Trichard C, Laprevote V, Sauvaget A, Abbar M, Misdrahi D, Berna F, Lancon C, Coulon N, El-Hage W, Rozier PE, Benoit M, Giordana B, Caqueo-Urizar A, Yon DK, Tran B, Auquier P, Fond G. Development of the PREMIUM computerized adaptive testing for measuring the access and care coordination for patients with severe mental illness. Psychiatry Res 2023; 328:115444. [PMID: 37677894 DOI: 10.1016/j.psychres.2023.115444] [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: 05/21/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.
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Affiliation(s)
- Laurent Boyer
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France.
| | - Sara Fernandes
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Yann Brousse
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Xavier Zendjidjian
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Delphine Cano
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Jeremie Riedberger
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Pierre-Michel Llorca
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), University Clermont Auvergne, Clermont-Ferrand, France
| | - Ludovic Samalin
- CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), University Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Dassa
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | | | - Vincent Laprevote
- Department of Addictology and Psychiatry, Centre Psychothérapique de Nancy, Laxou, France; INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Anne Sauvaget
- CHU Nantes, Movement - Interactions - Performance, Nantes Université, MIP, UR 4334, Nantes F-44000, France
| | - Mocrane Abbar
- Department of Psychiatry, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - David Misdrahi
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Fabrice Berna
- University Hospital of Strasbourg - Department of Psychiatry, INSERM U1114, FMTS, University of Strasbourg, France
| | - Christophe Lancon
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Nathalie Coulon
- Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours F-37000, France
| | | | - Michel Benoit
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | - Bruno Giordana
- Department of Psychiatry, Hopital Pasteur, University Hospital of Nice, Nice, France
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Bach Tran
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France; Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Pascal Auquier
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
| | - Guillaume Fond
- AP-HM, School of medicine - La Timone Medical Campus, UR3279: Health Service Research and Quality of Life Center (CEReSS), Aix-Marseille University, Marseille, France
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Ma CF, Luo H, Leung SF, Wong GHY, Lam RPK, Bastiampillai T, Chen EYH, Chan SKW. Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 39:100814. [PMID: 37927999 PMCID: PMC10625018 DOI: 10.1016/j.lanwpc.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023]
Abstract
Background There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years. Methods Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates. Findings A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates. Interpretation ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time. Funding None.
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Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Gehri B, Bachnick S, Schwendimann R, Simon M. Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study. Int J Nurs Stud 2023; 146:104583. [PMID: 37619391 DOI: 10.1016/j.ijnurstu.2023.104583] [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: 03/08/2023] [Revised: 06/16/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied. OBJECTIVES The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave. DESIGN Cross-sectional survey study. SETTING(S) Swiss psychiatric hospitals with 24-hour services. PARTICIPANTS Registered nurses (N = 994) from 114 adult-inpatient units. METHODS To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately. RESULTS Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime. CONCLUSION Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.
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Affiliation(s)
- Beatrice Gehri
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland; University Psychiatric Clinics, Basel, Switzerland
| | - Stefanie Bachnick
- HS-Gesundheit Bochum, University of Applied Sciences, Bochum, Germany
| | - René Schwendimann
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland; University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.
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McLaughlin S, Staniland L, Egan SJ, Wheadon J, Munro C, Preece D, Furlong Y, Mavaddat N, Thompson A, Robinson S, Chen W, Myers B. Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol. BMJ Open 2023; 13:e073438. [PMID: 37678945 PMCID: PMC10496663 DOI: 10.1136/bmjopen-2023-073438] [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: 03/08/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION The demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely access to mental health services is critical to reducing the risk of symptom chronicity and progression to mental disorder. A better understanding of whether and how interventions to reduce wait times impact mental health outcomes is needed to guide mental health policymakers and service planners in their approach to reducing wait times. METHODS AND ANALYSIS The scoping review will use Arksey and O'Malley's six-stage framework for scoping reviews and Rayyan to support screening, data extraction and evidence synthesis. The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will search the Cochrane Library, EBSCOhost, MEDLINE (Ovid), PsycArticles (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Web of Science, ProQuest and Scopus databases for peer-reviewed texts published in English between 1 January 2000 and 28 February 2023. We will also search Google Scholar for additional grey literature. To be eligible for inclusion, studies must focus on adolescent populations aged 13-18 years and report on interventions to reduce wait times for any mental health service except crisis and emergency services. Title, abstract and full-text screening will be done by two reviewers. We will extract data describing the interventions and their effects on wait times and adolescent mental health outcomes, and we will identify strengths and limitations in the evidence base to inform recommendations for future research. A youth advisory group with lived experience of mental health difficulties will be consulted throughout the review process. ETHICS AND DISSEMINATION Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences. STUDY REGISTRATION The protocol was registered with the Open Science Framework on 20 February 2023 (https://osf.io/qt4zy).
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Affiliation(s)
- Stella McLaughlin
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Lexy Staniland
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Sarah J Egan
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jessica Wheadon
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Caitlin Munro
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - David Preece
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Yulia Furlong
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Nahal Mavaddat
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Alexander Thompson
- Western Australia Country Health Service, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Health Economics Unit, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Wai Chen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Youth Mental Health and Developmental Neuropsychiatry, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Ngune I, Myers H, Cole A, Palamara P, Redknap R, Roche M, Twigg D. Developing nurse-sensitive outcomes in acute inpatient mental health settings-A systematic review. J Clin Nurs 2023; 32:6254-6267. [PMID: 36915223 DOI: 10.1111/jocn.16679] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND While nurse-sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings. AIM To assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care. METHODS Databases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta-analysis was not possible because of the large number of variables and measurement inconsistencies. RESULTS A total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non-significant relationship between nurse variables and patient outcomes. Seven outcomes-aggression, seclusion, restraint, absconding, pro-re-nata medications, special observations and self-harm-were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self-harm, absconding, pro-re-nata medications and special observations. CONCLUSION All the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high-quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience. PATIENT AND PUBLIC CONTRIBUTION Patient or public contribution was not possible because of the type of the variables being explored.
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Affiliation(s)
- Irene Ngune
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Helen Myers
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Cole
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter Palamara
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robina Redknap
- Western Australia Department of Health, Perth, Western Australia, Australia
| | - Michael Roche
- University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Diane Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Wong BHC, Cross S, Zavaleta-Ramírez P, Bauda I, Hoffman P, Ibeziako P, Nussbaum L, Berger GE, Hassanian-Moghaddam H, Kapornai K, Mehdi T, Tolmac J, Barrett E, Romaniuk L, Davico C, Moghraby OS, Ostrauskaite G, Chakrabarti S, Carucci S, Sofi G, Hussain H, Lloyd ASK, McNicholas F, Meadowcroft B, Rao M, Csábi G, Gatica-Bahamonde G, Öğütlü H, Skouta E, Elvins R, Boege I, Dahanayake DMA, Anderluh M, Chandradasa M, Girela-Serrano BM, Uccella S, Stevanovic D, Lamberti M, Piercey A, Nagy P, Mehta VS, Rohanachandra Y, Li J, Tufan AE, Mirza H, Rozali F, Baig BJ, Noor IM, Fujita S, Gholami N, Hangül Z, Vasileva A, Salucci K, Bilaç Ö, Yektaş Ç, Cansız MA, Aksu GG, Babatunde S, Youssef F, Al-Huseini S, Kılıçaslan F, Kutuk MO, Pilecka I, Bakolis I, Ougrin D. Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2023; 62:998-1009. [PMID: 36806728 PMCID: PMC9933093 DOI: 10.1016/j.jaac.2022.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations. METHOD This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed. RESULTS Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58). CONCLUSION Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs. DIVERSITY & INCLUSION STATEMENT One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
- Ben Hoi-Ching Wong
- East London NHS Foundation Trust, London, United Kingdom; King's College London, United Kingdom.
| | | | - Patricia Zavaleta-Ramírez
- Children's Psychiatric Hospital Dr. Juan N. Navarro., Servicios de Atención Psiquiatrica, Mexico City, Mexico
| | - Ines Bauda
- Medical University of Vienna, Vienna Austria
| | - Pamela Hoffman
- Yale Child Study Center, Child Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Patricia Ibeziako
- Boston Children's Hospital, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts
| | - Laura Nussbaum
- Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | | | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tauseef Mehdi
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Jovanka Tolmac
- Harrow Child and Adolescent Mental Health Service, Central and North West London NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Omer S Moghraby
- King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Sara Carucci
- "A. Cao" Pediatric Hospital, "ARNAS G. Brotzu" Hospital Trust, Cagliari, Italy, and the University of Cagliari, Italy
| | - Gyula Sofi
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Haseena Hussain
- Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, United Kingdom
| | - Alexandra S K Lloyd
- Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | | | - Ben Meadowcroft
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Manish Rao
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | | | - Hakan Öğütlü
- Cognitive Behavioral Psychotherapies Association, Ankara, Turkey
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, London, United Kingdom; Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Rachel Elvins
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Isabel Boege
- ZfP Suedwuerttemberg, Child and Adolescent Psychiatry, Ravensburg, Germany, and University of Graz, Graz, Austria
| | | | - Marija Anderluh
- Child Psychiatry Unit, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | | | - Sara Uccella
- DINOGMI, University of Genoa, Genoa, Italy, and IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Marco Lamberti
- Child and Adolescent Psychiatry Unit, "Franz Tappeiner" Hospital, Merano, Italy
| | - Amy Piercey
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | - Varun S Mehta
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Jie Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University
| | | | | | - Farah Rozali
- NHS Lothian, Child and Adolescent Mental Health Services, Edinburgh, United Kingdom
| | - Benjamin J Baig
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Isa M Noor
- Dr. Soeharto Heerdjan Teaching Mental Hospital, Jakarta, Indonesia
| | - Saori Fujita
- Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Narges Gholami
- Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Anna Vasileva
- V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg, Russia
| | - Katie Salucci
- Berkshire Healthcare NHS Foundation Trust, Berkshire, United Kingdom
| | - Öznur Bilaç
- Manisa Celal Bayar University, Manisa, Turkey
| | | | | | | | | | - Fatima Youssef
- Dubai Department of Medical Education, Dubai, United Arab Emirates
| | - Salim Al-Huseini
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | | | | | | | | | - Dennis Ougrin
- King's College London, United Kingdom; Queen Mary University of London
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Boyer L, Auquier P, Yon DK, Llorca PM, Fond G. Reducing Health Inequalities in Individuals with Severe Mental Disorders: Harnessing Real-World Data and Patient-Reported Measures. J Clin Med 2023; 12:4481. [PMID: 37445517 DOI: 10.3390/jcm12134481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Mental disorders are the leading cause of diminished lifespans worldwide and make up 5 of the top 10 most significant causes of disability [...].
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Affiliation(s)
- Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
| | - Pascal Auquier
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul 130-701, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 130-701, Republic of Korea
| | - Pierre-Michel Llorca
- Department of Psychiatry B, CHU Clermont-Ferrand, Institut Pascal, Axe TGI, CNRS-UMR 6602, Université Clermont Auvergne, 63011 Clermont-Ferrand, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 13005 Marseille, France
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Lakshman SJ, Mohd Daud TI, Midin M, Ahmad F, Tommy K. Validation of the Malay-Version of Recovery Knowledge Inventory among mental health providers in Malaysia. Front Psychiatry 2023; 14:1078423. [PMID: 37383615 PMCID: PMC10293667 DOI: 10.3389/fpsyt.2023.1078423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/30/2023] [Indexed: 06/30/2023] Open
Abstract
Background The Recovery Knowledge Inventory (RKI) is a widely used self-report instrument that assesses recovery-oriented knowledge among mental health professionals. The purpose of this study is to translate the RKI into the Malay language (RKI-M) and to examine its psychometric properties among Malaysian health care workers. Methods A cross-sectional study involving 143 participants was conducted at an urban teaching hospital, an urban government hospital, and a rural government hospital. Following the translation of the RKI, its internal reliability was determined using Cronbach's alpha. Construct validity was also determined using confirmatory factor analysis. Results The Malay-Version RKI (RKI-M) has good internal reliability with a Cronbach's alpha of 0.83. However, the Malay-version RKI failed to replicate the original four-factor structure. The final model only achieved the best model fit after the removal of 9 items with two-factor loadings: (GFI = 0.92; AGFI = 0 0.87; CFI = 0.91; RMSEA = 0.074). Conclusion The 20-item RKI-M is reliable but has poor construct validity. However, the modified 11-item Malay-version RKI is a more reliable measure as it has good construct validity, with room for future studies to examine the psychometric properties of the modified 11-item RKI among mental health care workers. More training on recovery knowledge should be done, and a simple worded questionnaire should be developed in keeping with local practitioners.
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Affiliation(s)
- Stella Jane Lakshman
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
- Department of Psychiatry, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Tuti Iryani Mohd Daud
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | - Marhani Midin
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, Malaysia
| | | | - Kezia Tommy
- Faculty of Business and Economics, University Malaya, Kuala Lumpur, Malaysia
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van der Hoeven ML, Assink M, Stams GJJM, Daams JG, Lindauer RJL, Hein IM. Victims of Child Abuse Dropping Out of Trauma-Focused Treatment: A Meta-Analysis of Risk Factors. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:269-283. [PMID: 37234839 PMCID: PMC10205941 DOI: 10.1007/s40653-022-00500-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 05/27/2023]
Abstract
A substantial number of children who experienced child maltreatment drop out of evidence-based trauma-focused treatments (TF-CBT). Identifying child, family, and treatment-related factors associated with treatment dropout is important to be able to prevent this from happening and to effectively treat children's trauma-related symptoms. Methods: A quantitative review was performed based on a systematic synthesis of the literature on potential risk factors for dropout of trauma-focused treatment in maltreated children. Results: Eight studies were included, that examined TF-CBT, reporting on 139 effects of potential risk factors for dropout. Each factor was classified into one of ten domains. Small but significant effects were found for the "Demographic and Family" risk domain (r = .121), with factors including being male, child protective services involvement or placement, and minority status, and for the "Youth Alliance" risk domain (r = .207), with factors including low therapist-child support and low youth perception of parental approval. Moderator analyses suggested that family income and parental education may better predict the risk for TF-CBT dropout than other variables in the "Demographic and Family" domain. Conclusions: Our results provide a first overview of risk factors for dropout of trauma-focused treatments (TF-CBT) after child maltreatment, and highlight the role of the therapeutic relationship in this. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-022-00500-2.
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Affiliation(s)
- Mara L. van der Hoeven
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Mark Assink
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands
| | - Geert-Jan J. M. Stams
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Ramón J. L. Lindauer
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
| | - Irma M. Hein
- Amsterdam UMC, Department of Child and Adolescent Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, the Netherlands
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39
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Liebmann EP, Resnick SG, Hoff RA, Katz IR. Outcomes for treatment of depression in the Veterans Health Administration: Rates of response and remission calculated from clinical and survey data. Psychiatry Res 2023; 324:115196. [PMID: 37058792 DOI: 10.1016/j.psychres.2023.115196] [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: 01/18/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/16/2023]
Abstract
Healthcare Effectiveness Data and Information Set (HEDIS) quality measures for depression treatment aggregate Patient Health Questionnaire (PHQ)-9 data from routine clinical assessments recorded in electronic health records (EHR). To determine whether aggregated PHQ-9 data in US Veterans Health Administration (VHA) EHRs should be used to characterize the organization's performance, we compared rates for depression response and remission calculated from EHRs with rates calculated with data representing the underlying Veteran patient population estimated using Veterans Outcome Assessment (VOA) survey data. We analyzed data from initial assessments and 3-month follow-up for Veterans beginning treatment for depression. EHR data were available for only a minority of Veteran patients, and the group of Veterans with EHR data differed from the underlying Veteran patient population with respect to demographic and clinical characteristics. Aggregated rates of response and remission from EHR data were significantly different from estimates based on representative VOA data. The findings suggest that until patient-reported outcome from EHRs are available for a substantial majority of patients receiving care, aggregated measures of patient outcomes derived from these data cannot be assumed to be representative of the outcomes for the overall population, and they should not be used as outcome-based measures of quality or performance.
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Affiliation(s)
- Edward P Liebmann
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Rani A Hoff
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT 06516, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Ira R Katz
- VA Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC 20420, United States.
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40
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Hove E, Hazelton MJ, Santangelo P, Wilson RL. Integrated nursing care for people with combined mental health and substance use disorders. Int J Ment Health Nurs 2023; 32:378-401. [PMID: 36408951 DOI: 10.1111/inm.13094] [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] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
Many health problems arise from mental, neurological, and substance use disorders. These disorders are highly prevalent and complex and contribute to poor health outcomes, premature mortality, security risk, social isolation, and global and national economic loss. Mental health and substance use disorders are among Australia's top four causes of disease burden. Our objective was to investigate and synthesize contemporary literature regarding factors that influence nurses' delivery of integrated care to people with combined mental health and substance use disorders within mental health services. We systematically searched five electronic databases with a limit on publications from 2009 to 2021. The search yielded 26 articles. Following thematic analysis, three themes were identified: individual nursing characteristics, nursing education, and professional development characteristics, and organizational factors. This study reveals that there is a fundamental absence of adequate integrative models of care within mental health services to enable the optimal nursing care of people with combined mental health and substance use disorders. Future research is needed to determine nurses' perceptions and factors influencing their role as participants in integrative care. The results could strengthen nurses' contributions in developing/adopting integrative models of care and contribute to clinical, educational, and organizational development.
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Affiliation(s)
- Elizabeth Hove
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Newcastle Callaghan, University Drive, Australia
| | - Michael J Hazelton
- Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia
| | - Peter Santangelo
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Newcastle Callaghan, University Drive, Australia
| | - Rhonda L Wilson
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Newcastle Callaghan, University Drive, Australia.,Hunter Medical Research Institute, New South Wales, New Lambton Heights, Australia.,School of Nursing, Massey University, Auckland, New Zealand
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41
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Bohman B. Clinicians' perceptions and practices of diagnostic assessment in psychiatric services. BMC Psychiatry 2023; 23:191. [PMID: 36959577 PMCID: PMC10037793 DOI: 10.1186/s12888-023-04689-w] [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: 12/22/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Diagnostic assessment in psychiatric services typically involves applying clinical judgment to information collected from patients using multiple sources, including anamnesis and structured diagnostic interviews. Research shows that clinicians' perceptions of diagnostic assessment are associated with their diagnostic practices, and that perceptions and practices may vary according to clinician characteristics. Examining clinicians' perceptions and practices of diagnostic assessment is important for quality improvement in psychiatric services, including implementation of evidence-based practice procedures. The purpose of the present study was to evaluate clinicians' perceptions and practices of diagnostic assessment in psychiatric services and examine whether these perceptions and practices varied according to profession and age, with the aim of providing a basis for quality improvement. METHODS A total of 183 (53.2%) clinicians in community-based adult psychiatric services in Stockholm, Sweden participated in an online survey. Differences between professions were analyzed using Kruskal-Wallis tests and effect sizes were calculated. Associations of clinicians' perceptions with their age were examined using Spearman correlations. RESULTS Overall, clinicians had positive attitudes toward diagnostic assessment, and they considered themselves as competent. Differences were as most pronounced between nurses and other professions. Nursed had conducted fewer assessments, perceived themselves as less competent, and reported to a smaller extent to be able to determine which diagnosis should be the target for treatment in patients with multiple diagnoses. There were no associations of clinicians' perceptions with their age. Some potential areas of improvement were identified, including clinician qualifications, education in diagnostic assessment, and contents of diagnostic assessment. CONCLUSIONS The results of the present study may provide a basis for quality improvement in psychiatric services. For example, it may be important to pay attention to potential differences in perceptions and practices between professions in efforts to improve quality of assessment and care.
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Affiliation(s)
- Benjamin Bohman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
- Centre for Psychiatry Research, Liljeholmstorget 7, Stockholm, SE- 117 63, Sweden.
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Roldán-Merino JF, Tomás-Jiménez M, Schröder A, Lundqvist LO, Puig-Llobet M, Moreno-Poyato AR, Domínguez del Campo M, Sanchez-Balcells S, Lluch-Canut MT. Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4043. [PMID: 36901056 PMCID: PMC10002304 DOI: 10.3390/ijerph20054043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.
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Affiliation(s)
- Juan Francisco Roldán-Merino
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
| | - Manuel Tomás-Jiménez
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Patient Safety Research Group, Hospital Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
- Department of Nursing, Faculty of Health Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway
| | - Lars-Olov Lundqvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
| | - Montserrat Puig-Llobet
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antonio R. Moreno-Poyato
- Mental Health, Psychosocial and Complex Nursing Care Research Group—NURSEARCH, University of Barcelona, 08907 Barcelona, Spain
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Marta Domínguez del Campo
- Mental Health Department, Campus Docent Sant Joan de Déu Private Foundation, University of Barcelona, C/Sant Benito Menni, 18-20, 08830 Sant Boi de Llobregat, Spain
- Grupo DAFNiS, Campus Docent Sant Joan de Déu, Universitat de Barcelona, 08830 Sant Boi de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Etiopatogenia I Tractament Dels Trastorns Mental Severs (MERITT), Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Maria Teresa Lluch-Canut
- Public Health, Mental Health and Maternal Infant Nursing Department, Nursing College, University of Barcelona, Health Sciences Campus Bellvitge, Hospitalet de Llobregat, 08907 Barcelona, Spain
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Frank RG, Shim RS. Toward Greater Accountability in Mental Health Care. Psychiatr Serv 2023; 74:182-187. [PMID: 35734866 DOI: 10.1176/appi.ps.20220097] [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: 02/03/2023]
Abstract
Lack of accountability contributes to the gap between best practices and potential outcomes. Few mental health providers routinely practice evidence-based care. In fact, within the mental health field, there is significant controversy over the use of evidence-based practices. Lack of accountability affects individuals receiving care at the patient level, provider level, and systems level. The authors identify several impediments to accountability in behavioral health care. These include failure to develop a diverse, well-trained workforce; challenges in measurement; misalignment of payment incentives; and misguided regulations. Accountability arrangements typically consist of several elements: a clear articulation of goals, objectives, or standards; metrics so that progress toward achieving goals can be tracked; and consequences for insurers, providers, and professionals for achieving or failing to achieve objectives. To advance system goals, the full complement of accountability tools should be consistently applied to all sources of behavioral health care and supports. The authors focus on three sets of accountability tools-performance metrics, payment incentives, and regulatory standards-that when implemented thoughtfully can help move the field toward more positive outcomes in behavioral health.
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Affiliation(s)
- Richard G Frank
- Department of Health Care Policy, Harvard Medical School, Boston, and Brookings Institution, Washington, D.C. (Frank); Department of Psychiatry, University of California, Davis, Sacramento (Shim)
| | - Ruth S Shim
- Department of Health Care Policy, Harvard Medical School, Boston, and Brookings Institution, Washington, D.C. (Frank); Department of Psychiatry, University of California, Davis, Sacramento (Shim)
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [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: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Patient-reported outcomes of the nurse-patient relationship in psychiatric inpatient hospitals: A multicentred descriptive cross-sectional study. J Psychiatr Ment Health Nurs 2023; 30:568-579. [PMID: 36588478 DOI: 10.1111/jpm.12895] [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: 07/19/2022] [Revised: 12/08/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Psychiatric and/or mental health nurses are struggling to measure the outcomes of the nurse-patient relationship. Collecting nurse-sensitive patient outcomes is a strategy to provide outcomes of a nurse-patient relationship from patients' perspectives. Because there was no validated scale, the Mental Health Nurse-Sensitive Patient Outcome-Scale (six-point Likert-scale) was recently developed and psychometrically evaluated. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study using the Mental Health Nurse-Sensitive Patient Outcome-scale to measure nurse-sensitive patient outcomes of the nurse-patient relationship in psychiatric hospitals. Moderate to good average scores for the MH-NURSE-POS total (4.42) and domains scores (≥4.09). are observed. Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). Our results are consistent with the patient-reported effect(s) of relation-based nursing in qualitative research. The scores generate evidence to support the outcomes of the nurse-patient relationship and implicates that further investment in (re)defining and elaborating nurse-patient relationships in mental healthcare is meaningful and justified. More comparative patient-reported data can determine how nurse-sensitive patient outcomes are affected by the patient, nurse, and context. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Demonstrating patient-reported outcomes of the nurse-patient relationship can be important to enhance the therapeutic alliance between nurses and patients, organize responsive nursing care, and create nursing visibility in mental healthcare. Further nursing staff training on interpersonal competencies, such as self-awareness and cultural sensitivity, can be pivotal to achieving the patient-reported outcomes for inpatients with mental health problems. ABSTRACT INTRODUCTION: Identifying patient-reported outcomes of the nurse-patient relationship is a priority in inpatient mental healthcare to guide clinical decision-making and quality improvement initiatives. Moreover, demonstrating nurse-sensitive patient outcomes can be a strategy to avoid further erosion of the specialism of psychiatric and/or mental health nursing. AIM/QUESTION To measure nurse-sensitive patient outcomes of the nurse-patient relationship. METHOD In a multicentred cross-sectional study, 296 inpatients admitted to five psychiatric hospitals completed the recently developed and validated Mental Health Nurse-Sensitive Patient Outcome-Scale (MH-NURSE-POS). The MH-NURSE-POS consists of 21 items (six-point Likert-scale) in four domains: 'growth', 'expression', 'control', and 'motivation'. RESULTS Participants displayed moderate to good average scores for the MH-NURSE-POS total (4.42) and domain scores (≥4.09). Especially outcomes related to 'motivation' to follow and stay committed to the treatment received high average scores (≥4.60). DISCUSSION The results demonstrate that patients perceive the nurse-patient relationship and the care given by psychiatric and/or mental health nurses as contributing to their treatment. IMPLICATIONS FOR PRACTICES Patient-reported outcomes can guide nurses and managers to provide and organize nursing care and to build a nurse-patient relationship that has a positive impact on these outcomes. Additionally, outcomes can create nursing visibility as a profession in- and outside mental healthcare.
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Affiliation(s)
- Karel Desmet
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Peter J J Goossens
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Dimence Mental Health Center for Bipolar Disorder, Deventer, The Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic St-Joseph, Pittem, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,School of Health Sciences, Örebro University, Örebro, Sweden.,School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium.,Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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Man H, Wood L, Glover N. A systematic review and narrative synthesis of indirect psychological intervention in acute mental health inpatient settings. Clin Psychol Psychother 2023; 30:24-37. [PMID: 35997039 PMCID: PMC10087275 DOI: 10.1002/cpp.2780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/25/2022] [Accepted: 07/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Psychologists frequently deliver indirect psychological interventions in mental health inpatient settings to support staff to reflect upon and improve their clinical practice. However, research into these interventions is sparse. Therefore, this study aimed to undertake a systematic review and narrative synthesis of the indirect psychological interventions used in mental health inpatient settings. METHODS MEDLINE, PsycINFO and Embase were searched for eligible studies and forward-citation searching was undertaken. A narrative synthesis was undertaken to synthesize results. The quality of studies was assessed using the Mixed Methods Appraisal Tool. RESULTS Ten studies were included in the review, and all utilized a small to moderate sample size. We identified five categories of interventions involving a range of methodologies and the studies were assessed to be of good to adequate quality. The most common type of indirect intervention employed was case formulation sessions. Other types of indirect interventions included formal clinical supervision, reflective practice and staff practice-based education sessions. Overall, the utilization of indirect psychological interventions shows promise, particularly case formulation sessions. CONCLUSIONS The use of indirect psychological interventions within mental health inpatient settings may have benefits for patient care. However, additional larger scale research is required to further develop the evidence base of indirect interventions for this setting.
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Affiliation(s)
- Holly Man
- Division of Psychiatry, University College London, London, UK
| | - Lisa Wood
- Division of Psychiatry, University College London, London, UK.,Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK
| | - Naomi Glover
- Division of Psychiatry, University College London, London, UK
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Abstract
PURPOSE OF REVIEW There are increasing calls for mental health treatments to be adapted for different groups to maximize their acceptability and benefit to patients. However, adaptations can be costly to develop and evaluate, difficult to implement in routine clinical practice and may reduce service capacity at a time when there is unprecedented unmet need. An alternative method is personalization on an individual level. This review provides an overview of the issues related to personalization and adaptation of mental health interventions. RECENT FINDINGS Several terms have been used to describe changes to existing therapies, these reflect different extents to which existing treatments have been changed. Evidence-based practice and modular therapies allow a level of flexibility within intervention delivery without formal changes and not all changes to therapy should be considered as a new/adapted treatment but instead regarded as 'metacompetence'. Implementing existing interventions in new contexts is preferable to developing new interventions in many instances. New guidance outlines how researchers can adapt and transfer interventions to varied contexts. SUMMARY The review provides proposed definitions of different changes to therapy. Modified and personalized treatments may improve acceptability to patients whilst maximizing implementation of evidence-based practice within clinical services.
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48
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Petkari E, Priebe S. Subjective quality of life factorial structure across mental disorders: should we switch to assessing dimensions? Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01536-z. [PMID: 36571599 DOI: 10.1007/s00406-022-01536-z] [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: 08/26/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022]
Abstract
A two-factor structure of subjective quality of life (SQoL) was established for patients with schizophrenia with the dimensions being 'Life and Health' and 'Living Environment'. This study investigated whether the same structure applies in patients with mood and anxiety disorders and, if so, whether the dimension scores differ between the three diagnostic groups. SQoL data of 1366 patients with mood and 419 patients with anxiety disorders obtained on the Manchester Short Assessment of Quality of Life (MANSA) were retrieved from 3 multisite studies. We performed Confirmatory Factor Analyses (CFAs) based on the MANSA SQoL items of each diagnostic sample. Next, through a series of Kruskal-Wallis and Mann-Whitney tests, we compared the scores of the two factors across patients with mood disorders, anxiety disorders and schizophrenia. The two CFAs showed adequate fit of the two-factor structure across mood and anxiety disorders. The dimension scores on 'Life and Health' differed significantly between all three diagnostic groups. They were lowest in patients with anxiety disorders, higher in patients with mood disorders and highest in patients with schizophrenia. However, on the 'Living Environment' dimension, patients with mood disorders had significantly higher scores than patients with schizophrenia, whilst patients with anxiety disorders did not differ significantly from either other group. The findings suggest that a two-factor structure of SQoL applies across mental disorders. The two dimensions vary across diagnostic groups in different ways. Assessing two dimensions of SQoL may provide more specific and relevant information than global scores.
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Affiliation(s)
- Eleni Petkari
- School of Health Sciences, Universidad Internacional de la Rioja, Av. de la Paz, 137, 26006, Logroño, Spain.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
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49
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de Beurs E, Oudejans S, Terluin B. A Common Measurement Scale for Self-Report Instruments in Mental Health Care. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.1027/1015-5759/a000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract. The diversity of measures in clinical psychology hampers a straightforward interpretation of test results, complicates communication with the patient, and constitutes a challenge to the implementation of measurement-based care. In educational research and assessment, it is common practice to convert test scores to a common metric, such as T scores. We recommend applying this also in clinical psychology and propose and test a procedure to arrive at T scores approximating a normal distribution that can be applied to individual test scores. We established formulas to estimate normalized T scores from raw scale scores by regressing IRT-based θ scores on raw scores. With data from a large population and clinical samples, we established crosswalk formulas. Their validity was investigated by comparing calculated T scores with IRT-based T scores. IRT and formulas yielded very similar T scores, supporting the validity of the latter approach. Theoretical and practical advantages and disadvantages of both approaches to convert scores to common metrics and alternative approaches are discussed. Provided that scale characteristics allow for their computation, T scores will help to better understand measurement results, which makes it easier for patients and practitioners to use test results in joint decision-making about the course of treatment.
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Affiliation(s)
- Edwin de Beurs
- Department of Clinical Psychology, Faculty of Social Sciences, Leiden University, The Netherlands
- Arkin Mental Health Institute, Amsterdam, The Netherlands
| | | | - Berend Terluin
- EMGO Institute, VU Medical Center, Amsterdam, The Netherlands
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Hoffmann MS, Rocha KB, Evans-Lacko S, Gosmann NP, Becker N, Magalhães PVDS, Razzouk D, Spanemberg L, Fleck MPDA, Mari JDJ, Thornicroft G, Salum GA. Latent structure and factor reliability of the National Health Service Community Mental Health Service User Questionnaire. J Ment Health 2022; 31:809-815. [PMID: 33978546 DOI: 10.1080/09638237.2021.1922655] [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: 01/24/2023]
Abstract
BACKGROUND National Health Service use the Community Mental Health Service User Questionnaire (NHS-CMH) to assess care quality. However, its reliability and internal validity is uncertain. AIMS To test the NHS-CMH structure, reliability and item-level characteristics. METHODS We used data from 11,373 participants who answered the 2017 NHS-CMH survey. First, we estimated the NHS-CMH structure using Exploratory Factor Analysis (EFA) in half of the dataset. Second, we tested the best EFA-derived model with Confirmatory Factor Analysis (CFA). We tested the internal validity, construct reliability (omega - ω), explained common variance of each factor (ECV), and item thresholds. RESULTS EFA suggested a 4-factor solution. The structure derived from the EFA was confirmed, demonstrating good reliability for the four correlated dimensions: "Relationship with Staff" (ω = 0.952, ECV = 40.1%), "Organizing Care" (ω = 0.855, ECV = 21.4%), "Medication and Treatments" (ω = 0.837, ECV = 13.3%), and "Support and Well-being" (ω = 0.928, ECV = 25.3%). A second-order model with a high-order domain of "Quality of Care" is also supported. CONCLUSIONS The NHS-CMH can be used to reliably assess four user-informed dimensions of mental health care quality. This model offers an alternative for its current use (item-level and untested sum scores analysis).
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Affiliation(s)
- Mauricio Scopel Hoffmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Neuropsiquiatria, Universidade Federal de Santa Maria, Santa Maria, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Katia Bones Rocha
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Natan Pereira Gosmann
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Natalia Becker
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Vieira da Silva Magalhães
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Denise Razzouk
- Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Lucas Spanemberg
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Pio de Almeida Fleck
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jair de Jesus Mari
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil.,Department of Psychiatry, Univerisdade Federal de São Paulo, São Paulo, Brazil
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Giovanni Abrahão Salum
- Graduate Program in Psychiatry and Behavioral Sciences, Centro de Pesquisa Clínica, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, Brazil
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