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Estacio RO, Ambrose A, Bonaca MP, Flattery N, Hubley S, Kilbourn K, Coronel-Mockler S. Codesign and Integration of a Promotora-Led Behavioral Health Intervention to Support Cardiovascular Risk Reduction in Latino Communities. Circ Cardiovasc Qual Outcomes 2023; 16:e009349. [PMID: 37463253 DOI: 10.1161/circoutcomes.122.009349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Raymond O Estacio
- Colorado Prevention Center Community Health, Aurora (R.O.E., A.A., M.P.B., N.F., S.C.-M.)
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO (R.O.E.)
- General Internal Medicine, University of Colorado School of Medicine, University of Colorado, Aurora (R.O.E.)
| | - Ashley Ambrose
- Colorado Prevention Center Community Health, Aurora (R.O.E., A.A., M.P.B., N.F., S.C.-M.)
| | - Mark P Bonaca
- Colorado Prevention Center Community Health, Aurora (R.O.E., A.A., M.P.B., N.F., S.C.-M.)
- Division of Cardiology, University of Colorado School of Medicine, University of Colorado, Aurora (M.P.B.)
| | - Nick Flattery
- Colorado Prevention Center Community Health, Aurora (R.O.E., A.A., M.P.B., N.F., S.C.-M.)
| | - Samuel Hubley
- Renée Crown Wellness Institute, University of Colorado Boulder (S.H.)
- Department of Psychology and Neuroscience, University of Colorado Boulder (S.H.)
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Rossom RC, Peterson EL, Chawa MS, Prabhakar D, Hu Y, Yeh HH, Owen-Smith AA, Simon GE, Williams LK, Hubley S, Lynch F, Beck A, Daida YG, Lu CY, Ahmedani BK. Understanding TBI as a Risk Factor Versus a Means of Suicide Death Using Electronic Health Record Data. Arch Suicide Res 2023; 27:599-612. [PMID: 35118931 PMCID: PMC9881390 DOI: 10.1080/13811118.2022.2029782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this research was to examine predictors and characterize causes of suicide death in people with traumatic brain injury (TBI) and conduct sensitivity analyses with and without people whose first diagnosis of TBI occurred within 3 days of their suicide death. METHODS This case-control study examined suicide risk for people with TBI in eight Mental Health Research Network-affiliated healthcare systems. Sample 1 included 61 persons with TBI who died by suicide and their 75 matched controls with TBI who did not die by suicide between January 1, 2000, and December 31, 2013. Sample 2 excluded the 34 persons with TBI whose first TBI diagnosis occurred within 3 days of their suicide death and their 46 matched controls. Descriptive statistics characterized the sample stratified by cases and controls, while conditional logistic regression models estimated the adjusted odds of suicide. RESULTS Over half of suicide deaths occurred within 3 days of a person's first diagnosis of TBI in the larger sample. After excluding these persons, people with TBI were 2.84 (95% confidence interval [CI]: 2.15-2.73) times more likely to die by suicide than were people without TBI. Among those with TBI, men were 16.39 times (95% CI: 1.89-142.15) more likely to die by suicide than were women. CONCLUSIONS Accounting for TBI as a potential consequence of suicide attenuates the association between TBI and suicide, but a robust association persists-especially among men. Ultimately, all people with TBI should be carefully screened and monitored for suicide risk.HIGHLIGHTSPeople with traumatic brain injury (TBI) were at considerably elevated risk for suicide deathMen with TBI had significantly increased risk of suicide death compared to women with TBITBI timing suggests confusion of risk factors for and consequences of suicide.
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Zeber JE, Coleman KJ, Fischer H, Yoon T, Ahmedani BK, Beck A, Hubley S, Imel Z, Rossom RC, Shortreed SM, Stewart C, Waitzfelder BE, Simon GE. The impact of race and ethnicity on rates of return to psychotherapy for depression. Depress Anxiety 2017; 34:1157-1163. [PMID: 29095538 PMCID: PMC5718939 DOI: 10.1002/da.22696] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/21/2017] [Accepted: 09/28/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There are many limitations with the evidence base for the role of race and ethnicity in continuation of psychotherapy for depression. METHODS The study sample consisted of 242,765 patients ≥ 18 years old from six healthcare systems in the Mental Health Research Network (MHRN) who had a new episode of psychotherapy treatment for depression between 1/1/2010 and 12/31/2013. Data were from electronic medical records and organized in a Virtual Data Warehouse (VDW). The odds of racial and ethnic minority patients returning for a second psychotherapy visit within 45 days of the initial session were examined using multilevel regression. RESULTS The sample was primarily middle aged (68%, 30-64 years old), female (68.5%), and non-Hispanic white (50.7%), had commercial insurance (81.4%), and a low comorbidity burden (68.8% had no major comorbidities). Return rates within 45 days of the first psychotherapy visit were 47.6%. Compared to their non-Hispanic white counterparts, racial and ethnic minority patients were somewhat less likely to return to psychotherapy for a second visit (adjusted odds ratios [aORs] ranged from 0.80 to 0.90). Healthcare system was a much stronger predictor of return rates (aORs ranged from 0.89 to 5.53), while providers accounted for 21.1% of the variance in return rates. CONCLUSIONS Provider and healthcare system variation were stronger predictors of patient return to psychotherapy than race and ethnicity. More research is needed to understand why providers and healthcare systems determine psychotherapy return rates for patients of all racial and ethnic groups.
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Affiliation(s)
- John E. Zeber
- Baylor Scott & White Health, Center for Applied Health Research; Central Texas Veterans Health Care System; Temple, TX
| | - Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Heidi Fischer
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Tae Yoon
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Brian K. Ahmedani
- Henry Ford Health System, Behavioral Health Services and Center for Health Policy and Health Services Research, Detroit, MI
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO
| | | | - Zac Imel
- University of Utah, Salt Lake City, UT
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Ahmedani BK, Peterson EL, Hu Y, Rossom RC, Lynch F, Lu CY, Waitzfelder BE, Owen-Smith AA, Hubley S, Prabhakar D, Williams LK, Zeld N, Mutter E, Beck A, Tolsma D, Simon GE. Major Physical Health Conditions and Risk of Suicide. Am J Prev Med 2017; 53:308-315. [PMID: 28619532 PMCID: PMC5598765 DOI: 10.1016/j.amepre.2017.04.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/02/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Most individuals make healthcare visits before suicide, but many do not have a diagnosed mental health condition. This study seeks to investigate suicide risk among patients with a range of physical health conditions in a U.S. general population sample and whether risk persists after adjustment for mental health and substance use diagnoses. METHODS This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case-control study conducted in 2016 across eight Mental Health Research Network healthcare systems. A total of 19 physical health conditions were identified using diagnostic codes within the healthcare systems' Virtual Data Warehouse, including electronic health record and insurance claims data, during the year before index date. RESULTS Seventeen physical health conditions were associated with increased suicide risk after adjustment for age and sex (p<0.001); nine associations persisted after additional adjustment for mental health and substance use diagnoses. Three conditions had a more than twofold increased suicide risk: traumatic brain injury (AOR=8.80, p<0.001); sleep disorders; and HIV/AIDS. Multimorbidity was present in 38% of cases versus 15.5% of controls, and represented nearly a twofold increased risk for suicide. CONCLUSIONS Although several individual conditions, for example, traumatic brain injury, were associated with high risk of suicide, nearly all physical health conditions increased suicide risk, even after adjustment for potential confounders. In addition, having multiple physical health conditions increased suicide risk substantially. These data support suicide prevention based on the overall burden of physical health.
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Affiliation(s)
- Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; Behavioral Health Services, Henry Ford Health System, Detroit, Michigan.
| | | | - Yong Hu
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | - Frances Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Christine Y Lu
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Ashli A Owen-Smith
- School of Public Health, Georgia State University, Atlanta, Georgia; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Samuel Hubley
- Department of Family Medicine, University of Colorado at Denver, Denver, Colorado
| | - Deepak Prabhakar
- Behavioral Health Services, Henry Ford Health System, Detroit, Michigan
| | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
| | - Nicole Zeld
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Elizabeth Mutter
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia
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Boggs JM, Simon GE, Ahmedani BK, Peterson EL, Hubley S, Beck A. The Association of Firearm Suicide With Mental Illness, Substance Use Conditions, and Previous Suicide Attempts. Ann Intern Med 2017; 167:287-288. [PMID: 28672343 PMCID: PMC5555812 DOI: 10.7326/l17-0111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Brian K. Ahmedani
- Henry Ford Health System, Center for Health Policy and Health Services Research
- Henry Ford Health System, Behavioral Health Services
| | | | - Samuel Hubley
- Kaiser Permanente Colorado, Institute for Health Research
- University of Colorado at Denver, Department of Family Medicine
| | - Arne Beck
- Kaiser Permanente Colorado, Institute for Health Research
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Fuchs CH, Haradhvala N, Hubley S, Nash JM, Keller MB, Ashley D, Weisberg RB, Uebelacker LA. Physician actions following a positive PHQ-2: implications for the implementation of depression screening in family medicine practice. Fam Syst Health 2015; 33:18-27. [PMID: 25485822 DOI: 10.1037/fsh0000089] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Systematic screening of depression in primary care settings that have adequate follow-up and treatment is recommended. The Patient Health Questionnaire (PHQ-9) was developed as a depression screening measure for use in primary care. The PHQ-2, which includes just 2 items from the PHQ-9, is designed to be used as a first line depression screening measure, to be followed by the full PHQ-9 when a patient screens positive. However, completion of the first step in the process (PHQ-2) does not necessarily lead to completion of the second step (administration of the PHQ-9 when the PHQ-2 is positive), even when treatment and follow-up are available. The objective of the current study was to describe family medicine physicians' actions following a positive PHQ-2 and factors that affect their use of depression screening measures and treatment decisions. A retrospective chart review of 200 family medicine patients who screened positive on the PHQ-2 during an office visit was conducted. Additionally, 26 family medicine physicians in the practice were surveyed. Only 5% of patients with positive PHQ-2 scores were administered a PHQ-9. Physicians relied on their clinical judgment and prior knowledge about the patient's depression status to inform treatment decisions and cited time constraints and competing demands as reasons for not administered the PHQ-9. Physicians tended to treat depression with adequate doses of antidepressants and counseling. PHQ-2 screening did not necessarily lead to further evaluation, systematic follow-up, or changes in treatment. Implications for the implementation of depression screening in primary care settings are discussed.
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McCauley E, Gudmundsen G, Schloredt K, Martell C, Rhew I, Hubley S, Dimidjian S. The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence. J Clin Child Adolesc Psychol 2015; 45:291-304. [PMID: 25602170 DOI: 10.1080/15374416.2014.979933] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.
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Affiliation(s)
| | | | - Kelly Schloredt
- a Seattle Children's Research Institute and University of Washington
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Petty CR, Rosenbaum JF, Hirshfeld-Becker DR, Henin A, Hubley S, LaCasse S, Faraone SV, Biederman J. The child behavior checklist broad-band scales predict subsequent psychopathology: A 5-year follow-up. J Anxiety Disord 2008; 22:532-9. [PMID: 17521868 PMCID: PMC2408858 DOI: 10.1016/j.janxdis.2007.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 04/11/2007] [Accepted: 04/17/2007] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the utility of the Child Behavior Check list (CBCL) for identifying children of parents with panic disorder or major depression at high-risk for future psychopathology. METHODS Baseline Internalizing and Externalizing CBCL T-scores were used to predict subsequent depressive, anxiety, and disruptive behavior disorders at a 5-year follow-up in children of parents with panic disorder, major depression, or neither disorder. RESULTS The Internalizing scale predicted subsequent agoraphobia, generalized anxiety disorder, separation anxiety disorder, and social phobia. In contrast, the Externalizing scale predicted subsequent disruptive behavior disorders and major depression. CONCLUSIONS The convergence of these results with previous findings based on structured diagnostic interviews suggests that the CBCL broad-band scales can inexpensively and efficiently help identify children at high risk for future psychopathology within a population of children already at risk by virtue of parental psychopathology.
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Affiliation(s)
- Carter R Petty
- Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Warren 705, 15 Parkman Street, Boston, MA 02114, USA.
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