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Chen JI, Bui D, Iwashyna TJ, Shahoumian TA, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Govier DJ, Osborne TF, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB, Hynes DM. Correction to: Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08800-z. [PMID: 38743168 DOI: 10.1007/s11606-024-08800-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - David Bui
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | | | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA
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Chen JI, Bui D, Iwashyna TJ, Shahoumian TA, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Govier DJ, Osborne TF, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB, Hynes DM. Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans. J Gen Intern Med 2024:10.1007/s11606-024-08630-z. [PMID: 38625482 DOI: 10.1007/s11606-024-08630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/11/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 infection given their high rates of pre-existing mental and physical health comorbidities. However, few studies have tried to isolate SARS-COV-2 infection associations with long term, patient-reported depression symptoms from other factors (e.g., physical health comorbidities, pandemic-related stress). OBJECTIVE To evaluate the association between SARS-COV-2 infection and subsequent depression symptoms among United States Military Veterans. DESIGN Survey-based non-randomized cohort study with matched comparators. PARTICIPANTS A matched-dyadic sample from a larger, stratified random sample of participants with and without known to SARS-COV-2 infection were invited to participate in a survey evaluating mental health and wellness 18-months after their index infection date. Sampled participants were stratified by infection severity of the participant infected with SARS-COV-2 (hospitalized or not) and by month of index date. A total of 186 participants in each group agreed to participate in the survey and had sufficient data for inclusion in analyses. Those in the uninfected group who were later infected were excluded from analyses. MAIN MEASURES Participants were administered the Patient Health Questionnaire-9 as part of a phone interview survey. Demographics, physical and mental health comorbidities were extracted from VHA administrative data. KEY RESULTS Veterans infected with SARS-COV-2 had significantly higher depression symptoms scores compared with those uninfected. In particular, psychological symptoms (e.g., low mood, suicidal ideation) scores were elevated relative to the comparator group (MInfected = 3.16, 95%CI: 2.5, 3.8; MUninfected = 1.96, 95%CI: 1.4, 2.5). Findings were similar regardless of history of depression. CONCLUSION SARS-COV-2 infection was associated with more depression symptoms among Veterans at 18-months post-infection. Routine evaluation of depression symptoms over time following SARS-COV-2 infection is important to facilitate adequate assessment and treatment.
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Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - David Bui
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | | | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- VISN 6 Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA
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Hynes DM, Niederhausen M, Chen JI, Shahoumian TA, Rowneki M, Hickok A, Shepherd-Banigan M, Hawkins EJ, Naylor J, Teo A, Govier DJ, Berry K, McCready H, Osborne TF, Wong E, Hebert PL, Smith VA, Bowling CB, Boyko EJ, Ioannou GN, Iwashyna TJ, Maciejewski ML, O'Hare AM, Viglianti EM, Bohnert ASB. Risk of Suicide-Related Outcomes After SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of US Veterans. J Gen Intern Med 2024; 39:626-635. [PMID: 37884839 DOI: 10.1007/s11606-023-08440-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Negative mental health-related effects of SARS-COV-2 infection are increasingly evident. However, the impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk. OBJECTIVE To determine risk of suicide attempts and other self-directed violence (SDV) after SARS-COV-2 infection in a high-risk population. DESIGN We employed an observational design supported by comprehensive electronic health records from the Veterans Health Administration (VHA) to examine the association of SARS-COV-2 infection with suicide attempts and other SDV within one year of infection. Veterans with SARS-COV-2 infections were matched 1:5 with non-infected comparators each month. Three periods after index were evaluated: days 1-30, days 31-365, and days 1-365. PARTICIPANTS VHA patients infected with SARS-COV-2 between March 1, 2020 and March 31, 2021 and matched non-infected Veteran comparators. MAIN MEASURES Suicide attempt and other SDV events for the COVID-19 and non-infected comparator groups were analyzed using incidence rates per 100,000 person years and hazard ratios from Cox regressions modeling time from matched index date to first event. Subgroups were also examined. KEY RESULTS 198,938 veterans with SARS-COV-2 (COVID-19 group) and 992,036 comparators were included. Unadjusted one-year incidence per 100,000 for suicide attempt and other SDV was higher among the COVID-19 group: 355 vs 250 and 327 vs 235, respectively. The COVID-19 group had higher risk than comparators for suicide attempts: days 1-30 hazard ratio (HR) = 2.54 (CI:2.05, 3.15), days 31-365 HR = 1.30 (CI:1.19, 1.43) and days 1-365 HR = 1.41 (CI:1.30, 1.54), and for other SDV: days 1-30 HR = 1.94 (CI:1.51, 2.49), days 31-365 HR = 1.32 (CI:1.20, 1.45) and days 1-365 HR = 1.38 (CI:1.26, 1.51). CONCLUSIONS COVID-19 patients had higher risks of both suicide attempts and other forms of SDV compared to uninfected comparators, which persisted for at least one year after infection. Results support suicide risk screening of those infected with SARS-COV-2 to identify opportunities to prevent self-harm.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA.
- College of Health, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA.
- School of Nursing, Oregon Health & Science University (OHSU), Portland, OR, USA.
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | | | - Mazhgan Rowneki
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Eric J Hawkins
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound HCS, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer Naylor
- School of Medicine, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Education and Clinical Center, VISN 6 Mental Illness Research, Durham, NC, USA
- Durham VA HCS, Durham, NC, USA
| | - Alan Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Diana J Govier
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- OHSU-Portland State University School of Public Health, OHSU, Portland, OR, USA
| | - Kristin Berry
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Holly McCready
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (HCS), Portland, OR, USA
- Department of Psychiatry, OHSU, Portland, OR, USA
| | - Thomas F Osborne
- VA Palo Alto HCS, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Edwin Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Paul L Hebert
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - C Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Durham VA Geriatric Research Education and Clinical Center, Durham VA HCS, Durham, NC, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research Information Center, VA Puget Sound HCS, Seattle, WA, USA
| | - George N Ioannou
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Theodore J Iwashyna
- Departments of Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA HCS, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Ann M O'Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound HCS, Seattle, WA, USA
- Hospital and Specialty Medicine Service, VA Puget Sound HCS, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Elizabeth M Viglianti
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Amy S-B Bohnert
- Center for Clinical Management Research, VA Ann Arbor HCS, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
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Chen JI, Roth B, Dobscha SK, Lowery JC. Implementation strategies in suicide prevention: a scoping review. Implement Sci 2024; 19:20. [PMID: 38409000 PMCID: PMC10895723 DOI: 10.1186/s13012-024-01350-2] [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: 10/26/2023] [Accepted: 02/09/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Implementation strategies can be a vital leveraging point for enhancing the implementation and dissemination of evidence-based suicide prevention interventions and programming. However, much remains unknown about which implementation strategies are commonly used and effective for supporting suicide prevention efforts. METHODS In light of the limited available literature, a scoping review was conducted to evaluate implementation strategies present in current suicide prevention studies. We identified studies that were published between 2013 and 2022 that focused on suicide prevention and incorporated at least one implementation strategy. Studies were coded by two independent coders who showed strong inter-rater reliability. Data were synthesized using descriptive statistics and a narrative synthesis of findings. RESULTS Overall, we found that studies most commonly utilized strategies related to iterative evaluation, training, and education. The majority of studies did not include direct measurement of suicide behavior outcomes, and there were few studies that directly tested implementation strategy effectiveness. CONCLUSION Implementation science strategies remain an important component for improving suicide prevention and intervention implementation. Future research should consider the incorporation of more type 3 hybrid designs as well as increased systematic documentation of implementation strategies. TRIAL REGISTRATION < de-identified > .
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Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University (OHSU), Portland, OR, USA.
| | - Brandon Roth
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University (OHSU), Portland, OR, USA
- Portland VA Research Foundation, Portland, OR, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Julie C Lowery
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Orlowski EW, Chen JI, Breznik LH, Gleason LDL, Karver MS. Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels. Clin Psychol Psychother 2024; 31:e2962. [PMID: 38404160 DOI: 10.1002/cpp.2962] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.
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Affiliation(s)
- Edmund W Orlowski
- Department of Educational and Counseling Psychology, University at Albany/SUNY, Albany, New York, USA
| | - Jason I Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | | | - La Donna L Gleason
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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Denneson LM, Hannon SA, McDonald KL, Chen JI, O'Neil ME. Inactivation of high-risk flags for suicide in the Veterans Health Administration: Association of documentation variation with suicide attempts. Psychol Serv 2023:2024-23207-001. [PMID: 37917478 DOI: 10.1037/ser0000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Medical record high-risk flags for suicide indicate patients are receiving enhanced care and alert treating providers to patients' high-risk status. Risk of suicide mortality remains high after flag inactivation, suggesting a need to improve inactivation determinations. This study describes variation in flag inactivation documentation, examines whether documentation varies by patient or facility characteristics, and explores the association between inactivation documentation type and subsequent suicide attempts. In a national sample of veterans with a documented suicide attempt who received a high-risk flag for suicide (n = 224), medical record review was used to categorize provider documentation of the rationale and procedures for high-risk flag inactivation. Mixed-effects logistic regression models were used to examine patient and facility characteristics associated with flag inactivation documentation type and to examine the association between documentation type and subsequent suicide attempts. Flag inactivation documentation fell into one of two categories: documentation stating the patient no longer met criteria for the high-risk flag (minimal documentation; n = 98, 43.8%); and documentation that included a review of one or more criteria for high-risk flag inactivation (more than minimal documentation; n = 126, 56.3%). Flag inactivation documentation was not associated with patient or facility characteristics. Veterans with minimal documentation (vs. more than minimal) were more likely to have a suicide attempt after flag inactivation (adjusted odds ratio, AOR = 2.20; 95% CI [1.01, 4.78]; p = .046). Findings suggest a need to better understand flag inactivation procedures in place and to develop a set of standardized procedures to reduce risk of premature high-risk flag inactivation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Sara A Hannon
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Katie L McDonald
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Maya E O'Neil
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System
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Laliberte AZ, Salvi A, Hooker E, Roth B, Handley R, Carlson K, Hynes D, Tuepker A, Chen JI. Factors associated with a lack of health care utilization among Veterans after a positive suicide screen in the emergency department. Acad Emerg Med 2023; 30:321-330. [PMID: 36786953 PMCID: PMC11081519 DOI: 10.1111/acem.14695] [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: 09/28/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Many Veterans at high risk for suicide are identified in Veterans Health Administration (VHA) emergency departments (ED). Little is known about what may predict care utilization in this population. To address this knowledge gap, we explored factors associated with Veterans' lack of VHA care utilization following a positive suicide risk screen in the ED. METHODS In a retrospective observational study, we identified all patients who were seen in a VHA ED from October 1, 2019, to September 30, 2020. We examined factors associated with not utilizing VHA mental health (MH) and all VHA care in the 6 months following a positive suicide ED screen. Predictors included comorbidity, homelessness, and MH visit and diagnosis history. RESULTS We identified 23,446 Veterans with a positive suicide risk screen in the ED in fiscal year 2020. Overall, 4.1% had no VHA MH visits 6 months postscreen. The probability of not utilizing MH care was significantly higher for Veterans with no comorbidity (4.7% vs. 3.4% for mild comorbidity), no MH diagnosis (10.5% vs 2.8%), no past-year MH visits (13.6% vs 2.3%), and no past-year homelessness (5.4% vs. 1.1%). A smaller proportion of the population did not receive any VHA care 6 months postscreen (0.5%). Veterans who did not experience homelessness (0.6% vs 0.2%), had no MH diagnosis (1.6% vs. 0.3%), and had no previous MH visits (1.9% vs 0.2%) were significantly more likely to not utilize VHA care. CONCLUSIONS Veterans who do not utilize VHA care after a positive suicide risk screen appear to have fewer documented health and housing concerns than those who do receive care. Yet, Veterans with a positive suicide risk screen who are otherwise healthy may remain at elevated risk for suicide following their ED visit. ED providers may consider enhanced follow-up care to mitigate suicide risk for these Veterans.
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Affiliation(s)
- Avery Z. Laliberte
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
| | - Apoorva Salvi
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Hooker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
| | - Brandon Roth
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Portland VA Research Foundation, Portland, Oregon, USA
| | - Robert Handley
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
| | - Kathleen Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Oregon Health & Science University–Portland State University School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Denise Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
- School of Nursing, Oregon Health & Science University, Portland, Oregon, USA
| | - Anaïs Tuepker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason I. Chen
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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8
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Ward MJ, Hwang U, Hastings SN, Timko C, Chen JI, Vashi AA, Mattocks K, Abel EA, Bravata DM. Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine. Acad Emerg Med 2023; 30:240-251. [PMID: 36775279 DOI: 10.1111/acem.14679] [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] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
To better understand and prioritize research on emergency care for Veterans, the Department of Veteran Affairs (VA) Health Services Research and Development convened the 16th State of the Art Conference on VA Emergency Medicine (SAVE) in Winter 2022 with emergency clinicians, researchers, operational leaders, and additional stakeholders in attendance. Three specific areas of focus were identified including older Veterans, Veterans with mental health needs, and emergency care in the community (non-VA) settings. Among older Veterans, identified priorities included examination of variation in care and its impact on patient outcomes, utilization, and costs; quality of emergency department (ED) care transitions and strategies to improve them; impact of geriatric ED care improvement initiatives; and use of geriatric assessment tools in the ED. For Veterans with mental health needs, priorities included enhancing the reach of effective, multicomponent suicide prevention interventions; development and evaluation of interventions to manage substance use disorders; and identifying and examining safety and effective acute psychosis practices. Community (non-VA) emergency care priorities included examining changes in patterns of use and costs in VA and the community care settings as a result of recent policy and coverage changes (with an emphasis on modifiable factors); understanding quality, safety, and Veteran experience differences between VA and community settings; and better understanding follow-up needs among Veterans who received emergency care (or urgent care) and how well those needs are being coordinated, communicated, and met. Beyond these three groups, cross-cutting themes included the use of telehealth and implementation science to refine multicomponent interventions, care coordination, and data needs from both VA and non-VA sources. Findings from this conference will be disseminated through multiple mechanisms and contribute to future funding applications focused on improving Veteran health.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Ula Hwang
- Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, New York, USA.,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - S Nicole Hastings
- HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christine Timko
- HSR&D Center for Innovation to Implementation, Center for Innovation to Implementation, VHA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
| | - Jason I Chen
- HSR&D Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Anita A Vashi
- HSR&D Center for Innovation to Implementation, Center for Innovation to Implementation, VHA Palo Alto Health Care System, Menlo Park, California, USA.,Department of Emergency Medicine, University of California, San Francisco, California, USA.,Department of Emergency Medicine (Affiliated), Stanford University, Stanford, California, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Erica A Abel
- HSR&D Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dawn M Bravata
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
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9
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Weaver FM, Niederhausen M, Hickok A, O’Neill AC, Gordon HS, Edwards ST, Govier DJ, Chen JI, Young R, Whooley M, Hynes DM. Hospital Readmissions Among Veterans Within 90 Days of Discharge Following Initial Hospitalization for COVID-19. Prev Chronic Dis 2022; 19:E80. [PMID: 36455563 PMCID: PMC9717697 DOI: 10.5888/pcd19.220200] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some patients experience ongoing sequelae after discharge, including rehospitalization; therefore, outcomes following COVID-19 hospitalization are of continued interest. We examined readmissions within 90 days of hospital discharge for veterans hospitalized with COVID-19 during the first 10 months of the pandemic in the US. METHODS Veterans hospitalized with COVID-19 at a Veterans Health Administration (VA) hospital from March 1, 2020, through December 31, 2020 were followed for 90 days after discharge to determine readmission rates. RESULTS Of 20,414 veterans hospitalized with COVID-19 during this time period, 13% (n = 2,643) died in the hospital. Among survivors (n = 17,771), 16% (n = 2,764) were readmitted within 90 days of discharge, with a mean time to readmission of 21.6 days (SD = 21.1). Characteristics of the initial COVID-19 hospitalization associated with readmission included length of stay, mechanical ventilator use, higher comorbidity index score, current smoking, urban residence, discharged against medical advice, and hospitalized from September through December 2020 versus March through August 2020 (all P values <.02). Veterans readmitted from September through December 2020 were more often White, lived in a rural or highly rural area, and had shorter initial hospitalizations than veterans hospitalized earlier in the year. CONCLUSION Approximately 1 of 6 veterans discharged alive following a COVID-19 hospitalization from March 1 through December 31, 2020, were readmitted within 90 days. The longer the hospital stay, the greater the likelihood of readmission. Readmissions also were more likely when the initial admission required mechanical ventilation, or when the veteran had multiple comorbidities, smoked, or lived in an urban area. COVID-19 hospitalizations were shorter from September through December 2020, suggesting that hospital over-capacity may have resulted in earlier discharges and increased readmissions. Efforts to monitor and provide support for patients discharged in high bed-capacity situations may help avoid readmissions.
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Affiliation(s)
- Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois,Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Oregon Health and Science University–Portland State University School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Alex Hickok
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Allison C. O’Neill
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and Veterans Affairs Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel T. Edwards
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Section of General Internal Medicine, Veterans Affairs Portland Healthcare System, Portland, Oregon
| | - Diana J. Govier
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Jason I. Chen
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Department of Psychiatry, Oregon Health and Science University, Portland, Oregon
| | - Rebecca Young
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon
| | - Mary Whooley
- San Francisco Veterans Affairs Health Care System, and the University of California, San Francisco, California
| | - Denise M. Hynes
- Center to Improve Veteran Involvement in Care, Portland VA Hospital, Portland, Oregon,Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon,School of Nursing, Oregon Health and Science University, Portland, Oregon
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10
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Chen JI, Ono SS, Laliberte AZ, Roth B, Dobscha SK. Veteran community engagement and social connection needs following inpatient psychiatric hospitalization. Psychiatr Rehabil J 2022; 45:324-330. [PMID: 35913855 PMCID: PMC9822856 DOI: 10.1037/prj0000534] [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: 01/11/2023]
Abstract
OBJECTIVE To understand barriers and facilitators to engaging in community activities for increasing social connectedness among recently psychiatrically hospitalized veterans, a population at elevated risk for suicide. METHOD We completed 30 semistructured qualitative interviews with veterans within 1 week of discharge from inpatient psychiatric hospitalization. Our interviews focused on understanding past and current barriers, facilitators, and needs for engaging in community activities after psychiatric hospitalization. Data were analyzed using a modified grounded theory approach. RESULTS Veterans shared feeling a lack of belonging and discussed several barriers to community engagement including lack of self-confidence, limited knowledge of opportunities, and negative expectations. Veterans identified several ways to facilitate engagement in community activities such as centralizing information on community activities and providing active support posthospitalization. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Veterans by and large valued community and the role of community activities for increasing social connectedness. However, more active intervention for supporting engagement in community activities appears necessary to facilitate connection posthospitalization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jason I. Chen
- U.S. Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, United States
- Department of Psychiatry, Oregon Health and Science University
| | - Sarah S. Ono
- U.S. Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, United States
- Department of Psychiatry, Oregon Health and Science University
- Veterans Rural Health Resource Center-Portland, VA Office of Rural Health, Portland, Oregon, United States
| | - Avery Z. Laliberte
- U.S. Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, United States
- Department of Psychiatry, Oregon Health and Science University
| | - Brandon Roth
- U.S. Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, United States
- Department of Psychiatry, Oregon Health and Science University
| | | | - Steven K. Dobscha
- U.S. Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, United States
- Department of Psychiatry, Oregon Health and Science University
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11
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Chen JI, Hickok A, O'Neill AC, Niederhausen M, Laliberte AZ, Govier DJ, Edwards ST, Gordon HS, Slatore CG, Weaver FM, Young R, Hynes DM. Psychiatric disorders newly diagnosed among veterans subsequent to hospitalization for COVID-19. Psychiatry Res 2022; 312:114570. [PMID: 35487047 PMCID: PMC9023376 DOI: 10.1016/j.psychres.2022.114570] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of our study was to evaluate the development of new mental health diagnoses up to 6-months following COVID-19 hospitalization for in a large, national sample. METHOD Data were extracted for all Veterans hospitalized at Veterans Health Administration hospitals for COVID-19 from March through August of 2020 utilizing national administrative data. After identifying the cohort, follow-up data were linked through six months post-hospitalization. Data were analyzed using logistic regression. RESULTS Eight percent of patients developed a new mental health diagnosis following hospitalization. The most common new mental health diagnoses involved depressive, anxiety, and adjustment disorders. Younger and rural patients were more likely to develop new mental health diagnoses. Women and those with more comorbidities were less likely to develop new diagnoses. CONCLUSION A subpopulation of patients hospitalized for COVID-19 developed new mental health diagnoses. Unique demographics predictors indicate the potential need for additional outreach and screening to groups at elevated risk of post-hospitalization, mental health sequelae.
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Affiliation(s)
- Jason I. Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA,Corresponding authors at: 3710 SW U.S. Veterans Hospital Road (R&D 66), Portland, OR 97239, USA
| | - Alex Hickok
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Allison C. O'Neill
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Meike Niederhausen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Avery Z. Laliberte
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Diana J. Govier
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Samuel T. Edwards
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and VA Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA,Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA,Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher G. Slatore
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Francis M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA,Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA
| | - Rebecca Young
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA
| | - Denise M. Hynes
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR 97239, USA,Health Management and Policy, School of Social and Behavioral Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA,School of Nursing, Oregon Health and Science University, Portland, OR, USA,Corresponding authors at: 3710 SW U.S. Veterans Hospital Road (R&D 66), Portland, OR 97239, USA
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12
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Nugent SM, Morasco BJ, Handley R, Clayburgh D, Hooker ER, Ganzini L, Knight SJ, Chen JI, Sullivan DR, Slatore CG. Risk of Suicidal Self-directed Violence Among US Veteran Survivors of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:981-989. [PMID: 34617963 DOI: 10.1001/jamaoto.2021.2625] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Head and neck cancer (HNC) survivors are about twice as likely to die by suicide compared with other cancer survivors. Objective To examine the associations between precancer mental health and pain and postcancer receipt of mental health, substance use disorder (SUD), or palliative care services with risk of suicidal self-directed violence (SSDV). Design, Setting, and Participants This retrospective cohort study used the Veterans Health Administration data of 7803 veterans with a diagnosis of HNC (stage I-IVB) who received cancer treatment between January 1, 2012, and January 1, 2018. Data were analyzed between May 2020 and July 2021. Exposures Presence of precancer chronic pain and SUD diagnoses, and postcancer SUD, mental health, or palliative care treatment. Exposures were defined using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes in Veterans Health Administration administrative data. Main Outcomes and Measures Documented SSDV event, including suicide attempt or death by suicide, after HNC diagnosis. Results Among the cohort of 7803 veterans (7685 [98.4%] male; mean [SD] age, 65 [10.7] years), 72 (0.9%) had at least 1 documented SSDV event following their cancer diagnosis, and 51 (0.7%) died by suicide. Four adjusted modified Poisson regression analyses identified that precancer chronic pain (incidence rate ratio [IRR], 2.58; 95% CI 1.54-4.32) or mood disorder diagnoses (IRR, 1.95; 95% CI, 1.17-3.24) were associated with higher risk of postcancer SSDV. Those who had at least 1 documented mental health (IRR, 2.73; 95% CI, 1.24-6.03) or SUD (IRR, 3.92; 95% CI, 2.46-6.24) treatment encounter in the 90 days following HNC diagnosis were at higher risk for SSDV. A palliative care encounter within 90 days of postcancer diagnosis was associated with decreased risk of SSVD (IRR, 0.49; 95% CI, 0.31-0.78). Conclusions and Relevance In this cohort study, a high proportion of HNC survivors with an SSVD event died from their injuries. Identification of risk factors for SSDV among HNC survivors may help direct additional resources to those who are at high risk. Referral to palliative care appears to be an important component of supportive oncologic care to reduce the risk of SSDV.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland.,Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Robert Handley
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Daniel Clayburgh
- Operative Care Division, VA Portland Health Care System, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Oregon Health & Science University, Portland
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Linda Ganzini
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Sara J Knight
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University, Portland.,Division of Pulmonology and Critical Care Medicine, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University, Portland.,Division of Pulmonology and Critical Care Medicine, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
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13
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Laliberte AZ, Roth B, Edwards B, Chen JI. Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor. J Emerg Nurs 2021; 47:846-851. [PMID: 34479740 DOI: 10.1016/j.jen.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 11/25/2022]
Abstract
One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.
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Bowersox NW, Jagusch J, Garlick J, Chen JI, Pfeiffer PN. Peer-based interventions targeting suicide prevention: A scoping review. Am J Community Psychol 2021; 68:232-248. [PMID: 33720444 PMCID: PMC9165581 DOI: 10.1002/ajcp.12510] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Peers of individuals at risk for suicide may be able to play important roles in suicide prevention. The aim of the current study is to conduct a scoping review to characterize the breadth of peer-delivered suicide prevention services and their outcomes to inform future service delivery and research. Articles were selected based on search terms related to peers, suicide, or crisis. After reviews of identified abstracts (N = 2681), selected full-text articles (N = 286), and additional references (N = 62), a total of 84 articles were retained for the final review sample. Types of suicide prevention services delivered by peers included being a gatekeeper, on-demand crisis support, crisis support in acute care settings, and crisis or relapse prevention. Peer relationships employed in suicide prevention services included fellow laypersons; members of the same sociodemographic subgroup (e.g., racial minority), workplace, or institution (e.g., university, correctional facility); and the shared experience of having a mental condition. The majority of published studies were program descriptions or uncontrolled trials, with only three of 84 articles qualifying as randomized controlled trials. Despite a lack of methodological rigor in identified studies, peer support interventions for suicide prevention have been implemented utilizing a diverse range of peer provider types and functions. New and existing peer-delivered suicide prevention services should incorporate more rigorous evaluation methods regarding acceptability and effectiveness.
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Affiliation(s)
- Nicholas W. Bowersox
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jennifer Jagusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - James Garlick
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jason I. Chen
- VA Center to Improve Veteran Involvement in Care, Portland, OR, USA
| | - Paul N. Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
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Chuop M, Michel Z, Shah R, Chen JI, Black W. From Screening to Interventions: Teaching Clinical Suicide Prevention Skills to Medical Students. Acad Psychiatry 2021; 45:292-296. [PMID: 32495309 PMCID: PMC9161659 DOI: 10.1007/s40596-020-01248-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/07/2020] [Indexed: 05/24/2023]
Affiliation(s)
- Maria Chuop
- Oregon Health & Science University, Portland, OR, USA
| | - Zack Michel
- Oregon Health & Science University, Portland, OR, USA
| | - Riva Shah
- Oregon Health & Science University, Portland, OR, USA
| | - Jason I Chen
- Oregon Health & Science University, Portland, OR, USA
- VA Portland Health Care System, Portland, OR, USA
| | - Whitney Black
- Oregon Health & Science University, Portland, OR, USA.
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16
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Chen JI, Cameron DC, Laliberte AZ, Hooker ER, Niederhausen M, Denneson LM. Assessment of Suicidal Intent in Self-directed Violence and Subsequent Care Received Among Military Veterans: A National Study of Gender Differences. Med Care 2021; 59:S17-S22. [PMID: 33438878 PMCID: PMC8375629 DOI: 10.1097/mlr.0000000000001455] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Veterans Health Administration's system for documenting self-directed violence (SDV) requires that clinicians make a determination of the suicidal intent of the behavior (ie, "undetermined" intent vs. "suicide attempt") which contributes to the enhanced care offered. Past studies suggest clinicians' judgment of suicide risk is impacted by patient demographics regardless of clinical presentation. As women are less likely to die by suicide than men, women's SDV may be taken less seriously; they may be more likely to have their SDV classified as "undetermined" than men, which may impact the care received. OBJECTIVES This study examines whether women veterans' SDV is disproportionately classified as "undetermined" suicidal intent versus "suicide attempt" as compared with men veterans, and how one's classification and gender modifies the care received. RESEARCH DESIGN This was an observational, retrospective study of data from Veterans Health Administration administrative databases. We included all veterans with documented nonfatal "undetermined" SDV events and "suicide attempts" between 2013 and 2018 (N=55,878). Objectives were evaluated using mixed-effects logistic regression models. RESULTS Women veterans were disproportionately more likely than men veterans to have SDV classified as "undetermined" (odds ratio=1.17; 95% confidence interval, 1.08-1.27). Veterans who received an "undetermined" classification were significantly less likely to receive enhanced care. However, this relationship was not moderated by gender. CONCLUSIONS Gender may impact clinicians' determinations of intent of SDV, but more research is needed on the extent of classification biases and to understand causes. Further, classification of intent is critical, as there is a strong relationship between classification and enhanced care.
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Affiliation(s)
- Jason I. Chen
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry
| | - David C. Cameron
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Avery Z. Laliberte
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry
| | - Elizabeth R. Hooker
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
| | - Meike Niederhausen
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry
- Oregon Health and Science University-Portland State University School of Public Health, Oregon Health & Science University, Portland, OR
| | - Lauren M. Denneson
- US Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care, VA Portland Health Care System
- Department of Psychiatry
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17
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Chen JI, Hooker ER, Niederhausen M, E Marsh H, Saha S, Dobscha SK, Teo AR. Social connectedness, depression symptoms, and health service utilization: a longitudinal study of Veterans Health Administration patients. Soc Psychiatry Psychiatr Epidemiol 2020; 55:589-597. [PMID: 31691842 PMCID: PMC7304483 DOI: 10.1007/s00127-019-01785-9] [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: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Our study explored whether aspects of veterans' social connectedness (social support, interpersonal conflict, loneliness, social norms, number of confidants) are associated with change in their depression symptoms and health services utilization over 1 year. METHODS We conducted a prospective, longitudinal study of 262 military veterans who obtained primary care and other services at a Veterans Health Administration (VHA) facility and screened positive for depression. Participants completed surveys at baseline and 12-month follow-up. We measured social connectedness variables using the NIH Toolbox Adult Social Relationship Scales. We used the Patient Health Questionnaire to assess depression symptoms and suicidal ideation and administrative medical record data for health services utilization. We calculated change scores to model outcomes over time using multivariable regressions. RESULTS We found that higher levels of baseline loneliness were associated with decreased depression severity over 1 year (B = - 1.55, 95% CI [- 2.53, - .56], p < .01). We found a similar association for suicidal ideation. In contrast, higher baseline number of confidants was associated with increased depression (B = .55, 95% CI [.18, .92], p < .01). Higher levels of emotional support were associated with decreased mental health visits (B = - 3.88, 95% CI [- 6.80, - .96], p < .01). No significant associations were found between social connectedness variables and primary care visits. CONCLUSIONS Emotional support may play an important role in reducing mental health treatment utilization among VHA-using veterans. Additional investigation as to how and why loneliness and number of confidants might be paradoxically associated with depression symptoms remains necessary.
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Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA.
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA.
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
| | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
- Oregon Health and Science University-Portland State University School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Heather E Marsh
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, U.S. Department of Veterans Affairs (VA), 3710 SW U.S. Veterans Hospital Road, R&D 66, Portland, OR, 97239, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
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18
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Affiliation(s)
- Jason I Chen
- 1 Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,2 Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Ginnifer L Mastarone
- 1 Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,3 Department of Communication, College of Liberal Arts and Sciences, Portland State University, Portland, OR, USA
| | - Lauren M Denneson
- 1 Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,2 Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
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19
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Chen JI, Osman A, Freedenthal SL, Gutierrez PM. An Examination of the Psychometric Properties of the Reasons for Living Inventory within a Male Veteran Clinical Sample. Arch Suicide Res 2020; 24:204-230. [PMID: 30636520 DOI: 10.1080/13811118.2018.1563576] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elevated suicide risk among veteran populations remains a significant public health concern. However, few suicide assessment measures have been validated for veterans. The current study evaluated the reliability and validity of the Reasons for Living Inventory (RFL) scores among veteran populations. The participants included male veterans (N = 421) from a broad range of ages, combat exposures, and history of suicide attempts. Participants completed the RFL and a set of additional self-report measures of relevant constructs in a cross-sectional design. Estimates of internal consistency reliability were adequate for scores on all the original RFL subscale scores. Exploratory factor analysis (EFA) and exploratory bifactor (bi-factor EFA) analyses provided detailed information regarding the 6-factor solution from the original validation studies with the RFL. Additional analyses identified potential correlates for the RFL total and subscale scores. Secondary analyses showed support for evidence of known-groups validity for the RFL total scale score. Overall, this study provides initial support for the RFL as a reliable and valid measure of protective factors in veterans. Future studies may wish to consider further validation of the current findings.
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Affiliation(s)
- Jason I Chen
- VA Portland Health Care System, Portland, OR, USA
| | - Augustine Osman
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Stacey L Freedenthal
- Department of Psychology, University of Denver Graduate School of Social Work, Denver, CO, USA
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center at the Denver VA Medical Center, Aurora, CO, USA.,Department of Psychology, University of Colorado School of Medicine, Aurora, CO, USA
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20
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Abstract
Since the late 1990s, mortality rates for middle-aged (45-55), White non-Hispanic (WNH) Americans began to rise while rates declined for all other demographic and age groups. Coinciding with the rise in mortality, rates of death due to suicide, drug- and alcohol-related overdoses, and alcohol-related liver diseases increased as well for this demographic. Research suggests these causes of death (i.e., suicide, poisoning, alcohol-related liver disease) are driving the overall mortality rate for middle-aged WNHs and have been described as "deaths of despair" in the literature. In the current paper, we describe the social and clinical features of "deaths of despair," explore theoretical models of psychopathology (e.g., depression, posttraumatic stress disorder) that may inform our understanding of mechanisms of risk for negative mental health outcomes, and propose an initial conceptual model of "deaths of despair" to identify intervention targets. We then review an applied case example demonstrating how this model could be used for clinical application. We conclude our paper by describing how current cognitive-behavioral interventions may address these mechanisms of "despair."
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Affiliation(s)
- Kristoffer Rehder
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jaimie Lusk
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jason I Chen
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
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21
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Franz D, Marsh HE, Chen JI, Teo AR. Using Facebook for Qualitative Research: A Brief Primer. J Med Internet Res 2019; 21:e13544. [PMID: 31411143 PMCID: PMC6711038 DOI: 10.2196/13544] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
As Facebook continues to grow its number of active users, the potential to harness data generated by Facebook users also grows. As much of Facebook users’ activity consists of creating (and commenting on) written posts, the potential use of text data for research is enormous. However, conducting a content analysis of text from Facebook users requires adaptation of research methods used for more traditional sources of qualitative data. Furthermore, best practice guidelines to assist researchers interested in conducting qualitative studies using data derived from Facebook are lacking. The purpose of this primer was to identify opportunities, as well as potential pitfalls, of conducting qualitative research with Facebook users and their activity on Facebook and provide potential options to address each of these issues. We begin with an overview of information obtained from a literature review of 23 studies published between 2011 and 2018 and our own research experience to summarize current approaches to conducting qualitative health research using data obtained from Facebook users. We then identify potential strategies to address limitations related to current approaches and propose 5 key considerations for the collection, organization, and analysis of text data from Facebook. Finally, we consider ethical issues around the use and protection of Facebook data obtained from research participants. In this primer, we have identified several key considerations that should aid health researchers in the planning and execution of qualitative studies involving content analysis of text data from Facebook users.
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Affiliation(s)
- Daschel Franz
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States
| | - Heather Elizabeth Marsh
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Department of Veterans Affairs, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States
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22
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Peterson AL, Chen JI, Karver MS, Labouliere CD. Frustration with feeling: Latent classes of non-suicidal self-injury and emotion regulation difficulties. Psychiatry Res 2019; 275:61-70. [PMID: 30878858 PMCID: PMC6543814 DOI: 10.1016/j.psychres.2019.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/14/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/23/2022]
Abstract
Although emotion regulation has been identified as a key function of non-suicidal self-injury (NSSI), it is unclear how specific indices of emotion regulation are associated with particular NSSI methods as markers of risk. This study used latent class analysis (LCA) to identify subgroups of individuals who engage in NSSI and their patterns of emotional regulation difficulties. Undergraduate students in the southeastern United States (N = 326) completed an online survey. LCA was used to identify subgroups of individuals engaging in NSSI and their associated emotion regulation difficulties. These subgroups were then compared across a variety of behavioral health outcomes (e.g. impulsive behavior, disordered eating, problematic alcohol use, suicide attempt history) to characterize specific risk profiles. The LCA revealed four subgroups who engage in NSSI and have specific emotion regulation difficulties. These subgroups were differentially associated with behavioral health outcomes, including suicide risk, disordered eating, and impulsive behavior. Results of this research could aid in clinical identification of at-risk individuals.
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Affiliation(s)
- Amanda L Peterson
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave, PCD4118G, Tampa, FL 33620, USA.
| | - Jason I Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave, PCD4118G, Tampa, FL 33620, USA
| | - Christa D Labouliere
- New York State Psychiatric Institue, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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23
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Chen JI, Mastarone GL, Ambrosino SA, Anzalone N, Carlson KF, Dobscha SK, Teo AR. Evaluation of the Safety and Design of Community Internet Resources for Veteran Suicide Prevention. Crisis 2019; 40:347-354. [PMID: 30935244 DOI: 10.1027/0227-5910/a000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Recent data show many veterans who die by suicide are not currently engaged in mental health care. Veterans frequently use the Internet for health information and may look online for community resources when in distress. However, little is known about their design characteristics. Aim: To evaluate the design and content of community, veteran suicide prevention websites. Method: Community websites focused on veteran suicide prevention were gathered through Internet searches using standardized search terms. Websites that met the inclusion criteria (n = 9) were evaluated for adherence to suicide safe messaging, usability, readability, and credibility heuristics. Interrater reliability was evaluated using kappa statistics. Descriptive statistics were used to describe website features. Results: Community websites tended to provide help-seeking information, safe messaging, and community activities. However, no websites provided information on lethal means safety or references to signal credibility. Limitations: The sample was small and only included English-language websites, and focused on veteran-oriented, community websites. Conclusion: Community suicide prevention websites focused on veterans could be improved through increased readability, credibility, and provision of lethal means safety information.
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Affiliation(s)
- Jason I Chen
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Ginnifer L Mastarone
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Santisia A Ambrosino
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA
| | - Nicole Anzalone
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Alan R Teo
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, US Department of Veterans Affairs (VA), Portland, OR, USA.,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
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24
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Chen JI, Bozzay ML, Monahan MF, Gryglewicz K, Romero G, Steding LH, Gleason LL, Karver MS. Life after loss: Comparing student service member/veteran and civilian mental health characteristics among individuals exposed to death by suicide. J Am Coll Health 2019; 67:197-206. [PMID: 29952727 DOI: 10.1080/07448481.2018.1469500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 03/28/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study evaluated the mental health characteristics and beliefs of student service members/veterans (SSM/Vs) who have been exposed to another's death by suicide. PARTICIPANTS A total of 39 SSM/Vs exposed to suicide and 32 SSM/Vs not exposed to suicide were sampled from a larger, epidemiological survey. An age- and gender-matched group of 39 civilian (C) students was drawn from a larger sample of individuals exposed to suicide. METHODS Data were collected as part of an Internet-based, campus needs survey that occurred in Fall 2014. Participants were asked to complete measures about suicide-related behaviors, suicide prevention, help-seeking, and demographics. RESULTS SSM/Vs exposed to suicide had more positive mental health/suicide prevention beliefs than SSM/Vs not exposed to suicide. Cs exposed to suicide were not significantly different from either group. Unique help-seeking patterns were also identified. CONCLUSIONS The current study identifies unique characteristics of SSM/Vs exposed to suicide that may inform prevention programming.
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Affiliation(s)
- Jason I Chen
- a HSR&D Center to Improve Veteran Involvement in Care , VA Portland Health Care System , Portland , OR , USA
- b Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA
| | - Melanie L Bozzay
- c Department of Psychology, College of Arts and Science , University of South Florida , Tampa , FL , USA
| | - Maureen F Monahan
- c Department of Psychology, College of Arts and Science , University of South Florida , Tampa , FL , USA
| | - Kim Gryglewicz
- d School of Social Work, College of Health and Public Affairs , University of Central Florida , Orlando , FL , USA
| | - Gabriela Romero
- c Department of Psychology, College of Arts and Science , University of South Florida , Tampa , FL , USA
| | - Lindsey H Steding
- e The Center for Child & Adolescent Behavioral Health , Cognitive Behavior Institute , Cranberry Township , PA , USA
| | - LaDonna L Gleason
- f Department of Psychology, College of Arts and Sciences , University of South Carolina , Columbia , SC , USA
| | - Marc S Karver
- c Department of Psychology, College of Arts and Science , University of South Florida , Tampa , FL , USA
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25
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Gryglewicz K, Monahan MF, Chen JI, Bozzay M, Bender A, Gleason LL, Witmeier M, Karver MS. Examining the effects of role play practice in enhancing clinical skills to assess and manage suicide risk. J Ment Health 2019; 29:549-557. [DOI: 10.1080/09638237.2018.1521936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kim Gryglewicz
- School of Social Work, College of Health Professions & Sciences, University of Central Florida, Orlando, FL, USA
| | | | - Jason I. Chen
- Center to Improve Veteran Involvement in Care, Portland Health Care System, U.S. Department of Veterans Affairs and Oregon Health and Science University, Portland State University School of Public Health, Portland, OR, USA
| | - Melanie Bozzay
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Ansley Bender
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - LaDonna L. Gleason
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Melissa Witmeier
- Florida Council for Community Mental Health, Tallahassee, FL, USA
| | - Marc S. Karver
- Department of Psychology, University of South Florida, Tampa, FL, USA
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26
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Teo AR, Chen JI, Kubo H, Katsuki R, Sato‐Kasai M, Shimokawa N, Hayakawa K, Umene‐Nakano W, Aikens JE, Kanba S, Kato TA. Development and validation of the 25-item Hikikomori Questionnaire (HQ-25). Psychiatry Clin Neurosci 2018; 72:780-788. [PMID: 29926525 PMCID: PMC6221010 DOI: 10.1111/pcn.12691] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/17/2018] [Accepted: 05/31/2018] [Indexed: 12/02/2022]
Abstract
AIM Hikikomori, a form of severe social withdrawal, is an emerging issue in mental health, for which validated measurement tools are lacking. The object was to develop a self-report scale of hikikomori, and assess its psychometric properties and diagnostic accuracy. METHODS A sample of 399 participants from clinical and community settings completed measures. Psychometric properties were assessed with factor analysis; diagnostic accuracy was compared against a semi-structured diagnostic interview. RESULTS The Hikikomori Questionnaire contained 25 items across three subscales representing socialization, isolation, and emotional support. Internal consistency, test-retest reliability, and convergent validity were all satisfactory. The area under the curve was 0.86 (95% confidence interval, 0.80-0.92). A cut-off score of 42 (out of 100) was associated with a sensitivity of 94%, specificity of 61%, and positive predictive value of 17%. CONCLUSION The 25-item Hikikomori Questionnaire (HQ-25) possesses robust psychometric properties and diagnostic accuracy in an initial sample of Japanese adults. Additional research on its psychometric properties and ability to support clinical assessment of hikikomori is warranted.
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Affiliation(s)
- Alan R. Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in CarePortlandUSA
- Department of PsychiatryOregon Health & Science UniversityPortlandUSA
- School of Public HealthOregon Health & Science University and Portland State UniversityPortlandUSA
| | - Jason I. Chen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in CarePortlandUSA
- Department of PsychiatryOregon Health & Science UniversityPortlandUSA
| | - Hiroaki Kubo
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Ryoko Katsuki
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Mina Sato‐Kasai
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Norihiro Shimokawa
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Kohei Hayakawa
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Wakako Umene‐Nakano
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - James E. Aikens
- Department of Family MedicineUniversity of MichiganAnn ArborUSA
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takahiro A. Kato
- Department of Neuropsychiatry, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Abstract
OBJECTIVE This study describes responses to OpenNotes, clinical notes available online, among patients receiving mental health care and explores whether responses vary by patient demographic or clinical characteristics. METHODS Survey data from 178 veterans receiving mental health treatment at a large Veterans Affairs medical center included patient-reported health self-efficacy, health knowledge, alliance with clinicians, and negative emotional responses after reading OpenNotes. Health care data were extracted from the patient care database. RESULTS Reading OpenNotes helped many participants feel in control of their health care (49%) and have more trust in clinicians (45%), although a few (8%) frequently felt upset after reading their notes. In multivariate models, posttraumatic stress disorder was associated with increased patient-clinician alliance (p=.046) but also with negative emotional responses (p<.01). CONCLUSIONS Patients receiving mental health care frequently reported benefits from reading OpenNotes, yet some experienced negative responses.
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Affiliation(s)
- Lauren M Denneson
- The authors are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Heath Care System, Portland, Oregon. Dr. Denneson, Dr. Chen, and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland
| | - Jason I Chen
- The authors are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Heath Care System, Portland, Oregon. Dr. Denneson, Dr. Chen, and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland
| | - Maura Pisciotta
- The authors are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Heath Care System, Portland, Oregon. Dr. Denneson, Dr. Chen, and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland
| | - Anais Tuepker
- The authors are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Heath Care System, Portland, Oregon. Dr. Denneson, Dr. Chen, and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland
| | - Steven K Dobscha
- The authors are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Heath Care System, Portland, Oregon. Dr. Denneson, Dr. Chen, and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland
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28
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Dobscha SK, Denneson LM, Pisciotta MK, Bourne DS, Chen JI, Philipps-Moses D, Woods SS. Predictors of viewing progress notes among users of VA's electronic health portal who receive mental health care. JAMIA Open 2018; 1:122-127. [PMID: 31984324 DOI: 10.1093/jamiaopen/ooy007] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Consistent with the OpenNotes movement, the Veterans Health Administration (VHA) offers patients online access to their clinical notes through the Blue Button feature in its electronic patient health portal, My HealtheVet. We identified demographic, diagnostic, and knowledge-related predictors of viewing clinical notes among veterans receiving VHA mental health care who recently used My HealtheVet. Materials and Methods Three hundred and thirty-eight patients receiving mental health care from 1 VHA medical center who had logged into My HealtheVet in the prior 6 months completed self-report questionnaires assessing their viewing of clinical notes. Additional data were extracted from VHA's Patient Care Database. Multivariable logistic regression was used to examine predictors of viewing notes. Results Fifty percent of respondents reported having read their notes. In the final multivariable model, post-traumatic stress disorder (PTSD) diagnosis [odds ratio (OR) = 2.30 (1.31-4.07)], speaking with their mental health clinician about their ability to view notes [OR = 3.84 (1.69-8.72)], and being very or extremely confident in understanding the purpose and uses of Blue Button [OR = 9.80 (2.23-43.07) and OR = 13.36 (2.74-65.20), respectively] were associated with viewing notes. Discussion Patient recall of mental health clinicians speaking to them about their ability to view notes, and confidence in understanding the use and purposes of Blue Button, were stronger predictors of viewing notes than demographic variables. PTSD diagnosis was the only clinical characteristic associated with viewing notes. Conclusion The findings support the value of mental health clinicians openly discussing the availability of notes with patients if they wish to help them take advantage of their potential benefits.
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Affiliation(s)
- Steven K Dobscha
- VHA Center to Improve Veteran Involvement in Care, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Lauren M Denneson
- VHA Center to Improve Veteran Involvement in Care, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Maura K Pisciotta
- VHA Center to Improve Veteran Involvement in Care, Portland, Oregon, USA
| | - Donald S Bourne
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason I Chen
- VHA Center to Improve Veteran Involvement in Care, Portland, Oregon, USA
| | | | - Susan S Woods
- Center for Outcomes Research & Evaluation, Maine Medical Center, Portland, Maine, USA
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Teo AR, Marsh HE, Forsberg CW, Nicolaidis C, Chen JI, Newsom J, Saha S, Dobscha SK. Loneliness is closely associated with depression outcomes and suicidal ideation among military veterans in primary care. J Affect Disord 2018; 230:42-49. [PMID: 29407537 DOI: 10.1016/j.jad.2018.01.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 10/04/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the substantial influence of social relationships on health is well-known, studies that concurrently examine the influence of varying dimensions of social connectedness on major depression are more limited. This study's aim was to determine to what degree several facets of social connectedness (number of confidants, social support, interpersonal conflict, social norms, and loneliness) are correlated with depression-related outcomes. METHODS Participants were primary care patients (n = 301) with probable major depression at a Veterans Health Administration hospital and its satellite clinics. Social connectedness was primarily measured using multi-item instruments from the NIH Toolbox of Adult Social Relationship Scales. Primary outcomes were clinical symptoms (depression and suicidal ideation) and secondary outcomes were self-reported health-related behaviors (medication adherence, patient activation, and help-seeking intentions). RESULTS In multivariate models adjusting for potential confounders and other facets of connectedness, loneliness was associated with higher levels of depression and suicidal ideation, as well as lower patient activation and help-seeking intentions. Social support and social norms about depression treatment were each associated with higher patient activation and help-seeking intentions. Social connectedness was not associated with medication adherence. LIMITATIONS The limitations of this study are primarily related to its cross-sectional survey design and study population. CONCLUSIONS Multiple aspects of social connectedness are associated with depression outcomes among military veterans with depression. Loneliness may represent the most important component of connectedness, as it is associated with depression severity, suicidality, and health-related behaviors.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States; Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States.
| | - Heather E Marsh
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christina Nicolaidis
- Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Portland State University, School of Social Work, 1600 SW 4th Ave, Portland, OR 97201-5522, United States
| | - Jason I Chen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Jason Newsom
- Portland State University, School of Community Health: Institute on Aging, P.O. Box 751 - IOA, Portland, OR 97207-0751, United States
| | - Somnath Saha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, 3181 SW Sam Jackson Park Rd (5th Floor, Biomedical Information Communication Center), Portland, OR 97239-3098, United States
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States
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Teo AR, Marsh HE, Liebow SBL, Chen JI, Forsberg CW, Nicolaidis C, Saha S, Dobscha SK. Help-Seeking on Facebook Versus More Traditional Sources of Help: Cross-Sectional Survey of Military Veterans. J Med Internet Res 2018; 20:e62. [PMID: 29483064 PMCID: PMC5847817 DOI: 10.2196/jmir.9007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 09/20/2017] [Revised: 11/02/2017] [Accepted: 11/19/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems. OBJECTIVE This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help. METHODS Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and nonusers were compared via t tests, Chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models. RESULTS The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and nonusers, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (eg, psychologists), informal (eg, friends), or phone helpline sources of support were significantly higher. Results did not substantially change when examining users of other social media, women, or younger adults. CONCLUSIONS In its current form, the social media platform Facebook is not seen as a venue to seek help for emotional problems or suicidality among veterans with major depression in the United States.
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Affiliation(s)
- Alan R Teo
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States
| | - Heather E Marsh
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Samuel B L Liebow
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Jason I Chen
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
| | - Christopher W Forsberg
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States.,Department of Medicine, Oregon Health & Science University, Portland, OR, United States.,Regional Research Institute, School of Social Work, Portland State University, Portland, OR, United States
| | - Somnath Saha
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, United States.,Department of Medicine, Oregon Health & Science University, Portland, OR, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Steven K Dobscha
- Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR, United States.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States
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Chen JI, Hergert DC. New perspectives in mental health: addressing cognitive deficits in remitted depression. J Psychiatr Ment Health Nurs 2017; 24:252-259. [PMID: 28177555 DOI: 10.1111/jpm.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- J I Chen
- HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - D C Hergert
- Department of Psychology, College of Arts and Science, University of South Florida, Tampa, FL, USA
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Chen JI, Romero GD, Karver MS. The relationship of perceived campus culture to mental health help-seeking intentions. J Couns Psychol 2016; 63:677-684. [DOI: 10.1037/cou0000095] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Many mental health professionals (MHPs) encounter youth at risk for suicide but lack knowledge and confidence to assist these individuals. Unfortunately, training for MHPs on suicide risk assessment and management is often not adequately accessible. AIMS The aim of this study was to evaluate whether MHPs' knowledge, attitudes, perceived social norms, and perceived behavioral control in working with at-risk suicidal youth improve following an online training (QPRT: Question, Persuade, Refer, Treat). METHOD QPRT was provided to 225 MHPs from three large urban areas in the United States. Suicide prevention literacy, attitudes, perceived social norms, and perceived behavioral control in assessing and managing suicide risk were assessed before and after training. Data were also collected on training engagement and completion. RESULTS Suicide prevention literacy in most competency domains and perceived behavioral control increased significantly after participation in QPRT. Suicide prevention attitudes and some knowledge domains did not significantly improve. MHPs reported high satisfaction with the training. CONCLUSION The current study provides initial support for offering MHPs online suicide risk assessment and management training. Online training programs may be an engaging and feasible means for providing advanced suicide prevention skills to MHPs who may have numerous barriers to accessing face-to-face training.
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Affiliation(s)
- Kim Gryglewicz
- 1 School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Jason I Chen
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Gabriela D Romero
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Marc S Karver
- 2 Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Melissa Witmeier
- 3 Florida Council for Community Mental Health, Tallahassee, FL, USA
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Abstract
The present study examined whether men view gender-atypical (i.e., feminine) psychological disorders as threats to their gender status. Men and women ( N = 355) rated their expectations of gender status loss, feelings of distress, and help-seeking intentions in response to 10 different stereotypically masculine and feminine psychological disorders. Men as compared to women expected greater gender status loss for, and reported more distress to, gender-atypical versus gender-typical disorders. Expectations of gender status loss partially mediated the link between participant gender and distress at the thought of gender-atypical disorders. These findings suggest that feminine disorders pose more powerful gender status threats for men than masculine disorders do and that men’s expectations of gender status loss for feminine disorders drive their negative reactions to these mental illnesses. The discussion emphasizes the importance of considering the gender-typicality of disorders, and the implications of these findings for clinical interventions.
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Affiliation(s)
| | | | - Joshua G. Lenes
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Jason I. Chen
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Caporino NE, Chen JI, Karver MS. Preliminary examination of ethnic group differences in adolescent girls’ attitudes toward depression treatments. ACTA ACUST UNITED AC 2014; 20:37-42. [DOI: 10.1037/a0033467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Coates EE, Chen JI, Storch EA. A case of schizencephaly associated with obsessive-compulsive disorder. Ann Clin Psychiatry 2013; 25:151-2. [PMID: 23638447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Matuskey D, Pittman B, Chen JI, Wanyiri J, Nadim H, Jatlow P, Gueorguieva R, Potenza MN, Morgan PT, Bhagwagar Z, Malison RT. A single-day paradigm of self-regulated human cocaine administration. Pharmacol Biochem Behav 2013; 103:95-101. [PMID: 22922558 DOI: 10.1016/j.pbb.2012.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 02/27/2012] [Revised: 08/10/2012] [Accepted: 08/15/2012] [Indexed: 11/25/2022]
Abstract
UNLABELLED Prior work by our group has shown the feasibility, safety, and validity of a multi-day, multi-dose paradigm of self-regulated cocaine administration in humans. The current work sought to consolidate these methods in a single-day design focused on reducing logistical complexity, decreasing research burden to human subjects, and increasing suitability for medication development designs. METHODS Eleven experienced cocaine users participated in a 6-hour, single-day design, consisting of one safety/eligibility and three experimental cocaine periods (during which subjects were allowed to self-administer 8, 16, and 32 mg/70 kg cocaine doses under a fixed-ratio 1:5 minute timeout schedule). Changes in cocaine-induced cardiovascular response, self-administration behavior, and subjective effects were assessed. RESULTS Procedures were well tolerated by participants, and no significant adverse events were noted. Significant (p < 0.05), changes in measures of cocaine self-administration (e.g., responses, infusions, interinfusion intervals, consumption, and plasma levels), cardiovascular response (HR), and subjective effects (“high”) were observed. In contrast, cocaine-induced increases in other vital signs (e.g., SBP, DBP) and subjective effect measures (e.g., paranoia) did not differ between doses. CONCLUSIONS These data support the safety, tolerability and validity of our single-day design. Depending on the application, such methods may afford advantages for assessing the self-regulation of cocaine administration behavior in humans (e.g., including medication development designs).
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Affiliation(s)
- D Matuskey
- Department of Psychiatry, Yale University, New Haven, CT, USA
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Saricicek A, Esterlis I, Maloney KH, Mineur YS, Ruf BM, Muralidharan A, Chen JI, Cosgrove KP, Kerestes R, Ghose S, Tamminga CA, Pittman B, Bois F, Tamagnan G, Seibyl J, Picciotto MR, Staley JK, Bhagwagar Z. Persistent β2*-nicotinic acetylcholinergic receptor dysfunction in major depressive disorder. Am J Psychiatry 2012; 169:851-9. [PMID: 22772158 PMCID: PMC3494404 DOI: 10.1176/appi.ajp.2012.11101546] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [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: 11/30/2022]
Abstract
BACKGROUND Modulation of nicotinic acetylcholine receptors (nAChRs), specifically those containing the β2 subunit, may be effective in treating patients with major depressive disorder. Using [123I]5-I-A-85380 single photon emission computed tomography (SPECT), the authors studied the availability of β2-subunit-containing nAChRs (β2*-nAChRs) in depressed patients. To understand its molecular basis, the authors also studied β2*-nAChR binding in postmortem brain samples from depressed subjects. METHOD The participants were 23 medication-free, nonsmoking subjects with familial, early-onset depression (eight acutely ill and 15 recovered) and 23 age- and gender-matched nonsmoking comparison subjects. Each received one [123I]5-I-A-85380 SPECT scan and an MRI scan. The availability of β2*-nAChRs was quantified as VT/fP. Postmortem analysis of β2*-nAChR binding was conducted with [123I]5-I-A-85380 on prefrontal cortex samples from 14 depressed subjects and 14 age-matched comparison subjects. RESULTS The β2*-nAChR availability in both the acutely ill and recovered depressed subjects was significantly lower across all brain regions than in the respective comparison subjects, and it was lower in the acutely ill subjects than in those who were recovered. In the depressed patients, β2*-nAChR availability was significantly correlated with lifetime number of depressive episodes, trauma score, and anxiety score. There were no differences in β2*-nAChR number between groups in the postmortem study. CONCLUSIONS Depressed patients have lower β2*-nAChR availability than do healthy subjects. The difference between β2*-nAChR availability in vivo and in post-mortem samples may be analogous to data with dopaminergic PET ligands and dopamine receptor availability; lower receptor availability for the SPECT ligand could be caused by greater endogenous acetylcholine.
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Affiliation(s)
| | - Irina Esterlis
- Department of Psychiatry, Yale University, New Haven, CT
| | | | - Yann S. Mineur
- Department of Psychiatry, Yale University, New Haven, CT
| | - Barbara M. Ruf
- Department of Psychiatry, Yale University, New Haven, CT
| | | | - Jason I. Chen
- Department of Psychiatry, Yale University, New Haven, CT
| | | | | | - Subroto Ghose
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Brian Pittman
- Department of Psychiatry, Yale University, New Haven, CT
| | - Frederic Bois
- Department of Psychiatry, Yale University, New Haven, CT
| | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT
| | | | | | - Zubin Bhagwagar
- Department of Psychiatry, Yale University, New Haven, CT,Neuroscience, Bristol-Myers Squibb, Wallingford, CT
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Abstract
Anatomical, physiological, and lesion data implicate multiple cortical regions in the complex experience of pain. These regions include primary and secondary somatosensory cortices, anterior cingulate cortex, insular cortex, and regions of the frontal cortex. Nevertheless, the role of different cortical areas in pain processing is controversial, particularly that of primary somatosensory cortex (S1). Human brain-imaging studies do not consistently reveal pain-related activation of S1, and older studies of cortical lesions and cortical stimulation in humans did not uncover a clear role of S1 in the pain experience. Whereas studies from a number of laboratories show that S1 is activated during the presentation of noxious stimuli as well as in association with some pathological pain states, others do not report such activation. Several factors may contribute to the different results among studies. First, we have evidence demonstrating that S1 activation is highly modulated by cognitive factors that alter pain perception, including attention and previous experience. Second, the precise somatotopic organization of S1 may lead to small focal activations, which are degraded by sulcal anatomical variability when averaging data across subjects. Third, the probable mixed excitatory and inhibitory effects of nociceptive input to S1 could be disparately represented in different experimental paradigms. Finally, statistical considerations are important in interpreting negative findings in S1. We conclude that, when these factors are taken into account, the bulk of the evidence now strongly supports a prominent and highly modulated role for S1 cortex in the sensory aspects of pain, including localization and discrimination of pain intensity.
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Affiliation(s)
- M C Bushnell
- McGill University and Université de Montréal, Montreal, Quebec, Canada H3A 1A1.
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Chang PL, Huang ST, Hsieh ML, Wang TM, Chen JI, Kuo HH, Chuang YC, Chang CH. Use of the transurethral prostatectomy clinical path to monitor health outcomes. J Urol 1997; 157:177-83. [PMID: 8976245] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE We evaluated the effect on cost and medical care quality of use of the transurethral prostatectomy clinical path. MATERIALS AND METHODS Results in 100 patients treated when the transurethral prostatectomy clinical path was used were compared to those of 100 treated by the same physicians before implementation of this path. RESULTS After implementation of the transurethral prostatectomy clinical path the length of hospital stay was significantly decreased from 5.9 to 5.0 days (p < 0.01) and Foley catheterization time was significantly decreased from 3.13 to 2.84 days (p < 0.01). Antibiotics were routinely used from the day before surgery to the day of hospital discharge as required by patient conditions. Therefore, a shorter hospital stay will significantly decrease the use of antibiotics. After implementation of the clinical path the average admission charges were decreased significantly by 17% (p < 0.01). Although some results from use of this path will not significantly affect costs, they will reflect some quality improvement. The effect of clinical path implementation on length of hospital stay between patients treated by junior and senior attending physicians was not significant. However, there was a statistically significant difference (p < 0.01) between results obtained by junior and senior attending physicians regarding average admission charges. CONCLUSIONS Implementation of the transurethral prostatectomy clinical path can improve health care outcome by decreasing length of stay and admission charges, and improving quality of medical care, particularly for patients treated by junior attending physicians.
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Affiliation(s)
- P L Chang
- Department of Urology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China
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Chen JI, Chang SC. Fiber full-polarization-state controller. Appl Opt 1993; 32:298-302. [PMID: 20802688 DOI: 10.1364/ao.32.000298] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A fiber full-polarization-state controller made by applying variable axial strains to both ends of a section of properly central-twisted high linearly birefringent fiber is proposed and thoroughly studied. The equations for polarization control are extremely simple. Experimental results are in good agreement with theoretical predictions.
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Lee SC, Chen JI. New metal-clad fiber polarizer. Appl Opt 1990; 29:2667-2668. [PMID: 20567309 DOI: 10.1364/ao.29.002667] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
UNLABELLED High quality fiber polarizers are made easily by consecutively overcoatingsuitably polished fibers withMgF2and Al films. KEYWORDS Fiberpolarizer.
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Matsuda G, Maita T, Kato Y, Chen JI, Umegane T. Amino acid sequences of the cardiac L-2A, L-2B and gizzard 17 000-Mr light chains of chicken muscle myosin. FEBS Lett 1981; 135:232-6. [PMID: 7319048 DOI: 10.1016/0014-5793(81)80789-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
The light chain fraction was separated from chicken gizzard muscle myosin. After S-carboxymethylation or performic acid oxidation, two light chain components (20 000-Mr and 17 000-Mr chains) were isolated by chromatography on a column of DEAF-cellulose in the presence of 4 M urea. Tryptic peptides of the S-carboxymethylated 20 000-Mr chain were isolated, and their sequences were determined. The alignment of these tryptic peptides in the chain was deduced from the amino acid compositions and from the partial sequences of peptic peptide of the oxidized protein. The established sequence consists of 171 amino acids and its calculated molecular weight is 19692. Comparing the sequence with those of L-2 chains from chicken and rabbit skeletal muscle myosins, 81 and 78 amino acid substitutions were recognized, respectively, including insertions and/or deletions.
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