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Sesay MM, McCracken CE, Stewart C, Simon G, Penfold R, Ahmedani B, Rossom RC, Lu CY, Beck A, Coleman KJ, Daida Y, Lynch FL, Zeber J, Copeland L, Owen-Smith A. Short report: Transition to International Classification of Diseases, 10th Revision and the prevalence of autism in a cohort of healthcare systems. Autism 2024; 28:1316-1321. [PMID: 38240250 PMCID: PMC11065615 DOI: 10.1177/13623613231220687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
LAY ABSTRACT Currently, the prevalence of autism spectrum disorder (henceforth "autism") is 1 in 36, an increasing trend from previous estimates. In 2015, the United States adopted a new version (International Classification of Diseases, 10th Revision) of the World Health Organization coding system, a standard for classifying medical conditions. Our goal was to examine how the transition to this new coding system impacted autism diagnoses in 10 healthcare systems. We obtained information from electronic medical records and insurance claims data from July 2014 through December 2016 for each healthcare system. We used member enrollment data for 30 consecutive months to observe changes 15 months before and after adoption of the new coding system. Overall, the rates of autism per 1000 enrolled members was increasing for 0- to 5-year-olds before transition to International Classification of Diseases, 10th Revision and did not substantively change after the new coding was in place. There was variation observed in autism diagnoses before and after transition to International Classification of Diseases, 10th Revision for other age groups. The change to the new coding system did not meaningfully affect autism rates at the participating healthcare systems. The increase observed among 0- to 5-year-olds is likely indicative of an ongoing trend related to increases in screening for autism rather than a shift associated with the new coding.
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Affiliation(s)
- Musu M Sesay
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA, USA
| | | | - Christine Stewart
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Gregory Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Robert Penfold
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, USA
| | - Brian Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | | | - Christine Y Lu
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Yihe Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Northwest, Center of Health Research, Portland, OR, USA
| | - John Zeber
- University of Massachusetts, Department of Health Promotion & Policy, Amherst, MA, USA
| | - Laurel Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Ashli Owen-Smith
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA, USA
- Georgia State University, School of Public Health, Atlanta, GA, USA
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Flores JP, Kahn G, Penfold RB, Stuart EA, Ahmedani BK, Beck A, Boggs JM, Coleman KJ, Daida YG, Lynch FL, Richards JE, Rossom RC, Simon GE, Wilcox HC. Adolescents Who Do Not Endorse Risk via the Patient Health Questionnaire Before Self-Harm or Suicide. JAMA Psychiatry 2024:2818039. [PMID: 38656403 PMCID: PMC11044012 DOI: 10.1001/jamapsychiatry.2024.0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024]
Abstract
Importance Given that the Patient Health Questionnaire (PHQ) item 9 is commonly used to screen for risk of self-harm and suicide, it is important that clinicians recognize circumstances when at-risk adolescents may go undetected. Objective To understand characteristics of adolescents with a history of depression who do not endorse the PHQ item 9 before a near-term intentional self-harm event or suicide. Design, Setting, and Participants This was a retrospective cohort study design using electronic health record and claims data from January 2009 through September 2017. Settings included primary care and mental health specialty clinics across 7 integrated US health care systems. Included in the study were adolescents aged 13 to 17 years with history of depression who completed the PHQ item 9 within 30 or 90 days before self-harm or suicide. Study data were analyzed September 2022 to April 2023. Exposures Demographic, diagnostic, treatment, and health care utilization characteristics. Main Outcome(s) and Measure(s) Responded "not at all" (score = 0) to PHQ item 9 regarding thoughts of death or self-harm within 30 or 90 days before self-harm or suicide. Results The study included 691 adolescents (mean [SD] age, 15.3 [1.3] years; 541 female [78.3%]) in the 30-day cohort and 1024 adolescents (mean [SD] age, 15.3 [1.3] years; 791 female [77.2%]) in the 90-day cohort. A total of 197 of 691 adolescents (29%) and 330 of 1024 adolescents (32%), respectively, scored 0 before self-harm or suicide on the PHQ item 9 in the 30- and 90-day cohorts. Adolescents seen in primary care (odds ratio [OR], 1.5; 95% CI, 1.0-2.1; P = .03) and older adolescents (OR, 1.2; 95% CI, 1.0-1.3; P = .02) had increased odds of scoring 0 within 90 days of a self-harm event or suicide, and adolescents with a history of inpatient hospitalization and a mental health diagnosis had twice the odds (OR, 2.0; 95% CI, 1.3-3.0; P = .001) of scoring 0 within 30 days. Conversely, adolescents with diagnoses of eating disorders were significantly less likely to score 0 on item 9 (OR, 0.4; 95% CI, 0.2-0.8; P = .007) within 90 days. Conclusions and Relevance Study results suggest that older age, history of an inpatient mental health encounter, or being screened in primary care were associated with at-risk adolescents being less likely to endorse having thoughts of death and self-harm on the PHQ item 9 before a self-harm event or suicide death. As use of the PHQ becomes more widespread in practice, additional research is needed for understanding reasons why many at-risk adolescents do not endorse thoughts of death and self-harm.
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Affiliation(s)
- Jean P. Flores
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Geoffrey Kahn
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | | | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | | | | | | | | | - Holly C. Wilcox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Simon GE, Johnson E, Shortreed SM, Ziebell RA, Rossom RC, Ahmedani BK, Coleman KJ, Beck A, Lynch FL, Daida YG. Predicting suicide death after emergency department visits with mental health or self-harm diagnoses. Gen Hosp Psychiatry 2024; 87:13-19. [PMID: 38277798 PMCID: PMC10939795 DOI: 10.1016/j.genhosppsych.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Use health records data to predict suicide death following emergency department visits. METHODS Electronic health records and insurance claims from seven health systems were used to: identify emergency department visits with mental health or self-harm diagnoses by members aged 11 or older; extract approximately 2500 potential predictors including demographic, historical, and baseline clinical characteristics; and ascertain subsequent deaths by self-harm. Logistic regression with lasso and random forest models predicted self-harm death over 90 days after each visit. RESULTS Records identified 2,069,170 eligible visits, 899 followed by suicide death within 90 days. The best-fitting logistic regression with lasso model yielded an area under the receiver operating curve of 0.823 (95% CI 0.810-0.836). Visits above the 95th percentile of predicted risk included 34.8% (95% CI 31.1-38.7) of subsequent suicide deaths and had a 0.303% (95% CI 0.261-0.346) suicide death rate over the following 90 days. Model performance was similar across subgroups defined by age, sex, race, and ethnicity. CONCLUSIONS Machine learning models using coded data from health records have moderate performance in predicting suicide death following emergency department visits for mental health or self-harm diagnosis and could be used to identify patients needing more systematic follow-up.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America.
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Rebecca A Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Rebecca C Rossom
- HealthPartners Institute, Minneapolis, MN, United States of America
| | - Brian K Ahmedani
- Henry Ford Health Center for Health Services Research, Detroit, MI, United States of America
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, United States of America
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, United States of America
| | - Frances L Lynch
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States of America
| | - Yihe G Daida
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI, United States of America
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Angulo F, Goger P, Brent DA, Rozenman M, Gonzalez A, Schwartz KTG, Porta G, Lynch FL, Dickerson JF, Weersing VR. Impact of trauma exposure and depression comorbidity on response to transdiagnostic behavioral therapy for pediatric anxiety and depression. Npj Ment Health Res 2024; 3:8. [PMID: 38609501 PMCID: PMC10955846 DOI: 10.1038/s44184-023-00049-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/12/2023] [Indexed: 04/14/2024]
Abstract
By adolescence, two-thirds of youth report exposure to at least one traumatic event, yet the impact of trauma history is not routinely considered when evaluating the effect of psychotherapeutic interventions. Trauma may be a particularly important moderator of the effects of transdiagnostic therapies for emotional disorders, as trauma exposure is associated with risk for the development of comorbid depression and anxiety. The current study examined the history of trauma exposure and the presence of clinically significant depression as moderators of treatment outcomes in the Brief Behavioral Therapy (BBT) trial, the largest study of transdiagnostic psychotherapy for youth. Youths (age 8-16 years) were randomized to BBT (n = 89) based in pediatric primary care or assisted referral to outpatient community care (ARC; n = 86). Clinical response, functioning, anxiety symptoms, and depression symptoms were assessed at post-treatment (Week 16) and at follow-up (Week 32). A significant three-way interaction emerged between the treatment group, comorbid depression, and trauma exposure. BBT was broadly effective for 3/4 of the sample, but, for anxious-depressed youth with trauma exposure, BBT never significantly separated from ARC. Differences in outcome were not accounted for by other participant characteristics or by therapist-rated measures of alliance, youth engagement, or homework completion. Implications for models of learning and for intervention theory and development are discussed.
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Affiliation(s)
- Felix Angulo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Pauline Goger
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - David A Brent
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | | | - Araceli Gonzalez
- Department of Psychology, California State University Long Beach, Long Beach, CA, USA
| | | | | | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - V Robin Weersing
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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5
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Miller-Matero LR, Yeh HH, Maffett A, Mooney JT, Sala-Hamrick K, Frank CB, Simon GE, Rossom R, Owen-Smith AA, Lynch FL, Beck A, Waring S, Daida YG, Lu CY, Ahmedani BK. Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study. Psychiatr Serv 2024; 75:124-130. [PMID: 37554000 PMCID: PMC10840630 DOI: 10.1176/appi.ps.20220578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns. METHODS Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system. RESULTS Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents. CONCLUSIONS These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anissa Maffett
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jan T Mooney
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Kelsey Sala-Hamrick
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Cathrine B Frank
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca Rossom
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Stephen Waring
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Yihe G Daida
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Behavioral Health (Miller-Matero, Maffett, Mooney, Frank, Ahmedani) and Center for Health Policy and Health Services Research (Miller-Matero, Yeh, Sala-Hamrick, Ahmedani), Henry Ford Health, Detroit; Kaiser Permanente Washington Health Research Institute, Seattle (Simon); HealthPartners Institute, Minneapolis (Rossom); Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Essentia Institute of Rural Health, Duluth, Minnesota (Waring); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida); Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Lu)
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6
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Hoban HG, Yip TA, Chau JC, Bensen JT, Desrosiers LR, Finnila CR, Hindorff LA, Kelly NR, Lynch FL, Rolf BA, Smith HS, Wasserstein MP, Hassmiller Lich K. The motivation and process for developing a consortium-wide time and motion study to estimate resource implications of innovations in the use of genome sequencing to inform patient care. Clin Transl Sci 2024; 17:e13635. [PMID: 38064200 PMCID: PMC10766055 DOI: 10.1111/cts.13635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/09/2023] [Accepted: 07/25/2023] [Indexed: 12/17/2023] Open
Abstract
Costs of implementing genomic testing innovations extend beyond the cost of sequencing, affecting personnel and infrastructure for which little data are available. We developed a time and motion (T&M) study within the Clinical Sequencing Evidence-Generating Research (CSER) consortium to address this gap, and herein describe challenges of conducting T&M studies within a research consortium and the approaches we developed to overcome them. CSER investigators created a subgroup to carry out the T&M study (authors). We describe logistical and administrative challenges associated with resource use data collection across heterogeneous projects conducted in real-world clinical settings, and our solutions for completing this study and harmonizing data across projects. We delineate processes for feasible data collection on workflow, personnel, and resources required to deliver genetic testing innovations in each CSER project. A critical early step involved developing detailed project-specific process flow diagrams of innovation implementation in projects' clinical settings. Analyzing diagrams across sites, we identified common process-step themes, used to organize project-specific data collection and cross-project analysis. Given the heterogeneity of innovations, study design, and workflows, which affect resources required to deliver genetic testing innovations, flexibility was necessary to harmonize data collection. Despite its challenges, this heterogeneity provides rich insights about variation in clinical processes and resource implications for implementing genetic testing innovations.
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Affiliation(s)
- Hannah G. Hoban
- Institute for Human GeneticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Tiffany A. Yip
- Institute for Human GeneticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Joanna C. Chau
- Division of Genomic Medicine, National Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Jeannette T. Bensen
- Department of EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Lucia A. Hindorff
- Division of Genomic Medicine, National Human Genome Research InstituteNational Institutes of HealthBethesdaMarylandUSA
| | - Nicole R. Kelly
- Division of Pediatric Genetic Medicine, Department of PediatricsChildren's Hospital at Montefiore and the Albert Einstein College of MedicineBronxNew YorkUSA
| | - Frances L. Lynch
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregonUSA
| | - Bradley A. Rolf
- Division of Medical Genetics, Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Hadley S. Smith
- Center for Medical Ethics and Health PolicyBaylor College of MedicineHoustonTexasUSA
| | - Melissa P. Wasserstein
- Division of Pediatric Genetic Medicine, Department of PediatricsChildren's Hospital at Montefiore and the Albert Einstein College of MedicineBronxNew YorkUSA
| | - Kristen Hassmiller Lich
- Department of Health Policy and ManagementUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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7
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Goger P, Rozenman M, Gonzalez A, Brent DA, Porta G, Lynch FL, Dickerson JF, Weersing VR. Early indicators of response to transdiagnostic treatment of pediatric anxiety and depression. J Child Psychol Psychiatry 2023; 64:1689-1698. [PMID: 37605294 PMCID: PMC10841059 DOI: 10.1111/jcpp.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Pediatric anxiety and depression are prevalent, impairing, and highly comorbid. Available evidence-based treatments have an average response rate of 60%. One path to increasing response may be to identify likely non-responders midway through treatment to adjust course prior to completing an episode of care. The aims of this study, thus, were to identify predictors of post-intervention response assessing (a) mid-treatment symptom severity, (b) session-by-session treatment process factors, and (c) a model optimizing the combination of these. METHOD Data were drawn from the treatment arm (N = 95, ages 8-16) of a randomized transdiagnostic intervention trial (Msessions = 11.2). Mid-point measures of youth- and parent-reported anxiety and depression were collected, and therapists rated homework completion, youth and parent engagement, and youth therapeutic alliance at each session. Logistic regression was used to predict response on the Clinical Global Impression Improvement Scale (CGI-I ≤2) rated by independent evaluators masked to treatment condition. RESULTS Mid-point symptom measures were significant predictors of treatment response, as were therapist-ratings of youth and parent engagement, therapeutic alliance, and homework completion. Therapist ratings were significant when tested as mean ratings summing across the first eight sessions of treatment (all ps < .004) and at individual session points (all ps <0.05). A combined prediction model included youth-reported anxiety, parent-reported depression, youth engagement at Session 2, and parent engagement at Session 8. This model correctly classified 76.5% of youth as non-responders and 91.3% as responders at post-treatment (Nagelkerke R2 = .59, χ2 (4, 80) = 46.54, p < .001). CONCLUSION This study provides initial evidence that response to transdiagnostic intervention for pediatric anxiety and depression may be reliably predicted by mid-point. These data may serve as foundational evidence to develop adaptive treatment strategies to personalize intervention, correct treatment course, and optimize outcomes for youth with anxiety and depression.
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Affiliation(s)
- Pauline Goger
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Michelle Rozenman
- UCLA Division of Child and Adolescent Psychiatry, Department of Psychology, University of Denver, Denver, CO, USA
| | - Araceli Gonzalez
- Department of Psychology, California State University Long Beach, Long Beach, CA, USA
| | - David A Brent
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA
| | - Giovanna Porta
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - V Robin Weersing
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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8
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Llamocca EN, Yeh HH, Miller-Matero LR, Westphal J, Frank CB, Simon GE, Owen-Smith AA, Rossom RC, Lynch FL, Beck AL, Waring SC, Lu CY, Daida YG, Fontanella CA, Ahmedani BK. Association Between Adverse Social Determinants of Health and Suicide Death. Med Care 2023; 61:744-749. [PMID: 37708352 PMCID: PMC10592168 DOI: 10.1097/mlr.0000000000001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The aim of this study was to identify adverse social determinants of health (SDoH) International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code prevalence among individuals who died by suicide and to examine associations between documented adverse SDoH and suicide. RESEARCH DESIGN A case-control study using linked medical record, insurance claim, and mortality data from 2000 to 2015 obtained from 9 Mental Health Research Network-affiliated health systems. We included 3330 individuals who died by suicide and 333,000 randomly selected controls matched on index year and health system location. All individuals in the study (cases and controls) had at least 10 months of enrollment before the study index date. The index date for the study for each case and their matched controls was the suicide date for that given case. RESULTS Adverse SDoH documentation was low; only 6.6% of cases had ≥1 documented adverse SDoH in the year before suicide. Any documented SDoH and several specific adverse SDoH categories were more frequent among cases than controls. Any documented adverse SDoH was associated with higher suicide odds [adjusted odds ratio (aOR)=2.76; 95% CI: 2.38-3.20], as was family alcoholism/drug addiction (aOR=18.23; 95% CI: 8.54-38.92), being an abuse victim/perpetrator (aOR=2.53; 95% CI: 1.99-3.21), other primary support group problems (aOR=1.91; 95% CI: 1.32-2.75), employment/occupational maladjustment problems (aOR=8.83; 95% CI: 5.62-13.87), housing/economic problems (aOR: 6.41; 95% CI: 4.47-9.19), legal problems (aOR=27.30; 95% CI: 12.35-60.33), and other psychosocial problems (aOR=2.58; 95% CI: 1.98-3.36). CONCLUSIONS Although documented SDoH prevalence was low, several adverse SDoH were associated with increased suicide odds, supporting calls to increase SDoH documentation in medical records. This will improve understanding of SDoH prevalence and assist in identification and intervention among individuals at high suicide risk.
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Affiliation(s)
- Elyse N Llamocca
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Lisa R Miller-Matero
- Henry Ford Health, Center for Health Policy and Health Services Research
- Henry Ford Health, Behavioral Health Services
| | - Joslyn Westphal
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA
| | - Ashli A Owen-Smith
- Georgia State University, School of Public Health
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, GA
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Arne L Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO
| | | | - Christine Y Lu
- Harvard Medical School, Department of Population Medicine
- Harvard Pilgrim Health System, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Research, Honolulu, HI
| | - Cynthia A Fontanella
- Nationwide Children's Hospital, Abigail Wexner Research Institute, Center for Suicide Prevention and Research
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy and Health Services Research
- Henry Ford Health, Behavioral Health Services
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9
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Knerr S, Guo B, Wernli KJ, Mittendorf KF, Feigelson HS, Gilmore MJ, Jarvik GP, Kauffman TL, Keast E, Liles EG, Lynch FL, Muessig KR, Okuyama S, Veenstra DL, Zepp JM, Wilfond BS, Devine B, Goddard KAB. Longitudinal adherence to breast cancer surveillance following cancer genetic testing in an integrated health care system. Breast Cancer Res Treat 2023; 201:461-470. [PMID: 37470892 PMCID: PMC10503958 DOI: 10.1007/s10549-023-07007-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Screening with mammography and breast magnetic resonance imaging (MRI) is an important risk management strategy for individuals with inherited pathogenic variants (PVs) in genes associated with increased breast cancer risk. We describe longitudinal screening adherence in individuals who underwent cancer genetic testing as part of usual care in a vertically integrated health system. METHODS We determined the proportion time covered (PTC) by annual mammography and breast MRI for individuals with PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, and ATM. We determined time covered by biennial mammography beginning at age 50 years for individuals who received negative results, uncertain results, or with PVs in genes without specific breast cancer screening recommendations. RESULTS One hundred and forty individuals had PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, or ATM. Among these individuals, average PTC was 48% (range 0-99%) for annual screening mammography and 34% (range 0-100%) for annual breast MRI. Average PTC was highest for individuals with PVs in CHEK2 (N = 14) and lowest for individuals with PVs in TP53 (N = 3). Average PTC for biennial mammography (N = 1,027) was 49% (0-100%). CONCLUSION Longitudinal screening adherence in individuals with PVs in breast cancer associated genes, as measured by the proportion of time covered, is low; adherence to annual breast MRI falls below that of annual mammography. Additional research should examine screening behavior in individuals with PVs in breast cancer associated genes with a goal of developing interventions to improve adherence to recommended risk management.
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Affiliation(s)
- Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98195, USA.
| | - Boya Guo
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Gail P Jarvik
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, Denver, CO, USA
| | - David L Veenstra
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S Wilfond
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Beth Devine
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98195, USA
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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10
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Harry ML, Sanchez K, Ahmedani BK, Beck AL, Coleman KJ, Coley RY, Daida YG, Lynch FL, Rossom RC, Waring SC, Simon GE. Assessing the differential item functioning of PHQ-9 items for diverse racial and ethnic adults with mental health and/or substance use disorder diagnoses: A retrospective cohort study. J Affect Disord 2023; 338:402-413. [PMID: 37127116 PMCID: PMC10524453 DOI: 10.1016/j.jad.2023.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Improving health equity in depression care and suicide screening requires that measures like the Patient Health Questionnaire 9 (PHQ-9) function similarly for diverse racial and ethnic groups. We evaluated PHQ-9 differential item functioning (DIF) between racial/ethnic groups in a retrospective cohort study of secondary electronic health record (EHR) data from eight healthcare systems. METHODS The population (n = 755,156) included patients aged 18-64 with mental health and/or substance use disorder (SUD) diagnoses who had a PHQ-9 with no missing item data in the EHR for primary care or mental health visits between 1/1/2009-9/30/2017. We drew two random samples of 1000 from the following racial/ethnic groups originally recorded in EHRs (n = 14,000): Hispanic, and non-Hispanic White, Black, Asian, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, multiracial. We assessed DIF using iterative hybrid ordinal logistic regression and item response theory with p < 0.01 and 1000 Monte Carlo simulations, where change in model R2 > 0.01 represented non-negligible (e.g., clinically meaningful) DIF. RESULTS All PHQ-9 items displayed statistically significant, but negligible (e.g., clinically unmeaningful) DIF between compared groups. The negligible DIF varied between random samples, although six items showed negligible DIF between the same comparison groups in both random samples. LIMITATIONS Our findings may not generalize to disaggregated racial/ethnic groups or persons without mental health and/or SUD diagnoses. CONCLUSIONS We found the PHQ-9 had clinically unmeaningful cross-cultural DIF for adult patients with mental health and/or SUD diagnoses. Future research could disaggregate race/ethnicity to discern if within-group identification impacts PHQ-9 DIF.
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Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA.
| | - Katherine Sanchez
- Baylor Scott and White, Center for Applied Health Research, Temple, TX, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | - Arne L Beck
- The Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen C Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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11
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Guo B, Knerr S, Kauffman TL, Mittendorf KF, Keast E, Gilmore MJ, Feigelson HS, Lynch FL, Muessig KR, Okuyama S, Zepp JM, Veenstra DL, Hsu L, Phipps AI, Lindström S, Leo MC, Goddard KAB, Wilfond BS, Devine B. Risk management actions following genetic testing in the Cancer Health Assessments Reaching Many (CHARM) Study: A prospective cohort study. Cancer Med 2023; 12:19112-19125. [PMID: 37644850 PMCID: PMC10557878 DOI: 10.1002/cam4.6485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Genetic testing can identify cancer risk early, enabling prevention and early detection. We describe use of risk management interventions following genetic testing in the Cancer Health Assessment Reaching Many (CHARM) study. CHARM assessed risk and provided genetic testing to low income, low literacy, and other underserved populations that historically face barriers to accessing cancer genetic services. METHODS CHARM was implemented in Kaiser Permanente Northwest (KPNW) and Denver Health (DH) between 2018 and 2020. We identified post-testing screening (mammography, breast MRI, colonoscopy) and surgical (mastectomy, oophorectomy) procedures using electronic health records. We examined utilization in participants who did and did not receive actionable risk management recommendations from study genetic counselors following national guidelines. RESULTS CHARM participants were followed for an average of 15.4 months (range: 0.4-27.8 months) after results disclosure. Less than 2% (11/680) received actionable risk management recommendations (i.e., could be completed in the initial years following testing) based on their test result. Among those who received actionable recommendations, risk management utilization was moderate (54.5%, 6/11 completed any procedure) and varied by procedure (mammogram: 0/3; MRI: 2/4; colonoscopy: 4/5; mastectomy: 1/5; oophorectomy: 0/3). Cancer screening and surgery procedures were rare in participants without actionable recommendations. CONCLUSION Though the number of participants who received actionable risk management recommendations was small, our results suggest that implementing CHARM's risk assessment and testing model increased access to evidence-based genetic services and provided opportunities for patients to engage in recommended preventive care, without encouraging risk management overuse.
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Affiliation(s)
- Boya Guo
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Sarah Knerr
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Tia L. Kauffman
- Center for Health Research, Kaiser Permanente NorthwestPortlandOregonUSA
| | - Kathleen F. Mittendorf
- Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Erin Keast
- Center for Health Research, Kaiser Permanente NorthwestPortlandOregonUSA
| | - Marian J. Gilmore
- Department of Translational and Applied GenomicsCenter for Health ResearchPortlandOregonUSA
| | | | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente NorthwestPortlandOregonUSA
| | - Kristin R. Muessig
- Department of Translational and Applied GenomicsCenter for Health ResearchPortlandOregonUSA
| | - Sonia Okuyama
- Division of Oncology, Denver Health and Hospital AuthorityDenverColoradoUSA
| | - Jamilyn M. Zepp
- Department of Translational and Applied GenomicsCenter for Health ResearchPortlandOregonUSA
| | - David L. Veenstra
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Li Hsu
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
- Division of Public Health SciencesFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Amanda I. Phipps
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
- Division of Public Health SciencesFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Sara Lindström
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
- Division of Public Health SciencesFred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Michael C. Leo
- Center for Health Research, Kaiser Permanente NorthwestPortlandOregonUSA
| | - Katrina A. B. Goddard
- Department of Translational and Applied GenomicsCenter for Health ResearchPortlandOregonUSA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric BioethicsSeattle Children's Research InstituteSeattleWashingtonUSA
- Department of Pediatrics, Division of Bioethics and Palliative CareUniversity of WashingtonSeattleWashingtonUSA
| | - Beth Devine
- School of Public HealthUniversity of WashingtonSeattleWashingtonUSA
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of PharmacyUniversity of WashingtonSeattleWashingtonUSA
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12
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Loree AM, Hecht LM, Yeh HH, Gavrilova L, Furman K, Westphal J, Simon GE, Lynch FL, Beck A, Owen-Smith A, Rossom R, Daida YG, Lu CY, Boggs JM, Frank C, Waring S, Ahmedani BK. Factors associated with suicide mortality among reproductive age women: a case-control study. J Reprod Infant Psychol 2023:1-12. [PMID: 37310021 DOI: 10.1080/02646838.2023.2223636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Examine demographic, psychosocial, pregnancy-related, and healthcare utilisation factors associated with suicide mortality among reproductive age women. METHODS Data from nine health care systems in the Mental Health Research Network were included. A case-control study design was used in which 290 reproductive age women who died by suicide (cases) from 2000 to 2015 were matched with 2,900 reproductive age women from the same healthcare system who did not die by suicide (controls). Conditional logistic regression was used to analyse associations between patient characteristics and suicide. RESULTS Women of reproductive age who died by suicide were more likely to have mental health (aOR = 7.08, 95% CI: 5.17, 9.71) or substance use disorders (aOR = 3.16, 95% CI: 2.19, 4.56) and to have visited the emergency department in the year prior to index date (aOR = 3.47, 95% CI: 2.50, 4.80). Non-Hispanic White women (aOR = 0.70, 95% CI: 0.51, 0.97) and perinatal (pregnant or postpartum) women were less likely to have died by suicide (aOR = 0.27, 95% CI: 0.13, 0.58). CONCLUSIONS Reproductive age women with mental health and/or substance use disorders, prior emergency department encounters, or who are of racial or ethnic minority status were at increased risk of suicide mortality and may benefit from routine screening and monitoring. Future research should further examine the relationship between pregnancy-related factors and suicide mortality.
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Affiliation(s)
- Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Leah M Hecht
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Hsueh-Han Yeh
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Lyubov Gavrilova
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Joslyn Westphal
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Ashli Owen-Smith
- Georgia State University School of Public Health, Atlanta, GA, USA
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Rebecca Rossom
- Research and Evaluation Division, HealthPartners Institute, Minneapolis, MN, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO, USA
| | - Cathrine Frank
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, MI, USA
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13
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Negriff S, Lynch FL, Cronkite DJ, Pardee RE, Penfold RB. Using natural language processing to identify child maltreatment in health systems. Child Abuse Negl 2023; 138:106090. [PMID: 36758373 PMCID: PMC9984187 DOI: 10.1016/j.chiabu.2023.106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Rates of child maltreatment (CM) obtained from electronic health records are much lower than national child welfare prevalence rates indicate. There is a need to understand how CM is documented to improve reporting and surveillance. OBJECTIVES To examine whether using natural language processing (NLP) in outpatient chart notes can identify cases of CM not documented by ICD diagnosis code, the overlap between the coding of child maltreatment by ICD and NLP, and any differences by age, gender, or race/ethnicity. METHODS Outpatient chart notes of children age 0-18 years old within Kaiser Permanente Washington (KPWA) 2018-2020 were used to examine a selected set of maltreatment-related terms categorized into concept unique identifiers (CUI). Manual review of text snippets for each CUI was completed to flag for validated cases and retrain the NLP algorithm. RESULTS The NLP results indicated a crude rate of 1.55 % to 2.36 % (2018-2020) of notes with reference to CM. The rate of CM identified by ICD code was 3.32 per 1000 children, whereas the rate identified by NLP was 37.38 per 1000 children. The groups that increased the most in identification of maltreatment from ICD to NLP were adolescents (13-18 yrs. old), females, Native American children, and those on Medicaid. Of note, all subgroups had substantially higher rates of maltreatment when using NLP. CONCLUSIONS Use of NLP substantially increased the estimated number of children who have been impacted by CM. Accurately capturing this population will improve identification of vulnerable youth at high risk for mental health symptoms.
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Affiliation(s)
- Sonya Negriff
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States of America.
| | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR, United States of America
| | - David J Cronkite
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, United States of America
| | - Roy E Pardee
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, United States of America
| | - Robert B Penfold
- Kaiser Permanente Washington, Health Research Institute, Seattle, WA, United States of America; Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States of America
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14
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Bulkley JE, Varga AM, Dickerson JF, Crawford P, Croen LA, Daida YG, Fombonne E, Hatch B, Lee A, Massolo M, Vaughn K, Lynch FL. A framework for measuring the cost to families of caring for children's health: the design, methodology, and study population of the r-Kids study. BMC Pediatr 2023; 23:128. [PMID: 36941585 PMCID: PMC10025806 DOI: 10.1186/s12887-023-03893-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/06/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND All families experience financial and time costs related to caring for their children's health. Understanding the economic burden faced by families of children with chronic health conditions (CHC) is crucial for designing effective policies to support families. METHODS In this prospective study we used electronic health records to identify children between 3 and 17 years old with autism spectrum disorder (ASD), asthma, or neither (control) from three Kaiser Permanente regions and several community health centers in the OCHIN network. We oversampled children from racial and ethnic minority groups. Parent/guardian respondents completed surveys three times, approximately four months apart. The surveys included the Family Economic Impact Inventory (measuring financial, time, and employment costs of caring for a child's health), and standardized measures of children's quality of life, behavioral problems, and symptom severity for children with ASD or asthma. We also assessed parenting stress and parent physical and mental health. All materials were provided in English and Spanish. RESULTS Of the 1,461 families that enrolled (564 ASD, 468 asthma, 429 control), children were predominantly male (79%), with a mean age of 9.0 years, and racially and ethnically diverse (43% non-Hispanic white; 22% Hispanic; 35% Asian, Black, Native Hawaiian, or another race/ethnicity). The majority of survey respondents were female (86%), had a college degree (62%), and were married/partnered (79%). ASD group respondents were less likely to be employed (73%) than those in the asthma or control groups (both 80%; p = .023). Only 32% of the control group reported a household income ≤ $4,000/month compared with 41% of asthma and 38% of ASD families (p = .006). CONCLUSIONS Utilizing a novel measure assessing family economic burden, we successfully collected survey responses from a large and diverse sample of families. Drawing upon the conceptual framework, survey measures, and self-report data described herein we will conduct future analyses to examine the economic burdens related to CHC and the incremental differences in these burdens between health groups. This information will help policy makers to design more equitable health and social policies that could reduce the burden on families.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Alexandra M Varga
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Phil Crawford
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Lisa A Croen
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Yihe G Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Eric Fombonne
- Oregon Health & Science University, Portland, OR, USA
| | - Brigit Hatch
- Oregon Health & Science University, Portland, OR, USA
- OCHIN, Inc, Portland, OR, USA
| | | | - Maria Massolo
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Katherine Vaughn
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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15
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Baca SA, Goger P, Glaser D, Rozenman M, Gonzalez A, Dickerson JF, Lynch FL, Porta G, Brent DA, Weersing VR. Reduction in avoidance mediates effects of brief behavioral therapy for pediatric anxiety and depression. Behav Res Ther 2023; 164:104290. [PMID: 36965232 DOI: 10.1016/j.brat.2023.104290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/23/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
Brief behavioral therapy (BBT) is an efficacious transdiagnostic intervention for pediatric anxiety and depression that targets behavioral avoidance as a key mechanism. It is unknown if change in avoidance mediates treatment effects, as theorized. Data on avoidance at baseline and Week 16 were available on 52 youth (ages 8-16 years) from a randomized controlled trial (Weersing, Jeffreys, et al., 2017) comparing BBT and assisted referral to community care (ARC). BBT had significant effects on youth-reported behavioral avoidance, and significant indirect effects on functioning and anxiety, statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported avoidance was not a significant mediator of depression. Parent-report of avoidance was not impacted by treatment and was not a significant mediator. Overall, BBT appears to be an effective treatment for targeting behavioral avoidance, which in turn, may improve functioning and lessen anxiety. CLINICAL TRIAL REGISTRATION INFORMATION: https://clinicaltrials.gov; NCT01147614.
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Affiliation(s)
- Selena A Baca
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Pauline Goger
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Dale Glaser
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Michelle Rozenman
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO, 80210, USA
| | - Araceli Gonzalez
- Psychology Department, California State University Long Beach, 1250 Bellflower Blvd, PSY-100, Long Beach, CA, 90840-0901, USA
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, 100 N. Bellefield Ave, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 311 Bellefield Towers, Pittsburgh, PA, 15213, USA
| | - David A Brent
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, 100 N. Bellefield Ave, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 311 Bellefield Towers, Pittsburgh, PA, 15213, USA
| | - V Robin Weersing
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA; Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA.
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16
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Lynch FL, Bulkley JE, Varga A, Crawford P, Croen LA, Daida YG, Fombonne E, Hatch B, Massolo M, Dickerson JF. The impact of autism spectrum disorder on parent employment: Results from the r-Kids study. Autism Res 2023; 16:642-652. [PMID: 36546608 DOI: 10.1002/aur.2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
Parents of children with autism spectrum disorder (ASD) and other chronic health conditions often face exceptional caregiving demands that can lead to challenges related to maintaining and succeeding in employment. Detailed information on the specific ways in which these health conditions impact parent employment could aid in designing equitable, effective policies to support families. The r-Kids study used electronic health records to identify three groups of children: those with ASD, asthma, or neither condition (control), from several health care systems. We oversampled racial and ethnic minorities and matched the asthma and control groups to the age and sex distribution of the ASD group. Parents completed three online surveys over the course of a year to measure annual employment outcomes. Surveys included the Family Economic Impact Inventory (measuring employment impacts) and measures of quality of life and symptom severity. All materials were provided in English and Spanish. The study enrolled 1461 families (564 ASD, 468 asthma, 429 control). Youth were 3-16.5 years old and predominantly male (79%). The sample was diverse (43% non-Hispanic White; 35% non-Hispanic Asian, Black, Native Hawaiian, or Other; and 21% Hispanic ethnicity). Parents of children with ASD were significantly less likely to be employed than parents of youth with asthma and control combined (OR: 14.2, p < 0.001), and were more likely to have other difficulties with employment and productivity while at work. Public and employer policies to help mitigate these impacts could aid families in managing care for youth with ASD.
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Affiliation(s)
- Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA.,OCHIN, Inc., Portland, Oregon, USA
| | - Joanna E Bulkley
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Phillip Crawford
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Lisa A Croen
- Kaiser Permanente Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, Hawaii, USA
| | - Eric Fombonne
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Brigit Hatch
- OCHIN, Inc., Portland, Oregon, USA.,School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Massolo
- Kaiser Permanente Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
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17
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Sheppler CR, Edelmann AC, Firemark AJ, Sugar CA, Lynch FL, Dickerson JF, Miranda JM, Clarke GN, Asarnow JR. Stepped care for suicide prevention in teens and young adults: Design and methods of a randomized controlled trial. Contemp Clin Trials 2022; 123:106959. [PMID: 36228984 PMCID: PMC10832890 DOI: 10.1016/j.cct.2022.106959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Suicide is the second‑leading cause of death among adolescents and young adults in the United States, with rates rising over much of the last decade. The design, testing, and implementation of interventions to prevent suicide in this population is a public health priority. This manuscript outlines the design and methods for a research study that compares two interventions aimed at reducing suicide and suicide attempts in youth. METHODS We will enroll 300 youth aged 12-24 at high risk for suicide in this randomized controlled parallel group superiority trial. Participants will be randomly assigned to one of two study arms: (1) Zero Suicide Quality Improvement (ZSQI) implemented within the Kaiser Permanente Northwest (KPNW) health system, or (2) ZSQI plus a stepped care intervention for suicide prevention (SC-SP), where the services offered (including care management and dialectical behavior therapy [DBT]) increase based on risk level. Outcomes will be assessed at baseline, as well as 3-, 6-, and 12-months post randomization. The study was conceptualized and designed collaboratively by investigators at UCLA and KPNW. RESULTS To be reported in future manuscripts. CONCLUSION The main objective of the study is to determine whether the SC-SP intervention is superior to ZSQI with regard to lowering rates of fatal and nonfatal suicide attempts. Interventions that incorporate the latest research need to be designed and tested under controlled conditions to make progress toward the goal of achieving zero suicide. The results from this trial will directly inform those efforts. TRIAL REGISTRATION CLINICALTRIALS gov, NCT03092271, https://clinicaltrials.gov/ct2/show/NCT03092271https://clinicaltrials.gov/ct2/show/NCT01379027.
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Affiliation(s)
- Christina R Sheppler
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - Anna C Edelmann
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - Alison J Firemark
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - Catherine A Sugar
- University of California, Los Angeles, Departments of Biostatistics, Statistics, and Psychiatry, United States of America.
| | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - John F Dickerson
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - Jeanne M Miranda
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States of America.
| | - Gregory N Clarke
- Kaiser Permanente Northwest, Center for Health Research, United States of America.
| | - Joan R Asarnow
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, United States of America.
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18
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Braciszewski JM, Lanier A, Yeh HH, Sala-Hamrick K, Simon GE, Rossom RC, Lynch FL, Waring SC, Lu CY, Owen-Smith AA, Beck A, Daida YG, Maye M, Frank C, Hendriks M, Fabian N, Ahmedani BK. Health Diagnoses and Service Utilization in the Year Before Youth and Young Adult Suicide. Psychiatr Serv 2022:appips20220145. [PMID: 36349497 PMCID: PMC10166760 DOI: 10.1176/appi.ps.20220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Suicide rates among young people are rising. Health care visits provide opportunities for identification and intervention, yet studies have been limited by small or circumscribed samples. This study sought to expand the knowledge base by examining health care encounters and diagnoses among young people who later died by suicide. METHODS This case-control study examined diagnoses of mental and general medical disorders and health care utilization in the 30 and 365 days before suicide death in nine large U.S. health care systems. Data (years 2000-2015) from 445 suicide decedents ages 10-24 years were matched with data from 4,450 control group patients. RESULTS Suicide decedents were more likely to have at least one mental disorder diagnosis (51% vs. 16%; adjusted OR [AOR]=5.74, 95% CI=4.60-7.18) and had higher rates of nearly all mental health conditions. Substance use disorders were common (12%) and more likely (AOR=8.50, 95% CI=5.53-13.06) among suicide decedents. More than one in three (42%) suicide decedents had a health care visit in the month before death, and nearly all (88%) had a visit in the previous year. CONCLUSIONS Despite the greater likelihood of suicide associated with mental disorder diagnoses, such disorders were present among only 51% of suicide decedents. High rates of health care utilization among suicide decedents indicate a need for improving identification of mental health conditions and suicide risk across the health care system. Increased substance use screening may help identify youths at high risk because substance use disorders were significantly more prevalent and likely among suicide decedents.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ana Lanier
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Kelsey Sala-Hamrick
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances L Lynch
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Maye
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Hendriks
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Nina Fabian
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
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19
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Ferket BS, Baldwin Z, Murali P, Pai A, Mittendorf KF, Russell HV, Chen F, Lynch FL, Lich KH, Hindorff LA, Savich R, Slavotinek A, Smith HS, Gelb BD, Veenstra DL. Cost-effectiveness frameworks for comparing genome and exome sequencing versus conventional diagnostic pathways: A scoping review and recommended methods. Genet Med 2022; 24:2014-2027. [PMID: 35833928 PMCID: PMC9997042 DOI: 10.1016/j.gim.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Methodological challenges have limited economic evaluations of genome sequencing (GS) and exome sequencing (ES). Our objective was to develop conceptual frameworks for model-based cost-effectiveness analyses (CEAs) of diagnostic GS/ES. METHODS We conducted a scoping review of economic analyses to develop and iterate with experts a set of conceptual CEA frameworks for GS/ES for prenatal testing, early diagnosis in pediatrics, diagnosis of delayed-onset disorders in pediatrics, genetic testing in cancer, screening of newborns, and general population screening. RESULTS Reflecting on 57 studies meeting inclusion criteria, we recommend the following considerations for each clinical scenario. For prenatal testing, performing comparative analyses of costs of ES strategies and postpartum care, as well as genetic diagnoses and pregnancy outcomes. For early diagnosis in pediatrics, modeling quality-adjusted life years (QALYs) and costs over ≥20 years for rapid turnaround GS/ES. For hereditary cancer syndrome testing, modeling cumulative costs and QALYs for the individual tested and first/second/third-degree relatives. For tumor profiling, not restricting to treatment uptake or response and including QALYs and costs of downstream outcomes. For screening, modeling lifetime costs and QALYs and considering consequences of low penetrance and GS/ES reanalysis. CONCLUSION Our frameworks can guide the design of model-based CEAs and ultimately foster robust evidence for the economic value of GS/ES.
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Affiliation(s)
- Bart S Ferket
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Zach Baldwin
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA
| | - Priyanka Murali
- Division of Medical Genetics, Department of Medicine, University of Washington Medical Center, University of Washington, Seattle, WA
| | - Akila Pai
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Heidi V Russell
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX; Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Flavia Chen
- Program in Bioethics, University of California San Francisco, San Francisco, CA; Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | | | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lucia A Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Renate Savich
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS; Division of Neonatology, School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Anne Slavotinek
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Bruce D Gelb
- Departments of Pediatrics and Genetics & Genomic Sciences, Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David L Veenstra
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA
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20
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Kahn GD, Tam SH, Felton JW, Westphal J, Simon GE, Owen‐Smith AA, Rossom RC, Beck AL, Lynch FL, Daida YG, Lu CY, Waring S, Frank CB, Akinyemi EO, Ahmedani BK. Cancer and psychiatric diagnoses in the year preceding suicide. Cancer Med 2022; 12:3601-3609. [PMID: 36114785 PMCID: PMC9939190 DOI: 10.1002/cam4.5201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with cancer are known to be at increased risk for suicide but little is known about the interaction between cancer and psychiatric diagnoses, another well-documented risk factor. METHODS Electronic medical records from nine healthcare systems participating in the Mental Health Research Network were aggregated to form a retrospective case-control study, with ICD-9 codes used to identify diagnoses in the 1 year prior to death by suicide for cases (N = 3330) or matching index date for controls (N = 297,034). Conditional logistic regression was used to assess differences in cancer and psychiatric diagnoses between cases and controls, controlling for sex and age. RESULTS Among patients without concurrent psychiatric diagnoses, cancer at disease sites with lower average 5-year survival rates were associated with significantly greater relative risk, while cancer disease sites with survival rates of >70% conferred no increased risk. Patients with most psychiatric diagnoses were at higher risk, however, there was no additional risk conferred to these patients by a concurrent cancer diagnosis. CONCLUSION We found no evidence of a synergistic effect between cancer and psychiatric diagnoses. However, cancer patients with a concurrent psychiatric illness remain at the highest relative risk for suicide, regardless of cancer disease site, due to strong independent associations between psychiatric diagnoses and suicide. For patients without a concurrent psychiatric illness, cancer disease sites associated with worse prognoses appeared to confer greater suicide risk.
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Affiliation(s)
- Geoffrey D. Kahn
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Samantha H. Tam
- Department of Otolaryngology – Head and Neck SurgeryHenry Ford HealthDetroitMichiganUSA
| | - Julia W. Felton
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Joslyn Westphal
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research InstituteSeattleWAUSA
| | - Ashli A. Owen‐Smith
- Department of Health Policy and Behavioral SciencesGeorgia State University School of Public HealthAtlantaGeorgiaUSA
| | | | - Arne L. Beck
- Institute for Health Research, Kaiser Permanente ColoradoAuroraColoradoUSA
| | - Frances L. Lynch
- Center for Health ResearchKaiser Permanente HawaiiPortlandOregonUSA
| | - Yihe G. Daida
- Center for Integrated Health Care ResearchKaiser Permanente HawaiiHonoluluHawaiiUSA
| | - Christine Y. Lu
- Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMassachusettsUSA
| | | | | | | | - Brian K. Ahmedani
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
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21
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Weersing VR, Gonzalez A, Hatch B, Lynch FL. Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression. PRCP 2022; 4:80-88. [PMID: 36177440 PMCID: PMC9477232 DOI: 10.1176/appi.prcp.20210044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/26/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022] Open
Abstract
Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden from disorder as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Increasing access to services for anxiety and depression is of critical and immediate importance for racial/ethnic minority families. Issues of access may be associated with the physical location of services (e.g., primary care or telehealth) or with barriers of language, income, or financing. Both service settings and research treatment protocols frequently require families of ethnic/racial minority youths to fit themselves to the demands of care, in ways that may not be culturally compatible (e.g., little parent involvement in treatment) or practically feasible (i.e., weekly sessions during parent working hours). Whenever possible, non‐essential aspects of intervention should be freed to match patient preferences and constraints, and interventions for anxiety and depression should be adopted that have broad impacts and options for personalization of goals.
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Affiliation(s)
- V. Robin Weersing
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Araceli Gonzalez
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Brigit Hatch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
| | - Frances L. Lynch
- SDSU‐UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA (V. R. Weersing); California State University Long Beach, Long Beach, California, USA (A. Gonzalez); OCHIN Research, Oregon Health Sciences University (B. Hatch); OCHIN Research, Kaiser Permanente Center for Health Research, Portland, Oregon, USA (F. L. Lynch)
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22
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Knerr S, Guo B, Mittendorf KF, Feigelson HS, Gilmore MJ, Jarvik GP, Kauffman TL, Keast E, Lynch FL, Muessig KR, Okuyama S, Veenstra DL, Zepp JM, Goddard KA, Devine B. Risk-reducing surgery in unaffected individuals receiving cancer genetic testing in an integrated health care system. Cancer 2022; 128:3090-3098. [PMID: 35679147 PMCID: PMC9308746 DOI: 10.1002/cncr.34349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Germline genetic testing enables primary cancer prevention, including through prophylactic surgery. We examined risk-reducing surgeries in unaffected individuals tested for hereditary cancer susceptibly between 2010 and 2018 in the Kaiser Permanente Northwest health system. METHODS We used an internal genetic testing database to create a cohort of individuals who received tests including one or more high-penetrance hereditary cancer susceptibility gene. We then identified, after testing, bilateral mastectomy, bilateral salpingo-oophorectomy (BSO), and total hysterectomy procedures in electronic health record and claims data through 2019. We describe surgery utilization by genetic test results and National Comprehensive Cancer Network (NCCN) guidelines. RESULTS The cohort included 1020 individuals, 16% with pathogenic/likely pathogenic (P/LP) variants in one or more of the following genes: BRCA1, BRCA2, CHEK2, APC, MUTYH, ATM, MSH2, PALB2, BRIP1, MLH1, MSH6, EPCAM, FLCN, RAD51C, RAD51D, or TP53. Among individuals with P/LP variants making them candidates for mastectomy, BSO, or hysterectomy per NCCN guidelines, 34% (33/97), 24% (23/94), and 8% (1/12), respectively, underwent surgery during follow-up. Fifty-three percent (18/37) of hysterectomies were among APC, BRCA1, and BRCA2 P/LP variant heterozygotes, typically concurrent with BSO. Three individuals with variants of uncertain significance (only) and 22 with negative results had prophylactic surgery after genetic testing. CONCLUSIONS Uptake of risk-reducing surgery following usual care genetic testing appears to be lower than in studies that actively recruit high-risk patients and provide testing and follow-up care in specialized settings. Factors in addition to genetic test results and NCCN guidelines motivate prophylactic surgery use and deserve further study.
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Affiliation(s)
- Sarah Knerr
- School of Public Health, University of Washington, Seattle, WA
| | - Boya Guo
- School of Public Health, University of Washington, Seattle, WA
| | - Kathleen F. Mittendorf
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Marian J. Gilmore
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Gail P. Jarvik
- School of Medicine, University of Washington, Seattle, WA
| | - Tia L. Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland OR
| | - Erin Keast
- Center for Health Research, Kaiser Permanente Northwest, Portland OR
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland OR
| | - Kristin R. Muessig
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sonia Okuyama
- Division of Oncology, Denver Health and Hospital Authority, Denver, CO
| | - David L. Veenstra
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA
| | - Jamilyn M. Zepp
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Katrina A.B. Goddard
- Department of Translational and Applied Genomics, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Beth Devine
- The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA
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23
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Ahmedani BK, Cannella CE, Yeh HH, Westphal J, Simon GE, Beck A, Rossom RC, Lynch FL, Lu CY, Owen-Smith AA, Sala-Hamrick KJ, Frank C, Akinyemi E, Beebani G, Busuito C, Boggs JM, Daida YG, Waring S, Gui H, Levin AM. Detecting and distinguishing indicators of risk for suicide using clinical records. Transl Psychiatry 2022; 12:280. [PMID: 35831289 PMCID: PMC9279332 DOI: 10.1038/s41398-022-02051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Health systems are essential for suicide risk detection. Most efforts target people with mental health (MH) diagnoses, but this only represents half of the people who die by suicide. This study seeks to discover and validate health indicators of suicide death among those with, and without, MH diagnoses. This case-control study used statistical modeling with health record data on diagnoses, procedures, and encounters. The study included 3,195 individuals who died by suicide from 2000 to 2015 and 249,092 randomly selected matched controls, who were age 18+ and affiliated with nine Mental Health Research Network affiliated health systems. Of the 202 indicators studied, 170 (84%) were associated with suicide in the discovery cohort, with 148 (86%) of those in the validation cohort. Malignant cancer diagnoses were risk factors for suicide in those without MH diagnoses, and multiple individual psychiatric-related indicators were unique to the MH subgroup. Protective effects across MH-stratified models included diagnoses of benign neoplasms, respiratory infections, and utilization of reproductive services. MH-stratified latent class models validated five subgroups with distinct patterns of indicators in both those with and without MH. The highest risk groups were characterized via high utilization with multiple healthcare concerns in both groups. The lowest risk groups were characterized as predominantly young, female, and high utilizers of preventive services. Healthcare data include many indicators of suicide risk for those with and without MH diagnoses, which may be used to support the identification and understanding of risk as well as targeting of prevention in health systems.
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Affiliation(s)
- Brian K. Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA ,grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Cara E. Cannella
- Henry Ford Health, Public Health Sciences, Detroit, MI USA ,Henry Ford Health, Center for Bioinformatics, Detroit, MI USA
| | - Hsueh-Han Yeh
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Joslyn Westphal
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Gregory E. Simon
- grid.488833.c0000 0004 0615 7519Kaiser Permanente Washington, Health Research Institute, Seattle, WA USA
| | - Arne Beck
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO USA
| | - Rebecca C. Rossom
- grid.280625.b0000 0004 0461 4886HealthPartners Institute, Minneapolis, MN USA
| | - Frances L. Lynch
- grid.414876.80000 0004 0455 9821Kaiser Permanente Northwest, Center for Health Research, Portland, OR USA
| | - Christine Y. Lu
- grid.38142.3c000000041936754XHarvard Pilgrim Health Care Institute & Harvard Medical School, Department of Population Health, Boston, MA USA
| | - Ashli A. Owen-Smith
- grid.256304.60000 0004 1936 7400Georgia State University & Kaiser Permanente Georgia, Atlanta, GA USA
| | - Kelsey J. Sala-Hamrick
- Henry Ford Health, Center for Health Policy & Health Services Research, 1 Ford Place, Suite 3A, Detroit, MI 48202 USA
| | - Cathrine Frank
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Esther Akinyemi
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Ganj Beebani
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Christopher Busuito
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Jennifer M. Boggs
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Colorado, Institute for Health Research, Aurora, CO USA
| | - Yihe G. Daida
- grid.280062.e0000 0000 9957 7758Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI USA
| | - Stephen Waring
- grid.428919.f0000 0004 0449 6525Essentia Institute of Rural Health, Duluth, MN USA
| | - Hongsheng Gui
- grid.427930.b0000 0004 4903 9942Henry Ford Health, Behavioral Health Services, Detroit, MI USA
| | - Albert M. Levin
- Henry Ford Health, Public Health Sciences, Detroit, MI USA ,Henry Ford Health, Center for Bioinformatics, Detroit, MI USA
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24
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Goger P, Zerr AA, Weersing VR, Dickerson JF, Crawford PM, Sterling SA, Waitzfelder B, Daida YG, Ahmedani BK, Penfold RB, Lynch FL. Health Service Utilization Among Children and Adolescents with Posttraumatic Stress Disorder: A Case-Control Study. J Dev Behav Pediatr 2022; 43:283-290. [PMID: 34817448 PMCID: PMC9124718 DOI: 10.1097/dbp.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/01/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Trauma exposure is widely prevalent, with more than 60% of adolescents having experienced at least 1 traumatic event and a third of those at high risk to develop posttraumatic stress disorder (PTSD). Data are scarce and out of date on the services children and adolescents with PTSD receive, impeding efforts to improve care and outcomes. This study examines health service use for a large and diverse sample of children and adolescents with and without a diagnosis of PTSD. METHOD Using a matched case-control study, we gathered information from 4 large health care systems participating in the Mental Health Research Network. Data from each site's electronic medical records on diagnoses, health care encounters, and demographics were analyzed. Nine hundred fifty-five 4- to 18-year-olds with a diagnosis of PTSD were identified and matched on a 1:5 ratio to 4770 controls. We compared cases with controls on frequency of service use in outpatient primary care, medical specialty care, acute care, and mental health care. We also assessed psychotropic medication use. RESULTS Children and adolescents diagnosed with PTSD used nearly all physical and mental health service categories at a higher rate than controls. However, one-third of children and adolescents did not receive even 1 outpatient mental health visit (36.86%) during the year-long sampling window. CONCLUSION Our findings suggest that children and adolescents diagnosed with PTSD may have unmet mental health needs. They are high utilizers of health services overall, but lower utilizers of the sectors that may be most helpful in resolving their symptoms.
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Affiliation(s)
- Pauline Goger
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Argero A. Zerr
- California State University Channel Islands, Camarillo, CA
| | - V. Robin Weersing
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | | | | | | | - Beth Waitzfelder
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Yihe G. Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Brian K. Ahmedani
- Center for Health Services Research, Henry Ford Health System, Detroit, MI
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25
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Boggs JM, Simon GE, Beck A, Rossom RC, Lynch FL, Lu CY, Owen-Smith AA, Waring SC, Ahmedani BK. Are People Who Die by Intentional Medication Poisoning Dispensed Those Medications in the Year Prior to Death? Arch Suicide Res 2022:1-8. [PMID: 35579399 PMCID: PMC9762134 DOI: 10.1080/13811118.2022.2072253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The rate of suicidal poisoning in the United States has increased substantially over the past 20 years. Understanding whether prescription medications used for self-poisoning were recently dispensed would help inform suicide prevention efforts. Alternatively, medications for self-poisoning could have been formerly dispensed or collected from friends, family, or illicit sources. METHODS Among those who died by intentional opioid and psychotropic poisonings, we conducted a descriptive study to determine what proportion had a recently filled prescription that could have been the means of suicide. Subjects were all people who died by intentional poisoning across nine health-care systems within the NIH-funded Mental Health Research Network. RESULTS Among the 3,300 people who died by suicide, 700 died by any poisoning and 194 died by intentional opioid or psychotropic/hypnotic medication poisoning. Among those who died by intentional opioid poisoning 73% were dispensed an opioid in the year prior. Among those who died by intentional psychotropic/hypnotic poisoning, 83% were dispensed any psychotropic and 61% were dispensed a hypnotic in prior year. Most people were continuously dispensed the same medications used in their intentional poisonings in the year prior to death. CONCLUSIONS Our results indicate that most medications used in suicidal overdose were likely recently dispensed. Therefore, future suicide prevention studies and prevention resources should focus on medication safety interventions such as lethal-means counseling for medication access, limiting quantities dispensed, opioid antagonists, and blister packs. HIGHLIGHTSUnderstanding whether medications used for self-poisoning were recently dispensed or formerly/never dispensed would help inform future studies and suicide prevention efforts.We found that most people who died by intentional poisoning with opioids or psychotropic/hypnotic medications received frequent dispensings of the medication used for self-poisoning in the year prior to death.Future suicide prevention studies and efforts should focus on medication safety interventions such as lethal-means counseling for medication access, limiting quantities dispensed, opioid antagonists, and blister packs.
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26
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Fombonne E, Croen LA, Bulkley JE, Varga AM, Daida YG, Hatch BA, Dickerson JF, Lynch FL. Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning. J Dev Behav Pediatr 2022; 43:140-148. [PMID: 34693924 PMCID: PMC9021329 DOI: 10.1097/dbp.0000000000001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emotional and behavioral problems (EBPs) may co-occur with autism spectrum disorder (ASD) and impair children's functioning beyond autism symptomatology. We compared the prevalence of EBPs in youths with or without ASD and evaluated their unique contribution to impairment in ASD. METHODS We surveyed 1267 children (79.4% boys, mean age: 9.2 years, range: 3-17) recruited at 3 sites in Kaiser Permanente and OCHIN primary care clinical networks, with confirmed International Classification of Diseases-10th ed. diagnosis of ASD (N = 564), asthma (N = 468), or neither (N = 429). Children from the 2 comparison groups were age-matched and sex-matched to the ASD group. EBPs and impairment were measured by the Strengths and Difficulties Questionnaire and autism symptomatology by the Social Responsiveness Scale in the ASD group only. RESULTS EBPs and impairment mean scores were significantly (p < 0.001) higher in participants with ASD compared with children from the 2 comparison groups, across sexes and age groups, with no significant difference between the asthma and control groups. Among children with ASD, both EBPs and autistic symptoms were significantly correlated with impairment (r = 0.64 and r = 0.65, respectively) and explained a significant proportion of impairment variance (R2 = 0.525; p < 0.001) in multiple linear regression. In the relative importance analysis, EBPs and autistic symptoms explained comparable proportions of impairment variance (46% and 52%, respectively) with no significant difference between their relative weights (mean difference: 0.03; 95% confidence interval: -0.049 to 0.114). CONCLUSION Among youth with ASD, high levels of EBPs impair daily functioning as much as autistic symptoms. Systematic detection and management of EBPs may improve functioning and outcomes in youth with ASD.
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Affiliation(s)
| | | | - Joanna E. Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | - Brigit A. Hatch
- Oregon Health & Science University, Portland, OR
- OCHIN, Inc., Portland, OR
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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27
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Lynch FL, Dickerson JF, O'Keeffe-Rosetti M, Chow W, Pesa J. Understanding the Relationship Between Depression Symptom Severity and Health Care Costs for Patients With Treatment-Resistant Depression. J Clin Psychiatry 2022; 83. [PMID: 35120286 DOI: 10.4088/jcp.21m13976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To examine whether measures of depression symptom severity could improve understanding of health care costs for patients with major depressive disorder (MDD) or treatment-resistant depression (TRD) from the health plan perspective. Methods: In this retrospective cohort study within an integrated health system, cohorts consisted of 2 mutually exclusive groups: (1) adults with TRD based on a standard treatment algorithm and (2) adults with MDD, but no TRD, identified through ICD-9/10-CM codes. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Patterns of health care resource utilization (HRU) and costs were compared between the TRD and MDD groups overall and within the groups at different symptom levels. A general linear model with a γ distribution and log link for cost outcomes, logistic regression for binary outcomes, and negative binomial regression for count outcomes were used. Results: Patients with TRD (n = 24,534) had greater comorbidity than those in the MDD group (n = 17,628). Mean age in the TRD group was 52.8 years versus 48.2 for MDD (P < .001). Both groups were predominantly female (TRD: 72.8% vs MDD: 66.9%; P < .001). Overall, the TRD group had greater costs than the MDD group, with 1.23 times (95% CI, 1.21-1.26; P < .001) greater total cost on average over 1 year following index date. Within both groups, those with severe symptoms had greater total mean (SD) costs (TRD: moderate: $12,429 [$23,900] vs severe: $13,344 [$22,895], P < .001; low: $12,220 [$31,864] vs severe: $13,344 [$22,895], P < .001; MDD: moderate: $8,899 [$20,755] vs severe: $10,098 [$22,853]; P < .001; low: $8,752 [$25,800] vs severe: $10,098 [$22,853], P < .001). Conclusions: MDD and TRD impose high costs for health systems, with increasing costs as PHQ-9 symptom severity rises. Better understanding of subgroups with different symptom levels could improve clinical care by helping target interventions.
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Affiliation(s)
- Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.,Corresponding author: Frances L. Lynch, PhD, Center for Health Research, 3800 North Interstate, Portland, OR 97227
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Wing Chow
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Dr Chow's current affiliation is Sr Director, Systems of Care, Research Collaborations, US HEOR, Novartis, New Brunswick, New Jersey
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Rossom RC, Yarborough BJ, Boggs JM, Coleman KJ, Ahmedani BK, Lynch FL, Daida Y, Simon GE. Prediction of suicidal behavior using self-reported suicidal ideation among patients with bipolar disorder. J Affect Disord 2021; 295:410-415. [PMID: 34507220 PMCID: PMC8551064 DOI: 10.1016/j.jad.2021.08.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND People with bipolar disorder have elevated suicide risk. We estimated the ability of the Patient Health Questionnaire (PHQ9) to predict suicide outcomes for outpatients with bipolar disorder. METHODS Visits by adults with bipolar disorder who completed a PHQ9 were identified using electronic health record (EHR) data. Bipolar diagnoses and suicide attempts were ascertained from EHR and claims data, and suicide deaths from state and federal records. Depression severity was assessed via the first eight items of the PHQ9, while suicidal ideation was assessed by the ninth item. RESULTS 37,243 patients made 126,483 visits. Patients reported at least moderate symptoms of depression in 49% and suicidal ideation in 30% of visits. Risk of suicide attempt was 4.21% in the subsequent 90 days for those reporting nearly daily suicidal ideation compared to 0.74% in those reporting none. Patients with nearly daily suicidal ideation were 3.85 (95% CI 3.32-4.47) times more likely to attempt suicide and 13.78 (95% CI 6.56-28.94) times more likely to die by suicide in the subsequent 90 days than patients reporting none. Patients with self-harm in the last year were 8.86 (95% 7.84-10.02) times more likely to attempt suicide in the subsequent 90 days than those without. LIMITATIONS Our sample was limited to patients completing the PHQ9 and did not include data on some important social risk or protective factors. CONCLUSIONS The PHQ9 was a robust predictor of suicide. Suicidal ideation reported on the PHQ9 should be considered a strong indicator of suicide risk and prompt further evaluation.
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Affiliation(s)
| | | | - Jennifer M. Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO
| | - Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Services Research, Detroit, MI
| | - Frances L. Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | - Yihe Daida
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Penfold RB, Johnson E, Shortreed SM, Ziebell RA, Lynch FL, Clarke GN, Coleman KJ, Waitzfelder BE, Beck AL, Rossom RC, Ahmedani BK, Simon GE. Predicting suicide attempts and suicide deaths among adolescents following outpatient visits. J Affect Disord 2021; 294:39-47. [PMID: 34265670 PMCID: PMC8820270 DOI: 10.1016/j.jad.2021.06.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Few studies report on machine learning models for suicide risk prediction in adolescents and their utility in identifying those in need of further evaluation. This study examined whether a model trained and validated using data from all age groups works as well for adolescents or whether it could be improved. METHODS We used healthcare data for 1.4 million specialty mental health and primary care outpatient visits among 256,823 adolescents across 7 health systems. The prediction target was 90-day risk of suicide attempt following a visit. We used logistic regression with least absolute shrinkage and selection operator (LASSO) and generalized estimating equations (GEE) to predict risk. We compared performance of three models: an existing model, a recalibrated version of that model, and a newly-learned model. Models were compared using area under the receiver operating curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. RESULTS The AUC produced by the existing model for specialty mental health visits estimated in adolescents alone (0.796; [0.789, 0.802]) was not significantly different than the AUC of the recalibrated existing model (0.794; [0.787, 0.80]) or the newly-learned model (0.795; [0.789, 0.801]). Predicted risk following primary care visits was also similar: existing (0.855; [0.844, 0.866]), recalibrated (0.85 [0.839, 0.862]), newly-learned (0.842, [0.829, 0.854]). LIMITATIONS The models did not incorporate non-healthcare risk factors. The models relied on ICD9-CM codes for diagnoses and outcome measurement. CONCLUSIONS Prediction models already in operational use by health systems can be reliably employed for identifying adolescents in need of further evaluation.
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Affiliation(s)
- Robert B. Penfold
- Kaiser Permanente Washington Health Research Institute,Corresponding author Robert Penfold, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, (206) 287-2232 voice, (206) 287-2871 fax,
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | | | - Karen J. Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation
| | | | - Arne L. Beck
- Kaiser Permanente Colorado Institute for Health Research
| | | | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research
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Prabhakar D, Peterson EL, Hu Y, Chawa S, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Williams LK, Beck A, Simon GE, Ahmedani BK. Serious Suicide Attempts and Risk of Suicide Death. Crisis 2021; 42:343-350. [PMID: 33151092 PMCID: PMC8096861 DOI: 10.1027/0227-5910/a000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: In the US, more than one million people attempt suicide each year. History of suicide attempt is a significant risk factor for death by suicide; however, there is a paucity of data from the US general population on this relationship. Aim: The objective of this study was to examine suicide attempts needing medical attention as a risk for suicide death. Method: We conducted a case-control study involving eight US healthcare systems. A total of 2,674 individuals who died by suicide from 2000 to 2013 were matched to 267,400 individuals by year and location. Results: Prior suicide attempt associated with a medical visit increases risk for suicide death by 39.1 times, particularly for women (OR = 79.2). However, only 11.3% of suicide deaths were associated with an attempt that required medical attention. The association was the strongest for children 10-14 years old (OR = 98.0). Most suicide attempts were recorded during the 20-week period prior to death. Limitations: Our study is limited to suicide attempts for which individuals sought medical care. Conclusion: In the US, prior suicide attempt is associated with an increased risk of suicide death; the risk is high especially during the period immediately following a nonlethal attempt.
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Affiliation(s)
- Deepak Prabhakar
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD, 21204
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Kauffman TL, Dickerson JF, Lynch FL, Leo MC, Shuster E, Wilfond BS, Himes P, Gilmore MJ, Rollins NJ, Goddard KAB. Impact of expanded carrier screening on health care utilization. Am J Manag Care 2021; 27:316-321. [PMID: 34460173 DOI: 10.37765/ajmc.2021.88722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate potential consequences of expanded carrier screening (ECS) for reproductive risk on health care utilization among women who are not at increased reproductive risk. STUDY DESIGN Women planning pregnancy were randomized to usual care carrier screening or ECS to assess reproductive risks. Electronic health record (EHR) data were used to evaluate the effects of ECS on pregnancy-related utilization and general health care utilization among all study participants who did not receive positive ECS results of at least a 25% risk (ie, received negative [normal] ECS results). METHODS EHR data were extracted through research-ready databases and extensive chart review for 304 participants. We analyzed the effect of ECS for women who were not found to be at increased reproductive risk on (1) utilization of mental health services in the period between randomization and initial results disclosure; (2) utilization of general outpatient and inpatient services, specialty services, and mental health-related services in the year following randomization; and (3) utilization and refusal of pregnancy-related services among pregnant women (n = 129) prior to and following randomization. RESULTS No significant differences in health care utilization were found between women randomized to receive ECS and those receiving usual care. Women who received negative ECS results did not refuse recommended screening for conditions that are not identified via ECS at a higher rate than women in the usual care arm. CONCLUSIONS These results suggest that ECS does not have unintended negative impacts on the health care system for the majority of patients who are not at increased reproductive risk.
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Affiliation(s)
- Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227.
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Walker RL, Shortreed SM, Ziebell RA, Johnson E, Boggs JM, Lynch FL, Daida YG, Ahmedani BK, Rossom R, Coleman KJ, Simon GE. Evaluation of Electronic Health Record-Based Suicide Risk Prediction Models on Contemporary Data. Appl Clin Inform 2021; 12:778-787. [PMID: 34407559 PMCID: PMC8373461 DOI: 10.1055/s-0041-1733908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Suicide risk prediction models have been developed by using information from patients' electronic health records (EHR), but the time elapsed between model development and health system implementation is often substantial. Temporal changes in health systems and EHR coding practices necessitate the evaluation of such models in more contemporary data. OBJECTIVES A set of published suicide risk prediction models developed by using EHR data from 2009 to 2015 across seven health systems reported c-statistics of 0.85 for suicide attempt and 0.83 to 0.86 for suicide death. Our objective was to evaluate these models' performance with contemporary data (2014-2017) from these systems. METHODS We evaluated performance using mental health visits (6,832,439 to mental health specialty providers and 3,987,078 to general medical providers) from 2014 to 2017 made by 1,799,765 patients aged 13+ across the health systems. No visits in our evaluation were used in the previous model development. Outcomes were suicide attempt (health system records) and suicide death (state death certificates) within 90 days following a visit. We assessed calibration and computed c-statistics with 95% confidence intervals (CI) and cut-point specific estimates of sensitivity, specificity, and positive/negative predictive value. RESULTS Models were well calibrated; 46% of suicide attempts and 35% of suicide deaths in the mental health specialty sample were preceded by a visit (within 90 days) with a risk score in the top 5%. In the general medical sample, 53% of attempts and 35% of deaths were preceded by such a visit. Among these two samples, respectively, c-statistics were 0.862 (95% CI: 0.860-0.864) and 0.864 (95% CI: 0.860-0.869) for suicide attempt, and 0.806 (95% CI: 0.790-0.822) and 0.804 (95% CI: 0.782-0.829) for suicide death. CONCLUSION Performance of the risk prediction models in this contemporary sample was similar to historical estimates for suicide attempt but modestly lower for suicide death. These published models can inform clinical practice and patient care today.
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Affiliation(s)
- Rod L. Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Susan M. Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Rebecca A. Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
| | - Jennifer M. Boggs
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, United States
| | - Frances L. Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, United States
| | - Yihe G. Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, Hawaii, United States
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy & Health Services Research, Detroit, Michigan, United States
| | - Rebecca Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, United States
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, United States
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, United States
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Hecht LM, Yeh HH, Braciszewski JM, Miller-Matero LR, Thakrar A, Patel S, Simon GE, Lynch FL, Beck A, Owen-Smith AA, Rossom RC, Waitzfelder BE, Lu CY, Boggs JM, Ahmedani BK. Weighing the Association Between BMI Change and Suicide Mortality. Psychiatr Serv 2021; 72:920-925. [PMID: 33882679 PMCID: PMC8328861 DOI: 10.1176/appi.ps.202000475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Suicide rates continue to rise, necessitating the identification of risk factors. Obesity and suicide mortality rates have been examined, but associations among weight change, death by suicide, and depression among adults in the United States remain unclear. METHODS Data from 387 people who died by suicide in 2000-2015 with a recorded body mass index (BMI) in the first and second 6 months preceding their death ("index date") were extracted from the Mental Health Research Network. Each person was matched with five people in a control group (comprising individuals who did not die by suicide) by age, sex, index year, and health care site (N=1,935). RESULTS People who died by suicide were predominantly male (71%), White (69%), and middle aged (mean age=57 years) and had a depression diagnosis (55%) and chronic health issues (57%) (corresponding results for the control group: 71% male, 66% White, 14% with depression diagnosis, and 43% with chronic health issues; mean age=56 years). Change in BMI within the year before the index date statistically significantly differed between those who died by suicide (mean change=-0.72±2.42 kg/m2) and the control group (mean change=0.06±4.99 kg/m2) (p<0.001, Cohen's d=0.17). A one-unit BMI decrease was associated with increased risk for suicide after adjustment for demographic characteristics, mental disorders, and Charlson comorbidity score (adjusted odds ratio=1.11, 95% confidence interval=1.05-1.18, p<0.001). For those without depression, a BMI change was significantly associated with suicide (p<0.001). CONCLUSIONS An increased suicide mortality rate was associated with weight loss in the year before a suicide after analyses accounted for general and mental health indicators.
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Affiliation(s)
- Leah M Hecht
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Hsueh-Han Yeh
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jordan M Braciszewski
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Lisa R Miller-Matero
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Anjali Thakrar
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Shivali Patel
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Gregory E Simon
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Frances L Lynch
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Arne Beck
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Ashli A Owen-Smith
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Rebecca C Rossom
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Beth E Waitzfelder
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Christine Y Lu
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Jennifer M Boggs
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
| | - Brian K Ahmedani
- Henry Ford Health System Center for Health Policy and Health Services Research, Detroit (Hecht, Yeh, Braciszewski, Miller-Matero, Ahmedani); Henry Ford Health System Behavioral Health, Detroit (Hecht, Miller-Matero, Thakrar, Patel, Ahmedani); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon (Lynch); Kaiser Permanente Colorado, Institute for Health Research, Denver (Beck, Boggs); Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, and Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta (Owen-Smith); HealthPartners, Institute for Education and Research, Minneapolis (Rossom); Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu (Waitzfelder); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu)
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Lynch FL, Dickerson JF, Rozenman MS, Gonzalez A, Schwartz KTG, Porta G, O’Keeffe-Rosetti M, Brent D, Weersing VR. Cost-effectiveness of Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care. JAMA Netw Open 2021; 4:e211778. [PMID: 33720373 PMCID: PMC7961309 DOI: 10.1001/jamanetworkopen.2021.1778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Youth anxiety and depression are common and undertreated. Pediatric transdiagnostic interventions for anxiety and/or depression may be associated with improved access to treatment among youths. OBJECTIVE To evaluate the cost-effectiveness of a pediatric transdiagnostic brief behavioral therapy (BBT) program for anxiety and/or depression compared with assisted referral to community outpatient mental health care (ARC). DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, an incremental cost-effectiveness analysis was performed from the societal perspective using data from a randomized clinical trial of youths with full or probable diagnoses of anxiety or depression who were recruited from pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania. The trial was conducted from October 6, 2010, through December 5, 2014, and this analysis was performed from January 1, 2019, through October 20, 2020. INTERVENTIONS In the randomized clinical trial, youths were randomized to BBT (n = 95) or ARC (n = 90). The BBT program consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level therapists. Families randomized to ARC received personalized referrals to mental health care and telephone calls to support access to care. MAIN OUTCOMES AND MEASURES Anxiety-free days, depression-free days, quality-adjusted life-years (QALYs), and costs based on incremental cost-effectiveness ratios from intake through 32-week follow-up. A cost-effectiveness acceptability curve for QALYs was used to assess the probability that BBT was cost-effective compared with ARC over a range of amounts that a decision-maker might be willing to pay for an additional outcome. RESULTS Enrolled patients included 185 youths (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] White; and 38 [20.7%] Hispanic). Youths who received BBT experienced significantly more anxiety-free days (difference, 28.63 days; 95% CI, 5.86-50.71 days; P = .01) and QALYs (difference, 0.026; 95% CI, 0.009-0.046; P = .007) compared with youths who received ARC. Youths who received BBT experienced more depression-free days than did youths who received ARC (difference, 10.52 days; 95% CI, -4.50 to 25.76 days; P = .18), but the difference was not statistically significant. The mean incremental cost-effectiveness ratio was -$41 414 per QALY (95% CI, -$220 601 to $11 468). The cost-effectiveness acceptability curve analysis indicated that, at a recommended willingness-to-pay threshold of $50 000 per QALY, the probability that BBT would be cost-effective compared with ARC at 32 weeks was 95.6%. CONCLUSIONS AND RELEVANCE In this economic evaluation, BBT in primary care was significantly associated with better outcomes and a greater probability of cost-effectiveness at 32 weeks compared with ARC. The findings suggest that transdiagnostic BBT may be associated with improved youth anxiety and functioning at a reasonable cost.
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Affiliation(s)
- Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Araceli Gonzalez
- Department of Psychology, California State University of Long Beach, Long Beach
| | | | - Giovanna Porta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - V. Robin Weersing
- Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California San Diego, San Diego
- Department of Psychology, San Diego State University, San Diego, California
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Simon GE, Shortreed SM, Johnson E, Rossom RC, Lynch FL, Ziebell R, Penfold ARB. What health records data are required for accurate prediction of suicidal behavior? J Am Med Inform Assoc 2021; 26:1458-1465. [PMID: 31529095 DOI: 10.1093/jamia/ocz136] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/10/2019] [Accepted: 07/19/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The study sought to evaluate how availability of different types of health records data affect the accuracy of machine learning models predicting suicidal behavior. MATERIALS AND METHODS Records from 7 large health systems identified 19 061 056 outpatient visits to mental health specialty or general medical providers between 2009 and 2015. Machine learning models (logistic regression with penalized LASSO [least absolute shrinkage and selection operator] variable selection) were developed to predict suicide death (n = 1240) or probable suicide attempt (n = 24 133) in the following 90 days. Base models were used only historical insurance claims data and were then augmented with data regarding sociodemographic characteristics (race, ethnicity, and neighborhood characteristics), past patient-reported outcome questionnaires from electronic health records, and data (diagnoses and questionnaires) recorded during the visit. RESULTS For prediction of any attempt following mental health specialty visits, a model limited to historical insurance claims data performed approximately as well (C-statistic 0.843) as a model using all available data (C-statistic 0.850). For prediction of suicide attempt following a general medical visit, addition of data recorded during the visit yielded a meaningful improvement over a model using all data up to the prior day (C-statistic 0.853 vs 0.838). DISCUSSION Results may not generalize to setting with less comprehensive data or different patterns of care. Even the poorest-performing models were superior to brief self-report questionnaires or traditional clinical assessment. CONCLUSIONS Implementation of suicide risk prediction models in mental health specialty settings may be less technically demanding than expected. In general medical settings, however, delivery of optimal risk predictions at the point of care may require more sophisticated informatics capability.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Rebecca Ziebell
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - And Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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Lynch FL, Hoopes MJ, Hatch BA, Dunne M, Larson AE, O'Neill A, Pears KC. Understanding Health Need and Services Received by Youth in Foster Care in Community Safety-Net Health Centers in Oregon. J Health Care Poor Underserved 2021; 32:783-798. [PMID: 34120977 DOI: 10.1353/hpu.2021.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Youth in foster care have significant unmet health needs. We assessed health needs and health service use among youth in foster care in Oregon using electronic health record data from 258 community health centers and Medicaid enrollment data from 2014-2016. We identified 2,140 youth in foster care and a matched comparison group of 6,304 youth from the same clinics who were not in foster care, and compared the groups on demographic characteristics, health needs, and health service use. Youth in foster care were significantly more likely to have at least one chronic health condition, at least one mental health condition, and at least one mental health service compared with controls. Youth in foster care were significantly less likely to have a primary care visit. Despite significant mental health needs among youth in foster care, few received mental health care; this lack was greater among African American and Hispanic youth.
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Owen-Smith AA, Sesay MM, Lynch FL, Massolo M, Cerros H, Croen LA. Factors Influencing Participation in Biospecimen Research among Parents of Youth with Mental Health Conditions. Public Health Genomics 2020; 23:122-132. [PMID: 32698180 DOI: 10.1159/000509120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 06/02/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Biospecimens are tools that have the potential to improve early identification and treatment for autism spectrum disorders (ASD) and bipolar disorders (BPD). Unfortunately, most biobanks lack racial/ethnic diversity. One challenge to including a diverse sample of youth is recruiting and engaging families. OBJECTIVE We sought to better understand facilitators and barriers to participation in biospecimen research among a diverse group of parents of youth with ASD and BPD. METHODS The current study involved 3 Mental Health Research Network sites. At each site, parents participated in an interview that explored attitudes and beliefs about genetic research. Interviews were audio-recorded, and audio files were transcribed and coded using content analysis. RESULTS A total of 58 interviews were conducted. Four challenges emerged: (1) contacting and engaging potential research participants, (2) motivating potential participants to read recruitment and consent materials, (3) motivating participation in research, in general, and (4) motivating participation in research involving biospecimen donation, specifically. CONCLUSIONS Participants were eager to participate as long as the research process involved trust, clarity, and flexibility. Future research involving youth with mental health conditions would benefit from implementing multimodal strategies for recruitment and data collection and sharing knowledge gained by the research with study participants.
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Affiliation(s)
- Ashli A Owen-Smith
- Georgia State University, School of Public Health, Atlanta, Georgia, USA, .,Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia, USA,
| | - Musu M Sesay
- Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia, USA
| | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, USA
| | - Maria Massolo
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Hilda Cerros
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
| | - Lisa A Croen
- Kaiser Permanente Northern California, Division of Research, Oakland, California, USA
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Brent DA, Porta G, Rozenman MS, Gonzalez A, Schwartz KTG, Lynch FL, Dickerson JF, Iyengar S, Weersing VR. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Follow-up. J Am Acad Child Adolesc Psychiatry 2020; 59:856-867. [PMID: 31278996 PMCID: PMC6940557 DOI: 10.1016/j.jaac.2019.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 06/12/2019] [Accepted: 06/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. METHOD A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions-Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. RESULTS At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). CONCLUSION BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov; NCT01147614.
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Boggs JM, Lindrooth RC, Battaglia C, Beck A, Ritzwoller DP, Ahmedani BK, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Simon GE, Anderson HD. Association between suicide death and concordance with benzodiazepine treatment guidelines for anxiety and sleep disorders. Gen Hosp Psychiatry 2020; 62:21-27. [PMID: 31765794 PMCID: PMC7001528 DOI: 10.1016/j.genhosppsych.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/04/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Guidelines for management of anxiety and sleep disorders emphasize antidepressant medications and/or psychotherapy as first/second-line and benzodiazepines as third-line treatments. We evaluated the association between suicide death and concordance with benzodiazepine guidelines. METHODS Retrospective case-control study of patients with anxiety and/or sleep disorders from health systems across 8 U.S. states within the Mental Health Research Network. Suicide death cases were matched to controls on year and health system. Appropriate benzodiazepine prescribing defined as: no monotherapy, no long duration, and/or age < 65 years. The association between guideline concordance and suicide death was evaluated, adjusting for diagnostic and treatment covariates. RESULTS Sample included 6960 patients with anxiety disorders (2363 filled benzodiazepine) and 6215 with sleep disorders (1237 filled benzodiazepine). Benzodiazepine guideline concordance was associated with reduced odds for suicide in patients with anxiety disorders (OR = 0.611, 95% CI = 0.392-0.953, p = 0.03) and was driven by shorter duration of benzodiazepine use with concomitant psychotherapy or antidepressant medication. The association of benzodiazepine guideline concordance with suicide death did not meet statistical significance in the sleep disorder group (OR = 0.413, 95% CI = 0.154-1.11, p = 0.08). CONCLUSIONS We found reduced odds for suicide in those with anxiety disorders who filled benzodiazepines in short-moderate duration with concomitant psychotherapy or antidepressant treatment.
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Affiliation(s)
- Jennifer M Boggs
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States of America; Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.
| | - Richard C Lindrooth
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Catherine Battaglia
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus; Department of Veterans Affairs (VA) Eastern Colorado Health Care System, Aurora, CO, United States of America
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States of America; Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States of America; Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, United States of America; Behavioral Health Services, Henry Ford Health System, Detroit, MI, United States of America
| | - Rebecca C Rossom
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Frances L Lynch
- Kaiser Permanente Center for Integrated Health Care Research, Honolulu, HI, United States of America
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Beth E Waitzfelder
- Kaiser Permanente Center for Health Research, Honolulu, HI, United States of America
| | - Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, GA, United States of America; Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, United States of America
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Heather D Anderson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, CO, United States of America
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Coleman KJ, Yarborough BJ, Beck A, Lynch FL, Stewart C, Penfold RS, Hunkeler EM, Operskalski BH, Simon GE. Patterns of Health Care Utilization Before First Episode Psychosis in Racial and Ethnic Groups. Ethn Dis 2019; 29:609-616. [PMID: 31641328 PMCID: PMC6802164 DOI: 10.18865/ed.29.4.609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients. Design The study was a retrospective observational design. Setting The study was conducted in five health care systems in the western United States. All sites were also part of the National Institute of Mental Health-funded Mental Health Research Network (MHRN). Participants Patients (n = 852) were aged 15 - 59 years (average 26.9 ± 12.2 years), 45% women, and primarily non-Hispanic White (53%), with 16% Hispanic, 10% non-Hispanic Black, 6% Asian, 1% Native Hawaiian/Pacific Islander, 1% Native American/ Alaskan Native, and 12% unknown race/ethnicity. Main Outcome Measures Variables examined were patterns of health care utilization, type of comorbid mental health condition, and type of treatment received in the three years before first presentation of psychosis. Methods Data abstracted from electronic medical records and insurance claims data were organized into a research virtual data warehouse (VDW) and used for analysis. Results Compared with non-Hispanic Whites, Asian patients (16% vs 34%; P=.007) and non-Hispanic Black patients (20% vs 34%; P=.009) were less likely to have a visit with specialty mental health care before their first presentation of psychosis. Conclusions Early detection of first episode psychosis should start with wider screening for symptoms outside of any indicators for mental health conditions for non-Hispanic Black and Asian patients.
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Affiliation(s)
- Karen J. Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA
| | | | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO
| | - Frances L. Lynch
- Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | | | | | - Enid M. Hunkeler
- Kaiser Permanente Northern California Division of Research (Emeritus), Oakland, CA
| | | | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Yeh HH, Westphal J, Hu Y, Peterson EL, Williams LK, Prabhakar D, Frank C, Autio K, Elsiss F, Simon GE, Beck A, Lynch FL, Rossom RC, Lu CY, Owen-Smith AA, Waitzfelder BE, Ahmedani BK. Diagnosed Mental Health Conditions and Risk of Suicide Mortality. Psychiatr Serv 2019; 70:750-757. [PMID: 31185853 PMCID: PMC6718299 DOI: 10.1176/appi.ps.201800346] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although mental health conditions are risk factors for suicide, limited data are available on suicide mortality associated with specific mental health conditions in the U.S. population. This study aimed to fill this gap. METHODS This study used a case-control design. Patients in the case group were those who died by suicide between 2000 and 2013 and who were patients in eight health care systems in the Mental Health Research Network (N=2,674). Each was matched with 100 general population patients from the same system (N=267,400). Diagnostic codes for five mental health conditions in the year before death were obtained from medical records: anxiety disorders, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, depressive disorders, and schizophrenia spectrum disorder. RESULTS Among patients in the case group, 51.3% had a recorded psychiatric diagnosis in the year before death, compared with 12.7% of control group patients. Risk of suicide mortality was highest among those with schizophrenia spectrum disorder, after adjustment for age and sociodemographic characteristics (adjusted odds ratio [AOR]=15.0) followed by bipolar disorder (AOR=13.2), depressive disorders (AOR=7.2), anxiety disorders (AOR=5.8), and ADHD (AOR=2.4). The risk of suicide death among those with a diagnosed bipolar disorder was higher in women than men. CONCLUSIONS Half of those who died by suicide had at least one diagnosed mental health condition in the year before death, and most mental health conditions were associated with an increased risk of suicide. Findings suggest the importance of suicide screening and providing an approach to improve awareness of mental health conditions.
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Affiliation(s)
- Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Yong Hu
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Edward L Peterson
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - L Keoki Williams
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Deepak Prabhakar
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Kirsti Autio
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Farah Elsiss
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Frances L Lynch
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Beth E Waitzfelder
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
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Lynch FL, Dickerson JF, Clarke GN, Beardslee WR, Weersing VR, Gladstone TRG, Porta G, Brent DA, Mark TL, DeBar LL, Hollon SD, Garber J. Cost-Effectiveness of Preventing Depression Among At-Risk Youths: Postintervention and 2-Year Follow-Up. Psychiatr Serv 2019; 70:279-286. [PMID: 30929618 PMCID: PMC6897501 DOI: 10.1176/appi.ps.201800144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. METHODS A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. RESULTS Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CONCLUSIONS CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.
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Affiliation(s)
- Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Gregory N Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - William R Beardslee
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - V Robin Weersing
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tracy R G Gladstone
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Giovanna Porta
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - David A Brent
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Tami L Mark
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Lynn L DeBar
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Steven D Hollon
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
| | - Judy Garber
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch, Dickerson, Clarke, DeBar); Judge Baker Children's Center, Harvard University, Boston (Beardslee); San Diego State University (SDSU)-University of California, San Diego, Joint Doctoral Program in Clinical Psychology, SDSU, San Diego (Weersing); Wellesley Centers for Women, Wellesley College, Wellesley, Massachusetts (Gladstone); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Porta); Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh (Brent); Behavioral Health Financing, RTI International, Research Triangle Park, North Carolina (Mark); Department of Psychology (Hollon) and Department of Psychiatry (Garber), Vanderbilt University, Nashville, Tennessee
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Simon GE, Yarborough BJ, Rossom RC, Lawrence JM, Lynch FL, Waitzfelder BE, Ahmedani BK, Shortreed SM. Self-Reported Suicidal Ideation as a Predictor of Suicidal Behavior Among Outpatients With Diagnoses of Psychotic Disorders. Psychiatr Serv 2019; 70:176-183. [PMID: 30526341 PMCID: PMC6520048 DOI: 10.1176/appi.ps.201800381] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with psychotic disorders are at high risk of suicidal behavior. The study examined whether response to item 9 of the Patient Health Questionnaire (PHQ-9), which asks about thoughts of death or self-harm, predicts suicidal behavior among outpatients with diagnoses of psychotic disorders. METHODS Electronic health records (EHRs) from seven large integrated health systems were used to identify all outpatient visits by adults with a diagnosis of schizophrenia spectrum psychosis or unspecified psychosis from January 1, 2009, to June 30, 2015, during which a PHQ-9 was completed (N=32,982 visits by 5,947 patients). Suicide attempts over the 90 days following each visit were ascertained from EHRs and insurance claims. Suicide deaths were ascertained from state death certificate files. RESULTS Risk of suicide attempt within 90 days of an outpatient visit was .8% among patients reporting no thoughts of death or self-harm and 3.5% among those reporting such thoughts "nearly every day." Over 90 days of follow-up, 47% of suicide attempts occurred among those who reported any recent thoughts of death or self-harm at the sampled visit. Also, 59% of attempts occurred among those reporting thoughts of death or self-harm at the index visit or any visit in the prior year. The number of suicide deaths within 90 days (N=10) was too small to accurately assess the relationship between PHQ-9 item 9 response and subsequent suicide death. CONCLUSIONS Among outpatients with psychotic disorders, response to item 9 of the PHQ-9 accurately identified those at increased short-term risk of a suicide attempt.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Bobbi Jo Yarborough
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Rebecca C Rossom
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Jean M Lawrence
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Frances L Lynch
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Beth E Waitzfelder
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Brian K Ahmedani
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle (Simon, Shortreed); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Yarborough, Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Lawrence); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder); Center for Health Services Research, Henry Ford Health System, Detroit (Ahmedani)
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Owen-Smith AA, Ahmedani BK, Peterson E, Simon GE, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Beck A, DeBar LL, Sanon V, Maaz Y, Khan S, Miller-Matero LR, Prabhakar D, Frank C, Drake CL, Braciszewski JM. The Mediating Effect of Sleep Disturbance on the Relationship Between Nonmalignant Chronic Pain and Suicide Death. Pain Pract 2019; 19:382-389. [PMID: 30462885 DOI: 10.1111/papr.12750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Few studies have examined the relationship between nonmalignant chronic pain (NMCP) and suicide death, and even fewer have specifically explored what role sleep disturbance might play in the association between NMCP and suicide death. OBJECTIVE To assess whether sleep disturbance mediates the relationship between NMCP and suicide death. DESIGN This case-control study included 2,674 individuals who died by suicide between 2000 and 2013 (cases) and 267,400 matched individuals (controls). SETTING Eight Mental Health Research Network (MHRN)-affiliated healthcare systems. PARTICIPANTS All cases and matched controls were health plan members for at least 10 months during the year prior to the index date. MAIN OUTCOMES AND MEASURES Sociodemographic data and diagnosis codes for NMCP and sleep disorders were extracted from the MHRN's Virtual Data Warehouse. Suicide mortality was identified using International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes from official government mortality records matched to health system records. RESULTS After accounting for covariates, there was a significant relationship between NMCP and sleep disturbance; those who were diagnosed with NMCP were more likely to develop subsequent sleep disturbance. Similarly, sleep disturbance was significantly associated with suicide death. Finally, a significant indirect effect of NMCP on suicide death, through sleep disturbance, and a nonsignificant direct effect of NMCP on suicide death provide support for a fully mediated model. CONCLUSIONS AND RELEVANCE There is a need for clinicians to screen for both sleep disturbance and suicidal ideation in NMCP patients and for health systems to implement more widespread behavioral treatments that address comorbid sleep problems and NMCP.
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Affiliation(s)
- Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A.,Kaiser Permanente Georgia, Center for Research and Evaluation, Atlanta, Georgia
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Ed Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Gregory E Simon
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | | | - Frances L Lynch
- Kaiser Permanente Northwest, Center for Health Research, Portland, Oregon, U.S.A
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, U.S.A
| | - Beth E Waitzfelder
- Kaiser Permanente Hawaii, Center for Health Research, Honolulu, Hawaii, U.S.A
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Aurora, Colorado, U.S.A
| | - Lynn L DeBar
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington, U.S.A
| | - Victoria Sanon
- School of Public Health, Georgia State University, Atlanta, Georgia, U.S.A
| | - Yousef Maaz
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Shehryar Khan
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A.,Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Cathy Frank
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Christopher L Drake
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan, U.S.A
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, U.S.A
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Simon GE, Johnson E, Lawrence JM, Rossom RC, Ahmedani B, Lynch FL, Beck A, Waitzfelder B, Ziebell R, Penfold RB, Shortreed SM. Predicting Suicide Attempts and Suicide Deaths Following Outpatient Visits Using Electronic Health Records. Am J Psychiatry 2018; 175:951-960. [PMID: 29792051 PMCID: PMC6167136 DOI: 10.1176/appi.ajp.2018.17101167] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to develop and validate models using electronic health records to predict suicide attempt and suicide death following an outpatient visit. METHOD Across seven health systems, 2,960,929 patients age 13 or older (mean age, 46 years; 62% female) made 10,275,853 specialty mental health visits and 9,685,206 primary care visits with mental health diagnoses between Jan. 1, 2009, and June 30, 2015. Health system records and state death certificate data identified suicide attempts (N=24,133) and suicide deaths (N=1,240) over 90 days following each visit. Potential predictors included 313 demographic and clinical characteristics extracted from records for up to 5 years before each visit: prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency department care, and routinely administered depression questionnaires. Logistic regression models predicting suicide attempt and death were developed using penalized LASSO (least absolute shrinkage and selection operator) variable selection in a random sample of 65% of the visits and validated in the remaining 35%. RESULTS Mental health specialty visits with risk scores in the top 5% accounted for 43% of subsequent suicide attempts and 48% of suicide deaths. Of patients scoring in the top 5%, 5.4% attempted suicide and 0.26% died by suicide within 90 days. C-statistics (equivalent to area under the curve) for prediction of suicide attempt and suicide death were 0.851 (95% CI=0.848, 0.853) and 0.861 (95% CI=0.848, 0.875), respectively. Primary care visits with scores in the top 5% accounted for 48% of subsequent suicide attempts and 43% of suicide deaths. C-statistics for prediction of suicide attempt and suicide death were 0.853 (95% CI=0.849, 0.857) and 0.833 (95% CI=0.813, 0.853), respectively. CONCLUSIONS Prediction models incorporating both health record data and responses to self-report questionnaires substantially outperform existing suicide risk prediction tools.
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Affiliation(s)
- Gregory E Simon
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Eric Johnson
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Jean M Lawrence
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Rebecca C Rossom
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Brian Ahmedani
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Frances L Lynch
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Arne Beck
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Beth Waitzfelder
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Rebecca Ziebell
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Robert B Penfold
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
| | - Susan M Shortreed
- From the Kaiser Permanente Washington Health Research Institute, Seattle; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; the HealthPartners Institute, Minneapolis; the Center for Health Services Research, Henry Ford Health System, Detroit; the Center for Health Research, Kaiser Permanente Northwest, Portland, Oreg.; the Institute for Health Research, Kaiser Permanente Colorado, Denver; and the Center for Health Research, Kaiser Permanente Hawaii, Honolulu
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Boggs JM, Beck A, Hubley S, Peterson EL, Hu Y, Williams LK, Prabhakar D, Rossom RC, Lynch FL, Lu CY, Waitzfelder BE, Owen-Smith AA, Simon GE, Ahmedani BK. General Medical, Mental Health, and Demographic Risk Factors Associated With Suicide by Firearm Compared With Other Means. Psychiatr Serv 2018; 69:677-684. [PMID: 29446332 PMCID: PMC5984116 DOI: 10.1176/appi.ps.201700237] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mitigation of suicide risk by reducing access to lethal means, such as firearms and potentially lethal medications, is a highly recommended practice. To better understand groups of patients at risk of suicide in medical settings, the authors compared demographic and clinical risk factors between patients who died by suicide by using firearms or other means with matched patients who did not die by suicide (control group). METHODS In a case-control study in 2016 from eight health care systems within the Mental Health Research Network, 2,674 suicide cases from 2010-2013 were matched to a control group (N=267,400). The association between suicide by firearm or other means and medical record information on demographic characteristics, general medical disorders, and mental disorders was assessed. RESULTS The odds of having a mental disorder were higher among cases of suicide involving a method other than a firearm. Fourteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by firearm, including traumatic brain injury (TBI) (odds ratio [OR]=23.53), epilepsy (OR=3.17), psychogenic pain (OR=2.82), migraine (OR=2.35), and stroke (OR=2.20). Fifteen general medical disorders were associated with statistically significant (p<.001) greater odds of suicide by other means, with particularly high odds for TBI (OR=7.74), epilepsy (OR=3.28), HIV/AIDS (OR=6.03), and migraine (OR=3.17). CONCLUSIONS Medical providers should consider targeting suicide risk screening for patients with any mental disorder, TBI, epilepsy, HIV, psychogenic pain, stroke, and migraine. When suicide risk is detected, counseling on reducing access to lethal means should include both firearms and other means for at-risk groups.
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Affiliation(s)
- Jennifer M Boggs
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Arne Beck
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Sam Hubley
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Edward L Peterson
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Yong Hu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - L Keoki Williams
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Deepak Prabhakar
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Rebecca C Rossom
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Frances L Lynch
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Christine Y Lu
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Beth E Waitzfelder
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Ashli A Owen-Smith
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Gregory E Simon
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Brian K Ahmedani
- Ms. Boggs and Dr. Beck are with the Institute for Health Research, Kaiser Permanente Colorado, Denver. Dr. Hubley is with the Department of Family Medicine, University of Colorado School of Medicine, Aurora. Dr. Peterson is with the Department of Public Health Sciences, Mr. Hu and Dr. Ahmedani are with the Center for Health Policy and Health Services Research, Dr. Williams is with the Center for Health Policy and Health Services Research and the Department of Internal Medicine, and Dr. Prabhakar is with the Department of Behavioral Health Services, all at the Henry Ford Health System, Detroit. Dr. Rossom is with the HealthPartners Institute, Bloomington, Minnesota. Dr. Lynch is with the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon. Dr. Lu is with the Department of Population Medicine, Harvard Medical School, and with Harvard Pilgrim Health Care Institute, both in Boston. Dr. Waitzfelder is with the Center for Health Research, Kaiser Permanente Hawaii, Honolulu. Dr. Owen-Smith is with the Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, and the School of Public Health, Georgia State University, Atlanta. Dr. Simon is with the Health Research Institute, Kaiser Permanente Washington, Seattle
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Wilfond BS, Kauffman TL, Jarvik GP, Reiss JA, Richards CS, McMullen C, Gilmore M, Himes P, Kraft SA, Porter KM, Schneider JL, Punj S, Leo MC, Dickerson JF, Lynch FL, Clarke E, Rope AF, Lutz K, Goddard KAB. Lessons Learned From A Study Of Genomics-Based Carrier Screening For Reproductive Decision Making. Health Aff (Millwood) 2018; 37:809-816. [PMID: 29733724 DOI: 10.1377/hlthaff.2017.1578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Genomics-based carrier screening is one of many opportunities to use genomic information to inform medical decision making, but clinicians, health care delivery systems, and payers need to determine whether to offer screening and how to do so in an efficient, ethical way. To shed light on this issue, we conducted a study in the period 2014-17 to inform the design of clinical screening programs and guide further health services research. Many of our results have been published elsewhere; this article summarizes the lessons we learned from that study and offers policy insights. Our experience can inform understanding of the potential impact of expanded carrier screening services on health system workflows and workforces-impacts that depend on the details of the screening approach. We found limited patient or health system harms from expanded screening. We also found that some patients valued the information they learned from the process. Future policy discussions should consider the value of offering such expanded carrier screening in health delivery systems with limited resources.
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Affiliation(s)
- Benjamin S Wilfond
- Benjamin S. Wilfond ( ) is director of the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and of the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, all in Seattle, Washington
| | - Tia L Kauffman
- Tia L. Kauffman is a project director at the Center for Health Research, Kaiser Permanente Northwest, in Portland, Oregon
| | - Gail P Jarvik
- Gail P. Jarvik is a professor in the Division of Medical Genetics, Department of Medicine, and in the Department of Genome Sciences, both at the University of Washington
| | - Jacob A Reiss
- Jacob A. Reiss is a medical geneticist at the Center for Health Research, Kaiser Permanente Northwest
| | - C Sue Richards
- C. Sue Richards is a professor in the Knight Diagnostic Laboratories, Oregon Health & Science University, in Portland
| | - Carmit McMullen
- Carmit McMullen is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Marian Gilmore
- Marian Gilmore is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Patricia Himes
- Patricia Himes is a genetic counselor in the Department of Medical Genetics at Kaiser Permanente Northwest
| | - Stephanie A Kraft
- Stephanie A. Kraft is an acting assistant professor in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, and in the Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine
| | - Kathryn M Porter
- Kathryn M. Porter is a research scientist in the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute
| | - Jennifer L Schneider
- Jennifer L. Schneider is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Sumit Punj
- Sumit Punj is a senior clinical scientist in the Clinical Genomics Program, GeneDx, in Gaithersburg, Maryland
| | - Michael C Leo
- Michael C. Leo is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - John F Dickerson
- John F. Dickerson is an investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Frances L Lynch
- Frances L. Lynch is a senior investigator at the Center for Health Research, Kaiser Permanente Northwest
| | - Elizabeth Clarke
- Elizabeth Clarke is a research associate III at the Center for Health Research, Kaiser Permanente Northwest
| | - Alan F Rope
- Alan F. Rope is a staff physician at Northwest Permanente, Kaiser Permanente Northwest
| | - Kevin Lutz
- Kevin Lutz is publications manager at the Center for Health Research, Kaiser Permanente Northwest
| | - Katrina A B Goddard
- Katrina A. B. Goddard is associate director, research programs, at the Center for Health Research, Kaiser Permanente Northwest
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Becerra TA, Massolo ML, Yau VM, Owen-Smith AA, Lynch FL, Crawford PM, Pearson KA, Pomichowski ME, Quinn VP, Yoshida CK, Croen LA. A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments. Perm J 2018; 21:16-009. [PMID: 28488981 DOI: 10.7812/tpp/16-009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. OBJECTIVE This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. METHODS Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ2 statistics for differences between responders and nonresponders. RESULTS The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% < 10 years), and ASD diagnosis (64% autistic disorder). The most frequently used services and treatments were Individualized Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. CONCLUSION These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.
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Affiliation(s)
- Tracy A Becerra
- Postdoctoral Research Fellow at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Maria L Massolo
- Senior Research Project Manager for the Division of Research in Oakland, CA.
| | - Vincent M Yau
- Former Staff Scientist for the Autism Research Program at the Division of Research in Oakland, CA.
| | - Ashli A Owen-Smith
- Behavioral Scientist and Assistant Professor in Health Management and Policy at Georgia State University in Atlanta.
| | - Frances L Lynch
- Health Economist and Senior Investigator at the Center for Health Research in Portland, OR.
| | | | - Kathryn A Pearson
- Former Research Project Manager at the Center for Health Research in Portland, OR.
| | - Magdalena E Pomichowski
- Former Research Associate at the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | - Virginia P Quinn
- Former Research Scientist II in the Department of Research & Evaluation for Kaiser Permanente Southern California in Pasadena.
| | | | - Lisa A Croen
- Senior Research Scientist at the Division of Research in Oakland, CA.
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49
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Garber J, Weersing VR, Hollon SD, Porta G, Clarke GN, Dickerson JF, Beardslee WR, Lynch FL, Gladstone TG, Shamseddeen W, Brent DA. Prevention of Depression in At-Risk Adolescents: Moderators of Long-term Response. Prev Sci 2018; 19:6-15. [PMID: 26830893 PMCID: PMC4969230 DOI: 10.1007/s11121-015-0626-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a randomized controlled trial, we found that a cognitive behavioral program (CBP) was significantly more effective than usual care (UC) in preventing the onset of depressive episodes, although not everyone benefitted from the CBP intervention. The present paper explored this heterogeneity of response. Participants were 316 adolescents (M age = 14.8, SD = 1.4) at risk for depression due to having had a prior depressive episode or having current subsyndromal depressive symptoms and having a parent with a history of depression. Using a recursive partitioning approach to baseline characteristics, we (Weersing et al. 2016) previously had identified distinct risk clusters within conditions that predicted depressive episodes through the end of the continuation phase (month 9). The present study used the same risk clusters that had been derived in the CBP group through month 9 to reclassify the UC group and then to examine group differences in depression through month 33. We found that in this overall very high-risk sample, the CBP program was superior to UC among youth in the low-risk cluster (n = 33), characterized by higher functioning, lower anxiety, and parents not depressed at baseline, but not in the middle (n = 95) and high-risk (n = 25) clusters. Across conditions, significantly more depression-free days were found for youth in the low-risk cluster (M = 951.9, SD = 138.8) as compared to youth in the high-risk cluster (M = 800.5, SD = 226.7). Identification of moderators, based on purely prognostic indices, allows for more efficient use of resources and suggests possible prevention targets so as to increase the power of the intervention.
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Affiliation(s)
- J Garber
- Department of Psychology and Human Development, Vanderbilt University, 552 Peabody, 230 Appleton Pl, Nashville, TN, USA.
| | - V R Weersing
- Joint Doctoral Program in Clinical Psychiatry, San Diego State University, San Diego, CA, USA
- University of California, San Diego, CA, USA
| | - S D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - G Porta
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - G N Clarke
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - J F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - W R Beardslee
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - F L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - T G Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA
| | | | - D A Brent
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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50
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Dickerson JF, Lynch FL, Leo MC, DeBar LL, Pearson J, Clarke GN. Cost-effectiveness of Cognitive Behavioral Therapy for Depressed Youth Declining Antidepressants. Pediatrics 2018; 141:peds.2017-1969. [PMID: 29351965 PMCID: PMC5810604 DOI: 10.1542/peds.2017-1969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescents with depression identified in primary care settings often have limited treatment options beyond antidepressant (AD) therapy. We assessed the cost-effectiveness of a brief cognitive behavioral therapy (CBT) program among depressed adolescents who declined or quickly stopped using ADs. METHODS A total of 212 youth with depression were randomly assigned to treatment as usual (TAU) or TAU plus brief individual CBT. Clinical outcomes included depression-free days (DFDs) and estimated quality-adjusted life-years (QALYs). Costs were adjusted to 2008 US dollars. Incremental cost-effectiveness ratios (ICERs) comparing CBT to TAU were calculated over 12- and 24-month follow-up periods. RESULTS Youth randomly assigned to CBT had 26.8 more DFDs (P = .044) and 0.067 more QALYs (P = .044) on average compared with TAU over 12 months. Total costs were $4976 less (P = .025) by the end of the 24-month follow-up among youth randomly assigned to CBT. Total costs per DFD were -$51 (ICER = -$51; 95% confidence interval [CI]: -$394 to $9) at 12 months and -$115 (ICER = -$115; 95% CI: -$1090 to -$6) at 24 months. Total costs per QALY were -$20 282 (ICER = -$20 282; 95% CI: -$156 741 to $3617) at 12 months and -$45 792 (ICER = -$45 792; 95% CI: -$440 991 to -$2731) at 24 months. CONCLUSIONS Brief primary care CBT among youth declining AD therapy is cost-effective by widely accepted standards in depression treatment. CBT becomes dominant over TAU over time, as revealed by a statistically significant cost offset at the end of the 2-year follow-up.
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Affiliation(s)
| | - Frances L. Lynch
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
| | - Michael C. Leo
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
| | - Lynn L. DeBar
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - John Pearson
- Kaiser Permanente Center for Health Research, Portland, Oregon; and
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