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Narciso I, Albuquerque S, Nunes S. Addiction interprofessional experiences of care: Stress, coping and transformation. Int J Ment Health Nurs 2024; 33:928-936. [PMID: 38251813 DOI: 10.1111/inm.13289] [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: 10/11/2023] [Revised: 12/25/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
This study aimed to explore healthcare professionals' attribution of meaning to the concept of addiction, treatment and recovery. The study was conducted through semi-structured interviews with 18 healthcare professionals in the field of addiction: nine nurses, six psychologists, a psychiatrist, a social worker and a psychosocial technician. Based on a qualitative methodology, a thematic analysis was performed using the NVivo software. Regarding professional stress, the results revealed several stress factors related to the intervention (e.g. strategic powerlessness and uncertainty of intervention's effectiveness), the addicted individuals (e.g. motivation, difficulties in adhering to treatment, patient behaviour, negative patient emotionality and lack of socio-economic resources) as well as the healthcare services (e.g. team stress). Adaptive coping strategies were reported, both used in the work context (e.g. cognitive coping strategies and acceptance) and in personal life (e.g. work-family boundaries and family support and closeness). Despite the professional stress experienced, the participants' narratives indicated positive transformations of the self, which suggests resilient professional trajectories.
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Affiliation(s)
- Isabel Narciso
- CICPSI, Faculty of Psychology, University of Lisbon, Lisbon, Portugal
| | - Sara Albuquerque
- HEI-Lab: Digital Human-Environment Interaction Labs, Lusófona University, Lisbon, Portugal
| | - Sara Nunes
- Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
- Faculty of Psychology, Master in Clinical and Health Psychology, University of Lisbon, Lisbon, Portugal
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Emery H, Matthews A, Duggan M. "A little bit of hope goes a long way": Exploring the role of peer workers in alcohol and other drug rehabilitation services. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209408. [PMID: 38763216 DOI: 10.1016/j.josat.2024.209408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/11/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Peer workers operating within health care settings can offer unique perspectives based on their own lived experience. Within alcohol and other drug (AOD) rehabilitation services, the potential value of peer work is becoming increasingly recognised. This qualitative study aimed to evaluate a newly implemented peer worker program located across three rehabilitation services in Tasmania, Australia. METHODS Online interviews were conducted with eight clients, seven peer workers, and five non-peer worker employees with varied experience with peer worker programs. All interviews were audio-recorded and transcribed verbatim. RESULTS Guided by an overarching exploratory-descriptive methodological framework, thematic analysis generated three overarching themes: 1) Enhancing and supporting client experiences (what peer workers did in their role to improve client experiences, 2) Changing experiences with AOD rehabilitation (the unique benefits and changes that peer work brings to AOD rehabilitation services) and 3) Finding organizational value (how defining peer work and the feasibility of the peer worker role was challenged by different organizational factors). Overall, peer work was viewed as a positive addition to all rehabilitation services that was able to enhance client experiences through various mechanisms, such as by sharing their own stories, assisting with understanding, and creating safety. Peer work was also able to create change in AOD services, by instilling hope and reducing stigma. However, ongoing challenges with defining the peer worker role in a way that offers organizational recognition and financial security remain. CONCLUSION Peer workers offer a unique and valuable perspective when working within rehabilitation services. Through their own lived experience peer workers were able to support clients and assist them in their recovery. These findings highlight the potential benefit of peer work programs within AOD rehabilitation services.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia.
| | - Allison Matthews
- School of Psychological Sciences, University of Tasmania, Hobart, Australia.
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Robinson LD, Degan TJ, Deane FP, Kelly PJ. Patterns of substance use recovery following residential treatment: A repeated measures latent profile analysis. Drug Alcohol Rev 2024. [PMID: 39044399 DOI: 10.1111/dar.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 04/30/2024] [Accepted: 06/23/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Ongoing improvement to residential treatment for substance use disorders is critical as it typically targets people with the highest need. Assessing multiple recovery indicators, such as cravings and mental health, at intake and following discharge is important in evaluating treatment effectiveness. To refine services, research should explore whether there are subgroups of individuals with different patterns of recovery following treatment. METHODS Participants (n = 554) were attending Australian Salvation Army residential treatment services for substance use issues. Data were collected by surveys at intake and 3-month post-discharge ('early recovery'). Recovery indicators were cravings, confidence to resist substance use and the Depression, Anxiety and Stress Scale. Subgroups of individuals based on these recovery indicators ('profiles') were identified using repeated measures latent profile analysis. RESULTS Five profiles were identified, three profiles improved over time (81.4%) and two (18.6%) deteriorated across all indicators. These two profiles had the poorest mental health and addiction scores at intake and reported shorter time in treatment compared to the three profiles showing improvement. There were no demographic or substance type differences between profiles. DISCUSSION AND CONCLUSIONS By considering initial severity and multiple recovery indicators at early recovery, this study suggests that individuals at-risk of poor early recovery can be identified at intake. This opens opportunities for tailored treatment approaches to address both mental health and substance use, thereby potentially improving treatment outcomes and reducing the risk of relapse.
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Affiliation(s)
- Laura D Robinson
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Centre for Health Psychology Practice and Research, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Tayla J Degan
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Frank P Deane
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Centre for Health Psychology Practice and Research, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
- Centre for Health Psychology Practice and Research, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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McLeod KE, Buxton JA, Karim ME, Martin RE, Nosyk B, Kurz M, Scow M, Felicella G, Slaunwhite AK. Receipt of Opioid Agonist Treatment in provincial correctional facilities in British Columbia is associated with a reduced hazard of nonfatal overdose in the month following release. PLoS One 2024; 19:e0306075. [PMID: 38985687 PMCID: PMC11236203 DOI: 10.1371/journal.pone.0306075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/11/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND In many jurisdictions, policies restrict access to Opioid Agonist Treatment (OAT) in correctional facilities. Receipt of OAT during incarceration is associated with reduced risk of fatal overdose after release but little is known about the effect on nonfatal overdose. This study aimed to examine the association between OAT use during incarceration and nonfatal overdose in the 30 days following release. METHODS AND FINDINGS Using linked administrative healthcare and corrections data for a random sample of 20% of residents of British Columbia, Canada we examined releases from provincial correctional facilities between January 1, 2015 -December 1, 2018, among adults (aged 18 or older at the time of release) with Opioid Use Disorder. We fit Andersen-Gill models to examine the association between receipt of OAT in custody and the hazard of nonfatal following release. We conducted secondary analyses to examine the association among people continuing treatment initiated prior to their arrest and people who initiated a new episode of OAT in custody separately. We also conducted sex-based subgroup analyses. In this study there were 4,738 releases of 1,535 people with Opioid Use Disorder. In adjusted analysis, receipt of OAT in custody was associated with a reduced hazard of nonfatal overdose (aHR 0.55, 95% CI 0.41, 0.74). This was found for prescriptions continued from community (aHR 0.49, 95%CI 0.36, 0.67) and for episodes of OAT initiated in custody (aHR 0.58, 95%CI 0.41, 0.82). The effect was greater among women than men. CONCLUSIONS OAT receipt during incarceration is associated with a reduced hazard of nonfatal overdose after release. Policies to expand access to OAT in correctional facilities, including initiating treatment, may help reduce harms related to nonfatal overdose in the weeks following release. Differences in the effect seen among women and men indicate a need for gender-responsive policies and programming.
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Affiliation(s)
- Katherine E. McLeod
- Department of Family Medicine, McMaster University, Hamilton, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jane A. Buxton
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Ruth Elwood Martin
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Megan Kurz
- Health Economic Research Unit, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Marnie Scow
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Guy Felicella
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Amanda K. Slaunwhite
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Arunogiri S, Morley KC. Commentary on Aubin et al.: Could combination medication approaches target mental health comorbidity in the context of alcohol use disorder? Addiction 2024; 119:1224-1225. [PMID: 38757542 DOI: 10.1111/add.16526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Shalini Arunogiri
- Monash Addiction Research Centre and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kirsten C Morley
- Specialty of Addiction Medicine, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Conner TS, Teah GE, Sibley CG, Turner RM, Scarf D, Mason A. Psychological predictors of vaping uptake among non-smokers: A longitudinal investigation of New Zealand adults. Drug Alcohol Rev 2024; 43:1132-1142. [PMID: 38437024 DOI: 10.1111/dar.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Demographic and health factors are known to predict vaping. Less is known about psychological predictors of vaping uptake, particularly among non-smoking adults using longitudinal designs. We aimed to model how psychological factors related to personality and mental health predicted the likelihood of vaping uptake over time in non-smoking adults ages 18+ using longitudinal data. METHODS Longitudinal regression models utilised data from the 2018-2020 waves of the New Zealand Attitudes and Values Study to assess how the Big Five personality traits, mental distress and self-control predicted who began vaping over time among non-users (non-vapers and non-smokers), controlling for gender, age, ethnicity and economic deprivation. RESULTS Analyses included 36,309 adults overall (ages 18 to 99; M = 51.0). The number of non-users who transitioned into current vaping was small (transitioned from 2018 to 2019, n = 147; 0.48%; 2019 to 2020, n = 189, 0.63%). Fully adjusted models showed that adults with higher mental distress (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.09-1.88), lower self-control (aOR 0.79; 95% CI 0.69-0.89) and higher extraversion (aOR 1.09; 95% CI 1.06-1.13) were more likely to begin vaping at the next time point compared to adults who remained non-users. Higher neuroticism and lower conscientiousness also predicted vaping uptake in initial models, but inclusion of mental distress and self-control superseded these traits. DISCUSSION AND CONCLUSIONS Psychological factors related to mental distress, impulse control and sociability predicted who was more likely to begin vaping as non-smoking adults. Harm prevention interventions could target these factors to reduce vaping uptake in non-smokers.
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Affiliation(s)
- Tamlin S Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Grace E Teah
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Chris G Sibley
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Damian Scarf
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Andre Mason
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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Glancy M, Palmateer N, Yeung A, Hickman M, Macleod J, Bishop J, Barnsdale L, Trayner KM, Priyadarshi S, Wallace J, Hutchinson S, McAuley A. Risk of drug-related death associated with co-prescribing of gabapentinoids and Z-drugs among people receiving opioid-agonist treatment: A national retrospective cohort study. Psychiatry Res 2024; 339:116028. [PMID: 38917674 DOI: 10.1016/j.psychres.2024.116028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Prescribing of gabapentinoids and Z-drug-hypnotics has increased in the population and among people receiving opioid-agonist treatment (OAT) for opioid dependence. Evidence is mixed on whether co-prescribing of sedatives such as gabapentinoids and Z-drugs during OAT increases risk of drug-related death (DRD). METHODS We conducted a retrospective cohort study of individuals prescribed OAT between 2011 and 2020 in Scotland. Prescribing records were linked to mortality data and other healthcare datasets (sociodemographic, comorbidity). We identified episodes of treatment with gabapentinoids/Z-drugs and used multivariable quasi-Poisson regression to model associations between co-prescription and DRD risk. RESULTS Among 46,602 individuals with 304,783 person-years of follow-up, we found that co-prescription was common, with 25 % and 34 % ever being co-prescribed gabapentinoids and Z-drugs, respectively. Gabapentinoid exposure was strongly associated (adjusted hazard ratio (aHR)=2·18, 95 % CI=1·92, 2·46) and Z-drug exposure moderately associated (aHR=1·39, 95 % CI=1·15, 1·66) with elevated risk of DRD. Gabapentinoid exposure was associated with DRD risk on and off OAT; Z-drug exposure was less strongly associated with DRD risk when on OAT. CONCLUSIONS Co-prescription of gabapentinoids and Z-drugs is common among OAT patients. However, co-prescription is associated with increased risk of DRD. Alternatives to prescribing sedative medications to OAT patients and/or greater monitoring - if prescribed - are needed.
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Affiliation(s)
- Megan Glancy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK.
| | - Norah Palmateer
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Alan Yeung
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Kirsten Ma Trayner
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Saket Priyadarshi
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Glasgow Alcohol and Drug Recovery Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Sharon Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
| | - Andrew McAuley
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Glasgow, UK
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Duncan Z, Ward B, Kippen R, Dietze P, Sutton K. A narrative systematic review of associations and temporality between use of methamphetamine, ecstasy/MDMA, or cocaine with anxiety or depressive symptoms. Addict Behav 2024; 153:107988. [PMID: 38394960 DOI: 10.1016/j.addbeh.2024.107988] [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: 11/29/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Anxiety and depression are prevalent mental health problems in people who use illicit stimulants. Improved understanding of the temporal relationship between methamphetamine, ecstasy/MDMA, or cocaine use with anxiety or depression informs public health interventions and treatment options for those experiencing this co-occurrence. This narrative systematic review sought to examine associations and temporality between the use of methamphetamine, ecstasy/MDMA, or cocaine, with anxiety or depressive symptoms. Method Systematic searches of 4 electronic databases were conducted up to August 2023. Study eligibility included the measurement of anxiety and/or depressive symptoms, and frequency of illicit stimulant use (methamphetamine, cocaine, or ecstasy/MDMA) at two separate time points, with data analysis of the association between these variables. The Joanna Briggs Critical Appraisal Checklist was utilised to assess quality. Data was extracted, and a narrative synthesis incorporating an eight-criteria framework to assess associations was conducted. Results 4432 studies were screened for eligibility; 11 studies (3 RCTs and 8 prospective cohort studies) were included. Evidence for an association between depressive symptoms and methamphetamine use was demonstrated in six studies, with temporal evidence in three studies supporting methamphetamine use preceding depressive symptoms. Three studies reported an association between cocaine use and depressive symptoms. Evidence for associations with any of the illicit stimulants and anxiety symptoms was lacking. CONCLUSIONS There was some evidence to support a case for temporality, particularly for methamphetamine use and depressive symptoms. Investing in longitudinal studies is pivotal to understanding the dynamic and reciprocal relationship between illicit stimulant use and anxiety or depressive symptoms. A limitation of the study was the variation in the measurement and analysis of outcomes.
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Affiliation(s)
- Zoe Duncan
- Monash Rural Health, Monash University, Melbourne, Australia.
| | - Bernadette Ward
- Monash Rural Health, Monash University, Melbourne, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Kippen
- Monash Rural Health, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Keith Sutton
- Monash Rural Health, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
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Zhang Z, Das S. Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review. DISCOVER MENTAL HEALTH 2024; 4:17. [PMID: 38802580 PMCID: PMC11130112 DOI: 10.1007/s44192-024-00070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions. AIMS This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature. METHOD PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined. RESULTS The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7 years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%). CONCLUSION On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.
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Affiliation(s)
| | - Soumitra Das
- The University of Melbourne, Melbourne, Australia
- Western Health, Footscray, Australia
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Kwak K, Hew A, Arunogiri S. Research Letter: Australia and New Zealand's addiction psychiatrist workforce: Profile, recruitment and retention. Aust N Z J Psychiatry 2024:48674241253941. [PMID: 38755970 DOI: 10.1177/00048674241253941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- Kun Kwak
- Department of Addiction Medicine, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anthony Hew
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Turning Point, Eastern Health, Melbourne, VIC, Australia
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Andersson HW, Nordfjærn T, Mosti MP. The relationship between the Hopkins symptom checklist-10 and diagnoses of anxiety and depression among inpatients with substance use disorders. Nord J Psychiatry 2024; 78:319-327. [PMID: 38421343 DOI: 10.1080/08039488.2024.2323124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The Hopkins Symptom Checklist-10 (HSCL-10) is a self-report inventory of anxiety and depression symptoms that may assist clinicians in screening for clinical conditions among patients with substance use disorder (SUD). We examined the HSCL-10 as a screening tool for anxiety and depressive disorders within a general population of SUD inpatients. METHODS We used data from a cohort study of 611 SUD inpatients. Receiver operating characteristic (ROC) analyses were conducted, with and without covariates, to evaluate the potential of the HSCL-10 as a screening tool. This was explored using any anxiety disorder, especially posttraumatic stress disorder (PTSD), and any mood disorder, especially major depressive disorders, as the outcome criteria. Candidate covariates included gender, age, education, polydrug use and treatment center.Results: The HSCL-10 had a moderate ability to identify caseness (i.e. having or not having a clinical diagnosis) according to each outcome criterion, with the area under the ROC curve (AUC) varying from 0.64 to 0.66. Adding relevant covariates markedly enhanced the instrument's ability to identify those who met the criteria for any anxiety disorder (AUC = 0.77), especially PTSD (AUC = 0.82). CONCLUSION In a real-world clinical setting, the HSCL-10 has fair-to-good clinical utility for identifying SUD inpatients who have comorbid clinical symptoms of anxiety disorders or PTSD, when combined with common background variables. The HSCL-10, a brief self-report screening tool, may serve as an efficient proxy for comprehensive interviews used in research and for clinical anxiety symptom screening among patients with SUD.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mats P Mosti
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
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Carroll A, Bayes A, Montebello M, Brett J, Arunogiri S, Saunders JB, Loo CK. Drug dependence and prescribing ketamine for treatment-resistant depression in Australia and New Zealand. Aust N Z J Psychiatry 2024:48674241242315. [PMID: 38561896 DOI: 10.1177/00048674241242315] [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: 04/04/2024]
Abstract
Ketamine is a restricted and regulated medication in Australia and New Zealand, which has implications when considering treatment for patients with treatment-resistant depression and a history of illicit drug use, abuse or dependence. Regulations governing prescription of ketamine for treatment-resistant depression vary between jurisdictions in Australia and New Zealand, though most restrict use in those with drug dependence. There is substantial variation in definitions of drug dependence used in each jurisdiction, and between the legal and clinical definitions, with the latter specified in the current International Classification of Diseases, Eleventh Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This paper reviews the literature assessing the risk of ketamine misuse and dependence in patients with a history of illicit drug use, abuse or dependence and presents recommendations for psychiatrists who prescribe ketamine in such patients with treatment-resistant depression.
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Affiliation(s)
- Alistair Carroll
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Adam Bayes
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mark Montebello
- Drug and Alcohol Services, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Specialty of Addiction Medicine, The University of Sydney, Camperdown, NSW, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Jonathan Brett
- Clinical Pharmacology & Toxicology and Addiction Medicine, St Vincent's Hospital, Sydney, NSW, Australia
- NSW Poisons Information Centre, The Children's Hospital at Westmead, NSW, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
- Medicines and Health Intelligence, School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Arunogiri
- Statewide Addiction and Mental Health Centre, Turning Point, Eastern Health, Melbourne, VIC, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - John B Saunders
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia
| | - Colleen K Loo
- Neuromodulation and Interventional Psychiatry, Black Dog Institute, Sydney, NSW, Australia
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Cardiovascular program. The George Institute for Global Health, Sydney, NSW, Australia
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Matthews EB, Lushin V, Rzewinski J. Patterns & Predictors of Telehealth Utilization Among Individuals Who Use Substances: Implications for the Future of Virtual Behavioral Health Services. Community Ment Health J 2024; 60:148-153. [PMID: 37410213 DOI: 10.1007/s10597-023-01166-2] [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: 11/17/2022] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
Telehealth dramatically expanded during the COVID-19 pandemic, but there remains a dearth of literature examining how this service modality is utilized by individuals who use substances. This study examined patterns of telehealth use and individual level sources of variation among clients receiving counseling in an outpatient substance use clinic in early 2021 (n = 370). Univariate statistics described the percentage of counseling visits delivered via telehealth. OLS regression explored individual level demographic and clinical characteristics that predicted greater telehealth utilization. Overall, more than two thirds (86%) of counseling visits were conducted via telehealth. Individuals with unstable housing or with a co-occurring serious mental illness used less telehealth. Findings suggest that while telehealth appears to be an acceptable way to deliver substance use counseling, patterns varied among vulnerable subgroups. As telehealth becomes further integrated into behavioral health services delivery, it is critical to uncover sources of this variation and identify potential solutions.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W. 60th st. 7th Fl, New York, NY, 10023, USA.
| | - Viktor Lushin
- Long Island University Brooklyn Campus, Brooklyn, NY, USA
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Kalhovde AM, Kitzmüller G. Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness. QUALITATIVE HEALTH RESEARCH 2024; 34:154-165. [PMID: 37905732 PMCID: PMC10714708 DOI: 10.1177/10497323231203627] [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: 11/02/2023]
Abstract
Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.
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15
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Yuen AWH, Sang JM, Wang L, Barath J, Lachowsky NJ, Lal A, Elefante J, Hart TA, Skakoon-Sparling S, Grey C, Grace D, Cox J, Lambert G, Noor SW, Apelian H, Parlette A, Card KG, Hull MW, Jollimore J, Moore DM. Attitudes of Gay, Bisexual, and Other Men Who Have Sex with Men (GBM) toward Their Use of Amphetamine-Type Stimulants and Relation to Reducing Use in Three Canadian Cities. Subst Use Misuse 2023; 59:278-290. [PMID: 37867395 DOI: 10.1080/10826084.2023.2269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND We explored attitudes of gay, bisexual, and other men who have sex with men (GBM) toward their amphetamine-use and associations with reduced use over time. METHODS We recruited sexually-active GBM aged 16+ years in Montreal, Toronto, and Vancouver, Canada, from 02-2017 to 08-2019, with follow-up visits every 6-12 months until November 2020. Among participants who reported past-six-month (P6M) amphetamine-use at enrollment, we used logistic regression to identify demographic, psychological, social, mental health, other substance-use, and behavioral factors associated with reporting needing help reducing their substance-use. We used mixed-effects logistic regression to model reduced P6M amphetamine-use with perceived problematic-use as our primary explanatory variable. RESULTS We enrolled 2,449 GBM across sites. 15.5-24.7% reported P6M amphetamine-use at enrollment and 82.6 - 85.7% reported needing no help or only a little help in reducing their substance use. Reporting needing a lot/of help or completely needing help in reducing substance-use was associated with group sex participation (AOR = 2.35, 95%CI:1.25-4.44), greater anxiety symptomatology (AOR = 2.11, 95%CI:1.16-3.83), greater financial strain (AOR = 1.35, 95%CI:1.21-1.50), and greater Escape Motive scores (AOR = 1.07, 95%CI:1.03-1.10). Reductions in P6M amphetamine-use were less likely among GBM who perceived their amphetamine-use as problematic (AOR = 0.17 95% CI 0.10 - 0.29). CONCLUSIONS Most amphetamine-using GBM did not feel they needed help reducing their substance use, and many reported reduced amphetamine-use at subsequent visits. Those who perceived their use as problematic were less likely to reduce their use. Further interventions to assist GBM in reducing their use are needed to assist those who perceive their use as problematic.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- University of Victoria, Victoria, BC, Canada
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, ON, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Herak Apelian
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | | | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Mark W Hull
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David M Moore
- University of British Columbia, Vancouver, BC, Canada
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Moulis L, Le SM, Hai VV, Huong DT, Minh KP, Oanh KTH, Rapoud D, Quillet C, Thi TTN, Vallo R, Hoang GT, Moles JP, Laureillard D, Feelemyer J, Des Jarlais DC, Michel L, Nagot N. Gender, homelessness, hospitalization and methamphetamine use fuel depression among people who inject drugs: implications for innovative prevention and care strategies. Front Psychiatry 2023; 14:1233844. [PMID: 38025448 PMCID: PMC10661402 DOI: 10.3389/fpsyt.2023.1233844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions. Methods We enrolled PWID into a cohort using the respondent-driven sampling method. Over a 36-month period, we systematically tracked the emergence of depression and employed multiple imputation in conjunction with a mixed nonlinear model to pinpoint risk factors for depression in this demographic. At inclusion, depression was screened using the PHQ-2 questionnaire, and subsequent episodes of depression were assessed semi-annually using the CES-D8. Results Three hundred and ninety-one PWID (26.6%) were depressed. Major risk factors for depression included being female, not having a permanent residency, having been hospitalized and using methamphetamine more than weekly. Other risk factors included age, being single, not having a health insurance card and not being on methadone. Limitations The exclusion of missing visits and social desirability could have led to selection and information biases. In this observational study, confusion biases are possible despite our best efforts. Conclusion Depression is alarmingly frequent in PWID. In this study taking in account the chronological relationship between sociodemographic and clinical factors and depression, risk factors were identified in this specific setting of low-to-middle income country. The findings highlight the need to develop innovative targeted psychiatric interventions with the help of supporting peers.
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Affiliation(s)
- Lionel Moulis
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Sao Mai Le
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Haiphong, Vietnam
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Khuê Pham Minh
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Delphine Rapoud
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Catherine Quillet
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | | | - Roselyne Vallo
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Giang Thi Hoang
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jean-Pierre Moles
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Didier Laureillard
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | | | | | - Laurent Michel
- CESP Inserm UMRS, Pierre Nicole Center, Paris Saclay University, Fench Red Cross, Paris, France
| | - Nicolas Nagot
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
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Felton JW, Kleinman MB, Doran K, Satinsky EN, Tralka H, Dean D, Brown CJS, Anvari MS, Bradley VD, Magidson JF. Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. J Psychosoc Nurs Ment Health Serv 2023; 61:23-31. [PMID: 37256749 DOI: 10.3928/02793695-20230523-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although effective evidence-based interventions (EBIs) exist, racial/ethnic minority individuals with lower income are less likely to have access to these interventions and may experience greater stigma in the health care system, resulting in disproportionate rates of morbidity and mortality. Peer recovery specialists (PRSs) may be uniquely suited to address barriers faced by those from impoverished areas; however, peers have not traditionally been trained in implementing EBIs. The current open-label trial (N = 8) was performed to evaluate implementation and preliminary effectiveness of an adapted EBI supporting recovery, linkage to treatment, and reduced depression. Results suggest the intervention was feasible, acceptable, and appropriate for linking individuals from a community setting to substance use treatment and could be delivered with fidelity by a peer interventionist. Participants who completed the intervention demonstrated clinically reliable decreases in substance use and depressive symptoms. Findings provide initial support for PRS dissemination of EBIs to increase linkage to care and support recovery in traditionally underserved populations. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 23-31.].
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Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
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El-Ammari A, El Malki H, Moutawakkil SG, El Hilaly J, El Houari F, El Gnaoui S, Ragala MEA, El Rhazi K, Zarrouq B. Validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a Moroccan sample with substance use disorder. BMC Psychiatry 2023; 23:723. [PMID: 37803359 PMCID: PMC10557308 DOI: 10.1186/s12888-023-05245-2] [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: 06/14/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Transcultural validation studies of depression scales are rare in Morocco. The Center for Epidemiologic Studies Depression Scale (CES-D) is commonly one of the most common and frequently used screening instruments for depressive symptoms, but the scale has not, up to date, been validated in dialect of Arabic in Moroccan contexts. Given the importance of assessing and preventing depressive symptoms in our Moroccan context, this study aims to validate the CES-D, translated, and adapted to the dialect of Arabic and Moroccan culture, in a sample with substance use disorder. METHODS The data were analyzed in two successive phases. First, exploratory factor analysis (EFA) was used to assess the factor structure in the pilot sample (N = 140). Then, this structure was confirmed in the validation sample (N = 205) using confirmatory factor analysis (CFA). RESULTS Exploratory factor analysis extracted three factors different from the four factors in the original version. Confirmatory factor analysis confirmed the structure of three factors. The fit indices level showed acceptable to good performance of the measurement model. The instrument showed sufficient reliability and convergent validity, as demonstrated by acceptable values of composite reliability (CR = 0.89-0.93) and average variance extracted (AVE = 0.64-0.66), respectively. The square roots of AVE were higher than factor-factor pairs correlations, and the Heterotrait-Monotrait ratio (HTMT) of correlations values was less than 0.85, indicating acceptable discriminant validity. CONCLUSIONS Overall reliability and both convergent and discriminant validity tests indicated that the Moroccan dialectal Arabic version of the CES-D had a good performance and may serve as a valid tool for measuring the severity of depression in people with substance use disorder.
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Affiliation(s)
- Abdelfettah El-Ammari
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Hicham El Malki
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Salma Ghofrane Moutawakkil
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Jaouad El Hilaly
- R.N.E Laboratory, Multidisciplinary Faculty of Taza, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Pedagogical and Didactic Engineering of Sciences and Mathematics, Regional Center of Education and Training (CRMEF) of Fez, Fez, Morocco
| | | | | | - Mohammed El Amine Ragala
- Department of Biology-Geology, Teachers Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Btissame Zarrouq
- Laboratory of Epidemiology and Research in Health Sciences, Faculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
- Department of Biology-Geology, Teachers Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco.
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Eide D, McDonald R, Hamina A, Clausen T, Odsbu I, Skurtveit S. Prescription high-risk polysubstance use among opioid maintenance treatment patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104196. [PMID: 37741700 DOI: 10.1016/j.drugpo.2023.104196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/01/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Among individuals receiving buprenorphine or methadone as opioid maintenance treatment (OMT), concomitant use of other central nervous system depressants, including prescription drugs, can increase risk of overdose. We aimed to 1) determine the prevalence of use of high-risk prescription drugs (opioid analgesics, benzodiazepines, benzodiazepine-related drugs, and gabapentinoids) among OMT patients, 2) calculate its associations with different mental health and pain-related diagnoses, and 3) compare prevalence of concomitant use with the general population. METHODS A national sample comprising all individuals filling at least one prescription of OMT drugs in Norway in 2019 was formed. Healthcare registry data were linked to investigate high-risk prescription drug use and different diagnoses. We calculated one-year prevalence of use, amount dispensed in defined daily doses (DDDs), and the number of prescribers for the different high-risk prescription drugs. Logistic regression was used to determine associations (adjusted odds ratios; aOR, 95% confidence intervals (CIs)) between diagnoses and use. Prevalence of use was calculated both in the OMT patient sample and the general population. RESULTS Among the OMT patient sample (n=7,299), 47.6% (n=3,476) filled prescriptions for benzodiazepines. For each high-risk prescription drug group, there was a median of 1-2 prescribers. Musculoskeletal diagnoses were the strongest factor for concomitant high-risk prescription drug use for both males (aOR 3.23, CI: 2.72-3.85) and females (aOR 3.07, CI: 2.42- 3.90). The 1-year prevalence of benzodiazepine use was 11.4 times higher for males and 7.1 times higher for females in OMT than the general population. The amount in DDDs was higher for every drug for OMT patients than the general population, particularly for benzodiazepines. CONCLUSIONS OMT patients frequently filled prescriptions for high-risk drugs, and in higher dosages than the general population. However, we found little evidence of 'doctor shopping.' Given that these prescription drugs carry overdose risk, particularly when combined with OMT drugs, our findings emphasize the continued need for education and caution to both prescribers and patients on their concomitant use with OMT.
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Affiliation(s)
- Desiree Eide
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway.
| | - Rebecca McDonald
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Aleksi Hamina
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Thomas Clausen
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway
| | - Ingvild Odsbu
- Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research University of Oslo, 166 Kirkeveien 0450 Oslo, Norway; Department of Chronic Diseases Norwegian Institute of Public Health, PO Box 222 Skøyen 0213 Oslo, Norway
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Robinson M, Callinan S, Taylor N. Disentangling the messiness of natural experiments to evaluate public policy. Addiction 2023; 118:1618-1620. [PMID: 37279775 DOI: 10.1111/add.16265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Mark Robinson
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sarah Callinan
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Nicholas Taylor
- National Drug Research Institute, Curtin University, Melbourne, Australia
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The burden and trend of diseases and their risk factors in Australia, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Public Health 2023; 8:e585-e599. [PMID: 37516475 PMCID: PMC10400798 DOI: 10.1016/s2468-2667(23)00123-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. METHODS In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made. FINDINGS Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. INTERPRETATION An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. FUNDING Bill & Melinda Gates Foundation.
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Vergunst F, Berry HL, Minor K, Chadi N. Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:936-954. [PMID: 36441663 PMCID: PMC10336608 DOI: 10.1177/17456916221132739] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change. We suggest that systems thinking and developmental life-course approaches provide practical frameworks for conceptualizing this relationship. Further conceptual, methodological, and empirical work is urgently needed to evaluate the nature and scope of this burden so that effective adaptive and preventive action can be taken.
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Affiliation(s)
- Francis Vergunst
- Department of Special Needs Education, University of Oslo
- Department of Social and Preventive Medicine, University of Montreal
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
| | - Helen L Berry
- Australian Institute of Health Innovation, Macquarie University
| | - Kelton Minor
- Center for Social Data Science, University of Copenhagen
- Data Science Institute, Columbia University
| | - Nicholas Chadi
- Ste-Justine University Hospital Research Center, Montreal, Québec, Canada
- Department of Pediatrics, Faculty of Medicine, University of Montreal
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24
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Marceau EM, Berry J, Grenyer BFS. Neurocognition of females with substance use disorder and comorbid personality disorder: Divergence in subjective and objective cognition. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:368-378. [PMID: 34251923 DOI: 10.1080/23279095.2021.1948413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Jamie Berry
- Advanced Neuropsychological Treatment Services, Strathfield South, Australia
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, North Ryde, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
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Andersson HW, Mosti MP, Nordfjaern T. Inpatients in substance use treatment with co-occurring psychiatric disorders: a prospective cohort study of characteristics and relapse predictors. BMC Psychiatry 2023; 23:152. [PMID: 36894934 PMCID: PMC9999667 DOI: 10.1186/s12888-023-04632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The characteristics of substance use disorder (SUD) inpatients with co-occurring psychiatric disorders (COD) have been scantly described in the extant literature. This study investigated psychological, demographic and substance use characteristics in these patients, along with predictors of relapse 3 months post-treatment. METHODS Prospective data from a cohort of 611 inpatients were analyzed for demographics, motivation, mental distress, SUD diagnosis, psychiatric diagnoses (ICD-10) and relapse rate at 3 months post-treatment (retention rate = 70%). RESULTS Compared to patients without COD (n = 322), those with COD (n = 289) were younger, had higher mental distress, lower education and higher likelihood of no permanent residence. The relapse rate was also higher in patients with COD (39.8%) relative to patients without COD (26.4%) (OR = 1.85, 95% CI: 1.23-2.78). The relapse rate was particularly high for patients with COD who were diagnosed with cannabis use disorder (53.3%). Multivariate analysis revealed that among patients with COD, relapse was more likely for individuals with a cannabis use disorder (OR = 2.31, 95% CI: 1.34-4.00), and less likely for older ages (OR = 0.97, 95% CI: 0.94-1.00), females (OR = 0.56, 95% CI: 0.33-0.98) and for those with higher intrinsic motivation (OR = 0.58, 95% CI: 0.42-0.81). CONCLUSION This study showed that among SUD inpatients, those with COD had relatively persistent high levels of mental distress and an increased risk of relapse. Enhanced measures aimed at COD patients' mental health problems during the inpatient stay, along with close and personalized follow-up after discharge from residential SUD treatment may reduce the probability of relapse in this group.
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Affiliation(s)
- Helle Wessel Andersson
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway.
| | - Mats P Mosti
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway
| | - Trond Nordfjaern
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Pb 3250 Sluppen, Trondheim, 7006, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Fisher A, Eugene Dit Rochesson S, Harvey LR, Marel C, Mills KL. Development and pilot of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Purpose
Evidence is lacking as to the superiority of dual-focused versus single-focused approaches in treating depression and alcohol use comorbidity. Different people may also value the different features of treatment options differently, necessitating a decision-support tool. This study aims to test the acceptability, feasibility, safety and potential usefulness of the Alcohol and Depression Decision-Aid for Psychological Treatments (ADDAPT).
Design/methodology/approach
ADDAPT was developed according to International Patient Decision-Aid Standards and in consultation with potential end users. Adults with depression and alcohol use comorbidity, who were considering/recently considered psychological treatments, were recruited via online advertisements. After clicking on the study URL, participants accessed the ADDAPT e-book and completed validated and purpose-designed questionnaires.
Findings
Of the 24 participants, most would recommend ADDAPT to others (79.2% agree) and endorsed it as easy-to-use (75%), useful in decision-making (79.2%), presenting balanced (87.5%), up-to-date (91.7%), easy-to-understand (79.2%) and trustworthy information (83.3%), which did not provoke anxiety (i.e. safety; 75%). Post-use, participants felt well prepared to decide on treatment (M = 3.48/5) and demonstrated good treatment knowledge (M = 65.83%). All but one participant indicated a treatment choice supported by best available evidence, and decisional conflict scores except for the uncertainty subscale were below the threshold for decisional delay (all M < 37.5/100).
Originality/value
ADDAPT is the first decision-aid of its kind, with pilot findings supporting its acceptability, feasibility, safety and potential usefulness for improving decision-making quality among people considering psychological treatment options for depression and alcohol use comorbidity.
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Harvey LR, Hopkins R, Truscott M, Marel C, Slade T, Mills KL. A retrospective chart review of trauma-related documentation in an Australian substance use treatment service. Drug Alcohol Rev 2023; 42:373-383. [PMID: 36377196 PMCID: PMC10947072 DOI: 10.1111/dar.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/16/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trauma exposure among clients of substance use treatment services is almost universal and rates of trauma-related symptoms are correspondingly high. This study examined one aspect of clinical care-clinical documentation-and sought to systematically assess the documentation of trauma-related comorbidities and their treatment in a substance use treatment setting. METHODS A retrospective chart review was conducted on a sample of 300 patient records in a public substance use treatment setting. Rates of documentation of trauma-related events, symptoms and treatment, along with variables influencing the documentation of these issues, were examined. RESULTS Trauma-related documentation was present in 45.3% of records. There were documented trauma-related symptoms in 15.3% of records, although treatment activities addressing trauma were only present in 2.3% of records. Being female (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.42, 4.69), having prior mental health treatment (OR 1.82, 95% CI 1.05, 1.12) and having more treatment sessions (OR 1.08, 95% CI = 1.05, 1.12) increased the odds of trauma-related documentation being present, while being in the first episode of treatment (OR 0.49, 95% CI = 0.28, 0.84) decreased the odds. DISCUSSION AND CONCLUSIONS This study highlights significant under documentation of trauma-related comorbidities in substance-use treatment. There is limited evidence of consideration of trauma-related symptoms or diagnoses, and trauma-related comorbidities are rarely included in treatment planning activities. The lack of documented trauma-related information has important clinical and medico-legal implications for patients, and provides evidence to suggest a lack of integration of treatment for trauma-related disorders in substance use settings.
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Affiliation(s)
- Logan R. Harvey
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Rachel Hopkins
- Drug Health, Western Sydney Local Health DistrictSydneyAustralia
| | - Melanie Truscott
- Drug Health, Western Sydney Local Health DistrictSydneyAustralia
| | - Christina Marel
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Tim Slade
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
| | - Katherine L. Mills
- Matilda Centre for Research in Mental Health and Substance UseThe University of SydneySydneyAustralia
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Cheetham A, Arunogiri S, Lubman D. Integrated care – panacea or white elephant? A review of integrated care approaches in Australia over the past two decades. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose
Integrated care is widely supported as a means of improving treatment outcomes for people with co-occurring mental health and substance use disorders. Over the past two decades, Australian state and federal governments have identified integrated care as a policy priority and invested in a number of research and capacity building initiatives. This study aims to examine Australian research evaluating the effectiveness of integrated treatment approaches to provide insight into implications for future research and practice in integrated treatment.
Design/methodology/approach
This narrative review examines Australian research evaluating empirical evidence of the effectiveness of integrated treatment approaches within specific populations and evidence from initiatives aimed at integrating care at the service or system level.
Findings
Research conducted within the Australian context provides considerable evidence to support the effectiveness of integrated approaches to treatment, particularly for people with high prevalence co-occurring disorders or symptoms of these (i.e. anxiety and depression). These have been delivered through various modalities (including online and telephone-based services) to improve health outcomes in a range of populations. However, there is less evidence regarding the effectiveness of specific models or systems of integrated care, including for more severe mental disorders. Despite ongoing efforts on behalf of the Australian government, attempts to sustain system-level initiatives have remained hampered by structural barriers.
Originality/value
Effective integrated interventions can be delivered by trained clinicians without requiring integration at an organisational or structural level. While there is still considerable work to be done in terms of building sustainable models at a system level, this evidence provides a potential foundation for the development of integrated care models that can be delivered as part of routine practice.
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Thomas S, Cotroneo S, Pham D, Kalogeropoulos R, Tyler J, Arunogiri S. Social work in alcohol and other drug service navigation: supporting social complexity in dual diagnosis. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-10-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose
Many people with dual diagnosis present with social complexity that impedes service access. The role of social work support in such service navigation is poorly understood. This study aims to characterise client presentations to an Australian telephone-based social work alcohol and other drug (AOD) service navigation and linkage program, with consideration of presentation complexity compared between those clients who present with or without self-reported mental health (MH) concerns and a history of MH diagnoses, to identify differences in baseline characteristics, and linkage outcomes.
Design/methodology/approach
A retrospective audit was conducted of routinely collected clinical information from a six-month period, selected to capture the social and health challenges experienced during the mid-pandemic period (mid-2021) in Victoria, Australia, during which a number of lockdowns resulted in a reliance on telephone-based services. The audit focused on client and presentation characteristics, and compared clients with and without a history of co-occurring MH and AOD concerns.
Findings
It was found that three in four people accessing an Australian telephone-based AOD service navigation and linkage program presented with dual diagnosis. Individuals with dual diagnosis required more support from the service compared to those without a co-occurring MH disorder; but overall, were just as likely to achieve a successful linkage to services, when offered holistic, long-term social work support.
Originality/value
This study focused on the role of social workers in this service navigation program in supporting individuals with complexity. It also highlights the challenges in operationalising social complexity factors alongside clinical MH and AOD diagnoses, and points to the need for further research to guide future service development for this vulnerable client group.
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Morse AK, Sercombe J, Askovic M, Fisher A, Marel C, Chatterton ML, Kay-Lambkin F, Barrett E, Sunderland M, Harvey L, Peach N, Teesson M, Mills KL. Systematic review of the efficacy, effectiveness, and cost-effectiveness of stepped-care interventions for the prevention and treatment of problematic substance use. J Subst Abuse Treat 2023; 144:108928. [PMID: 36370469 DOI: 10.1016/j.jsat.2022.108928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 09/15/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stepped-care is a commonly recommended and implemented care model across health care domains, including substance use. Despite their presumed efficient allocation of treatment resources, a current and robust evidence synthesis is needed on the efficacy, effectiveness and cost-effectiveness of stepped-care for substance use. METHODS This systematic review analyzed articles describing evaluations of stepped-care models that measured the use of acutely psychoactive substances (i.e., alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, and stimulants) as a primary or secondary outcome, in participants over 18 years old. The analysis investigated model and participant characteristics associated with treatment outcomes. RESULTS The study team conducted a search of five databases of literature (PsychINFO, MEDLINE, Embase, Cochrane Library and Scopus) published between January 1, 2010, and November 1, 2020. The search yielded 1051 unique articles, 19 of which were included in the analysis. The studies had considerable variability in sample sizes (n = 18-2310), time to follow-up (4.5 months to 3 years), and retention rates (35.1-100 %). Studies examined outcomes for either alcohol alone (n = 9), alcohol and other drug use (n = 9), or drug use alone (n = 1). Most studies (n = 13;) were rated as good quality. Three (15.8 %) were rated as fair and three (15.8 %) were rated as poor quality. The evidence regarding the efficacy, effectiveness and cost-effectiveness of stepped-care approaches is limited, but four of seven studies found that adaptive-care interventions delivered in the context of other systemic interventions produced greater benefit than control conditions in relation to at least one alcohol-related outcome. We have insufficient evidence to determine whether the modes or intensity of interventions included in the models, or decision rules used to step people up or down to differing levels of care, have an impact on outcome. CONCLUSION Heterogeneity between studies with regard to model and evaluation design limited the degree to which the analysis could draw robust conclusions. Sample recruitment and statistical power are particular challenges, and the field needs more innovative evaluation designs to assess the efficacy, effectiveness, and cost-effectiveness of stepped-care models.
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Affiliation(s)
- Ashleigh K Morse
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Jayden Sercombe
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Mina Askovic
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Alana Fisher
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Mary-Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong Waterfront Campus, Locked Bag 20001, Geelong, VIC 3220, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle Callaghan NSW 2308, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Logan Harvey
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Natalie Peach
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building, Camperdown, NSW 2006, Australia.
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Armoon B, Fleury MJ, Griffiths MD, Bayani A, Mohammadi R, Ahounbar E. Emergency Department Use, Hospitalization, and Their Sociodemographic Determinants among Patients with Substance-Related Disorders: A Worldwide Systematic Review and Meta-Analysis. Subst Use Misuse 2023; 58:331-345. [PMID: 36592043 DOI: 10.1080/10826084.2022.2161313] [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: 01/03/2023]
Abstract
Background: Identifying the determinants of emergency department (ED) use and hospitalization among patients with substance-related disorders (SRD) can help inform healthcare services and case management regarding their unmet health needs and strategies to reduce their acute care. Objectives: The present study aimed to identify sociodemographic characteristics, type of used drug, and risky behaviors associated with ED use and hospitalization among patients with SRD. Methods: Studies in English published from January 1st, 1995 to April 30th, 2022 were searched from PubMed, Scopus, Cochrane Library, and Web of Science to identify primary studies on ED use and hospitalization among patients with SRD. Results: Of the 17,348 outputs found, a total of 39 studies met the eligibility criteria. Higher ED use and hospitalization among patients with SRD were associated with a history of homelessness (ED use: OR = 1.93, 95%CI = 1.32-2.83; hospitalization: OR = 1.53, 95%CI = 1.36-1.73) or of injection drug use (ED use: OR = 1.34, 95%CI = 1.13-1.59; hospitalization: OR = 1.42, 95%CI = 1.20-1.69). Being female (OR = 1.24, 95%CI = 1.14-1.35), using methamphetamine (OR = 1.99, 95%CI = 1.24-3.21) and tobacco (OR = 1.25, 95%CI = 1.11-1.42), having HIV (OR = 1.70, 95%CI = 1.47-1.96), a history of incarceration (OR = 1.90, 95%CI = 1.27-2.85) and injury (OR = 2.62, 95%CI = 1.08-6.35) increased ED use only, while having age over 30 years (OR = 1.40, 95%CI = 1.08-1.81) and using cocaine (OR = 1.60, 95%CI = 1.32-1.95) increased hospitalization only among patients with SRD. Conclusions: The finding outline the necessity of developing outreach program and primary care referral for patients with SRD. Establishing a harm reduction program, incorporating needle/syringe exchange programs, and safe injection training with the aim of declining ED use and hospitalization, is likely be another beneficial strategy for patients with SRD.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University InstituteMontreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia.,Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Mefodeva V, Carlyle M, Walter Z, Chan G, Hides L. Polysubstance use in young people accessing residential and day-treatment services for substance use: substance use profiles, psychiatric comorbidity and treatment completion. Addiction 2022; 117:3110-3120. [PMID: 35851706 PMCID: PMC9804256 DOI: 10.1111/add.16008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS People with substance use disorders (SUDs) frequently present to treatment with polysubstance use and mental health comorbidities. Different combinations of substance use and mental health problems require different treatment approaches. Our study aimed to: (i) identify the shared substance use classes among young people at treatment admission, (ii) determine which mental health symptoms, quality of life (QoL) and service types were associated with the identified substance use classes, and (iii) prospectively determine which substance use classes and service types were more likely to complete treatment. DESIGN Cross-sectional and prospective study using service and outcome data. SETTING Substance use treatment services in Queensland and New South Wales, Australia. PARTICIPANTS De-identified service and outcome measure data were extracted from the files of 744 clients aged 18-35 years (48% male) admitted into seven residential and four day-treatment programmes. MEASUREMENTS Substance use and severity among tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, opioids, sedatives and inhalants. Other variables included: depression, anxiety, post-traumatic stress and psychotic symptoms, as well as QoL. FINDINGS Latent class analysis identified three polysubstance use classes: wide-ranging polysubstance users (WRPU; 22.45%), primary amphetamine users (56.45%) and alcohol and cannabis users (21.10%). The WRPU class had higher odds of psychotic symptoms than the alcohol and cannabis use class [odds ratio (OR) = 1.30; 95% confidence interval (CI) = 1.11-1.11]; and double the odds of residential programme enrolment than those in the amphetamine use class (OR = 2.35; 95% CI = 1.50-3.68). No other class differences on mental health or QoL variables were found. Clients enrolled in day-programmes had higher odds of completing treatment. CONCLUSIONS There appear to be high levels of polysubstance use among young people entering substance use treatment in Australia. Wide-ranging polysubstance users were more likely to report psychotic symptoms and be enrolled into a residential programme than primary amphetamine users and alcohol and cannabis users.
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Affiliation(s)
- Valeriya Mefodeva
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Molly Carlyle
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Zoe Walter
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Gary Chan
- National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
| | - Leanne Hides
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia,National Centre for Youth Substance Use Research (NCYSUR)University of QueenslandBrisbaneQueenslandAustralia
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Formánek T, Krupchanka D, Mladá K, Winkler P, Jones PB. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. Lancet Psychiatry 2022; 9:957-968. [PMID: 36335974 DOI: 10.1016/s2215-0366(22)00335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.
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Affiliation(s)
- Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Pilsen, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Dachew BA, Bifftu BB, Tiruneh BT, Anlay DZ, Wassie MA. Prevalence of mental distress and associated factors among university students in Ethiopia: a meta-analysis. J Ment Health 2022; 31:851-858. [PMID: 31250685 DOI: 10.1080/09638237.2019.1630717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mental distress is an important public health problem and is becoming common health problems among university students. AIMS This study aimed to provide a pooled prevalence of mental distress and associated factors among university students in Ethiopia. METHOD We systematically searched PubMed, EMBASE and PsycINFO databases. A further search was performed at Google Scholar search engine for additional studies. All observational studies reporting the prevalence of mental distress and/or associated factors among university students in Ethiopia were included. Pooled prevalence with 95% confidence interval (95% CI) were calculated using random effects and quality effects models. Subgroup and sensitivity analyses were performed. Heterogeneity between studies and evidence of publication bias were assessed. RESULTS The pooled prevalence of mental distress was 35% (95% CI; 28%-43%). Being female, participating in religious programmes, having close friends, experiencing financial distress, alcohol use, khat use, conflict with friends, lack of interest in their field of study and a family history of mental illness were factors associated with mental distress among students. We found significant heterogeneity, but no evidence of publication bias. CONCLUSIONS More than one third of university students in Ethiopia have suffered with mental distress. The finding provides evidence that university students are at risk population for mental health problems and suggests the need for early intervention to prevent severe mental illness.
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Affiliation(s)
- Berihun Assefa Dachew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Brhanu Boru Bifftu
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewket Tadesse Tiruneh
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degefaye Zelalem Anlay
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pai N, Vella SL, Castle D. A comparative review of the epidemiology of mental disorders in Australia and India. Asia Pac Psychiatry 2022; 14:e12517. [PMID: 35667856 DOI: 10.1111/appy.12517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
Mental illness and substance use disorders have been increasing worldwide. Mental illness has a significant impact upon the lives of the individual as well as their loved ones. Mental disorders are known to result in a high level of disability. This article provides a comparative review of the epidemiology of mental disorders in Australia and India, summarizing and comparing prevalence rates in both countries based upon available data. Overall, it is evident that Australia has higher prevalence rates of mental disorders than India, across most diagnostic groups. Australia has the highest prevalence of anxiety disorders whereas India has the highest prevalence of substance use disorders; including tobacco use disorders. The next most prevalent mental disorders in India are depressive disorders. However, there are demographic parameters such as gender and age as well as service-provision differences across the countries that need to be factored into any interpretation of the data. There are also problems associated with different diagnostic instruments with language and cultural nuances that may impact comparisons. We suggest that a joint epidemiological survey between the two countries would help better understand and delineate the key similarities pertaining to the epidemiology of mental disorders in Australia and India. This will in turn assist with the development of policy and treatment of mental disorders.
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Affiliation(s)
- Nagesh Pai
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Shae-Leigh Vella
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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36
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Merrick TT, Louie E, Cleary M, Molloy L, Baillie A, Haber P, Morley KC. A systematic review of the perceptions and attitudes of mental health nurses towards alcohol and other drug use in mental health clients. Int J Ment Health Nurs 2022; 31:1373-1389. [PMID: 35909095 PMCID: PMC9796325 DOI: 10.1111/inm.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 01/01/2023]
Abstract
Mental and substance use disorders are leading contributing factors for the Australian non-fatal burden of disease. These disorders frequently co-occur in the mental health population, and mental health nurses are the largest group of professionals treating dual diagnosis. A comprehensive understanding of mental health nurses' attitudes and perceptions is required to inform future implementation of dual diagnosis training programs. A systematic literature review of sources derived from electronic databases including Medline, CINAHL, SCOPUS review, and PsychINFO, along with Connected Papers. Selection criteria included a focus on mental health nurses' attitudes towards dual diagnosis of mental illness and substance use. Extracted data was qualitatively synthesized. Of the 5232 articles retrieved initially, 12 were included in the review. Four themes emerged from the synthesis: drug and alcohol use among mental health consumers (seven studies), caring for dual diagnosis consumers (eight studies), role perception (six studies), and treatment optimism (five studies). Salient beliefs included substance use as a self-inflicted choice (71%) or a form of 'self-medication' (29%); a lack of willingness to provide care (75%), or a strong commitment to care (25%); greater comfort with screening and acute medical management rather than ongoing management (83%); and pessimism about treatment effectiveness (100%). Mental health nurses' beliefs and attitudes towards dual diagnosis were often negative, which is likely to result in poor quality care and treatment outcomes. However, the lack of recent studies in this research area indicates the need for up-to-date knowledge that can inform the development of training programs.
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Affiliation(s)
- Tammy Tran Merrick
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Eva Louie
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Science, Central Queensland University, Queensland, Rockhampton, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Haber
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten C Morley
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Edith Collins Centre for Translational Research, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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37
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Guiding Principles for Managing Co-occurring Alcohol/Other Drug and Mental Health Conditions: a Scoping Review. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AbstractThis scoping review aimed to synthesise the published literature on guiding principles for managing co-occurring alcohol/other drug (AOD) and mental health conditions in AOD treatment settings. Systematic search of key electronic databases (January 1, 2010, to February 17, 2021) produced 4583 articles, and independent title/abstract and full text screening left 43 articles for inclusion. Fifteen guiding principles were identified, most commonly: build a strong therapeutic relationship (n = 24 articles), provide holistic care (n = 12), involve peer support (n = 7), ensure continuity of care (n = 6), support the professional development and competence of workers (n = 6), and provide trauma-informed care (n = 5). Remaining principles were identified in < 5 articles. Limited empirical literature examined the impact of guiding principles on patient- and treatment-related outcomes. This review provides the first comprehensive synthesis of the international literature to derive guiding principles for managing co-occurring AOD and mental health conditions in AOD treatment. Further empirical research is needed to determine the effectiveness of principles at improving outcomes.
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38
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Sato T. Interventions for Co-occurring Cannabis Use and Depression. Cureus 2022; 14:e27632. [PMID: 36072196 PMCID: PMC9438295 DOI: 10.7759/cureus.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
This review aimed to investigate the effective intervention options for depression in patients with a history of cannabis use. The study eligibility criteria were as follows: English-language, peer-reviewed human studies; data not previously reported elsewhere; randomized controlled trials, non-randomized trials comparing an intervention group and a control group, and single-group trials. In total, eight studies of interventions for patients with depression who reported cannabis use were identified. Four studies evaluated the effectiveness of the following three pharmacological interventions: extended quetiapine release, extended venlafaxine release, and fluoxetine. However, all studies failed to demonstrate the effectiveness of these drugs. Four studies evaluated the following psychological interventions: motivational interviewing (MI) and cognitive behavior therapy (CBT). These studies found that CBT may improve depression symptoms and cannabis dependence, and MI was associated with improvements in cannabis dependence. CBT and MI may be effective in improving depression and reducing cannabis use. However, the conclusions of this review are limited because of the small number of studies and their low quality. Higher-quality research is required to evaluate the effectiveness of CBT, MI, and other interventions for comorbid cannabis use and depression.
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39
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Björkstedt SM, Koponen H, Kautiainen H, Gissler M, Pennanen P, Eriksson JG, Laine MK. Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in Primiparous Women. Front Public Health 2022; 10:880339. [PMID: 35910895 PMCID: PMC9326245 DOI: 10.3389/fpubh.2022.880339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background: One in four women of childbearing age has some degree of mental disorders and are, therefore, prone to both pregnancy complications and adverse health outcomes in their offspring. We aimed to evaluate the impact of preconception severe mental disorders on pregnancy outcomes in primiparous women. Methods The study cohort was composed of 6,189 Finnish primiparous women without previously diagnosed diabetes, who delivered between 2009 and 2015, living in the city of Vantaa, Finland. Women were classified to have a preconception severe mental disorder if they had one or more outpatient visits to a psychiatrist or hospitalization with a psychiatric diagnosis 1 year before conception. Data on pregnancies, diagnoses, and pregnancy outcomes were obtained from national registers at an individual level. Results Primiparous women with preconception severe psychiatric diagnosis were younger, more often living alone, smokers, and had lower educational attainment and lower taxable income than women without psychiatric diagnosis (for all p < 0.001). Of all women, 3.4% had at least one psychiatric diagnosis. The most common psychiatric diagnoses were depression and anxiety disorders. The most common comorbidity was the combination of depression and anxiety disorders. There were no differences in the need for respiratory treatments, admissions to the neonatal intensive care unit, or antibiotic treatments between the offspring's groups. Conclusion Although primiparous women had severe mental disorders, the well-being of newborns was good. The most common severe mental health disorders were depression and anxiety disorders, and psychiatric comorbidity was common. Women with severe mental disorders more often belonged to lower socioeconomic groups.
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Affiliation(s)
- Satu-Maarit Björkstedt
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Social Services and Health Care Division, Helsinki, Finland
- *Correspondence: Satu-Maarit Björkstedt
| | - Hannu Koponen
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institute and Region Stockholm, Stockholm, Sweden
| | | | - Johan G. Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Obstetrics and Gynecology and Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Agency for Science, Technology and Research (ASTAR), Singapore Institute for Clinical Sciences (SICS), Singapore, Singapore
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
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40
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Robinson LD, Deane FP. Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings. J Dual Diagn 2022; 18:165-176. [PMID: 35790104 DOI: 10.1080/15504263.2022.2090648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.
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Affiliation(s)
- Laura D Robinson
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- Centre for Health Psychology Practice and Research, University of Wollongong, Wollongong, Australia.,School of Psychology, Faculty of the Arts, Social Sciences and Humanities University of Wollongong, Wollongong, Australia
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41
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Saha S, Lim CC, Degenhardt L, Cannon DL, Bremner M, Prentis F, Lawrence Z, Heffernan E, Meurk C, Reilly J, McGrath JJ. Comorbidity between mood and substance-related disorders: A systematic review and meta-analysis. Aust N Z J Psychiatry 2022; 56:757-770. [PMID: 34708662 DOI: 10.1177/00048674211054740] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Evidence indicates that mood disorders often co-occur with substance-related disorders. However, pooling comorbidity estimates can be challenging due to heterogeneity in diagnostic criteria and in the overall study design. The aim of this study was to systematically review and, where appropriate, meta-analyse estimates related to the pairwise comorbidity between mood disorders and substance-related disorders, after sorting these estimates by various study designs. METHODS We searched PubMed (MEDLINE), Embase, CINAHL and Web of Science for publications between 1980 and 2017 regardless of geographical location and language. We meta-analysed estimates from original articles in 4 broadly defined mood and 35 substance-related disorders. RESULTS After multiple eligibility steps, we included 120 studies for quantitative analysis. In general, regardless of variations in diagnosis type, temporal order or use of adjustments, there was substantial comorbidity between mood and substance-related disorders. We found a sixfold elevated risk between broadly defined mood disorder and drug dependence (odds ratio = 5.7) and fivefold risk between depression and cannabis dependence (odds ratio = 4.9) while the highest pooled estimate, based on period prevalence risk, was found between broadly defined dysthymic disorder and drug dependence (odds ratio = 11.3). Based on 56 separate meta-analyses, all pooled odds ratios were above 1, and 46 were significantly greater than 1 (i.e. the 95% confidence intervals did not include 1). CONCLUSION This review found robust and consistent evidence of an increased risk of comorbidity between many combinations of mood and substance-related disorders. We also identified a number of under-researched mood and substance-related disorders, suitable for future scrutiny. This review reinforces the need for clinicians to remain vigilant in order to promptly identify and treat these common types of comorbidity.
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Affiliation(s)
- Sukanta Saha
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Carmen Cw Lim
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Danielle L Cannon
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Monique Bremner
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Finley Prentis
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Zoe Lawrence
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Ed Heffernan
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Carla Meurk
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - John Reilly
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Division, Queensland Health, Brisbane, QLD, Australia
| | - John J McGrath
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116607. [PMID: 35682194 PMCID: PMC9180458 DOI: 10.3390/ijerph19116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.
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43
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Fleury MJ, Grenier G, Cao Z, Huỳnh C, Chihade D. Predictors of Emergency Department Use for Suicidal Behaviors among Patients with Substance-Related Disorders. Arch Suicide Res 2022; 27:796-817. [PMID: 35499529 DOI: 10.1080/13811118.2022.2066591] [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: 11/02/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada). METHODS Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addiction treatment centers in 2012-13 were extracted from Quebec administrative databases. A multinomial logistic regression was produced, comparing predictors of suicide ideation or attempts to other reasons for ED use in 2015-16. RESULTS Patients using ED for both suicide ideation and attempt were more likely to have bipolar or personality disorders, problems related to the social environment, 4+ previous yearly outpatient consultations with their usual psychiatrist, high prior ED use, and dropout from SRD programs in addiction treatment centers in the previous 7 years, compared with those using ED for other reasons. Patients with alcohol- or drug-related disorders other than cannabis and living in the least materially deprived areas, urban territories, and university healthcare regions made more suicide attempts than those using ED for other reasons. Patients with common mental disorders, 1-3 previous yearly outpatient consultations with their usual psychiatrist, one previous treatment episode in addiction treatment centers, and those using at least one SRD program experienced more suicide ideation than patients using ED for other reasons. CONCLUSION Clinical variables most strongly predicted suicidal behaviors, whereas completion of SRD programs may help to reduce them. SRD services and outreach strategies should be reinforced, particularly for patients with complex issues living in more advantaged urban areas. HIGHLIGHTSOver 10% of ED visits were for suicidal behaviors among patients with SRD.ED use for suicidal behaviors was mainly associated with clinical variables.Addiction treatment centers may help reduce ED use for suicidal behaviors.
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Psychiatric Comorbidities of Substance Use Disorders: Does Dual Diagnosis Predict Inpatient Detoxification Treatment Outcomes? Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00821-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractComorbidity of substance use and psychiatric disorders, particularly depressive disorders, are well established. The impact of comorbidity on treatment outcomes, particularly following short-term inpatient detoxification and medical management units, has yet to be fully explored. This study reviewed 456 records of patients voluntarily presenting for medical management of substance misuse in Sydney, Australia. Documented psychiatric comorbidities and primary substance of misuse were extracted and used to predict length of stay, discharge against medical advice and number of readmissions. Our results showed that psychiatric comorbidity did not significantly predict treatment outcomes, although depression was reported in more than half our cohort, along with elevated rates of Post-traumatic Stress Disorder, anxiety disorders and bipolar affective disorders. Medication non-compliance and primary substance of misuse significantly predicted length of stay and discharge against medical advice. Further research into how specific substances interact and affect specific psychiatric disorders is needed to guide optimal treatment options.
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45
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Deans E, Ravulo J, Conroy E, Abdo J. A qualitative study exploring young offenders' perspectives on alcohol and other drug health promotion. BMC Public Health 2022; 22:568. [PMID: 35317763 PMCID: PMC8941814 DOI: 10.1186/s12889-022-12953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Drugs and alcohol can cause significant harm to individuals, families and communities. Young offenders represent an important population group, which often sport many characteristics that make them highly vulnerable to experiencing harm from drug use. For decades, research has shown the complexity of health behaviours and the need to consider consumer perspectives to respond and support different populations effectively. Methods This study utilised qualitative inquiry to explore young offenders’ (aged 13 to 18 years) experiences with drug use. The study sought to discern the pathways to drug dependencies for young people and to understand how community organisations can better support young people involved with the justice system. Results Three themes were identified in the data. First, the clear lack of knowledge about how to reduce harm from drug use among young offenders. Second, the structural and environmental influences on drug use and the need to develop personal skills and knowledge, alongside advocating for supportive environments for good health. Third, the power and hope that a youth advocate with lived experience can bring to the harm prevention and health promotion field. Conclusions Community services have an integral role in ensuring drug and alcohol education is accessible for different youth populations. Importantly, health promotion organisations should raise awareness about the environmental influences on drug use behaviours, and work deliberately to include consumer perspectives in the design and planning of prevention and harm reduction strategies.
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Affiliation(s)
| | | | | | - Joseph Abdo
- University of Wollongong, Wollongong, Australia
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46
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Le SM, Trouiller P, Duong TH, Khuat THO, Pham MK, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, Nham TTT, Hoang TG, Feelemyer J, Vu HV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N, Michel L. Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs. Drug Alcohol Rev 2022; 41:697-705. [PMID: 34786755 PMCID: PMC10150937 DOI: 10.1111/dar.13402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. METHODS We devised a tool that included nine questions covering anxiety, depression, suicide risk and psychotic symptomatology. Its use required no specific background and 2 h training. Specificity and sensitivity of the QST were assessed in a population of 418 PWID recruited via respondent driven sampling, using the Mini International Neuropsychiatric Interview questionnaire plus clinical evaluation as a reference standard. Acceptability was assessed using a self-administered anonymous questionnaire submitted to all CBO members who used the QST. RESULTS CBO members considered the QST easy to use, relevant and helpful to deal with mental health issues. Area under the curve for detection of any symptom using the QST was 0.770. The maximum sensitivity and specificity were reached with a cut-off of 2 [sensitivity was 71.1% (95% confidence interval 62.4, 78.8), specificity was 75.9% (70.5, 80.7)]. DISCUSSION AND CONCLUSIONS The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.
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Affiliation(s)
- Sao M Le
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Philippe Trouiller
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Thi H Duong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Thi H O Khuat
- Supporting Community Development Initiatives, Hanoi, Vietnam
| | - Minh K Pham
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Catherine Quillet
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Thuy L Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Quang D Nguyen
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Thi G Hoang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hai V Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Hong Q Doan
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, Nîmes, France
| | | | - Nicolas Nagot
- Pathogenesis and Control of Chronic Infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
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47
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Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100337. [PMID: 35024661 PMCID: PMC8669310 DOI: 10.1016/j.lanwpc.2021.100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding : This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
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Key Words
- ANRS, French Agency for Research on AIDS and Viral Hepatitis
- CBO, community-based organization
- CGI, clinical global impression scale
- DRIVE, Drug-Related Infections in ViEtnam
- EQ5D5L, 5 levels/5 dimensions EuroQol instrument
- HIV, human immunodeficiency virus
- LMICs, low-middle income countries
- MINI, MINI international neuropsychiatric interview
- MMT, methadone maintenance treatment
- NIDA, National Institute on Drug Abuse
- PHQ, patient health questionnaire
- PWID, people who inject drugs
- RDS, respondent driven sampling
- SCDI, Supporting Community Development Initiatives
- VND, Vietnamese dong
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48
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Gooden JR, Petersen V, Bolt GL, Curtis A, Manning V, Cox CA, Lubman DI, Arunogiri S. Maybe It's Not the Meth: Considering Biopsychosocial Contributors to Cognitive Impairment in Methamphetamine Polydrug Use. Front Psychiatry 2022; 13:795400. [PMID: 35237189 PMCID: PMC8882579 DOI: 10.3389/fpsyt.2022.795400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE In considering the cognitive harms of methamphetamine (MA) use, there is currently a limited appreciation of the profile of pre-existing, comorbid, or modifiable risk factors for cognitive impairment in individuals with MA-polydrug use who present to clinical services. This is in contrast to the well-recognized evidence in alcohol use groups. The aim of this study was to investigate the biopsychosocial and neuropsychological profiles of MA-polysubstance using individuals reporting cognitive impairment in comparison to an alcohol-using group. METHODS A retrospective file audit was undertaken of individuals who presented for assessment to a specialist addiction neuropsychology service and reported either more than 1 year of heavy MA use as part of a polydrug use history (n = 40) or having only used alcohol (n = 27). Clinical histories including demographic, medical, mental health, substance use, and neuropsychological assessment results were extracted from medical records. Between group comparisons were conducted to explore differences in the MA-polydrug vs. the alcohol group. RESULTS Individuals in the MA-polydrug group were significantly younger, commenced substance use at an earlier age, were more likely to have an offending history, and experienced an overdose than those in the alcohol group. No differences in comorbid neurodevelopmental, psychiatric or acquired brain injury diagnoses were observed between groups. For neuropsychological functioning, significant group differences were observed in overall IQ, semantic verbal fluency, and psychomotor tracking, where individuals in the alcohol group performed significantly worse. CONCLUSIONS Neuropsychological profiles were largely equivalent between groups across cognitive domains, with minor differences in favor of the MA-polydrug group. Relative to the general population, cognitive functioning was reduced for both groups across a range of domains. High rates of comorbid mental health concerns were common across both groups, however, individuals in the MA-polydrug group presented with a higher risk of overall harm from substance use at a significantly younger age which is a unique concern for this group. These findings highlight the importance of considering the biopsychosocial factors, such as age of first use, emotional distress, indirect substance related harms including overdose and blood born virus infection that may be relevant to experiences of cognitive difficulty in MA-polydrug users.
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Affiliation(s)
- James R Gooden
- Turning Point, Eastern Health, Richmond, VIC, Australia.,The National Centre for Clinical Research on Emerging Drugs, University of New South Wales, Sydney, NSW, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | | | - Ashlee Curtis
- Centre for Drug Use, Addictive and Anti-Social Behaviour Research, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Victoria Manning
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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49
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Armoon B, Grenier G, Cao Z, Huỳnh C, Fleury MJ. Frequencies of emergency department use and hospitalization comparing patients with different types of substance or polysubstance-related disorders. Subst Abuse Treat Prev Policy 2021; 16:89. [PMID: 34922562 PMCID: PMC8684146 DOI: 10.1186/s13011-021-00421-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background This study measured emergency department (ED) use and hospitalization for medical reasons among patients with substance-related disorders (SRD), comparing four subgroups: cannabis-related disorders, drug-related disorders other than cannabis, alcohol-related disorders and polysubstance-related disorders, controlling for various clinical, sociodemographic and service use variables. Methods Clinical administrative data for a cohort of 22,484 patients registered in Quebec (Canada) addiction treatment centers in 2012-13 were extracted for the years 2009-10 to 2015-16. Using negative binomial models, risks of frequent ED use and hospitalization were calculated for a 12-month period (2015-16). Results Patients with polysubstance-related disorders used ED more frequently than other groups with SRD. They were hospitalized more frequently than patients with cannabis or other drug-related disorders, but less frequently than those with alcohol-related disorders. Patients with alcohol-related disorders used ED more frequently than those with cannabis-related disorders and underwent more hospitalizations than both patients with cannabis-related and other drug-related disorders. Co-occurring SRD-mental disorders or SRD-chronic physical illnesses, more years with SRD, being women, living in rural territories, more frequent consultations with usual general practitioner or outpatient psychiatrist, and receiving more interventions in community healthcare centers increased frequency of ED use and hospitalization, whereas both adverse outcomes decreased with high continuity of physician care. Behavioral addiction, age less than 45 years, living in more materially deprived areas, and receiving 1-3 interventions in addiction treatment centers increased risk of frequent ED use, whereas living in semi-urban areas decreased ED use. Patients 25-44 years old receiving 4+ interventions in addiction treatment centers experienced less frequent hospitalization. Conclusion Findings showed higher risk of ED use among patients with polysubstance-related disorders, and higher hospitalization risk among patients with alcohol-related disorders, compared with patients affected by cannabis and other drug-related disorders. However, other variables contributed substantially more to the frequency of ED use and hospitalization, particularly clinical variables regarding complexity and severity of health conditions, followed by service use variables. Another important finding was that high continuity of physician care helped decrease the use of acute care services. Strategies like integrated care and outreach interventions may enhance SRD services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-021-00421-7.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances du Centre intégré universitaire de santé et des services sociaux du Centre-Sud-de-l'Île-de-Montréal, 950 Louvain Est, Montréal, Québec, H2M 2E8, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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50
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Roberts A, Rogers J, Mason R, Siriwardena AN, Hogue T, Whitley GA, Law GR. Alcohol and other substance use during the COVID-19 pandemic: A systematic review. Drug Alcohol Depend 2021; 229:109150. [PMID: 34749198 PMCID: PMC8559994 DOI: 10.1016/j.drugalcdep.2021.109150] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although evidence suggests substance and alcohol use may change during the Covid-19 pandemic there has been no full review of the evidence around this. METHODS A systematic review of all available evidence was carried out to document and interpret the frequency and severity of alcohol and other substance use during the Covid-19 pandemic and their relationship to demographic and mental health variables that may suggest further clinical implications. Peer reviewed articles in MEDLINE, Embase, PsycINFO, CINAHL complete and Sociological Abstracts were searched from December 2019 until November 2020. RESULTS The search and screening identified 45 articles from 513 deduplicated records. The evidence suggests a mixed picture for alcohol use. Overall, there was a trend towards increased alcohol consumption. The proportion of people consuming alcohol during the pandemic ranged from 21.7% to 72.9% in general population samples. Unlike alcohol use, there was a clear trend towards increased use of other substances use during the COVID-19 pandemic. The proportion of people consuming other substances during the pandemic ranged from 3.6% to 17.5% in the general population. Mental health factors were the most common correlates or triggers for increased use of both alcohol and other substances. CONCLUSION There is an increased need for treatment for alcohol and other substance use related problems during the pandemic. Increased targeting and evidence-based interventions will also be important in the period which follows this pandemic, to improve the quality of life for individuals and families, but also to prevent additional costs to society and health systems.
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Affiliation(s)
- Amanda Roberts
- School of Psychology, College of Social Science, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Jim Rogers
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
| | - Rachael Mason
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
| | - Aloysius Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
| | - Todd Hogue
- School of Psychology, College of Social Science, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
| | - Gregory Adam Whitley
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
| | - Graham R Law
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK
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