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Santopetro N, Jones D, Garron A, Meyer A, Joyner K, Hajcak G. Examining a Fully Automated Mobile-Based Behavioral Activation Intervention in Depression: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e54252. [PMID: 39212598 PMCID: PMC11378696 DOI: 10.2196/54252] [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: 11/02/2023] [Revised: 05/15/2024] [Accepted: 06/09/2024] [Indexed: 09/04/2024] Open
Abstract
Background Despite significant progress in our understanding of depression, prevalence rates have substantially increased in recent years. Thus, there is an imperative need for more cost-effective and scalable mental health treatment options, including digital interventions that minimize therapist burden. Objective This study focuses on a fully automated digital implementation of behavioral activation (BA)-a core behavioral component of cognitive behavioral therapy for depression. We examine the efficacy of a 1-month fully automated SMS text message-based BA intervention for reducing depressive symptoms and anhedonia. Methods To this end, adults reporting at least moderate current depressive symptoms (8-item Patient Health Questionnaire score ≥10) were recruited online across the United States and randomized to one of three conditions: enjoyable activities (ie, BA), healthy activities (ie, an active control condition), and passive control (ie, no contact). Participants randomized to enjoyable and healthy activities received daily SMS text messages prompting them to complete 2 activities per day; participants also provided a daily report on the number and enjoyment of activities completed the prior day. Results A total of 126 adults (mean age 32.46, SD 7.41 years) with current moderate depressive symptoms (mean score 16.53, SD 3.90) were recruited. Participants in the enjoyable activities condition (BA; n=39) experienced significantly greater reductions in depressive symptoms compared to participants in the passive condition (n=46). Participants in both active conditions-enjoyable activities and healthy activities (n=41)-reported reduced symptoms of anxiety compared to those in the control condition. Conclusions These findings provide preliminary evidence regarding the efficacy of a fully automated digital BA intervention for depression and anxiety symptoms. Moreover, reminders to complete healthy activities may be a promising intervention for reducing anxiety symptoms.
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Affiliation(s)
- Nicholas Santopetro
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Danielle Jones
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Andrew Garron
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alexandria Meyer
- School of Education and Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
| | - Keanan Joyner
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Greg Hajcak
- School of Education and Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
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Hoyt T, Blais RK. The Suicide Prevention and Response Independent Review Committee (SPRIRC): Translating Recommendations Into Actions. Mil Med 2024; 189:381-389. [PMID: 39160879 DOI: 10.1093/milmed/usae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/02/2024] [Accepted: 03/11/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES A number of reports over the past 2 decades have provided recommendations for reducing the rate of suicide in the U.S. Armed Forces. Notwithstanding their veracity, few of these recommendations have been fully implemented. METHODS At the direction of the Secretary of Defense and the U.S. Congress, a Suicide Prevention and Response Independent Review Committee was formed in 2022, with the mission of reviewing all policies and procedures regarding suicide within the DoD. The Suicide Prevention and Response Independent Review Committee considered over 400 specific recommendations garnered from component offices, military installation visits, and service member focus groups, ultimately making 127 recommendations. The Secretary of Defense then directed the formation of an implementation working group, which assessed these 127 recommendations for feasibility, impact, and required resourcing. RESULTS After being assessed by the implementation working group, DoD leadership approved 111 total actions to move forward for resource consideration in the formal budget process. These actions aligned to 5 lines of effort focused on reducing suicide behavior throughout the military. Resourcing decisions then determined that 83 of these recommendations would be funded beginning in fiscal year 2025. DISCUSSION From an implementation science perspective, broader agency concerns throughout the DoD often are primary barriers to implementing system-wide changes. By making deliberate decisions about prioritizing the most impactful actions, resourcing processes can be informed directly by relevant data. CONCLUSIONS Implementation of recommendations to reduce suicide deaths in the military must go through several deliberative steps in order to be prioritized, funded, and ultimately adopted by the military. As researchers and external stakeholders become more familiar with this process, recommendations for future prevention activities can better overcome barriers to implementation.
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Affiliation(s)
- Tim Hoyt
- Office of Force Resiliency, Office of the Under Secretary of Defense for Personnel and Readiness, Washington, DC 20301-4000, USA
| | - Rebecca K Blais
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA
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Melnyk BM, Davidson JE, Mayfield C, Zisook S, Tucker S, Hsieh AP, Cooper A, Gray-Bauer R, Hoying J, Cuccia AF, Tan A. A study protocol for the modified interactive screening program plus MINDBODYSTRONG© RCT: A mental health resiliency intervention for nurses. PLoS One 2024; 19:e0303425. [PMID: 38843149 PMCID: PMC11156330 DOI: 10.1371/journal.pone.0303425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Nurses, the largest workforce in healthcare, are at high risk of depression, anxiety, burnout, and suicidal ideation. Suicide among nurses is higher than the general population. This randomized controlled trial pairs the MINDBODYSTRONG© cognitive-behavioral skills building program with the American Foundation for Suicide Prevention's (AFSP) Modified Interactive Screening Program (mISP) to reduce depression, suicidal ideation, post-traumatic stress, anxiety, and burnout, and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in nurses with moderate to high risk of suicide. AIMS This study aims to determine the effects of the mISP combined with the digitized MINDBODYSTRONG© program versus the mISP alone on depression, suicidal ideation, burnout, anxiety, post-traumatic stress, healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction in 364 U.S. nurses. METHODS A digitized version of MINDBODYSTRONG© combined with the mISP screening and referral platform will be compared to the AFSP mISP alone through a two-arm randomized controlled trial. Follow-up post-intervention data will be collected at week eight and months three, six, and 12. DISCUSSION If successful, this study's findings could assist nurses who are hesitant to use conventional mental health resources by providing them with confidential aid and learning opportunities to reduce suicidality, depression, anxiety, post-traumatic stress, and burnout and improve healthy lifestyle beliefs, healthy lifestyle behaviors, and job satisfaction. TRIAL/STUDY REGISTRATION The Ohio State University Protocol Record 2021B0417, Modified Interactive Screening Program Plus MINDBODYSTRONG: A Mental Health Resiliency Intervention for Nurses, is registered and posted at ClinicalTrials.gov Identifier: NCT05582343. First posted date is October 17, 2022.
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Affiliation(s)
- Bernadette Mazurek Melnyk
- Vice President for Health Promotion, The Ohio State University, Columbus, Ohio, United States of America
- Office of the Chief Wellness Officer, The Ohio State University, Columbus, Ohio, United States of America
- Helene Fuld Health Trust National Institute for Evidence-Based Practice, The Ohio State University, Columbus, Ohio, United States of America
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Judy E. Davidson
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
- University of San Diego Health, San Diego, California, United States of America
| | - Cora Mayfield
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Sidney Zisook
- University of San Diego Health, San Diego, California, United States of America
| | - Sharon Tucker
- Helene Fuld Health Trust National Institute for Evidence-Based Practice, The Ohio State University, Columbus, Ohio, United States of America
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Andreanna Pavan Hsieh
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Andrea Cooper
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Rosalind Gray-Bauer
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Jacqueline Hoying
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Alison F. Cuccia
- Nursing Programs, American Nurses Association Enterprise, Silver Spring, Maryland, United States of America
| | - Alai Tan
- College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
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4
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Ku BS, Barrera Flores FJ, Congdon P, Yuan Q, Druss BG. The association between county-level mental health provider shortage areas and suicide rates in the United States during the COVID-19 pandemic. Gen Hosp Psychiatry 2024; 88:48-50. [PMID: 38492445 PMCID: PMC10999330 DOI: 10.1016/j.genhosppsych.2024.02.012] [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: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Prior literature has shown that mental health provider Health Professional Shortage Areas (MHPSAs) experienced a greater increase in suicide rates compared to non-shortage areas from 2010 to 2018. Although suicide rates have been on the rise, rates have slightly decreased during the COVID-19 pandemic. This study sought to characterize the differences in suicide rate trends during the pandemic by MHPSA status. METHOD We used generalized estimating equation regression to test the associations between MHPSA status and suicide rates from 2018 to 2021. Suicide deaths were obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. RESULTS MHPSA status was associated with higher suicide rates (adjusted IRR:1.088 [95% CI, 1.024-1.156]). Furthermore, there was a significant interaction between MHPSA status and year (adjusted IRR:1.056 [95% CI, 1.022-1.091]), such that suicide rates did not significantly change among MHPSAs but slightly decreased among non-MHPSAs from 2018 to 2021. CONCLUSIONS During the COVID-19 pandemic, there was a slight decrease in suicide rates among non-MHPSAs, while those with shortages experienced no significant changes in suicide rates. It will be important to closely monitor MHPSAs as continued at-risk regions for suicide as trendlines return to their pre-pandemic patterns.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Peter Congdon
- School of Geography, Queen Mary University of London, London E1 4NS, UK
| | - Qingyue Yuan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Koch EC, Ward MJ, Jeffery AD, Reese TJ, Dorn C, Pugh S, Rubenstein M, Ellen Wilson J, Campbell C, Han JH. Factors Associated with Acute Telemental Health Consultations in Older Veterans. West J Emerg Med 2024; 25:312-319. [PMID: 38801035 PMCID: PMC11112672 DOI: 10.5811/westjem.17996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/17/2023] [Accepted: 01/10/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65 years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. Methods This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55 years who received a mental health consultation in the ED or UCC from April 1, 2020-September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Results Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24-0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04-11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00-0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. Conclusion High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.
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Affiliation(s)
- Erica C. Koch
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Veterans Affairs Quality Scholars Program, Nashville, Tennessee
| | - Michael J. Ward
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Alvin D. Jeffery
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
- Tennessee Valley Healthcare System, Nursing Services, Nashville, Tennessee
| | - Thomas J. Reese
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Chad Dorn
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, Tennessee
| | - Shannon Pugh
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Melissa Rubenstein
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
| | - Jo Ellen Wilson
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
- Vanderbilt University Medical Center, Department of Psychiatry, Nashville, Tennessee
| | - Corey Campbell
- Tennessee Valley Healthcare System, Psychiatric Services, Nashville, Tennessee
| | - Jin H. Han
- Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee
- Tennessee Valley Healthcare System, Geriatric Research, Education, and Clinical Center, Nashville, Tennessee
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Jabir AI, Lin X, Martinengo L, Sharp G, Theng YL, Tudor Car L. Attrition in Conversational Agent-Delivered Mental Health Interventions: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e48168. [PMID: 38412023 PMCID: PMC10933752 DOI: 10.2196/48168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Conversational agents (CAs) or chatbots are computer programs that mimic human conversation. They have the potential to improve access to mental health interventions through automated, scalable, and personalized delivery of psychotherapeutic content. However, digital health interventions, including those delivered by CAs, often have high attrition rates. Identifying the factors associated with attrition is critical to improving future clinical trials. OBJECTIVE This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition. METHODS We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings. RESULTS The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84% (95% CI 16.74%-27.36%; I2=94%). Short-term studies that lasted ≤8 weeks showed a lower attrition rate (18.05%, 95% CI 9.91%- 27.76%; I2=94.6%) than long-term studies that lasted >8 weeks (26.59%, 95% CI 20.09%-33.63%; I2=93.89%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95% CI 0.99-1.50; I2=21.89%) and long-term studies (log odds ratio 1.33, 95% CI 1.08-1.65; I2=49.43%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition. CONCLUSIONS Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341415.
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Affiliation(s)
- Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Yin-Leng Theng
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Ostrow L, Cook JA, Salzer MS, Pelot M, Burke-Miller JK. Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:134-143. [PMID: 37962714 DOI: 10.1007/s10488-023-01318-2] [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] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.
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Affiliation(s)
- Laysha Ostrow
- Live & Learn, Inc, 785 Quintana Road, Suite 219, Morro Bay, CA, 93442, USA.
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60607, USA
| | - Mark S Salzer
- Department of Social and Behavioral Sciences, Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA
| | - Morgan Pelot
- Live & Learn, Inc, 785 Quintana Road, Suite 219, Morro Bay, CA, 93442, USA
| | - Jane K Burke-Miller
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60607, USA
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Katayama ES, Woldesenbet S, Munir MM, Endo Y, Moazzam Z, Lima HA, Shaikh CF, Pawlik TM. Poor Access to Mental Healthcare is Associated with Worse Postoperative Outcomes Among Patients with Gastrointestinal Cancer. Ann Surg Oncol 2024; 31:49-57. [PMID: 37814182 DOI: 10.1245/s10434-023-14374-7] [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: 04/13/2023] [Accepted: 09/17/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Mental health has an important role in the care of cancer patients, and access to mental health services may be associated with improved outcomes. Thus, poor access to psychiatric services may contribute to suboptimal cancer treatment. We conducted a geospatial analysis to characterize psychiatrist distribution and assess the impact of mental healthcare shortages with surgical outcomes among patients with gastrointestinal cancer. METHODS Medicare beneficiaries with mental illness diagnosed with complex gastrointestinal cancers between 2004 and 2016 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry. National Provider Identifier-registered psychiatrist locations were mapped and linked to SEER-Medicare records. Regional access to psychiatric services was assessed relative to textbook outcome, a composite assessment of postoperative complications, prolonged length of stay, 90-day readmission and mortality. RESULTS Among 15,714 patients with mental illness and gastrointestinal cancer, 3937 were classified as having high access to psychiatric services while 3910 had low access. On multivariable logistic regression, areas with low access had higher risk of worse postoperative outcomes. Specifically, individuals residing in areas with low access had increased odds of prolonged length of stay (OR 1.11, 95%CI 1.01-1.22; p = 0.028) and 90-day readmission (OR 1.19, 95%CI 1.08-1.31; p < 0.001), as well as decreased odds of textbook outcome (OR 0.85, 95%CI 0.77-0.93; p < 0.001) and discharge to home (OR 0.89, 95%CI 0.80-0.99; p = 0.028). CONCLUSION Patients with mental illness and lower access to psychiatric services had worse postoperative outcomes. Policymakers and providers should prioritize incorporating mental health screening and access to psychiatric services to address disparities among patients undergoing gastrointestinal surgery.
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Affiliation(s)
- Erryk S Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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9
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McGrath RL, Shephard S, Hemmings L, Verdon S, Parnell T. Preventing Suicide: Time to Mobilize the Physical Therapist Workforce. Phys Ther 2023; 103:pzad116. [PMID: 37622921 DOI: 10.1093/ptj/pzad116] [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: 01/11/2023] [Revised: 04/16/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023]
Abstract
Each year, approximately 700,000 people, including 46,000 Americans, die by suicide; however, many more people experience suicidal thoughts and behaviors. Historically, the prevention of suicide has largely been the domain of mental health professionals working within specialist mental health care settings. An issue with this approach is that many individuals who experience suicidal ideation never disclose these thoughts to a mental health professional. The nonprofessional and paraprofessional mental health movement aims to bring suicide prevention to the people who need it, rather than wait for them to seek help. The nonprofessional and paraprofessional mental health movement does so by upskilling people who are not recognized as mental health professionals but may have contact with people experiencing suicidal thoughts and behaviors. In this Perspective, we argue that physical therapists are well-positioned to engage in suicide prevention. For example, physical therapists working in pain management are likely to frequently encounter clients experiencing suicidal thoughts and behaviors. Physical therapy is also viewed as a physical health profession, meaning that they may have contact with a broad range of populations at high risk of suicide who may be difficult to reach through traditional channels (eg, men from rural communities). Physical therapists will require training on how to provide crisis support, including how to link clients with appropriate mental health services. However, given the size of the physical therapist workforce globally, the impact of mobilizing the physical therapist workforce could be significant.
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Affiliation(s)
- Ryan L McGrath
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Sophie Shephard
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Laura Hemmings
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, New South Wales, Australia
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Kang B, Lu YF. The Association between Mental Health-Related 911 Calls and the Mental Health Professional Shortage in New York City. J Urban Health 2023; 100:914-923. [PMID: 37640987 PMCID: PMC10618136 DOI: 10.1007/s11524-023-00777-0] [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] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
This study examines the relationship between designated Mental Health Professional Shortage Areas (MH HPSAs) and mental health-related 911 calls in New York City. Negative binomial regression models were used to estimate the relationship between MH HPSAs and MH 911 calls after adjusting for the population size and other neighborhood characteristics. The study found that neighborhoods designated as MH HPSAs had higher MH 911 calls compared to non-shortage areas, with a 27% increase in expected MH 911 calls after adjustment. Moreover, the results indicated that neighborhoods with higher rates of homelessness and poverty generated more MH 911 calls. The findings suggest a need to improve access to mental health services to reduce the burden on police and emergency services for crisis interventions in areas with limited resources.
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Affiliation(s)
- Byunggu Kang
- Center for Health Workforce Studies, School of Public Health, University at Albany, SUNY, 1 University Place, Suite 220, Rensselaer, NY, 12144, USA.
| | - Yi-Fang Lu
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
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11
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Mullens CL, Lussiez A, Scott JW, Kunnath N, Dimick JB, Ibrahim AM. Association of Health Professional Shortage Area Hospital Designation With Surgical Outcomes and Expenditures Among Medicare Beneficiaries. Ann Surg 2023; 278:e733-e739. [PMID: 36538612 DOI: 10.1097/sla.0000000000005762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. BACKGROUND More than a quarter of Americans live in federally designated Health Professional Shortage Areas. Although there is growing concern that medical outcomes may be worse, far less is known about hospitals providing surgical care in these areas. METHODS Cross-sectional retrospective study from 2014 to 2018 of 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair. We assessed risk-adjusted outcomes using multivariable logistic regression accounting for patient factors, admission type, and year were compared for each of the 4 operations. Hospital expenditures were price-standardized, risk-adjusted 30-day surgical episode payments. Primary outcome measures included 30-day mortality, hospital readmissions, and 30-day surgical episode payments. RESULTS Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%, P <0.001) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%, P <0.001). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%, odds ratio=0.90, CI, 0.90-0.91, P <0.001) and readmission (14.99% vs 15.74%, odds ratio=0.94, CI, 0.94-0.95, P <0.001). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685, difference= -$1168, P <0.001). CONCLUSIONS Patients presenting to Health Professional Shortage Area hospitals obtain safe care for common surgical procedures without evidence of higher expenditures among Medicare beneficiaries. These findings should be taken into account as current legislative proposals to increase funding for care in these underserved communities are considered.
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Affiliation(s)
- Cody L Mullens
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Alisha Lussiez
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Nicholas Kunnath
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI
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12
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Sheehan AE, Bounoua N, Stumps A, Miglin R, Huerta W, Sadeh N. Neurobiological metric of cortical delay discounting differentiates risk for self- and other-directed violence among trauma-exposed individuals. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:897-907. [PMID: 37676141 PMCID: PMC10592155 DOI: 10.1037/abn0000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Self- and other-directed violence (SDV/ODV) contribute to elevated rates of mortality. Early trauma exposure shows robust positive associations with these forms of violence but alone does not distinguish those at heightened risk for later engagement in SDV/ODV. Novel assessment metrics could aid early identification efforts for individuals with vulnerabilities to violence perpetration. This study examined a novel neurobiological measure of impulsive choice for reward as a potential moderator of associations between childhood trauma exposure and lifetime SDV/ODV. A high-risk community sample of 177 adults (89 men; 50.3%) were assessed for childhood trauma exposure, engagement in SDV (e.g., suicide attempts), and ODV (e.g., assault). A cortical delay discounting (C-DD) measure was created using a multivariate additive model of gray matter thickness across both hemispheres, previously found to be positively associated with susceptibility to impulsivity and externalizing disorders. Childhood trauma exposure was positively associated with ODV and SDV; however, these relationships differed as a function of C-DD. Engagement in ODV increased as scores on C-DD increased, and SDV increased as scores on C-DD decreased. Furthermore, moderation revealed biological sex differences, as the association between childhood trauma and SDV depended on C-DD for women but not for men. Findings from the present work demonstrate that risk conferred by childhood trauma exposure to violence varied as a function of a C-DD. Together, these findings point to the utility of neurobiological markers of impulsive decision-making for differentiating risk for violence among individuals with a history of trauma exposure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware
| | - Nadia Bounoua
- Department of Psychological and Brain Sciences, University of Delaware
| | - Anna Stumps
- Department of Psychological and Brain Sciences, University of Delaware
| | - Rickie Miglin
- Department of Psychological and Brain Sciences, University of Delaware
| | - Wendy Huerta
- Department of Psychological and Brain Sciences, University of Delaware
| | - Naomi Sadeh
- Department of Psychological and Brain Sciences, University of Delaware
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13
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Katayama ES, Moazzam Z, Woldesenbet S, Lima HA, Endo Y, Azap L, Yang J, Dillhoff M, Ejaz A, Cloyd J, Pawlik TM. Suicidal Ideation Among Patients with Gastrointestinal Cancer. Ann Surg Oncol 2023; 30:3929-3938. [PMID: 37061648 DOI: 10.1245/s10434-023-13471-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Mental illness (MI) and suicidal ideation (SI) often are associated with a diagnosis of cancer. We sought to define the incidence of MI and SI among patients with gastrointestinal cancers, as well as ascertain the predictive factors associated with SI. METHODS Patients diagnosed between 2004 and 2016 with stomach, liver, pancreatic, and colorectal cancer were identified from the SEER-Medicare database. County-level social vulnerability index (SVI) was extracted from the Centers for Disease Control database. Multivariable logistic regression was used to identify factors associated with SI. RESULTS Among 382,266 patients, 83,514 (21.9%) individuals had a diagnosis of MI. Only 1410 (0.4%) individuals experienced SI, and 359 (0.1%) committed suicide. Interestingly, SI was least likely among patients with pancreatic cancer (ref: hepatic cancer; odds ratio [OR] 0.67, 95% confidence interval [CI] 0.52-0.86; p = 0.002), as well as individuals with stage III/IV disease (OR 0.59, 95% CI 0.52-067; p < 0.001). In contrast, male (OR 1.34, 95% CI 1.19-1.50), White (OR 1.34, CI 1.13-1.59), and single (OR 2.03, 95% CI 1.81-2.28) patients were at higher odds of SI risk (all p < 0.001). Furthermore, individuals living in relative privilege (low SVI) had markedly higher risk of SI (OR 1.33, 95% CI 1.14-1.54; p < 0.001). Moreover, living in a county with a shortage of mental health professionals was associated with increased odds of developing SI (OR 1.21, 95% CI 1.04-1.40; p = 0.012). CONCLUSIONS Oncology care teams should incorporate routine mental health and SI screening in the treatment of patients with gastrointestinal cancers, as well as target suicide prevention towards patients at highest risk.
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Affiliation(s)
- Erryk S Katayama
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jason Yang
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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14
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Wright-Berryman J, Cohen J, Haq A, Black DP, Pease JL. Virtually screening adults for depression, anxiety, and suicide risk using machine learning and language from an open-ended interview. Front Psychiatry 2023; 14:1143175. [PMID: 37377466 PMCID: PMC10291825 DOI: 10.3389/fpsyt.2023.1143175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Background Current depression, anxiety, and suicide screening techniques rely on retrospective patient reported symptoms to standardized scales. A qualitative approach to screening combined with the innovation of natural language processing (NLP) and machine learning (ML) methods have shown promise to enhance person-centeredness while detecting depression, anxiety, and suicide risk from in-the-moment patient language derived from an open-ended brief interview. Objective To evaluate the performance of NLP/ML models to identify depression, anxiety, and suicide risk from a single 5-10-min semi-structured interview with a large, national sample. Method Two thousand four hundred sixteen interviews were conducted with 1,433 participants over a teleconference platform, with 861 (35.6%), 863 (35.7%), and 838 (34.7%) sessions screening positive for depression, anxiety, and suicide risk, respectively. Participants completed an interview over a teleconference platform to collect language about the participants' feelings and emotional state. Logistic regression (LR), support vector machine (SVM), and extreme gradient boosting (XGB) models were trained for each condition using term frequency-inverse document frequency features from the participants' language. Models were primarily evaluated with the area under the receiver operating characteristic curve (AUC). Results The best discriminative ability was found when identifying depression with an SVM model (AUC = 0.77; 95% CI = 0.75-0.79), followed by anxiety with an LR model (AUC = 0.74; 95% CI = 0.72-0.76), and an SVM for suicide risk (AUC = 0.70; 95% CI = 0.68-0.72). Model performance was generally best with more severe depression, anxiety, or suicide risk. Performance improved when individuals with lifetime but no suicide risk in the past 3 months were considered controls. Conclusion It is feasible to use a virtual platform to simultaneously screen for depression, anxiety, and suicide risk using a 5-to-10-min interview. The NLP/ML models performed with good discrimination in the identification of depression, anxiety, and suicide risk. Although the utility of suicide risk classification in clinical settings is still undetermined and suicide risk classification had the lowest performance, the result taken together with the qualitative responses from the interview can better inform clinical decision-making by providing additional drivers associated with suicide risk.
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Affiliation(s)
- Jennifer Wright-Berryman
- Department of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | | | - Allie Haq
- Clarigent Health, Mason, OH, United States
| | | | - James L. Pease
- Department of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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15
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Rochford B, Pendse S, Kumar N, De Choudhury M. Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data. JMIR Ment Health 2023; 10:e43253. [PMID: 36716082 PMCID: PMC9926343 DOI: 10.2196/43253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals. OBJECTIVE We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web. METHODS We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons. RESULTS We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10-12). CONCLUSIONS This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care.
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Affiliation(s)
- Ben Rochford
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Sachin Pendse
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Neha Kumar
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Munmun De Choudhury
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
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16
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Gyorda JA, Nemesure MD, Price G, Jacobson NC. Applying ensemble machine learning models to predict individual response to a digitally delivered worry postponement intervention. J Affect Disord 2023; 320:201-210. [PMID: 36167247 PMCID: PMC10037342 DOI: 10.1016/j.jad.2022.09.112] [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: 03/09/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Generalized anxiety disorder (GAD) is a prevalent mental health disorder that often goes untreated. A core aspect of GAD is worry, which is associated with negative health outcomes, accentuating a need for simple treatments for worry. The present study leveraged pretreatment individual differences to predict personalized treatment response to a digital intervention. METHODS Linear mixed-effect models were used to model changes in daytime and nighttime worry duration and frequency for 163 participants who completed a six-day worry postponement intervention. Ensemble-based machine learning regression and classification models were implemented to predict changes in worry across the intervention. Model feature importance was derived using SHapley Additive exPlanation (SHAP). RESULTS Moderate predictive performance was obtained for predicting changes in daytime worry duration (test r2 = 0.221, AUC = 0.77) and nighttime worry frequency (test r2 = 0.164, AUC = 0.72), while poor predictive performance was obtained for nighttime worry duration and daytime worry frequency. Baseline levels of worry and subjective health complaints were most important in driving model predictions. LIMITATIONS A complete-case analysis was leveraged to analyze the present data, which was collected from participants that were Dutch and majority female. CONCLUSIONS This study suggests that treatment response to a digital intervention for GAD can be accurately predicted using baseline characteristics. Particularly, this worry postponement intervention may be most beneficial for individuals with high baseline worry but fewer subjective health complaints. The present findings highlight the complexities of and need for further research into daily worry dynamics and the personalizable utility of digital interventions.
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Affiliation(s)
- Joseph A Gyorda
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Mathematical Data Science Program, Dartmouth College, Hanover, NH, United States.
| | - Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
| | - George Price
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States; Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
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17
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Abstract
Chronic pain is a debilitating medical condition affecting a significant percentage of the population worldwide. Considerable evidence suggests that pain is an independent risk factor for suicide and inadequately managing pain has been identified as a risk for suicidal behaviour. Additionally, medications used to treat pain may also contribute to suicidal behaviour. Extensive research on pain highlights deficiencies in the clinical management on pain with more gaps in care when patients have pain in combination with mental illness and suicidal behaviour. Providing trainees additional knowledge and equipping them with relevant tools to screen and manage chronic pain efficiently is a potential strategy to mitigate suicide risk. Also, trainees need to be educated on how to screen for suicidality in individuals with pain and apply suicide prevention interventions. This paper will emphasise the necessity to improve education about pain, its close relationship with suicide and effective suicide screening as well as management strategies for medical providers. With additional research, it is the hope that novel treatment modalities will be developed to treat pain to improve the quality of life of individuals suffering from this condition and to decrease suicide risk in this patient population.
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18
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Kumar V, Sznajder KK, Kumara S. Machine learning based suicide prediction and development of suicide vulnerability index for US counties. NPJ MENTAL HEALTH RESEARCH 2022; 1:3. [PMID: 38609492 PMCID: PMC10938858 DOI: 10.1038/s44184-022-00002-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/08/2022] [Indexed: 04/14/2024]
Abstract
Suicide is a growing public health concern in the United States. A detailed understanding and prediction of suicide patterns can significantly boost targeted suicide control and prevention efforts. In this article we look at the suicide trends and geographical distribution of suicides and then develop a machine learning based US county-level suicide prediction model, using publicly available data for the 10-year period from 2010-2019. Analysis of the trends and geographical distribution of suicides revealed that nearly 25% of the total counties experienced at least a 10% increase in suicides from 2010 to 2019, with about 12% of total counties exhibiting an increase of at least 50%. An eXtreme Gradient Boosting (XGBoost) based machine learning model was used with 17 unique features for each of the 3140 counties in the US to predict suicides with an R2 value of 0.98. Using the SHapley Additive exPlanations (SHAP) values, the importance of all the 17 features used in the prediction model training set were identified. County level features, namely Total Population, % African American Population, % White Population, Median Age and % Female Population were found to be the top 5 important features that significantly affected prediction results. The top five important features based on SHAP values were then used to create a Suicide Vulnerability Index (SVI) for US Counties. This newly developed SVI has the potential to detect US counties vulnerable to high suicide rates and can aid targeted suicide control and prevention efforts, thereby making it a valuable tool in an informed decision-making process.
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Affiliation(s)
- Vishnu Kumar
- Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA.
| | - Kristin K Sznajder
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Soundar Kumara
- Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, PA, USA
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19
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Goldstein EV, Prater LC. Examining the policy effects of Arizona's 2016 pre-emption law on firearm suicide rates in the greater Tucson area: an observational study. BMJ Open 2022; 12:e058196. [PMID: 35534056 PMCID: PMC9086613 DOI: 10.1136/bmjopen-2021-058196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE In 2016, Arizona enacted SB 1487 to nullify Tucson's ordinance permitting the municipality to destroy confiscated and forfeited firearms and instead require the firearms to be resold to the public through an auctioneer. Our objective was to examine whether firearm suicide rates increased in Pima County (greater Tucson area) relative to other Arizona counties following the enactment of Arizona's 2016 pre-emption law. DESIGN An observational study of a natural policy experiment. We used a difference-in-differences approach to estimate the effects of Arizona enacting SB 1487 on firearm suicide rates in Pima County. Our statistical analyses adjusted for county-level differences in population demographics (age, gender and race) and unemployment rates, as well as a proxy for firearm availability and mental health professional shortage area status. SETTING 9 Arizona counties from 2014 to 2019. PARTICIPANTS A policy group was constructed using Pima County (Tucson area) observations. A comparison group was created using data from eight other Arizona counties. 54 county-year observations were analysed. INTERVENTION SB 1487, which pre-empted Tucson law and allowed firearms that were seized/surrendered to law enforcement to be recirculated instead of destroyed. OUTCOMES AND MEASURES Annual rates of firearm and non-firearm suicides per 100 000 persons extracted from the Centers for Disease Control and Prevention WONDER system. RESULTS Over the study period, comparison group counties had an average of 14.87 firearm suicides per 100 000 persons per year, compared with 11.56 firearm suicides per 100 000 persons per year in Pima County. A 1.13 increase in Pima County's firearm suicides per 100 000 persons coincided with the enactment of Arizona's 2016 pre-emption law, relative to comparison group counties over the same period. CONCLUSIONS SB 1487 was associated with higher firearm suicide rates in Pima County relative to other areas not targeted by the law, assuming fewer firearms were destroyed and more firearms re-entered the greater Tucson area through 2019.
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Affiliation(s)
- Evan V Goldstein
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Laura C Prater
- Department of Psychiatry and Behavioral Health Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Firearm Injury Prevention and Research Program, Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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20
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Lemke MK, Akinlotan M, Yang Y, Drake SA. Rural-urban, age, and gender disparities and trends in suicide and homicide: Multistate evidence across 12 years. J Rural Health 2022; 38:754-763. [PMID: 35504852 DOI: 10.1111/jrh.12670] [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: 11/28/2022]
Abstract
PURPOSE Few studies have simultaneously assessed age and gender trends in homicide and suicide across the rural-urban continuum. Herein, we examine geographic and demographic trends in suicide and homicide death rates by: (1) determining overall macro and disaggregated trends; (2) examining differences in trends based on rural-urban county classification; and (3) identifying differences in stratified trends among age and gender classifications. METHODS A retrospective study design used suicide and homicide data (n = 199,456) from years 2005to 2017 across 16 US states. Suicide and homicide deaths were grouped by age, gender, and rural-urban classification for descriptive analyses, and trends were analyzed using Joinpoint trend analysis software. FINDINGS Violence resulted in 142,470 suicide and 56,986 homicide deaths between 2005 and 2017. Among both males and females, overall macro trends of suicide and homicide rates generally increased with greater rurality, and trends in rural rates differed from those in nonrural areas. Joinpoint trend analysis revealed significant increases in male suicide rates in large metropolitan (1.66%), micropolitan (1.78%), and rural areas (1.77%); female suicide rates in large metropolitan (2.17%), small metropolitan (3.25%), and micropolitan areas (3.26%); male homicide rates in large metropolitan areas (10.19%); and female homicide rates in rural areas (8.29%). Finally, when stratified by age, several significant trends were found, including increases in suicide rates among females aged 64 and older in rural areas (11.71%). CONCLUSIONS Heterogeneous trends were found in suicide and homicide rates within specific rural-urban, age, and gender subgroups. Prevention efforts should proactively target those subgroups identified herein as most at-risk of violence.
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Affiliation(s)
| | | | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Stacy A Drake
- Center of Excellence in Forensic Nursing, Texas A&M University, Houston, Texas, USA
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21
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Schmutte T, Olfson M, Xie M, Marcus SC. Factors Associated With 7-Day Follow-Up Outpatient Mental Healthcare in Older Adults Hospitalized for Suicidal Ideation, Suicide Attempt, and Self-Harm. Am J Geriatr Psychiatry 2022; 30:478-491. [PMID: 34563430 PMCID: PMC10563141 DOI: 10.1016/j.jagp.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Older adults are one of the fastest growing age groups seeking emergency care for suicidal ideation and self-harm. Timely follow-up outpatient mental healthcare is important to suicide prevention, yet little is known about predictors of care continuity following hospital discharge. This study identified patient-, hospital-, and regional-level factors associated with 7-day follow-up outpatient mental healthcare in suicidal older adults. METHODS Retrospective cohort analysis using 2015 Medicare data for adults aged ≥65 years hospitalized for suicidal ideation, suicide attempt, or deliberate self-harm (n = 27,257) linked with the American Hospital Association survey and Area Health Resource File. Rates and adjusted risk ratios stratified by patient, hospital, and regional variables were assessed for 7-day follow-up outpatient mental healthcare. RESULTS Overall, 30.3% of patients received follow-up mental healthcare within 7 days of discharge. However, follow-up rates were higher for patients with any mental healthcare within 30 days prehospitalization (43.7%) compared to patients with no recent mental healthcare (15.7%). Longer length of stay and care in psychiatric hospitals were associated with higher odds of follow-up. For patients with no mental healthcare in the 30 days prehospitalization, discharge from hospitals that were large, system-affiliated, academic medical centers, or provided hospitalist-based care were associated with lower odds of follow-up. Females were more likely to receive 7-day follow-up, whereas non-white patients were less likely to receive follow-up care. CONCLUSION Timely follow-up is influenced by multiple patient, hospital, and community characteristics. Findings highlight the need for quality improvement to promote successful transitions from inpatient to outpatient care.
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Affiliation(s)
- Timothy Schmutte
- Department of Psychiatry, Program for Recovery and Community Health, Yale University, New Haven, Connecticut.
| | - Mark Olfson
- Department of Psychiatry and the New York State Psychiatric Institute, Columbia University, New York, New York
| | - Ming Xie
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven C Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania
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Nierengarten MB. Cancer-related suicides are trending downward: A recent study has discovered that cancer-related suicide rates have declined while overall suicide rates have increased; however, there is speculation as to the reasons behind the trend. Cancer 2021; 127:3497-3498. [PMID: 34478155 DOI: 10.1002/cncr.33882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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