1
|
Bunting SR, Feinstein BA, Vidyasagar N, Sheth NK, Yu R, Hazra A. Psychiatry and Family Medicine Residents' Likelihood of Prescribing HIV Pre-exposure Prophylaxis to Patients With Mental Illness and HIV Vulnerability. J Acquir Immune Defic Syndr 2024; 96:231-240. [PMID: 38567904 DOI: 10.1097/qai.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/14/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND People living with mental illness (PLMI) experience disproportionately high incidence of and vulnerability to HIV. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method, but data regarding prescription to PLMI are lacking. Psychiatrists may serve as important points of access for PrEP prescription for PLMI. METHODS We conducted a vignette-based study of residents in psychiatry and family medicine (FM) to assess likelihood of prescribing PrEP and assumptions about the fictional patient. Participants were randomized to one of five vignettes in which the patients' psychiatric diagnosis was varied (schizophrenia on long-acting injectable or oral antipsychotic, bipolar disorder, major depression) or a control vignette without a psychiatric diagnosis. RESULTS A total of 439 residents participated. We found that high percentages of psychiatry (96.8%) and FM (97.4%) residents were aware of PrEP. High percentages of psychiatry (92.0%-98.1%) and FM (80.8%-100%) residents reported that PrEP was indicated for all patient conditions. Family medicine residents were more likely to prescribe PrEP to all experimental conditions than psychiatry residents. There was no difference in likelihood of prescribing to the control condition without a psychiatric diagnosis. The belief that PrEP prescription was out of scope of practice was greater among psychiatry residents. CONCLUSIONS A majority of psychiatry residents responded that PrEP was indicated for an array of patients with psychiatric diagnoses. However, psychiatry residents were broadly less likely to prescribe PrEP to patients with these diagnoses. The high percentage of psychiatry residents who reported that PrEP was indicated for all patients suggests that additional training is needed to facilitate PrEP prescription by psychiatrists.
Collapse
Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL
| | - Brian A Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, IL
| | - Nitin Vidyasagar
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Neeral K Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL; and
| | - Roger Yu
- Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
2
|
Mikkelsen TJ, Agerskov H, Jensen DM, Stenager E, Rothmann MJ. Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study. J Clin Nurs 2024; 33:1862-1874. [PMID: 38356190 DOI: 10.1111/jocn.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024]
Abstract
AIM To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. DESIGN The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. METHODS Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. RESULTS Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. CONCLUSION Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. IMPLICATIONS FOR PATIENT CARE The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
Collapse
Affiliation(s)
- Tanja Juhl Mikkelsen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
- Family Focused Health Care Research Centre, University of Southern Denmark, Odense, Denmark
| | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Psychiatric Research Unit, Aabenraa, Department of Regional Health Services Research, University of Southern Denmark, Denmark
- University of Southern Denmark, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Koly KN, Saba J, Christopher E, Hossain ANN, Akter T, Rahman Z, Ahmed HU, Eaton J. Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders' perspectives in Bangladesh. BMC Health Serv Res 2024; 24:270. [PMID: 38433239 PMCID: PMC10910748 DOI: 10.1186/s12913-024-10742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Bangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services. METHODS Four stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised. RESULT Stakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery. CONCLUSION The peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.
Collapse
Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh.
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Enryka Christopher
- Trauma and Community Resilience Center, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anan Nisat Nabela Hossain
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
| | - Taslima Akter
- Centre for Disability in Development, Dhaka, Bangladesh
| | - Zakia Rahman
- CBM Bangladesh Country Office (CBMBCO), Dhaka, Bangladesh
| | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- CBM Global Disability and Inclusion, Laudenbach, Germany
| |
Collapse
|
4
|
Sander AM, Pappadis MR, Bushnik T, Chiaravalloti ND, Driver S, Hanks R, Lercher K, Neumann D, Rabinowitz A, Seel RT, Weber E, Ralston RK, Corrigan J, Kroenke K, Hammond FM. An Umbrella Review of Self-Management Interventions for Health Conditions With Symptom Overlap With Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:140-151. [PMID: 37294622 DOI: 10.1097/htr.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI. DESIGN An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI. METHOD A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2). RESULTS A total of 26 reviews met the inclusion criteria, covering a range of chronic conditions and a range of outcomes. Seven reviews were of moderate or high quality and focused on self-management in persons with stroke, chronic pain, and psychiatric disorders with psychotic features. Self-management interventions were found to have positive effects on quality of life, self-efficacy, hope, reduction of disability, pain, relapse and rehospitalization rates, psychiatric symptoms, and occupational and social functioning. CONCLUSIONS Findings are encouraging with regard to the effectiveness of self-management interventions in patients with symptoms similar to those of TBI. However, reviews did not address adaptation of self-management interventions for those with cognitive deficits or for populations with greater vulnerabilities, such as low education and older adults. Adaptations for TBI and its intersection with these special groups may be needed.
Collapse
Affiliation(s)
- Angelle M Sander
- Author Affiliations: H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine and Harris Health System, Houston, Texas (Dr Sander); Brain Injury Research Center, TIRR Memorial Herman, Houston, Texas (Drs Sander and Pappadis); Department of Population Health and Health Disparities, School of Public and Population Health, and Sealy Center on Aging, The University of Texas Medical Branch (UTMB) (Dr Pappadis); Rusk Rehabilitation and NYU Langone Health, New York City, New York (Dr Bushnik); Kessler Foundation, East Hanover, New Jersey (Drs Chiaravalloti, Weber, and Lercher); Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark (Drs Chiaravalloti, Weber, and Lercher); Department of Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas (Dr Driver); Baylor Scott and White Research Institute, Dallas, Texas (Dr Driver); Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan (Dr Hanks); Department of Physical Medicine and Rehabilitation (Drs Neumann and Hammond), Ruth Lilly Medical Library (Mr Ralston), and Department of Medicine (Dr Kroenke), Indiana University School of Medicine, Indianapolis; Rehabilitation Hospital of Indiana, Indianapolis (Drs Neumann and Hammond); Moss Rehabilitation Research Institute, Elkins, Pennsylvania (Dr Rabinowitz); Department of Physical Medicine and Rehabilitation, Thomas Jefferson University Philadelphia, Pennsylvania (Dr Rabinowitz); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond (Dr Seel); Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus (Dr Corrigan); and Regenstrief Institute, Indianapolis, Indiana (Dr Kroenke)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Goh YSS, Ow Yong JQY, Li AZ. Effectiveness of Illness Management and Recovery program on people with severe mental illnesses: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1162288. [PMID: 37255686 PMCID: PMC10225549 DOI: 10.3389/fpsyt.2023.1162288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/19/2023] [Indexed: 06/01/2023] Open
Abstract
Background The Illness Management and Recovery (IMR) program has been established in response to the challenges faced by people with severe mental illnesses (SMIs). The program emphasizes the self-management of mental health conditions and the achievement of personally meaningful goals. However, reviews on its efficacy remain scarce, especially in recent years. Objective This review aimed to examine the efficacy of IMR in improving personal-recovery outcomes among people with SMIs. Methods A search was conducted on seven databases (CINAHL, Embase, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science) from inception to February 2022, without limits on the dates and types of publications. Studies were included if they had examined the efficacy of IMR in one or more outcomes, investigated at least one group of participants, and been published in English. The participants were adults (at least 16 years of age) with a formal diagnosis of at least one SMI. Results Fourteen studies were included in this review, and eight outcomes were examined: personal recovery, global functioning, social functioning, hope, perceived social support, quality of life, substance abuse, and knowledge of mental illness. There is limited evidence on the superiority of IMR to existing treatment plans or other interventions in improving the outcomes of interest among people with SMIs. However, the low attendance rates in many included studies suggest the presence of a threshold of exposure to IMR beyond which its treatment effects could be observed. Suggestions for future IMR implementation are discussed. Conclusions The IMR program may serve as an alternative or complementary intervention for people with SMIs, especially with enhanced program exposure and access to resource materials. Systematic review registration https://inplasy.com/inplasy-2022-10-0005/.
Collapse
Affiliation(s)
- Yong Shian Shawn Goh
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Jenna Qing Yun Ow Yong
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Amy Ziqiang Li
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
- Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
6
|
Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
Collapse
Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
| |
Collapse
|
7
|
Sippel LM, Myers AL, Brooks JM, Storm M, Mois G, Fortuna KL. Risk and protective factors in relation to early mortality among people with serious mental illness: Perspectives of peer support specialists and service users. Psychiatr Rehabil J 2022; 45:343-351. [PMID: 35797164 PMCID: PMC9822841 DOI: 10.1037/prj0000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) experience a 10-25-year reduced life expectancy when compared to the general population that is due, in part, to poor health behaviors. Yet, in spite of the development of health promotion and self-management interventions designed for people with SMI to promote health behavior change, the mortality gap has increased, suggesting that relevant factors are not being addressed. The objective of the present study was to explore potential contributors to early mortality among individuals with SMI by drawing from the lived experience of certified peer support specialists and service users (SUs). METHOD Face-to-face semistructured interviews were conducted with a convenience sample of SU participants (n = 17) and certified peer specialists (n = 15). Qualitative data were analyzed using a grounded-theory approach. RESULTS We identified a final set of 27 codes relating to five overarching themes that relate to both risk factors and protective factors for early death: social connectedness (24.1% of coded items), treatment (21.3%), coping (21.3%), physical health and wellness (18.5%), and resilience and mental health (14.8%). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings add to the literature supporting the powerful role of social processes in shaping health in people with SMI beyond social determinants of health (SDOH; e.g., income, employment) and health behavior change. Interventions that reduce loneliness and isolation in combination with addressing more conventional SDOH may have the most potential to reduce early mortality in people with SMI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
|
8
|
Fortuna KL, Myers AL, Ferron J, Kadakia A, Bianco C, Bruce ML, Bartels SJ. Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness. J Ment Health 2022; 31:833-841. [PMID: 35088619 PMCID: PMC9329481 DOI: 10.1080/09638237.2021.2022619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention ("PeerTECH") for adults with a serious mental illness. METHODS Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older received the PeerTECH intervention in the community. Nine peer support specialists were trained to deliver PeerTECH. Data were collected at baseline and 12-weeks. RESULTS This pilot study demonstrated that a 12-week, digital peer support integrated medical and psychiatric self-management intervention for adults with serious mental illness was feasible and acceptable among peer support specialists and patients and was associated with statistically significant improvements in self-efficacy to manage chronic disease and personal empowerment. In addition, pre/post non-statistically significant improvements were observed in psychiatric self-management, medical self-management skills, and feelings of loneliness. CONCLUSIONS This single-arm pre/post pilot study demonstrated preliminary evidence peer support specialists could offer a fidelity-adherent digital peer support self-management intervention to adults with serious mental illness. These findings build on the evidence that a digital peer support self-management intervention for adults with serious mental illness designed to improve medical and psychiatric self-management is feasible, acceptable, and shows promising evidence of improvements in clinical outcomes. The use of technology among peer support specialists may be a promising tool to facilitate the delivery of peer support and guided evidence-based self-management support.People with serious mental illness (SMI; defined as individuals diagnosed with schizophrenia spectrum disorder, bipolar disorder, or treatment-refractory major depressive disorder) are increasingly utilizing peer support services to support their health and recovery. Peer support is defined as shared knowledge, experience, emotional, social, and/or practical assistance to support others with similar lived experiences (Solomon, 2004). Most recently the definition also includes the provision of evidence-based peer-supported self-management services (Fortuna et al., 2020). Mental health peer support can augment the traditional mental health treatment system through providing support services to maintain recovery between clinical encounters (Solomon, 2004) and is classified by the World Health Organization as an essential element of recovery (World, Health, and Organization, About social determinants of health, 2017).
Collapse
Affiliation(s)
- Karen L. Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Joelle Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Arya Kadakia
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover NH, USA
| | - Cynthia Bianco
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martha L. Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | |
Collapse
|
9
|
Feasibility, Acceptability, and Potential Utility of Peer-supported Ecological Momentary Assessment Among People with Serious Mental Illness: a Pilot Study. Psychiatr Q 2022; 93:717-735. [PMID: 35661317 PMCID: PMC9166198 DOI: 10.1007/s11126-022-09986-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/03/2022]
Abstract
To examine the feasibility, acceptability, and initial validity of using smartphone-based peer-supported ecological momentary assessment (EMA) as a tool to assess loneliness and functioning among adults with a serious mental illness diagnosis. Twenty-one adults with a diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older completed EMA surveys via smartphones once per day for 12-weeks. Nine peer support specialists prompted patients with SMI to complete the EMA surveys. Data were collected at baseline and 12-weeks. EMA acceptability (15.9%) was reported, and participants rated their experience with EMA methods positively. EMA responses were correlated with higher social support at 3 months. Higher levels of EMA-measured loneliness were significantly correlated with levels of social support, less hope, and less empowerment at 3 months. Lastly, those who contacted their peer specialist reported higher levels of loneliness and lower levels of functioning on that day suggesting that participants were able to use their peers for social support. Peer-supported EMA via smartphones is a feasible and acceptable data collection method among adults with SMI and appears to be a promising mobile tool to assess loneliness and functioning. These preliminary findings indicate EMA-measured loneliness and functioning are significantly predicted by baseline variables and such variables may impact engagement in EMA. EMA may contribute to future research examining the clinical utility of peer support specialists to alleviate feelings of loneliness and improve functioning.
Collapse
|
10
|
Beaudin J, Chouinard MC, Girard A, Houle J, Ellefsen É, Hudon C. Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a scoping review. BMC Nurs 2022; 21:212. [PMID: 35918723 PMCID: PMC9344621 DOI: 10.1186/s12912-022-01000-2] [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: 12/09/2021] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To map integrated and non-integrated self-management support interventions provided by primary care nurses to persons with chronic diseases and common mental disorders and describe their characteristics. DESIGN A scoping review. DATA SOURCES In April 2020, we conducted searches in several databases (Academic Research Complete, AMED, CINAHL, ERIC, MEDLINE, PsycINFO, Scopus, Emcare, HealthSTAR, Proquest Central) using self-management support, nurse, primary care and their related terms. Of the resulting 4241 articles, 30 were included into the analysis. REVIEW METHODS We used the Rainbow Model of Integrated Care to identify integrated self-management interventions and to analyze the data and the PRISMS taxonomy for the description of interventions. Study selection and data synthesis were performed by the team. Self-management support interventions were considered integrated if they were consistent with the Rainbow model's definition of clinical integration and person-focused care. RESULTS The 30 selected articles related to 10 self-management support interventions. Among these, five interventions were considered integrated. The delivery of the interventions showed variability. Strategies used were education, problem-solving therapies, action planning, and goal setting. Integrated self-management support intervention characteristics were nurse-person relationship, engagement, and biopsychosocial approach. A framework for integrated self-management was proposed. The main characteristics of the non-integrated self-management support were disease-specific approach, protocol-driven, and lack of adaptability. CONCLUSION Our review synthesizes integrated and non-integrated self-management support interventions and their characteristics. We propose recommendations to improve its clinical integration. However, further theoretical clarification and qualitative research are needed. IMPLICATION FOR NURSING Self-management support is an important activity for primary care nurses and persons with chronic diseases and common mental disorders, who are increasingly present in primary care, and require an integrated approach. IMPACT This review addresses the paucity of details surrounding integrated self-management support for persons with chronic diseases and common mental disorders and provides a framework to better describe its characteristics. The findings could be used to design future research and improve the clinical integration of this activity by nurses.
Collapse
Affiliation(s)
- Jérémie Beaudin
- Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, 3001J1H 5N4, Canada.
| | - Maud-Christine Chouinard
- Faculté Des Sciences Infirmières, Université de Montréal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada
| | - Ariane Girard
- Faculté de Médecine, Université Laval, VITAM Research Center On Sustainable Health, 2601, Chemin de La Canardière (G-2300), Québec, Québec, G1J 2G3, Canada
| | - Janie Houle
- Département de Psychologie, Université du Québec À Montréal, case postale 8888, succ. Centre-ville, Montréal, Québec, H3C 3P8, Canada
| | - Édith Ellefsen
- École des sciences infirmières, Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, 3001J1H 5N4, Canada
| | - Catherine Hudon
- Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec, 3001J1H 5N4, Canada
| |
Collapse
|
11
|
Non-Pharmacological Integrated Interventions for Adults Targeting Type 2 Diabetes and Mental Health Comorbidity: A Mixed-Methods Systematic Review. Int J Integr Care 2022; 22:27. [PMID: 35855093 PMCID: PMC9248983 DOI: 10.5334/ijic.5960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: Adults living with Type 2 diabetes (T2D) and severe mental illness (SMI) disproportionally experience premature mortality and health inequality. Despite this, there is a limited evidence-base and evaluation of non-pharmacological integrated interventions that may contribute to improved patient experience and outcomes. To improve our understanding of how to optimise integrated care for this group, this review evaluates the effectiveness, acceptability, and feasibility of non-pharmacological integrated interventions for adults with SMI and T2D. Methods: Studies from nine electronic databases were searched. Of the 6750 papers retrieved, seven papers (five quantitative and two qualitative) met the inclusion/exclusion criteria. A convergent integrated approach was used to narratively synthesise data into four main themes: effectiveness, acceptability, feasibility, integrated care. Results: There is moderate evidence to suggest non-pharmacological integrated interventions may be effective in improving some diabetes-related and psychosocial outcomes. Person-centred integrated interventions that are delivered collaboratively by trained facilitators who exemplify principles of integrated care may be effective in reducing the health-treatment gap. Conclusions: Recommendations from this review can provide guidance to healthcare professionals, commissioners, and researchers to inform improvements to non-pharmacological integrated interventions that are evidence-based, theoretically driven, and informed by patient and healthcare professionals’ experiences of care.
Collapse
|
12
|
Fortuna KL, Marceau SR, Kadakia A, Pratt SI, Varney J, Walker R, Myers AL, Thompson S, Carter K, Greene K, Pringle W. Peer Support Specialists’ Perspectives of a Standard Online Research Ethics Training: Qualitative Study. JMIR Form Res 2022; 6:e29073. [PMID: 35103606 PMCID: PMC8848236 DOI: 10.2196/29073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background
Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for people who, unlike CPS, have had exposure to prior formal research training.
Objective
The aim of this study is to explore the perspectives of CPS in completing the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training.
Methods
A total of 5 CPS were recruited using a convenience sample framework through the parent study, a patient-centered outcomes research study that examined the comparative effectiveness of two chronic health disease management programs for people with serious mental illness. Participants independently completed the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training. All participants completed 15 online modules in approximately 7-9 hours and also filled out a self-report measure of executive functioning (the Adult Executive Functioning Inventory [ADEXI]). Qualitative data were collected from a 1-hour focus group and qualitative analysis was informed by the grounded theory approach. The codebook consisted of codes inductively derived from the data. Codes were independently assigned to text, grouped, and checked for themes. Thematic analysis was used to organize themes.
Results
Passing scores for each module ranged from 81%-89%, with an average of 85.4% and a median of 86%. The two themes that emerged from the focus group were the following: comprehension (barrier) and opportunity (facilitator). Participants had a mean score of 27.4 on the ADEXI.
Conclusions
The CPS perceived the research ethics online training as an opportunity to share their lived experience expertise to enhance current research efforts by nonpeer scientists. Although the CPS completed the online research ethics training, the findings indicate CPS experienced difficulty with comprehension of the research ethics online training materials. Adaptations may be needed to facilitate uptake of research ethics online training by CPS and create a workforce of CPS to offer their lived experience expertise alongside peer and nonpeer researchers.
Collapse
Affiliation(s)
- Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Skyla R Marceau
- Geisel School of Medicine, Dartmouth College, Concord, NH, United States
| | | | - Sarah I Pratt
- Geisel School of Medicine, Dartmouth College, Concord, NH, United States
| | - Joy Varney
- Centerstone Kentucky, Louisville, KY, United States
| | - Robert Walker
- Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston, MA, United States
| | - Amanda L Myers
- Institute for Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States
| | | | | | - Kaycie Greene
- Centerstone Tennessee, Clarksville, TN, United States
| | | |
Collapse
|
13
|
Zabeen S, Lawn S, Venning A, Fairweather K. Why Do People with Severe Mental Illness Have Poor Cardiovascular Health?-The Need for Implementing a Recovery-Based Self-Management Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312556. [PMID: 34886281 PMCID: PMC8656807 DOI: 10.3390/ijerph182312556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/20/2021] [Accepted: 11/27/2021] [Indexed: 12/04/2022]
Abstract
People with severe mental illness (SMI) die significantly earlier than their well counterparts, mainly due to preventable chronic conditions such as cardiovascular disease (CVD). Based on the existing research, this perspective paper summarises the key contributors to CVD in people with SMI to better target the areas that require more attention to reduce, and ultimately resolve this health inequity. We discuss five broad factors that, according to current international evidence, are believed to be implicated in the development and maintenance of CVD in people with SMI: (1) bio-psychological and lifestyle-related factors; (2) socio-environmental factors; (3) health system-related factors; (4) service culture and practice-related factors; and (5) research-related gaps on how to improve the cardiovascular health of those with SMI. This perspective paper identifies that CVD in people with SMI is a multi-faceted problem involving a range of risk factors. Furthermore, existing chronic care or clinical recovery models alone are insufficient to address this complex problem, and none of these models have identified the significant roles that family caregivers play in improving a person’s self-management behaviours. A new framework is proposed to resolve this complex health issue that warrants a collaborative approach within and between different health and social care sectors.
Collapse
Affiliation(s)
- Sara Zabeen
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (S.L.); (A.V.); (K.F.)
- Menzies School of Health Research, Charles Darwin University, Darwin 0811, Australia
- Correspondence: ; Tel.: +61-0481-525-497
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (S.L.); (A.V.); (K.F.)
| | - Anthony Venning
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (S.L.); (A.V.); (K.F.)
| | - Kate Fairweather
- College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia; (S.L.); (A.V.); (K.F.)
| |
Collapse
|
14
|
Bunting SR, Hazra A, Sheth NK. Psychiatrists as prescribers of HIV pre-exposure prophylaxis: An untapped resource for HIV prevention among patients living with mental illness. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2020.1855007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Samuel R. Bunting
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Neeral K. Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
15
|
Fortuna KL, Williams A, Mois G, Jason K, Bianco CL. Social Processes Associated With Health and Health Behaviors Linked to Early Mortality in People With a Diagnosis of a Serious Mental Illness. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2021; 17:183-190. [PMID: 34264159 DOI: 10.1177/1745691621990613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Individuals with serious mental illness (SMI) experience a 10- to 25-year reduced life expectancy compared with the general population. Early mortality for people with SMI has mainly been attributed to unhealthy behaviors (e.g., poor diet, sedentary lifestyle), which has led to the development of health promotion and self-management interventions specifically for people with SMI to promote health behavior change. Yet after decades of research, the mortality gap between people with SMI and the general population is increasing. To address this early mortality disparity for individuals with SMI, a new paradigm must be explored. In this article, we present the social processes impacting early mortality in people with SMI paradigm, which highlights the powerful role of social processes in shaping the health and health behaviors of people with SMI. This paradigm explores how loneliness, stigma (social and self), trauma, social exclusion, social isolation, and social norms are related to early mortality in people with SMI. This new paradigm is an important step in understanding and potentially addressing early mortality in people with SMI.
Collapse
Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | | | - George Mois
- School of Social Work, University of Georgia
| | - Kendra Jason
- Department of Sociology, University of North Carolina Charlotte
| | | |
Collapse
|
16
|
Emerson MR, Harsh Caspari J, Notice M, Watanabe-Galloway S, Dinkel D, Kabayundo J. Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings. Gen Hosp Psychiatry 2021; 69:67-75. [PMID: 33571926 DOI: 10.1016/j.genhosppsych.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Margaret R Emerson
- University of Nebraska Medical Center College of Nursing, Omaha, NE, United States of America.
| | - Jennifer Harsh Caspari
- University of Nebraska Medical Center College of Medicine, Omaha, NE, United States of America
| | - Maxine Notice
- University of Central Missouri, School of Human Service, Warrensburg, MO, United States of America
| | | | - Danae Dinkel
- University of Nebraska Omaha, School of Health & Kinesiology, Omaha, NE, United States of America
| | - Josiane Kabayundo
- University of Nebraska Medical Center College of Public Health, Omaha, NE, United States of America
| |
Collapse
|
17
|
Carter H, Araya R, Anjur K, Deng D, Naslund JA. The emergence of digital mental health in low-income and middle-income countries: A review of recent advances and implications for the treatment and prevention of mental disorders. J Psychiatr Res 2021; 133:223-246. [PMID: 33360867 PMCID: PMC8801979 DOI: 10.1016/j.jpsychires.2020.12.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
In low-income and middle-income countries (LMICs), emerging digital mental health interventions should be accompanied by regular and comprehensive assessment of available scientific evidence. This review aims to support efforts to monitor progress in digital mental health research, ensuring new evidence can guide researchers, clinicians, policymakers and program managers positioned to adopt and implement these digitally-enabled treatments. In accordance with PRISMA guidelines, an electronic database search from 2016 to 2020 yielded 37 digital intervention studies for detection, diagnosis, prevention, treatment, and/or management of a broad range of mental disorders in 13 LMICs. This date range was selected to update previous reviews. Most studies involved online interventions and many reported feasibility and acceptability, reflected by participant satisfaction or program adherence. About half the studies (N = 23) reported clinical benefits based on changes in mental health. For depression and mood disorders, some digital interventions showed improvements in depressive symptoms, quality of life, treatment adherence, and recovery. However, sample sizes were small and studies focused primarily on adults. Further limiting generalizability was the lack of consistency in clinical assessment and measurement tools between studies. No studies reported worsening symptoms, negative acceptability or dissatisfaction with digital interventions, suggesting possible publication bias. While digital interventions show promise, it remains difficult to conclude that digital interventions are effective from these studies, as it is prudent to exercise caution before drawing conclusions about clinical effectiveness. This review reflects continued growth in digital mental health research in LMICs and further highlights the need for rigorous evaluation of effectiveness and cost-effectiveness.
Collapse
Affiliation(s)
- Helena Carter
- The Center for Global Mental Health, King's College London, London, UK
| | - Ricardo Araya
- The Center for Global Mental Health, King's College London, London, UK; Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kavya Anjur
- Johns Hopkins University, Baltimore, MD, USA
| | - Davy Deng
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA
| | - John A Naslund
- The Mental Health for All Lab, Harvard Medical School, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
18
|
Griffiths H. The Acceptability and Feasibility of Using Text Messaging to Support the Delivery of Physical Health Care in those Suffering from a Psychotic Disorder: a Review of the Literature. Psychiatr Q 2020; 91:1305-1316. [PMID: 32970312 PMCID: PMC7593303 DOI: 10.1007/s11126-020-09847-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Those suffering with serious mental illness (SMI), such as psychotic disorders, experience life expectancy 15 years shorter than the general population. Cardiovascular disease is the biggest cause of death in those with psychotic disease and many risk factors may be limited by healthy lifestyle choices. Text messaging interventions represent mobile health (mHealth), a nascent way to deliver physical health care to those suffering with a psychotic disorder. This paper aims to review the literature on the feasibility of text messaging to support the delivery of physical health care in those with a psychotic disorder. A thorough electronic database literature review of Medline via Ovid, Embase, APA Psycinfo, Scopus, Cochrane and Web of Science was conducted. Articles were included if text messaging was used as an intervention targeting the physical health of patients with psychotic disorders. A final sample of 11 articles satisfied the eligibility criteria, of which, 3 were ongoing randomised controlled trials. Of the 8 completed trials, all demonstrated the promising feasibility of text messaging, assessed via quotes, conversation samples, response rates, questionnaires or directly based on physical results. 36% of studies analysed those with schizophrenia or schizoaffective disorder, 55% with SMI and 9% with schizophrenia and psychotic disorders, mood disorders or anxiety disorders. Text messaging was used as motivation or reminders (91%), service delivery (27%) or social support (27%) with studies targeting multiple themes simultaneously. This review highlights compelling evidence for the feasibility of text messaging for improvement of physical health in those suffering with psychotic disorders.
Collapse
|
19
|
Szlyk H, Tan J. The Role of Technology and the Continuum of Care for Youth Suicidality: Systematic Review. J Med Internet Res 2020; 22:e18672. [PMID: 33034568 PMCID: PMC7584980 DOI: 10.2196/18672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background Youth suicide is a global public health issue, and using technology is one strategy to increase participation in preventive interventions. However, there is minimal knowledge on how technology-enhanced interventions for youth correspond to the stages of care, from illness or risk recognition to treatment follow-up. Objective This systematic review aims to examine the efficacy of technology-enhanced youth suicide prevention and interventions across the continuum of care. Methods Four electronic databases were searched up to spring 2019 for youth suicide preventive interventions that used technology. The review was not restricted by study design and eligible studies could report outcomes on suicidality or related behaviors, such as formal treatment initiation. An adapted version of the Methodological Quality Ratings Scale was used to assess study quality. Results A total of 26 studies were identified. The findings support the emerging efficacy of technology-enhanced interventions, including a decline in suicidality and an increase in proactive behaviors. However, evidence suggests that there are gaps in the continuum of care and recent study samples do not represent the diverse identities of vulnerable youth. Conclusions The majority of identified studies were conducted in school settings and were universal interventions that aligned with the illness and risk recognition and help-seeking stages of the continuum of care. This field could be strengthened by having future studies target the stages of assessment and treatment initiation, include diverse youth demographics, and examine the varying roles of providers and technological components in emerging interventions.
Collapse
Affiliation(s)
- Hannah Szlyk
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Jia Tan
- The Brown School, Washington University in St Louis, Saint Louis, MO, United States
| |
Collapse
|
20
|
Richardson A, Richard L, Gunter K, Cunningham R, Hamer H, Lockett H, Wyeth E, Stokes T, Burke M, Green M, Cox A, Derrett S. A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. J Psychiatr Res 2020; 128:52-67. [PMID: 32521251 DOI: 10.1016/j.jpsychires.2020.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
Integrated care approaches have been recommended to remove barriers to healthcare and improve the physical health outcomes of people living with serious mental illness (SMI) and/or substance use disorders (SUDs). The aim of this systematic scoping review was to describe empirical investigations of interventions designed to integrate physical, mental, and addiction healthcare for this population. An iterative and systematic search of five electronic databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus) was conducted to identify peer-reviewed articles published between January 2000 and April 2019. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. Data from each included publication were extracted independently by two reviewers using a standardised spreadsheet. A total of 28 eligible publications were identified, representing 25 unique studies. Over half of the included studies investigated the use of case managers to provide self-management skills or to coordinate mental and physical healthcare (n = 14). Other interventions examined the co-location of services (n = 9) and the implementation of screening and referral pathways to specialist treatment (n = 2). Less than half of the included studies described a framework, theory or model that was underpinning the intervention tested. While some aspects of integrated care have been identified and addressed by interventions, other key dimensions have not been considered, such as shared decision-making. Identification of a comprehensive model of integrated care is recommended to inform the development and evaluation of future interventions for people with SMI/SUDs.
Collapse
Affiliation(s)
- Amy Richardson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Kathryn Gunter
- Chicago Center for Diabetes Translation Research, The University of Chicago Department of Medicine, Chicago, IL, 60637, USA.
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Helen Hamer
- Helen Hamer & Associates Ltd, Auckland, New Zealand.
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Martin Burke
- Addictions, Supportive Accommodation, Reintegration and Palliative Care Services, Salvation Army, PO Box 6015, Wellington, 6141, New Zealand.
| | - Mel Green
- South Community Mental Health Team, Southern District Health Board, Private Bag 1921, Dunedin, 9054, New Zealand.
| | - Adell Cox
- Southern District Health Board, New Zealand.
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| |
Collapse
|
21
|
Shalaby RAH, Agyapong VIO. Peer Support in Mental Health: Literature Review. JMIR Ment Health 2020; 7:e15572. [PMID: 32357127 PMCID: PMC7312261 DOI: 10.2196/15572] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/06/2019] [Accepted: 02/15/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources. OBJECTIVE In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields. METHODS The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care. RESULTS There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce. CONCLUSIONS There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.
Collapse
|
22
|
Fortuna KL, Venegas M, Bianco CL, Smith B, Batsis JA, Walker R, Brooks J, Umucu E. The relationship between hopelessness and risk factors for early mortality in people with a lived experience of a serious mental illness. SOCIAL WORK IN MENTAL HEALTH 2020; 18:369-382. [PMID: 33442334 PMCID: PMC7802745 DOI: 10.1080/15332985.2020.1751772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to explore the relationships between self-reported hopelessness and risk factors for premature mortality in people with serious mental illness (SMI). Data were extracted from the 2014 Health Center Patient Survey (N = 5,592). Having a diagnosis of SMI was significantly associated with self-reported hopelessness. Hypertension or high blood pressure, congestive heart failure, and chronic obstructive pulmonary disorder were significantly associated with self-reported hopelessness. Higher levels of hopelessness were found to be significantly associated with increased alcohol consumption. Hopelessness may be an important dimension of health in people with SMI.
Collapse
Affiliation(s)
- Karen L. Fortuna
- Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Concord, New Hampshire, USA
| | - Maria Venegas
- Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Concord, New Hampshire, USA
| | - Cynthia L. Bianco
- Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Concord, New Hampshire, USA
| | - Bret Smith
- Manchester Peer Collaborative at the Mental Health Center of Greater Manchester, Manchester, New Hampshire, USA
| | - John A. Batsis
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, USA
| | - Robert Walker
- Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Jessica Brooks
- School of Nursing, Columbia University, New York, New York, USA
| | - Emre Umucu
- Department of Rehabilitation Sciences, College of Health Sciences, University of Texas at El Paso, El Paso, Texas, USA
| |
Collapse
|
23
|
Fortuna KL, Naslund JA, LaCroix JM, Bianco CL, Brooks JM, Zisman-Ilani Y, Muralidharan A, Deegan P. Digital Peer Support Mental Health Interventions for People With a Lived Experience of a Serious Mental Illness: Systematic Review. JMIR Ment Health 2020; 7:e16460. [PMID: 32243256 PMCID: PMC7165313 DOI: 10.2196/16460] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Peer support is recognized globally as an essential recovery service for people with mental health conditions. With the influx of digital mental health services changing the way mental health care is delivered, peer supporters are increasingly using technology to deliver peer support. In light of these technological advances, there is a need to review and synthesize the emergent evidence for peer-supported digital health interventions for adults with mental health conditions. OBJECTIVE The aim of this study was to identify and review the evidence of digital peer support interventions for people with a lived experience of a serious mental illness. METHODS This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures. The PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO databases were searched for peer-reviewed articles published between 1946 and December 2018 that examined digital peer support interventions for people with a lived experience of a serious mental illness. Additional articles were found by searching the reference lists from the 27 articles that met the inclusion criteria and a Google Scholar search in June 2019. Participants, interventions, comparisons, outcomes, and study design (PICOS) criteria were used to assess study eligibility. Two authors independently screened titles and abstracts, and reviewed all full-text articles meeting the inclusion criteria. Discrepancies were discussed and resolved. All included studies were assessed for methodological quality using the Methodological Quality Rating Scale. RESULTS A total of 30 studies (11 randomized controlled trials, 2 quasiexperimental, 15 pre-post designs, and 2 qualitative studies) were included that reported on 24 interventions. Most of the studies demonstrated feasibility, acceptability, and preliminary effectiveness of peer-to-peer networks, peer-delivered interventions supported with technology, and use of asynchronous and synchronous technologies. CONCLUSIONS Digital peer support interventions appear to be feasible and acceptable, with strong potential for clinical effectiveness. However, the field is in the early stages of development and requires well-powered efficacy and clinical effectiveness trials. TRIAL REGISTRATION PROSPERO CRD42020139037; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID= 139037.
Collapse
Affiliation(s)
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, United States
| | - Cynthia L Bianco
- The Giesel School of Medicine, Dartmouth College, Concord, NH, United States
| | - Jessica M Brooks
- Geriatric Research, Education and Clinical Center, James J Peters VA Medical Center, New York, NY, United States
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Anjana Muralidharan
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Rockville, MD, United States
| | | |
Collapse
|
24
|
Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Clin Geriatr Med 2020; 36:341-352. [PMID: 32222306 DOI: 10.1016/j.cger.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
Collapse
Affiliation(s)
- Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA.
| | - Peter R DiMilia
- The Dartmouth Institute for Health Policy and Clinical Practice, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - Karen L Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - John A Naslund
- Dartmouth Center for Technology and Behavioral Health, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| |
Collapse
|
25
|
Application of Self-determination Theory to Illness Self-management Interventions: Identifying Mediators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:760-767. [PMID: 31267242 DOI: 10.1007/s10488-019-00953-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
NIMH requires intervention research to utilize an experimental therapeutic approach, identifying mediators to examine causal mechanisms of change. The authors propose utilizing self-determination theory (SDT) to guide research design for self-management interventions, using Wellness Recovery Action Plan (WRAP) as an exemplar. To delineate the theory's relevance to self-management interventions and recovery outcomes, the authors describe the main constructs of SDT and demonstrate its applicability to WRAP and recovery. Suggestions for research design and measurement strategies are provided.
Collapse
|
26
|
Muralidharan A, Mills WL, Evans DR, Fujii D, Molinari V. Preparing Long-Term Care Staff to Meet the Needs of Aging Persons With Serious Mental Illness. J Am Med Dir Assoc 2019; 20:683-688. [PMID: 31056455 PMCID: PMC6611673 DOI: 10.1016/j.jamda.2019.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Individuals with serious mental illness (SMI; schizophrenia spectrum disorders and affective psychoses) are increasingly aging into older adulthood and are overrepresented in residential long-term care settings. The present study aimed to examine the preparedness of staff in these settings to care for individuals with SMI. DESIGN A multidisciplinary US Department of Veterans Affairs (VA) workgroup of professionals with expertise in geriatric mental health collected voluntary feedback via online questionnaire as part of a quality improvement project. SETTING AND PARTICIPANTS Respondents were mental health providers (N=51) embedded in VA nursing homes called Community Living Centers (CLCs). MEASURES The questionnaire contained multiple-choice, Likert-type scale, and open-ended questions regarding the opportunities and challenges associated with caring for Veterans with SMI in CLCs. RESULTS Respondents identified a lack of training of front-line staff as a key challenge in providing high-quality care to residents with SMI. Specifically, respondents indicated a need to increase staff knowledge about SMI symptoms and diagnoses, to improve staff communication and interactions with residents with SMI, and to decrease mental illness stigma among staff. CONCLUSIONS/IMPLICATIONS The present study revealed significant areas of training need for front-line staff in nursing homes. Many perceived staff training needs overlap with the knowledge and skill set required to provide high-quality dementia care. Integrating training regarding the care of residents with SMI into dementia care training efforts may be a fruitful future direction. Strategies for this and a suggested curriculum are provided.
Collapse
Affiliation(s)
- Anjana Muralidharan
- VA Capitol Healthcare Network, Mental Illness Research Education and Clinical Center, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
| | - Whitney L Mills
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI; Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
| | - Denise R Evans
- Charlie Norwood VA Medical Center, Augusta, GA; Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Daryl Fujii
- VA Pacific Islands Healthcare System, Honolulu, HI
| | - Victor Molinari
- School of Aging Studies, University of South Florida, Tampa, FL
| |
Collapse
|
27
|
Matheson FI, Hamilton-Wright S, Kryszajtys DT, Wiese JL, Cadel L, Ziegler C, Hwang SW, Guilcher SJT. The use of self-management strategies for problem gambling: a scoping review. BMC Public Health 2019; 19:445. [PMID: 31035978 PMCID: PMC6489359 DOI: 10.1186/s12889-019-6755-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern. Methods We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool. Results We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness. Conclusions Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment. Electronic supplementary material The online version of this article (10.1186/s12889-019-6755-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Flora I Matheson
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Sarah Hamilton-Wright
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - David T Kryszajtys
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jessica L Wiese
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Carolyn Ziegler
- Health Information Sciences Library, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Sara J T Guilcher
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
28
|
Fortuna KL, Naslund JA, Aschbrenner KA, Lohman MC, Storm M, Batsis JA, Bartels SJ. Text message exchanges between older adults with serious mental illness and older certified peer specialists in a smartphone-supported self-management intervention. Psychiatr Rehabil J 2019; 42:57-63. [PMID: 30010355 PMCID: PMC6335192 DOI: 10.1037/prj0000305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify the strategies peer specialists use to provide illness self-management support for older adults with serious mental illness (SMI) through text messaging. METHOD Transcripts of text message exchanges between 8 older adult participants with SMI who completed the PeerTECH intervention and 3 older adult certified peer specialists who delivered the 12-week program were analyzed. Text message analyses explored themes relevant to peer support and health behavior change. Quantitative data comprised frequency of text messages by either the peer or consumer. RESULTS Consumers (N = 8) had a mean age of 68.8 years (SD = 4.9) and were mainly women (88%), White (100%), and married (75%). Certified peer specialists (N = 3) were all 55 or older; 100% were female, 66% identified as White, and 33% identified as African American. Overall, peers sent 215 text messages whereas consumers sent 141 text messages. In the peer specialist-consumer text message exchanges, we identified 4 themes on different aspects of illness self-management, including health behavior change, self-management therapeutic techniques, engagement in health technology, and peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This exploratory qualitative study offers preliminary support that peers are able to use text messages to support the delivery of a peer-delivered home-based medical and psychiatric self-management intervention. Certified peer specialists can potentially provide a range of illness self-management support to older adults with SMI via text messaging. These findings will inform the development of standardized peer text-messaging services to augment evidence-based illness self-management interventions for older adults with SMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Karen L. Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - John A. Naslund
- Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Avenue Boston, MA 02115
| | - Kelly A. Aschbrenner
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | | | - Marianne Storm
- The Dartmouth Institute, 1 Medical Center Drive, Lebanon, NH 03766
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Stephen J. Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
29
|
Muralidharan A, Brown CH, E Peer J, A Klingaman E, M Hack S, Li L, Walsh MB, Goldberg RW. Living Well: An Intervention to Improve Medical Illness Self-Management Among Individuals With Serious Mental Illness. Psychiatr Serv 2019; 70:19-25. [PMID: 30353790 PMCID: PMC6494087 DOI: 10.1176/appi.ps.201800162] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions. METHODS Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes. RESULTS Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up. CONCLUSIONS Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.
Collapse
Affiliation(s)
- Anjana Muralidharan
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Clayton H Brown
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Jason E Peer
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Elizabeth A Klingaman
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Samantha M Hack
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Lan Li
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Mary Brighid Walsh
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Richard W Goldberg
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| |
Collapse
|
30
|
Hossain MM, Tasnim S, Sharma R, Sultana A, Shaik AF, Faizah F, Kaur R, Uppuluri M, Sribhashyam M, Bhattacharya S. Digital interventions for people living with non-communicable diseases in India: A systematic review of intervention studies and recommendations for future research and development. Digit Health 2019; 5:2055207619896153. [PMID: 31897307 PMCID: PMC6920343 DOI: 10.1177/2055207619896153] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/29/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A high burden of non-communicable diseases (NCDs) is contributing to high mortality and morbidity in India. Recent advancements in digital health interventions, including mHealth, eHealth, and telemedicine, have facilitated patient-centered care for NCDs. OBJECTIVE This systematic review aims to evaluate the current evidence on digital interventions for people living with NCDs in India and the outcomes of those interventions. METHODS We adopted PRISMA guidelines and systematically reviewed articles from MEDLINE, CINAHL, PsycINFO, ERIC, and Scopus databases with following criteria: journal articles presenting digital intervention(s) used by people with at least one of the NCDs, reporting health outcomes following the intervention, studies conducted in India among Indian population. RESULTS Among 1669 articles retrieved from multiple sources, only 13 articles met our criteria. Most (n = 7) studies were conducted in southern states of India; eight studies included patients with diabetes, followed by neuropsychiatric disorders and other NCDs. Five studies recruited participants from tertiary hospitals; six interventions used text-messaging for delivering health services, and 10 studies reported randomized controlled trials. All the studies reported positive health outcomes following the intervention, including better self-management, increased patient-provider communication, improved medication adherence, and reduced disease symptoms. Most studies scored moderate to high in quality assessment checklist of Downs and Black. CONCLUSION Current evidence suggests a low number of interventions with positive outcomes. Future research should explore avenues of advanced technologies ensuring equitable and sustainable development of digital health interventions for people living with NCDs in India.
Collapse
Affiliation(s)
- Md Mahbub Hossain
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | - Samia Tasnim
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | | | - Abida Sultana
- Gazi Medical College, Mojid Sarani, Sonadanga, Khulna,
Bangladesh
| | | | - Farah Faizah
- The United Nations Population Fund (UNFPA), Dhaka,
Bangladesh
| | - Ravneet Kaur
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | - Madhuri Uppuluri
- School of Public Health, Texas A&M University, College
Station, TX, USA
| | | | | |
Collapse
|
31
|
Fortuna KL, Aschbrenner KA, Lohman MC, Brooks J, Salzer M, Walker R, St George L, Bartels SJ. Smartphone Ownership, Use, and Willingness to Use Smartphones to Provide Peer-Delivered Services: Results from a National Online Survey. Psychiatr Q 2018; 89:947-956. [PMID: 30056476 PMCID: PMC6413732 DOI: 10.1007/s11126-018-9592-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Assess certified peer specialists' smartphone ownership, use, and willingness to use smartphones to provide peer-delivered services. Certified peer specialist from 38 states completed an online survey. The final sample of 267 certified peer specialists included respondents from 38 states. The majority of certified peer specialists were female (73%; n = 195) and Caucasian (79.8%; n = 213), with an average age of 50.9 (SD = 12) years, range from 21 to 77 years. More than half of the certified peer specialists (82.1%; n = 184) were currently working in peer support positions. Of those who reported their mental health diagnoses, 11% reported their diagnosis as schizophrenia spectrum disorder, 22% of respondents reported bipolar disorder, and 23% reported persistent major depressive disorder. Nearly all respondents owned a smartphone (94.8%; n = 253), and everyone indicated that smartphones and tablets could enhance the services they deliver. Certified peer specialists reported substantial ownership and use of smartphones, comparable to existing national data. They are willing to deliver smartphone interventions for mental health and physical health self-management, suggesting that smartphones may be an increasingly useful tool for offering evidence-based care. Without Medicaid mandate, certified peer specialists are naturally trying to enhance peer delivered services with technology. Peer support could act as a mechanism to promote consumer engagement in a smartphone-based intervention. Certified peer specialist own and utilize smartphones, and the majority are willing to deliver technology-based and technology-enhanced interventions using these devices to address medical and psychiatric self-management.
Collapse
Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA. .,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
| | - Kelly A Aschbrenner
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
| | - Matthew C Lohman
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Jessica Brooks
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
| | - Mark Salzer
- Temple University Department of Rehabilitation Sciences, 1700 N Broad St, Philadelphia, PA, 19121, USA
| | - Robert Walker
- Massachusetts Department of Mental Health, 25 Staniford St, Boston, MA, 02114, USA
| | - Lisa St George
- RI International, 2701 N. 16th Street, Phoenix, AZ, 85006, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH, 03766, USA
| |
Collapse
|
32
|
Waugh M, Calderone J, Brown Levey S, Lyon C, Thomas M, DeGruy F, Shore JH. Using Telepsychiatry to Enrich Existing Integrated Primary Care. Telemed J E Health 2018; 25:762-768. [PMID: 30394851 DOI: 10.1089/tmj.2018.0132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Integrated care is characterized by evolving heterogeneity in models. Using telepsychiatry to enhance these models can increase access, quality, and efficiencies in care. Introduction: The purpose of this report is to describe the process and outcomes of adapting telepsychiatry into an existing integrated care service. Materials and Methods: Telepsychiatry was implemented into an existing integrated care model in a high-volume, urban, primary care clinic in Colorado serving patients with complex physical and behavioral needs. Consultative, direct care, educational/training encounters, provider-to-provider communication, process changes, and patient-level descriptive measures were tracked as part of ongoing quality improvement. Results: Telepsychiatry was adapted into the existing behavioral health services using an iterative team meeting process within a stepped care model. Over 35% of the requests for psychiatry services were medication related-and medication changes (type/dose) were the most frequent referral outcome of psychiatric consultation. Forty percent of patients in the service had multiple behavioral health diagnoses, in addition to physical health diagnoses. Discussion: Telehealth will become an increasingly necessary component in building hybrid/blended integrated care teams. Examples of flexible model implementation will support clinics in tailoring effective applications for their unique patient panels. Conclusions: An adapted integrated care model leveraging telepsychiatry is successfully serving the complex deep end of a primary care patient population in Colorado. Lessons learned in implementing this model include the importance of team attitudes.
Collapse
Affiliation(s)
- Maryann Waugh
- 1Evaluation and Research Department, Colorado Access, Denver, Colorado
| | - Jacqueline Calderone
- 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Shandra Brown Levey
- 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Corey Lyon
- 3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Marshall Thomas
- 1Evaluation and Research Department, Colorado Access, Denver, Colorado.,2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Frank DeGruy
- 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jay H Shore
- 1Evaluation and Research Department, Colorado Access, Denver, Colorado.,2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,3Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
33
|
Fortuna KL, Storm M, Naslund JA, Aschbrenner KA, Lohman MC, Chow PI, DiMilia PR, Bartels SJ. Certified Peer Specialists and Older Adults With Serious Mental Illness' Perspectives of the Impact of a Peer-Delivered and Technology-Supported Self-Management Intervention. J Nerv Ment Dis 2018; 206:875-881. [PMID: 30371642 PMCID: PMC6209327 DOI: 10.1097/nmd.0000000000000896] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored the perspectives of certified peer specialists and older adults with serious mental illness on the impact of a peer-delivered medical and psychiatric self-management intervention, "PeerTECH." Transcripts from interviews with consumers with serious mental illness and a focus group with certified peer specialists who were engaged in PeerTECH were analyzed. Consumer participants (n = 8) had a mean age of 68.8 years (SD = 4.9) and included individuals diagnosed with major depressive disorder (five people), schizophrenia spectrum disorders (two people), and bipolar disorder (one person). Certified peer specialists (n = 3) were aged 55 years or more. Themes included internal and external forces of accountability, confidence, internal and external locus of hope, human bonding, and peer support. This exploratory qualitative study found that human support from peers can potentially influence health behavioral change in a combined peer and technology-based medical and psychiatric illness self-management intervention.
Collapse
Affiliation(s)
- Karen L. Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Marianne Storm
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- The Dartmouth Institute, 1 Medical Center Drive, Lebanon, NH 03766
| | - John A. Naslund
- Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Avenue Boston, MA 02115
| | - Kelly A. Aschbrenner
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Matthew C. Lohman
- University of South Carolina, Arnold School of Public Health, Department of Epidemiology and Biostatistics, 921 Assembly St, Columbia, SC 29208
| | - Philip I. Chow
- Center for Behavioral Health and Technology, Dept. of Psychiatry and Neurobehavioral Sciences, University of Virginia, 1300 Jefferson Park Ave, Charlottesville, VA 22903
| | - Peter R. DiMilia
- The Dartmouth Institute, 1 Medical Center Drive, Lebanon, NH 03766
| | - Stephen J. Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200 Lebanon, NH 03766
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute, 1 Medical Center Drive, Lebanon, NH 03766
| |
Collapse
|
34
|
Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018; 28:325-338. [PMID: 30202185 DOI: 10.18865/ed.28.s2.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Significance Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design Secondary analyses of a cluster-randomized trial. Setting 93 health care and community-based programs in two neighborhoods. Participants Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
Collapse
Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
| |
Collapse
|
35
|
Young AS, Cohen AN, Chang ET, Flynn AWP, Hamilton AB, Oberman R, Vinzon M. A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol. BMC Health Serv Res 2018; 18:428. [PMID: 29880047 PMCID: PMC5992687 DOI: 10.1186/s12913-018-3237-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results. While people with SMI often do poorly with usual primary care arrangements, research suggests that integrated care and medical care management may improve treatment and outcomes, and reduce treatment costs. METHODS This hybrid implementation-effectiveness study is a prospective, cluster controlled trial of a medical home, the SMI Patient-Aligned Care Team (SMI PACT), to improve the healthcare of patients with SMI enrolled with the Veterans Health Administration. The SMI PACT team includes proactive medical nurse care management, and integrated mental health treatment through regular psychiatry consultation and a collaborative care model. Patients are recruited to receive primary care through SMI PACT based on having a serious mental illness that is manageable with treatment, and elevated risk for hospitalization or death. In a site-level prospective controlled trial, this project studies the effect, relative to usual care, of SMI PACT on provision of appropriate preventive and medical treatments, health-related quality of life, satisfaction with care, and medical and mental health treatment utilization and costs. Research includes mixed-methods formative evaluation of usual care and SMI PACT implementation to strengthen the intervention and assess barriers and facilitators. Investigators examine relationships among organizational context, intervention factors, and patient and clinician outcomes, and identify patient factors related to successful patient outcomes. DISCUSSION This will be one of the first controlled trials of the implementation and effectiveness of a patient centered medical home for people with serious mental illness. It will provide information regarding the value of this strategy, and processes and tools for implementing this model in community healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov, NCT01668355 . Registered August 20, 2012.
Collapse
Affiliation(s)
- Alexander S. Young
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Amy N. Cohen
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Evelyn T. Chang
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, CA 90095 USA
| | - Anthony W. P. Flynn
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Alison B. Hamilton
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
| | - Rebecca Oberman
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
| | - Merlyn Vinzon
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
| |
Collapse
|
36
|
Fortuna KL, DiMilia PR, Lohman MC, Bruce ML, Zubritsky CD, Halaby MR, Walker RM, Brooks JM, Bartels SJ. Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness. Psychiatr Q 2018; 89:293-305. [PMID: 28948424 PMCID: PMC5874159 DOI: 10.1007/s11126-017-9534-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.
Collapse
Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Peter R DiMilia
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Cynthia D Zubritsky
- Center for Mental Health Policy and Services Research, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jessica M Brooks
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| |
Collapse
|
37
|
Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
Collapse
Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| |
Collapse
|
38
|
Wainberg ML, McKinnon K, Norcini-Pala A, Hughes OK, Schrage E, Erby W, Mann CG, Cournos F. Ending AIDS as a Public Health Threat: Treatment-as-Usual Risk Reduction Services for Persons With Mental Illness in Brazil. Psychiatr Serv 2018; 69:483-486. [PMID: 29493417 PMCID: PMC5880686 DOI: 10.1176/appi.ps.201700125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persons with mental illness have higher HIV infection rates than the general population. Little is known about whether care systems for this population are effectively participating in global efforts to end AIDS as a public health threat. This study examined treatment-as-usual HIV risk reduction services within public mental health settings. METHODS The authors interviewed 641 sexually active adults attending eight public psychiatric clinics in Rio de Janeiro about participation in a sexual risk reduction program, HIV testing, HIV knowledge, and sexual behaviors. RESULTS Nine percent reported participation in a risk reduction program in the past year, and 75% reported having unprotected sex in the past three months. Program participants had greater HIV knowledge (p=.04) and were more likely to have had HIV testing in the past three months (p=.02), compared with nonparticipants. Participation was not associated with sexual behaviors. CONCLUSIONS Including persons with mental illness in efforts to end AIDS requires a greater commitment to implementing effective interventions in public mental health systems.
Collapse
Affiliation(s)
- Milton L Wainberg
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Karen McKinnon
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Andrea Norcini-Pala
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Olivia K Hughes
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Ezra Schrage
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Whitney Erby
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Claudio G Mann
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| | - Francine Cournos
- Dr. Wainberg, Ms. McKinnon, and Dr. Norcini-Pala are with the New York State Psychiatric Institute and with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York. Ms. Hughes is an undergraduate student, Boston University, Boston. Mr. Schrage is a medical student, SUNY Downstate College of Medicine and SUNY Downstate Medical Center, New York. Ms. Erby is with the Department of Psychiatry, Columbia University, New York. Dr. Mann is with the Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro. Dr. Cournos is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York
| |
Collapse
|
39
|
Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Psychiatr Clin North Am 2018; 41:153-164. [PMID: 29412843 PMCID: PMC5806142 DOI: 10.1016/j.psc.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
Collapse
Affiliation(s)
| | - Peter R. DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Karen L. Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - John A. Naslund
- Dartmouth Center for Technology and Behavioral Health, Lebanon, NH, USA
| |
Collapse
|
40
|
Schmutte T, Davidson L, O'Connell M. Improved Sleep, Diet, and Exercise in Adults with Serious Mental Illness: Results from a Pilot Self-Management Intervention. Psychiatr Q 2018; 89:61-71. [PMID: 28455555 DOI: 10.1007/s11126-017-9516-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Compared to the general population, adults with serious mental illnesses have elevated rates of medical morbidity resulting in a reduced life expectancy of approximately 15 years. Chronic disease self-management programs for adults with serious mental and chronic medical illnesses show some promise in improving physical health-related outcomes, yet none of them address sleep quality. Poor sleep affects a majority of adults with serious mental illness and is robust risk factor for physical morbidity and premature mortality. This pilot project examined the impact of a 14-week educational and support group that included sleep quality as a cornerstone in promoting wellness and self-management in 78 adults with serious mental illness and poor health. Results provide preliminary data that the self-management program was associated with significant improvements in self-reported sleep quality at post-intervention. At 3-month follow-up, participants reported additional increases in sleep quality as well as in healthy diet and exercise frequency. Addressing sleep quality as part of self-management and wellness programs may be a viable approach to assist adults with chronic mental and physical illnesses to adopt health-promoting changes.
Collapse
Affiliation(s)
- Timothy Schmutte
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA.
| | - Larry Davidson
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA
| | - Maria O'Connell
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA
| |
Collapse
|
41
|
Blixen C, Kanuch SW, Perzynski AT, Thomas C, Dawson NV, Sajatovic M. What Works in a Nurse Led Self-Management Program for Patients with Serious Mental Illness (SMI) and Diabetes (DM). Arch Psychiatr Nurs 2018; 32:127-132. [PMID: 29413063 PMCID: PMC6014592 DOI: 10.1016/j.apnu.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/12/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a deeper understanding of "how" a nurse led self-management intervention in a successful randomized controlled trial (RCT) for individuals with both serious mental illness (SMI) and diabetes (DM) influenced health outcomes and the lives of the participants. METHODS In depth interviews, were conducted with a sample of 10 participants who received the self-management intervention in the RCT. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis, with an emphasis on dominant themes. RESULTS The mean age of the respondents was 53.9years (SD=5.6); 6 (60%) were women and the mean level of education was 12.4years (SD=2.4). Transcript based analysis generated 3 major mechanisms of action that led to improved self-management of their SMI and DM: (Colton & Manderscheid, 2006) positive group experience, (Osborn et al., 2008) increased health knowledge, and (Newcomer, 2005) increased self- confidence. CONCLUSIONS Developing complex interventions for testing in RCTs of individuals with SMI and other comorbid conditions is of increasing importance in healthcare planning for this vulnerable population. Using qualitative methods to explore mechanisms of action underlying quantitative outcomes, can enrich our understanding of processes relevant for individuals with SMI and comorbid conditions.
Collapse
Affiliation(s)
- Carol Blixen
- Case Western Reserve University and Senior Scholar, Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, United States.
| | - Stephanie W Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, United States
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, United States
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, United States
| | - Neal V Dawson
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, United States
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine and Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH, United States
| |
Collapse
|
42
|
Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018. [PMID: 30202185 DOI: 10.18865/ed.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
SIGNIFICANCE Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. OBJECTIVE To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. DESIGN Secondary analyses of a cluster-randomized trial. SETTING 93 health care and community-based programs in two neighborhoods. PARTICIPANTS Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. INTERVENTION CEP or RS for implementing depression quality improvement programs. OUTCOMES AND ANALYSES Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). RESULTS Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. CONCLUSIONS CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
Collapse
Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
| |
Collapse
|
43
|
Naslund JA, Aschbrenner KA, Kim SJ, McHugo GJ, Unützer J, Bartels SJ, Marsch LA. Health behavior models for informing digital technology interventions for individuals with mental illness. Psychiatr Rehabil J 2017; 40:325-335. [PMID: 28182469 PMCID: PMC5550360 DOI: 10.1037/prj0000246] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. METHOD In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. RESULTS Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. CONCLUSION AND IMPLICATIONS FOR PRACTICE Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record
Collapse
Affiliation(s)
- John A. Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sunny Jung Kim
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Gregory J. McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Stephen J. Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A. Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
44
|
Wainberg M, Dixon L. Ending HIV, hepatitis B, and hepatitis C: what about people with severe mental illness? Lancet Psychiatry 2017; 4:651-653. [PMID: 28687480 PMCID: PMC8048764 DOI: 10.1016/s2215-0366(17)30282-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 10/26/2022]
Affiliation(s)
- Milton Wainberg
- Columbia University Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA
| | - Lisa Dixon
- Columbia University Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA.
| |
Collapse
|
45
|
Sajatovic M, Gunzler DD, Kanuch SW, Cassidy KA, Tatsuoka C, McCormick R, Blixen CE, Perzynski AT, Einstadter D, Thomas CL, Lawless ME, Martin S, Falck-Ytter C, Seeholzer EL, McKibben CL, Bauer MS, Dawson NV. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus. Psychiatr Serv 2017; 68:883-890. [PMID: 28502243 PMCID: PMC5675044 DOI: 10.1176/appi.ps.201600377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.
Collapse
Affiliation(s)
- Martha Sajatovic
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas D Gunzler
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Stephanie W Kanuch
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Kristin A Cassidy
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Curtis Tatsuoka
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Richard McCormick
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Carol E Blixen
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Adam T Perzynski
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas Einstadter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Charles L Thomas
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mary E Lawless
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Siobhan Martin
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Corinna Falck-Ytter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Eileen L Seeholzer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Christine L McKibben
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mark S Bauer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Neal V Dawson
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| |
Collapse
|
46
|
Fortuna KL, Lohman MC, Gill LE, Bruce ML, Bartels SJ. Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness. Am J Geriatr Psychiatry 2017; 25:819-828. [PMID: 28169129 PMCID: PMC5498268 DOI: 10.1016/j.jagp.2016.12.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 11/17/2016] [Accepted: 12/12/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. METHODS First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. RESULTS We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. CONCLUSIONS Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions.
Collapse
Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Lydia E Gill
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Martha L Bruce
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
47
|
Naslund JA, Whiteman KL, McHugo GJ, Aschbrenner KA, Marsch LA, Bartels SJ. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2017; 47:83-102. [PMID: 28807143 PMCID: PMC5575752 DOI: 10.1016/j.genhosppsych.2017.04.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to estimate effects of lifestyle intervention participation on weight reduction among overweight and obese adults with serious mental illness. METHOD We systematically searched electronic databases for randomized controlled trials comparing lifestyle interventions with other interventions or usual care controls in overweight and obese adults with serious mental illness, including schizophrenia spectrum or mood disorders. Included studies reported change in weight [kg] or body mass index (BMI) [kg/m2] from baseline to follow-up. Standardized mean differences (SMD) were calculated for change in weight from baseline between intervention and control groups. RESULTS Seventeen studies met inclusion criteria (1968 participants; 50% male; 66% schizophrenia spectrum disorders). Studies were grouped by intervention duration (≤6-months or ≥12-months). Lifestyle interventions of ≤6-months duration showed greater weight reduction compared with controls as indicated by effect size for weight change from baseline (SMD=-0.20; 95% CI=-0.34, -0.05; 10 studies), but high statistical heterogeneity (I2=90%). Lifestyle interventions of ≥12-months duration also showed greater weight reduction compared with controls (SMD=-0.24; 95% CI=-0.36, -0.12; 6 studies) with low statistical heterogeneity (I2=0%). CONCLUSION Lifestyle interventions appear effective for treating overweight and obesity among people with serious mental illness. Interventions of ≥12-months duration compared to ≤6-months duration appear to achieve more consistent outcomes, though effect sizes are similar for both shorter and longer duration interventions.
Collapse
Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States.
| | - Karen L Whiteman
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
48
|
Bartels SJ, DiMilia P. Why serious mental illness should be designated a health disparity and the paradox of ethnicity. Lancet Psychiatry 2017; 4:351-352. [PMID: 28330588 DOI: 10.1016/s2215-0366(17)30111-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
| | - Peter DiMilia
- Dartmouth Centers for Health and Aging, Lebanon, NH 03766, USA
| |
Collapse
|
49
|
DiNapoli EA, Cinna C, Whiteman KL, Fox L, Appelt CJ, Kasckow J. Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective. Int J Geriatr Psychiatry 2016; 31:1097-104. [PMID: 27442187 PMCID: PMC5839102 DOI: 10.1002/gps.4550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore middle-aged and older veterans' current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). METHODS Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. RESULTS Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran's Administration services and reducing mental health stigma. CONCLUSIONS These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran's Administration for middle-aged and older veterans with multiple chronic conditions. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Elizabeth A DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christopher Cinna
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
| | - Karen L Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Pittsburgh, PA, USA
| | - Lauren Fox
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Cathleen J Appelt
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
- Department of Sociology, Duquesne University, Pittsburgh, PA, USA
| | - John Kasckow
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- MIRECC and Behavioral Health, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Pittsburgh Center for Health and Equity Promotion, Pittsburgh, PA, USA
| |
Collapse
|