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Menzies RE, Richmond B, Sharpe L, Skeggs A, Liu J, Coutts-Bain D. The 'revolving door' of mental illness: A meta-analysis and systematic review of current versus lifetime rates of psychological disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:178-196. [PMID: 38197576 DOI: 10.1111/bjc.12453] [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: 11/01/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta-analysis was to test this hypothesis. METHODS A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta-analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only. RESULTS Meta-analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders. CONCLUSIONS These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention.
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Affiliation(s)
| | | | - Louise Sharpe
- The University of Sydney, Sydney, New South Wales, Australia
| | - Amira Skeggs
- The University of Sydney, Sydney, New South Wales, Australia
| | - Janessa Liu
- The University of Sydney, Sydney, New South Wales, Australia
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Thompson RG, Mullinax S, De Monte R, McBain S, Porter A, Eastin C, Landes SJ, Wilson MP. Effectiveness of a Self-Administered Computerized Mental Health Screening Tool in the Emergency Department. Psychiatr Serv 2023; 74:1180-1184. [PMID: 37161345 DOI: 10.1176/appi.ps.20220523] [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] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The authors sought to determine the effectiveness of a self-administered computerized mental health screening tool in a general acute care emergency department (ED). METHODS Changes in patient care (diagnosis of a past-year psychiatric disorder, request for psychiatric consultation, psychiatric referral at discharge, or transfer to psychiatric facility) and patient ED return visits (3 months after discharge vs. 3 months before) were assessed among ED physicians (N=451) who received patients' computerized screening reports (N=207) and those who did not (N=244). All patients received copies of screening results. RESULTS The computerized mental health screening tool identified previously undiagnosed psychiatric problems. However, no statistically significant differences were found in physician care or patient ED return visits. CONCLUSIONS Computerized mental health screening did not result in further psychiatric diagnoses or treatment; it also did not significantly reduce patient ED return visits. Collaboration among EDs and mental health treatment agencies, organizations, and researchers is needed to facilitate appropriate treatment referrals and linkage.
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Affiliation(s)
- Ronald G Thompson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Samuel Mullinax
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Robert De Monte
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sacha McBain
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Austin Porter
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Carly Eastin
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Sara J Landes
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
| | - Michael P Wilson
- Department of Psychiatry, College of Medicine (Thompson, McBain, Landes, Wilson), Department of Emergency Medicine, College of Medicine (Mullinax, Eastin, Wilson), and Department of Health Policy and Management, Fay W. Boozman College of Public Health (Porter), University of Arkansas for Medical Sciences, Little Rock; Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania (De Monte); Arkansas Department of Health, Little Rock (Porter); Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, North Little Rock (Landes)
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Nelson SE, LaRaja A, Juviler J, Williams PM. Evaluating the Computerized Assessment and Referral System (CARS) Screener: Sensitivity and Specificity as a Screening Tool for Mental Health Disorders among DUI Offenders. Subst Use Misuse 2021; 56:1785-1796. [PMID: 34304704 DOI: 10.1080/10826084.2021.1954024] [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: 10/20/2022]
Abstract
Background/Purpose: A growing body of evidence suggests that people who are arrested for driving under the influence (DUI) of alcohol are more likely to screen positive for psychiatric disorders than the general population. Additionally, psychiatric comorbidity has been shown to increase vulnerability to criminal re-offense. However, DUI programs face many barriers to screening for psychiatric disorders. This paper evaluates the sensitivity and specificity of a screening tool developed for these programs, the Computerized Assessment and Referral System (CARS) Screener. Methods: We used data from 381 DUI offenders in Massachusetts, as well as a secondary data source, the National Comorbidity Survey-Replication (NCS-R: N = 9,282) to examine the accuracy of the CARS Screener when compared to full assessment. Results: Based on both sets of analyses, we found that the CARS Screener offers a sensitive and specific method to screen for many psychiatric disorders. Specifically, the CARS Screener has a high sensitivity and specificity for bipolar disorder, intermittent explosive disorder, depressive disorders, generalized anxiety disorder, alcohol and drug use disorders, gambling disorder, post-traumatic stress disorder, panic attacks, and social phobia. Conclusion: The CARS Screener appears to be an effective tool that will help DUI programs better understand and address the mental health issues facing their clients.
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Affiliation(s)
- Sarah E Nelson
- Division on Addiction, Cambridge Health Alliance, Malden, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex LaRaja
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Jamie Juviler
- Division on Addiction, Cambridge Health Alliance, Malden, Massachusetts, USA
| | - Pat M Williams
- Suffolk University Law School, Boston, Massachusetts, USA
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