1
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Medenblik AM, Garner AR, Basting EJ, Sullivan JA, Jensen MC, Shorey RC, Stuart GL. Examining trauma, anxiety, and depression as predictors of dropout from residential treatment for substance use disorders. J Clin Psychol 2024; 80:1767-1779. [PMID: 38662953 DOI: 10.1002/jclp.23692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/27/2024] [Accepted: 04/01/2024] [Indexed: 07/05/2024]
Abstract
Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one's health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.
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Affiliation(s)
- Alyssa M Medenblik
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Alisa R Garner
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Evan J Basting
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Jacqueline A Sullivan
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Mary C Jensen
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
| | - Ryan C Shorey
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Gregory L Stuart
- Department of Psychology, University of Tennessee-Knoxville, Knoxville, Tennessee, USA
- Residential Addiction Treatment Center, Cornerstone of Recovery, Alcoa, Tennessee, USA
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2
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Donato S, Ray LA. Neurobiology and the Treatment of Alcohol Use Disorder: A Review of the Evidence Base. Subst Abuse Rehabil 2023; 14:157-166. [PMID: 38026786 PMCID: PMC10657770 DOI: 10.2147/sar.s409943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Alcohol use disorder (AUD) is a significant public health concern, accounting for a majority of substance use disorder cases in the United States. Treatment for AUD is complex, with multiple intervention points that may be further complicated by genotype and phenotype, resulting in diverse outcomes. In order to better understand the current landscape of AUD treatment, the present review considers different etiological models of AUD and assesses the evidence base of current treatment options. The first section of this review summarizes various etiological models of AUD and presents different approaches to classifying the disorder. Various theories, including neurobiological models, are discussed. The second section presents a comprehensive analysis of available treatment options for AUD, encompassing behavioral and pharmacological interventions and their current evidence base. Finally, this review discusses the ongoing treatment gap and significant factors contributing to low treatment utilization. Together, this review provides an overview of different etiological processes and mechanisms of AUD, as well as summarizes the literature on key treatment approaches. By integrating historical, theoretical, and empirical data, this review aims to inform both researchers and providers with valuable insights to advance AUD treatment approaches and narrow the treatment gap.
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Affiliation(s)
- Suzanna Donato
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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3
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Venegas A, Donato S, Meredith LR, Ray LA. Understanding low treatment seeking rates for alcohol use disorder: A narrative review of the literature and opportunities for improvement. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:664-679. [PMID: 34464542 PMCID: PMC9059657 DOI: 10.1080/00952990.2021.1969658] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Despite a well-documented global burden of disease attributable to alcohol use disorder (AUD), treatment seeking rates remain low. In this qualitative literature review, we address treatment seeking for AUD from a host of perspectives and summarize the literature on key factors. First, we summarize the rates of alcohol treatment seeking across various epidemiological surveys, spanning decades. Second, we discuss the definition of treatment seeking and 'what' is typically considered formal treatment. Third, we consider timing and discuss 'when' individuals are most likely to seek treatment. Fourth, we review the literature on 'who' is most likely to seek treatment, including demographic and clinical correlates. Fifth, we address the critical question of 'why' so few people receive clinical services for AUD, relative to the number of individuals affected by the disorder, and review barriers to treatment seeking at the treatment- and person-levels of analysis. Finally, we identify opportunities to improve treatment seeking rates by focusing on tangible points of intervention. Specifically, we recommend a host of adaptations to models of care including efforts to make treatment more appealing across stages of AUD severity, accept a range of health-enhancing drinking goals as opposed to an abstinence-only model, educate providers and consumers about evidence-based behavioral and pharmacological treatments, and incentivize the delivery of evidence-based services.
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Affiliation(s)
- Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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4
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Puangsri P, Jinanarong V, Wattanapisit A. Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19. Clin Pract Epidemiol Ment Health 2021; 17:52-60. [PMID: 34497660 PMCID: PMC8386085 DOI: 10.2174/1745017902117010052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022]
Abstract
The outbreak of coronavirus disease (COVID-19) in December 2019 has led to massive lifestyle, economic, and health changes. The COVID-19 pandemic has had broad impacts on psychiatric patients, exacerbating symptoms such as psychosis, depression, and suicidal ideation. Therefore, we aimed to review the psychological impacts of COVID-19 on psychiatric patients and mental healthcare staff and provide practical guidance for medical staff and authorities. The main findings of this review included the impacts of COVID-19 on psychiatric patients and mental health professionals as well as the transformation of mental health care. Greater consideration should be given to the care of patients with psychosis and depression because of their lack of self-care ability, neurocognitive impairment, and impaired immune function. Depressive symptoms can be exacerbated due to several factors, such as economic crises, social isolation, and limited physical activity. Unemployment and financial problems can lead to an increased suicide rate. Consequently, mental healthcare workers’ workload can increase, which could lead to burnout and psychological symptoms such as insomnia, depression, and anxiety. A transformation of psychiatric care is needed during the time of the pandemic. While emergency care should be maintained, outpatient care should be limited to decrease viral spread. Shifting care to telemedicine and community-based psychiatry can be helpful. Inpatient services should be adapted by tightening admission criteria, shortening the length of hospital stays, suspending some group activities, limiting visitors, and preparing for quarantine if necessary. Mental healthcare workers can be supported with telecommunication, appropriate work shifts, alternative accommodations, and good communication between the team leader and staff.
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Affiliation(s)
- Pavarud Puangsri
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, Thailand
| | - Vinn Jinanarong
- Walailak University Hospital, Thasala, Nakhon Si Thammarat, Thailand
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5
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Freed MC. Remember the denominator: improving population impact of translational behavioral research. Transl Behav Med 2021; 10:667-673. [PMID: 32766861 DOI: 10.1093/tbm/ibz184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Michael C Freed
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
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Zhdanava M, Voelker J, Pilon D, Cornwall T, Morrison L, Vermette-Laforme M, Lefebvre P, Nash AI, Joshi K, Neslusan C. Cluster Analysis of Care Pathways in Adults with Major Depressive Disorder with Acute Suicidal Ideation or Behavior in the USA. PHARMACOECONOMICS 2021; 39:707-720. [PMID: 34043148 PMCID: PMC8166679 DOI: 10.1007/s40273-021-01042-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Suicidal ideation or behavior are core symptoms of major depressive disorder (MDD). This study aimed to understand heterogeneity among patients with MDD and acute suicidal ideation or behavior. METHODS Adults with a diagnosis of MDD on the same day or 6 months before a claim for suicidal ideation or behavior (index date) were identified in the MarketScan® Databases (10/01/2014-04/30/2019). A mathematical algorithm was used to cluster patients on characteristics of care measured pre-index. Patient care pathways were described by cluster during the 12-month pre-index period and up to 12 months post-index. RESULTS Among 38,876 patients with MDD and acute suicidal ideation or behavior, three clusters were identified. Across clusters, pre-index exposure to mental healthcare was revealed as a key differentiator: Cluster 1 (N = 16,025) was least exposed, Cluster 2 (N = 5640) moderately exposed, and Cluster 3 (N = 17,211) most exposed. Patients whose MDD diagnosis was first observed during their index event comprised 86.0% and 72.8% of Clusters 1 and 2, respectively; in Cluster 3, all patients had an MDD diagnosis pre-index. Within 30 days post-index, in Clusters 1, 2, and 3, respectively, 79.3%, 85.2%, and 88.2% used mental health services, including outpatient visits for MDD. Within 12 months post-index, 61.5%, 91.5%, and 84.6% had one or more antidepressant claim, respectively. Per-patient index event costs averaged $5614, $6645, and $5853, respectively. CONCLUSIONS Patients with MDD and acute suicidal ideation or behavior least exposed to the healthcare system pre-index similarly received the least care post-index. An opportunity exists to optimize treatment and follow-up with mental health services.
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Affiliation(s)
| | | | | | | | | | | | - Patrick Lefebvre
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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7
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Monahan PO, Kroenke K, Stump TE. SymTrak-8 as a Brief Measure for Assessing Symptoms in Older Adults. J Gen Intern Med 2021; 36:1197-1205. [PMID: 33174184 PMCID: PMC8131465 DOI: 10.1007/s11606-020-06329-5] [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: 04/25/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient- and caregiver-reported 23-item SymTrak scales were validated for monitoring clinically actionable symptoms and impairments associated with multiple chronic conditions (MCCs) in older adults. Items capture physical and emotional symptoms and impairments in physical and cognitive functioning. An abbreviated SymTrak is desirable when response burden is a concern. OBJECTIVE Develop and validate the 8-item SymTrak. DESIGN AND PARTICIPANTS Secondary analysis of SymTrak validation study; 600 participants (200 patient-caregiver dyads; 200 patients without an identified caregiver). MAIN MEASURES Demographic questions, SymTrak, and Health Utility Index Mark 3 (HUI3). KEY RESULTS SymTrak-8 demonstrated good fit to a one-factor model using confirmatory factor analysis (CFA). Concurrent criterion validity was supported by high standardized linear regression coefficients (STB) between baseline SymTrak-8 total score (independent variable) and baseline HUI3 preference-based overall HRQOL utility score (dependent variable; 0 = death, 1 = perfect health), after adjusting for demographics, comorbid conditions, and medications, with strength comparable to SymTrak-23 (STB = - 0.81 and - 0.84, respectively, for SymTrak-8 and SymTrak-23, when patient-reported; and - 0.60 and - 0.62, respectively, when caregiver-reported). Coefficient alpha (0.74; 0.76) and 24-h test-retest reliability (0.83; 0.87) were high for SymTrak-8 for patients and caregivers, respectively. The convergent correlation between brief and parent SymTrak scales was high (0.94). SymTrak-8 demonstrated approximate normality and a linear relationship with SymTrak-23 and HUI3. Importantly, a 3-month change in SymTrak-8 was sensitive to detecting the criterion (3-month reliable change categories; improved, stable, declined in HUI3 overall utility), with results comparable to SymTrak-23. CONCLUSIONS SymTrak-8 total score demonstrates internal reliably, test-retest reliability, criterion validity, and sensitivity to change that are comparable to SymTrak-23. Thus, patient- or caregiver-reported SymTrak-8 is a viable option for identifying and monitoring the aggregate effect of symptoms and functional impairments in patients with multimorbidity when response burden is a concern.
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Affiliation(s)
- Patrick O Monahan
- School of Medicine, Indiana University, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202-3002, USA. .,Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.
| | - Kurt Kroenke
- School of Medicine, Indiana University, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202-3002, USA.,Center for Health Information and Communication, VA HSR&D, Washington DC, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Timothy E Stump
- School of Medicine, Indiana University, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202-3002, USA
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8
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Abstract
Mental health disorders face less stigma today than in the past, yet they continue to be misdiagnosed and at times improperly treated. One account for this problem is that physicians rely exclusively on a verbal interview of patients for diagnosis. Because this diagnostic method is likely to be shaped by the way patients present their symptoms, it is critical that we examine whether and how patients' communication practices shape diagnostic and treatment outcomes. This study examines a sample of 14 encounters involving mental health-related symptoms from a dataset of adult primary care visits. Using conversation analytic methods, I show that when patients present mental health symptoms by simply describing the symptoms, primary care physicians exhibit a preference for providing a physical health diagnosis. Conversely, when patients provide a concrete link between their symptoms and the way the symptoms are disrupting their everyday lives, primary care physicians typically provide a mental health diagnosis.
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9
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Boscarino JJ, Figley CR, Adams RE, Urosevich TG, Kirchner HL, Boscarino JA. Mental health status in veterans residing in rural versus non-rural areas: results from the veterans' health study. Mil Med Res 2020; 7:44. [PMID: 32951600 PMCID: PMC7504679 DOI: 10.1186/s40779-020-00272-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 09/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. METHODS Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. RESULTS A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). CONCLUSIONS Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.
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Affiliation(s)
- Joseph J Boscarino
- Clinical Psychology Department, William James College, Newton, MA, 02459, USA
| | - Charles R Figley
- School of Social Work, Tulane University, New Orleans, LA, 70112, USA
| | - Richard E Adams
- Department of Sociology, Kent State University, Kent, OH, 44242, USA
| | | | - H Lester Kirchner
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, 100 N. Academy Avenue, 44-00, Danville, PA, 17822, USA.
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Carmona R, Cook BL, Baca-García E, Chavez L, Alvarez K, Iza M, Alegría M. Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid. J Behav Health Serv Res 2020. [PMID: 29516339 DOI: 10.1007/s11414-018-9596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.
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Affiliation(s)
- Rodrigo Carmona
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, 01241, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Enrique Baca-García
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain.,Psychiatry Department, Autonoma University of Madrid, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Curico, Chile
| | - Ligia Chavez
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, Rio Piedras, 00935, Puerto Rico
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Miren Iza
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA.
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11
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Muldoon OT, Haslam SA, Haslam C, Cruwys T, Kearns M, Jetten J. The social psychology of responses to trauma: social identity pathways associated with divergent traumatic responses. EUROPEAN REVIEW OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1080/10463283.2020.1711628] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Orla T. Muldoon
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick V94 T9PX, Ireland
| | - S. Alexander Haslam
- School of Psychology, McElwain Building University of Queensland, St Lucia, QLD 4072, Australia
| | - Catherine Haslam
- School of Psychology, McElwain Building University of Queensland, St Lucia, QLD 4072, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, 39 Science Road, ACT 0200, Australia
| | - Michelle Kearns
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick V94 T9PX, Ireland
- International Rescue Committee, Freetown, Sierra Leone
| | - Jolanda Jetten
- School of Psychology, McElwain Building University of Queensland, St Lucia, QLD 4072, Australia
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12
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Aneshensel CS, van Draanen J, Riess H, Villatoro AP. Newcomers and Old Timers: An Erroneous Assumption in Mental Health Services Research. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:453-473. [PMID: 31912763 DOI: 10.1177/0022146519887475] [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: 06/10/2023]
Abstract
Based on the premise that treatment changes people in ways that are consequential for subsequent treatment-seeking, we question the validity of an unrecognized and apparently inadvertent assumption in mental health services research conducted within a psychiatric epidemiology paradigm. This homogeneity assumption statistically constrains the effects of potential determinants of recent treatment to be identical for former patients and previously untreated persons by omitting treatment history or modeling only main effects. We test this assumption with data from the 2001-2003 Collaborative Psychiatric Epidemiology Surveys; the weighted pooled sample is representative of noninstitutionalized U.S. adults (18+; analytic n = 19,227). Contrary to the homogeneity assumption, some associations with recent treatment are conditional on past treatment, including psychiatric disorder and race-ethnicity-measures of need and treatment disparities, respectively. We conclude that the widespread application of the homogeneity assumption probably masks differences in the determinants of recent use between previously untreated persons and former patients.
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Monahan PO, Kroenke K, Callahan CM, Bakas T, Harrawood A, Lofton P, Frye D, Draucker C, Stump T, Saliba D, Galvin JE, Keegan A, Austrom MG, Boustani M. Development and Feasibility of SymTrak, aMulti-domain Tool for Monitoring Symptoms of Older Adults in Primary Care. J Gen Intern Med 2019; 34:915-922. [PMID: 30912032 PMCID: PMC6544681 DOI: 10.1007/s11606-018-4772-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/29/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND A clinically practical, brief, user-friendly, multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE Develop and assess usability, administration time, and internal reliability of SymTrak. DESIGN AND PARTICIPANTS Phase I: legacy instruments, content validity, analyses of existing data, focus groups (physicians, nurses, patients, informal caregivers), and Think Aloud interviews (patients, caregivers) were used to develop SymTrak. Phase II (pilot feasibility study): 81 (27 patient-caregiver dyads, 27 patients without an identified caregiver) participants were self-administered SymTrak in clinic. MAIN MEASURES SymTrak and demographic questions. KEY RESULTS Consistent themes emerged from phase I focus groups. Ambiguous wording was corrected with Think Aloud feedback. In phase II, patients and caregivers preferred circling words instead of numbers for item response options. SymTrak self-administration completion time in clinic was brief; mean was 2.4, 3.0, and 3.3 min for the finalized circlingwords version, respectively, for caregivers, dyadic patients, and patients without a caregiver; and the maximum was 6.2 min for any participant. Usability questionnaire ratings were high. Cronbach's alpha for the SymTrak 23-item total score was 0.86, 0.79, and 0.81 for caregivers, dyadic patients, and patients without a caregiver, respectively. CONCLUSIONS SymTrak demonstrates content validity, positive qualitative findings, high perceived usability, brief self-administered completion time, and good internal reliability.
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Affiliation(s)
- Patrick O Monahan
- Indiana University School of Medicine, Indianapolis, IN, USA. .,Indiana University School of Public Health, Indianapolis, IN, USA.
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, USA.,VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Christopher M Callahan
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Tamilyn Bakas
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Amanda Harrawood
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Phillip Lofton
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Danielle Frye
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | | | - Timothy Stump
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Debra Saliba
- University of California Borun Center and Veterans Administration, Los Angeles, CA, USA
| | - James E Galvin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda Keegan
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Mary G Austrom
- Indiana University Department of Psychiatry, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University Center for Aging Research, Indianapolis, IN, USA
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14
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Monahan PO, Kroenke K, Callahan CM, Bakas T, Harrawood A, Lofton P, Frye D, Draucker C, Stump T, Saliba D, Galvin JE, Keegan A, Austrom MG, Boustani M. Reliability and Validity of SymTrak, a Multi-Domain Tool for Monitoring Symptoms of Older Adults with Multiple Chronic Conditions. J Gen Intern Med 2019; 34:908-914. [PMID: 31001721 PMCID: PMC6544736 DOI: 10.1007/s11606-018-4780-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/18/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND A reliable and valid clinically practical multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE Assess internal consistency reliability, test-retest reliability, construct validity, and sensitivity to change for SymTrak. DESIGN AND PARTICIPANTS Among 600 (200 patient-caregiver dyads, 200 patients without an identified caregiver) participants, SymTrak was telephone interviewer-administered at baseline and 3-month follow-up, and at 24 h post-baseline for assessing test-retest reliability in a random subsample of 180 (60 dyads, 60 individual patients) participants. MAIN MEASURES Demographic questions, SymTrak, Health Utility Index Mark 3 (HUI3). KEY RESULTS Exploratory factor analysis indicated a single dominant dimension for SymTrak items for both patients and caregivers. Coefficient alpha and 24-h test-retest reliability, respectively, were high for the 23-item SymTrak total score for both patient-reported (0.85; 0.87) and caregiver-reported (0.86; 0.91) scores. Construct validity was supported by monotone decreasing relationships between the mean of SymTrak total scores across the poor-to-excellent categories of physical and emotional general health, and by high correlations with HUI3 overall utility score, even after adjusting for demographic covariates (standardized linear regression coefficient = - 0.84 for patients; - 0.70 for caregivers). Three-month change in the SymTrak total score was sensitive to detecting criterion standard 3-month reliable change categories (Improved, Stable, Declined) in HUI3-based health-related quality of life, especially for caregiver-reported scores. CONCLUSIONS SymTrak demonstrates good internal consistency and test-retest reliability, construct validity, and sensitivity to change over a 3-month period, supporting its use for monitoring symptoms for older adults with MCCs.
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Affiliation(s)
- Patrick O Monahan
- School of Medicine, Indiana University, Indianapolis, IN, USA. .,School of Public Health, Indiana University, Indianapolis, IN, USA.
| | - Kurt Kroenke
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Center for Health Information and Communication, VA HSR&D, Washington, DC, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Christopher M Callahan
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Aging Research, Indiana University, Indianapolis, IN, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, CA, USA
| | - Amanda Harrawood
- Center for Aging Research, Indiana University, Indianapolis, IN, USA
| | - Phillip Lofton
- Center for Aging Research, Indiana University, Indianapolis, IN, USA
| | - Danielle Frye
- Center for Aging Research, Indiana University, Indianapolis, IN, USA
| | - Claire Draucker
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Timothy Stump
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Debra Saliba
- Borun Center and Veterans Administration Los Angeles, University of California, Los Angeles, CA, USA
| | - James E Galvin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda Keegan
- Center for Aging Research, Indiana University, Indianapolis, IN, USA
| | - Mary G Austrom
- Department of Psychiatry, Indiana University, Indianapolis, IN, USA
| | - Malaz Boustani
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Aging Research, Indiana University, Indianapolis, IN, USA
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Olfson M, Wang S, Wall M, Marcus SC, Blanco C. Trends in Serious Psychological Distress and Outpatient Mental Health Care of US Adults. JAMA Psychiatry 2019; 76:152-161. [PMID: 30484838 PMCID: PMC6439744 DOI: 10.1001/jamapsychiatry.2018.3550] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Reports of a recent increase in US outpatient mental health care raise questions about whether it has been driven by rising rates of psychological distress and whether mental health treatment has become either more or less focused on people with higher levels of distress. OBJECTIVE To characterize national trends in serious psychological distress and trends in outpatient mental health service use by adults with and without serious psychological distress. DESIGN, SETTING, AND PARTICIPANTS The 2004-2005, 2009-2010, and 2014-2015 Medical Expenditure Panel Surveys (MEPS) were nationally representative surveys taken in US households. The analysis was limited to participants 18 years or older. Dates of this analysis were February 2018 to April 2018. MAIN OUTCOMES AND MEASURES Annual national trends in the percentages of adults with serious psychological distress (Kessler 6 scale score ≥13), outpatient mental health service use (outpatient visit with a mental disorder diagnosis, psychotherapy visit, or psychotropic medication), and type of psychotropic medication use (antidepressants, anxiolytics/sedatives, antipsychotics, mood stabilizers, and stimulants). Age- and sex-adjusted odds ratios of the associations of survey period with the odds of serious psychological distress, outpatient mental health service use, and outpatient mental health service use were stratified by level of psychological distress. RESULTS The analysis involved 139 862 adult participants from the 2004-2005, 2009-2010, and 2014-2015 MEPS, including 51.67% women, 48.33% men, 67.11% white adults, and 32.89% nonwhite adults, with an overall mean (SE) age of 46.41 (0.14) years. Serious psychological distress declined overall from 4.82% (2004-2005) to 3.71% (2014-2015), including significant declines among young (3.94% to 3.07%), middle-aged (5.52% to 4.36%), and older adults (5.24% to 3.79%); men (3.94% to 3.09%) and women (5.64% to 4.29%); and major racial/ethnic groups (white, 4.52% to 3.82%; African American, 5.12% to 3.64%; Hispanic, 6.03% to 3.55%; and other, 5.22% to 3.26%). Overall, the percentage of adults receiving any outpatient mental health service increased from 19.08% (2004-2005) to 23.00% (2014-2015) (adjusted odds ratio, 1.25; 95% CI, 1.17-1.34). Although the proportionate increase in outpatient mental health service use for adults with serious psychological distress (54.17% to 68.40%) was larger than that for adults with less serious or no psychological distress (17.26% to 21.08%), the absolute increase in outpatient mental health service use was almost completely the result of growth in outpatient mental health service use by individuals with less serious or no psychological distress. CONCLUSIONS AND RELEVANCE The recent increase in outpatient mental health service use occurred during a period of decline in serious psychological distress. Adults with less serious psychological distress accounted for most of the absolute increase in outpatient mental health service use, while adults with serious psychological distress experienced a greater relative increase in outpatient mental health service use.
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Affiliation(s)
- Mark Olfson
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Shuai Wang
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Melanie Wall
- New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Steven C. Marcus
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, Maryland
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16
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Abstract
Objective: The recognition of concurrent disorders (combined mental health and substance use disorders) has increased substantially over the last three decades, leading to greater numbers of people with these diagnoses and a subsequent greater financial burden on the health care system, yet establishing effective modes of management remains a challenge. Further, there is little evidence on which to base recommendations for a particular mode of health service delivery. This paper will further summarize the existing treatment models for a comprehensive overview. The objectives of this study are to determine whether existing service models are effective in treating combined mental health and substance use disorders and to examine whether an integrated model of service delivery should be recommended to policy makers. The following two research questions are the focus of this paper: (1) Are the existing service models effective at treating mental health and substance use disorders? (2) How are existing service models effective at treating mental health and substance use disorders? Methods: We used various databases to systematically review the effectiveness of service delivery models to treat concurrent disorders. Models were considered effective if they are found to be cost-effective and significantly improve clinical and social outcomes. Results: This systematic review revealed that integrated models of care are more effective than conventional, nonintegrated models. Integrated models demonstrated superiority to standard care models through reductions in substance use disorders and improvement of mental health in patients who had diagnoses of concurrent disorders. Our meta-analysis revealed similar findings, indicating that the integrated model is more cost-effective than standard care. Conclusions: Given the limited number of studies in relation to service delivery for concurrent disorders, it is too early to make a strong evidence-based recommendation to policy makers and service providers as to the superiority of one approach over the others. However, the available evidence suggests that integrated care models for concurrent disorders are the most effective models for patient care. More research is needed, especially around the translation of research findings to policy development and, vice versa, around the translation from the policy level to the patients' level.
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Affiliation(s)
- Venu Karapareddy
- a Department of Psychiatry , University of British Columbia , Vancouver , Canada.,b Vancouver Coastal Health , Vancouver , Canada
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17
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Ghesquiere A, Bagaajav A, Metzendorf M, Bookbinder M, Gardner DS. Hospice Bereavement Service Delivery to Family Members and Friends With Bereavement-Related Mental Health Symptoms. Am J Hosp Palliat Care 2018; 36:370-378. [PMID: 30428680 DOI: 10.1177/1049909118812025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: A sizable minority of those who lose a loved one in hospice will experience symptoms of bereavement-related mental health disorders. Though hospices offer services to bereaved informal caregivers (family members or friends) of patients, little is known about services offered or interest in them. Therefore, we sought to assess services offered by hospice staff and interest expressed by bereaved informal caregivers with symptoms of depression, anxiety, or complicated grief (CG). METHODS: De-identified electronic bereavement care charts of 3561 informal caregivers who lost someone in a large urban metropolitan hospice from October 1, 2015, to June 30, 2016, were reviewed. RESULTS: Of bereaved informal caregivers in the sample, 9.4% (n = 333) were positive for symptoms of depression, anxiety, or CG. The symptom-positive family members/friends were more likely than other family members/friends to be offered mailings, one-to-one counseling, telephone calls, and reference material. However, interest in most services by symptom-positive caregivers was low, with only 6% interested in one-to-one counseling and 7% interested in outside referral. DISCUSSION: The findings suggest that hospices offer a range of services to family members or friends with symptoms of anxiety, depression, and CG, but that there can be a gap between what is offered and in the interest levels of the bereaved. Engagement with symptomatic family members and friends could be enhanced in future work.
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Affiliation(s)
- Angela Ghesquiere
- 1 Brookdale Center for Healthy Aging, Hunter College of the City University of New York, New York, NY, USA
| | - Ariunsanaa Bagaajav
- 2 Silberman School of Social Work, Hunter College of the City University of New York, New York, NY, USA
| | - Marguerite Metzendorf
- 3 Bereavement and Creative Art Services, MJHS Hospice and Palliative Care, New York, NY, USA
| | | | - Daniel S Gardner
- 2 Silberman School of Social Work, Hunter College of the City University of New York, New York, NY, USA
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18
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Ault-Brutus A, Alegria M. Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990-1992 and 2001-2003. ETHNICITY & HEALTH 2018; 23:142-157. [PMID: 27809570 DOI: 10.1080/13557858.2016.1252834] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This study examines whether there are racial/ethnic differences in perceived need for mental health care among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003 in the US. Then among those with perceived need, we examine whether racial/ethnic disparities in use of mental health care existed in both time periods. DESIGN Using data from the 1990-1992 National Comorbidity Survey (NCS) and 2001-2003 National Comorbidity Survey - Replication (NCS-R), the study analyzes whether whites differed from blacks and Latinos in rates of perceived need among those with a mood and/or anxiety disorder in 1990-1992 and 2001-2003. Then among those with a disorder and perceived need, rates of mental health care use for whites are compared to black rates and Latino rates in within the 1990-1992 cohort and then within the 2001-2003 cohort. RESULTS There were no statistical racial/ethnic differences in perceived need in both time periods. Among those with perceived need in 1990-1992, there were no statistical racial/ethnic disparities in the use of mental health care. However, in 2001-2003, disparities in mental health care use existed among those with perceived need. CONCLUSIONS The emergence of racial/ethnic disparities in use of mental health care among those with a perceived need for care in 2001-2003 suggests that personal/cultural belief along with issues concerning access and quality of mental health care may create barriers to receiving perceived needed care. More research is needed to understand why these disparities emerged among those with perceived need in the latter time period and whether these disparities continue to exist in more recent years.
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Affiliation(s)
- Andrea Ault-Brutus
- a Center for Multicultural Mental Health Research/Cambridge Health Alliance , Cambridge , MA , USA
| | - Margarita Alegria
- b MGH Department of Medicine/ Harvard Medical School , Disparities Research Unit , Boston , MA , USA
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19
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Park S, Jang H, Furnham A, Jeon M, Park SJ. Beliefs about the causes of and treatments for depression and bipolar disorder among South Koreans. Psychiatry Res 2018; 260:219-226. [PMID: 29216484 DOI: 10.1016/j.psychres.2017.11.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/19/2017] [Accepted: 11/17/2017] [Indexed: 11/25/2022]
Abstract
Public beliefs about psychiatric disorders are important for understanding help-seeking behaviours. We investigated factors that affect South Koreans' beliefs about the causes and treatment of depression and bipolar disorder. We recruited 654 participants aged 15-54 years using an online panel survey. Participants completed two questionnaires: 34 possible causes of and 33 possible treatments for depression and bipolar disorder. For both disorders, the questionnaires about causes revealed four factors: social-environmental, God/fate, heath/lifestyle, and biological; the questionnaires about treatments revealed five factors: self-help/stress management, physical treatment/health management, seeking mental health services, religious help, and resting. Causes of depression were more recognized as social-environmental, religious, and health/lifestyle compared to bipolar disorder. Participants expressed more beliefs in self-help/stress management, physical treatment/health management, seeking mental health services, and resting for depression, compared to bipolar disorder. Participants' beliefs about the causes of the disorders and their demographic and psychiatric characteristics were closely associated with beliefs about treatment validity. Participants' beliefs about the causes of depression and bipolar disorder significantly affected their beliefs about treatment. Therefore, strategies to improve mental health literacy should provide the aetiology of specific mental disorders. Further research using a representative community sample is needed to generalize our findings.
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Affiliation(s)
- Subin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea.
| | - Hyesue Jang
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea
| | - Adrian Furnham
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mina Jeon
- Department of Psychology and Human Development, University College London, United Kingdom
| | - Se Jin Park
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, South Korea
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20
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Kumar S, Jones Bell M, Juusola JL. Mobile and traditional cognitive behavioral therapy programs for generalized anxiety disorder: A cost-effectiveness analysis. PLoS One 2018; 13:e0190554. [PMID: 29300754 PMCID: PMC5754075 DOI: 10.1371/journal.pone.0190554] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 12/16/2017] [Indexed: 12/29/2022] Open
Abstract
Background Generalized anxiety disorder (GAD) is a debilitating mental health illness that affects approximately 3.1% of U.S. adults and can be treated with cognitive behavioral therapy (CBT). With the emergence of digital health technologies, mobile CBT may be a cost-effective way to deliver care. We developed an analysis framework to quantify the cost-effectiveness of internet-based CBT for individuals with GAD. As a case study, we examined the potential value of a new mobile-delivered CBT program for GAD. Methods We developed a Markov model of GAD health states combined with a detailed economic analysis for a cohort of adults with GAD in the U.S. In our case study, we used pilot program efficacy data to evaluate a mobile CBT program as either prevention or treatment only and compared the strategies to traditional CBT and no CBT. Traditional CBT efficacy was estimated from clinical trial results. We calculated discounted incremental costs and quality-adjusted life-years (QALYs) over the cohort lifetime. Case study results In the base case, for a cohort of 100,000 persons with GAD, we found that mobile CBT is cost-saving. It leads to a gain of 34,108 QALYs and 81,492 QALYs and a cost reduction of $2.23 billion and $4.54 billion when compared to traditional CBT and no CBT respectively. Results were insensitive to most model inputs and mobile CBT remained cost-saving in almost all scenarios. Limitations The case study was conducted for illustrative purposes and used mobile CBT efficacy data from a small pilot program; the analysis should be re-conducted once robust efficacy data is available. The model was limited in its ability to measure the effectiveness of CBT in combination with pharmacotherapy. Conclusions Mobile CBT may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment.
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Affiliation(s)
- Shefali Kumar
- Evidation Health, San Mateo, California, United States of America
- * E-mail:
| | - Megan Jones Bell
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, United States of America
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21
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Liu F, Zhou N, Cao H, Fang X, Deng L, Chen W, Lin X, Liu L, Zhao H. Chinese college freshmen's mental health problems and their subsequent help-seeking behaviors: A cohort design (2005-2011). PLoS One 2017; 12:e0185531. [PMID: 29040266 PMCID: PMC5644985 DOI: 10.1371/journal.pone.0185531] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 09/14/2017] [Indexed: 12/04/2022] Open
Abstract
Based on cohort data obtained from 13,085 college freshmen’s (2005 to 2011) SCL-90 (the Symptom Check-List-90) reports and their subsequent 4-year psychological counseling help-seeking records, this study examined the association between college students’ mental health problems and help-seeking behaviors across four college years. Female students’ mental health problems and help-seeking behaviors increased from the 2005 to the 2011 cohorts and no changes emerged for male students across cohorts. Overall, male students reported higher levels of mental health problems than did female students in the first college year, whereas female students reported more help-seeking behaviors than did male students in the following four college years. College students’ mental health problems was associated positively with help-seeking behaviors. College students were more likely to seek help from the college psychological counselling center when they experienced relatively few or quite a lot of mental health issues (i.e., an inversed U shape). Implications for future studies and practices are discussed.
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Affiliation(s)
- Fenge Liu
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- Counseling Center, Central University of Finance and Economics, Beijing, China
| | - Nan Zhou
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- * E-mail: (NZ); (XYF)
| | - Hongjian Cao
- School of Education, Guangzhou University, Guangzhou, China
- Psychological and Behavioral Research Center of Cantonese, Guangzhou University, Guangzhou, China
| | - Xiaoyi Fang
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- * E-mail: (NZ); (XYF)
| | - Linyuan Deng
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Wenrui Chen
- New York University, New York, New York, United States of America
| | - Xiuyun Lin
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Lu Liu
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
| | - Huichun Zhao
- Counseling Center, Central University of Finance and Economics, Beijing, China
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22
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Wallisch L, Zemore SE, Cherpitel CJ, Borges G. Wanting and Getting Help for Substance Problems on Both Sides of the US-Mexico Border. J Immigr Minor Health 2017; 19:1174-1185. [PMID: 27286883 PMCID: PMC5149114 DOI: 10.1007/s10903-016-0442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The US-Mexico border presents potential cultural and logistic barriers to obtaining substance abuse treatment. We compare the prevalence and correlates of wanting and getting help between border and non-border residents in both the US and Mexico. Data come from the 2011 to 2012 US-Mexico Study on Alcohol and Related Conditions which surveyed 3214 border and 1582 non-border residents in the US and Mexico. Multivariate logistic regressions estimate the effect of border residence on desire for and receipt of help. In both countries, border substance users were about half as likely as nonborder substance users to have wanted or obtained any kind of help, independent of predisposing, need and enabling factors, including migration status. Among those desiring help, however, about half had obtained it, both on and off the border in both countries. While substantial proportions of those who need help do not get it either on or off the border, lower motivation for treatment may be more important than access in explaining border/non-border differences. Future research should investigate whether there are border-specific barriers to wanting help, and how to minimize them.
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Affiliation(s)
- Lynn Wallisch
- Addiction Research Institute, The University of Texas at Austin, 1717 W. 6th Street, Suite 335, Austin, TX, 78703, USA.
| | - Sarah E Zemore
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA, 94608, USA
| | - Cheryl J Cherpitel
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA, 94608, USA
| | - Guilherme Borges
- Instituto Nacional de Psiquiatría, Universidad Autónoma Metropolitana, Calzada México Xochimilco, No. 101, Col. San Lorenzo Huipulco, C.P. 14370, Mexico, DF, Mexico
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23
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Surviving Depression: Clinical Qualitative Analysis of Long-Term Survival for Ethnically Diverse, Depressed Patients. J Nerv Ment Dis 2017; 205:589-599. [PMID: 28005576 PMCID: PMC5479756 DOI: 10.1097/nmd.0000000000000632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is persistent and recurrent across ethnic groups. Few narrative analyses of long-term outcomes for ethnically diverse adults with depression exist. We combined 9 years of quantitative data, qualitative interviews at 10 years, clinician ratings of outcomes, and a community discussion group with the objective of describing long-term recovery and survival of diverse primary care patients after an episode of depression. Nearly half of participants were found to be depressed at some time over a 10-year period, and most cases across ethnic groups were judged to need further treatment. The ethnically diverse community members that analyzed the transcripts emphasized assets that participants showed in surviving multiple life stresses. Different sex and ethnic/racial groups had different characteristics of engaging in care, with Latino women in particular raising concerns about care engagement, coping with stress, and long-term outcomes.
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24
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Morton PM, Ferraro KF. Does Early-Life Misfortune Increase the Likelihood of Psychotropic Medication Use in Later Life? Res Aging 2017; 40:558-579. [PMID: 28659019 DOI: 10.1177/0164027517717045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Life-course research has linked childhood experiences to adult mental illness, but most studies focus on anxiety or depressive symptoms, which may be transient. Therefore, this study investigates whether childhood misfortune is associated with taking psychotropic medication, a measure reflecting an underlying chronic mental disorder. Data are from three waves of a national survey of 2,999 U.S. men and women aged 25-74 years. Four domains of childhood misfortune (childhood socioeconomic status, family structure, child maltreatment, and poor health) are considered-specified as separate domains and a single additive measure-as key predictors of psychotropic medication use. Findings reveal an association between additive childhood misfortune and adult psychotropic medication use, net of adult risk factors. Psychotropic medication use is also more likely during the 20-year study for adults who experienced maltreatment and poor health during childhood. These results reveal the importance of early intervention to reduce consumption of psychotropic medications and associated costs.
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Affiliation(s)
| | - Kenneth F Ferraro
- 2 Department of Sociology, Purdue University, West Lafayette, IN, USA.,3 Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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25
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Lovett BJ, Nelson JM. Test Anxiety and the Americans With Disabilities Act. JOURNAL OF DISABILITY POLICY STUDIES 2017. [DOI: 10.1177/1044207317710699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Test anxiety leads to requests for accommodations under the Americans With Disabilities Act (ADA), but many testing entities have expressed skepticism about whether test anxiety qualifies as a disability. This article addresses three legal issues raised by the inclusion of test anxiety under ADA: whether test anxiety is a mental impairment, whether test-taking is a major life activity, and whether test anxiety substantially limits test-taking. The article then turns to questions of policy: How should ADA claims for test anxiety be handled by educational institutions, independent testing agencies, and employers? A review of scientific research and legal authorities are used to answer these questions. Most individuals with high test anxiety levels will not qualify as disabled under ADA, although there will be exceptions to that general rule, and testing entities should always conduct an individualized inquiry into each claim.
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Burnett-Zeigler I, Lee Y, Bohnert KM. Ethnic Identity, Acculturation, and 12-Month Psychiatric Service Utilization Among Black and Hispanic Adults in the U.S. J Behav Health Serv Res 2017; 45:13-30. [DOI: 10.1007/s11414-017-9557-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Abstract
Anxiety disorders constitute the largest group of mental disorders in most western societies and are a leading cause of disability. The essential features of anxiety disorders are excessive and enduring fear, anxiety or avoidance of perceived threats, and can also include panic attacks. Although the neurobiology of individual anxiety disorders is largely unknown, some generalizations have been identified for most disorders, such as alterations in the limbic system, dysfunction of the hypothalamic-pituitary-adrenal axis and genetic factors. In addition, general risk factors for anxiety disorders include female sex and a family history of anxiety, although disorder-specific risk factors have also been identified. The diagnostic criteria for anxiety disorders varies for the individual disorders, but are generally similar across the two most common classification systems: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the International Classification of Diseases, Tenth Edition (ICD-10). Despite their public health significance, the vast majority of anxiety disorders remain undetected and untreated by health care systems, even in economically advanced countries. If untreated, these disorders are usually chronic with waxing and waning symptoms. Impairments associated with anxiety disorders range from limitations in role functioning to severe disabilities, such as the patient being unable to leave their home.
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Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California Los Angeles, 405 Hilgard Avenue, Los Angeles, California 90095, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Thalia C Eley
- King's College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mohammed R Milad
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Charleston, Massachusetts, USA
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland, USA
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Faculty of Science, Technische Universitaet Dresden, Dresden, Germany
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Fekadu A, Medhin G, Selamu M, Giorgis TW, Lund C, Alem A, Prince M, Hanlon C. Recognition of depression by primary care clinicians in rural Ethiopia. BMC FAMILY PRACTICE 2017; 18:56. [PMID: 28431526 PMCID: PMC5399858 DOI: 10.1186/s12875-017-0628-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/11/2017] [Indexed: 11/24/2022]
Abstract
Background Depression is a common health condition affecting up to a third of patients attending primary care, where most of the care for people with depression is provided. Adequate recognition of depression is the critical step in the path to effective care, particularly in low income countries. As part of the Programme for Improving Mental healthcare (PRIME), a project supporting the implementation of integrated mental healthcare in primary care, we evaluated the level of recognition of depression by clinicians working in primary care in rural Ethiopia prior to in service training. We hypothesised that the detection rate of depression will be under 10% and that detection would be affected by gender, education and severity of depression. Methods Cross-sectional survey in eight health centres serving a population of over 160,000 people. A validated version of the 9-item patient health questionnaire (PHQ-9) was administered as an indicator of probable depression. In addition, primary care clinicians completed a clinician encounter form. Participants were consecutive primary care attendees aged 18 years and above. Results A total of 1014 participants were assessed. Primary care clinicians diagnosed 13 attendees (1.3%) with depression. The PHQ9 prevalence of depression at a cut-off score of ten was 11.5% (n = 117), of whom 5% (n = 6/117) had received a diagnosis of depression by primary care clinicians. Attendees with higher PHQ scores and suicidality were significantly more likely to receive a diagnosis of depression by clinicians. Women (n = 9/13) and participants with higher educational attainment were more likely to be diagnosed with depression, albeit non-significantly. All cases diagnosed with depression by the clinicians had presented with psychological symptoms. Conclusion Although not based on a gold standard diagnosis, over 98% of cases with PHQ-9 depression were undetected. Failure of recognition of depression may pose a serious threat to the scale up of mental healthcare in low income countries. Addressing this threat should be an urgent priority, and requires a better understanding of the nature of depression and its presentation in rural low-income primary care settings.
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Affiliation(s)
- Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, PO Box 9086, Addis Ababa, Ethiopia. .,Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia. .,Department of Psychological Medicine, Centre for Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, London, UK
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Chen J, Dagher R. Gender and Race/Ethnicity Differences in Mental Health Care Use before and during the Great Recession. J Behav Health Serv Res 2017; 43:187-99. [PMID: 24699888 DOI: 10.1007/s11414-014-9403-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the changes in health care utilization for mental health disorders among patients who were diagnosed with depressive and/or anxiety disorders during the Great Recession 2007-2009 in the USA. Negative binomial regressions are used to estimate the association of the economic recession and mental health care use for females and males separately. Results show that prescription drug utilization (e.g., antidepressants, psychotropic medications) increased significantly during the economic recession 2007-2009 for both females and males. Physician visits for mental health disorders decreased during the same period. Results show that racial disparities in mental health care might have increased, while ethnic disparities persisted during the Great Recession. Future research should separately examine mental health care utilization by gender and race/ethnicity.
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Affiliation(s)
- Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, 3310A School of Public Health Building, College Park, MD, 20742-2611, USA.
| | - Rada Dagher
- Department of Health Services Administration, School of Public Health, University of Maryland, 3310B School of Public Health Building, College Park, MD, 20742-2611, USA
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Early improvement with pregabalin predicts endpoint response in patients with generalized anxiety disorder: an integrated and predictive data analysis. Int Clin Psychopharmacol 2017; 32:41-48. [PMID: 27583543 DOI: 10.1097/yic.0000000000000144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Generalized anxiety disorder (GAD), a common mental disorder, has several treatment options including pregabalin. Not all patients respond to treatment; quickly determining which patients will respond is an important treatment goal. Patient-level data were pooled from nine phase II and III randomized, double-blind, short-term, placebo-controlled trials of pregabalin for the treatment of GAD. Efficacy outcomes included the change from baseline in the Hamilton Anxiety Scale (HAM-A) total score and psychic and somatic subscales. Predictive modelling assessed baseline characteristics and early clinical responses to determine those predictive of clinical improvement at endpoint. A total of 2155 patients were included in the analysis (1447 pregabalin, 708 placebo). Pregabalin significantly improved the HAM-A total score compared with the placebo at endpoint, treatment difference (95% confidence interval), -2.61 (-3.21 to -2.01), P<0.0001. Pregabalin significantly improved HAM-A psychic and somatic scores compared with placebo, -1.52 (-1.85 to -1.18), P<0.0001, and -1.10 (-1.41 to -0.80), P<0.0001, respectively. Response to pregabalin in the first 1-2 weeks (≥20 or ≥30% improvement in HAM-A total, psychic or somatic score) was predictive of an endpoint greater than or equal to 50% improvement in the HAM-A total score. Pregabalin is an effective treatment option for patients with GAD. Patients with early response to pregabalin are more likely to respond significantly at endpoint.
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Use of aids for smoking cessation and alcohol reduction: A population survey of adults in England. BMC Public Health 2016; 16:1237. [PMID: 27931202 PMCID: PMC5146832 DOI: 10.1186/s12889-016-3862-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/22/2016] [Indexed: 02/04/2023] Open
Abstract
Background It is important for policy planning to chart the methods smokers and high-risk drinkers use to help them change their behaviour. This study assessed prevalence of use, and characteristics of users, of support for smoking cessation and alcohol reduction in England. Methods Data were used from the Smoking and Alcohol Toolkit Studies, which involve monthly face-to-face computer-assisted interviews of adults aged 16+ in England. We included data collected between June 2014 and July 2015 on 1600 smokers who had made at least one quit attempt and 911 high-risk drinkers (defined as scores >8+ on the full AUDIT or 5+ on questions 1–3 of the AUDIT-C) who had made an attempt to cut down in the past 12 months. Participants provided information on their socio-demographic characteristics and use of aids during their most recent quit attempt including pharmacotherapy, face-to-face counselling, telephone support, self-help materials (digital and printed), and complementary medicine. Results A total of 60.3% of smokers used aids in the past year, compared with just 14.9% of high-risk drinkers. Use of pharmacotherapy was high among smokers and very low among drinkers (56.0%versus1.2%). Use of other aids was low for both behaviours: face-to-face counselling (2.6%versus4.8%), self-help materials (1.4%versus4.1%) and complementary medicine (1.0%versus0.5%). Use of aids was more common among smokers aged 25–54 compared with 16–24 year olds (25–34,ORadj1.49,p = 0.012; 35–44,ORadj1.93,p < 0.001; 35–44,ORadj1.93,p < 0.001; 45–54,ORadj1.66,p = 0.008), with cigarette consumption >10 relative to <1 (10–20,ORadj2.47,p = 0.011; >20,ORadj4.23,p = 0.001), and less common among ethnic minorities (ORadj0.69,p = 0.026). For alcohol reduction, use of aids was higher among ethnic minority groups (ORadj2.41;p = 0.015), and those of social-grade D/E relative to AB (ORadj2.29,p = 0.012&ORadj3.13,p < 0.001). Conclusion In England, the use of pharmacotherapy is prevalent for smoking cessation but not alcohol reduction. Other aids are used at a low rate, with face-to-face counselling being more common for alcohol reduction than smoking cessation. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3862-7) contains supplementary material, which is available to authorized users.
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Downing A, Wright P, Wagland R, Watson E, Kearney T, Mottram R, Allen M, Cairnduff V, McSorley O, Butcher H, Hounsome L, Donnelly C, Selby P, Kind P, Cross W, Catto JWH, Huws D, Brewster DH, McNair E, Matheson L, Rivas C, Nayoan J, Horton M, Corner J, Verne J, Gavin A, Glaser AW. Life after prostate cancer diagnosis: protocol for a UK-wide patient-reported outcomes study. BMJ Open 2016; 6:e013555. [PMID: 27927667 PMCID: PMC5168696 DOI: 10.1136/bmjopen-2016-013555] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. METHODS AND ANALYSIS Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome data will be linked with administrative health data (eg, treatment information from hospital data). To ensure detailed understanding of issues of importance, qualitative interviews will be undertaken with a sample of men who complete the survey across the UK (n=∼150) along with a small number of partners/spouses (n=∼30). ETHICS AND DISSEMINATION The study has received the following approvals: Newcastle and North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D approval from Wales, Scotland and Northern Ireland. Using traditional and innovative methods, the results will be made available to men and their partners/spouses, the funders, the NHS, social care, voluntary sector organisations and other researchers.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Rebecca Mottram
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Oonagh McSorley
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Conan Donnelly
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - James W H Catto
- Academic Urology Unit, University of Sheffield, Medical School, Sheffield, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
| | - David H Brewster
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Emma McNair
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Horton
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Julia Verne
- Knowledge and Intelligence Directorate, Public Health England, Bristol, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
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Chiang VCL, Chien WT, Wong HT, Lee RLP, Ha J, Leung SSK, Wong DFK. A Brief Cognitive-Behavioral Psycho-Education (B-CBE) Program for Managing Stress and Anxiety of Main Family Caregivers of Patients in the Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13100962. [PMID: 27690068 PMCID: PMC5086701 DOI: 10.3390/ijerph13100962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/28/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
Having a loved one in the intensive care unit (ICU) is a stressful event, which may cause a high level of anxiety to the family members. This could threaten their wellbeing and ability to support the patients in, or after discharge from, the ICU. To investigate the outcomes of a brief cognitive-behavioral psycho-education program (B-CBE) to manage stress and anxiety of the main family caregivers (MFCs), a pragmatic quasi-experimental study involving 45 participants (treatment group: 24; control group: 21) was conducted in an ICU. The Depression and Anxiety Stress Scale and the Critical Care Family Need Inventory were used to evaluate the primary outcomes on stress and anxiety, and satisfaction with family needs. The treatment group reported significantly better improvement in the information satisfaction score compared to the control group (p < 0.05; η² = 0.09). Overall main effects were observed on the stress (p < 0.01; η² = 0.20), anxiety (p < 0.01; η² = 0.18), depression (p < 0.05; η² = 0.13), support satisfaction (p < 0.05; η² = 0.13), and comfort satisfaction (p < 0.05; η² = 0.11) scores. The experience of this study suggest that MFCs are in great need of additional support like B-CBE to manage their stress and anxiety. Given the brevity of B-CBE, it is practical for critical care nurses to deliver and MFCs to take within the industrious context of an ICU. More studies are needed to investigate these types of brief psychological interventions.
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Affiliation(s)
| | - Wai Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Ho Ting Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | | | - Juana Ha
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | | | - Daniel Fu Keung Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban Federally Qualified Health Center. Complement Ther Clin Pract 2016; 25:59-67. [PMID: 27863611 DOI: 10.1016/j.ctcp.2016.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/12/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND In this study we examine the feasibility and preliminary effectiveness of mindfulness based stress reduction adapted for delivery in an urban Federally Qualified Health Center (FQHC). METHODS Thirty-one African- American adult women ages 18-65 with depressive symptoms enrolled to participate in an 8-week mindfulness group intervention. The primary outcome (depression) and secondary outcomes (stress, mindfulness, functioning, well-being, and depression stigma) were assessed at baseline, 8 and 16-weeks. RESULTS Depressive symptoms significantly decreased from baseline to 16 weeks. A significant decrease in stress and significant increase in mindfulness was found from baseline to 8 weeks and baseline to 16 weeks. Additionally, aspects of well-being-self-acceptance and growth-significantly increased from baseline to 8-weeks. Stigma significantly increased from baseline to 8 weeks and significantly decreased from 8 to 16 weeks (all p's < 0.05). CONCLUSIONS Mindfulness-based interventions implemented in FQHCs may increase access to effective treatments for mental health symptoms.
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Goodwin RD, Friedman HS. Health Status and the Five-factor Personality Traits in a Nationally Representative Sample. J Health Psychol 2016; 11:643-54. [PMID: 16908463 DOI: 10.1177/1359105306066610] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The authors’ objective was to determine the association between the ‘big-five’ personality traits and mental and physical disorders among adults in the United States. The Midlife Development in the United States Survey, a nationally representative sample of 3032 adults ages 25-74, was used to determine the association between the five-factor traits of personality and common mental and physical disorders. Findings are consistent with and extend previous results showing that conscientiousness is associated with significantly reduced likelihood of a wide range of mental and physical disorders among adults in the general population, and inversely that neuroticism is associated with increased rates. Among adults with physical illnesses, associations were found between personality and likelihood of physical limitations, especially conscientiousness. These findings provide a framework upon which research on complex causal processes may proceed. Thus future research attention might profitably be directed to conscientiousness-relevant processes, such as adherence to health and treatment recommendations and internalization of healthy societal norms for sensible health-related behavior.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Krueger RF, Markon KE. Understanding Psychopathology: Melding Behavior Genetics, Personality, and Quantitative Psychology to Develop an Empirically Based Model. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016; 15:113-117. [PMID: 18392116 DOI: 10.1111/j.0963-7214.2006.00418.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research on psychopathology is at a historical crossroads. New technologies offer the promise of lasting advances in our understanding of the causes of human psychological suffering. Making the best use of these technologies, however, requires an empirically accurate model of psychopathology. Much current research is framed by the model of psychopathology portrayed in current versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000). Although the modern DSMs have been fundamental in advancing psychopathology research, recent research also challenges some assumptions made in the DSM-for example, the assumption that all forms of psychopathology are well conceived of as discrete categories. Psychological science has a critical role to play in working through the implications of this research and the challenges it presents. In particular, behavior-genetic, personality, and quantitative-psychological research perspectives can be melded to inform the development of an empirically based model of psychopathology that would constitute an evolution of the DSM.
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Carnide N, Franche RL, Hogg-Johnson S, Côté P, Breslin FC, Severin CN, Bültmann U, Krause N. Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:204-215. [PMID: 26324252 DOI: 10.1007/s10926-015-9604-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12 months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12 months post-injury. Participants self-reported they had not received a depression diagnosis 1 year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12 months was 50.3 % (95 % CI 44.9-55.7 %). At 12 months, 24.7 % (95 % CI 20.1-29.3 %) of workers exhibited high levels. Over 12 months, 49.7 % (95 % CI 44.3-55.1 %) had low levels at all 3 interviews, 14.5 % (95 % CI 10.7-18.2 %) had persistently high levels, and 25.6 % (95 % CI 20.9-30.3 %) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12 months was 6.0 % (95 % CI 2.7-9.3 %). For workers with high baseline levels, 36.1 % (95 % CI 27.9-44.3 %) exhibited persistent high symptoms at 6 and 12 months, while 38.4 % (95 % CI 30.1-46.6 %) experienced low levels at 6 and 12 months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8 % (95 % CI 7.7-29.8 %) self-reported receiving a depression diagnosis by 12 months and 29.2 % (95 % CI 16.3-42.0 %) were receiving treatment at 12 months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12 months post-injury. While symptoms appear to improve over time, the first 6 months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.
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Affiliation(s)
- Nancy Carnide
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Renée-Louise Franche
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- WorkSafe BC, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sheilah Hogg-Johnson
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Pierre Côté
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - F Curtis Breslin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- General Education Department, Seneca College of Applied Arts and Technology, Toronto, ON, Canada
| | - Colette N Severin
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
| | - Ute Bültmann
- Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, M5G 2E9, Canada
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niklas Krause
- Department of Environmental Health Sciences and Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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Brown AH, Grella CE, Cooper L. Living it or Learning It: Attitudes and Beliefs about Experience and Expertise in Treatment for the Dually Diagnosed. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090202900403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article examines mental health and substance abuse treatment providers' attitudes and beliefs regarding the relative values of academic knowledge and experiential knowledge. These two forms of “knowing” increasingly come into conflict as providers from the two service systems work together to provide services to individuals with co-occurring disorders. Data to address this issue were obtained from seven focus groups conducted with 48 substance abuse and mental health treatment providers and stakeholders in Los Angeles County. Findings suggest the tenuous role of experience-based knowledge within the emergent framework of dual diagnosis treatment and its emphasis on the professionalization of providers. The article raises concerns as to how differing, and often competing, treatment approaches affect the provision of care for this population and questions how these tensions will be resolved within efforts to increase collaboration between the two systems in providing services to dually diagnosed patients.
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Chang HA, Chang CC, Kuo TBJ, Huang SY. Distinguishing bipolar II depression from unipolar major depressive disorder: Differences in heart rate variability. World J Biol Psychiatry 2016; 16:351-60. [PMID: 25800950 DOI: 10.3109/15622975.2015.1017606] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Bipolar II (BPII) depression is commonly misdiagnosed as unipolar depression (UD); however, an objective and reliable tool to differentiate between these disorders is lacking. Whether cardiac autonomic function can be used as a biomarker to distinguish BPII from UD is unknown. METHODS We recruited 116 and 591 physically healthy patients with BPII depression and UD, respectively, and 421 healthy volunteers aged 20-65 years. Interviewer and self-reported measures of depression/anxiety severity were obtained. Cardiac autonomic function was evaluated by heart rate variability (HRV) and frequency-domain indices of HRV. RESULTS Patients with BPII depression exhibited significantly lower mean R-R intervals, variance (total HRV), low frequency (LF)-HRV, and high frequency (HF)-HRV but higher LF/HF ratio compared to those with UD. The significant differences remained after adjusting for age. Compared to the controls, the patients with BPII depression showed cardiac sympathetic excitation with reciprocal vagal impairment, whereas the UD patients showed only vagal impairment. Depression severity independently contributed to decreased HRV and vagal tone in both the patients with BPII depression and UD, but increased sympathetic tone only in those with BPII depression. CONCLUSIONS HRV may aid in the differential diagnosis of BPII depression and UD as an adjunct to diagnostic interviews.
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Affiliation(s)
- Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
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Hettema JM. The nosologic relationship between generalized anxiety disorder and major depression. Depress Anxiety 2016; 25:300-16. [PMID: 18412057 DOI: 10.1002/da.20491] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Generalized anxiety disorder (GAD) has undergone a series of revisions in its diagnostic criteria that has moved it, nosologically, away from its original affiliation with panic disorder (PD) and closer to major depressive disorder (MDD). This, together with its high comorbidity and putative shared genetic risk with MDD, has brought into question its place in future psychiatric nosology, prompting the planners of Diagnostic and Statistical Manual-V (DSM-V) and International Classification of Diseases-11 (ICD-11) to set up a workgroup tasked to better understand the relationship between GAD and MDD. This review attempts to summarize the extant data to compare GAD and MDD on a series of research validators to explore this relationship. Although insufficient data currently exist for GAD in several key validator classes, tentative conclusions can be drawn on the diagnostic status of GAD in relation to MDD. Although GAD possesses substantial overlap with MDD in the areas of genetics, childhood environment, demographics, and personality traits, this tends to hold true for other anxiety disorders (ADs) as well, with the strongest evidence for PD. Data from life events, personality disorders, biology, comorbidity, and pharmacology are mixed, showing some areas of similarity between GAD and MDD but some clear differences, again with a moderate degree of nonspecificity. Thus, although the bulk of evidence supports a close underlying relationship between them, the relatively nonspecific nature of these findings provides little more reason to question the nosologic validity of GAD in relation to MDD than that of some other anxiety disorders.
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Affiliation(s)
- John M Hettema
- Virginia Institute for Psychiatry and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
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Peripartum changes in partnership quality among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study. Arch Womens Ment Health 2016; 19:281-90. [PMID: 26264505 DOI: 10.1007/s00737-015-0556-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 07/08/2015] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to prospectively examine peripartum changes in partnership characteristics among women with and without anxiety and depressive disorders prior to pregnancy. In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 expectant mothers completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Lifetime anxiety and depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) were evaluated at baseline using the Composite International Diagnostic Interview for Women (CIDI-V, Martini et al. 2009). Partnership characteristics were assessed during pregnancy as well as 4 and 16 months postpartum using the Partnership Questionnaire (Hahlweg 1996). Linear regressions were applied to test associations between diagnostic status prior to pregnancy and peripartum partnership characteristics. Compared to women without anxiety and depressive disorders prior to pregnancy, women with comorbid anxiety and depressive disorders reported less tenderness during pregnancy, less postpartum tenderness, satisfaction, and overall partnership quality as well as a lower decrease in communication from pre- to postpartum. Women with pure depressive disorders and comorbid anxiety and depressive disorders prior to pregnancy indicated a higher increase in quarreling from pre- to postpartum. Findings suggest that women with depressive (and comorbid anxiety) disorders prior to pregnancy are at elevated risk for an unfavorable peripartum partnership development and might thus profit from targeted family interventions during this period.
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Birney AJ, Gunn R, Russell JK, Ary DV. MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial. JMIR Mhealth Uhealth 2016; 4:e8. [PMID: 26813737 PMCID: PMC4748138 DOI: 10.2196/mhealth.4231] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/27/2015] [Accepted: 10/07/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Worldwide, depression is rated as the fourth leading cause of disease burden and is projected to be the second leading cause of disability by 2020. Annual depression-related costs in the United States are estimated at US $210.5 billion, with employers bearing over 50% of these costs in productivity loss, absenteeism, and disability. Because most adults with depression never receive treatment, there is a need to develop effective interventions that can be more widely disseminated through new channels, such as employee assistance programs (EAPs), and directly to individuals who will not seek face-to-face care. OBJECTIVE This study evaluated a self-guided intervention, using the MoodHacker mobile Web app to activate the use of cognitive behavioral therapy (CBT) skills in working adults with mild-to-moderate depression. It was hypothesized that MoodHacker users would experience reduced depression symptoms and negative cognitions, and increased behavioral activation, knowledge of depression, and functioning in the workplace. METHODS A parallel two-group randomized controlled trial was conducted with 300 employed adults exhibiting mild-to-moderate depression. Participants were recruited from August 2012 through April 2013 in partnership with an EAP and with outreach through a variety of additional non-EAP organizations. Participants were blocked on race/ethnicity and then randomly assigned within each block to receive, without clinical support, either the MoodHacker intervention (n=150) or alternative care consisting of links to vetted websites on depression (n=150). Participants in both groups completed online self-assessment surveys at baseline, 6 weeks after baseline, and 10 weeks after baseline. Surveys assessed (1) depression symptoms, (2) behavioral activation, (3) negative thoughts, (4) worksite outcomes, (5) depression knowledge, and (6) user satisfaction and usability. After randomization, all interactions with subjects were automated with the exception of safety-related follow-up calls to subjects reporting current suicidal ideation and/or severe depression symptoms. RESULTS At 6-week follow-up, significant effects were found on depression, behavioral activation, negative thoughts, knowledge, work productivity, work absence, and workplace distress. MoodHacker yielded significant effects on depression symptoms, work productivity, work absence, and workplace distress for those who reported access to an EAP, but no significant effects on these outcome measures for those without EAP access. Participants in the treatment arm used the MoodHacker app an average of 16.0 times (SD 13.3), totaling an average of 1.3 hours (SD 1.3) of use between pretest and 6-week follow-up. Significant effects on work absence in those with EAP access persisted at 10-week follow-up. CONCLUSIONS This randomized effectiveness trial found that the MoodHacker app produced significant effects on depression symptoms (partial eta(2) = .021) among employed adults at 6-week follow-up when compared to subjects with access to relevant depression Internet sites. The app had stronger effects for individuals with access to an EAP (partial eta(2) = .093). For all users, the MoodHacker program also yielded greater improvement on work absence, as well as the mediating factors of behavioral activation, negative thoughts, and knowledge of depression self-care. Significant effects were maintained at 10-week follow-up for work absence. General attenuation of effects at 10-week follow-up underscores the importance of extending program contacts to maintain user engagement. This study suggests that light-touch, CBT-based mobile interventions like MoodHacker may be appropriate for implementation within EAPs and similar environments. In addition, it seems likely that supporting MoodHacker users with guidance from counselors may improve effectiveness for those who seek in-person support. TRIAL REGISTRATION ClinicalTrials.gov NCT02335554; https://clinicaltrials.gov/ct2/show/NCT02335554 (Archived by WebCite at http://www.webcitation.org/6dGXKWjWE).
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Kuester A, Niemeyer H, Knaevelsrud C. Internet-based interventions for posttraumatic stress: A meta-analysis of randomized controlled trials. Clin Psychol Rev 2015; 43:1-16. [PMID: 26655959 DOI: 10.1016/j.cpr.2015.11.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/18/2015] [Accepted: 11/21/2015] [Indexed: 12/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent and highly distressing affliction, but access to trauma-focused psychotherapy is limited. Internet-based interventions (IBIs) could improve the delivery of and access to specialized mental health care. Currently, no meta-analytical evidence is available on IBIs for PTSD. We conducted a meta-analysis of 20 randomized controlled studies, including 21 comparisons, in order to summarize the current state of efficacy for the treatment of PTSD and to identify moderator variables. Studies tested internet-based cognitive behavioral therapy (CBT) and expressive writing (EW) against active or passive comparison conditions, including subclinical and clinical samples. Results show that at post-assessment CBT-IBIs are significantly more efficacious than passive controls, resulting in medium to large effects on the PTSD sum and all sub-symptom scores (0.66<g<0.83), but both EW and CBT are not superior to active controls. EW differed from controls only at follow-up in reducing intrusions and hyperarousal, but based on merely two studies. Subgroup analyses reveal that for CBT none of the program components such as provision of therapeutic support, reminders, or number of sessions serves as a moderator. Overall, results for CBT-IBIs are promising, but the number of includable studies for subgroup analyses was low, limiting statistical power. Future research is necessary to systematically investigate the impact of treatment components and test against active controls with optimal power.
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Affiliation(s)
- Annika Kuester
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Germany
| | - Helen Niemeyer
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Germany
| | - Christine Knaevelsrud
- Freie Universität Berlin, Department of Clinical Psychology and Psychotherapy, Germany
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Burnett-Zeigler I, Schuette S, Victorson D, Wisner KL. Mind-Body Approaches to Treating Mental Health Symptoms Among Disadvantaged Populations: A Comprehensive Review. J Altern Complement Med 2015; 22:115-24. [PMID: 26540645 DOI: 10.1089/acm.2015.0038] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mind-body approaches are commonly used to treat a variety of chronic health conditions, including depression and anxiety. A substantial proportion of individuals with depression and anxiety disorders do not receive conventional treatment; disadvantaged individuals are especially unlikely to receive treatment. Mind-body approaches offer a potentially more accessible and acceptable alternative to conventional mental health treatment for disadvantaged individuals, who may not otherwise receive mental health treatment. This review examines evidence for the efficacy of mind-body interventions for mental health symptoms among disadvantaged populations. While rates of utilization were relatively lower for racial/ethnic minorities, evidence suggests that significant proportions of racial/ethnic minorities are using complementary health approaches as health treatments, especially prayer/healers and natural or herbal remedies. This review of studies on the efficacy of mind-body interventions among disadvantaged populations found evidence for the efficacy of mind-body approaches for several mental and physical health symptoms, functioning, self-care, and overall quality of life.
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Affiliation(s)
- Inger Burnett-Zeigler
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Stephanie Schuette
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - David Victorson
- 2 Medical Social Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
| | - Katherine L Wisner
- 1 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, IL
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Kircanski K, Thompson RJ, Sorenson J, Sherdell L, Gotlib IH. Rumination and Worry in Daily Life: Examining the Naturalistic Validity of Theoretical Constructs. Clin Psychol Sci 2015; 3:926-939. [PMID: 26783506 PMCID: PMC4714789 DOI: 10.1177/2167702614566603] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rumination and worry, two forms of perseverative thinking, hold promise as core processes that transect depressive and anxiety disorders. Whereas previous studies have been limited to the laboratory or to single diagnoses, we used experience sampling methods to assess and validate rumination and worry as transdiagnostic phenomena in the daily lives of individuals diagnosed with Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and co-occurring MDD-GAD. Clinical and healthy control participants carried a hand-held electronic device for one week. Eight times per day they reported on their current levels of rumination and worry and their theoretically postulated features: thought unpleasantness, repetitiveness, abstractness, uncontrollability, temporal orientation, and content, and overall senses of certainty and control. Both rumination and worry emerged as transdiagnostic processes that cut across MDD, GAD, and MDD-GAD. Furthermore, most psychological theories concerning rumination and worry strongly mapped onto participants' reports, providing the first naturalistic validation of these constructs.
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Fleury MJ, Bamvita JM, Grenier G, Caron J. Help Received for Perceived Needs Related to Mental Health in a Montreal (Canada) Epidemiological Catchment Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:13016-37. [PMID: 26501306 PMCID: PMC4627014 DOI: 10.3390/ijerph121013016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/20/2015] [Accepted: 10/10/2015] [Indexed: 12/28/2022]
Abstract
This study sought to identify variables associated with help received in terms of information, medication, counselling and total help received (including other needs) among 571 individuals needing health care services for mental health problems. Study participants were randomly selected from an epidemiological survey. Data on help received were collected using the Canadian version of the Perceived Need for Care Questionnaire (PNCQ), and were analyzed using a multinomial logistic regression model. Most help received was in the form of counselling, followed by medication and information. Compared with individuals who received no help, those who reported receiving help for all their needs were more likely to have psychological distress, to be non-verbally aggressive, to consult more healthcare professionals, to be men and to be somewhat older. Compared with individuals who received no help, those who received partial help were more likely to be not addicted to drugs or alcohol, to consult more healthcare professionals, and to be older. Healthcare services should prioritize strategies (e.g., early detection, outreach, public education on mental and addiction disorders) that address barriers to help seeking among youth, as well as individuals addicted to drugs and alcohol or those presenting with aggressive behavior.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, PQ H4R 1R3, Canada.
- Montreal Addiction Rehabilitation Centre-University Institute (CRDM-IU), Montreal, PQ H2M 2E8, Canada.
| | | | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, PQ H4H 2R3, Canada.
| | - Jean Caron
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, PQ H4R 1R3, Canada.
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Lee S, Leung CM, Kwok KP, Lam Ng K. A community-based study of the relationship between somatic and psychological distress in Hong Kong. Transcult Psychiatry 2015; 52:594-615. [PMID: 25665587 DOI: 10.1177/1363461515569756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Although the predominantly somatic presentation of distress has been used to explain low rates of emotional illnesses and health service use in Chinese communities, this concept of somatization has not been examined by concurrently studying the profile of somatically and psychologically distressed Chinese individuals. A random population-based sample of 3014 adults underwent a structured telephone interview that examined their sociodemographic characteristics, somatic distress (Patient Health Questionnaire-15, PHQ-15), non-specific psychological distress (Kessler Scale-6, K6), health service use, and functional impairment. Four groups of individuals identified by PHQ-15 and K6 cut-off scores were compared. Results showed that PHQ-15 and K6 scores were positively correlated. The large majority of respondents (85.9%) reported both somatic and psychological distress. The proportions of Low Distress Group, Somatically Distressed Group, Psychologically Distressed Group, and Mixed Distress Group were 69.2%, 5.0%, 15.8%, and 10.0%, respectively. Specific age range, male gender, greater family income, higher education level, and retirement were associated with decreased odds of somatic and/or psychological distress. Although psychological distress best predicted impairment, somatic distress best predicted health service use. Mixed distress predicted most impairment and health service use. Thus, psychological distress and somatic distress commonly coexist across Chinese sociodemographic groups. This speaks against the conventional notion of somatization and is consistent with recent findings of a higher prevalence of emotional illnesses in Chinese people. That psychologically distressed individuals are more impaired but less inclined to seek help than somatically distressed individuals may partly explain low levels of help-seeking for mental disorders found in epidemiological studies.
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Affiliation(s)
- Sing Lee
- The Chinese University of Hong Kong
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Baldwin DS, den Boer JA, Lyndon G, Emir B, Schweizer E, Haswell H. Efficacy and safety of pregabalin in generalised anxiety disorder: A critical review of the literature. J Psychopharmacol 2015; 29:1047-60. [PMID: 26259772 DOI: 10.1177/0269881115598411] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of this review is to summarise the literature on the efficacy and safety of pregabalin for the treatment of generalised anxiety disorder (GAD). Of 241 literature citations, 13 clinical trials were identified that were specifically designed to evaluate the efficacy and safety of pregabalin in GAD, including 11 randomised double-blind trials and two open-label studies. Pregabalin efficacy has been consistently demonstrated across the licensed dose range of 150-600 mg/day. Efficacy has been reported for pregabalin monotherapy in elderly patients with GAD, patients with severe anxiety, and for adjunctive therapy when added to a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor in patients who have failed to respond to an initial course of antidepressant therapy. The two most common adverse events with pregabalin are somnolence and dizziness, both of which appear to be dose-related. Pregabalin appears to have a low potential for causing withdrawal symptoms when long-term therapy is discontinued; however, tapering over the course of at least one week is recommended. A review of available evidence indicates that pregabalin is a well-tolerated and consistently effective treatment for GAD, with a unique mechanism of action that makes it a useful addition to the therapeutic armamentarium.
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Affiliation(s)
- David S Baldwin
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Johan A den Boer
- PRA Health Sciences, AE Zuidlaren, the Netherlands Department of Nuclear Medicine and Molecular Imaging, University of Groningen, Groningen, the Netherlands
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Boscarino JA, Hoffman SN, Pitcavage JM, Urosevich TG. Mental Health Disorders and Treatment Seeking Among Veterans in Non-VA Facilities: Results and Implications from the Veterans' Health Study. ACTA ACUST UNITED AC 2015; 3:244-254. [PMID: 26640743 DOI: 10.1080/21635781.2015.1077179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
We surveyed 700 veterans who were outpatients in a non-Veterans Affairs (VA) multihospital system. Our objective was to assess the prevalence of mental disorders and service use among these veterans. The majority were Vietnam veterans (72.0%), and male (95.9%), and 40.4% reported recently using the VA for care. The prevalence of lifetime post-traumatic stress disorder (PTSD) was 9.6%, lifetime depression 18.4%, and lifetime mental health service use 50.1%. In multivariate analyses, significant factors associated with PTSD, depression, and mental health service use were low self-esteem, use of alcohol/drugs to cope, history of childhood adversity, high combat exposure, and low psychological resilience. VA service use was associated with greater mental health service use and combat exposure. With the exception of alcohol misuse, the mental health status of veterans seen in non-VA facilities appeared to be better than reported in past studies. Because most veterans have access to both VA and non-VA services, these findings have implications for veterans and outcomes research.
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Jang Y, Yoon H, Chiriboga DA, Molinari V, Powers DA. Bridging the Gap Between Common Mental Disorders and Service Use: The Role of Self-Rated Mental Health Among African Americans. Am J Geriatr Psychiatry 2015; 23:658-65. [PMID: 24698444 DOI: 10.1016/j.jagp.2014.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 01/07/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individual's subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use. DESIGN Cross-sectional analyses of the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005-2006. SETTING In-home personal interviews. PARTICIPANTS Self-identified African American/black participants aged 40 to 85 years (N = 460). MEASUREMENTS Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy). RESULTS Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor. CONCLUSIONS Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individual's self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.
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Affiliation(s)
- Yuri Jang
- School of Social Work, The University of Texas at Austin, TX.
| | - Hyunwoo Yoon
- School of Social Work, The University of Texas at Austin, TX
| | - David A Chiriboga
- Department of Child and Family Studies, University of South Florida, Tampa, FL
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Daniel A Powers
- Department of Sociology, The University of Texas at Austin, TX
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