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Olson JR, Walker ER, Chwastiak L, Druss BG, Molfenter T, Benson F, Cerrato A, Gotham HJ. Supporting Implementation Through Online Learning Communities: Lessons Learned From a National Training and Technical Assistance Network. Eval Health Prof 2024; 47:178-191. [PMID: 38790111 DOI: 10.1177/01632787241237246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Recent implementation science frameworks highlight the role of training and technical assistance (TTA) in building workforce capacity to implement evidence-based practices (EBPs). However, evaluation of TTA is limited. We describe three case examples that highlight TTA by three regional centers in the national Mental Health Technology Transfer Center (MHTTC) network. Each MHTTC formed Learning Communities (LCs) to facilitate connections among behavioral health professionals with the goals of sharing implementation strategies, discussing best-practices, and developing problem solving techniques. Data on outcomes were collected through a combination of self-report surveys and qualitative interviews. LC participants reported strong connectedness, gains in knowledge and skills, improvements in implementation capacity, and intentions to advocate for organizational and systems-level change. Furthermore, across the case examples, we identified LC characteristics that are associated with participant perceptions of outcomes, including tailoring LC content to workforce needs, providing culturally relevant information, engaging leaders, forming connections among participants and trainers, and challenging participants' current workplace practices. These findings are interpreted through the lens of the Interactive Systems Framework, which focuses on how TTA, such as LCs, can facilitate connections between the theoretical and empirical foundations of interventions and the practices of implementing interventions in real-world settings to advance workforce capacity.
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Affiliation(s)
| | | | - Lydia Chwastiak
- Northwest Mental Health Technology Transfer Center (MHTTC), USA
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Reilly S, Hobson-Merrett C, Gibbons B, Jones B, Richards D, Plappert H, Gibson J, Green M, Gask L, Huxley PJ, Druss BG, Planner CL. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2024; 5:CD009531. [PMID: 38712709 PMCID: PMC11075124 DOI: 10.1002/14651858.cd009531.pub3] [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] [Indexed: 05/08/2024]
Abstract
BACKGROUND Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.
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Affiliation(s)
- Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Charley Hobson-Merrett
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Plymouth, UK
| | | | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Debra Richards
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
| | - Humera Plappert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Maria Green
- Pennine Health Care NHS Foundation Trust, Bury, UK
| | - Linda Gask
- Health Sciences Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter J Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Benjamin G Druss
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | - Claire L Planner
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Ku BS, Barrera Flores FJ, Congdon P, Yuan Q, Druss BG. The association between county-level mental health provider shortage areas and suicide rates in the United States during the COVID-19 pandemic. Gen Hosp Psychiatry 2024; 88:48-50. [PMID: 38492445 PMCID: PMC10999330 DOI: 10.1016/j.genhosppsych.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Prior literature has shown that mental health provider Health Professional Shortage Areas (MHPSAs) experienced a greater increase in suicide rates compared to non-shortage areas from 2010 to 2018. Although suicide rates have been on the rise, rates have slightly decreased during the COVID-19 pandemic. This study sought to characterize the differences in suicide rate trends during the pandemic by MHPSA status. METHOD We used generalized estimating equation regression to test the associations between MHPSA status and suicide rates from 2018 to 2021. Suicide deaths were obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. RESULTS MHPSA status was associated with higher suicide rates (adjusted IRR:1.088 [95% CI, 1.024-1.156]). Furthermore, there was a significant interaction between MHPSA status and year (adjusted IRR:1.056 [95% CI, 1.022-1.091]), such that suicide rates did not significantly change among MHPSAs but slightly decreased among non-MHPSAs from 2018 to 2021. CONCLUSIONS During the COVID-19 pandemic, there was a slight decrease in suicide rates among non-MHPSAs, while those with shortages experienced no significant changes in suicide rates. It will be important to closely monitor MHPSAs as continued at-risk regions for suicide as trendlines return to their pre-pandemic patterns.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Peter Congdon
- School of Geography, Queen Mary University of London, London E1 4NS, UK
| | - Qingyue Yuan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Shuey B, Halbisen A, Lakoma M, Zhang F, Argetsinger S, Williams EC, Druss BG, Wen H, Wharam JF. High-Acuity Alcohol-Related Complications During the COVID-19 Pandemic. JAMA Health Forum 2024; 5:e240501. [PMID: 38607643 PMCID: PMC11065164 DOI: 10.1001/jamahealthforum.2024.0501] [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] [Received: 11/17/2023] [Accepted: 02/15/2024] [Indexed: 04/13/2024] Open
Abstract
Importance Research has demonstrated an association between the COVID-19 pandemic and increased alcohol-related liver disease hospitalizations and deaths. However, trends in alcohol-related complications more broadly are unclear, especially among subgroups disproportionately affected by alcohol use. Objective To assess trends in people with high-acuity alcohol-related complications admitted to the emergency department, observation unit, or hospital during the COVID-19 pandemic, focusing on demographic differences. Design, Setting, and Participants This longitudinal interrupted time series cohort study analyzed US national insurance claims data using Optum's deidentified Clinformatics Data Mart database from March 2017 to September 2021, before and after the March 2020 COVID-19 pandemic onset. A rolling cohort of people 15 years and older who had at least 6 months of continuous commercial or Medicare Advantage coverage were included. Subgroups of interest included males and females stratified by age group. Data were analyzed from April 2023 to January 2024. Exposure COVID-19 pandemic environment from March 2020 to September 2021. Main Outcomes and Measures Differences between monthly rates vs predicted rates of high-acuity alcohol-related complication episodes, determined using claims-based algorithms and alcohol-specific diagnosis codes. The secondary outcome was the subset of complication episodes due to alcohol-related liver disease. Results Rates of high-acuity alcohol-related complications were statistically higher than expected in 4 of 18 pandemic months after March 2020 (range of absolute and relative increases: 0.4-0.8 episodes per 100 000 people and 8.3%-19.4%, respectively). Women aged 40 to 64 years experienced statistically significant increases in 10 of 18 pandemic months (range of absolute and relative increases: 1.3-2.1 episodes per 100 000 people and 33.3%-56.0%, respectively). In this same population, rates of complication episodes due to alcohol-related liver disease increased above expected in 16 of 18 pandemic months (range of absolute and relative increases: 0.8-2.1 episodes per 100 000 people and 34.1%-94.7%, respectively). Conclusions and Relevance In this cohort study of a national, commercially insured population, high-acuity alcohol-related complication episodes increased beyond what was expected in 4 of 18 COVID-19 pandemic months. Women aged 40 to 64 years experienced 33.3% to 56.0% increases in complication episodes in 10 of 18 pandemic months, a pattern associated with large and sustained increases in high-acuity alcohol-related liver disease complications. Findings underscore the need for increased attention to alcohol use disorder risk factors, alcohol use patterns, alcohol-related health effects, and alcohol regulations and policies, especially among women aged 40 to 64 years.
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Affiliation(s)
- Bryant Shuey
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
- Now with Center for Research on Health Care, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alyssa Halbisen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Matthew Lakoma
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Argetsinger
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Emily C. Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Hefei Wen
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - J. Franklin Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Duke University, Durham, North Carolina
- Duke-Margolis Institute for Health Policy, Durham, North Carolina
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Ku BS, Ren J, Compton MT, Druss BG, Guo S, Walker EF. The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends. Psychol Med 2024:1-9. [PMID: 38362835 DOI: 10.1017/s0033291724000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents. METHODS Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends. RESULTS Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted β = 0.05; 95% CI: 0.01-0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted β = -0.02; 95% CI: -0.04 to <-0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted β = 0.07; 95% CI: 0.03-0.11). However, among those with more close friends, the association was non-significant (adjusted β = 0.03; 95% CI: -0.01 to 0.07). CONCLUSIONS Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jiyuan Ren
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shuyi Guo
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Druss BG, Gülöksüz S, Mathalon DH, Perkins DO, Tsuang MT, Walker EF, Woods SW, Carrión RE. Associations Between Childhood Area-Level Social Fragmentation, Maladaptation to School, and Social Functioning Among Healthy Youth and Those at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:1437-1446. [PMID: 37358832 PMCID: PMC10686327 DOI: 10.1093/schbul/sbad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although studies have identified social fragmentation as an important risk factor for schizophrenia and other psychotic disorders, it is unknown whether it may impact social functioning. This study investigates whether social fragmentation during childhood predicts maladaptation to school as well as social functioning during childhood and adulthood. STUDY DESIGN Data were collected from the North American Prodrome Longitudinal Study. Participants included adults at clinical high risk for psychosis (CHR-P) and healthy comparisons (HC). Maladaptation to school and social functioning during childhood were assessed retrospectively and social functioning in adulthood was assessed at baseline. STUDY RESULTS Greater social fragmentation during childhood was associated with greater maladaptation to school (adjusted β = 0.21; 95% CI: 0.02 to 0.40). Social fragmentation was not associated with social functioning during childhood (unadjusted β = -0.08; 95% CI: -0.31 to 0.15). However, greater social fragmentation during childhood predicted poorer social functioning in adulthood (adjusted β = -0.43; 95% CI: -0.79 to -0.07). Maladaptation to school mediated 15.7% of the association between social fragmentation and social functioning. The association between social fragmentation and social functioning was stronger among adults at CHR-P compared to HC (adjusted β = -0.42; 95% CI: -0.82 to -0.02). CONCLUSIONS This study finds that social fragmentation during childhood is associated with greater maladaptation to school during childhood, which in turn predicts poorer social functioning in adulthood. Further research is needed to disentangle aspects of social fragmentation that may contribute to social deficits, which would have implications for the development of effective interventions at the individual and community levels.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sinan Gülöksüz
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Hockenberry JM, Wen H, Druss BG, Loux T, Johnston KJ. No Improvement In Mental Health Treatment Or Patient-Reported Outcomes At Medicare ACOs For Depression And Anxiety Disorders. Health Aff (Millwood) 2023; 42:1478-1487. [PMID: 37931192 PMCID: PMC11122701 DOI: 10.1377/hlthaff.2023.00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Accountable care organizations (ACOs) have become Medicare's dominant care model because policy makers believe that ACOs will improve the quality and efficiency of care for chronic conditions. Depression and anxiety disorders are the most prevalent and undertreated chronic mental health conditions in Medicare. Yet it is unknown whether ACOs influence treatment and outcomes for these conditions. To explore these questions, this longitudinal study used data from the 2016-19 Medicare Current Beneficiary Survey, linked to validated depression and anxiety symptom instruments, among diagnosed and undiagnosed fee-for-service Medicare patients with these conditions. Among patients not enrolled in ACOs at baseline, those who newly enrolled in ACOs in the following year were 24 percent less likely to have their depression or anxiety treated during the year than patients who remained unenrolled in ACOs, and they saw no relative improvements at twelve months in their depression and anxiety symptoms. Better-designed incentives are needed to motivate Medicare ACOs to improve mental health treatment.
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Affiliation(s)
| | - Hefei Wen
- Hefei Wen, Harvard University and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Travis Loux
- Travis Loux, Saint Louis University, St. Louis, Missouri
| | - Kenton J Johnston
- Kenton J. Johnston , Washington University in St. Louis, St. Louis, Missouri
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Ku BS, Collins M, Anglin DM, Diomino AM, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Cornblatt BA, Druss BG, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Woods SW, Walker EF. Associations between childhood ethnoracial minority density, cortical thickness, and social engagement among minority youth at clinical high-risk for psychosis. Neuropsychopharmacology 2023; 48:1707-1715. [PMID: 37438421 PMCID: PMC10579230 DOI: 10.1038/s41386-023-01649-6] [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: 04/28/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
An ethnoracial minority density (EMD) effect in studies of psychotic spectrum disorders has been observed, whereby the risk of psychosis in ethnoracial minority group individuals is inversely related to the proportion of minorities in their area of residence. The authors investigated the relationships among area-level EMD during childhood, cortical thickness (CT), and social engagement (SE) in clinical high risk for psychosis (CHR-P) youth. Data were collected as part of the North American Prodrome Longitudinal Study. Participants included 244 ethnoracial minoritized (predominantly Hispanic, Asian and Black) CHR-P youth and ethnoracial minoritized healthy controls. Among youth at CHR-P (n = 164), lower levels of EMD during childhood were associated with reduced CT in the right fusiform gyrus (adjusted β = 0.54; 95% CI 0.17 to 0.91) and right insula (adjusted β = 0.40; 95% CI 0.05 to 0.74). The associations between EMD and CT were significantly moderated by SE: among youth with lower SE (SE at or below the median, n = 122), lower levels of EMD were significantly associated with reduced right fusiform gyrus CT (adjusted β = 0.72; 95% CI 0.29 to 1.14) and reduced right insula CT (adjusted β = 0.57; 95% CI 0.18 to 0.97). However, among those with greater SE (n = 42), the associations between EMD and right insula and fusiform gyrus CT were not significant. We found evidence that lower levels of ethnic density during childhood were associated with reduced cortical thickness in regional brain regions, but this association may be buffered by greater levels of social engagement.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Meghan Collins
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Deidre M Anglin
- Department of Psychology, The City College of New York, City University of New York, New York, NY, USA
- The Graduate Center, City University of New York, New York, NY, USA
| | - Anthony M Diomino
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychology, The City College of New York, City University of New York, New York, NY, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Matcheri Keshavan
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Scott W Woods
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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Aftab A, Druss BG. Addressing the Mental Health Crisis in Youth-Sick Individuals or Sick Societies? JAMA Psychiatry 2023; 80:863-864. [PMID: 37342020 DOI: 10.1001/jamapsychiatry.2023.1298] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
This Viewpoint examines whether increased anxiety and depression among youth is a true epidemic of psychiatric disorders or a reflection of sociopolitical adversity and disorganization.
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Affiliation(s)
- Awais Aftab
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Kim K, Pacula RL, Dick AW, Stein BD, Druss BG, Agbese E, Cohrs AC, Leslie DL. Medical marijuana access and prolonged opioid use among adolescents and young adults. Am J Addict 2023; 32:479-487. [PMID: 37291067 PMCID: PMC10686234 DOI: 10.1111/ajad.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Laws liberalizing access to medical marijuana are associated with reduced opioid analgesic use among adults, but little is known about the impact of such policies on adolescents and young adults. METHODS This retrospective cohort study used 2005 to 2014 claims from MarketScan® Commercial database, which covers all 50 states and Washington D.C. The sample included 195,204 adolescent and young adult patients (aged 12-25) who underwent one of 13 surgical procedures. RESULTS Of the 195,204 patients, 4.8% had prolonged opioid use. Several factors were associated with a higher likelihood of prolonged opioid use, including being female (adjusted odds ratio [aOR], 1.27; 95% confidence interval [CI], 1.21-1.33), longer hospital stay (aOR, 1.04; 95% CI, 1.02-1.06), greater days of index opioid supply (8-14 days: aOR, 1.39, 95% CI, 1.33-1.45; greater than 14 days: aOR, 2.42, 95% CI, 2.26-2.59), rural residence (aOR, 1.07; 95% CI, 1.01-1.14), and cholecystectomy (aOR, 1.16; 95% CI, 1.08-1.25). There was not a significant association of medical marijuana dispensary laws on prolonged opioid use (aOR, 0.98; 95% CI, 0.81-1.18). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Medical marijuana has been suggested as a substitute for opioids, but our results focusing on adolescents and young adults provide new evidence that this particularly vulnerable population does not exhibit reductions in prolonged use of opioids after surgery when they have legal access to medical marijuana. These findings are the first to demonstrate potentially important age differences in sustained use of opioids, and point to the need for prescriber oversight and management with this vulnerable population.
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Affiliation(s)
- Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rosalie L. Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | | | | | - Benjamin G. Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Austin C. Cohrs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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11
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Ku BS, Walker EF, Druss BG, Murray CR, Compton MT. Residential instability during adolescence predicts earlier age at onset of psychosis: The moderating role of extraversion. Early Interv Psychiatry 2023; 17:527-531. [PMID: 36650675 PMCID: PMC10175105 DOI: 10.1111/eip.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/20/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Residential instability (RI) during adolescence is associated with poor health outcomes. Also, extraversion has been shown to be a moderator of these associations. However, the associations between RI, extraversion, and age at onset of psychosis (AOP) remain unknown. METHODS Data were collected from patients with first-episode psychosis (FEP). Linear regression models assessed the association between RI during adolescence and AOP. Extraversion was tested as a moderator using the interaction term RI-by-extraversion. RESULTS Among 89 participants with FEP, both RI (adjusted β = -.278, p = .006) and the interaction term RI-by-extraversion (adjusted β = .290, p < .001) were associated with earlier AOP. Stratified analyses showed that RI was only significantly associated with earlier AOP among those with low extraversion (adjusted β = -.598, p < .001). CONCLUSIONS RI predicted earlier AOP and this association was moderated by extraversion. These findings suggest that extraversion may buffer the negative relationship between RI and AOP. Future research should replicate these findings.
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Affiliation(s)
- Benson S. Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Camille R. Murray
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael T. Compton
- New York State Psychiatric Institute, New York, NY, United States
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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12
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Walker ER, Moore E, Tapscott S, Howard L, Tucker SJ, Hayes R, Johnson C, Li J, Druss BG. Hearing Their Voices: Engaging Certified Peer Specialists in Dialogues About Racism and Recovery. Psychiatr Serv 2022:appips20220146. [PMID: 36415993 DOI: 10.1176/appi.ps.20220146] [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: 11/24/2022]
Abstract
Certified peer specialists (CPSs) may be uniquely situated to help address inequities within the behavioral health system. However, CPSs and other mental health care providers often do not have opportunities to discuss their experiences with racism in the workplace. The Southeast Mental Health Technology Transfer Center and Georgia Mental Health Consumer Network offered the six-part Racism and Recovery event series as a space for such discussions (N=356 participants). Participant responses on the Government Performance and Results Act survey (N=239) and supplemental Qualtrics survey (N=213) identified potential actions at the individual and organizational levels for disrupting racism. The responses indicated that the series was a feasible and well-received model for engaging diverse participants.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Emily Moore
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Stephanie Tapscott
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Leah Howard
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Sharon Jenkins Tucker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Rosalind Hayes
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Chris Johnson
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Jianheng Li
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard) and Department of Health Policy and Management (Moore, Tapscott, Li, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker (Tucker, Hayes, Johnson)
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13
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Cohrs AC, Husnul Khotimah DE, Dick AW, Stein BD, Pacula RL, Druss BG, Kim K, Leslie DL. Spatial and temporal trends in the diagnosis of opioid-related problems in commercially-insured adolescents and young adults. Prev Med 2022; 163:107194. [PMID: 35970406 PMCID: PMC10654710 DOI: 10.1016/j.ypmed.2022.107194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022]
Abstract
Little is known about the extent to which the prevalence of opioid-related problems (ORPs) varies among U.S. adolescents and young adults across geographic regions and over time, information that can help to guide policies that aim to curb the opioid epidemic. A retrospective, cross-sectional design was used to analyze longitudinal claims data from privately insured individuals aged 12-64 years who had an outpatient or inpatient diagnosis of an ORP in the years 2005-2018. The prevalence of opioid-related problem diagnoses (per 10,000) varied considerably across census divisions, both over time and between age groups. Knowledge of the origin of and variation in diagnosed opioid-related problems in terms of age group and census division is important so that interventions and policies can be more targeted and effective.
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Affiliation(s)
- Austin C Cohrs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America.
| | - Diah E Husnul Khotimah
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Andrew W Dick
- RAND Corporation, Boston, MA, United States of America
| | | | - Rosalie Liccardo Pacula
- Sol Price School of Public Policy, Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, United States of America
| | - Benjamin G Druss
- Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Kyungha Kim
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
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14
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Goldman ML, Swartz MS, Norquist GS, Horvitz-Lennon M, Balasuriya L, Jorgensen S, Greiner M, Brinkley A, Hayes H, Isom J, Dixon LB, Druss BG. Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type. Psychiatr Serv 2022; 73:1165-1168. [PMID: 35378994 DOI: 10.1176/appi.ps.202100428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marvin S Swartz
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Grayson S Norquist
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marcela Horvitz-Lennon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lilanthi Balasuriya
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Shea Jorgensen
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Miranda Greiner
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Amy Brinkley
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Heath Hayes
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Jessica Isom
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lisa B Dixon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Benjamin G Druss
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
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15
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Walker ER, Gonzalez T, Howard L, Nguyen JK, Tucker SJ, Hayes R, Johnson C, Moore E, Druss BG. Qualitative Study of Certified Peer Specialists' Experiences Delivering Peer Support Services During the COVID-19 Pandemic. Psychiatr Serv 2022; 74:539-542. [PMID: 36128695 DOI: 10.1176/appi.ps.202100662] [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 The purpose of this qualitative study was to examine the experiences of certified peer specialists (CPSs) in delivering telehealth services during the COVID-19 pandemic. METHODS Fourteen semistructured interviews with CPSs were conducted from August to November 2020. Data were analyzed by using thematic analysis. RESULTS Helpful support from employers during the transition to telehealth included clear communication and access to training on telehealth technologies. Main barriers and facilitators were related to interpersonal relationships and logistical factors. CPSs reported that telehealth allowed them to continue to support the peers they serve but that the quality of interactions was not as good as with in-person services. Logistical challenges included inadequate equipment and Internet access. CONCLUSIONS To support CPSs in delivering telehealth, employers can engage them in open and transparent communication about guidelines for service delivery, provide training and equipment, and allow them the flexibility to tailor service delivery modalities to the peers they serve.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Tatiana Gonzalez
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Leah Howard
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Julie K Nguyen
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Sharon Jenkins Tucker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Roslind Hayes
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Chris Johnson
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Emily Moore
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Howard), Hubert Department of Global Health (Gonzalez), and Department of Health Policy and Management (Nguyen, Moore, Druss), Rollins School of Public Health, Emory University, Atlanta; Georgia Mental Health Consumer Network, Tucker, Georgia (Tucker, Hayes, Johnson)
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16
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Ku BS, Aberizk K, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Carrión RE, Compton MT, Cornblatt BA, Druss BG, Mathalon DH, Perkins DO, Tsuang MT, Woods SW, Walker EF. The Association Between Neighborhood Poverty and Hippocampal Volume Among Individuals at Clinical High-Risk for Psychosis: The Moderating Role of Social Engagement. Schizophr Bull 2022; 48:1032-1042. [PMID: 35689540 PMCID: PMC9434451 DOI: 10.1093/schbul/sbac055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Reductions in hippocampal volume (HV) have been associated with both prolonged exposure to stress and psychotic illness. This study sought to determine whether higher levels of neighborhood poverty would be associated with reduced HV among individuals at clinical high-risk for psychosis (CHR-P), and whether social engagement would moderate this association. This cross-sectional study included a sample of participants (N = 174, age-range = 12-33 years, 35.1% female) recruited for the second phase of the North American Prodrome Longitudinal Study. Generalized linear mixed models tested the association between neighborhood poverty and bilateral HV, as well as the moderating role of social engagement on this association. Higher levels of neighborhood poverty were associated with reduced left (β = -0.180, P = .016) and right HV (β = -0.185, P = .016). Social engagement significantly moderated the relation between neighborhood poverty and bilateral HV. In participants with lower levels of social engagement (n = 77), neighborhood poverty was associated with reduced left (β = -0.266, P = .006) and right HV (β = -0.316, P = .002). Among participants with higher levels of social engagement (n = 97), neighborhood poverty was not significantly associated with left (β = -0.010, P = .932) or right HV (β = 0.087, P = .473). In this study, social engagement moderated the inverse relation between neighborhood poverty and HV. These findings demonstrate the importance of including broader environmental influences and indices of social engagement when conceptualizing adversity and potential interventions for individuals at CHR-P.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | | | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, USA
| | | | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CTUSA
- Department of Psychology, Yale University, New Haven, CTUSA
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GAUSA
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco, CAUSA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CTUSA
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17
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Larsen AR, Cummings JR, von Esenwein SA, Druss BG. Trends in Alcohol Use Disorder Treatment Utilization and Setting From 2008 to 2017. Psychiatr Serv 2022; 73:991-998. [PMID: 35193376 DOI: 10.1176/appi.ps.202000323] [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 Little is known about recent trends in treatment for alcohol use disorder. The authors used national data to examine treatment trends among individuals with alcohol use disorder. METHODS A sample of nonelderly adults (ages 18-64 years, N=36,707) with alcohol use disorder was identified from the National Survey on Drug Use and Health. Multinomial logistic regression analysis was conducted to examine trends in treatment for alcohol use disorder in 2008-2010, 2011-2013, and 2014-2017 in any medical setting (hospitals, rehabilitation centers, mental health centers, emergency departments, and private doctors' offices), self-help groups only (no medical setting), and no setting (i.e., no treatment). Additional analyses investigated trends in mental health treatment. Regression models adjusted for predisposing, enabling, and need-related characteristics. RESULTS Among those with an alcohol use disorder, the percentage who received any treatment was significantly lower in 2011-2013 (5.6%) than in 2008-2010 (6.9%) (p<0.05). In adjusted analyses, the probability of receiving no treatment increased by 1.5 percentage points in 2014-2017 (95% CI=0.5-2.5) compared with the 2008-2010 baseline. Significant declines were observed in the receipt of any treatment in a medical setting (marginal effect [ME]=-1.0%, 95% CI=-2.0 to -0.0) and self-help treatment only (ME=-0.5%, 95% CI=-0.8 to -0.1) in 2014-2017 compared with the baseline period. The probability of receiving any mental health treatment did not change during the study period. CONCLUSIONS Among persons with an alcohol use disorder, treatment declined from 2008 to 2017. Future studies should examine the mechanisms that may be responsible for this decline.
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Affiliation(s)
- Aidan R Larsen
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Janet R Cummings
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Silke A von Esenwein
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
| | - Benjamin G Druss
- Mathematica Policy Research, Washington, D.C. (Larsen); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Cummings, Druss); Center for Public Partnerships and Research, University of Kansas, Lawrence (von Esenwein)
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18
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Druss BG, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Woods SW, Walker EF. The associations between area-level residential instability and gray matter volumes from the North American Prodrome Longitudinal Study (NAPLS) consortium. Schizophr Res 2022; 241:1-9. [PMID: 35066429 PMCID: PMC8960350 DOI: 10.1016/j.schres.2021.12.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Area-level residential instability (ARI), an index of social fragmentation, has been shown to explain the association between urbanicity and psychosis. Urban upbringing has been shown to be associated with reduced gray matter volumes (GMV)s of brain regions corresponding to the right caudal middle frontal gyrus (CMFG) and rostral anterior cingulate cortex (rACC). We hypothesize that greater ARI will be associated with reduced right CMFG and rACC GMVs. METHODS Data were collected at baseline as part of the North American Prodrome Longitudinal Study Phase 2. Counties where participants resided during childhood were geographically coded using the US Census to area-level factors. ARI was defined as the percentage of residents living in a different house 5 years ago. Generalized linear mixed models tested associations between ARI and GMVs. RESULTS This study included 29 healthy controls (HC)s and 64 clinical high risk for psychosis (CHR-P) individuals who were aged 12 to 24 years, had remained in their baseline residential area, and had magnetic resonance imaging scans. ARI was associated with reduced right CMFG (adjusted β = -0.258; 95% CI = -0.502 to -0.015) and right rACC volumes (adjusted β = -0.318; 95% CI = -0.612 to -0.023). The interaction term (ARI-by-diagnostic group) in the prediction of both brain regions was not significant, indicating that the relationships between ARI and regional brain volumes held for both CHR-P and HCs. CONCLUSIONS ARI may adversely impact similar brain regions as urban upbringing. Further investigation into the potential mechanisms of the relationship between ARI and neurobiology, including social stress, is needed.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, United States; Department of Psychology, Yale University, New Haven, CT, United States
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
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19
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Abstract
Objective: Accumulating evidence implicates social context in the etiology of psychosis. One important line of epidemiologic research pointing to a potentially causal role of social context pertains to what is termed social fragmentation. The authors conducted a systematic review of the relationship between area-level social fragmentation and psychosis. Data Sources: Three databases (MEDLINE, PsycINFO, and Web of Science) were searched from inception to May 2, 2021. There were no language restrictions. Search terms were those that identify the area-level orientation, social fragmentation, sample, and outcome. Study Selection: Inclusion criteria were the following: (1) social environment measured at the area level with (2) psychosis outcomes (incidence rates, prevalence of psychosis or schizophrenia, age at onset of psychosis, psychotic symptom severity, and duration of untreated psychosis). In total, 579 research articles were identified, and 19 were eligible to be included in this systematic review. Data Extraction: Two reviewers independently screened, extracted data from, and coded all articles. Results: Evidence from 14 of 19 articles indicates that area-level characteristics reflecting social fragmentation are associated with higher psychosis rates and other outcomes of psychosis even after controlling for other area-level characteristics including deprivation, social capital, race/ethnicity, and urbanicity and individual-level characteristics including age, sex, migrant status, and socioeconomic status. Conclusions: In conclusion, this review finds evidence that measures of area-level social fragmentation are associated with higher psychosis rates. Further research into mechanisms is needed to better characterize this association.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Corresponding author: Benson S. Ku, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr NE #300, Atlanta, GA 30329
| | - Michael T Compton
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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20
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Balasuriya L, Quinton JK, Canavan ME, Holland ML, Edelman EJ, Druss BG, Ross JS. The Association Between History of Depression and Access to Care Among Medicare Beneficiaries During the COVID-19 Pandemic. J Gen Intern Med 2021; 36:3778-3785. [PMID: 34405350 PMCID: PMC8370448 DOI: 10.1007/s11606-021-06990-4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is associated with a higher risk for experiencing barriers to care, unmet social needs, and poorer economic and mental health outcomes. OBJECTIVE To determine the impact of COVID-19 on ability to access care, social and economic needs, and mental health among Medicare beneficiaries with and without depression. DESIGN AND PARTICIPANTS Cross-sectional study using data from the 2020 Medicare Current Beneficiary Survey COVID-19 Summer Supplement Public Use File. MAIN MEASURES Access to medical care, inability to access food, medications, household supplies, pay rent or mortgage, feelings of economic security, and mental health effects since COVID-19, risk-adjusted for sociodemographic and clinical characteristics. KEY RESULTS Participants were 11,080 Medicare beneficiaries (nationally representative of 55,960,783 beneficiaries), 27.0% with and 73.0% without a self-reported history of depression. As compared to those without a history of depression, Medicare beneficiaries with a self-reported history of depression were more likely to report inability to get care because of COVID-19 (aOR = 1.28, 95% CI, 1.09, 1.51; P = 0.003), to get household supplies such as toilet paper (aOR = 1.32, 95% CI, 1.10, 1.58; P = 0.003), and to pay rent or mortgage (aOR = 1.64, 95% CI, 1.07, 2.52; P = 0.02). Medicare beneficiaries with a self-reported history of depression were more likely to report feeling less financially secure (aOR = 1.43, 95% CI, 1.22, 1.68; P < 0.001), more stressed or anxious (aOR = 1.68, 95% CI, 1.49, 1.90; P < 0.001), more lonely or sad (aOR = 1.97, 95% CI, 1.68, 2.31; P < 0.001), and less socially connected (aOR = 1.27, 95% CI, 1.10, 1.47; P = 0.001). CONCLUSION A self-reported history of depression was associated with greater inability to access care, more unmet social needs, and poorer economic and mental health outcomes, suggesting greater risk for adverse health outcomes during COVID-19.
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Affiliation(s)
- Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA.
| | - Jacob K Quinton
- UCLA National Clinician Scholars Program, UCLA Department of General Internal Medicine, New Haven, CT, USA
| | - Maureen E Canavan
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - E Jennifer Edelman
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | | | - Joseph S Ross
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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21
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Ku BS, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Compton MT, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone WS, Tsuang MT, Walker EF, Woods SW, Druss BG. Association between residential instability at individual and area levels and future psychosis in adolescents at clinical high risk from the North American Prodrome Longitudinal Study (NAPLS) consortium. Schizophr Res 2021; 238:137-144. [PMID: 34673386 PMCID: PMC10800030 DOI: 10.1016/j.schres.2021.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Accumulating evidence supports an association between residential instability and increased risk for psychosis, but the association between residential instability and conversion to psychosis among adolescents at clinical high risk (CHR) is unclear. In this study, we determined whether individual-level and area-level residential instability and their interaction are associated with conversion to psychosis within two years. METHODS Data were collected as part of the North American Prodrome Longitudinal Study Phase 2. Individual-level residential instability, defined as having ever moved during lifetime, was derived from the Life Events Scale. Area-level residential instability, defined as the percentage of people who were not living in the same house five years ago, was derived from the U.S. Decennial Censuses. RESULTS This study included 285 adolescents at CHR (including 36 subjects who later converted to full psychosis). We found that individual-level residential instability was associated with conversion (adjusted OR = 2.769; 95% CI = 1.037-7.393). The interaction between individual-level and area-level residential instability was significant (p = 0.030). In a subgroup of CHR participants who have never moved (n = 91), area-level residential instability during childhood was associated with conversion (adjusted OR = 1.231; 95% CI = 1.029-1.473). Conversely, in a subgroup of CHR participants who resided in residentially stable areas during childhood (n = 142), the association between individual-level residential instability and conversion remained significant (adjusted OR = 15.171; 95% CI = 1.753-131.305). CONCLUSIONS These findings suggest that individual-level and area-level residential instability may be associated with conversion to psychosis.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, United States
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Matcheri Keshavan
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel H Mathalon
- Department of Psychiatry, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - William S Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, MA, United States
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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22
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Walker ER, Fukuda J, McMonigle M, Nguyen J, Druss BG. A Qualitative Study of Barriers and Facilitators to Transitions From the Emergency Department to Outpatient Mental Health Care. Psychiatr Serv 2021; 72:1311-1319. [PMID: 33887957 DOI: 10.1176/appi.ps.202000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with psychiatric disorders are among the most frequent users of emergency departments (EDs). The transition of care from the ED to outpatient mental health treatment may be important for continuity of care; however, little is known about the barriers and facilitators that patients experience in transitions to and engagement in outpatient mental health care. In this qualitative study, the authors examined the perspectives of patients and providers on these barriers and facilitators at the patient, provider, and health care system levels. METHODS The authors (trained interviewers) conducted 30 semistructured interviews with patients and 15 interviews with 13 mental health providers. Data were analyzed by using thematic analysis. RESULTS Patients and providers discussed similar barriers and facilitators to patient transitions and engagement in care. Patients with psychiatric disorders experienced barriers and facilitators at multiple levels when engaging in mental health care after discharge from the ED. Patient-level themes included openness to treatment and logistical challenges. Provider-level themes focused on the connection between patients and providers and on establishing and maintaining contact. Themes at the health care system level were coordination between the ED and outpatient clinics, managing appointments, and health care resources. CONCLUSIONS Key factors that influence transitions of care from the ED to outpatient treatment include patients' complex health and life circumstances, the establishment of a relationship with providers built on trust and compassion, and the level of coordination between care settings.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Julia Fukuda
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Megan McMonigle
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Julie Nguyen
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
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23
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McGinty EE, Presskreischer R, Breslau J, Brown JD, Domino ME, Druss BG, Horvitz-Lennon M, Murphy KA, Pincus HA, Daumit GL. Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector. Psychiatr Serv 2021; 72:1301-1310. [PMID: 34074150 PMCID: PMC8570967 DOI: 10.1176/appi.ps.202000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness die 10-20 years earlier, compared with the overall population, and the excess mortality is driven by undertreated physical health conditions. In the United States, there is growing interest in models integrating physical health care delivery, management, or coordination into specialty mental health programs, sometimes called "reverse integration." In November 2019, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness convened a forum of 25 experts to discuss the current state of the evidence on integrated care models based in the specialty mental health system and to identify priorities for future research, policy, and practice. This article summarizes the group's conclusions. Key research priorities include identifying the active ingredients in multicomponent integrated care models and developing and validating integration performance metrics. Key policy and practice recommendations include developing new financing mechanisms and implementing strategies to build workforce and data capacity. Forum participants also highlighted an overarching need to address socioeconomic risks contributing to excess mortality among adults with serious mental illness.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Joshua Breslau
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marisa Elena Domino
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Benjamin G Druss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marcela Horvitz-Lennon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Karly A Murphy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Harold Alan Pincus
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
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Druss BG, Cohen AN, Brister T, Cotes RO, Hendry P, Rolin D, Torous J, Ventura J, Gorrindo T. Supporting the Mental Health Workforce During and After COVID-19. Psychiatr Serv 2021; 72:1222-1224. [PMID: 33882690 DOI: 10.1176/appi.ps.202000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.
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Affiliation(s)
- Benjamin G Druss
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Amy N Cohen
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Teri Brister
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Robert O Cotes
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Patrick Hendry
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Donna Rolin
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - John Torous
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Joseph Ventura
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
| | - Tristan Gorrindo
- Rollins School of Public Health (Druss), and Department of Psychiatry and Behavioral Sciences (Cotes), Emory University, Atlanta; American Psychiatric Association, Washington, D.C. (Cohen, Gorrindo); National Alliance on Mental Illness (Brister), and Mental Health America, Arlington, Virginia (Hendry); School of Nursing, University of Texas at Austin (Rolin); Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston (Torous); Department of Psychiatry and Biobehavioral Sciences, UCLA Medical School, Los Angeles (Ventura)
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Abstract
Self-help groups and medications (buprenorphine, methadone, and naltrexone) both play important roles in opioid addiction treatment. The relative use of these two treatment modalities has not been characterized in a national study. Using national treatment data, we found that self-help groups were rarely provided in conjunction with medication treatment: Among all adult discharges from opioid addiction treatment in the period 2015-17, 10.4 percent used both self-help groups and medications, 29.2 percent used only medications, 29.8 percent used only self-help groups, and 30.5 percent used neither self-help groups nor medications. Use of self-help groups without medication is most common in residential facilities, among those with criminal justice referrals, and among uninsured or privately insured patients, as well as in the South and West regions of the US. These subgroups may be important targets for future efforts to identify and overcome barriers to medication treatment and create multimodal paths to recovery.
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Affiliation(s)
- Hefei Wen
- Hefei Wen ( hefei_wen@hphci. harvard. edu ) is a faculty member in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts
| | - Benjamin G Druss
- Benjamin G. Druss is the Rosalynn Carter Chair and a professor in the Department of Health Policy and Management, Emory University Rollins School of Public Health, in Atlanta, Georgia
| | - Brendan Saloner
- Brendan Saloner is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
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26
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Abstract
The COVID-19 pandemic has disrupted public mental health systems across the country, nowhere more than in New York State (NYS). The authors describe the NYS public health agency's response to the pandemic and offer ideas for redesigning public mental health systems post-COVID-19.
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Affiliation(s)
- Thomas E Smith
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Ann-Marie T Sullivan
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Benjamin G Druss
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
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27
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Ku BS, Li J, Cathy Lally, Compton MT, Druss BG. Associations between mental health shortage areas and county-level suicide rates among adults aged 25 and older in the USA, 2010 to 2018. Gen Hosp Psychiatry 2021; 70:44-50. [PMID: 33714795 PMCID: PMC8127358 DOI: 10.1016/j.genhosppsych.2021.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Suicide is a serious public health concern, but little is known about the relationship between access to mental health care and suicide deaths, and whether suicide rates differ by mental health provider Health Professional Shortage Areas (HPSAs). This study investigated the associations between mental health HPSAs and suicide rates. METHOD We used generalized linear mixed models to test the associations between HPSAs and suicide rates from 2010 to 2018. For each county during a 3-year period, the total number of suicides was obtained from Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER). RESULTS Mental health HPSAs had higher suicide rates (adjusted incidence rate ratio (IRR), 1.06 [95% CI, 1.03-1.09]). The interaction terms of mental health HPSAs and time (adjusted IRR, 1.01 [95% CI, 1.00-1.01]) showed that the association between mental health shortage areas and suicide rates has increased over time. CONCLUSIONS Suicide rates are more common in mental health provider shortage areas, and this association has been growing over time. The study's findings suggest that many communities in the US are likely facing simultaneous challenges of limited access to mental health care, social and economic disadvantage, and high burden of suicide.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
| | - Jianheng Li
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cathy Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Michael T Compton
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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28
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Cohrs AC, Pacula RL, Dick AW, Stein BD, Druss BG, Leslie DL. Trends in personal and family member opioid prescriptions prior to a diagnosis of an opioid-related problem among adolescents and young adults. Subst Abus 2021; 42:483-486. [PMID: 33797321 PMCID: PMC10695273 DOI: 10.1080/08897077.2021.1901175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Efforts to reduce the risk of opioid misuse are often focused on reducing unnecessary prescriptions for opioid medications or reducing the dose prescribed; however, not all misuse occurs in individuals with a personal prescription. This study examined trends in the proportion of adolescents and young adults (AYAs) who had an opioid-related problem (ORP) and who also had a personal opioid prescription drug claim or had a family member with an opioid prescription drug claim prior to the ORP diagnosis. Methods: A retrospective cohort design was used to analyze longitudinal claims data. We identified individuals aged 12 to 25 years who had a newly diagnosed ORP in the years 2006 to 2014. Trends over time in personal or family opioid prescription drug claims within 1 year prior to ORP diagnosis were examined. Results: We identified 53,560 AYAs with an ORP diagnosis. Over the entire study period, 40% of AYAs with an ORP diagnosis had a personal opioid prescription in the year prior to diagnosis, and 48% had a family member with an opioid prescription in the prior year. While the proportion of AYAs with a family prescription remained constant, the proportion with a personal prescription fell from 77.1% in 2006 to 27.3% in 2014. Conclusions: The number of AYAs with an ORP increased over time, yet the proportion with a personal opioid prescription claim prior to their diagnosis decreased over time. This suggests that providers are paying greater attention to prescribing opioids to AYAs directly, although prescriptions to family members may still remain a point of access.
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Affiliation(s)
- Austin C. Cohrs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | | | | | - Benjamin G. Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Douglas L. Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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29
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Walker ER, Moore E, Tapscott S, Alperin M, Cummings JR, Druss BG. Developing Regional Mental Health Priorities: Mixed-Methods Needs Assessment of Eight States in the Southeastern United States. Psychiatr Serv 2021; 72:358-361. [PMID: 33234050 DOI: 10.1176/appi.ps.202000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
State mental health agencies (SMHAs), which provide a variety of services to meet their residents' mental health needs, typically work within their own state, with little opportunity for cross-state collaboration and information exchange. This column describes a mixed-methods needs assessment conducted by the Southeast Mental Health Technology Transfer Center (MHTTC) to identify regional mental health priorities in eight states of the southeastern United States. The six priority areas identified were mental health workforce, school-based mental health, suicide prevention, peer workforce, criminal justice and mental health, and supported housing. These regional priorities inform the Southeast MHTTC's activities and can be used to promote collaborative exchange and problem solving among SMHAs.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Emily Moore
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Stephanie Tapscott
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Melissa Alperin
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Janet R Cummings
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Alperin) and Department of Health Policy and Management (Moore, Tapscott, Cummings, Druss), Rollins School of Public Health, Emory University, Atlanta. Marvin S. Swartz, M.D., is editor of this column
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30
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Goldman ML, Druss BG, Horvitz-Lennon M, Norquist GS, Kroeger Ptakowski K, Brinkley A, Greiner M, Hayes H, Hepburn B, Jorgensen S, Swartz MS, Dixon LB. Mental Health Policy in the Era of COVID-19. Psychiatr Serv 2020; 71:1158-1162. [PMID: 32517639 DOI: 10.1176/appi.ps.202000219] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The response to the global COVID-19 pandemic has important ramifications for mental health systems and the patients they serve. This article describes significant changes in mental health policy prompted by the COVID-19 crisis across five major areas: legislation, regulation, financing, accountability, and workforce development. Special considerations for mental health policy are discussed, including social determinants of health, innovative technologies, and research and evaluation. These extraordinary advances provide an unprecedented opportunity to evaluate the effects of mental health policies that may be adopted in the post-COVID-19 era in the United States.
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Benjamin G Druss
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Marcela Horvitz-Lennon
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Grayson S Norquist
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Kristin Kroeger Ptakowski
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Amy Brinkley
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Miranda Greiner
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Heath Hayes
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Brian Hepburn
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Shea Jorgensen
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Marvin S Swartz
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
| | - Lisa B Dixon
- Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Rollins School of Public Health (Druss) and Department of Psychiatry and Behavioral Sciences (Norquist), Emory University, Atlanta; RAND Corporation, Boston, and Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts (Horvitz-Lennon); Department of Policies, Programs, and Partnerships, American Psychiatric Association, Washington, D.C. (Kroeger Ptakowski); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Department of Psychiatry, Weill Cornell Medical Center, New York (Greiner); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); National Association of State Mental Health Program Directors, Alexandria, Virginia (Hepburn); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Dixon)
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31
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Affiliation(s)
- Benjamin G Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Ku BS, Lally CA, Compton MT, Druss BG. Neighborhood Predictors of Outpatient Mental Health Visits Among Persons With Comorbid Medical and Serious Mental Illnesses. Psychiatr Serv 2020; 71:906-912. [PMID: 32393159 PMCID: PMC7646987 DOI: 10.1176/appi.ps.201900363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses are at risk of receiving inadequate outpatient mental health services, increasing the likelihood of medication nonadherence, readmission, and self-harm. The purpose of this study was to identify individual- and neighborhood-level factors associated with outpatient mental health visits. METHODS This study included 418 participants from two randomized trials of patients with comorbid medical conditions and serious mental illnesses across two study sites between 2011 and 2017. On the basis of individual addresses, data were collected about participants' distance to the nearest mental health facility and 13 neighborhood characteristics from the American Community Survey. Three neighborhood-level factors were derived from factor analysis. Poisson regression was used to assess associations between individual- and neighborhood-level characteristics and the number of visits to mental health providers. Known individual-level risk factors for outpatient follow-up were mutually adjusted in a model with neighborhood covariates added. RESULTS Male gender, older age, unemployment, and lower education level were associated with less outpatient mental health service utilization. Neighborhood-level residential mobility, defined as the combination of percentage of residents living in a different house in the past year and percentage of non-owner-occupied housing, was significantly associated with fewer mental health service visits even after controlling for other neighborhood- and individual-level factors. CONCLUSIONS Among individuals with comorbid medical conditions and serious mental illnesses, living in neighborhoods with higher residential mobility was associated with fewer visits to outpatient mental health providers. This finding suggests the importance of recognizing social conditions that may shape clinical interactions.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Ku); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Lally, Druss); New York State Psychiatric Institute, New York (Compton)
| | - Cathy A Lally
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Ku); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Lally, Druss); New York State Psychiatric Institute, New York (Compton)
| | - Michael T Compton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Ku); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Lally, Druss); New York State Psychiatric Institute, New York (Compton)
| | - Benjamin G Druss
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Ku); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Lally, Druss); New York State Psychiatric Institute, New York (Compton)
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Abstract
OBJECTIVE Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings. METHODS This randomized study enrolled 311 participants with a serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes to receive a mobile personal health record application (N=156) or usual care (N=155). A secure mobile personal health record (mPHR) app provided participants in the intervention group with key information about diagnoses, medications, and laboratory test values and allowed them to track health goals. The primary study outcome was a chart-derived composite measure of quality of cardiometabolic and preventive services. RESULTS At 12-month follow-up, participants in the mPHR group maintained high quality of care (70% of indicated services at baseline and at 12-month follow-up), in contrast to a decline in quality for the usual-care group (71% at baseline and 67% at follow-up), resulting in a statistically significant but clinically modest differential impact between the groups. No differences between the study groups were found in secondary self-reported outcomes, including delivery of chronic illness care, patient activation, and quality of life related to mental or general medical health. CONCLUSIONS Use of a mPHR app was associated with a statistically significant but clinically modest differential benefit for quality of medical care among individuals with serious mental illness and comorbid cardiometabolic conditions.
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Affiliation(s)
- Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Jianheng Li
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Cathy A Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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Abstract
OBJECTIVE Little is known about the role of primary care safety-net clinics, including federally qualified health centers and rural health clinics, in providing mental health services to youths. This study examined correlates and quality of mental health care for youths treated in these settings. METHODS Medicaid claims data (2008-2010) from nine states were used to identify youths initiating medication for attention-deficit hyperactivity disorder (ADHD) (N=6,433) and youths with an incident depression diagnosis (N=13,209). The authors identified youths who received no ADHD or depression-related visits in a primary care safety-net clinic, some (but less than most) visits in these clinics, and most visits in these clinics. Using bivariate and regression analyses, they examined correlates of mental health treatment in these settings and whether mental health visits in these settings were associated with quality measures. RESULTS Only 13.5% of the ADHD cohort and 7.2% of the depression cohort sought any ADHD- or depression-related visits in primary care safety-net clinics. Residence in a county with a higher (versus lower) percentage of residents living in an urban area was negatively associated with receiving the majority of mental health visits in these settings (p<0.05). Compared with youths with no visits in these settings, youths who received most of their mental health treatment in these settings received lower-quality care on five of six measures (p<0.01). CONCLUSIONS As investment in the expansion of mental health services in primary care safety-net clinics grows, future research should assess whether these resources translate into improved mental health care access and quality for Medicaid-enrolled youths.
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Affiliation(s)
- Janet R. Cummings
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322
| | - Xu Ji
- Department of Pediatrics, School of Medicine, Emory University
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322
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35
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Wen H, Hockenberry JM, Druss BG. The Effect of Medical Marijuana Laws on Marijuana-Related Attitude and Perception Among US Adolescents and Young Adults. Prev Sci 2020; 20:215-223. [PMID: 29767282 DOI: 10.1007/s11121-018-0903-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Marijuana liberalization policies are gaining momentum in the USA, coupled with limited federal interference and growing dispensary industry. This evolving regulatory landscape underscores the importance of understanding the attitudinal/perceptual pathways from marijuana policy to marijuana use behavior, especially for adolescents and young adults. Our study uses the restricted-access National Survey on Drug Use and Health (NSDUH) 2004-2012 data and a difference-in-differences design to compare the pre-policy, post-policy changes in marijuana-related attitude/perception between adolescents and young adults from ten states that implemented medical marijuana laws during the study period and those from the remaining states. We examined four attitudinal/perception pathways that may play a role in adolescent and young adult marijuana use behavior, including (1) perceived availability of marijuana, (2) perceived acceptance of marijuana use, (3) perceived wrongfulness of recreational marijuana use, and (4) perceived harmfulness of marijuana use. We found that state implementation of medical marijuana laws between 2004 and 2012 was associated with a 4.72% point increase (95% CI 0.15, 9.28) in the probability that young adults perceived no/low health risk related to marijuana use. Medical marijuana law implementation is also associated with a 0.37% point decrease (95% CI - 0.72, - 0.03) in the probability that adolescents perceived parental acceptance of marijuana use. As more states permit medical marijuana use, marijuana-related attitude/perception need to be closely monitored, especially perceived harmfulness. The physical and psychological effects of marijuana use should be carefully investigated and clearly conveyed to the public.
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Affiliation(s)
- Hefei Wen
- Department of Health Management & Policy, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY, 40536, USA.
| | - Jason M Hockenberry
- Department of Health Policy & Management, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Benjamin G Druss
- Department of Health Policy & Management, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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36
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Affiliation(s)
- Ezra Golberstein
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN USA
| | - Jennifer M. Joseph
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN USA
| | - Benjamin G. Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | - Paul Goering
- Mental Health and Addiction Services, Allina Health, Minneapolis, MN USA
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37
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Abstract
This study uses National Ambulatory Medical Care Survey data to assess the percentage of psychiatrists who have accepted Medicaid-insured patients before and after Medicaid expansion.
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Affiliation(s)
- Hefei Wen
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington
| | - Adam S. Wilk
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Benjamin G. Druss
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Janet R. Cummings
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
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38
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Hockenberry JM, Joski P, Yarbrough C, Druss BG. Trends in Treatment and Spending for Patients Receiving Outpatient Treatment of Depression in the United States, 1998-2015. JAMA Psychiatry 2019; 76:810-817. [PMID: 31017627 PMCID: PMC6487900 DOI: 10.1001/jamapsychiatry.2019.0633] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 01/12/2023]
Abstract
CONTEXT After marked increases from 1987 to 1997, trends in depression treatment in the United States increased modestly from 1998 to 2007. However, multiple policy changes that expanded insurance coverage for mental health conditions may have shifted these trends again since 2007. OBJECTIVE To examine national trends in outpatient treatment of depression from 1998 to 2015, with particular focus on 2007 to 2015. DESIGN, SETTING, AND PARTICIPANTS This analysis of the use of health services and spending for treatment of depression in the United States assessed data from the 1998 (n = 22 953), 2007 (n = 29 370), and 2015 (n = 33 893) Medical Expenditure Panel Surveys (MEPSs). Participants included respondent households to the nationally representative survey. Data were analyzed from June 15 through December 18, 2018. MAIN OUTCOMES AND MEASURES Rates of outpatient and pharmaceutical treatment of depression; counts of outpatient visits, psychotherapy visits, and prescriptions; and expenditures. RESULTS The analysis included 86 216 individuals from the 1998, 2007, and 2015 MEPSs. Respondents' mean (SD) age was 37.2 (22.7) years; 45 086 (52.3%) were female, 24 312 (28.2%) were Hispanic, 15 463 (17.9%) were black, and 62 926 (72.9%) were white. Rates of outpatient treatment of depression increased from 2.36 (95% CI, 2.12-2.61) per 100 population in 1998 to 3.47 (95% CI, 3.16-3.79) per 100 population in 2015. The proportion of respondents who were treated for depression using psychotherapy decreased from 53.7% (95% CI, 48.3%-59.1%) in 1998 to 43.2% (95% CI, 39.0%-47.4%) in 2007 and then increased to 50.4% (95% CI, 46.0%-54.9%) in 2015, whereas the proportion receiving pharmacotherapy remained steady at 81.9% (95% CI, 77.9%-85.9%) in 1998, 82.4% (95% CI, 79.3%-85.4%) in 2007, and 80.8% (95% CI, 77.9%-83.7%) in 2015. After adjusting for inflation using 2015 US dollars, prescription expenditures for these individuals decreased from $848 (95% CI, $713-$984) per year in 1998 to $603 (95% CI, $484-$722) per year in 2015, whereas the mean number of prescriptions decreased from 7.64 (95% CI, 6.61-8.67) in 1998 to 7.03 (95% CI, 6.51-7.56) in 2015. National expenditures for outpatient treatment of depression increased from $12 430 000 000 in 1997 to $15 554 000 000 in 2007 and then to $17 404 000 000 in 2015, consistent with a slowing growth in national outpatient expenditures for depression. The percentage of this spending that came from self-pay (uninsured) individuals decreased from 32% in 1998 to 29% in 2007 and then to 20% in 2015. This decrease was largely associated with increasing Medicaid coverage, because the percentage of this spending covered was 19% in 1998, 15% in 2007, and 36% in 2015. CONCLUSIONS AND RELEVANCE Recent policy changes that increased insurance coverage for depression may be associated with reduced uninsured burden and with modest increases in the prevalence of and overall spending for outpatient treatment of depression. The lower-than-expected rate of treatment suggests that substantial barriers remain to individuals receiving treatment for their depression.
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Affiliation(s)
| | - Peter Joski
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Courtney Yarbrough
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Benjamin G. Druss
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
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39
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Affiliation(s)
- Martha C Ward
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
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40
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Cummings JR, Ji X, Lally C, Druss BG. Racial and Ethnic Differences in Minimally Adequate Depression Care Among Medicaid-Enrolled Youth. J Am Acad Child Adolesc Psychiatry 2019; 58:128-138. [PMID: 30577928 PMCID: PMC8051617 DOI: 10.1016/j.jaac.2018.04.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/04/2018] [Accepted: 06/20/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine racial and ethnic disparities in the receipt of minimally adequate depression treatment in Medicaid-enrolled youth. METHOD Medicaid claims data of 2008 through 2011 were used to derive a cohort of youth (5-17 years old) who were diagnosed with a new episode of major depression (N = 45,816) across 9 states. Dichotomous outcomes measured the receipt of minimally adequate psychotherapy (≥4 psychotherapy visits within 12 weeks of initiation); minimally adequate medication (filled antidepressants for 84 of 144 days); any minimally adequate treatment (psychotherapy or medication); and no psychotherapy or medication. Racial/ethnic disparities in the outcome measures were estimated using logistic regression models that controlled for predisposing, enabling, and need-related factors. RESULTS Less than four-tenths (38.3%) of the cohort received minimally adequate psychotherapy, 19.2% received minimally adequate pharmacotherapy, and 49.9% received any minimally adequate treatment; conversely, 16.4% received no treatment. Adjusted percentages of black (42.3%; p < .001) and Hispanic (48.2%; p < .001) youth who received minimally adequate treatment were significantly smaller than for non-Hispanic whites (54.7%) because of lower likelihoods of receiving minimally adequate psychotherapy and/or minimally adequate pharmacotherapy. In addition, adjusted percentages of black (20.2%; p < .001) and Hispanic (15.0%; p < .01) youth who received no treatment were significantly larger than for non-Hispanic white youth (12.9%). CONCLUSION The percentage of Medicaid-enrolled youth who receive minimally adequate treatment for depression is small overall and even smaller for racial/ethnic minorities than for whites. Future research is needed to identify strategies that improve the overall quality of depression treatment in Medicaid-enrolled youth and decrease disparities in care.
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Affiliation(s)
| | - Xu Ji
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cathy Lally
- Rollins School of Public Health, Emory University, Atlanta, GA
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41
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Affiliation(s)
- Benjamin G Druss
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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42
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Abstract
The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services. [AJP AT 175: Remembering Our Past As We Envision Our Future July 1928: A President Takes Stock Adolf Meyer: "I sometimes feel that Einstein, concerned with the relativity in astronomy, has to deal with very simple facts as compared to the complex and erratic and multicontingent performances of the human microcosmos, the health, happiness and efficiency of which we psychiatrists are concerned with." (Am J Psychiatry 1928; 85(1):1-31 )].
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Affiliation(s)
- Benjamin G Druss
- From the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Howard H Goldman
- From the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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43
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Abstract
Stakeholder engagement is an important component of pragmatic trials seeking to improve mental health care in real-world settings. Models of stakeholder engagement outline the benefits of involving a diverse array of partners in all phases of research. This column describes a stakeholder engagement plan for a comparative-effectiveness pragmatic trial of a care navigator program to increase linkage between emergency departments and outpatient treatment at community mental health centers. Benefits of stakeholder engagement include meaningful input on program design and implementation, insights into balancing the need for flexibility among clinical sites while implementing the program with fidelity, and early discussions about program sustainability and dissemination.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Rachel Zahn
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Benjamin G Druss
- Dr. Walker and Ms. Zahn are with the Department of Behavioral Sciences and Health Education and Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta. Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
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Abstract
PURPOSE OF REVIEW Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders. RECENT FINDINGS Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness. A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Ave, Atlanta, GA, 30322, USA.
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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45
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Freedman R, Brown AS, Cannon TD, Druss BG, Earls FJ, Escobar J, Hurd YL, Lewis DA, López-Jaramillo C, Luby J, Mayberg HS, Moffitt TE, Oquendo M, Perlis RH, Pine DS, Rush AJ, Tamminga CA, Tohen M, Vieta E, Wisner KL, Xin Y. Can a Framework Be Established for the Safe Use of Ketamine? Am J Psychiatry 2018; 175:587-589. [PMID: 29656666 DOI: 10.1176/appi.ajp.2018.18030290] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/01/2022]
Affiliation(s)
- Robert Freedman
- The authors are members of the Editorial Board of the Journal
| | - Alan S Brown
- The authors are members of the Editorial Board of the Journal
| | - Tyrone D Cannon
- The authors are members of the Editorial Board of the Journal
| | | | - Felton J Earls
- The authors are members of the Editorial Board of the Journal
| | - Javier Escobar
- The authors are members of the Editorial Board of the Journal
| | - Yasmin L Hurd
- The authors are members of the Editorial Board of the Journal
| | - David A Lewis
- The authors are members of the Editorial Board of the Journal
| | | | - Joan Luby
- The authors are members of the Editorial Board of the Journal
| | - Helen S Mayberg
- The authors are members of the Editorial Board of the Journal
| | | | - Maria Oquendo
- The authors are members of the Editorial Board of the Journal
| | - Roy H Perlis
- The authors are members of the Editorial Board of the Journal
| | - Daniel S Pine
- The authors are members of the Editorial Board of the Journal
| | - A John Rush
- The authors are members of the Editorial Board of the Journal
| | | | - Mauricio Tohen
- The authors are members of the Editorial Board of the Journal
| | - Eduard Vieta
- The authors are members of the Editorial Board of the Journal
| | | | - Yu Xin
- The authors are members of the Editorial Board of the Journal
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46
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Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
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Gulley SP, Rasch EK, Altman BM, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L. Introducing the Adults with Chronic Healthcare Needs (ACHCN) definition and screening instrument: Rationale, supporting evidence and testing. Disabil Health J 2018; 11:204-213. [PMID: 28823389 PMCID: PMC5803472 DOI: 10.1016/j.dhjo.2017.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/10/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Among working age adults in the United States, there is a large, heterogeneous population that requires ongoing and elevated levels of healthcare and related services. At present, there are conflicting approaches to the definition and measurement of this population in health services research. OBJECTIVE An expert panel was convened by the National Institutes of Health with the objective of developing a population-level definition of Adults with Chronic Healthcare Needs (ACHCN). In addition, the panel developed a screening instrument and methods for its use in health surveys to identify and stratify the population consistently. METHODS The panel employed multiple methods over the course of the project, including scoping literature reviews, quantitative analyses from national data sources and cognitive testing. RESULTS The panel defined the ACHCN population as "Adults (age 18-65) with [1] ongoing physical, cognitive, or mental health conditions or difficulties functioning who [2] need health or related support services of a type or amount beyond that needed by adults of the same sex and similar age." The screener collects information on chronic health conditions, functional difficulties, and elevated use of or unmet need for healthcare services. CONCLUSIONS Adapted from the Maternal and Child Health Bureau definition that identifies Children with Special Healthcare Needs, aligned with the ACS-6 disability measure, and consistent with the HHS Multiple Chronic Condition Framework, this definition and screener provide the research community with a common denominator for the identification of ACHCN.
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Affiliation(s)
- Stephen P Gulley
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States; National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, United States.
| | - Elizabeth K Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, United States
| | | | - Christina D Bethell
- John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Adam C Carle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Benjamin G Druss
- Rollins School of Public Health, Emory University, GA, United States
| | - Amy J Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, United States
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Gulley SP, Rasch EK, Bethell CD, Carle AC, Druss BG, Houtrow AJ, Reichard A, Chan L. At the intersection of chronic disease, disability and health services research: A scoping literature review. Disabil Health J 2018; 11:192-203. [PMID: 29396271 PMCID: PMC5869152 DOI: 10.1016/j.dhjo.2017.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND There is a concerted effort underway to evaluate and reform our nation's approach to the health of people with ongoing or elevated needs for care, particularly persons with chronic conditions and/or disabilities. OBJECTIVE This literature review characterizes the current state of knowledge on the measurement of chronic disease and disability in population-based health services research on working age adults (age 18-64). METHODS Scoping review methods were used to scan the health services research literature published since the year 2000, including medline, psycINFO and manual searches. The guiding question was: "How are chronic conditions and disability defined and measured in studies of healthcare access, quality, utilization or cost?" RESULTS Fifty-five studies met the stated inclusion criteria. Chronic conditions were variously defined by brief lists of conditions, broader criteria-based lists, two or more (multiple) chronic conditions, or other constructs. Disability was generally assessed through ADLs/IADLs, functional limitations, activity limitations or program eligibility. A smaller subset of studies used information from both domains to identify a study population or to stratify it by subgroup. CONCLUSIONS There remains a divide in this literature between studies that rely upon diagnostically-oriented measures and studies that instead rely on functional, activity or other constructs of disability to identify the population of interest. This leads to wide ranging differences in population prevalence and outcome estimates. However, there is also a growing effort to develop methods that account for the overlap between chronic disease and disability and to "segment" this heterogeneous population into policy or practice relevant subgroups.
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Affiliation(s)
- Stephen P Gulley
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA; National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA.
| | - Elizabeth K Rasch
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
| | | | - Adam C Carle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Amy J Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Leighton Chan
- National Institutes of Health, Clinical Research Center, Rehabilitation Medicine Department, Bethesda, MD, USA
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Abstract
OBJECTIVE This study examined the association between race-ethnicity and patterns of medication gaps and discontinuities among Medicaid-insured children initiating pharmacotherapy for attention-deficit hyperactivity disorder (ADHD). METHODS Medicaid claims data from nine states were used to identify racial-ethnic differences in patterns of ADHD medication treatment among 102,669 children initiating ADHD medication. Multinomial logistic regression with state indicators was used to estimate these differences, with adjustment for individual and contextual confounders. RESULTS Approximately three-fifths of the sample did not receive continuous medication treatment as defined by HEDIS guidelines; among them, one-fifth discontinued treatment with no subsequent reinitiation (early termination), less than one-tenth reinitiated pharmacotherapy following a single medication gap, more than three-tenths experienced discontinuous pharmacotherapy with two gaps, and more than four-tenths experienced discontinuous pharmacotherapy with three or more gaps. Compared with white children, black children had a 25% relative increase in the likelihood of early termination and Hispanic children had a 21% relative increase (p<.001); their relative increases in the likelihood of two medication gaps were 41% and 29%, respectively (p<.001), and for three or more gaps they were 56% and 40%, respectively (p<.001). CONCLUSIONS Black and Hispanic children were much more likely than white children to be classified as discontinuing ADHD medication treatment, according to HEDIS. The differences predominantly occurred because youths from minority groups were more likely to experience multiple medication gaps, rather than complete discontinuation. Future studies should examine reasons for these multiple gaps to inform interventions to improve ADHD treatment continuity.
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Affiliation(s)
- Xu Ji
- The authors are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- The authors are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Cathy Lally
- The authors are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Janet R Cummings
- The authors are with the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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Druss BG, Chwastiak L, Kern J, Parks JJ, Ward MC, Raney LE. Psychiatry's Role in Improving the Physical Health of Patients With Serious Mental Illness: A Report From the American Psychiatric Association. Psychiatr Serv 2018; 69:254-256. [PMID: 29385957 DOI: 10.1176/appi.ps.201700359] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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
The American Psychiatric Association Integrated Care Workgroup recently convened an expert panel charged with addressing the role of psychiatry in improving the physical health of persons with serious mental illness. The group reviewed the peer-reviewed and gray literature and developed a set of recommendations grounded in this review. This column summarizes the panel's primary findings and recommendations to key stakeholders, including clinicians, health care organizations, researchers, and policy makers.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
| | - Lydia Chwastiak
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
| | - John Kern
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
| | - Joseph J Parks
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
| | - Martha C Ward
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
| | - Lori E Raney
- Dr. Druss is with the Department of Health Policy and Management, Rollins School of Public Health, and Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Internal Medicine, Emory University School of Medicine, Emory University, Atlanta. Dr. Chwastiak and Dr. Kern are with the Department of Psychiatry, University of Washington, Seattle. Dr. Parks is with the National Council for Behavioral Health, Washington, D.C. Dr. Raney is with Health Management Associates, Dolores, Colorado. Dr. Druss and Gail L. Daumit, M.D., M.H.S., are editors of this column
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