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Montelongo M, Lee J, Poa E, Boland R, Rufino KA, Patriquin M, Oh H. A next-generation approach to mental health outcomes: Treatment, time, and trajectories. J Psychiatr Res 2023; 158:172-179. [PMID: 36586216 DOI: 10.1016/j.jpsychires.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Over the last several decades, inpatient psychiatric length of stay (LOS) has been greatly reduced to the detriment of patients. Latent variable mixture modeling, can be used to improve the quality of care for patients by identifying unobserved subgroups and optimize treatment variables, including LOS. This study had three objectives (1) to replicate the findings made by Oh et al. in a distinct sample, (2) to examine demographic differences related to inpatient treatment trajectories, and (3) to relate additional variables to each trajectory. We collected data on six key mental illness factors and information on felonies, misdemeanors, history of stopping psychiatric medication and psychotherapy, length of time in psychotherapy, and the number of therapists and psychiatrists from 489 patients at an inpatient psychiatric hospital. We derived latent mental illness scores after applying growth mixture modeling to these data. We identified three distinct trajectories of mental illness change: High-Risk, Rapid Improvement (HR-RI), Low-Risk, Partial Response (LR-PR), and High-Risk, Gradual Improvement (HR-GI). The HR-GI group was more likely to have patients who were female, Asian, younger, Yearly Income (YI) <$20,000, that spent more time in psychotherapy throughout their life, and had the longest LOS while inpatient. The LR-PR group had was more likely to be male, Hispanic/Latino and multiracial, older, YI >$500,000, have a history of misdemeanors, and this group had the shortest LOS (p < .05). These findings replicate and extend our previous findings in Oh et al. (2020a) and highlight the clinical utility of agnostically determining the treatment trajectories.
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Affiliation(s)
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, College of Education, Texas Tech University, 3002 18th Street, Lubbock, TX, 79409, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA
| | - Edward Poa
- The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA
| | - Robert Boland
- The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA
| | - Katrina A Rufino
- The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA; University of Houston Downtown, 1 Main St, Houston, TX, 77002, USA
| | - Michelle Patriquin
- The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA
| | - Hyuntaek Oh
- The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, USA; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX, 77030, USA.
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Adair CE, Streiner DL, Barnhart R, Kopp B, Veldhuizen S, Patterson M, Aubry T, Lavoie J, Sareen J, LeBlanc SR, Goering P. Outcome Trajectories among Homeless Individuals with Mental Disorders in a Multisite Randomised Controlled Trial of Housing First. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:30-39. [PMID: 27310238 PMCID: PMC5302104 DOI: 10.1177/0706743716645302] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. METHODS Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. RESULTS In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajectories included gender, age, prior month income, Aboriginal status, total time homeless, previous hospitalizations, overall health, psychiatric symptoms, and comorbidity, while others such as education, diagnosis, and substance use problems did not. CONCLUSION While the observed patterns and their predictors are of interest for further research and general service planning, no set of variables is yet known that can accurately predict the likelihood of particular individuals benefiting from HF programs at the outset.
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Affiliation(s)
- Carol E. Adair
- Departments of Psychiatry and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - David L. Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Ryan Barnhart
- Centre for Addiction and Mental Health, York University, Toronto, Ontario
| | - Brianna Kopp
- Mental Health Commission of Canada, Calgary, Alberta
| | - Scott Veldhuizen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Michelle Patterson
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario
| | - Jennifer Lavoie
- Department of Criminology, Wilfrid Laurier University, Brantford, Ontario
| | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Stefanie Renée LeBlanc
- Centre de recherche et de développement en éducation, Université de Moncton, Moncton, New Brunswick
| | - Paula Goering
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, York University, Toronto, Ontario
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Wilson AD, Bravo AJ, Pearson MR, Witkiewitz K. Finding success in failure: using latent profile analysis to examine heterogeneity in psychosocial functioning among heavy drinkers following treatment. Addiction 2016; 111:2145-2154. [PMID: 27367263 PMCID: PMC5218991 DOI: 10.1111/add.13518] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022]
Abstract
AIMS To estimate differences in post-treatment psychosocial functioning among treatment 'failures' (i.e. heavy drinkers, defined as 4+/5+ drinks for women/men) from two large multi-site clinical trials and to compare these levels of functioning to those of the purported treatment 'successes' (i.e. non-heavy drinkers). DESIGN Separate latent profile analyses of data from two of the largest alcohol clinical trials conducted in the United States, COMBINE (Combined Pharmacotherapies and Behavioral Interventions) and Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), comparing psychosocial outcomes across derived classes of heterogeneous treatment responders. SETTING Eleven US academic sites in COMBINE, 27 US treatment sites local to nine research sites in Project MATCH. PARTICIPANTS A total of 962 individuals in COMBINE (69% male, 77% white, mean age: 44 years) treated January 2001 to January 2004 and 1528 individuals in Project MATCH (75% male, 80% white, mean age: 40 years) treated April 1991 to September 1994. MEASUREMENTS In COMBINE, we analyzed health, quality of life, mental health symptoms and alcohol consequences 12 months post-baseline. In Project MATCH, we examined social functioning, mental health symptoms and alcohol consequences 15 months post-baseline. FINDINGS Latent profile analysis of measures of functioning in both samples supported a three-profile solution for the group of treatment 'failures', characterized by high-, average- and low-functioning individuals. The high-functioning treatment 'failures' generally performed better across measures of psychosocial functioning at follow-up than participants designated treatment 'successes' by virtue of being abstainers or light drinkers. CONCLUSIONS Current United States Food and Drug Administration guidance to use heavy drinking as indicative of treatment 'failure' fails to take into account substantial psychosocial improvements made by individuals who continue occasionally to drink heavily post-treatment.
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Affiliation(s)
- Adam D. Wilson
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM, 87106 USA
| | - Adrian J. Bravo
- Department of Psychology, Old Dominion University, 250 Mills Godwin Life Sciences Bldg, Norfolk, VA 23529 USA
| | - Matthew R. Pearson
- Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, & Addictions, University of New Mexico, 2650 Yale Blvd SE, Albuquerque, NM 87106 USA
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