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Hein TC, Austin K, Grau PP, Keith JA, Claes NJ, Bowersox NW. Predictors of non-fatal suicide attempts among Veterans Health Administration (VHA) patients who experienced military sexual trauma. Suicide Life Threat Behav 2024; 54:263-274. [PMID: 38421037 DOI: 10.1111/sltb.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/10/2023] [Accepted: 12/22/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Military sexual trauma (MST) has been identified as a risk factor for suicidal behavior. To inform suicide prevention efforts within the Veterans Health Administration (VHA), this study evaluates predictors of non-fatal suicide attempts (NFSAs) among VHA patients who experienced MST. METHODS For VHA patients in fiscal year (FY) 2019 who previously screened positive for a history of MST, documented NFSAs were assessed. Using multivariable logistic regression, demographic, clinical, and VHA care utilization predictors of NFSAs were assessed. RESULTS Of the 212,215 VHA patients who screened positive for MST prior to FY 2019 and for whom complete race, service connection, and rurality information was available, 1742 (0.8%) had a documented NFSA in FY 2019. In multivariable logistic regression analyses, total physical and mental health morbidities were not associated with NFSA risk. Predictors of a documented NFSA included specific mental health diagnoses [adjusted odds ratio (aOR) range: 1.28-1.94], receipt of psychotropic medication prescriptions (aOR range: 1.23-2.69) and having a prior year emergency department visit (aOR = 1.32) or inpatient psychiatric admission (aOR = 2.15). CONCLUSIONS Among VHA patients who experienced MST, specific mental health conditions may increase risk of NFSAs, even after adjustment for overall mental health morbidity. Additionally, indicators of severity of mental health difficulties such as receipt of psychotropic medication prescriptions and inpatient psychiatric admissions are also associated with increased risk above and beyond risk associated with diagnoses. Findings highlight targets for suicide prevention initiatives among this vulnerable group within VHA and may help identify patients who would benefit from additional support.
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Affiliation(s)
- Tyler C Hein
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- TRAILS, a Project of Tides Center, Ann Arbor, Michigan, USA
| | - Karen Austin
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
| | - Peter P Grau
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan, USA
| | - Jessica A Keith
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention (11MHSP), Washington, DC, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Nathan J Claes
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention (11MHSP), Washington, DC, USA
| | - Nicholas W Bowersox
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health and Suicide Prevention (11MHSP), Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan, USA
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Grau PP, Browne J, Nelson SM, Austin K, Keith JA, Claes NJ, Kawentel LM, Bowersox NW. Engagement in posttraumatic stress disorder treatment for veterans who experienced military sexual trauma and are diagnosed with serious mental illness. Psychol Serv 2024:2024-53069-001. [PMID: 38358699 DOI: 10.1037/ser0000845] [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: 02/16/2024]
Abstract
It is important to ensure that veterans who have experienced military sexual trauma (MST) and have posttraumatic stress disorder (PTSD) have access to trauma-focused treatment. For veterans with serious mental illness (SMI), prior work documents decreased likelihood to receive trauma-focused care. This study focused on evaluating the engagement of Veterans Health Administration (VHA) patients diagnosed with PTSD and who have experienced MST in PTSD specialty care, as well as how this differs for veterans with SMI. Using VHA administrative data, all VHA patients who screened positive for MST prior to fiscal year 2019 (FY2019) were identified (N = 84,503). Based on information from FY2019, measures of psychiatric diagnosis status and VHA treatment participation were generated for all cohort members. Logistic regressions assessed whether there were differences in the likelihood to initiate PTSD care (1+ VHA PTSD specialty clinic encounter) or receive guideline-concordant levels of PTSD specialty care (8+ VHA PTSD specialty clinic encounter) during FY2019. Several other patient characteristics associated with decreased likelihood to receive VHA PTSD specialty servies were identified, including White race and older age. Patient SMI status was not significantly associated with likelihood to initiate or receive guideline-concordant levels of PTSD specialty care. Overall, PTSD treatment initiation was low (11% of veterans with SMI initiated PTSD specialty treatment, as opposed to 10% of veterans without SMI). Additional work is merited to identify ways that VHA is able to overcome barriers to trauma care participation experienced by persons who have experienced MST and been diagnosed with PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Peter P Grau
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Julia Browne
- Durham VA Health Care System Geriatric Research Education and Clinical Center
| | - Sharon M Nelson
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Karen Austin
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
| | - Jessica A Keith
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention
| | - Nathan J Claes
- Department of Veterans Affairs, Military Sexual Trauma Support Team, Office of Mental Health and Suicide Prevention
| | - Linda M Kawentel
- Quality Enhancement Research Initiative Center for Evaluation and Implementation Resources
| | - Nicholas W Bowersox
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, VA Ann Arbor Healthcare System
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Bowersox NW, Smith CM, Austin K, Bradford DW, Browne J, Nelson SM, Szymanski BR, Glynn SM. Mortality and suicidality in veterans health administration patients with newly-identified early episode psychosis. Schizophr Res 2024; 264:362-369. [PMID: 38219412 DOI: 10.1016/j.schres.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
Within the Veterans Affairs (VA), management of self-harm is a major clinical priority. However, there is limited information on risks for self-harm among VA patients with emerging psychotic disorders relative to VA patients with other emerging mental health conditions. Using information from fiscal years 2010 through 2018, a national cohort of VA patients 30 or younger was classified based on mental health diagnoses into three groups: 1) early episode psychosis (EEP), 2) non-early episode psychosis mental health (non-EEP MH), or 3) no mental health (no MH). Analyses focused on cohort members' risk for all-cause mortality, suicide mortality, and non-fatal suicide attempts (NFSA) during the year following initial diagnosis of mental health conditions (or first year of VA care, for the no MH group). In unadjusted analyses, the EEP group had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the non-EEP MH and no MH groups and the non-EEP MH had elevated rates of all-cause mortality, suicide mortality, and NFSA relative to the no MH group. After adjusting for demographics and care receipt, EEP status was unrelated to all-cause mortality but associated with increased suicide mortality risk and NFSA. Non-EEP MH status was associated with reduced risk of all-cause mortality but increased risk for NFSA. In the year following first diagnosis, VA patients with EEP are at increased risk for suicide mortality and self-harm even after accounting for other risk factors. Clinical services targeting this crucial time can help promote safety for this vulnerable group.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Colin M Smith
- Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA
| | - Karen Austin
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Daniel W Bradford
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA; Duke University Medical Center, Durham, NC, USA
| | - Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Sharon M Nelson
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Psychology Department, Pennsylvania State University, University Park, PA, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Shirley M Glynn
- VA Greater Los Angeles Healthcare System at West Los Angeles, Los Angeles, CA, USA; Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
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Bowersox NW, Browne J, Grau PP, Merrill SL, Haderlein TP, Llorente MD, Washington DL. COVID-19 mortality among veterans with serious mental illness in the veterans health administration. J Psychiatr Res 2023; 163:222-229. [PMID: 37230006 PMCID: PMC10171776 DOI: 10.1016/j.jpsychires.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis. METHODS National VHA administrative data was used to identify all patients (N = 52,916) who received a positive COVID-19 test result between March 1, 2020, and September 30, 2020. Mortality risk was assessed by SMI status via bivariate comparisons and multivariate regression analyses. RESULTS In unadjusted analyses, VHA patients with SMI overall and patients with bipolar disorder in particular did not experience increased mortality risk in the 30 days following a positive COVID test, although patients with schizophrenia had increased risk. Within adjusted analyses, patients with schizophrenia remained at increased mortality risk (OR = 1.38), but at reduced levels relative to previous evaluations in other healthcare settings. CONCLUSIONS Within VHA, patients with schizophrenia, but not those with bipolar disorder, experience increased mortality risk in the 30 days following a positive COVID-19 test. Large integrated healthcare settings such as VHA may offer services which may protect against COVID-19 mortality for vulnerable groups such as persons with SMI. Additional work is needed to identify practices which may reduce the risk of COVID-19 mortality among persons with SMI.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter P Grau
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie L Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA
| | - Taona P Haderlein
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Maria D Llorente
- Patient Care Services, Department of Veterans Affairs, Washington DC, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington DC, USA
| | - Donna L Washington
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Portillo EC, Lehmann MR, Hagen TL, Costner MG, Kettner JT, Bhardwaj SD, McFarland MS, Henderson BY, Bowersox NW, Zhao Q, Chui MA. Integration of the patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management. J Am Pharm Assoc (2003) 2022. [DOI: 10.1016/j.japh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Katz IR, Szymanski BR, Marder SR, Shotwell A, Hein TC, McCarthy JF, Bowersox NW. Comparative risks of all-cause mortality for Veterans with schizophrenia with ongoing receipt of clozapine and other antipsychotic medications. Psychiatry Res 2022; 313:114590. [PMID: 35567853 DOI: 10.1016/j.psychres.2022.114590] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/15/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022]
Abstract
To guide care for patients with schizophrenia, the Veterans Health Administration (VHA) evaluated the associations between current or recent use of clozapine and all-cause mortality and explored associations for other antipsychotic medications. Using a case-control design, patients with schizophrenia who died in fiscal years 2014-2018 were matched on age, sex, race, and VHA facility to up to 10 controls who were alive on the case's date of death (index date). Medication coverage during the 91 days before the index date was classified as none, partial (1-44 days), and consistent (45-91 days). Medication coverage patterns during the index period were compared to coverage patterns during the period of 92-182 days prior to index date with each medication coverage classified as no change, no coverage, increased, or decreased. Conditional logistic regression analyses controlling for patient characteristics identified no associations of consistent or increasing clozapine coverage with mortality; partial and decreasing coverage were associated with greater mortality and these effects did not differ from those of other the medications considered. Exploratory analyses considering non-clozapine antipsychotic agents suggest that consistent coverage by olanzapine may be associated with increased mortality, that mortality associated with olanzapine may be greater than aripiprazole, and that this effect can be attributed primarily to patients with diabetes. Further study of this topic is needed.
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Affiliation(s)
- Ira R Katz
- Department of Veterans Affairs, VA Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Benjamin R Szymanski
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Stephen R Marder
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA; Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, USA
| | - Abigail Shotwell
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA
| | - Tyler C Hein
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John F McCarthy
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, North Campus Research Complex, 2800 Plymouth Rd, Building 16, Room 016-233W, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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7
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Bradford DW, Austin K, Nelson SM, Merrill S, Bowersox NW. Predictors of High-Intensity Psychiatric Service Utilization by Veterans Health Administration Patients With Early Psychosis. Psychiatr Serv 2022; 73:287-292. [PMID: 34346728 DOI: 10.1176/appi.ps.202000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with early episode psychosis (EEP) have more negative care outcomes than do people with later episode psychosis (LEP), including higher levels of high-intensity psychiatric service use. It is unclear whether these differences are best explained by clinical differences between these two groups or whether people with EEP have specific treatment needs. An assessment of the treatment needs of patients with EEP can help inform the implementation of national treatment programming designed to provide better care to this group. METHODS Administrative data were used to compare characteristics of Veterans Health Administration patients who had EEP (i.e., a psychotic diagnosis, diagnosis history of ≤4 years, and age ≤30 years; N=4,595) with those with LEP (i.e., a psychotic diagnosis, longer diagnosis history, and older age; N=108,713) who received care during a 1-year evaluation period. The authors generated logistic regressions to assess the potential impact of EEP status on the likelihood of receipt of emergency department (ED) and inpatient psychiatric admissions while controlling for other patient characteristics. RESULTS Patients with EEP had elevated psychiatric comorbidity and mental health severity yet received equivalent outpatient mental health services. Patients with EEP were more likely to have had an ED visit for the treatment of a mental health condition and inpatient psychiatric admissions; this pattern persisted in analyses that controlled for group differences. CONCLUSIONS Patients with EEP have unique mental health treatment needs. The development and implementation of EEP-specific treatments could help address these needs and reduce the number of patients using higher levels of psychiatric services within large health care systems.
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Affiliation(s)
- Daniel W Bradford
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Karen Austin
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Sharon M Nelson
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Stephanie Merrill
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
| | - Nicholas W Bowersox
- Psychosocial Rehabilitation and Recovery Services (Bradford) and Serious Mental Illness Treatment Resource and Evaluation Center (Austin, Nelson, Merrill, Bowersox), Office of Mental Health and Suicide Prevention, U.S. Department of Veterans Affairs Central Office, Washington, D.C.; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina (Bradford); Department of Psychiatry, University of Michigan, Ann Arbor (Nelson, Bowersox)
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Bowersox NW, Williams V, Kawentel L, Kilbourne AM. Sustaining effective research/operational collaborations: Lessons learned from a National Partnered Evaluation Initiative. Healthcare (Basel) 2021; 9:100588. [DOI: 10.1016/j.hjdsi.2021.100588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 10/19/2022] Open
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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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10
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Nelson SM, Mach JJ, Hein TC, Abraham KM, Jedele JM, Bowersox NW. Access to timely mental health care treatment initiation among Veterans Health Administration patients with and without serious mental illness. Psychol Serv 2021; 19:488-493. [PMID: 34081526 DOI: 10.1037/ser0000534] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Timely care initiation is a priority within the Veterans Health Administration (VHA). Patients with serious mental illnesses (SMI) are a group that benefits from timely care initiation due to elevated risks of negative outcomes with delayed care. However, no evaluation has assessed whether VHA SMI patients disproportionately experience delays in mental health care initiation. VHA administrative care data were used to compare delays in mental health care initiation for VHA patients with and without SMI who had newly identified mental health needs. Analyses assessed rates of delayed initial mental health appointments within five settings (General Mental Health [GMH], Primary Care Mental Health Integration [PC-MHI], Post-Traumatic Stress Disorder [PTSD], Substance Use Disorder [SUD], and Psychosocial Rehabilitation clinics [PSR]). SMI patients were more likely to receive delayed initial appointments in three of five clinical settings (PTSD, SUD, PSR) and had significantly longer average wait times for an initial appointment when referred to the PTSD clinic for an initial appointment. Overall, SMI patients were equally as likely to receive delayed initial appointments. While VHA SMI patients were not more likely to experience delayed mental health care initiation overall, they were more likely to experience delays within three of the five treatment settings. Findings suggest that the majority of VHA SMI patients experience equivalent timeliness, though those with more complex needs, and particularly those with trauma-related care needs, may be more likely to experience treatment initiation delays. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Sharon M Nelson
- Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
| | - Jennifer J Mach
- Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
| | - Tyler C Hein
- Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
| | - Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
| | - Jenefer M Jedele
- Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC)
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Kilbourne AM, Braganza MZ, Bowersox NW, Goodrich DE, Miake-Lye I, Floyd N, Garrido MM, Frakt AB, Bever CT, Vega R, Ramoni R. Research Lifecycle to Increase the Substantial Real-world Impact of Research: Accelerating Innovations to Application. Med Care 2019; 57 Suppl 10 Suppl 3:S206-S212. [PMID: 31517789 PMCID: PMC6750195 DOI: 10.1097/mlr.0000000000001146] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND US health care systems face a growing demand to incorporate innovations that improve patient outcomes at a lower cost. Funding agencies increasingly must demonstrate the impact of research investments on public health. The Learning Health System promotes continuous institutional innovation, yet specific processes to develop innovations for further research and implementation into real-world health care settings to maximize health impacts have not been specified. OBJECTIVE We describe the Research Lifecycle and how it leverages institutional priorities to support the translation of research discoveries to clinical application, serving as a broader operational approach to enhance the Learning Health System. METHODS Developed by the US Department of Veterans Affairs Office of Research and Development Research-to-Real-World Workgroup, the Research Lifecycle incorporates frameworks from product development, translational science, and implementation science methods. The Lifecycle is based on Workgroup recommendations to overcome barriers to more direct translation of innovations to clinical application and support practice implementation and sustainability. RESULTS The Research Lifecycle posits 5 phases which support a seamless pathway from discovery to implementation: prioritization (leadership priority alignment), discovery (innovation development), validation (clinical, operational feasibility), scale-up and spread (implementation strategies, performance monitoring), and sustainability (business case, workforce training). An example of how the Research Lifecycle has been applied within a health system is provided. CONCLUSIONS The Research Lifecycle aligns research and health system investments to maximize real-world practice impact via a feasible pathway, where priority-driven innovations are adapted for effective clinical use and supported through implementation strategies, leading to continuous improvement in real-world health care.
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Affiliation(s)
- Amy M. Kilbourne
- Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
- Department of Psychiatry, University of Michigan Medical School
| | - Melissa Z. Braganza
- Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
| | - Nicholas W. Bowersox
- Department of Psychiatry, University of Michigan Medical School
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
| | - David E. Goodrich
- Center for Evaluation and Implementation Resources, VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
| | - Isomi Miake-Lye
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angles Healthcare System, Los Angeles, CA
| | - Nicole Floyd
- Evidence Synthesis Program Coordinating Center, Portland VA Health Care System, Portland, OR
| | - Melissa M. Garrido
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Austin B. Frakt
- Partnered Evidence-based Policy Resource Center, Boston VA Healthcare System
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Christopher T. Bever
- Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
| | - Ryan Vega
- Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
| | - Rachel Ramoni
- Veterans Health Administration, US Department of Veterans Affairs, Washington, DC
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12
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Panaite V, Bowersox NW, Zivin K, Ganoczy D, Kim HM, Pfeiffer PN. Individual and neighborhood characteristics as predictors of depression symptom response. Health Serv Res 2019; 54:586-591. [PMID: 30829408 DOI: 10.1111/1475-6773.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Assess whether neighborhood characteristics predict patient-reported outcomes for depression. DATA SOURCES VA electronic medical record data and U.S. census data. STUDY DESIGN Retrospective longitudinal cohort. DATA EXTRACTION METHODS Neighborhood and individual characteristics of patients (N = 4,269) with a unipolar depressive disorder diagnosis and an initial Patient Health Questionnaire (PHQ-9) score ≥10 were used to predict 50 percent improvement in 4-8-month PHQ-9 scores. PRINCIPAL FINDINGS The proportion of a patient's neighborhood living in poverty (OR = 0.98; 95% CI: 0.97-.1.00; P = 0.03) was associated with lower likelihood of depression symptom improvement in addition to whether the patient was black (OR = 0.76; 95% CI:0.61-0.96; P = 0.02) had PTSD (OR = 0.59; 95% CI:0.50-0.69; P < 0.001) or had any service-connected disability (OR = 0.73; 95% CI:0.61-0.87; P < 0.001). CONCLUSIONS Neighborhood poverty should be considered along with patient characteristics when determining likelihood of depression improvement.
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Affiliation(s)
- Vanessa Panaite
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Nicholas W Bowersox
- VA QUERI Center for Evaluation and Implementation Resources (CEIR), Ann Arbor, Michigan.,VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.,School of Public Health, Health Management and Policy, University of Michigan, Ann Arbor, Michigan.,Survey Research Center, Institute for Social Research, Ann Arbor, Michigan.,VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
| | - Dara Ganoczy
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan.,Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, Michigan
| | - Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.,VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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Burton CZ, Abraham KM, Grindle CM, Visnic S, Hack SM, McCarthy JF, Bowersox NW. Outreach to veterans with serious mental illness who are lost to care: Predictors of outreach contact. Psychol Serv 2018; 15:40-44. [DOI: 10.1037/ser0000140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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14
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Barry CN, Abraham KM, Weaver KR, Bowersox NW. Innovating team-based outpatient mental health care in the Veterans Health Administration: Staff-perceived benefits and challenges to pilot implementation of the Behavioral Health Interdisciplinary Program (BHIP). Psychol Serv 2017; 13:148-155. [PMID: 27148949 DOI: 10.1037/ser0000072] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the past decade, the demand for Veterans Health Administration (VHA) mental health care has increased rapidly. In response to the increased demand, the VHA developed the Behavioral Health Interdisciplinary Program (BHIP) team model as an innovative approach to transform VHA general outpatient mental health delivery. The present formative evaluation gathered information about pilot implementation of BHIP to understand the struggles and successes that staff experienced during facility transitions to the BHIP model. Using a purposive, nonrandom sampling approach, we conducted 1-on-1, semistructured interviews with 37 licensed and nonlicensed clinical providers and 13 clerical support staff assigned to BHIP teams in 21 facilities across the VHA. Interviews revealed that having actively involved facility mental health leaders, obtaining adequate staffing for teams to meet the requirements of the BHIP model, creating clear descriptions and expectations for team member roles within the BHIP framework, and allocating designated time for BHIP team meetings challenged many VHA sites but are crucial for successful BHIP implementation. Despite the challenges, staff reported that the transition to BHIP improved team work and improved patient care. Staff specifically highlighted the potential for the BHIP model to improve staff working relationships and enhance communication, collaboration, morale, and veteran treatment consistency. Future evaluations of the BHIP implementation process and BHIP team functioning focusing on patient outcomes, organizational outcomes, and staff functioning are recommended for fully understanding effects of transitioning to the BHIP model within VHA general mental health clinics and to identify best practices and areas for improvement. (PsycINFO Database Record
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15
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Lusk R, Lyubkin M, Chermack ST, Sanborn ML, Bowersox NW. Quasi-experimental evaluation of the impact of a cognitive behavioral pretreatment intervention for veterans seeking psychotherapy. Psychotherapy (Chic) 2016; 53:424-432. [PMID: 27918190 DOI: 10.1037/pst0000088] [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] [Indexed: 11/08/2022]
Abstract
Pretreatment interventions have documented efficacy for reducing initial therapy refusal and early therapy departure. However, these interventions have not been well-studied in diagnostically diverse patient populations or within Veterans Affairs (VA) health care settings. We designed a manualized 4-session group cognitive-behavioral therapy-based pretreatment intervention (PTI) for a diagnostically diverse population of Veterans referred for psychotherapy in a general mental health clinic (MHC) in a large VA hospital. Retrospective record review was used to collect patient data over a period of 6 months after their completion of the PTI. A sample of 50 Veterans who were referred for care at the MHC prior to the implementation of the PTI was used for comparison (NoPTI). Two hundred sixty-six Veterans participated in the PTI. Veterans who participated in the PTI were equally as likely to attend at least one psychotherapy session as NoPTI Veterans, but had more individual and group therapy sessions during the 6-month therapy tracking period. PTI participants were also less likely to have a psychiatric hospitalization during the 6-month therapy tracking period. Study findings suggest that PTIs are a good fit to a VA general mental health setting and effective in bolstering therapy attendance. Limitations and future directions are discussed. (PsycINFO Database Record
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Affiliation(s)
- Rebecca Lusk
- U.S. Department of Veterans Affairs, VA Ann Arbor Healthcare System
| | - Mark Lyubkin
- U.S. Department of Veterans Affairs, VA Ann Arbor Healthcare System
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16
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Sripada RK, Bowersox NW, Ganoczy D, Valenstein M, Pfeiffer PN. Self-Determination Theory and Outpatient Follow-Up After Psychiatric Hospitalization. Community Ment Health J 2016; 52:662-6. [PMID: 26319610 DOI: 10.1007/s10597-015-9929-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/06/2014] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess whether the constructs of self-determination theory-autonomy, competence, and relatedness-are associated with adherence to outpatient follow-up appointments after psychiatric hospitalization. 242 individuals discharged from inpatient psychiatric treatment within the Veterans Health Administration completed surveys assessing self-determination theory constructs as well as measures of depression and barriers to treatment. Medical records were used to count the number of mental health visits and no-shows in the 14 weeks following discharge. Logistic regression models assessed the association between survey items assessing theory constructs and attendance at mental healthcare visits. In multivariate models, none of the self-determination theory factors predicted outpatient follow-up attendance. The constructs of self-determination theory as measured by a single self-report survey may not reliably predict adherence to post-hospital care. Need factors such as depression may be more strongly predictive of treatment adherence.
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Affiliation(s)
- Rebecca K Sripada
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA. .,VA Ann Arbor Health Care System, Ann Arbor, MI, USA. .,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Nicholas W Bowersox
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Dara Ganoczy
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Marcia Valenstein
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48109, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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17
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Goodrich DE, Klingaman EA, Verchinina L, Goldberg RW, Littman AJ, Janney CA, Kim HM, Maguen S, Hoerster KD, Owen RR, Holleman RG, Roman P, Lai Z, Bowersox NW. Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program. Womens Health Issues 2016; 26:410-9. [PMID: 27365284 DOI: 10.1016/j.whi.2016.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/14/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Obesity disproportionately burdens individuals with serious mental illness (SMI), especially women. This observational study investigated whether there were sex differences in weight loss and program participation among veterans with SMI enrolled in the Veterans Health Administration's (VHA) MOVE! weight management program. PROCEDURES Participants were identified from a national cohort of 148,254 veterans enrolled in MOVE! during fiscal years 2008 through 2012 who attended two or more sessions within 12 months of enrollment. The cohort included those with International Classification of Disease, 9th Edition, Clinical Modification (ICD-9-CM) diagnoses for SMI, age less than 70 years, and weight data at baseline and one or more follow-up timepoints within approximately 1 year of enrollment (n = 8,943 men; n = 2,245 women). Linear mixed models assessed associations of sex with 6- and 12-month weight change from baseline, adjusting for demographic- and site-level variables. FINDINGS Both sexes averaged 6.4 (standard deviation, 4.6) sessions within 12 months; however, women with and without SMI participated at rates double their respective proportion rates among all VHA users. Participants averaged statistically significant weight loss at 6 months (men, -2.5 lb [95% CI, -2.8 to -2.1]; women, -2.4 lb [95% CI, -3.1 to -1.7]) and 12 months (men, -2.5 lb [95% CI, -2.8 to -2.2]; women, -2.9 lb [95% CI, -3.6 to -2.2]), but no sex-based difference in absolute weight loss at either timepoint. Slightly more women achieved 5% or greater (clinically significant) weight loss at the 12-month follow-up than did men (25.7% vs. 23.0%; p < .05). CONCLUSIONS Women with SMI participated in MOVE! at rates equivalent to or greater than men with SMI, with comparable weight loss. More women were Black, single, had bipolar and posttraumatic stress disorder, and higher service-connected disability, suggesting areas for program customization.
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Affiliation(s)
- David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Elizabeth A Klingaman
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland.
| | - Lilia Verchinina
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Richard W Goldberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland; Department of Psychiatry, University of Maryland School of Medicine, Division of Psychiatric Services Research, Baltimore, Maryland
| | - Alyson J Littman
- Epidemiologic Research and Information Center, VA Puget Sound Medical Center, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, Michigan
| | - Shira Maguen
- San Francisco VA Medical Center, San Francisco, California; Department of Psychiatry, University of California, San Francisco, California
| | - Katherine D Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle, Washington; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Richard R Owen
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Pia Roman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Nicholas W Bowersox
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
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18
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Sripada RK, Bohnert ASB, Teo AR, Levine DS, Pfeiffer PN, Bowersox NW, Mizruchi MS, Chermack ST, Ganoczy D, Walters H, Valenstein M. Social networks, mental health problems, and mental health service utilization in OEF/OIF National Guard veterans. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1367-78. [PMID: 26032182 DOI: 10.1007/s00127-015-1078-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 01/30/2015] [Accepted: 05/25/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal. METHODS Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization. RESULTS In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models. CONCLUSIONS General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care.
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Affiliation(s)
- Rebecca K Sripada
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA. .,VA Ann Arbor Health Care System, Ann Arbor, MI, USA. .,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Amy S B Bohnert
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alan R Teo
- Portland VA Medical Center, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Debra S Levine
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Paul N Pfeiffer
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas W Bowersox
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mark S Mizruchi
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen T Chermack
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Dara Ganoczy
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA
| | - Heather Walters
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marcia Valenstein
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road Bldg 16, Ann Arbor, MI, 48105, USA.,VA Ann Arbor Health Care System, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Kilbourne AM, Goodrich DE, Lai Z, Almirall D, Nord KM, Bowersox NW, Abraham KM. Reengaging veterans with serious mental illness into care: preliminary results from a national randomized trial. Psychiatr Serv 2015; 66:90-3. [PMID: 25554233 PMCID: PMC4640185 DOI: 10.1176/appi.ps.201300497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study compared effectiveness of an enhanced versus standard implementation strategy (Replicating Effective Programs [REP]) on site-level uptake of Re-Engage, a national program for veterans with serious mental illness. METHODS Mental health providers at 158 Veterans Affairs (VA) facilities were given REP-based manuals and training in Re-Engage, which involved identifying veterans who had not been seen in VA care for at least one year, documenting their clinical status, and coordinating further health care. After six months, facilities not responding to REP (N=88) were randomized to receive six months of facilitation (enhanced REP) or continued standard REP. Site-level uptake was defined as percentage of patients (N=1,531) with updated documentation or with whom contact was attempted. RESULTS Rate of Re-Engage uptake was greater for enhanced REP sites compared with standard REP sites (41% versus 31%, p=.01). Total REP facilitation time was 7.3 hours per site for six months. CONCLUSIONS Added facilitation improved short-term uptake of a national mental health program.
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Affiliation(s)
- Amy M Kilbourne
- With the exception of Dr. Almirall, the authors are with the Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, and the Department of Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail: ). Dr. Abraham is also with the Department of Psychology, University of Detroit Mercy, Detroit. Dr. Almirall is with the Institute for Social Research, University of Michigan, Ann Arbor
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20
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Kilbourne AM, Almirall D, Goodrich DE, Lai Z, Abraham KM, Nord KM, Bowersox NW. Enhancing outreach for persons with serious mental illness: 12-month results from a cluster randomized trial of an adaptive implementation strategy. Implement Sci 2014; 9:163. [PMID: 25544027 PMCID: PMC4296543 DOI: 10.1186/s13012-014-0163-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022] Open
Abstract
Background Few implementation strategies have been empirically tested for their effectiveness in improving uptake of evidence-based treatments or programs. This study compared the effectiveness of an immediate versus delayed enhanced implementation strategy (Enhanced Replicating Effective Programs (REP)) for providers at Veterans Health Administration (VA) outpatient facilities (sites) on improved uptake of an outreach program (Re-Engage) among sites not initially responding to a standard implementation strategy. Methods One mental health provider from each U.S. VA site (N = 158) was initially given a REP-based package and training program in Re-Engage. The Re-Engage program involved giving each site provider a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assessing patient clinical status, and where appropriate, facilitating appointments to VA health services. At month 6, sites considered non-responsive (N = 89, total of 3,075 patients), defined as providers updating documentation for less than <80% of patients on their list, were randomized to two adaptive implementation interventions: Enhanced REP (provider coaching; N = 40 sites) for 6 months followed by Standard REP for 6 months; versus continued Standard REP (N = 49 sites) for 6 months followed by 6 months of Enhanced REP for sites still not responding. Outcomes included patient-level Re-Engage implementation and utilization. Results Patients from sites that were randomized to receive Enhanced REP immediately compared to Standard REP were more likely to have a completed contact (adjusted OR = 2.13; 95% CI: 1.09–4.19, P = 0.02). There were no differences in patient-level utilization between Enhanced and Standard REP sites. Conclusions Enhanced REP was associated with greater Re-Engage program uptake (completed contacts) among sites not responding to a standard implementation strategy. Further research is needed to determine whether national implementation of Facilitation results in tangible changes in patient-level outcomes. Trial registration ISRCTN: ISRCTN21059161 Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0163-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Kilbourne
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104-2321, USA.
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Kristen M Abraham
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48221-3038, USA.
| | - Kristina M Nord
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Nicholas W Bowersox
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105, USA. .,Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
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Abstract
OBJECTIVE The objective was to assess the prevalence and impact of anxiety disorders on service utilization among Veterans Health Administration (VHA) patients with schizophrenia. METHODS This cross-sectional study examined diagnostic, utilization, and medication records included in the VHA National Psychosis Registry. Relationships between schizophrenia and anxiety disorders were evaluated along demographic and service utilization dimensions. RESULTS During fiscal year 2011, 23.8% (N=20,722) of 87,006 VHA patients with schizophrenia were diagnosed as having a comorbid anxiety disorder; 15.2% of the sample had a posttraumatic stress disorder (PTSD) diagnosis and 8.6% a non-PTSD anxiety disorder. Comorbid anxiety disorders were associated with increased psychiatric comorbidity (depression, personality disorder, and substance use disorder), higher rates of psychiatric and medical hospitalization, and increased utilization of outpatient mental health services. CONCLUSIONS Anxiety disorders are common among individuals with schizophrenia within the VHA and appeared in this study to convey additional disability in terms of psychiatric comorbidity and the need for increased psychiatric care. Future research should investigate ways to improve detection and enhance treatment provided to this population.
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Affiliation(s)
- Denis G Birgenheir
- At the time of the study, all authors were with Health Services Research and Development, U.S. Department of Veterans Affairs (VA) Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan (e-mail: ). Dr. Birgenheir is now with the Mental Health Department, VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska
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Birgenheir DG, Ilgen MA, Bohnert ASB, Abraham KM, Bowersox NW, Austin K, Kilbourne AM. Authors' response to the letter to the editor: "Pain in primary care patients with bipolar disorder". Gen Hosp Psychiatry 2014; 36:229. [PMID: 24359679 DOI: 10.1016/j.genhosppsych.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Denis G Birgenheir
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI.
| | - Mark A Ilgen
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Amy S B Bohnert
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Kristen M Abraham
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Nicholas W Bowersox
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Karen Austin
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI
| | - Amy M Kilbourne
- Department of Veterans Affairs Healthcare System, VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI; Department of Psychiatry, University of Michigan, Ann Arbor, MI
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Kilbourne AM, Abraham KM, Goodrich DE, Bowersox NW, Almirall D, Lai Z, Nord KM. Cluster randomized adaptive implementation trial comparing a standard versus enhanced implementation intervention to improve uptake of an effective re-engagement program for patients with serious mental illness. Implement Sci 2013; 8:136. [PMID: 24252648 PMCID: PMC3874628 DOI: 10.1186/1748-5908-8-136] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/14/2013] [Indexed: 11/17/2022] Open
Abstract
Background Persons with serious mental illness (SMI) are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage. Methods/Design This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services. Discussion Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site’s uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies. Trial registration Current Controlled Trials
ISRCTN21059161.
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Affiliation(s)
- Amy M Kilbourne
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
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Birgenheir DG, Ilgen MA, Bohnert ASB, Abraham KM, Bowersox NW, Austin K, Kilbourne AM. Pain conditions among veterans with schizophrenia or bipolar disorder. Gen Hosp Psychiatry 2013; 35:480-4. [PMID: 23639185 DOI: 10.1016/j.genhosppsych.2013.03.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 01/15/2013] [Revised: 03/15/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the rates of chronic, noncancer pain conditions in patients with schizophrenia or bipolar disorder within the Veterans Health Administration (VHA) System. METHOD This cross-sectional study used administrative data extracted from VHA treatment records of all individuals receiving VHA services in fiscal year 2008 (N=5,195,551). The associations between severe psychiatric disorders (schizophrenia and bipolar disorder) and chronic pain (arthritis, back pain, chronic pain, migraine, headache, psychogenic and neuropathic) were evaluated using a series of logistic regression analyses. RESULTS Veterans with schizophrenia [odds ratio (OR)=1.21] and bipolar disorder (OR=2.17) were significantly more likely to have chronic pain overall relative to veterans without these psychiatric conditions. These associations were slightly lower than for the association between depression and pain in this sample (OR=2.61). The highest associations between specific psychiatric diagnosis and pain condition were found with chronic pain, headache and psychogenic pain. CONCLUSIONS Noncancer pain conditions occur in elevated rates among patients with schizophrenia and bipolar disorder. Future research could further examine possible barriers to adequate pain treatment among people with serious mental illness, as well as the extent to which chronic pain might impact mental health recovery.
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Affiliation(s)
- Denis G Birgenheir
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs Healthcare System, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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Bowersox NW, Bohnert ASB, Ganoczy D, Pfeiffer PN. Inpatient psychiatric care experience and its relationship to posthospitalization treatment participation. Psychiatr Serv 2013; 64:554-62. [PMID: 23494079 DOI: 10.1176/appi.ps.002342012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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
OBJECTIVE This study used factor analysis of a Veterans Health Administration (VHA) survey to identify factors that measure satisfaction with inpatient treatment and to examine the factors' utility in evaluating treatment participation following discharge. METHODS The Survey of Healthcare Experiences of Patients (inpatient version) (I-SHEP) was mailed to 34,237 veterans who were discharged from inpatient to outpatient care in the VHA during fiscal year 2009 and was completed by 7,408 patients. A factor analysis of survey responses identified underlying I-SHEP factors and evaluated relationships between the factors, patient characteristics, and attendance at VHA mental health appointments within seven and 30 days of discharge. RESULTS The factor analysis identified three domains of satisfaction: respect and caring by nurses-overall hospital impression; involvement and information about care; and respect and caring by doctors. These factors demonstrated good internal consistency (Cronbach's α=.93, .90, and .94, respectively) and accounted for a moderate amount of variance in patient responses (r2=.167). Only the care involvement and information factor was associated with participation in follow-up care: increased satisfaction (one standard deviation change in scale score) was associated with improved odds of a mental health visit within seven and 30 days of discharge (odds ratio=1.14 and 1.17, respectively, p<.01). CONCLUSIONS After discharge, persons may not generalize satisfaction about the respect and caring shown by inpatient treatment teams toward their decision to attend outpatient care. Providing patients with information about treatment and involving them in care decisions during inpatient care may help facilitate the transition to outpatient settings.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Health Services Research and Development Service, Department of Veterans Affairs Ann Arbor Healthcare System, North Campus Research Complex, Ann Arbor, MI 48109, USA.
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Abraham KM, Lai Z, Bowersox NW, Goodrich DE, Visnic S, Burk JP, Kilbourne AM. Health care utilization prior to loss to care among veterans with serious mental illness. Psychiatr Serv 2013; 64:594-6. [PMID: 23728603 DOI: 10.1176/appi.ps.002382012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
OBJECTIVE This study examined the association between utilization of Veterans Affairs (VA) health services and the probability of treatment dropout among veterans with serious mental illness. METHODS Utilization of VA health services in the fiscal year (FY) before treatment dropout among veterans with serious mental illness who were lost to care for at least 12 months beginning in FYs 2008 or 2009 (N=6,687) was compared with utilization in FYs 2007 or 2008 among veterans with serious mental illness who remained in care (N=6,687). RESULTS The veterans (mean age=54) were predominantly male (91%) and Caucasian (76%). After accounting for demographic and clinical variables, the analyses found that more primary care and mental health outpatient visits and fewer general medical and mental health hospitalizations were associated with lower odds of dropout. CONCLUSIONS Engagement in outpatient health care was associated with lower odds of loss to care among veterans with serious mental illness.
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Affiliation(s)
- Kristen M Abraham
- Department of Psychiatry, Universityof Michigan Medical School, North Campus Research Complex, Ann Arbor, MI 48109, USA.
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Valenstein M, McCarthy JF, Ganoczy D, Bowersox NW, Dixon LB, Miller R, Visnic S, Slade EP. Assertive community treatment in veterans affairs settings: impact on adherence to antipsychotic medication. Psychiatr Serv 2013; 64:445-51, 451.e1. [PMID: 23412131 DOI: 10.1176/appi.ps.201100543] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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
OBJECTIVES Assertive community treatment (ACT) programs may improve patients' outcomes, in part by increasing adherence to antipsychotic medication. This study assessed the association between ACT enrollment and subsequent antipsychotic adherence. METHODS The authors identified a national sample of 763 Veterans Affairs (VA) patients with schizophrenia who were newly enrolled in ACT in fiscal years 2001 to 2004 and had valid antipsychotic medication possession ratios (MPRs) for five sequential six-month periods, the first occurring before ACT enrollment. Propensity scores were used to match ACT patients 1:1 with eligible veterans who did not initiate ACT. Logistic regression analyses and generalized estimating equations (GEE) were used to assess the association between ACT enrollment and subsequent antipsychotic adherence. Antipsychotic adherence was compared among ACT enrollees with high, partial, or no participation in ACT services. RESULTS Before the index date, there was no significant difference in rates of good adherence (MPR ≥.8) among subsequent ACT enrollees (72%) and patients in the control group (70%). However, in each of the four periods after enrollment, ACT enrollees were more likely to have MPRs ≥.8. In GEE analyses, ACT enrollment was associated with 2.3 greater odds of MPRs ≥.8 (95% confidence interval=1.9-2.7). Among ACT enrollees, higher levels of participation were associated with MPRs ≥.8. CONCLUSIONS In this large, national study, ACT enrollment was associated with higher levels of antipsychotic adherence among VA patients with schizophrenia. This association persisted over time and was greatest among those with higher levels of ACT use.
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Affiliation(s)
- Marcia Valenstein
- U.S. Department of Veterans Affairs Health Services Research and Development Service and the Serious Mental Illness Treatment, Resource and Evaluation Center, University of Michigan North Campus Research Complex, Building 16, Ann Arbor, MI 48109, USA.
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Abstract
OBJECTIVE The goal of this study was to evaluate relationships between recovery-supportive and integrated care features with health-related quality of life for veterans with serious mental illness. METHODS Data were utilized from several national Veterans Affairs (VA) databases for 2,394 patients with serious mental illness from 107 VA sites. Regressions evaluated relationships between health-related quality of life and care features. RESULTS Higher quality of life in regard to general health was associated with sites that offered peer support (β=1.79, p<.01) and with patients' increased understanding of their treatment (β=.80, p<.01), whereas lower quality of life was associated with sites with colocated general medical and mental health care providers (β=-1.37, p<.05) and family psychoeducation (β=-1.41, p<.05). Care at sites with vocational rehabilitation (β=1.38, p<.05), peer support (β=1.85, p<.05), and colocated providers (β=1.60, p<.05) and patients' increased understanding of care (β=.82, p<.01) were all associated with increased mental health quality of life, whereas reduced mental health quality of life was associated with care at sites with social skills training (β=-1.48, p<.05) or increased levels of care collaboration between primary care and mental health providers (β=-.27, p<.01). CONCLUSIONS Recovery-oriented care might be associated with increased health-related quality of life among patients with serious mental illness.
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Affiliation(s)
- Nicholas W Bowersox
- Health Services Research and Development, the Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, North Campus Research Complex, Building 10, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
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Bowersox NW, Szymanski BJ, McCarthy JF. Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in Veterans Affairs nursing homes. Am J Public Health 2012; 103:1325-31. [PMID: 23078462 DOI: 10.2105/ajph.2012.300783] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether reductions in inpatient psychiatric beds resulted in transinstitutionalization to nursing home care of patients with serious mental illness (SMI) within the Veterans Health Administration (VHA). METHODS We assessed trends in national and site-level inpatient psychiatric beds and nursing home patient demographics, service use, and functioning from the VHA National Patient Care Database, VHA Service Support Center Bed Control, and VHA Minimum Data Set. We estimated nursing home admission appropriateness using propensity score analyses based on Michigan Medicaid Nursing Facility Level of Care Determinations ratings. RESULTS From 1999 to 2007, the number of VHA inpatient psychiatric beds declined (43,894-40,928), the average inpatient length of stay decreased (33.1-19.0 days), and the prevalence of SMI in nursing homes rose (29.4%-43.8%). At site level, psychiatric inpatient bed availability was unrelated to SMI prevalence in nursing home admissions. However, nursing home residents with SMI were more likely to be inappropriately admitted than were residents without SMI (4.0% vs 3.2%). CONCLUSIONS These results suggest the need for increased attention to the long-term care needs of individuals with SMI. Additional steps need to be taken to ensure that patients with SMI are offered appropriate alternatives to nursing home care and receive adequate screening before admission to nursing home treatment.
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Affiliation(s)
- Nicholas W Bowersox
- Veterans Health Administration, Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management, Ann Arbor, MI 48109-2800, USA.
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Abstract
233 high-service-utilizing (HSU) psychiatric patients were recruited during an inpatient psychiatric treatment. They completed a questionnaire related to their treatment beliefs and were tracked via computerized medical records over 2 years. During the follow-up period, 79.8% were readmitted for additional inpatient psychiatric treatment. Survival analysis techniques were used to examine patients' rates of readmittance during the follow-up period. Number of previous year inpatient psychiatric days served as a significant predictor of readmittance status and time to readmission. The survival plot was split by previous-year inpatient days to examine the effect of this variable on readmission. Implications of findings are discussed.
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Affiliation(s)
- Nicholas W Bowersox
- Department of Veterans Affairs, Health Services Research and Development, Serious Mental Illness Treatment Research and Evaluation Center, PO Box 130170, Ann Arbor, MI 48113-0170, USA.
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Pfeiffer PN, Ganoczy D, Bowersox NW, McCarthy JF, Blow FC, Valenstein M. Depression care following psychiatric hospitalization in the Veterans Health Administration. Am J Manag Care 2011; 17:e358-e364. [PMID: 21902443] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess quality of depression care during the high-risk period following a psychiatric hospitalization. STUDY DESIGN Retrospective administrative data analysis. METHODS Using Veterans Health Administration (VHA) administrative data, we assessed mental health follow-up within 7 and 30 days of psychiatric hospitalizations for major depression from 2004 to 2008. Adequate antidepressant medication coverage and number of psychotherapy visits were assessed within 90 days of discharge. Multivariable logistic regression was used to identify patient demographic and clinical characteristics associated with each quality indicator. RESULTS Of the 45,587 patients discharged from a psychiatric inpatient stay with a diagnosis of major depressive disorder, 39.4% and 75.8% received an outpatient visit within 7 and 30 days of discharge, respectively; 58.7% of patients received adequate antidepressant coverage (72 of 90 days) and 12.9% received adequate psychotherapy encounters (8 visits). Receipt of outpatient mental health visits and of adequate psychotherapy were less likely among patients who were male, aged >35 or <65 years, had >3 major general medical comorbidities, lived >30 miles from a VHA clinic, or whose hospital length of stay was <7 days. Patients with comorbid substance use disorders were less likely to receive adequate antidepressant treatment. CONCLUSIONS To optimize evidence-based depression care after a psychiatric hospitalization, health systems might increase receipt of psychotherapy by considering potential barriers related to age, medical condition, and distance. Patients with comorbid substance use disorders or their providers may need additional services to support antidepressant treatment.
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Affiliation(s)
- Paul N Pfeiffer
- National Serious Mental Illness Treatment Resource and Evaluation Center and VA Center for Clinical Management Research, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Bowersox NW, Saunders SM, Wojcik JV. An Evaluation of the Utility of Statistical Versus Clinical Significance in Determining Improvement in Alcohol and Other Drug (AOD) Treatment in Correctional Settings. Alcoholism Treatment Quarterly 2009. [DOI: 10.1080/07347320802591700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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