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Smith A, Goulet JL, Vlahov D, Justice AC, Womack JA. Risk factors for suicide among veterans living with and without HIV: a nested case-control study. AIDS Behav 2024; 28:115-124. [PMID: 37751112 PMCID: PMC11289766 DOI: 10.1007/s10461-023-04164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
The rate of suicide among people with HIV (PWH) remains elevated compared to the general population. The aim of the study was to examine the association between a broad range of risk factors, HIV-specific risk factors, and suicide. We conducted a nested case-control study using data from the Veterans Aging Cohort Study (VACS) between 2006 and 2015. The risk of suicide was estimated using conditional logistic regression and models were stratified by HIV status. Most risk factors associated with suicide were similar between PWH and people without HIV; these included affective disorders, use of benzodiazepines, and mental health treatment. Among PWH, HIV-specific risk factors were not associated with suicide. A multiplicative interaction was observed between a diagnosis of HIV and a previous suicide attempt. Among PWH, a high prevalence of psychiatric, substance use disorders and multimorbidity contribute to the risk of suicide.
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Affiliation(s)
- Alexandria Smith
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
- Yale School of Public Health, Orange, USA.
| | - Joseph L Goulet
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - David Vlahov
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Julie A Womack
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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Mao W, Shalaby R, Owusu E, Elgendy H, Shalaby N, Agyapong B, Nichols A, Eboreime E, Nkire N, Agyapong VIO. Status after Hospital Discharge: An Observational Study of the Progression of Patients' Mental Health Symptoms Six Weeks after Hospital Discharge. J Clin Med 2023; 12:7559. [PMID: 38137628 PMCID: PMC10744019 DOI: 10.3390/jcm12247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38-13.20) (OR = 4.04; 95% CI: 1.25-13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21-42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Hossam Elgendy
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Nermin Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Angel Nichols
- Queen Elizabeth II Hospital, Alberta Health Services, Grande Prairie, AB T5J 3E4, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
| | - Nnamdi Nkire
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada (N.N.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada;
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Musgrove R, Carr MJ, Kapur N, Chew-Graham CA, Mughal F, Ashcroft DM, Webb RT. Suicide and other causes of death among working-age and older adults in the year after discharge from in-patient mental healthcare in England: matched cohort study. Br J Psychiatry 2022; 221:468-475. [PMID: 35049478 PMCID: PMC7613106 DOI: 10.1192/bjp.2021.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence for risk of dying by suicide and other causes following discharge from in-patient psychiatric care throughout adulthood is sparse. AIMS To estimate risks of all-cause mortality, natural and external-cause deaths, suicide and accidental, alcohol-specific and drug-related deaths in working-age and older adults within a year post-discharge. METHOD Using interlinked general practice, hospital, and mortality records in the Clinical Practice Research Datalink we delineated a cohort of discharged adults in England, 2001-2018. Each patient was matched to up to 20 general population comparator patients. Cumulative incidence (absolute risks) and hazard ratios (relative risks) were estimated separately for ages 18-64 and ≥65 years with additional stratification by gender and practice-level deprivation. RESULTS The 1-year cumulative incidence of dying post-discharge was 2.1% among working-age adults (95% CI 2.0-2.3) and 14.1% (95% CI 13.6-14.5) among older adults. Suicide risk was particularly elevated in the first 3 months, with hazard ratios of 191.1 (95% CI 125.0-292.0) among working-age adults and 125.4 (95% CI 52.6-298.9) in older adults. Older patients were vulnerable to dying by natural causes within 3 months post-discharge. Risk of dying by external causes was greater among discharged working-age adults in the least deprived areas. Relative risk of suicide in discharged working-age women relative to their general population peers was double the equivalent male risk elevation. CONCLUSIONS Recently discharged adults at any age are at increased risk of dying from external and natural causes, indicating the importance of close monitoring and provision of optimal support to all such patients, particularly during the first 3 months post-discharge.
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Affiliation(s)
- Rebecca Musgrove
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Matthew J. Carr
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Nav Kapur
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | - Faraz Mughal
- School of Medicine, Keele University, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, UK; Unit of Academic Primary Care, University of Warwick, UK
| | - Darren M. Ashcroft
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
| | - Roger T. Webb
- National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, UK; Centre for Mental Health and Safety, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK; Manchester Academic Health Science Centre, UK
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Rodgers I, Dixon LB, Olfson M. The Effectiveness of Discharge Planning for Psychiatric Inpatients With Varying Levels of Preadmission Engagement in Care. Psychiatr Serv 2022; 73:149-157. [PMID: 34157859 PMCID: PMC8695636 DOI: 10.1176/appi.ps.202000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the extent to which prehospital treatment engagement is related to posthospital follow-up treatment among psychiatric inpatients and whether the effects of inpatient discharge planning on posthospital follow-up treatment vary by level of pretreatment engagement in care. METHODS New York State Medicaid and other administrative databases were used to examine service use by 18,793 adult patients discharged to the community after inpatient psychiatric care in 2012-2013. Outcomes included attending an outpatient mental health service within 7 days and within 30 days after discharge. The sample was stratified by whether patients had high, partial, low, or no engagement in outpatient psychiatric services in the 6 months before admission. RESULTS Scheduling an outpatient appointment as part of the patient's discharge plan was significantly associated with attending outpatient psychiatric appointments, regardless of the patient's level of engagement in care before admission. The differences were most pronounced for patients who had not received any outpatient care in the 6 months before admission. When an appointment was scheduled, these patients were three times more likely to follow up with care within 7 days and more than twice as likely to follow up within 30 days than were patients without a scheduled appointment. CONCLUSIONS The likelihood of psychiatric inpatients following up with outpatient psychiatric care was directly related to their level of outpatient care engagement before hospital admission. Even among those who had not been engaged in outpatient care, inpatient discharge planning was associated with a greater likelihood of receiving follow-up outpatient care.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Ian Rodgers
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
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Schmidt EM, Wright D, Cherkasova E, Harris AHS, Trafton J. Evaluating and Improving Engagement in Care After High-Intensity Stays for Mental or Substance Use Disorders. Psychiatr Serv 2022; 73:18-25. [PMID: 34106740 DOI: 10.1176/appi.ps.202000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This interrupted time-series analysis examined whether activating a quality measure, supported by education and a population management tool, was associated with higher postdischarge engagement (PDE) in outpatient care after inpatient and residential stays for mental or substance use disorder care. METHODS Discharges from October 2016 to May 2019 were identified from national Veterans Health Administration (VHA) records representing all 140 VHA health care systems. Engagement was defined as multiple mental or substance use disorder outpatient visits in the 30 days postdischarge. The number of such visits required to meet the engagement definition depended on a patient's suicide risk and acuity level of inpatient or residential treatment. Health care system-level performance was calculated as the percentage of qualifying discharges with 30-day PDE. A segmented mixed-effects linear regression model tested whether monthly health care system performance changed significantly after activation of the PDE measure (activation rollout period, October-December 2017). RESULTS A total of 322,344 discharges qualified for the measure. In the regression model, average health care system performance was 65.6% at the beginning of the preactivation period (October 2016) and did not change significantly in the following 12 months. Average health care system performance increased by 5.7% (SE=0.8%, p<0.001) after PDE measure activation and did not change significantly thereafter-a difference representing 11,464 more patients engaging in care than would have without activation of the measure. CONCLUSIONS Results support use of this measure, along with education, technical assistance, and population management tools, to improve engagement after discharge from residential and inpatient mental and substance use disorder treatment.
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Affiliation(s)
- Eric M Schmidt
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - David Wright
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Elena Cherkasova
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Alex H S Harris
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
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Britton PC, Crasta D, Bohnert KM, Kane C, Klein J, Pigeon WR. Shorter and longer-term risk for non-fatal suicide attempts among male U.S. military veterans after discharge from psychiatric hospitalization. J Psychiatr Res 2021; 143:9-15. [PMID: 34438203 DOI: 10.1016/j.jpsychires.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
Although there are key differences in shorter-term (days 1-90) and longer-term (days 91-365) risk factors for suicide after discharge from inpatient psychiatry, there are no comparable data on non-fatal suicide attempts. Risk factors for non-fatal attempts in the first 90 days after discharge were compared with those over the remainder of the year to identify temporal changes in risk. Records were extracted from 208,554 male veterans discharged from Veterans Health Administration acute psychiatric inpatient units from 2008 through 2013. Proportional hazard regression models identified correlates of non-fatal attempts for 1-90 days and 91-365 days; adjusted piecewise proportional hazards regression compared risk between these time frames. 5010 (2.4%) veterans made a non-fatal attempt, 1261 (0.60%) on days 1-90 and 3749 (1.78%) on days 91-365. Risk across both time frames was highest among younger veterans ages 18-59, and those hospitalized with a suicide attempt or suicidal ideation. It was lowest among those with a dementia diagnosis. Risk estimates were generally stable over time but increased among those with substance use disorders and decreased among those with sleep disturbance and discharged against medical advice. Estimates of some risk factors for non-fatal attempts change over time in the year after discharge and differ from those that change for suicide. Different preventive approaches may be needed to reduce shorter and longer-term risk for non-fatal attempts and suicide in the year after discharge.
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Affiliation(s)
- Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Dev Crasta
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kipling M Bohnert
- Department of Public Health, Michigan State University, Lansing, MI, USA; Department of Veteran Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Cathleen Kane
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - John Klein
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA
| | - Wilfred R Pigeon
- VISN 2 Center of Excellence for Suicide Prevention, Department of Veteran Affairs, Finger Lakes Healthcare System, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population. BJPsych Open 2021. [PMCID: PMC8444048 DOI: 10.1192/bjo.2021.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care. Psychiatr Serv 2021; 72:498-506. [PMID: 33657838 PMCID: PMC8102313 DOI: 10.1176/appi.ps.202000021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined associations of patient, hospital, and service system factors with provision of discharge planning to individuals treated in hospital psychiatric units. METHODS This retrospective cohort analysis used 2012-2013 New York State Medicaid claims data of 18,185 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. The claims data were linked to data from managed behavioral health care organizations indicating whether inpatient staff scheduled a follow-up outpatient appointment with a mental health provider. Additional data regarding hospital and service system characteristics were obtained from the American Hospital Association Annual Survey, the Area Health Resource File, and other state administrative databases. Rates and adjusted odds ratios were assessed for the likelihood of inpatient staff scheduling a follow-up appointment. RESULTS Inpatient staff scheduled outpatient appointments for 79.8% of discharges. The adjusted odds of not having an outpatient appointment scheduled as part of the patient's discharge plan were significantly associated with several factors, including being homeless on admission, having a diagnosis of a co-occurring substance use disorder, having high levels of medical comorbid conditions, and not being engaged in psychiatric outpatient services in the month prior to admission. CONCLUSIONS Patient characteristics were more strongly associated with failure to receive discharge planning than were hospital and service system characteristics.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Matarazzo BB, Gerard GR, Jankovsky MC, Oslin DW, Brenner LA. Feasibility and Acceptability of the HOME Program for Veterans Recently Discharged from a Psychiatric Hospitalization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:974-982. [PMID: 33523330 DOI: 10.1007/s10488-021-01109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Enrollment in the Home-Based Mental Health Evaluation (HOME) Program is associated with higher rates of treatment engagement following psychiatric hospitalization discharge, as compared to enhanced care as usual. We aim to describe feasibility and acceptability data related to implementation of the HOME Program at two Department of Veterans Affairs Medical Centers (VAMCs) to inform future program refinement and implementation. Process evaluation data regarding feasibility and acceptability were collected in the context of an interventional multi-site trial. Data regarding enrollment in the study and the intervention were collected by study staff. Additional acceptability and feasibility data were obtained via the Client Satisfaction Questionnaire-8 (CSQ-8) and Narrative Evaluation of Intervention Interview (NEII). Between 82 and 91% of enrolled Veterans participated in at least one post-discharge telephone contact. Site differences existed with respect to completion of home visits. CSQ-8 results suggested high levels of satisfaction with the HOME Program. Themes identified via the NEII reflect that as a result of participation in the HOME Program, Veterans felt hopeful and cared for and learned how to keep themselves safe following hospital discharge. Process evaluation data from a clinical trial of the HOME Program demonstrated that the intervention was feasible to implement at two VAMCs and was acceptable to participants. These data inform considerations for future research and implementation efforts.Trial Registration ClinicalTrials.gov Identifier: NCT03347552.
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Affiliation(s)
- Bridget B Matarazzo
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA.
- Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA.
| | - Georgia R Gerard
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
| | - Molly C Jankovsky
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
| | - David W Oslin
- Veterans Integrated Service Network (VISN) 4 MIRECC, US Department of Veterans Affairs, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa A Brenner
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Veteran Suicide Prevention, US Department of Veterans Affairs, 1700 N. Wheeling St, Aurora, CO, 80045, USA
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
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10
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Prestmo A, Høyen K, Vaaler AE, Torgersen T, Drange OK. Mortality Among Patients Discharged From an Acute Psychiatric Department: A 5-Year Prospective Study. Front Psychiatry 2020; 11:816. [PMID: 33013492 PMCID: PMC7461827 DOI: 10.3389/fpsyt.2020.00816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
The primary aim of the study was to explore the post discharge standardized mortality ratio of patients from an acute psychiatric department in Norway. The secondary aims were to explore if the standardized mortality ratio is still increasing and to examine the causes of death in the defined population. We conducted a 5-year prospective study among patients admitted to an acute psychiatric department with catchment area responsibilities. A total of 380 patients were included in the study, and the number and causes of deaths were obtained from the Norwegian Cause of Death Registry. Excess mortality was found for the patient group. The standardized mortality ratio for all causes of death was 6.7 (95% CI, 4.6-8.8). The study finds an increased standardized mortality ratio relative to a previous corresponding study in Norway, and the suicide risk was especially elevated the first 2 years after discharge.
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Affiliation(s)
- Astrid Prestmo
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karina Høyen
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Einar Vaaler
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Torgersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Orkdal District Psychiatric Centre, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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11
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Ådnanes M, Cresswell-Smith J, Melby L, Westerlund H, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Discharge planning, self-management, and community support: Strategies to avoid psychiatric rehospitalisation from a service user perspective. PATIENT EDUCATION AND COUNSELING 2020; 103:1033-1040. [PMID: 31836249 DOI: 10.1016/j.pec.2019.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Psychiatric rehospitalisation is often seen as a negative outcome in terms of healthcare quality and cost, as well as potentially hindering the process of recovery. The purpose of our study was to explore psychiatric rehospitalisation from a service-user perspective, paying attention to how rehospitalisation can be avoided. METHOD Eight focus groups, including a total of 55 mental health service users, were conducted in six European countries (Austria, Finland, Italy, Norway, Romania, and Slovenia). The results were analysed using systematic text condensation. RESULTS All participants had been in touch with mental health services for at least one year, and had experienced more than one psychiatric hospitalisation. Participants emphasised the importance of discharge planning and psychoeducation both during and after the hospital stay, as well as the benefits of structured plans, coping strategies, self-monitoring techniques, and close contact with local community services.Social contacts and meaningful activities were also considered to be critical, as was support from peers and family members. CONCLUSION Efforts to avoid psychiatric rehospitalisation should include actions that support a functional day-to-day life, improve coping strategies, and build on cross-sectoral collaboration. PRACTICE IMPLICATIONS The study emphasises the need for psychoeducational and psychosocial interventions, starting already during the inpatient stay.
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Affiliation(s)
- M Ådnanes
- SINTEF Digital, Dept of Health Research, PO Box 4760 Torgarden, 7465 Trondheim, Norway.
| | - J Cresswell-Smith
- National Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland.
| | - L Melby
- SINTEF Digital, Dept of Health Research, Trondheim, Norway.
| | - H Westerlund
- Competence Centre for Experiential Knowledge and Service Development, Trondheim, Norway.
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia.
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest; 2. Faculty of Psychology and Educational Sciences, Bucharest, Romania.
| | - C Straßmayr
- IMEHPS. Research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria.
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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Goldman-Mellor S, Olfson M, Lidon-Moyano C, Schoenbaum M. Association of Suicide and Other Mortality With Emergency Department Presentation. JAMA Netw Open 2019; 2:e1917571. [PMID: 31834399 PMCID: PMC6991205 DOI: 10.1001/jamanetworkopen.2019.17571] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Emergency departments (EDs) have the potential to play a pivotal role in suicide risk detection and prevention, yet little is known about the profile of risk of suicide after ED visits in the United States. OBJECTIVES To examine 1-year incidence of suicide and other mortality among ED patients who presented with nonfatal deliberate self-harm, suicidal ideation, or any other chief concern, and to examine sociodemographic and clinical factors associated with suicide mortality risk. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included statewide, all-payer, longitudinally linked ED patient records and mortality data from all California residents who presented to a California-licensed ED at least 1 time from January 1, 2009, to December 31, 2011, with deliberate self-harm, suicidal ideation but not self-harm, or neither (a 5% random sample). Age-, sex-, and race/ethnicity-adjusted standardized mortality ratios (SMRs) for suicide and other manners or causes of death were determined for each patient group using statewide mortality data. Data were analyzed from January 10 to July 18, 2019. MAIN OUTCOMES AND MEASURES Suicide and other manners or causes of death were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Suicide rate and all mortality rates were measured per 100 000 person-years. RESULTS Among 648 646 individuals (mean [SD] age, 43.8 [20.6] years; 350 687 [54.1%] women) who visited an ED in California from 2009 to 2011, the rates of suicide deaths per 100 000 person-years in the year after index ED presentation were 693.4 deaths among 83 507 individuals presenting with deliberate self-harm (SMR, 56.8; 95% CI, 52.1-61.4), 384.5 deaths among 67 379 individuals presenting with suicidal ideation but not self-harm (SMR, 31.4; 95% CI, 27.5-35.2), and 23.4 deaths among 497 760 reference patients (SMR, 1.9; 95% CI, 1.6-2.3). Compared with the demographically matched general population, the rates of nonsuicide external-cause mortality were also increased among patients with self-harm (SMR, 14.2; 95% CI, 12.9-15.5), patients with suicidal ideation (SMR, 11.8; 95% CI, 10.6-13.0), and reference patients (SMR, 2.2; 95% CI, 2.0-2.3). In all 3 groups, the rates of suicide mortality per 100 000 person-years were higher among men (deliberate self-harm: 1011.1 deaths; suicidal ideation: 539.8 deaths; reference: 36.6 deaths), people 65 years or older (deliberate self-harm: 1919.5 deaths; suicidal ideation: 691.2 deaths; reference: 28.6 deaths), and non-Hispanic white patients (deliberate self-harm: 914.1 deaths; suicidal ideation: 511.6 deaths; reference: 33.8 deaths) than among their respective referent groups. Other sociodemographic factors and clinical diagnoses were associated with striking differences in suicide rates, but these patterns were heterogeneous across patient groups. CONCLUSIONS AND RELEVANCE These findings suggest that ED patients with deliberate self-harm or suicidal ideation are associated with substantially increased risk of suicide and other mortality during the year after ED presentation. The process of planning for ED discharge may present opportunities to help ensure safe transitions to continuing outpatient mental health care and to consider broader risk for unintentional injury and other causes of premature mortality.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York
| | - Cristina Lidon-Moyano
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
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13
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Affiliation(s)
- Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
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14
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Li G, Fife D, Wang G, Sheehan JJ, Bodén R, Brandt L, Brenner P, Reutfors J, DiBernardo A. All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population. Ann Gen Psychiatry 2019; 18:23. [PMID: 31583010 PMCID: PMC6771113 DOI: 10.1186/s12991-019-0248-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed. METHODS Data were obtained from Optum Clinformatics™ Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged ≥ 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan-Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index. RESULTS Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22-1.38; p < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort (p < 0.0001). CONCLUSIONS Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.
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Affiliation(s)
- Gang Li
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | - Daniel Fife
- 2Department of Epidemiology, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | - Grace Wang
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | | | - Robert Bodén
- 4Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Brandt
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Philip Brenner
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Reutfors
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Allitia DiBernardo
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
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