1
|
Lau C, Kendall CE, Burchell AN, Bayoumi AM, Loutfy M, Rourke SB, Antoniou T. Outcomes Among Persons with HIV Following a Mental Health Admission: A Population-Based Study. AIDS Res Hum Retroviruses 2018; 34:590-597. [PMID: 29661003 DOI: 10.1089/aid.2017.0275] [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: 11/12/2022] Open
Abstract
To compare outcomes following psychiatric hospitalization between people with and without HIV. Population-based study of people with (n = 1,089) and without (n = 280,888) HIV who were hospitalized for psychiatric illness between January 1, 2006 and December 31, 2014. Overall, 9 (0.8%) people with HIV died within 30 days of discharge, compared with 3,710 (1.3%) HIV-negative individuals. Following multivariable adjustment, there was no difference in the risk of readmission or emergency department (ED) visits for psychiatric illness in the 90 days following discharge. Conversely, people with HIV were at higher risk of ED visits for substance use disorders and less likely to receive psychiatry follow-up during this period. HIV is associated with ED use for substance use disorders and less psychiatry follow-up within 90 days of hospital discharge for psychiatric illness. Interventions facilitating continuity of care following discharge are warranted.
Collapse
Affiliation(s)
- Cindy Lau
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Claire E. Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- CT Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Ann N. Burchell
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ahmed M. Bayoumi
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Mona Loutfy
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Sean B. Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
2
|
Examining predictors of help-seeking behaviours in patients with mood and anxiety symptoms. Psychiatry Res 2018; 265:190-197. [PMID: 29729499 DOI: 10.1016/j.psychres.2018.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 04/06/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
Relatively little is known about individual characteristics that factor into the decision to seek help for mood and anxiety symptoms. The current study was undertaken in order to examine factors that predict the likelihood of seeking help for mood and anxiety symptoms amongst a clinical population. Patients (N = 278) referred to a tertiary care clinic in Toronto, Canada were asked about their help-seeking behaviours (HSB) through initial intake assessments and self-administered questionnaires, including the Beck Anxiety Inventory, Anxiety Sensitivity Index, Intolerance of Uncertainty Scale, and Beck Depression Inventory-II. Correlates of anxiety and depression were examined to determine whether they could predict HSB amongst individuals with Generalized Anxiety Disorder with or without comorbid Major Depressive Disorder, as well as Panic Disorder and Social Anxiety Disorder. Psychiatric diagnoses were then examined to determine whether comorbidity and demographic factors impacted HSB. Results indicated that there were significant differences in anxiety and depression correlating mainly with anxiety sensitivity, as a predictor of HSB, and that there is a complex relationship between disorder type and demographic variables. The implications of these findings and suggested targeted interventions are discussed.
Collapse
|
3
|
Postpartum psychiatric emergency visits: a nested case-control study. Arch Womens Ment Health 2016; 19:1019-1027. [PMID: 27511109 DOI: 10.1007/s00737-016-0651-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.
Collapse
|
4
|
Samuels-Dennis J, Xia L, Secord S, Raiger A. Health Advocacy Project: Evaluating the Benefits of Service Learning to Nursing Students and Low Income Individuals Involved in a Community-Based Mental Health Promotion Project. Int J Nurs Educ Scholarsh 2016; 13:/j/ijnes.ahead-of-print/ijnes-2015-0069/ijnes-2015-0069.xml. [PMID: 27705899 DOI: 10.1515/ijnes-2015-0069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/02/2016] [Indexed: 11/15/2022]
Abstract
Poverty, along with other factors such as unemployment, work and life stressors, interpersonal violence, and lack of access to high quality health and/or social services all play a role in determining who develops a mental illness and for whom those symptoms persist or worsen. Senior nursing student preparing to enter the field and working in a service learning capacity may be able to influence early recovery and symptom abatement among those most vulnerable to mental illness. A consortium of community stakeholders and researchers collaboratively designed a 10-week mental health promotion project called the Health Advocacy Project (HAP). The project combines case management and system navigation support delivered by trained and highly supervised nursing students to individuals experiencing major depressive disorder (MDD) and/or post-traumatic stress disorder (PTSD). In this article, we present the findings of a qualitative fidelity evaluation that examines the effectiveness of nursing students in delivering the health advocacy intervention at the level and with the intensity originally intended. The findings demonstrate how the services of senior nursing students may be optimized to benefit our healthcare system and populations most at risk for developing MDD and PTSD.
Collapse
|
5
|
Dolovich L, Consiglio G, MacKeigan L, Abrahamyan L, Pechlivanoglou P, Rac VE, Pojskic N, Bojarski EA, Su J, Krahn M, Cadarette SM. Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013. Can Pharm J (Ott) 2016; 149:293-302. [PMID: 27708675 DOI: 10.1177/1715163516662670] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND MedsCheck Annual (MCA) is an Ontario government-funded medication review service for individuals taking 3 or more prescription medications for chronic conditions. METHODS This cohort study analyzed linked administrative claims data from April 1, 2007, to March 31, 2013. Trends in MCA claims and recipient characteristics were examined. RESULTS A total of 1,498,440 Ontarians (55% seniors, 55% female) received an MCA. One-third (36%) had 2 or more MCAs within 6 years. Service provision increased over time, with a sharper increase from 2010 onward. Almost half of Ontario pharmacies made at least 1 MCA claim in the first month of the program. Hypertension, respiratory disease, diabetes, psychiatric conditions and arthritis were common comorbidities. Recipients older than 65 years were most commonly dispensed an antihypertensive and/or antihyperlipidemic drug in the prior year and received an average of 11 unique prescription medications. Thirty-eight percent of recipients visited an emergency department or were hospitalized in the year prior to their first MCA. DISCUSSION Over the first 6 years of the program, approximately 1 in 9 Ontarians received an MCA. There was rapid and widespread uptake of the service. Common chronic conditions were well represented among MCA recipients. Older MCA recipients had less emergency department use compared with population-based estimates. CONCLUSIONS Medication reviews increased over time; however, the number of persons receiving the service more than once was low. Service delivery was generally consistent with program eligibility; however, there are some findings possibly consistent with delivery to less complex patients.
Collapse
Affiliation(s)
- Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | - Giulia Consiglio
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | - Linda MacKeigan
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | - Lusine Abrahamyan
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | | | - Valeria E Rac
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | - Nedzad Pojskic
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | | | - Jiandong Su
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | - Murray Krahn
- Department of Family Medicine, McMaster University, Hamilton (Dolovich)
| | | |
Collapse
|
6
|
Choi SKY, Boyle E, Cairney J, Gardner S, Collins EJ, Bacon J, Rourke SB. Adequacy of Mental Health Services for HIV-Positive Patients with Depression: Ontario HIV Treatment Network Cohort Study. PLoS One 2016; 11:e0156652. [PMID: 27280751 PMCID: PMC4900603 DOI: 10.1371/journal.pone.0156652] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/17/2016] [Indexed: 01/06/2023] Open
Abstract
Background Major depression can profoundly impact clinical and quality-of-life outcomes of people living with HIV, and this disease is underdiagnosed and undertreated in many HIV-positive individuals. Here, we describe the prevalence of publicly funded primary and secondary mental health service use and antidepressant use, as well as mental health care for depression in accordance with existing Canadian guidelines for HIV-positive patients with depression in Ontario, Canada. Methods We conducted a prospective cohort study linking data from the Ontario HIV Treatment Network Cohort Study with administrative health databases in the province of Ontario, Canada. Current depression was assessed using the Center for Epidemiologic Depression Scale or the Kessler Psychological Distress Scale. Multivariable regressions were used to characterize prevalence outcomes. Results Of 990 HIV-positive patients with depression, 493 (50%) patients used mental health services; 182 (18%) used primary services (general practitioners); 176 (18%) used secondary services (psychiatrists); and 135 (14%) used both. Antidepressants were used by 407 (39%) patients. Patients who identified as gay, lesbian, or bisexual, as having low income or educational attainment, or as non-native English speakers or immigrants to Canada were less likely to obtain care. Of 493 patients using mental health services, 250 (51%) received mental health care for depression in accordance with existing Canadian guidelines. Conclusions Our results showed gaps in delivering publicly funded mental health services to depressed HIV-positive patients and identified unequal access to these services, particularly among vulnerable groups. More effective mental health policies and better access to mental health services are required to address HIV-positive patient needs and reduce depression’s impact on their lives.
Collapse
Affiliation(s)
- Stephanie K. Y. Choi
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- The Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eleanor Boyle
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - John Cairney
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sandra Gardner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Evan J. Collins
- University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jean Bacon
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sean B. Rourke
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
| | | |
Collapse
|