42 CFR 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

Code of Federal Regulations, 2014 CFR

2014-10-01

...; disqualification from UR committee membership. 456.206 Section 456.206 Public Health CENTERS FOR MEDICARE... UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Administrative Requirements § 456.206... the diagnosis and treatment of mental diseases, and assisted by other professional personnel. (c) The...

42 CFR 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; disqualification from UR committee membership. 456.206 Section 456.206 Public Health CENTERS FOR MEDICARE... UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Administrative Requirements § 456.206... the diagnosis and treatment of mental diseases, and assisted by other professional personnel. (c) The...

42 CFR 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; disqualification from UR committee membership. 456.206 Section 456.206 Public Health CENTERS FOR MEDICARE... UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Administrative Requirements § 456.206... the diagnosis and treatment of mental diseases, and assisted by other professional personnel. (c) The...

42 CFR 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

Code of Federal Regulations, 2013 CFR

2013-10-01

...; disqualification from UR committee membership. 456.206 Section 456.206 Public Health CENTERS FOR MEDICARE... UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Administrative Requirements § 456.206... the diagnosis and treatment of mental diseases, and assisted by other professional personnel. (c) The...

Utilization of dental care among patients with severe mental illness: a study of a National Health Insurance database.

PubMed

Teng, Po-Ren; Lin, Miao-Jean; Yeh, Ling-Ling

2016-09-01

The oral health of patients with severe mental illness is poor, in general, and this may be attributed, in part, to inadequate dental care. This study investigated dental care utilization among patients with severe mental illness using a national representative sample. This study used Taiwan's National Health Insurance Research Dataset for 2009. Patients with the diagnosis of severe mental illness (ICD-9-CM: 290-298) were recruited as the study sample, and others comprised the control. Any visit to a dentist was defined as positive in terms of dental care utilization. Regression analyses were applied to determine the odds of dental care utilization for each diagnostic entity of severe mental illness, compared with the general population and controlling for potential covariates. Only 40 % of 19,609 patients with severe mental illness visited the dentist within 12 months. This was significantly lower than the dental visit rate of 48.3 % for the control population (odds ratio [OR] = .72, 95 % confidence interval [CI] = .69-.74; P <0.0001). The odds of dental care utilization differed among the severe mental illness diagnostic categories; e.g., the odds were lowest among those with alcohol psychoses (OR = .54, CI = .43-.68), senile dementia (OR = .55, CI = .52-.59) and other organic psychoses (OR = .58, CI = .52-.65), and highest among those with mood disorder (OR = .89, CI = .85-.94), with schizophrenic patients occupying a mid-level position (OR = .63, CI = .59-.67). Patients with severe mental illness received less dental care than the general population. Health care providers and caregivers of patients with severe mental illness should encourage them to visit the dentist regularly, in order to improve the oral health of these vulnerable patient groups.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses.

PubMed

Su, Chen-Hsiang; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Li, Chih-Yi; Chang, Kao-Ping; Huang, Chun-Jen

2016-09-01

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time..., mental hospital, and ICF located within a 50-mile radius of the facility; (e) The distance and average...

42 CFR 456.508 - Withdrawal of waiver.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Waiver of Requirements § 456.508 Withdrawal of waiver.... (b) If a waiver is withdrawn by the Administrator, each hospital or mental hospital covered by the...

42 CFR 456.437 - Notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... qualified mental retardation professional, if applicable; (d) The Medicaid agency; (e) The recipient; and (f...

Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns.

PubMed

Logsetty, Sarvesh; Shamlou, Amir; Gawaziuk, Justin P; March, Justin; Doupe, Malcolm; Chateau, Dan; Hoppensack, Mike; Khan, Sazzadul; Medved, Maria; Leslie, William D; Enns, Murray W; Stein, Murray B; Asmundson, Gordon J G; Sareen, Jitender

2016-06-01

This study investigates the increased risk of mental health outcomes and health care utilization associated with burn with two year of follow-up using a longitudinal population-based matched cohort design. Adult burn survivors (n=157) were identified from a provincial burn registry and matched 1:5 with non-burn control subjects from the general population (matching variables age and gender). The prevalence of mental health outcomes and the rates of health care utilization between the groups were compared for the 2years pre and post index date using anonymously linked population-based administrative health care data. Rates were adjusted for age, gender and sociodemographic characteristics. While the burn cohort had an increased prevalence of mental health problems after burn compared to the control cohort, the burn group also had an increased prevalence of pre-burn depression (16.6% vs 7.8%; p=0.0005) and substance use disorders (8.9% vs 3.2%; p=0.001) when compared to controls. Once the pre-existing prevalence of mental illness was taken into account there was no significant change in the prevalence of mental health problems when comparing the burn group to controls over time. Although burns may not increase rates of mental health issues and health care utilization, burn survivors are a vulnerable group who already demonstrate increased rates of psychopathology and need for care. The present study highlights the importance of assessment and treatment of mental health outcomes in this population. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

42 CFR 456.181 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... evaluation or plan. Utilization Review (UR) Plan: General Requirements ...

42 CFR 456.234 - Subsequent continued stay review dates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... least every 90 days each time it decides under § 456.236 that the continued stay is needed; and (c) The...

42 CFR 456.501 - UR plans as a condition for FFP.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals § 456.501 UR plans as a condition for FFP. (a) Except... services furnished by a hospital or mental hospital unless the facility has in effect a UR plan that meets...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

Understanding Service Utilization Disparities and Depression in Latinos: The Role of Fatalismo.

PubMed

Anastasia, Elizabeth A; Bridges, Ana J

2015-12-01

Research demonstrates a disparity between need and utilization of mental health services for Latinos. Cultural variations in perceptions of mental illness may be partially responsible for this discrepancy. Past research with Latinos has shown links between fatalismo, a cultural value similar to external locus of control, and both depression and lower service utilization in medical care, while links to psychiatric care have not been investigated. The current study therefore aimed to explore the associations between fatalismo, depression, and past year mental health service utilization by Latinos. A community sample of 83 Latino adults were recruited during local cultural events. Participants completed self-report measures of depression, fatalism, and past year service utilization. Analyses using structural equation modeling showed fatalismo was directly negatively related to past year medical service utilization (β = -.35). In contrast, the link between fatalismo and past year mental health service utilization was mediated by self-reported depressive symptoms (indirect β = .19, p < .001). We conclude that while fatalismo is associated with depression in Latinos, other barriers likely serve as more salient deterrents of service utilization.

42 CFR 456.523 - Revised UR plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.523 Revised... control over the utilization of services; and (2) Conducts reviews in a way that improves the quality of...

42 CFR 456.523 - Revised UR plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.523 Revised... control over the utilization of services; and (2) Conducts reviews in a way that improves the quality of...

Racial/Ethnic Disparities in the Mental Health Care Utilization of Fifth Grade Children

PubMed Central

Coker, Tumaini R.; Elliott, Marc N.; Kataoka, Sheryl; Schwebel, David C.; Mrug, Sylvie; Grunbaum, Jo Anne; Cuccaro, Paula; Peskin, Melissa F.; Schuster, Mark A.

2015-01-01

Objective The aim of this study was to examine racial/ethnic differences in fifth grade children’s mental health care utilization. Methods We analyzed cross-sectional data from a study of 5147 fifth graders and their parents in 3 US metropolitan areas from 2004–06. Multivariate logistic regression was used to examine racial/ethnic differences in mental health care utilization. Results Nine percent of parents reported that their child had ever used mental health care services; fewer black (6%) and Hispanic (8%) children had used services than white children (14%). Fewer black and Hispanic children with recent symptoms of attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder, and fewer black children with symptoms of depression had ever utilized services compared with white children. In multivariate analyses controlling for demographic factors, parental mental health, social support, and symptoms of the 4 mental health conditions, we found that black children were less likely than white children to have ever used services (Odds ratio [OR] 0.3, 95% confidence interval [95% CI], 0.2–0.4, P <.001). The odds ratio for black children remained virtually unchanged when the analysis was restricted to children with symptoms of ≥1 mental health condition, and when the analysis was stratified by mental health condition. The difference in utilization for Hispanic compared with white children was fully explained by sociodemographics in all multivariate models. Conclusions Disparities exist in mental health care utilization for black and Hispanic children; the disparity for black children is independent of sociodemographics and child mental health need. Efforts to reduce this disparity may benefit from addressing not only access and diagnosis issues, but also parents’ help-seeking preferences for mental health care for their children. PMID:19329099

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for...

Mental workload in decision and control

NASA Technical Reports Server (NTRS)

Sheridan, T. B.

1979-01-01

This paper briefly reviews the problems of defining and measuring the 'mental workload' of aircraft pilots and other human operators of complex dynamic systems. Of the alternative approaches the author indicates a clear preference for the use of subjective scaling. Some recent experiments from MIT and elsewhere are described which utilize subjective mental workload scales in conjunction with human decision and control tasks in the laboratory. Finally a new three-dimensional mental workload rating scale, under current development for use by IFR aircraft pilots, is presented.

42 CFR 456.213 - Confidentiality.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Confidentiality. 456.213 Section 456.213 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan...

42 CFR 456.520 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.520 Definitions...

Mental Health Services in the Marine Corps: An Exploratory Study of Stigma and Potential Benefits of Destigmatization Training Within the Operational Stress Control and Readiness (OSCAR) Program

DTIC Science & Technology

2004-12-01

table. This organization believes that the prevalence of misrepresented mental patients and/or actors / actresses with mental illness in shows and... vs . appropriate mental health care 40 utilization) produce high rates of absenteeism. These rates of absenteeism are compounded by a lack of

42 CFR 456.212 - Records and reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Records and reports. 456.212 Section 456.212 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan...

42 CFR 456.237 - Notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Notification of adverse decision. 456.237 Section 456.237 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

42 CFR 456.205 - UR committee required.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false UR committee required. 456.205 Section 456.205 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan...

42 CFR 456.151 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Definitions. 456.151 Section 456.151 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals § 456.151 Definitions. As used...

42 CFR 456.51 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals § 456.51 Definitions. As used in this... institution for mental disease, as defined in § 440.10; (2) [Reserved] (3) Services provided in specialty...

42 CFR 456.51 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals § 456.51 Definitions. As used in this... institution for mental disease, as defined in § 440.10; (2) [Reserved] (3) Services provided in specialty...

42 CFR 456.51 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals § 456.51 Definitions. As used in this... institution for mental disease, as defined in § 440.10; (2) [Reserved] (3) Services provided in specialty...

42 CFR 456.51 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals § 456.51 Definitions. As used in this... institution for mental disease, as defined in § 440.10; (2) [Reserved] (3) Services provided in specialty...

42 CFR 456.505 - Applicability of waiver.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Waiver of Requirements § 456.505 Applicability of...

42 CFR 456.521 - Conditions for granting variance requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

42 CFR 456.525 - Request for renewal of variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

42 CFR 456.525 - Request for renewal of variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time...

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for high utilization and expenditures for those with obesity, chronic physical illness, and mental illness.

42 CFR 456.234 - Subsequent continued stay review dates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Subsequent continued stay review dates. 456.234 Section 456.234 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

42 CFR 456.211 - Recipient information required for UR.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Recipient information required for UR. 456.211 Section 456.211 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

42 CFR 456.232 - Evaluation criteria for continued stay.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Evaluation criteria for continued stay. 456.232 Section 456.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses.

PubMed

Hendrie, Hugh C; Lindgren, Donald; Hay, Donald P; Lane, Kathleen A; Gao, Sujuan; Purnell, Christianna; Munger, Stephanie; Smith, Faye; Dickens, Jeanne; Boustani, Malaz A; Callahan, Christopher M

2013-12-01

Patients with serious mental illness are living longer. Yet, there remain few studies that focus on healthcare utilization and its relationship with comorbidities in these elderly mentally ill patients. Comparative study. Information on demographics, comorbidities, and healthcare utilization was taken from an electronic medical record system. Wishard Health Services senior care and community mental health clinics. Patients age 65 years and older-255 patients with serious mental illness (schizophrenia, major recurrent depression, and bipolar illness) attending a mental health clinic and a representative sample of 533 nondemented patients without serious mental illness attending primary care clinics. Patients having serious mental illness had significantly higher rates of medical emergency department visits (p = 0.0027) and significantly longer lengths of medical hospitalizations (p <0.0001) than did the primary care control group. The frequency of medical comorbidities such as diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, thyroid disease, and cancer was not significantly different between the groups. Hypertension was lower in the mentally ill group (p <0.0001). Reported falls (p <0.0001), diagnoses of substance abuse (p = 0.02), and alcoholism (p = 0.0016) were higher in the seriously mentally ill. The differences in healthcare utilization between the groups remained significant after adjusting for comorbidity levels, lifestyle factors, and attending primary care. Our findings of higher rates of emergency care, longer hospitalizations, and increased frequency of falls, substance abuse, and alcoholism suggest that seriously mentally ill older adults remain a vulnerable population requiring an integrated model of healthcare. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

42 CFR 456.243 - Content of medical care evaluation studies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections of care and services intermediate care facilities (ICF's), and institutions for mental diseases (IMD...

Disaster and subsequent healthcare utilization: a longitudinal study among victims, their family members, and control subjects.

PubMed

Dorn, Tina; Yzermans, C Joris; Kerssens, Jan J; Spreeuwenberg, Peter M M; van der Zee, Jouke

2006-06-01

The impact of disasters on primary healthcare utilization is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members. The objective of this study was to examine the long-term effects of a catastrophic fire on primary healthcare utilization. We conducted a prospective, population-based cohort study covering 1 year pre- and 3 years postfire. Utilization data were extracted from primary care records. Subjects consisted of 286 disaster victims, 802 family members of disaster victims, 3722 community control subjects, and 10,230 patients from a national reference population. As outcome measures, we studied 1) the annual number of contacts in primary care and 2) the annual number of contacts for problems related to mental health. Determinants are injury characteristics of victims and bereavement. All analyses control for age, gender, and insurance status. Being an uninjured victim who witnessed the disaster increases the number of contacts by a factor of 1.55 during the first year postfire (95% confidence interval [CI], 1.35-1.78). Uninjured victims contact the family practitioner more often for mental health-related problems than adolescent community control subjects (incidence rate ratio [IRR], 4.54; 95% CI, 1.69-12.20). In adult family members, the loss of a child predicts overall utilization (IRR, 1.88; 95% CI, 1.35-2.63) and utilization for mental health (IRR, 8.69; 95% CI, 2.10-35.92) during the first year postfire. Attention should be paid to the primary care needs of bereaved individuals and those who have witnessed the disaster.

42 CFR 456.507 - Review and granting of waiver requests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Waiver of Requirements § 456.507 Review and...

42 CFR 456.524 - Notification of Administrator's action and duration of variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2011 CFR

2011-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2013 CFR

2013-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2014 CFR

2014-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2012 CFR

2012-10-01

....614 Section 456.614 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

42 CFR 456.171 - Medicaid agency review of need for admission.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid agency review of need for admission. 456.171 Section 456.171 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...; (2) In an ICF that cares primarily for mental patients, at least one individual knowledgeable in the...

42 CFR 456.181 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reports of evaluations and plans of care. 456.181 Section 456.181 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the... psychiatric facilities, and mental hospitals; and (2) At least quarterly in ICFs; (c) Tests or observations of...

Developing a science of clinical utility in diagnostic classification systems field study strategies for ICD-11 mental and behavioral disorders.

PubMed

Keeley, Jared W; Reed, Geoffrey M; Roberts, Michael C; Evans, Spencer C; Medina-Mora, María Elena; Robles, Rebeca; Rebello, Tahilia; Sharan, Pratap; Gureje, Oye; First, Michael B; Andrews, Howard F; Ayuso-Mateos, José Luís; Gaebel, Wolfgang; Zielasek, Juergen; Saxena, Shekhar

2016-01-01

The World Health Organization (WHO) Department of Mental Health and Substance Abuse has developed a systematic program of field studies to evaluate and improve the clinical utility of the proposed diagnostic guidelines for mental and behavioral disorders in the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11). The clinical utility of a diagnostic classification is critical to its function as the interface between health encounters and health information, and to making the ICD-11 be a more effective tool for helping the WHO's 194 member countries, including the United States, reduce the global disease burden of mental disorders. This article describes the WHO's efforts to develop a science of clinical utility in regard to one of the two major classification systems for mental disorders. We present the rationale and methodologies for an integrated and complementary set of field study strategies, including large international surveys, formative field studies of the structure of clinicians' conceptualization of mental disorders, case-controlled field studies using experimental methodologies to evaluate the impact of proposed changes to the diagnostic guidelines on clinicians' diagnostic decision making, and ecological implementation field studies of clinical utility in the global settings in which the guidelines will ultimately be implemented. The results of these studies have already been used in making decisions about the structure and content of ICD-11. If clinical utility is indeed among the highest aims of diagnostic systems for mental disorders, as their developers routinely claim, future revision efforts should continue to build on these efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

42 CFR 456.160 - Certification and recertification of need for inpatient care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization... made at the time of admission or, if an individual applies for assistance while in a mental hospital...

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...

Intensely Exposed Oklahoma City Terrorism Survivors: Long-term Mental Health and Health Needs and Posttraumatic Growth.

PubMed

Tucker, Phebe; Pfefferbaum, Betty; Nitiéma, Pascal; Wendling, Tracy L; Brown, Sheryll

2016-03-01

In this study, we explore directly exposed terrorism survivors' mental health and health status, healthcare utilization, alcohol and tobacco use, and posttraumatic growth 18½ years postdisaster. Telephone surveys compared terrorism survivors and nonexposed community control subjects, using Hopkins Symptom Checklist, Breslau's PTSD screen, Posttraumatic Growth Inventory, and Health Status Questionnaire 12. Statistical analyses included multivariable logistic regression and linear modeling. Survivors, more than 80% injured, reported more anxiety and depression symptoms than did control subjects, with survivors' anxiety and depression associated with heavy drinking (≥5 drinks) and worse mental health and social functioning. While survivors had continued posttraumatic stress disorder symptoms (32 [23.2%] met probable posttraumatic stress disorder threshold), they also reported posttraumatic growth. Survivors had more care from physical, speech, respiratory, and occupational therapists. In this unprecedented long-term assessment, survivors' psychiatric symptoms, alcohol use, and ancillary health service utilization suggest unmet mental health and health needs. Extended recovery efforts might benefit from maximizing positive growth and coping.

Characteristics of private-sector managed care for mental health and substance abuse treatment.

PubMed

Garnick, D W; Hendricks, A M; Dulski, J D; Thorpe, K E; Horgan, C

1994-12-01

This study examined diversity during the late 1980s in managed care programs for mental health, alcohol abuse, and drug abuse to identify ways in which research can generate more meaningful data on the effectiveness of utilization review programs. Telephone interviews were conducted with representatives of utilization review programs for employee health insurance plans in 31 firms that employed 2.1 million people in 1990. Questions addressed qualifications of personnel, clinical criteria to authorize care, integration with employee assistance plans, penalties for not complying with utilization review procedures, outpatient review, and carve out of mental health and substance abuse review. Large variations in utilization review programs were found. Programs employed a range of review personnel and used a variety of clinical criteria to authorize care. More than two-thirds did not carve out mental health and substance abuse review from medical-surgical review. Some firms' employee assistance plans were integrated with utilization review programs, while others remained unintegrated. Penalties for not following program procedures varied widely, as did review of outpatient services. Because of trends toward even more diversity in utilization review programs in the 1990s, research that identifies the specific features of managed care programs that hold most promise for controlling costs while maintaining quality of care will increasingly be needed.

Primary health care utilization prior to suicide: a retrospective case-control study among active-duty military personnel.

PubMed

Hochman, Eldar; Shelef, Leah; Mann, J John; Portugese, Shirly; Krivoy, Amir; Shoval, Gal; Weiser, Mark; Fruchter, Eyal

2014-08-01

About 45% of civilians who died by suicide had contact with a doctor within 1 month of death. Thus, educating primary care physicians (PCP) to detect and mitigate depression is an important suicide-prevention strategy. However, the PCP consulting rate before suicide has not been examined in a military population. We investigated the utilization of primary health care and mental health services by active-duty military personnel suicide cases prior to death in comparison to matched military controls. All suicides (N = 170) were extracted from a cohort of all active-duty Israeli military male personnel between 2002 and 2012. Applying a retrospective, nested case-control design, we compared primary care services utilization by suicide cases with demographic and occupationally matched military controls (N = 500). Whereas 38.3% of suicide cases contacted a PCP within the last month before death, only 27.6% of suicide cases contacted a mental health specialist during their entire service time. The PCP contact rate within 1 month before death or index day did not differ between suicide cases and military controls (38.3% vs. 33.8%, χ²₁ = 1.05, P = .3). More suicide cases contacted a mental health specialist within service time than did military controls (27.6% vs. 13.6%, χ²₁ = 10.85, P = .001). Even though PCP contact rate by military personnel who died by suicide is slightly lower than that reported for civilians who died by suicide prior to their death, it is higher than mental health specialist contact rate and higher than that by age-matched civilians who died by suicide. These results imply that PCPs education is a viable approach to suicide prevention in a military setting. © Copyright 2014 Physicians Postgraduate Press, Inc.

Dietary Habits and Nutritional Status in Mentally Retarded Children and Adolescents: A Study from North Western India

ERIC Educational Resources Information Center

Mathur, Manju; Bhargava, Rachna; Benipal, Ramandeep; Luthra, Neena; Basu, Sabita; Kaur, Jasbinder; Chavan, B. S.

2007-01-01

Objective: To compare the dietary habits and nutritional status of mentally retarded (MR) and normal (NG) subjects and to examine the relationship between the dietary habits and nutritional status and the level of mental retardation in the MR group. Method: A case control design was utilized: 117 MR (random sampling) and 100 NG (quota sampling)…

[Costs of Mental Health Care in Patients with Posttraumatic Stress Disorder Related to Sexual Abuse One Year Before and After Inpatient DBT-PTSD].

PubMed

Priebe, Kathlen; Roth, Mascha; Krüger, Antje; Glöckner-Fink, Kristina; Dyer, Anne; Steil, Regina; Salize, Hans-Joachim; Kleindienst, Nikolaus; Bohus, Martin

2017-03-01

Objective In Germany, patients with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (CSA) often receive inpatient treatment. However, data on utilization and costs of mental health care as well as on the impact of trauma-focused treatment are missing. Methods Within the context of a randomized controlled trial mental health service utilization was assessed in female patients with PTSD related to CSA. Data on psychiatric-psychotherapeutic inpatient and outpatient treatment and psychotropic medication was obtained for the year before and after inpatient DBT-PTSD. Results The mean total costs of utilization of psychiatric-psychotherapeutic care and use of psychotropics were € 18.100 per patient in the year before and € 7.233 in the year after DBT-PTSD. The significant cost decrease was due to large reductions in inpatient treatment days (on average 57 days before and 14 days after DBT-PTSD), while outpatient treatment and psychotropic medication remained unchanged. Conclusion PTSD related to CSA is associated with high utilization and costs of mental health care. The results suggest that DBT-PTSD might contribute to reducing the mental health care costs. © Georg Thieme Verlag KG Stuttgart · New York.

42 CFR 456.520 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.520 Definitions... granted by the Administrator to the Medicaid agency for a specific remote facility to use time periods...

English Proficiency, Threshold Language Policy and Mental Health Service Utilization among Asian-American Children.

PubMed

Aratani, Yumiko; Liu, Cindy H

2015-10-01

This paper explores the role of English proficiency, ethnicity, and California's threshold language policy in the rates of discontinuing mental health services among Asian-American children. We used data from the 2001-2006 Client and Services Information (CSI) System, which contains county-level information about service users in public mental health systems. Our data included 59,218 service users under the age of 18. We used logistic regression to determine the likelihood of discontinuing services, while controlling for sociodemographic and clinical characteristics. English-speaking Asians were 11% more likely than English-speaking Whites to discontinue mental health services. Non-English-speaking Asians were 50% significantly more likely to stay in services. The results also revealed some inter-ethnic variations in the discontinuation patterns; however, the patterns of mental health service utilization appear to be driven by the availability of mental health services in Asian-ethnic languages in county of residence. Further research is needed to understand the intake and referral processes that Asian children go through within the mental health service system. Copyright © 2015 Elsevier Inc. All rights reserved.

A cluster-randomised controlled trial of values-based training to promote autonomously held recovery values in mental health workers.

PubMed

Williams, Virginia; Deane, Frank P; Oades, Lindsay G; Crowe, Trevor P; Ciarrochi, Joseph; Andresen, Retta

2016-02-02

The implementation and use of evidence-based practices is a key priority for recovery-oriented mental health service provision. Training and development programmes for employees continue to be a key method of knowledge and skill development, despite acknowledged difficulties with uptake and maintenance of behaviour change. Self-determination theory suggests that autonomy, or a sense that behaviour is self-generated, is a key motivator to sustained behaviour change, in this case practices in mental health services. This study examined the utility of values-focused staff intervention as a specific, reproducible method of autonomy support. Mental health workers (n = 146) were assigned via cluster randomisation to either a values clarification condition or an active problem-solving control condition. Results demonstrated that a structured values clarification exercise was useful in promoting integrated motivation for the changed practice and resulted in increased implementation planning. Structured values clarification intervention demonstrates utility as a reproducible means of autonomy support within the workplace. We discuss future directions for the study of autonomous motivation in the field of implementation science. ACTRN12613000353796.

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time... travel time between the remote facility and each facility listed in paragraph (e) of this section; (f...

42 CFR 456.521 - Conditions for granting variance requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time... is unable to meet the time requirements for which the variance is requested; and (2) A revised UR...

42 CFR 456.524 - Notification of Administrator's action and duration of variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.524 Notification of Administrator's action and duration of...

Marital Distress and Mental Health Care Service Utilization

ERIC Educational Resources Information Center

Schonbrun, Yael Chatav; Whisman, Mark A.

2010-01-01

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…

42 CFR 456.480 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Inpatient Psychiatric Services for Individuals Under Age 21... requirements that apply to inpatient psychiatric services for individuals under age 21 in hospitals, mental...

A pilot study on the Chinese Minnesota Multiphasic Personality Inventory-2 in detecting feigned mental disorders: Simulators classified by using the Structured Interview of Reported Symptoms.

PubMed

Chang, Yi-Ting; Tam, Wai-Cheong C; Shiah, Yung-Jong; Chiang, Shih-Kuang

2017-09-01

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is often used in forensic psychological/psychiatric assessment. This was a pilot study on the utility of the Chinese MMPI-2 in detecting feigned mental disorders. The sample consisted of 194 university students who were either simulators (informed or uninformed) or controls. All the participants were administered the Chinese MMPI-2 and the Structured Interview of Reported Symptoms-2 (SIRS-2). The results of the SIRS-2 were utilized to classify the participants into the feigning or control groups. The effectiveness of eight detection indices was investigated by using item analysis, multivariate analysis of covariance (MANCOVA), and receiver operating characteristic (ROC) analysis. Results indicated that informed-simulating participants with prior knowledge of mental disorders did not perform better in avoiding feigning detection than uninformed-simulating participants. In addition, the eight detection indices of the Chinese MMPI-2 were effective in discriminating participants in the feigning and control groups, and the best cut-off scores of three of the indices were higher than those obtained from the studies using the English MMPI-2. Thus, in this sample of university students, the utility of the Chinese MMPI-2 in detecting feigned mental disorders was tentatively supported, and the Chinese Infrequency Scale (ICH), a scale developed specifically for the Chinese MMPI-2, was also supported as a valid scale for validity checking. © 2017 The Institute of Psychology, Chinese Academy of Sciences and John Wiley & Sons Australia, Ltd.

Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness.

PubMed

McDonell, Michael G; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M; Sugar, Andrea; Short, Robert A; Roll, John M; Ries, Richard K

2013-01-01

The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization. A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self report, clinician-report, and service utilization outcomes were assessed during the 3-month treatment period and the 3-month follow-up period. Although participants in the contingency management condition were significantly less likely to complete the treatment period than those assigned to the control condition (42% compared with 65%), they were 2.4 times (95% CI=1.9–3.0)more likely to submit a stimulant-negative urine test during treatment. Compared with participants in the control condition,they had significantly lower levels of alcohol use, injection drug use, and psychiatric symptoms and were one-fifth as likely as those assigned to the control condition to be admitted for psychiatric hospitalization during treatment. They also reported significantly fewer days of stimulant drug use during the 3-month follow-up. When added to treatment as usual, contingency management is associated with large reductions in stimulant,injection drug, and alcohol use.Reductions in psychiatric symptoms and hospitalizations are important secondary benefits.

A randomized controlled trial of contingency management for psycho-stimulant use in community mental health outpatients with co-occurring serious mental illness

PubMed Central

McDonell, Michael G.; Srebnik, Debra; Angelo, Frank; McPherson, Sterling; Lowe, Jessica M.; Sugar, Andrea; Short, Robert A.; Roll, John M.; Ries, Richard K.

2014-01-01

Objective The primary objective of this study was to determine if contingency management was associated with increased stimulant drug abstinence in community mental health outpatients with serious mental illness and stimulant dependence. Secondary objectives were to determine if contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV-risk behavior, and inpatient service utilization. Method A randomized controlled design compared outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomized to three months of contingency management for stimulant abstinence plus treatment-as-usual or treatment-as-usual with reinforcement for study participation only. Urine drug tests, self-report, clinician-report, and service utilization outcomes were assessed during three-month treatment and three-month follow-up periods. Results While participants in the contingency management condition were less likely to complete the treatment period (n=38; 42%) than those assigned to the control condition (n=55; 65%), X2(1)=9.8, p=0.02; those assigned to the contingency management condition were 2.4 (CI=1.9-3.0) times more likely to submit a stimulant-negative urine test during treatment. Participants assigned to contingency management experienced significantly lower levels of alcohol use, injection drug use, psychiatric symptoms, and were five times less likely than those assigned to the control condition to be admitted for psychiatric hospitalization, X2(1)=5.4, p=0.02. Contingency management participants reported significantly fewer days of stimulant drug use, relative to controls during the three-month follow-up. Conclusions When added to treatment-as-usual, contingency management is associated with large reductions in stimulant, injection drug, and alcohol use. Reductions in psychiatric symptoms and hospitalizations were important secondary benefits. PMID:23138961

Recent and lifetime utilization of health care services by children and adolescent suicide victims: a case-control study.

PubMed

Renaud, Johanne; Berlim, Marcelo T; Séguin, Monique; McGirr, Alexander; Tousignant, Michel; Turecki, Gustavo

2009-10-01

In the present paper we describe a case-control study on the utilization of health care services prior to suicide (across different time periods) among children and adolescents aged 11 to 18 years in the Province of Quebec, Canada and matched healthy controls. Utilization of services (i.e., contact with general practitioners, mental health professionals, psychiatrists and/or youth protection groups) was examined at different time periods in 55 child and adolescent suicide victims and 54 matched community controls using proxy-based interviews and questionnaires. In addition, we examined the rates of detection of psychopathology by health care professionals, the use of psychotropic medications and the subjects' compliance with treatment. Although more than 90% of child and adolescent suicide completers in our sample suffered from mental disorders, a significant proportion of them were left without appropriate healthcare support (including psychiatric consultation) in the period preceding their suicide. Also, 20% of suicide completers and no control subject made prior suicide attempts. More specifically, over two-thirds of suicide completers had no treatment contact within the month prior to the completion, while only 12.7% (n=7) of them were in contact with psychiatric services during that same period. Moreover, 56.4% (n=31) of the suicide completers had not been diagnosed as having a mental disorder at the time of their death, and 54.5% of the subjects' that received treatment (12 out of 22) were considered poorly compliant or not compliant at all according to their medical/psychosocial records. Finally, we also found that females seemed to have more psychiatric and mental health service contacts in the past month, that subjects with depressive and anxious disorders received more psychiatric and general mental health services in the past year, and that past month hospitalization was more often associated with alcohol abuse and psychosis. Relatively small sample size, and cross-sectional design. Our findings indicate the need for an overall increase in the rates of healthcare services delivered to young subjects at risk for suicide, as well as better training of health professionals in detecting and treating youth psychopathology.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.

PubMed

Gianinazzi, Micol E; Rueegg, Corina S; von der Weid, Nicolas X; Niggli, Felix K; Kuehni, Claudia E; Michel, Gisela

2014-02-01

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

Mental Health Utilization Among Diverse Parenting Young Couples.

PubMed

Albritton, Tashuna; Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace

2015-09-01

Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness.

PubMed

Waters, Heidi C; Furukawa, Michael F; Jorissen, Shari L

2018-06-14

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.5 - Evaluation criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL General Provisions § 456.5 Evaluation criteria. The agency... services. This section does not apply to services in hospitals and mental hospitals. For these facilities...

Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach

PubMed Central

Perlman, Christopher

2018-01-01

Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. PMID:29587426

Predictors of Healthcare Service Utilization for Mental Health Reasons

PubMed Central

Fleury, Marie-Josée; Ngamini Ngui, André; Bamvita, Jean-Marie; Grenier, Guy; Caron, Jean

2014-01-01

This study was designed to identify: (1) predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2) correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior) and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care. PMID:25321874

Utilization of professional mental health services according to recognition rate of mental health centers.

PubMed

Lee, Hyo Jung; Ju, Young Jun; Park, Eun-Cheol

2017-04-01

Despite the positive effect of community-based mental health centers, the utilization of professional mental health services appears to be low. Therefore, we analyzed the relationship between regional recognition of mental health centers and utilization of professional mental health services. We used data from the Community Health Survey (2014) and e-provincial indicators. Only those living in Seoul, who responded that they were either feeling a lot of stress or depression, were included in the study. Multiple logistic regression analysis using generalized estimating equations was performed to examine both individual- and regional-level variables associated with utilization of professional mental health services. Among the 7338 participants who reported depression or stress, 646 (8.8%) had consulted a mental health professional for their symptoms. A higher recognition rate of mental health centers was associated with more utilization of professional mental health services (odds ratio [OR]=1.05, 95% confidence interval [CI]=1.03-1.07). Accessibility to professional mental health services could be improved depending on the general population's recognition and attitudes toward mental health centers. Therefore, health policy-makers need to plan appropriate strategies for changing the perception of mental health services and informing the public about both the benefits and functions of mental health centers. Copyright © 2017. Published by Elsevier B.V.

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

Increased use of mental health services related to isotretinoin treatment: a 5-year analysis.

PubMed

Friedman, Tal; Wohl, Yonit; Knobler, Haim Y; Lubin, Gadi; Brenner, Sarah; Levi, Yehezkel; Barak, Yoram

2006-08-01

The association between exposure to Isotretinoin, the development of depression and suicide attempts is controversial. To retrospectively assess pattern of utilization of mental health services in the Israeli Defense Forces (IDF) during a 5-year period for all subjects exposed to Isotretinoin in comparison to a control group consisting of army conscripts suffering from psoriasis. All subjects were young adults (18 to 21 years old) in compulsory military service. Exposure to Isotretinoin mandates reporting and marking as a coded medical profile in the IDFs' computerized medical record of each conscript and soldier. Medical data, tracked by military medical profiles, were summarized from medical records of all subjects treated by Isotretinion during the years 1999-2003 and for the control group for the same period. Use of mental health services was the a-priori defined primary outcome measure. During the study period 1419 subjects were exposed to Isotretinoin and 1102 suffered from psoriasis. Utilization of mental health services was highest for the index group wherein 17.2% (245/1419) of subjects were evaluated or treated compared to 12.5% in the control group (psoriasis). The inter-group differences were statistically significant; Chi-square=15.9 (df=2), p=0.0003. We suggest that psychiatric evaluation be regularly undertaken prior to initiation of Isotretinion treatment in young adults at risk, as well as providing follow-up visits during and at completion of treatment.

County Context and Mental Health Service Utilization by Older Hispanics.

PubMed

Kim, Kyeongmo

2018-04-16

Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.

The gravitational force of mental health services: distance decay effects in a rural Swiss service area.

PubMed

Stulz, Niklaus; Pichler, Eva-Maria; Kawohl, Wolfram; Hepp, Urs

2018-02-05

Previous research suggested a distance decay effect in health services systems, with people living closer to service facilities being more likely to use them. In this ecological cross sectional study, we conducted spatial and statistical analyses in a Swiss mental health services system being legally bound to provide primary mental health care to approximately 620,000 inhabitants. We examined a cohort of all patients who were over 18 years old and who were treated in the mental health services system between January and December 2011. There were 5574 treatment cases during the 12-month period, 2161 inpatient cases and 3413 outpatient cases. Travel time by public transportation between patients' residence and the closest mental health service facility negatively predicted the utilization of outpatient services for all mental disorders, even after controlling for variability in ecological (e.g. socioeconomic) characteristics of the communities in the service provision area. For utilization of inpatient wards no geographical distance decay effect was observed, except for organic mental disorders. Based on these findings, outpatient clinics should be most effectively located decentralized and in the largest communities to meet the needs of the population as close as possible to where people live and to avoid remote areas being insufficiently supplied with mental health care. For mental hospitals and inpatient services decentralized location seems to be less important.

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

Mental health service utilization in sub-Saharan Africa: is public mental health literacy the problem? Setting the perspectives right.

PubMed

Atilola, Olayinka

2016-06-01

The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization. © The Author(s) 2015.

Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings.

PubMed

Skosireva, Anna; O'Campo, Patricia; Zerger, Suzanne; Chambers, Catharine; Gapka, Susan; Stergiopoulos, Vicky

2014-09-07

Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination. (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization. We used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis. Perceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination. Understanding the experience of discrimination in healthcare settings and associated healthcare utilization is the first step towards designing policies and interventions to address health disparities among vulnerable populations. This study contributes to the knowledge base in this important area. This study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.

Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.

PubMed

Torio, Celeste Marie; Encinosa, William; Berdahl, Terceira; McCormick, Marie C; Simpson, Lisa A

2015-01-01

To examine national trends in hospital utilization, costs, and expenditures for children with mental health conditions. The analyses of children aged 1 to 17 are based on AHRQ's 2006 and 2011 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) databases, and on AHRQ's pooled 2006 to 2011 Medical Expenditure Panel Survey (MEPS). All estimates are nationally representative, and standard errors account for the complex survey designs. Although overall all-cause children's hospitalizations did not increase between 2006 and 2011, hospitalizations for all listed mental health conditions increased by nearly 50% among children aged 10 to 14 years, and by 21% for emergency department (ED) visits. Behavioral disorders experienced a shift in underlying patterns between 2006 and 2011: inpatient stays for alcohol-related disorders declined by 44%, but ED visits increased by 34% for substance-related disorders and by 71% for impulse control disorders. Inpatient visits for suicide, suicidal ideation, and self-injury increased by 104% for children ages 1 to 17 years, and by 151% for children ages 10 to 14 years during this period. A total of $11.6 billion was spent on hospital visits for mental health during this period. Medicaid covered half of the inpatient visits, but with 50% to 30% longer length of stays in 2006 and 2011, respectively, than private payers. Medicaid's overall share of the ED visits increased from 45% in 2006 to 53% in 2011. These alarming trends highlight the renewed need for research on mental health care for children. This study also provides a baseline for evaluating the impact of the Affordable Care Act and the mental health parity legislation on mental health utilization and expenditures for children. Published by Elsevier Inc.

Analysis of mental workload of electrical power plant operators of control and operation centers.

PubMed

Vitório, Daiana Martins; Masculo, Francisco Soares; Melo, Miguel O B C

2012-01-01

Electrical systems can be categorized as critical systems where failure can result in significant financial loss, injury or threats to human life. The operators of the electric power control centers perform an activity in a specialized environment and have to carry it out by mobilizing knowledge and reasoning to which they have adequate training under the terms of the existing rules. To reach this there is a common mental request of personnel involved in these centers due the need to maintain attention, memory and reasoning request. In this sense, this study aims to evaluate the Mental Workload of technical workers of the Control Centers of Electrical Energy. It was undertaken a research on operators control centers of the electricity sector in Northeast Brazil. It was used for systematic observations, followed by interview and application of the instrument National Aeronautics and Space Administration Task Load Index known as NASA-TLX. As a result there will be subsidies for an assessment of mental workload of operators, and a contribution to improving the processes of managing the operation of electric utilities and the quality of workers.

42 CFR 456.608 - Personal contact with and observation of recipients and review of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608 Personal...

Health state utility values of high prevalence mental disorders in Australia: results from the National Survey of Mental Health and Wellbeing.

PubMed

Mihalopoulos, Cathrine; Engel, Lidia; Le, Long Khanh-Dao; Magnus, Anne; Harris, Meredith; Chatterton, Mary Lou

2018-07-01

High prevalence mental disorders including depression, anxiety and substance use disorders are associated with high economic and disease burden. However, there is little information regarding the health state utility values of such disorders according to their clinical severity using comparable instruments across all disorders. This study reports utility values for high prevalence mental disorders using data from the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). Utility values were derived from the AQoL-4D and analysed by disorder classification (affective only (AD), anxiety-related only (ANX), substance use only (SUB) plus four comorbidity groups), severity level (mild, moderate, severe), symptom recency (reported in the past 30 days), and comorbidity (combination of disorders). The adjusted Wald test was applied to detect statistically significant differences of weighted means and the magnitude of difference between groups was presented as a modified Cohen's d. In total, 1526 individuals met criteria for a 12-month mental disorder. The mean utility value was 0.67 (SD = 0.27), with lower utility values associated with higher severity levels and some comorbidities. Utility values for AD, ANX and SUB were 0.64 (SD = 0.25), 0.71 (SD = 0.25) and 0.81 (SD = 0.19), respectively. No differences in utility values were observed between disorders within disorder groups. Utility values were significantly lower among people with recent symptoms (within past 30 days) than those without; when examined by diagnostic group, this pattern held for people with SUB, but not for people with ANX or AD. Health state utility values of people with high prevalence mental disorders differ significantly by severity level, number of mental health comorbidities and the recency of symptoms, which provide new insights on the burden associated with high prevalence mental disorders in Australia. The derived utility values can be used to populate future economic models.

[Mental health service utilization among borderline personality disorder patients inpatient].

PubMed

Cailhol, L; Thalamas, C; Garrido, C; Birmes, P; Lapeyre-Mestre, M

2015-04-01

Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. Several North American prospective studies support the high level of mental health care utilization in this population. There is little data in other systems of health organization, such as France. Furthermore, little is known on the variables associated with the mental health service utilization among BPD patients. The main objective was to compare the utilization of mental health care among BPD patients, to the general population and patients with another personality disorder (PD) and to describe the demographic and clinical factors associated with the group of patients who use the most health care. A multi-center (5 public and private centers), epidemiological study. Data were collected prospectively (database of an insurance fund covering 80% of the population) and viewed, retrospectively. We used the data collected during the five years previously to the inclusion. Inclusion criteria were age (18-60 years) and membership in the health insurance fund targeted. Patients on legal protection, forced hospitalization, with a chronic psychotic disorder, manic, mental retardation, or not reading French were excluded. First, four groups were composed: BPD, other PD, control groups for PD and other PD. The first two groups were recruited from a screening of inpatients including a self-administered questionnaire (Personality Disorder Questionnaire 4+). Assessment by a psychologist including the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) was given straight to those who had a score above 28. This questionnaire allowed us to distinguish one group of subjects with BPD and a group with other PD (without BPD). Clinical evaluation included Axis I (MINI), Axis II (SIDP-IV), psychopathological features (YSQ-I, DSQ-40), demographic variables and therapeutic alliance (Haq-II). Matched controls (age, sex) composed the 3rd and 4th group (BPD control and other PD control). They were randomly chosen in the health database insurance previously used. One hundred and thirty-seven (95.8%) screened patients agreed to answer the psychological assessment. In this sample, 44 (32.1%) had BPD, 39 (28.5%) other PD and another 39 (28.5%) did not have PD. The BPD group was compared to a sample of 165 matched subjects and the other group PD to a sample of 123 matched controls. There was no difference between BPD and other PD groups regarding the mental health utilization. However, there was an increased use of hospitalizations and deliverances of nervous system drugs in both clinical groups compared to their controls. The analysis of drugs supplied in pharmacies for BPD patients showed that the first two drugs were opiate substitutes (12.3% methadone, buprenorphine 6.7%). No anticonvulsants or atypical antipsychotics appear in the top 20 of treatments delivered. A composite variable (hospitalization for more than 6 months during previous five years and 500 supplied drugs) allowed the discrimination of two groups among patients with BPD: heavy users of care and low care users. No variables (demographics, Axis I, Axis II, self-aggressiveness, DSQ-40, Haq-II, YSQ-I) could discriminate the two groups except the number of previous psychotherapies (heavy users: n=0.4 (SD 0.5) vs low users: n=1.8 (SD 2.1) P=0.0054). This study confirms the important use of the service of BPD patients in France, as well as the possible moderating role of psychotherapy. We found a mismatch between these uses and recommendations. Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Personality Accounts for the Connection Between Volunteering and Health

PubMed Central

Jackson, Joshua J.; Morrow-Howell, Nancy; Oltmanns, Thomas F.

2015-01-01

Objectives. Existing literature has shown that volunteering is related to better physical and mental health outcomes. The purpose of this study is to examine whether personality traits and volunteering are independent predictors of physical and mental health. Methods. The current study utilizes data from the St. Louis Personality and Aging Network (SPAN), a representative sample of community-based adults between the ages of 55 and 64. Using hierarchical linear regressions, we test whether volunteering is a significant predictor of both physical and mental health while controlling for personality traits. Results. We find that volunteering is not significantly related to either physical or mental health while controlling for personality traits. We also find that lower neuroticism is related to better physical functioning and mental health, whereas higher extraversion is related to better mental health. Discussion. These results indicate that volunteering may be related to health outcomes because of the personality characteristics of volunteers, not the volunteering experience in and of itself. Future longitudinal studies are needed to further explore the relationship between personality, volunteering, and health. PMID:24704620

Mental health status and healthcare utilization among community dwelling older adults.

PubMed

Adepoju, Omolola; Lin, Szu-Hsuan; Mileski, Michael; Kruse, Clemens Scott; Mask, Andrew

2018-04-27

Shifts in mental health utilization patterns are necessary to allow for meaningful access to care for vulnerable populations. There have been long standing issues in how mental health is provided, which has caused problems in that care being efficacious for those seeking it. To assess the relationship between mental health status and healthcare utilization among adults ≥65 years. A negative binomial regression model was used to assess the relationship between mental health status and healthcare utilization related to office-based physician visits, while a two-part model, consisting of logistic regression and negative binomial regression, was used to separately model emergency visits and inpatient services. The receipt of care in office-based settings were marginally higher for subjects with mental health difficulties. Both probabilities and counts of inpatient hospitalizations were similar across mental health categories. The count of ER visits was similar across mental health categories; however, the probability of having an emergency department visit was marginally higher for older adults who reported mental health difficulties in 2012. These findings are encouraging and lend promise to the recent initiatives on addressing gaps in mental healthcare services.

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders.

PubMed

Nam, Eunji; Matejkowski, Jason; Lee, Sungkyu

2017-03-01

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

42 CFR 456.600 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.600 Purpose. This subpart prescribes requirements for periodic inspections...

Variations in Student Mental Health and Treatment Utilization Across US Colleges and Universities.

PubMed

Ketchen Lipson, Sarah; Gaddis, S Michael; Heinze, Justin; Beck, Kathryn; Eisenberg, Daniel

2015-01-01

On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants were 43,210 undergraduates at 72 campuses that participated in the Healthy Minds Study from 2007 to 2013. Multivariable logistic regressions focus on associations between institutional characteristics and student mental health and treatment utilization. The following institutional characteristics are associated with worse mental health: doctoral-granting, public, large enrollment, nonresidential, less competitive, and lower graduation rates. Among students with apparent mental health problems, treatment utilization is higher at doctorate-granting institutions, baccalaureate colleges, institutions with small enrollments, and schools with strong residential systems. Although high rates of mental health problems and low treatment utilization are major concerns at all types of institutions of higher education, substantial variation occurs across campuses.

Trends in mental health services utilization and stigma in US soldiers from 2002 to 2011.

PubMed

Quartana, Phillip J; Wilk, Joshua E; Thomas, Jeffrey L; Bray, Robert M; Rae Olmsted, Kristine L; Brown, Janice M; Williams, Jason; Kim, Paul Y; Clarke-Walper, Kristina; Hoge, Charles W

2014-09-01

We characterized trends in mental health services utilization and stigma over the course of the Afghanistan and Iraq wars among active-component US soldiers. We evaluated trends in mental health services utilization and stigma using US Army data from the Health-Related Behavior (HRB) surveys from 2002, 2005, and 2008 (n = 12,835) and the Land Combat Study (LCS) surveys administered to soldiers annually from 2003 to 2009 and again in 2011 (n = 22,627). HRB and LCS data suggested increased mental health services utilization and decreased stigma in US soldiers between 2002 and 2011. These trends were evident in soldiers with and without posttraumatic stress disorder (PTSD), major depressive disorder (MDD), or PTSD and MDD. Despite the improving trends, more than half of soldiers with mental health problems did not report seeking care. Mental health services utilization increased and stigma decreased over the course of the wars in Iraq and Afghanistan. Although promising, these findings indicate that a significant proportion of US soldiers meeting criteria for PTSD or MDD do not utilize mental health services, and stigma remains a pervasive problem requiring further attention.

Correlates of VA mental health treatment utilization among OEF/OIF/OND veterans: Resilience, stigma, social support, personality, and beliefs about treatment.

PubMed

DeViva, Jason C; Sheerin, Christina M; Southwick, Steven M; Roy, Alicia M; Pietrzak, Robert H; Harpaz-Rotem, Ilan

2016-05-01

Veterans of Operations Iraqi Freedom/Enduring Freedom/New Dawn (OEF/OIF/OND) tend not to engage in mental health care. Identifying modifiable factors related to mental health service utilization could facilitate development of interventions to increase utilization. The current study examined the relationship between mental health care utilization and measures of PTSD symptoms, resilience, stigma, beliefs about mental health care, perceived barriers to mental health care, posttraumatic growth and meaning, social support, and personality factors in a sample of 100 OEF/OIF/OND veterans with PTSD symptoms referred to VA mental health care. Participants who received psychotherapy and pharmacotherapy (PP) scored higher on measures of PTSD symptoms, stigma, and adaptive beliefs about mental health treatment, and lower on measures of resilience, postdeployment social support, emotional stability, and conscientiousness, than participants who received no treatment (NT). Participants who received psychotherapy only (PT) scored higher on a measure of PTSD symptoms than NT participants. PT participants scored higher on an emotional stability measure and lower on measures of PTSD symptoms and stigma than PP participants. Multinomial logistic regression including all variables significantly related to treatment utilization indicated that PTSD symptoms and adaptive beliefs about psychotherapy and pharmacotherapy were higher in the PT and PP groups than in the NT group, and concerns about discrimination were higher in the PP group than the NT group. Interventions targeting beliefs about mental health care could increase mental health treatment utilization among OEF/OIF/OND veterans. Concerns about stigma may affect the utilization process differently at different decision points. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Predictors of medical and mental health care use in patients with irritable bowel syndrome in the United States.

PubMed

Gudleski, Gregory D; Satchidanand, Nikhil; Dunlap, Laura J; Tahiliani, Varnita; Li, Xiaohua; Keefer, Laurie; Lackner, Jeffrey M

2017-01-01

Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Performance of subjects with and without severe mental illness on a clinical test of problem solving.

PubMed

Marshall, R C; McGurk, S R; Karow, C M; Kairy, T J; Flashman, L A

2006-06-01

Severe mental illness is associated with impairments in executive functions, such as conceptual reasoning, planning, and strategic thinking all of which impact problem solving. The present study examined the utility of a novel assessment tool for problem solving, the Rapid Assessment of Problem Solving Test (RAPS) in persons with severe mental illness. Subjects were 47 outpatients with severe mental illness and an equal number healthy controls matched for age and gender. Results confirmed all hypotheses with respect to how subjects with severe mental illness would perform on the RAPS. Specifically, the severely mentally ill subjects (1) solved fewer problems on the RAPS, (2) when they did solve problems on the test, they did so far less efficiently than their healthy counterparts, and (3) the two groups differed markedly in the types of questions asked on the RAPS. The healthy control subjects tended to take a systematic, organized, but not always optimal approach to solving problems on the RAPS. The subjects with severe mental illness used some of the problem solving strategies of the healthy controls, but their performance was less consistent and tended to deteriorate when the complexity of the problem solving task increased. This was reflected by a high degree of guessing in lieu of asking constraint questions, particularly if a category-limited question was insufficient to continue the problem solving effort.

Mental Health Needs and Service Utilization by Hispanic Immigrants Residing in Mid-Southern United States

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Deen, Tisha L.

2014-01-01

Purpose This study assessed mental health needs and service utilization patterns in a convenience sample of Hispanic immigrants. Design and Method A total of 84 adult Hispanic participants completed a structured diagnostic interview and a semistructured service utilization interview with trained bilingual research assistants. Results In the sample, 36% met diagnostic criteria for at least one mental disorder. Although 42% of the sample saw a physician in the prior year, mental health services were being rendered primarily by religious leaders. The most common barriers to service utilization were cost (59%), lack of health insurance (35%), and language (31%). Although more women than men met criteria for a disorder, service utilization rates were comparable. Participants with a mental disorder were significantly more likely to have sought medical, but not psychiatric, services in the prior year and faced significantly more cost barriers than participants without a mental disorder. Conclusions Findings suggest that Hispanic immigrants, particularly those with a mental illness, need to access services but face numerous systemic barriers. The authors recommend specific ways to make services more affordable and linguistically accessible. PMID:22802297

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

42 CFR 456.610 - Basis for determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.610 Basis for determinations. In making the...

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

PubMed

Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso

2013-06-01

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

PubMed

Busch, Alisa B; Yoon, Frank; Barry, Colleen L; Azzone, Vanessa; Normand, Sharon-Lise T; Goldman, Howard H; Huskamp, Haiden A

2013-02-01

The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so.

Mental Health Service and Drug Treatment Utilization: Adolescents with Substance Use/Mental Disorders and Dual Diagnosis

ERIC Educational Resources Information Center

Cheng, Tyrone C.; Lo, Celia C.

2010-01-01

This research is a secondary data analysis of the impact of adolescents' mental/substance-use disorders and dual diagnosis on their utilization of drug treatment and mental health services. By analyzing the same teenagers who participated in the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study, logistic…

Correctional Officers and the Incarcerated Mentally Ill: Responses to Psychiatric Illness in Prison

PubMed Central

Galanek, Joseph D.

2014-01-01

Based on ethnographic fieldwork in a U.S. men’s prison, I investigate how this social and cultural context structures relations between correctional officers and inmates with severe mental illness. Utilizing interpretivist perspectives, I explore how these relations are structured by trust, respect, and meanings associated with mental illness. Officers’ discretionary responses to mentally ill inmates included observations to ensure psychiatric stability and flexibility in rule enforcement and were embedded within their role to ensure staff and inmate safety. Officers identified housing, employment, and social support as important for inmates’ psychiatric stability as medications. Inmates identified officers’ observation and responsiveness to help seeking as assisting in institutional functioning. These findings demonstrate that this prison’s structures and values enable officers’ discretion with mentally ill inmates, rather than solely fostering custodial responses to these inmates’ behaviors. These officers’ responses to inmates with mental illness concurrently support custodial control and the prison’s order. PMID:25219680

Mental health and suicidal behavior among graduate students.

PubMed

Garcia-Williams, Amanda G; Moffitt, Lauren; Kaslow, Nadine J

2014-10-01

The objective of this paper is to describe the mental health and service utilization of graduate students at a large southeastern university and identify psychological factors associated with their student suicidal behavior. E-mail invitations to complete the Interactive Screening Program, an online anonymous mental health questionnaire, were sent to graduate students. The questionnaire included the Patient Health Questionnaire (PHQ-9) as well as items assessing suicide behavior, anxiety, negative emotion, substance use, eating behavior, and service utilization. A total of 301 graduate students responded to the questionnaires between 14 July 2010 and 24 January 2012. With regards to suicide, 7.3 % of the sample reported thoughts of suicide, 2.3 % reported having plans for suicide, and 1.7 % had hurt themselves in the past 2 weeks; while 9.9 % had ever made a suicide attempt in their lifetime. Graduate students had PHQ-9 scores indicating mild depression, and more than half endorsed feeling nervous, irritable, stressed, anxious, lonely, or having fights/arguments. In terms of service utilization, 22.2 % of the sample was currently taking some type of medication, and 18.5 % currently in counseling/therapy are females and those with higher PHQ-9 scores more likely to be using services. Those endorsing suicidal behavior in the past 2 weeks had significantly higher depression scores than those without such behavior and were characterized by more anxiety, negative emotions (such as loneliness, anger, hopelessness, desperation, and being out of control), substance use, and eating problems. Graduate students experience significant amounts of stress and anxiety, and their suicidal behavior is strongly characterized by depression, hopelessness, desperation, lack of control, and eating problems. Future work with this population should focus on the development and evaluation of mental health and wellness interventions and on ways to promote help-seeking, especially among male students.

Connection to mental health care upon community reentry for detained youth: a qualitative study

PubMed Central

2014-01-01

Background Although detained youth evidence increased rates of mental illness, relatively few adolescents utilize mental health care upon release from detention. Thus, the goal of this study is to understand the process of mental health care engagement upon community reentry for mentally-ill detained youth. Methods Qualitative interviews were conducted with 19 youth and caregiver dyads (39 participants) recruited from four Midwest counties affiliated with a state-wide mental health screening project. Previously detained youth (ages 11–17), who had elevated scores on a validated mental health screening measure, and a caregiver were interviewed 30 days post release. A critical realist perspective was used to identify themes on the detention and reentry experiences that impacted youth mental health care acquisition. Results Youth perceived detention as a crisis event and having detention-based mental health care increased their motivation to seek mental health care at reentry. Caregivers described receiving very little information regarding their child during detention and felt “out of the loop,” which resulted in mental health care utilization difficulty. Upon community reentry, long wait periods between detention release and initial contact with court or probation officers were associated with decreased motivation for youth to seek care. However, systemic coordination between the family, court and mental health system facilitated mental health care connection. Conclusions Utilizing mental health care services can be a daunting process, particularly for youth upon community reentry from detention. The current study illustrates that individual, family-specific and systemic issues interact to facilitate or impair mental health care utilization. As such, in order to aid youth in accessing mental health care at detention release, systemic coordination efforts are necessary. The systematic coordination among caregivers, youth, and individuals within the justice system are needed to reduce barriers given that utilization of mental health care is a complex process. PMID:24499325

Personal Control and Service Connection as Paths to Improved Mental Health and Exiting Homelessness among Severely Marginalized Homeless Youth.

PubMed

Slesnick, Natasha; Zhang, Jing; Brakenhoff, Brittany

2017-02-01

Non-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes. Seventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline. Personal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health. This study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.

Association of anxiety and depression with hypertension control: a US multidisciplinary group practice observational study.

PubMed

Ho, Aaron K; Thorpe, Carolyn T; Pandhi, Nancy; Palta, Mari; Smith, Maureen A; Johnson, Heather M

2015-11-01

The presence of a mental health disorder with hypertension is associated with higher cardiovascular disease mortality than hypertension alone. Although earlier detection of hypertension has been demonstrated in patients with anxiety and depression, the relationship of mental health disorders to hypertension control is unknown. Our objective was to evaluate rates and predictors of incident hypertension control among patients with anxiety and/or depression compared with patients without either mental health diagnosis. A 4-year retrospective analysis included 4362 patients, at least 18 years old, who received primary care in a large academic group practice from 2008 to 2011. Patients met The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria and had a hypertension diagnosis. Kaplan-Meier analysis estimated the probability of achieving control for patients with and without anxiety and/or depression. Cox proportional hazard models were fit to identify predictors of time to control. Overall, 13% (n = 573) had a baseline diagnosis of anxiety and/or depression. Those with anxiety and/or depression demonstrated more primary care and specialty visits than those without either condition. After adjustment, patients with anxiety and/or depression had faster rates of hypertension control (hazard ratio [HR] 1.22; 1.07-1.39] than patients without either diagnosis. Other associations of faster hypertension control included female gender (HR 1.32; 1.20-1.44), absence of tobacco use (HR 1.17; 1.03-1.33), Medicaid use (HR 1.27; 1.09-1.49), and a higher Adjusted Clinical Group Risk Score (HR 1.13; 1.10-1.17), a measure of healthcare utilization. Greater healthcare utilization among patients with anxiety and/or depression may contribute to faster hypertension control.

A systematic review of online interventions for mental health in low and middle income countries: a neglected field.

PubMed

Arjadi, R; Nauta, M H; Chowdhary, N; Bockting, C L H

2015-01-01

Low and middle income countries (LMICs) are facing an increase of the impact of mental health problems while confronted with limited resources and limited access to mental health care, known as the 'mental health gap'. One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care. We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs. We systematically searched the data-bases PubMed, PsycINFO, JMIR, and additional sources. MeSH terms, Thesaurus, and free text keywords were used. We included all randomized controlled trials (RCTs) of online interventions in LMICs. We found only three articles reported results of RCTs on online interventions for mental health conditions in LMICs, but none of these interventions was compared with an active control condition. Also, the mental health conditions were diverse across the three studies. There is a dearth of studies examining the effect of online interventions in LMICs, so we cannot draw a firm conclusion on its effectiveness. However, given the effectiveness of online interventions in high income countries and sharp increase of internet access in LMICs, online interventions may offer a potential to help reduce the 'mental health gap'. More studies are urgently needed in LMICs.

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2012 CFR

2012-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2014 CFR

2014-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

42 CFR 456.606 - Frequency of inspections.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.606 Frequency of inspections. The team and the agency...

42 CFR 456.607 - Notification before inspection.

Code of Federal Regulations, 2013 CFR

2013-10-01

....607 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.607 Notification before inspection. No facility may be...

Working with sports organizations and teams.

PubMed

McDuff, David R; Garvin, Michelle

2016-12-01

Athletes and coaches at all competitive levels will utilize sports performance and psychiatric services at very high rates if the services are offered on-site and free of charge and are broad in scope and culturally sensitive. Services should be available throughout the team year and cover areas such as team building, mental preparation, stress control, substance prevention, sleep and energy regulation, injury recovery, crisis intervention, and mental disorder treatment. The staff offering these services should be diverse by gender, profession, and culture, and the fees should be paid by the organization. When these services are endorsed by the team's leaders and integrated with the athletic training/medical/player development staff, their utilization will grow quickly and lead to positive outcomes individually and collectively.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PubMed

Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

2017-06-01

As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

Personality Accounts for the Connection Between Volunteering and Health.

PubMed

King, Hannah R; Jackson, Joshua J; Morrow-Howell, Nancy; Oltmanns, Thomas F

2015-09-01

Existing literature has shown that volunteering is related to better physical and mental health outcomes. The purpose of this study is to examine whether personality traits and volunteering are independent predictors of physical and mental health. The current study utilizes data from the St. Louis Personality and Aging Network (SPAN), a representative sample of community-based adults between the ages of 55 and 64. Using hierarchical linear regressions, we test whether volunteering is a significant predictor of both physical and mental health while controlling for personality traits. We find that volunteering is not significantly related to either physical or mental health while controlling for personality traits. We also find that lower neuroticism is related to better physical functioning and mental health, whereas higher extraversion is related to better mental health. These results indicate that volunteering may be related to health outcomes because of the personality characteristics of volunteers, not the volunteering experience in and of itself. Future longitudinal studies are needed to further explore the relationship between personality, volunteering, and health. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Utilization of Ambulatory Mental Health Services.

ERIC Educational Resources Information Center

Williams, Stephen J.; Richardson, Mary

1980-01-01

Studied the use of mental health services by enrolled populations, in order to establish a model or predictor of utilization. Primary focus of utilization data has been patient characteristics; organizational variables, such as plan design and benefit packages, are also shown to affect utilization. (LAB)

Mental Strain and Chronic Stress among University Students with Symptoms of Irritable Bowel Syndrome.

PubMed

Gulewitsch, Marco D; Enck, Paul; Schwille-Kiuntke, Juliane; Weimer, Katja; Schlarb, Angelika A

2013-01-01

Aim. To investigate the degree of mental strain and chronic stress in a German community sample of students with IBS-like symptoms. Methods and Materials. Following an internet-based survey about stress, this study recruited 176 German university students (23.45 ± 2.48 years; 48.3% males) with IBS-like symptoms according to Rome III and 181 students without IBS (23.55 ± 2.82 years; 50.3% males) and compared them regarding current mental strain (SCL-90-R) and the extend of chronic stress. Beyond this, IBS subtypes, IBS severity, and health care utilization were assessed. Results. Students fulfilling IBS criteria showed significantly elevated values of mental strain and chronic stress. Nearly 40% of the IBS group (versus 20% of the controls) reached a clinically relevant value on the SCL-90-R global severity scale. IBS subtypes did not differ in terms of mental distress or chronic stress. Somatization, anxiety, and the chronic stressors "work overload," "social tension," and "dissatisfaction with job" were most closely connected to IBS symptom severity. Regarding health care utilization, our results show that consulting a physician frequently was not associated significantly with elevated mental strain or chronic stress but with IBS symptom severity. Conclusion. Our data contribute additional evidence to the distinct association between psychological stress and IBS in community samples.

Race and health in Guyana: an empirical assessment from survey data.

PubMed

Wilson, Leon C; Wilson, Colwick M; Johnson, Bridgette M

2010-01-01

This paper examines racial differences in physical health and mental well-being in Guyana, South America: a country with cultural ties to the Caribbean. It explores the complex relationship among race, socioeconomic status and health outcomes which in developed societies continues to be of significant research interest. Utilizing a random probability sample of over 900 adults, the analyses provide information on the general physical and mental health status of this population and examine the differences by racial groups when other factors are controlled. The results indicate significant age-specific racial differences in physical and mental health in Guyana. Higher rates of diabetes, arthritis or rheumatism, back and breathing problems among Indo-Guyanese when compared to other groups were noted. Racial differences in physical health were attenuated when gender and educational levels were controlled.

Heterogeneity of Mental Health Service Utilization and High Mental Health Service Use Among Women Eight Years After Initiating Substance Use Disorder Treatment.

PubMed

Evans, Elizabeth; Padwa, Howard; Li, Libo; Lin, Veronique; Hser, Yih-Ing

2015-12-01

The aim of this study was to determine mental health service utilization patterns among women treated for substance use disorders (SUD) and identify factors associated with patterns of high mental health service use. Data were provided by 4447 women treated for SUD in California during 2000-2002 for whom mental health services utilization records were acquired. A latent class model was fitted to women's high use of services (>6 services/year over 8 years). Multinomial logistic regression was used to identify predisposing, enabling, and need factors associated with utilization patterns. In 8 years after initiating SUD treatment, 50% of women utilized mental health services. High use probability was consistently low for most women (76.9%); for others, however, it decreased immediately following SUD treatment and then increased over time (8.7%), increased immediately following SUD treatment and then decreased (9.3%), or remained consistently high (5.1%). Consistently high services use was negatively associated with marriage (OR 0.60, p<0.05) and employment (OR 0.53, p<0.05) and positively associated with older age (OR 1.04, p<0.001), homelessness (OR 1.68, p<0.05), public assistance (OR 1.76, p<0.01), outpatient SUD treatment (OR 3.69, p<0.01), longer SUD treatment retention (OR 1.00, p<0.01), treatment desire (ORs 1.46, p<0.001), and co-occurring disorder diagnosis (ORs 2.89-44.93, p<0.001). Up to 29% of women with co-occurring mental health disorders at SUD treatment entry did not receive any mental health treatment in the subsequent 8 years. Mental health services utilization patterns among women treated for SUD are heterogeneous and dynamic. Understanding factors related to women's utilization patterns may aid efforts to optimize care and ensure appropriate use of mental health services. Copyright © 2015 Elsevier Inc. All rights reserved.

Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City.

PubMed

Kupprat, Sandra A; Dayton, Alex; Guschlbauer, Andrea; Halkitis, Perry N

2009-07-01

A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances, only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n=29) and substance use (54%, n=25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n=7) were significantly more likely to be retained in group (i.e., attend 11 or more sessions) than those at medical model agencies (39.1%, n=9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.

Chinese mental illness narratives: controlling the spirit.

PubMed

Ramsay, Guy

2009-01-01

Through analysis of local level narrative themes and linguistic features and their attendant narrative 'domains' and emotive content, this study explicates the discursive forms of Chinese personal narratives about mental illness published in a psychoeducational volume in mainland China. The cultural phenomena underpinning the explicated discursive forms are considered. The study finds that the Chinese mental illness narratives emphasize the problematic nature of the illness experience for the individual concerned, as well as the importance of gaining control over the personal and social disembodiment that mental illness brings about. The language of medicine presents as a dominant linguistic feature of the texts. Narrative authors appear to respond to their illness experience by negotiating and utilizing social relationships and support structures and through active medical intercession. As such, their narratives appear deeply culturally marked despite their psychoeducational intent and institutional context of publication. The study findings bear out the call for more attention to be given to the cultural dimension when analysing illness narratives.

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

42 CFR 456.611 - Reports on inspections.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.611 Reports on inspections. (a) The team must submit a...

42 CFR 456.613 - Action on reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.613 Action on reports. The agency must take corrective action as needed...

Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care.

PubMed

Leung, Lucinda B; Yoon, Jean; Rubenstein, Lisa V; Post, Edward P; Metzger, Maureen E; Wells, Kenneth B; Sugar, Catherine A; Escarce, José J

2018-01-01

Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary Care-Mental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs. We performed a retrospective longitudinal cohort study of primary care patients with identified mental health needs in 29 Southern California VA clinics from October 1, 2008 to September 30, 2013, using electronic administrative data (n = 66,638). We calculated clinic PC-MHI engagement as the proportion of patients receiving PC-MHI services among all primary care clinic patients in each year. Capitalizing on variation in PC-MHI engagement across clinics, our multivariable regression models predicted annual patient use of 1) non-primary care based mental health specialty (MHS) visits, 2) total mental health visits (ie, the sum of MHS and PC-MHI visits), and 3) health care utilization and costs. We controlled for year- and clinic-fixed effects, other clinic interventions, and patient characteristics. Median clinic PC-MHI engagement increased by 8.2 percentage points over 5 years. At any given year, patients treated at a clinic with 1 percentage-point higher PC-MHI engagement was associated with 0.5% more total mental health visits (CI, 0.18% to 0.90%; P = .003) and 1.0% fewer MHS visits (CI, -1.6% to -0.3%; P = .002); this is a substitution rate, at the mean, of 1.5 PC-MHI visits for each MHS visit. There was no PC-MHI effect on other health care utilization and costs. As intended, greater clinic engagement in PC-MHI services seems to increase realized accessibility to mental health care for primary care patients, substituting PC-MHI for MHS visits, without increasing acute care use or total costs. Thus, PC-MHI services within primary care clinics may improve mental health care value at the patient population level. More research is needed to understand the relationship between clinic PC-MHI engagement and clinical quality of mental health care. © Copyright 2018 by the American Board of Family Medicine.

Perceived need for care and mental health service utilization among college students with suicidal ideation.

PubMed

Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E

2018-01-31

This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

Evaluation of the utility of Liebowitz Social Anxiety Scale and Barratt Impulsiveness Scale in the diagnosis of social anxiety, impulsivity and depression.

PubMed

Tyrała, Kinga; Seweryn, Mariusz; Bonk, Magdalena; Bulska, Weronika; Orszulak, Kamila; Bratek, Agnieszka; Krysta, Krzysztof

2015-09-01

Often mental disorders are serious problems concerning psychological well-being. They require comprehensive and specialized psychiatric and psychological help, but there are no public methods of controlling your mental state. The aim of study was the evaluation of the utility of Liebowitz Social Anxiety Scale and Barratt Impulsiveness Scale in the diagnosis of social anxiety, impulsivity and depression. The study included 85 persons. The study group had 34 patients treated in an open ward of the Department of Psychiatry and Psychotherapy of Medical University of Silesia in Katowice. The control group included 51 persons without mental disorders. Three self-rating questionnaires were used: Beck Depression Inventory, Barratt Impulsiveness Scale and Liebowitz Social Anxiety Scale. Statistica v10 Statsoft software was used for statistical analysis. The analyzed groups had significant differences in terms of Beck Scale (U Mann-Whitney test p=0.000001). Average score in study group: 22.94±12.50; in control group: 7.15±6.44. Groups had significant differences in terms of Liebowitz Scale (U test Mann-Whitney test, p=0.000164). Average score in the study group: 60.41±30.30; in control group: 35.01±23.94. Groups had significant differences in terms of Barratt Scale (t-student test p=0.000601). Average in study group: 66.35±9,49; in control group: 59.54±7.87. Significant positive correlation was observed between the results of Beck Scale and Liebowitz Scale (r=0.64465). Correlation was not observed between the results of the Liebowitz and Barrat (r=0.12091 and Beck and Barrat (r=0.21482). The intensity of the Liebowitz Social Anxiety Scale is directly proportional to the severity of depression according to the Beck Depression Inventory. The degree of impulsivity by Barrat Impulsiveness Scale does not correlate with the level of depression according to Beck Depression Inventory. The analyzed scales are relevant in the diagnosis of mental disorders.

Coordination Program Reduced Acute Care Use And Increased Primary Care Visits Among Frequent Emergency Care Users.

PubMed

Capp, Roberta; Misky, Gregory J; Lindrooth, Richard C; Honigman, Benjamin; Logan, Heather; Hardy, Rose; Nguyen, Dong Q; Wiler, Jennifer L

2017-10-01

Many high utilizers of the emergency department (ED) have public insurance, especially through Medicaid. We evaluated how participation in Bridges to Care (B2C)-an ED-initiated, multidisciplinary, community-based program-affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible high ED utilizers. During the six months after the B2C intervention was completed, participants had significantly fewer ED visits (a reduction of 27.9 percent) and significantly more primary care visits (an increase of 114.0 percent), compared to patients in the control group. In a subanalysis of patients with mental health comorbidities, we found that recipients of B2C services had significantly fewer ED visits (a reduction of 29.7 percent) and hospitalizations (30.0 percent), and significantly more primary care visits (an increase of 123.2 percent), again compared to patients in the control group. The B2C program reduced acute care use and increased the number of primary care visits among high ED utilizers, including those with mental health comorbidities. Project HOPE—The People-to-People Health Foundation, Inc.

Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A)

ERIC Educational Resources Information Center

Merikangas, Kathleen Ries; He, Jian-ping; Burstein, Marcy; Swendsen, Joel; Avenevoli, Shelli; Case, Brady; Georgiades, Katholiki; Heaton, Leanne; Swanson, Sonja; Olfson, Mark

2011-01-01

Objective: Mental health policy for youth has been constrained by a paucity of nationally representative data concerning patterns and correlates of mental health service utilization in this segment of the population. The objectives of this investigation were to examine the rates and sociodemographic correlates of lifetime mental health service use…

Long-term effects of adolescent marijuana use prevention on adult mental health services utilization: the midwestern prevention project.

PubMed

Riggs, Nathaniel R; Pentz, Mary Ann

2009-01-01

Evaluated were effects of a drug abuse(1) prevention program, previously shown to prevent marijuana use in adolescence, on adulthood mental health service use. Analyses were conducted on 961 6th (41%) and 7th (59%) grade participants randomly assigned to intervention or control groups at baseline in 1984. These participants were followed-up through 2003 representing 15 waves of data collection. Eighty-five percent of participants were Caucasian and 56% were female. The hypothesis was that direct program effects on early adulthood mental health service use would be mediated by program effects on high school marijuana use trajectories. Structural equation models, imputing for missing data, demonstrated that MPP (Midwestern Prevention Project) program effects on mental health were mediated by the marijuana use growth curve intercept. Findings support the role of early adolescent drug use prevention programs in impacting later mental health problems. The study's limitations are noted.

The changing purpose of mental health law: From medicalism to legalism to new legalism.

PubMed

Brown, Jennifer

2016-01-01

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does ethno-cultural betrayal in trauma affect Asian American/Pacific Islander college students' mental health outcomes? An exploratory study.

PubMed

Gómez, Jennifer M

2017-01-01

Interpersonal trauma has deleterious effects on mental health, with college students experiencing relatively high rates of lifetime trauma. Asian American/Pacific Islanders (AAPIs) have the lowest rate of mental healthcare utilization. According to cultural betrayal trauma theory, societal inequality may impact within-group violence in minority populations, thus having implications for mental health. In the current exploratory study, between-group (interracial) and within-group (ethno-cultural betrayal) trauma and mental health outcomes were examined in AAPI college students. Participants (N = 108) were AAPI college students from a predominantly white university. Data collection concluded in December 2015. Participants completed online self-report measures. A multivariate analysis of variance revealed that when controlling for interracial trauma, ethno-cultural betrayal trauma significantly impacted dissociation, hallucinations, posttraumatic stress symptoms, and hypervigilance. The results have implications for incorporating identity, discrimination, and ethno-cultural betrayal trauma victimization into assessments and case conceptualizations in therapy.

The impact of realignment on utilization and cost of community-based mental health services in California.

PubMed

Scheffler, R; Zhang, A; Snowden, L

2001-11-01

Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.

Mental health help-seeking attitudes, utilization, and intentions among older Chinese immigrants in Canada.

PubMed

Tieu, Yvonne; Konnert, Candace A

2014-03-01

This study had three objectives. First, to determine the extent to which demographic factors, perceived social support, and Chinese cultural beliefs predict attitudes toward mental health help seeking; second, to assess mental health utilization; and third, to assess intentions to utilize mental health services among older Chinese immigrants in Canada aged 55 and above. A total of 149 older Chinese adults (M = 73.92 years, SD = 9.99, range = 55-95 years) completed a semi-structured interview protocol in Cantonese or Mandarin. Demographic and health information were collected, and questionnaires assessing perceived social support, mental health help-seeking attitudes, and belief in Chinese culture and values were administered. Demographic and health information, perceived social support, Chinese cultural beliefs and values accounted for 21.8% of the variance in help-seeking attitudes. Descriptive data related to mental health utilization and intentions are provided. Older Chinese participants exhibited less positive attitudes that were significantly associated with Chinese cultural beliefs and values. Implications for practice with older Chinese adults are also discussed.

Factors Associated with Mental Health Service Utilization among Korean American Immigrants

PubMed Central

Park, So-Youn; Cho, Sunhee; Park, Yeddi; Bernstein, Kunsook S.; Shin, Jinah K.

2014-01-01

This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services. PMID:23417654

Effects of Mental Health Parity on High Utilizers of Services: Pre-Post Evidence From a Large, Self-Insured Employer.

PubMed

Grazier, Kyle L; Eisenberg, Daniel; Jedele, Jenefer M; Smiley, Mary L

2016-04-01

This study evaluated utilization of mental health and substance use services among enrollees at a large employee health plan following changes to benefit limits after passage in 2008 of federal mental health parity legislation. This study used a pre-post design. Benefits and claims data for 43,855 enrollees in the health plan in 2009 and 2010 were analyzed for utilization and costs after removal of a 30-visit cap on the number of covered mental health visits. There was a large increase in the proportion of health plan enrollees with more than 30 outpatient visits after the cap's removal, an increase of 255% among subscribers and 176% among dependents (p<.001). The number of people near the 30-visit limit for substance use disorders was too few to observe an effect. Federal mental health parity legislation is likely to increase utilization of mental health services by individuals who had previously met their benefit limit.

A cross-sectional study about associations between personality characteristics and mental health service utilization in a Korean national community sample of adults with psychiatric disorders.

PubMed

Park, Subin; Lee, Yeeun; Seong, Su Jeong; Chang, Sung Man; Lee, Jun Young; Hahm, Bong Jin; Hong, Jin Pyo

2017-05-05

Personality traits are not only associated with psychiatric symptoms, but also with treatment seeking behavior. Our purpose was to examine the relationship between mental health service utilization and personality characteristics in a nationwide community sample of Korean adults. Of the 6022 subjects aged 18-74 years who participated in the Korean Epidemiologic Catchment Area study, 1544 (25.6%) with a lifetime diagnosis of any DSM-IV psychiatric disorder were analyzed. Diagnostic assessments were based on the Composite International Diagnostic Interview and personality constructs were measured by Big Five Personality Inventory-10. Of the 1544 participants, 275 (17.8%) had used mental health services. Multivariate analyses revealed positive associations between mental health service utilization and both neuroticism and openness, and an inverse association between mental health service utilization and agreeableness. These findings suggest that specific personality traits may have a role in treatment-seeking behaviors for mental health problems independent of the psychiatric disorder.

Emergency department utilization among recently released prisoners: a retrospective cohort study

PubMed Central

2013-01-01

Background The population of ex-prisoners returning to their communities is large. Morbidity and mortality is increased during the period following release. Understanding utilization of emergency services by this population may inform interventions to reduce adverse outcomes. We examined Emergency Department utilization among a cohort of recently released prisoners. Methods We linked Rhode Island Department of Corrections records with electronic health record data from a large hospital system from 2007 to 2009 to analyze emergency department utilization for mental health disorders, substance use disorders and ambulatory care sensitive conditions by ex-prisoners in the year after release from prison in comparison to the general population, controlling for patient- and community-level factors. Results There were 333,369 total ED visits with 5,145 visits by a cohort of 1,434 ex-prisoners. In this group, 455 ex-prisoners had 3 or more visits within 1 year of release and 354 had a first ED visit within 1 month of release. ED visits by ex-prisoners were more likely to be made by men (85% vs. 48%, p < 0.001) and by blacks (26% vs. 16%, p < 0.001) compared to the Rhode Island general population. Ex-prisoners were more likely to have an ED visit for a mental health disorder (6% vs. 4%, p < 0.001) or substance use disorder (16%vs. 4%, p < 0.001). After controlling for patient- and community-level factors, ex-prisoner visits were significantly more likely to be for mental health disorders (OR 1.43; 95% CI 1.27-1.61), substance use disorders (OR 1.93; 95% CI 1.77-2.11) and ambulatory care sensitive conditions (OR 1.09; 95% CI 1.00-1.18). Conclusions ED visits by ex-prisoners were significantly more likely due to three conditions optimally managed in outpatient settings. Future work should determine whether greater access to outpatient services after release from prison reduces ex-prisoners’ utilization of emergency services. PMID:24188513

Teach It, Don't Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information.

PubMed

Canning, Elizabeth A; Harackiewicz, Judith M

2015-03-01

Social-psychological interventions in education have used a variety of "self-persuasion" or "saying-is-believing" techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples.

Should "standard gamble" and "'time trade off" utility measurement be used more in mental health research?

PubMed

Flood, Chris

2010-06-01

This review and discussion paper demonstrates that utility and preference measurement in mental health research is increasing. However there is still a general reluctance around using the methods due to methodological challenges and concerns around the capacity of users to understand utility methods during the research process. This paper sets out to describe and review some of the previously documented difficulties of using utility measurements in mental health services research and to highlight where they have been used successfully as measures. Additionally the paper aims to discuss a means of improving the methods used to capture service user utility and preference measurement and why decision making would be better informed as a result. International literature on utility measurement is reviewed, specifically examining the use of standard gamble and time trade off methods in mental health. Utility measurement in mental health is increasing though as the review demonstrates, concerns still exist over its application. A number of methods can be used to improve the approach overall and these are discussed as well as specific areas worthy of utility measurement including 'disutility' of admission, medication and medication side effects. Overall this paper argues that it is necessary to persist with efforts to conduct utility measurement calculation albeit with a critical eye on the methods in an attempt to ensure improvements are continually made. Utility and preference scores may be limited in that they only provide a rough score but they are defended as a means of providing some form of strength of preference for health states. The review is limited to English only texts. The debate on whether to use standard gamble and time trade off has implications for health services resource allocations, decision making, health economics research, policy making and health services research generally involving psychiatric service users. The paper argues that the absence of utility measurement in mental health runs the risk of mental health being disadvantaged in decisions around resource allocation. Institutions involved in decision making like the United Kingdom's National Institute for Health and Clinical Excellence, would be better served in their decision making and calculation of Quality Adjusted Life Years if more utility measurement in psychiatric research was carried out. Other arguments for using utility measurement include the desirability of using utility measurement to elicit a patient dimension of risk. Future utility research should aim for better involvement of service users in the design stage, the changing of time frames offered to users in health state scenarios used, a greater need for comparative work of utilities scoring across illness and between standard gamble and time trade off and more staff training in the use of utility methodology with mental health service users.

U.S. military mental health care utilization and attrition prior to the wars in Iraq and Afghanistan.

PubMed

Garvey Wilson, Abigail L; Messer, Stephen C; Hoge, Charles W

2009-06-01

Health care utilization studies of mental disorders focus largely on the ICD-9 category 290-319, and do not generally include analysis of visits for mental health problems identified under V-code categories. Although active duty service members represent a large young adult employed population who use mental health services at similar rates as age-matched civilian populations, V-codes are used in a larger proportion of mental health visits in military mental health care settings than in civilian settings. However, the utilization of these diagnoses has not been systematically studied. The purpose of this study is to characterize outpatient behavioral health visits in military health care facilities prior to Operation Iraqi Freedom, including the use of diagnoses outside of the ICD-9 290-319 range, in order to evaluate the overall burden of mental health care. This study establishes baseline rates of mental health care utilization in military mental health clinics in 2000 and serves as a comparison for future studies of the mental health care burden of the current war. All active duty service members who received care in military outpatient clinics in 2000 (n = 1.35 million) were included. Primary diagnoses were grouped according to mental health relevance in the following categories: mental disorders (ICD-9 290-319), mental health V-code diagnoses (used primarily by behavioral health providers that were indicative of a potential mental health problem), and all other diagnoses. Rates of service utilization within behavioral health clinics were compared with rates in other outpatient clinics for each of the diagnostic groups, reported as individuals or visits per 1,000 person-years. Cox proportional hazard regression was used to produce hazard ratios as measures of association between each of the diagnostic groups and attrition from military service. Time to attrition in months was the difference between the date of military separation and the date of first clinic visit in 2000. Data were obtained from the Defense Medical Surveillance System. The total number of individuals who utilized behavioral health services in 2000 was just over 115 per 1,000 person-years, almost 12% of the military population. Out of every 1,000 person-years, 57.5 individuals received care from behavioral health providers involving an ICD-9 290-319 mental disorder diagnosis, and an additional 26.7 per 1,000 person-years received care in behavioral health clinics only for V-code diagnoses. Attrition from service was correlated with both categories of mental health-related diagnoses. After 1 year, approximately 38% of individuals who received a mental disorder diagnosis left the military, compared with 23% of those who received mental health V-code diagnoses and 14% of those who received health care for any other reason (which included well visits for routine physicals). This study establishes baseline rates of pre-war behavioral healthcare utilization among military service members, and the relationship of mental health care use and attrition from service. The research indicates that in the military population the burden of mental illness in outpatient clinics is significantly greater when V-code diagnoses are included along with conventional mental disorder diagnostic codes.

Use of Multi-Sensory Reinforcement in Toilet Training Retardates.

ERIC Educational Resources Information Center

Bates, Karla K.; Armenti, Simma

A behavior modification program in toilet training, utilizing reinforcing properties of music, candy, cold drinks, and television was instigated with institutionalized (nontoilet trained) males, ages 15-20 , who were profoundly, severely and moderately mentally handicapped. Eleven experimental and 11 control subjects were involved. A Toileting…

Examining the association between suicidal behaviors and referral for mental health services among children involved in the child welfare system in Ontario, Canada.

PubMed

Baiden, Philip; Fallon, Barbara

2018-05-01

Although various studies have investigated factors associated with mental health service utilization, few studies have examined factors associated with referral for mental health services among maltreated children. The objective of this study was to examine the association between suicidal thoughts and self-harming behavior and referral for mental health services among children involved in the Child Welfare System in Ontario, Canada. Data for this study were obtained from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013. An estimate 57,798 child maltreatment investigations was analyzed using binary logistic regression with referral for mental health service as the outcome variable. Of the 57,798 cases, 4709 (8.1%), were referred for mental health services. More than seven out of ten maltreated children who engaged in self-harming behavior and two out of three maltreated children who expressed suicidal thoughts were not referred for mental health services. In the multivariate logistic regression model, children who expressed suicidal thoughts had 2.39 times higher odds of being referred for mental health services compared to children with no suicidal thoughts (AOR = 2.39, 99% C.I. 2.05-2.77) and children who engaged in self-harming behavior had 1.44 times higher odds of being referred for mental health services compared to children who did not engage in self-harming behavior (AOR = 1.44, 99% C.I. 1.24-1.67), both after controlling for child demographic characteristics, maltreatment characteristics, and child functioning concerns. Given that referral is the initial step towards mental health service utilization, it is important that child welfare workers receive the necessary training so as to carefully assess and refer children in care who expressed suicidal thoughts or engaged in self-harming behavior for appropriate mental health services. The paper discusses the results and their implications for child welfare policy and practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Defense Health Care: DOD Is Meeting Most Mental Health Care Access Standards, but It Needs a Standard for Follow-up Appointments

DTIC Science & Technology

2016-04-01

domestically and overseas. GAO analyzed recent, available data on MHS mental health utilization , staffing, and appointment access and compared... utilization of mental health treatment services in both the direct and purchased care systems by active duty servicemembers, including activated...reservists, from fiscal years 2009 to 2014.5 To determine the reliability of the utilization data, we reviewed relevant documentation, discussed this

Self-reliance, mental health need, and the use of mental healthcare among island Puerto Ricans.

PubMed

Ortega, Alexander N; Alegría, Margarita

2002-09-01

This paper examines the relationship between self-reliance (preference to solve emotional problems on one's own) and 5 mental healthcare utilization outcomes for Puerto Ricans living in low-income areas. A random probability community sample of noninstitutionalized Puerto Ricans, ages 18-69, living in low-income areas of the island were selected and interviewed in 1992-93 and 1993-94. A series of logistic regression models tested the association between self-reliance and 5 mental health utilization measures, after adjusting for covariates measuring predisposing, enabling, need and barrier factors: any use of mental health services, any use of general health services for mental healthcare, any use of specialty care, use of psychotropic medications, and retention in mental healthcare. Self-reliance was found to be negatively associated with all 5 dependent service utilization measures. Those with a positive self-reliant attitude were 40% less likely to use care on any of the 5 outcome measures. An interaction was also observed between definite need for mental healthcare and having a self-reliant attitude when predicting mental health service use. Definite needers with a self-reliant attitude were 54%-58% less likely to use mental health services compared with definite needers who did not have a self-reliant attitude. Further, decreases in self-reliant attitude over the two data collection periods were associated with increases in mental health service use. Our findings suggest that self-reliance is a significant and robust predictor of mental healthcare utilization among Puerto Ricans living in low-income areas of the island.

Racial and ethnic differences in utilization of mental health services among high-risk youths.

PubMed

Garland, Ann F; Lau, Anna S; Yeh, May; McCabe, Kristen M; Hough, Richard L; Landsverk, John A

2005-07-01

Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial/ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. Significant racial/ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race/ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. Racial/ethnic disparities in service use remain a public health problem.

Differences in Physical and Mental Health Symptoms and Mental Health Utilization Associated With Intimate-Partner Violence Versus Childhood Abuse

PubMed Central

Nicolaidis, Christina; McFarland, Bentson; Curry, MaryAnn; Gerrity, Martha

2009-01-01

Background There is ample evidence that both intimate-partner violence (IPV) and childhood abuse adversely affect the physical and mental health of adult women over the long term. Objective The authors assessed the associations between abuse, symptoms, and mental health utilization. Method The authors performed a cross-sectional survey of 380 adult female, internal-medicine patients. Results Although both IPV and childhood abuse were associated with depressive and physical symptoms, IPV was independently associated with physical symptoms, and childhood abuse was independently associated with depression. Women with a history of childhood abuse had higher odds, whereas women with IPV had lower odds, of receiving care from mental health providers. Conclusion IPV and childhood abuse may have different effects on women’s symptoms and mental health utilization. PMID:19687174

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system.

PubMed

Rawal, Purva; Romansky, Jill; Jenuwine, Michael; Lyons, John S

2004-01-01

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995-1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.

Health service utilization before and after evidence-based treatment for PTSD.

PubMed

Tuerk, Peter W; Wangelin, Bethany; Rauch, Sheila A M; Dismuke, Clara E; Yoder, Matthew; Myrick, Hugh; Eftekhari, Afsoon; Acierno, Ron

2013-11-01

Posttraumatic stress disorder (PTSD) is associated with functional impairment, co-occurring diagnoses, and increased health care utilization. Associated high demand for health care services is an important contributor to the large public-health cost of PTSD. Treatments incorporating exposure therapy are efficacious in ameliorating or eliminating PTSD symptoms. Accordingly, the Veterans Health Administration has made significant investments toward nationwide dissemination of a manualized exposure therapy protocol, prolonged exposure (PE). PE is effective with veterans; however, the relationship between PE and mental health service utilization is unknown. The current study investigates PE as it relates to actual tracked mental health service utilization in an urban VA medical center. A sample of 60 veterans with a diagnosis of PTSD was used to examine mental health service utilization in the 12-months prior to and 12-months after being offered PE. Hierarchical Linear Models and traditional repeated-measures ANOVA were used to estimate R²- and d-type effect sizes for service utilization. Associated estimated cost saving are reported. PE was associated with large reductions in symptoms and diagnosis remission. Treatment was also associated with statistically significant, large reductions in mental health service utilization for veterans who completed treatment. Findings suggest that expanding access to PE can increase access to mental health services in general by decreasing ongoing demand for specialty care clinical services.

Trends of utilization of government disability benefits among chronic mentally ill.

PubMed

Kashyap, Kartik; Thunga, Ravish; Rao, Arun K; Balamurali, N P

2012-01-01

Mentally retarded and chronic mentally ill are being certified using IQ Assessment and Indian Disability Evaluation and Assessment Scale (IDEAS). They have been granted various benefits including monthly pension, from Ministry of Social Welfare, Government of India. The monthly pension appears to be the strongest reason for seeking certification and applying for government benefits. The caregivers appear to have only partial information and awareness about the remaining schemes. The study aims to assess the severity of disability in the mentally retarded and mentally ill who are certified for disability benefits, as well as to assess the trends of utilization of disability benefits over a 3 year period. This was a retrospective, file review based study of certificates of patients certified for mental disability in the period of January 2006 to December 2008. Certificates of a total of 1794 mentally retarded and 285 mentally ill were reviewed. The data regarding utilization of disability benefits was assessed. Patients from rural areas did not avail any benefits other than the disability pension. Among Mentally Ill, Schizophrenia accounted for highest certifications. Males had higher disability compared to females, and Dementia showed highest disability as per IDEAS. Though initial hurdles due to disability measurement have been crossed, disability benefits are still elusive to the vast majority of the disabled. Proper awareness and education will help in reducing the stigma and in the effective utilization of benefits.

Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS).

PubMed

Lam, Linda Chiu-Wa; Wong, Corine Sau-Man; Wang, Min-Jung; Chan, Wai-Chi; Chen, Eric Yu-Hai; Ng, Roger Man-Kin; Hung, Se-Fong; Cheung, Eric Fuk-Chi; Sham, Pak-Chung; Chiu, Helen Fung-Kum; Lam, Ming; Chang, Wing-Chung; Lee, Edwin Ho-Ming; Chiang, Tin-Po; Lau, Joseph Tak-Fai; van Os, Jim; Lewis, Glyn; Bebbington, Paul

2015-09-01

Data on mental disorder prevalence and health service utilization required to inform healthcare management and planning are lacking in Hong Kong. The current study determined the prevalence of common mental disorders (CMD), and examined the patterns of mental health service utilization and associated factors. We analyzed data from the Hong Kong Mental Morbidity Survey (HKMMS) of 5,719 Chinese adults aged 16-75 years in the general Hong Kong population, using the Chinese Revised Clinical Interview Schedule (CIS-R). The weighted prevalence estimate for any past-week CMD was 13.3 %, with mixed anxiety and depressive disorder being the most frequent diagnoses. CMD was positively associated with female gender, being divorced or separated, alcohol misuse, substance dependence, lack of regular physical exercise, and a family history of mental disorder. Among individuals with CMD, only 26 % had consulted mental health services in the past year; less than 10 % consulted general practitioners or family physicians. Lack of mental health service usage was significantly more likely in men and those with lower educational attainment. Apart from attention to psychosocial risks, health and lifestyle factors are important considerations for mental health promotion. Service utilization for individuals with CMD in Hong Kong remains suboptimal, and would be enhanced by strengthening community primary care.

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Definitions. 456.601 Section 456.601 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.601...

42 CFR 456.601 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Definitions. 456.601 Section 456.601 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.601...

42 CFR 456.608 - Personal contact with and observation of recipients and review of records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and review of records. 456.608 Section 456.608 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.608 Personal...

Mental Health Service Utilization among African American and Caucasian Mothers and Fathers

ERIC Educational Resources Information Center

Thurston, Idia B.; Phares, Vicky

2008-01-01

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors…

Utilization of Computer Technology To Facilitate Money Management by Individuals with Mental Retardation.

ERIC Educational Resources Information Center

Davies, Daniel K.; Stock, Steven E.; Wehmeyer, Michael L.

2003-01-01

This report describes results of an initial investigation of the utility of a specially designed money management software program for improving management of personal checking accounts for individuals with mental retardation. Use with 19 adults with mental retardation indicated the software resulted in significant reduction in check writing and…

Utilization of Mental Health Services in School-Based Health Centers

ERIC Educational Resources Information Center

Bains, Ranbir M.; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen

2017-01-01

Background: We summarize utilization patterns for mental health services in school-based health centers. Methods: Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were…

Mental Health Consumer Experiences and Strategies When Seeking Physical Health Care

PubMed Central

Ewart, Stephanie B.; Bocking, Julia; Happell, Brenda; Platania-Phung, Chris; Stanton, Robert

2016-01-01

People with mental illness have higher rates of physical health problems and consequently live significantly shorter lives. This issue is not yet viewed as a national health priority and research about mental health consumer views on accessing physical health care is lacking. The aim of this study is to explore the experience of mental health consumers in utilizing health services for physical health needs. Qualitative exploratory design was utilized. Semistructured focus groups were held with 31 consumer participants. Thematic analysis revealed that three main themes emerged: scarcity of physical health care, with problems accessing diagnosis, advice or treatment for physical health problems; disempowerment due to scarcity of physical health care; and tenuous empowerment describing survival resistance strategies utilized. Mental health consumers were concerned about physical health and the nonresponsive health system. A specialist physical health nurse consultant within mental health services should potentially redress this gap in health care provision. PMID:28462330

Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan.

PubMed

Hoge, Charles W; Auchterlonie, Jennifer L; Milliken, Charles S

2006-03-01

The US military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment. To determine the relationship between combat deployment and mental health care use during the first year after return and to assess the lessons learned from the postdeployment mental health screening effort, particularly the correlation between the screening results, actual use of mental health services, and attrition from military service. Population-based descriptive study of all Army soldiers and Marines who completed the routine postdeployment health assessment between May 1, 2003, and April 30, 2004, on return from deployment to Operation Enduring Freedom in Afghanistan (n = 16,318), Operation Iraqi Freedom (n = 222,620), and other locations (n = 64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. Screening positive for posttraumatic stress disorder, major depression, or other mental health problems; referral for a mental health reason; use of mental health care services after returning from deployment; and attrition from military service. The prevalence of reporting a mental health problem was 19.1% among service members returning from Iraq compared with 11.3% after returning from Afghanistan and 8.5% after returning from other locations (P<.001). Mental health problems reported on the postdeployment assessment were significantly associated with combat experiences, mental health care referral and utilization, and attrition from military service. Thirty-five percent of Iraq war veterans accessed mental health services in the year after returning home; 12% per year were diagnosed with a mental health problem. More than 50% of those referred for a mental health reason were documented to receive follow-up care although less than 10% of all service members who received mental health treatment were referred through the screening program. Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment. The deployment mental health screening program provided another indicator of the mental health impact of deployment on a population level but had limited utility in predicting the level of mental health services that were needed after deployment. The high rate of using mental health services among Operation Iraqi Freedom veterans after deployment highlights challenges in ensuring that there are adequate resources to meet the mental health needs of returning veterans.

Racial-Ethnic Variation in Mental Health Service Utilization Among People with a Major Affective Disorder and a Criminal History.

PubMed

Lee, Sungkyu; Matejkowski, Jason; Han, Woojae

2017-01-01

Using a nationally representative sample, this study examined the extent to which the utilization of various mental health services was associated with racial-ethnic identity among people with major affective disorders who have a criminal history. Approximately 33.7 % of the sample received any type of mental health services in a given year. Multivariate models indicated that married Blacks and Latinos were less likely to use specialty mental health care than their white counterparts. To provide equitable mental health treatment for vulnerable subgroups of this population, mental health professionals should account for the heterogeneity of mental health care in diverse cultural contexts.

Do adults with mental retardation show pictorial superiority effects in recall and recognition?

PubMed

Cherry, Katie E; Applegate, Heather; Reese, Celinda M

2002-01-01

We examined memory for pictures and words in adults with mental retardation and a control group of adults of normal intelligence. During acquisition, sets of simple line drawings and matching words were presented for study using an intentional learning procedure. The principle dependent measures were free recall and recognition. Measures of working memory span were also administered. Pictorial superiority effects occurred in free recall and recognition for both intelligence-level groups. Correlational analyses indicated that working memory span was primarily related to recall performance, irrespective of stimulus format. These data strongly suggest that persons with mental retardation can utilize nonverbal memory codes to support long-term retention as effectively as do adults of normal intelligence.

Cognitive Appraisals of Specialty Mental Health Services and Their Relation to Mental Health Service Utilization in the Rural Population

ERIC Educational Resources Information Center

Deen, Tisha L.; Bridges, Ana J.; McGahan, Tara C.; Andrews, Arthur R., III

2012-01-01

Purpose: Rural individuals utilize specialty mental health services (eg, psychiatrists, psychologists, counselors, and social workers) at lower rates than their urban counterparts. This study explores whether cognitive appraisals (ie, individual perceptions of need for services, outcome expectancies, and value of a positive therapeutic outcome) of…

Caregiver Factors Predicting Service Utilization among Youth Participating in a School-Based Mental Health Intervention

ERIC Educational Resources Information Center

Burnett-Zeigler, Inger; Lyons, John S.

2010-01-01

Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention…

Teach It, Don’t Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information

PubMed Central

Canning, Elizabeth A.; Harackiewicz, Judith M.

2015-01-01

Social-psychological interventions in education have used a variety of “self-persuasion” or “saying-is-believing” techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples. PMID:26495326

Effects of mental health benefits legislation: a community guide systematic review.

PubMed

Sipe, Theresa Ann; Finnie, Ramona K C; Knopf, John A; Qu, Shuli; Reynolds, Jeffrey A; Thota, Anilkrishna B; Hahn, Robert A; Goetzel, Ron Z; Hennessy, Kevin D; McKnight-Eily, Lela R; Chapman, Daniel P; Anderson, Clinton W; Azrin, Susan; Abraido-Lanza, Ana F; Gelenberg, Alan J; Vernon-Smiley, Mary E; Nease, Donald E

2015-06-01

Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence was limited for other mental health outcomes. Published by Elsevier Inc.

Effects of Mental Health Benefits Legislation

PubMed Central

Sipe, Theresa Ann; Finnie, Ramona K.C.; Knopf, John A.; Qu, Shuli; Reynolds, Jeffrey A.; Thota, Anilkrishna B.; Hahn, Robert A.; Goetzel, Ron Z.; Hennessy, Kevin D.; McKnight-Eily, Lela R.; Chapman, Daniel P.; Anderson, Clinton W.; Azrin, Susan; Abraido-Lanza, Ana F.; Gelenberg, Alan J.; Vernon-Smiley, Mary E.; Nease, Donald E.

2015-01-01

Context Health insurance benefits for mental health services typically have paid less than benefits for physical health services, resulting in potential underutilization or financial burden for people with mental health conditions. Mental health benefits legislation was introduced to improve financial protection (i.e., decrease financial burden) and to increase access to, and use of, mental health services. This systematic review was conducted to determine the effectiveness of mental health benefits legislation, including executive orders, in improving mental health. Evidence acquisition Methods developed for the Guide to Community Preventive Services were used to identify, evaluate, and analyze available evidence. The evidence included studies published or reported from 1965 to March 2011 with at least one of the following outcomes: access to care, financial protection, appropriate utilization, quality of care, diagnosis of mental illness, morbidity and mortality, and quality of life. Analyses were conducted in 2012. Evidence synthesis Thirty eligible studies were identified in 37 papers. Implementation of mental health benefits legislation was associated with financial protection (decreased out-of-pocket costs) and appropriate utilization of services. Among studies examining the impact of legislation strength, most found larger positive effects for comprehensive parity legislation or policies than for less-comprehensive ones. Few studies assessed other mental health outcomes. Conclusions Evidence indicates that mental health benefits legislation, particularly comprehensive parity legislation, is effective in improving financial protection and increasing appropriate utilization of mental health services for people with mental health conditions. Evidence is limited for other mental health outcomes. PMID:25998926

Formative research on a teacher accompaniment model to promote youth mental health in Haiti: Relevance to mental health task-sharing in low-resource school settings

PubMed Central

Eustache, Eddy; Gerbasi, Margaret E.; Severe, Jennifer; Fils-Aimé, J. Reginald; Smith Fawzi, Mary C.; Raviola, Giuseppe J.; Darghouth, Sarah; Boyd, Kate; Thérosmé, Tatiana; Legha, Rupinder; Pierre, Ermaze L.; Affricot, Emmeline; Alcindor, Yoldie; Grelotti, David J.; Becker, Anne E.

2017-01-01

Background Task-sharing with teachers to promote youth mental health is a promising but underdeveloped strategy in improving care access in low-income countries. Aims To assess feasibility, acceptability, and utility of the teacher accompaniment phase of a school-based teacher accompagnateur pilot study (TAPS) in Haiti. Methods We assigned student participants, ages 18–22 (n=120) to a teacher participant (n=22) within four Haitian schools; we instructed participants to arrange meetings with their assigned counterparts to discuss mental health treatment, academic skills, and/or well-being. We measured student and teacher perceived feasibility, acceptability, and utility of meetings with self-report Likert-style questions. We examined overall program feasibility by the percentage of students with a documented meeting, acceptability by a composite measure of student satisfaction, and utility by the percentage with identified mental health need who discussed treatment with a teacher. Results Favorable ratings support feasibility, acceptability, and utility of teacher-accompagnateur meetings with students. The majority of students (54%) met with a teacher. Among students with an identified mental disorder, 43.2% discussed treatment during a meeting. Conclusions This accompaniment approach to mental health task-sharing with teachers provided a school-based opportunity for students with mental health need to discuss treatment and has potential relevance to other low-income settings. PMID:28367718

Formative research on a teacher accompaniment model to promote youth mental health in Haiti: Relevance to mental health task-sharing in low-resource school settings.

PubMed

Eustache, Eddy; Gerbasi, Margaret E; Severe, Jennifer; Fils-Aimé, J Reginald; Smith Fawzi, Mary C; Raviola, Giuseppe J; Darghouth, Sarah; Boyd, Kate; Thérosmé, Tatiana; Legha, Rupinder; Pierre, Ermaze L; Affricot, Emmeline; Alcindor, Yoldie; Grelotti, David J; Becker, Anne E

2017-06-01

Task-sharing with teachers to promote youth mental health is a promising but underdeveloped strategy in improving care access in low-income countries. To assess feasibility, acceptability and utility of the teacher accompaniment phase of a school-based Teacher- Accompagnateur Pilot Study (TAPS) in Haiti. We assigned student participants, aged 18-22 years ( n = 120), to teacher participants ( n = 22) within four Haitian schools; we instructed participants to arrange meetings with their assigned counterparts to discuss mental health treatment, academic skills, and/or well-being. We measured student and teacher perceived feasibility, acceptability and utility of meetings with self-report Likert-style questions. We examined overall program feasibility by the percentage of students with a documented meeting, acceptability by a composite measure of student satisfaction and utility by the percentage with identified mental health need who discussed treatment with a teacher. Favorable ratings support feasibility, acceptability and utility of teacher- accompagnateur meetings with students. The majority of students (54%) met with a teacher. Among students with an identified mental disorder, 43.2% discussed treatment during a meeting. This accompaniment approach to mental health task-sharing with teachers provided a school-based opportunity for students with mental health need to discuss treatment and has potential relevance to other low-income settings.

A systematic review of relations between neighborhoods and mental health.

PubMed

Truong, Khoa D; Ma, Sai

2006-09-01

The relationship between neighborhood characteristics and resident mental health has been widely investigated in individual studies in recent years, but this literature is not adequately reviewed. To systematically review relevant individual research of the relation between neighborhoods and adult mental health by identifying and synthesizing all relevant studies in this literature. We conducted an electronic search with PubMed and PsycINFO, and manual reference-checking, resulting in 8,562 screened studies of which 29 were selected. Studies were included in the main synthesis if they (i) were published in English in peer reviewed journals; (ii) had relevant definitions and measures of neighborhood characteristics; (iii) utilized standardized measures of adult mental health; (iv) controlled for individual characteristics; (v) reported quantitative results; and, (vi) studied a population in a developed country. We focused on two key areas within this literature: the methodologies utilized to study neighborhood effects and quantitative results. With regard to the former, we examined five major issues: (i) definitions and measures of neighborhoods; (ii) definitions and measures of mental health; (iii) controls for individual level characteristics; (iv) conceptual models; and (v) analytical models. As for quantitative results, the relation was reviewed by types of neighborhood characteristics. We summarized general quantitative findings and drew common conclusions across groups of studies. 27/29 studies found statistically significant association between mental health and at least one measure of neighborhood characteristics, after adjusting for individual factors. This association was evident for all types of neighborhood features, varying from sociodemographic characteristics to physical environment, and from objective to subjective measures. Neighborhood effects were weakened when adding individual-level characteristics into the regression models, and were generally modest relative to individual effects. Although the evidence is highly consistent across studies, detailed evaluation of each individual study reveals a complex reality. The included studies used various study designs and measures of mental health and neighborhoods, making generalization of their relationships less meaningful. It is not possible to conclude that studies with weaker controls for individual characteristics found stronger association between neighborhoods and mental health and vice versa. As only two studies used randomized and controlled trials, causal effects must be interpreted with caution. Formal meta-analysis techniques cannot be used due to large heterogeneity across the included studies. Efficient methods for quantitative analysis remain a great challenge. The current evidence suggests that efforts to improve mental health may be limited if only individual-level interventions are implemented. The calculation of the costs and benefits of neighborhood-level interventions deserves more attention. Moreover, policy makers may want to incorporate mental health as a measure for evaluating neighborhood improvement programs. There are not enough replicated or comparable studies in this literature to make more precise quantitative conclusions of this relation. Key aspects of study design and analyses could be improved to better understand the true nature of causal relationships. The data resolution of neighborhood characteristics needs to better match with the scale of neighborhood definition that is hypothesized to affect the residents' mental health. As experimental designs are rare in this area, thoughtful use of panel data, instrumental variable (IV) techniques, and other non-experimental approaches deserves further exploration.

Psychiatric Disorders and Mental Health Service Use in Patients with Advanced Cancer

PubMed Central

Kadan-Lottick, Nina S.; Vanderwerker, Lauren C.; Block, Susan D.; Zhang, Baohui; Prigerson, Holly G.

2006-01-01

BACKGROUND. Psychological morbidity has been proposed as a source of distress in cancer patients. This study aimed to: 1) determine the prevalence of diagnosable psychiatric illnesses, and 2) describe the mental health services received and predictors of service utilization in patients with advanced cancer. METHODS. This was a cross-sectional, multi-institutional study of 251 eligible patients with advanced cancer. Eligibility included: distant metastases, primary therapy failure, nonpaid caregiver, age ≥20 years, stamina for the interview, English or Spanish-speaking, and adequate cognitive ability. Trained interviewers administered the Structured Clinical Interview for the Diagnostic Statistical Manual IV (DSM-IV) modules for Major Depressive Disorder, Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, and a detailed questionnaire regarding mental health service utilization. RESULTS. Overall, 12% met criteria for a major psychiatric condition and 28% had accessed a mental health intervention for a psychiatric illness since the cancer diagnosis. Seventeen percent had discussions with a mental health professional; 90% were willing to receive treatment for emotional problems. Mental health services were not accessed by 55% of patients with major psychiatric disorders. Cancer patients who had discussed psychological concerns with mental health staff (odds ratio [OR] = 19.2; 95% confidence interval [95% CI], 8.90-41.50) and non-Hispanic white patients (OR = 2.7; 95% CI, 1.01-7.43) were more likely to receive mental health services in adjusted analysis. CONCLUSIONS. Advanced cancer patients experience major psychiatric disorders at a prevalence similar to the general population, but affected individuals have a low rate of utilizing mental health services. Oncology providers can enhance utilization of mental health services, and potentially improve clinical outcomes, by discussing mental health concerns with their patients. PMID:16284994

Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat.

PubMed

Kim, Paul Y; Thomas, Jeffrey L; Wilk, Joshua E; Castro, Carl A; Hoge, Charles W

2010-06-01

This study examined rates of utilization of mental health care among active duty and National Guard soldiers with mental health problems three and 12 months after they returned from combat in Iraq. Stigma and barriers to care were also reported for each component (active duty and National Guard). Cross-sectional, anonymous surveys were administered to 10,386 soldiers across both time points and components. Mean scores from 11 items measuring stigma and barriers to care were computed. Service utilization was assessed by asking soldiers whether they had received services for a mental health problem from a mental health professional, a medical doctor, or the Department of Veterans Affairs in the past month. Risk of mental problems was measured using the Patient Health Questionnaire, the PTSD Checklist, and items asking about aggressive behaviors and "stress, emotional, alcohol, or family" problems within the past month. A higher proportion of active duty soldiers than National Guard soldiers reported at least one type of mental health problem at both three months (45% versus 33%) and 12 months (44% versus 35%) postdeployment. Among soldiers with mental health problems, National Guard soldiers reported significantly higher rates of mental health care utilization 12 months after deployment, compared with active duty soldiers (27% versus 13%). Mean stigma scores were higher among active duty soldiers than among National Guard soldiers. Active duty soldiers with a mental health problem had significantly lower rates of service utilization than National Guard soldiers and significantly higher endorsements of stigma. Current and future efforts to improve care for veterans should work toward reducing the stigma of receiving mental health care.

Military sexual trauma among homeless veterans.

PubMed

Pavao, Joanne; Turchik, Jessica A; Hyun, Jenny K; Karpenko, Julie; Saweikis, Meghan; McCutcheon, Susan; Kane, Vincent; Kimerling, Rachel

2013-07-01

Military sexual trauma (MST) is the Veteran Health Administration's (VHA) term for sexual assault and/or sexual harassment that occurs during military service. The experience of MST is associated with a variety of mental health conditions. Preliminary research suggests that MST may be associated with homelessness among female Veterans, although to date MST has not been examined in a national study of both female and male homeless Veterans. To estimate the prevalence of MST, examine the association between MST and mental health conditions, and describe mental health utilization among homeless women and men. National, cross-sectional study of 126,598 homeless Veterans who used VHA outpatient care in fiscal year 2010. All variables were obtained from VHA administrative databases, including MST screening status, ICD-9-CM codes to determine mental health diagnoses, and VHA utilization. Of homeless Veterans in VHA, 39.7 % of females and 3.3 % of males experienced MST. Homeless Veterans who experienced MST demonstrated a significantly higher likelihood of almost all mental health conditions examined as compared to other homeless women and men, including depression, posttraumatic stress disorder, other anxiety disorders, substance use disorders, bipolar disorders, personality disorders, suicide, and, among men only, schizophrenia and psychotic disorders. Nearly all homeless Veterans had at least one mental health visit and Veterans who experienced MST utilized significantly more mental health visits compared to Veterans who did not experience MST. A substantial proportion of homeless Veterans using VHA services have experienced MST, and those who experienced MST had increased odds of mental health diagnoses. Homeless Veterans who had experienced MST had higher intensity of mental health care utilization and high rates of MST-related mental health care. This study highlights the importance of trauma-informed care among homeless Veterans and the success of VHA homeless programs in providing mental health care to homeless Veterans.

Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study.

PubMed

Marrast, Lyndonna; Himmelstein, David U; Woolhandler, Steffie

2016-10-01

Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care. © The Author(s) 2016.

"Please Don't Make Me Ask for Help": Implicit Social Support and Mental Health in Chinese Individuals Living with HIV.

PubMed

Yang, Joyce P; Leu, Janxin; Simoni, Jane M; Chen, Wei Ti; Shiu, Cheng-Shi; Zhao, Hongxin

2015-08-01

China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.

Behavioral predictors of outpatient mental health service utilization within 6 months after traumatic brain injury in adolescents.

PubMed

Kurowski, Brad G; Wade, Shari L; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry; Taylor, H Gerry

2013-12-01

To characterize utilization of mental health services and determine the ability of a behavior problem and clinical functioning assessment to predict utilization of such services within the first 6 months after moderate and severe traumatic brain injury in a large cohort of adolescents. Multicenter cross-sectional study. Outpatient setting of 4 tertiary pediatric hospitals, 2 tertiary general medical centers, and 1 specialized children's hospital. Adolescents age 12-17 years (n = 132), 1-6 months after moderate-to-severe traumatic brain injury. Logistic regression was used to determine the association of mental health service utilization with clinical functioning as assessed by the Child and Adolescent Functional Assessment Scale and behavior problems assessed by the Child Behavioral Checklist. Mental health service utilization measured by the Service Assessment for Children and Adolescents. Behavioral or functional impairment occurred in 37%-56%. Of the total study population, 24.2% reported receiving outpatient mental health services, 8.3% reported receiving school services, and 28.8% reported receiving any type of mental health service. Use of any (school or outpatient) mental health service was associated with borderline to impaired total Child and Adolescent Functional Assessment Scale (odds ratio 3.50 [95% confidence interval, 1.46-8.40]; P < .01) and the Child Behavioral Checklist Total Competence (odds ratio 5.08 [95% confidence interval, 2.02-12.76]; P < .01). A large proportion of participants had unmet mental health needs. Both the Child and Adolescent Functional Assessment Scale and the Child Behavioral Checklist identified individuals who would likely benefit from mental health services in outpatient or school settings. Future research should focus on methods to ensure early identification by health care providers of adolescents with traumatic brain injury in need of mental health services. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Patterns of Adaptive Behavior in Very Young Children with Autism.

ERIC Educational Resources Information Center

Stone, Wendy L.; Ousley, Opal Y.; Hepburn, Susan L.; Hogan, Kerry L.; Brown, Christia S.

1999-01-01

A study used the Vineland Adaptive Behavior Scales to investigate patterns of adaptive behavior in 30 children with autism who were under 3 years. Relative to controls, participants demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and mental age. The utility of the scales is discussed.…

Influence of gender, sexual orientation, and need on treatment utilization for substance use and mental disorders: Findings from the California Quality of Life Survey

PubMed Central

Grella, Christine E; Greenwell, Lisa; Mays, Vickie M; Cochran, Susan D

2009-01-01

Background Prior research has shown a higher prevalence of substance use and mental disorders among sexual minorities, however, the influence of sexual orientation on treatment seeking has not been widely studied. We use a model of help-seeking for vulnerable populations to investigate factors related to treatment for alcohol or drug use disorders and mental health disorders, focusing on the contributions of gender, sexual orientation, and need. Methods Survey data were obtained from a population-based probability sample of California residents that oversampled for sexual minorities. Logistic regression was used to model the enabling, predisposing, and need-related factors associated with past-year mental health or substance abuse treatment utilization among adults aged 18–64 (N = 2,074). Results Compared with individuals without a diagnosed disorder, those with any disorder were more likely to receive treatment. After controlling for both presence of disorder and other factors, lesbians and bisexual women were most likely to receive treatment and heterosexual men were the least likely. Moreover, a considerable proportion of sexual orientation minorities without any diagnosable disorder, particularly lesbians and bisexual women, also reported receiving treatment. Conclusion The study highlights the need to better understand the factors beyond meeting diagnostic criteria that underlie treatment utilization among sexual minorities. Future research should also aim to ascertain the effects of treatment provided to sexual minorities with and without diagnosable disorders, including the possibility that the provision of such treatment may reduce the likelihood of their progression to greater severity of distress, disorders, or impairments in functioning. PMID:19682355

Does mental illness affect consumer direction of community-based care? Lessons from the Arkansas Cash and Counseling program.

PubMed

Shen, Ce; Smyer, Michael A; Mahoney, Kevin J; Loughlin, Dawn M; Simon-Rusinowitz, Lori; Mahoney, Ellen K

2008-02-01

Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumer-directed care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling-a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care-changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their well-being. Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver's reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.

Considering Context, Place, and Culture: The National Latino and Asian American Study

PubMed Central

Alegria, Margarita; Takeuchi, David; Canino, Glorisa; Duan, Naihua; Shrout, Patrick; Meng, Xiao-Li; Vega, William; Zane, Nolan; Vila, Doryliz; Woo, Meghan; Vera, Mildred; Guarnaccia, Peter; Aguilar-Gaxiola, Sergio; Sue, Stanley; Escobar, Javier; Lin, Keh-Ming; Gong, Fong

2009-01-01

This paper provides a rationale and overview of procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization of Latinos and Asian Americans in the United States. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication; NCS-R) and African Americans (from the National Survey of American Life; NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research. PMID:15719529

Mental and Emotional Self-Help Technology Apps: Cross-Sectional Study of Theory, Technology, and Mental Health Behaviors.

PubMed

Crookston, Benjamin T; West, Joshua H; Hall, P Cougar; Dahle, Kaitana Martinez; Heaton, Thomas L; Beck, Robin N; Muralidharan, Chandni

2017-10-17

Mental and emotional self-help apps have emerged as potential mental illness prevention and treatment tools. The health behavior theory mechanisms by which these apps influence mental health-related behavior change have not been thoroughly examined. The objective of this study was to examine the association between theoretical behavior change mechanisms and use of mental and emotional self-help apps and whether the use of such apps is associated with mental health behaviors. This study utilized a cross-sectional survey of 150 users of mental or emotional health apps in the past 6 months. Survey questions included theory-based items, app engagement and likeability items, and behavior change items. Stata version 14 was used to calculate all statistics. Descriptive statistics were calculated for each of the demographic, theory, engagement, and behavior variables. Multiple regression analysis was used to identify factors associated with reported changes in theory and separately for reported changes in actual behavior after controlling for potentially confounding variables. Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. Engagement (P<.001) was positively associated with the reported changes in theory items, whereas perceived behavior change was positively associated with theory (P<.001), engagement (P=.004), frequency of use of apps (P=.01), and income (P=.049). Participants reported that app use increased their motivation, desire to set goals, confidence, control, and intentions to be mentally and emotionally healthy. This increase in perceptions, beliefs, and attitudes surrounding their mental and emotional health was considerably associated with perceived change in behavior. There was a positive association between the level of engagement with the app and the impact on theory items. Future efforts should consider the value of impacting key theoretical constructs when designing mental and emotional health apps. As apps are evaluated and additional theory-based apps are created, cost-effective self-help apps may become common preventative and treatment tools in the mental health field. ©Benjamin T Crookston, Joshua H West, P Cougar Hall, Kaitana Martinez Dahle, Thomas L Heaton, Robin N Beck, Chandni Muralidharan. Originally published in JMIR Mental Health (http://mental.jmir.org), 17.10.2017.

Increasing use of mental health services in remote areas using mobile technology: a pre–post evaluation of the SMART Mental Health project in rural India

PubMed Central

Maulik, Pallab K; Kallakuri, Sudha; Devarapalli, Siddhardha; Vadlamani, Vamsi Krishna; Jha, Vivekanand; Patel, Anushka

2017-01-01

Background About 25% of the Indian population experience common mental disorders (CMD) but only 15–25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile–technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence–based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India. Methods The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists – ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti–stigma campaign using multi–media approaches was conducted across the villages at the outset of the project. A pre–post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation. Results Training was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project. Conclusions The intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up. PMID:28400954

Increasing use of mental health services in remote areas using mobile technology: a pre-post evaluation of the SMART Mental Health project in rural India.

PubMed

Maulik, Pallab K; Kallakuri, Sudha; Devarapalli, Siddhardha; Vadlamani, Vamsi Krishna; Jha, Vivekanand; Patel, Anushka

2017-06-01

About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti-stigma campaign using multi-media approaches was conducted across the villages at the outset of the project. A pre-post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation. Training was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project. The intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up.

Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study

PubMed Central

van Eck van der Sluijs, Jonna F; ten Have, Margreet; Rijnders, Cees A; van Marwijk, Harm WJ; de Graaf, Ron; van der Feltz-Cornelis, Christina M

2016-01-01

Objective The aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms. Methods Data were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18–64 years. We selected subjects with medically unexplained symptoms (MUS) only (MUSonly; n=177), explained physical symptoms only (PHYonly, n=1,952), combined MUS and explained physical symptoms (MUS + PHY, n=209), and controls without physical symptoms (NONE, n=4,168). We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0. Results At the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95) for MUSonly, 1.55 (1.13, 2.12) for PHYonly, and 2.25 (1.41, 3.57) for MUS + PHY. At the specialized mental health care level, this was the case only for MUSonly subjects (adjusted odds ratio 1.65 [1.04, 2.61]). In both the primary and specialized mental health care, there were no significant differences between the four groups in the number of treatment contacts once they entered into treatment. Conclusion All sorts of physical symptoms, unexplained as well as explained, were associated with significant higher entry into primary care for mental problems. In specialized mental health care, this was true only for MUSonly. No differences were found in the number of treatment contacts. This warrants further research aimed at the content of the treatment contacts. PMID:27574433

Childhood Trauma and Minimization/Denial in People with and without a Severe Mental Disorder.

PubMed

Church, Chelsea; Andreassen, Ole A; Lorentzen, Steinar; Melle, Ingrid; Aas, Monica

2017-01-01

Background: Childhood trauma has garnered extensive research concerning its role in the psychopathology of mental disorders, including psychosis. The Childhood Trauma Questionnaire (CTQ) utilizes a minimization/denial (MD) scale to denote potential under-reporters of trauma, yet MD scores are infrequently reported and validations of the scale are lacking in the literature. Elucidate differences in MD between patients with severe mental disorders to healthy individuals, and secondly, investigate if MD influences reports of childhood trauma between the groups. Methods: We included 621 patients with a DSM-schizophrenia spectrum, bipolar spectrum diagnosis, or major depression disorder with psychotic features and 299 healthy controls as part of the NORMENT study in Oslo, Norway. History of childhood trauma was obtained using the CTQ. Clinical diagnoses were assessed using the Structured Clinical Interview for DSM Disorders. Results: A significantly greater proportion of healthy controls (42.8%) had a positive MD score compared to patients (26.7%). When controlling for MD, the patient group still exhibited elevated reports of childhood trauma compared to controls (Cohen's d = 1.27), concordant with reports of childhood trauma being more frequently reported in a population of severe mental disorders. Conclusion: Elevated MD in the healthy control group could suggest an enhanced self-serving bias, potentially attenuated in the psychiatric group. Clinicians and researchers would benefit from including the MD component of CTQ when assessing retrospective information on childhood trauma to rule out potential effect of MD.

The effects of organization on medical utilization: an analysis of service line organization.

PubMed

Byrne, Margaret M; Charns, Martin P; Parker, Victoria A; Meterko, Mark M; Wray, Nelda P

2004-01-01

To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization. All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed. Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line. Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.

The Relation between Food Insecurity and Mental Health Care Service Utilization in Ontario.

PubMed

Tarasuk, Valerie; Cheng, Joyce; Gundersen, Craig; de Oliveira, Claire; Kurdyak, Paul

2018-01-01

To determine the relationship between household food insecurity status over a 12-month period and adults' use of publicly funded health care services in Ontario for mental health reasons during this period. Data for 80,942 Ontario residents, 18 to 64 years old, who participated in the Canadian Community Health Survey in 2005, 2007-2008, 2009-2010, or 2011-2012 were linked to administrative health care data to determine individuals' hospitalizations, emergency department visits, and visits to psychiatrists and primary care physicians for mental health reasons. Household food insecurity over the past 12 months was assessed using the Household Food Security Survey Module. Logistic regression models were used to estimate the odds of mental health service utilization in the past 12 months by household food insecurity status, adjusting for sociodemographic factors and prior use of mental health services. In our fully adjusted models, in comparison to food-secure individuals, the odds of any mental health care service utilization over the past 12 months were 1.15 (95% confidence interval [CI], 1.04 to 1.29) for marginally food-insecure individuals, 1.39 (95% CI, 1.19 to 1.42) for moderately food-insecure individuals, and 1.50 (95% CI, 1.35 to 1.68) for severely food-insecure individuals. A similar pattern persisted across individual types of services, with odds of utilization highest with severe food insecurity. Household food insecurity status is a robust predictor of mental health service utilization among working-age adults in Ontario. Policy interventions are required to address the underlying causes of food insecurity and the particular vulnerability of individuals with mental illness.

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war.

PubMed

Morina, Nexhmedin; Emmelkamp, Paul M G

2012-05-11

The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.

Health care utilization, somatic and mental health distress, and well-being among widowed and non-widowed female survivors of war

PubMed Central

2012-01-01

Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population. PMID:22578096

Individual Markers of Resilience in Train Traffic Control: The Role of Operators' Goals and Strategic Mental Models and Implications for Variation, Expertise, and Performance.

PubMed

Lo, Julia C; Pluyter, Kari R; Meijer, Sebastiaan A

2016-02-01

The aim of this study was to examine individual markers of resilience and obtain quantitative insights into the understanding and the implications of variation and expertise levels in train traffic operators' goals and strategic mental models and their impact on performance. The Dutch railways are one of the world's most heavy utilized railway networks and have been identified to be weak in system and organizational resilience. Twenty-two train traffic controllers enacted two scenarios in a human-in-the-loop simulator. Their experience, goals, strategic mental models, and performance were assessed through questionnaires and simulator logs. Goals were operationalized through performance indicators and strategic mental models through train completion strategies. A variation was found between operators for both self-reported primary performance indicators and completion strategies. Further, the primary goal of only 14% of the operators reflected the primary organizational goal (i.e., arrival punctuality). An incongruence was also found between train traffic controllers' self-reported performance indicators and objective performance in a more disrupted condition. The level of experience tends to affect performance differently. There is a gap between primary organizational goals and preferred individual goals. Further, the relative strong diversity in primary operator goals and strategic mental models indicates weak resilience at the individual level. With recent and upcoming large-scale changes throughout the sociotechnical space of the railway infrastructure organization, the findings are useful to facilitate future railway traffic control and the development of a resilient system. © 2015, Human Factors and Ergonomics Society.

Explaining the link among self-controlling and children parenting techniques and mental insurance of high school pupils.

PubMed

Sekhavati, E; Rahimian Boogar, M; Khodadost, M; Afkari, R; Atefeh, Raoufi

2015-01-01

Introduction: One of the wellness estimation axes of various communities are the mental well-being of the communities. Health means an attempt to Self-actualization and development that exhibit in the adaptation of person's skills and experiences. No doubt mental health plays a major role in assuring efficiency in any organization and can be affected via different parameters. Accordingly, the current research conducted by the purpose of illustrating the relationship among self-managing and kid parenting techniques and mental health amongst high school pupils of Abadeh Town. Methodology: In this sectional-correlation research, 375 pupils are taken and involved in the research in stage group sampling technique of Abadeh high schools. Tangney's self-managing survey, Barry's kid parenting rate, Reef's mental survey and a framework of demographic data utilized to obtain data. Information investigated utilizing software SPSS 19 or Pearson's relationship coefficient analysis and stepwise multivariable regression investigation. Findings: Information investigation depicts self-managing parameter has a great and opposite predictability regarding mental health parameter (t =0.003, = β-0.158, P=2.99). Therefore self-managing has great and opposite predictability regarding 2 parts of mental health rate i.e. self-approval (P= 0.0001, t=4.87, β= - 0.181) and dominance on conditions (P= 0.0001, t=3.807, β= - 0.200). The decisions represent the proximity of a consequence relationship among predictability of kid parenting techniques regarding mental health (p=0.01, F=3.85, r2= 0.031, r=0.177). These sequences reveal great predictability of kid parenting styles in 2 various ways in 2 methods of grinding (P=0.035, t= 2.12, β=0.113) and standard (P=0.014, t=2.437, β= 0.434). The Severe method has a reversed important connection in maximum features of mental health. Furthermore, they note that "authoritative method" parameter just has prediction capacity 0.143 based on mental health variance parameter. Plus combining 2 other parameters i.e. self-managing and cruel way, this value rises to 0.188 and 0.225. The greatest rate for prognosticating skill refers to the standard method of kid parenting straight and after that to self-managing and severe method reversely. Conclusion: based on the significant relationship of kid parenting styles and self-managing in foretelling mental health, the need of notice to these parts is felt in describing the mental health of pupils as many as feasible. Therefore, it is suggested that education of kid parenting techniques is examined as a defensive and serving method for mental health in mental wellness plans for all teens particularly scholars therefore that parents could be satisfied in supporting their kids' emotional health and stopping their mental troubles via data and utilizing peculiar kid parenting techniques and withdrawing ineffective systems of kid parenting (as severe behavior).

Explaining the link among self-controlling and children parenting techniques and mental insurance of high school pupils

PubMed Central

Sekhavati, E; Rahimian Boogar, M; Khodadost, M; Afkari, R; Atefeh, Raoufi

2015-01-01

Introduction: One of the wellness estimation axes of various communities are the mental well-being of the communities. Health means an attempt to Self-actualization and development that exhibit in the adaptation of person's skills and experiences. No doubt mental health plays a major role in assuring efficiency in any organization and can be affected via different parameters. Accordingly, the current research conducted by the purpose of illustrating the relationship among self-managing and kid parenting techniques and mental health amongst high school pupils of Abadeh Town. Methodology: In this sectional-correlation research, 375 pupils are taken and involved in the research in stage group sampling technique of Abadeh high schools. Tangney’s self-managing survey, Barry's kid parenting rate, Reef’s mental survey and a framework of demographic data utilized to obtain data. Information investigated utilizing software SPSS 19 or Pearson’s relationship coefficient analysis and stepwise multivariable regression investigation. Findings: Information investigation depicts self-managing parameter has a great and opposite predictability regarding mental health parameter (t =0.003, = β-0.158, P=2.99). Therefore self-managing has great and opposite predictability regarding 2 parts of mental health rate i.e. self-approval (P= 0.0001, t=4.87, β= - 0.181) and dominance on conditions (P= 0.0001, t=3.807, β= - 0.200). The decisions represent the proximity of a consequence relationship among predictability of kid parenting techniques regarding mental health (p=0.01, F=3.85, r2= 0.031, r=0.177). These sequences reveal great predictability of kid parenting styles in 2 various ways in 2 methods of grinding (P=0.035, t= 2.12, β=0.113) and standard (P=0.014, t=2.437, β= 0.434). The Severe method has a reversed important connection in maximum features of mental health. Furthermore, they note that "authoritative method" parameter just has prediction capacity 0.143 based on mental health variance parameter. Plus combining 2 other parameters i.e. self-managing and cruel way, this value rises to 0.188 and 0.225. The greatest rate for prognosticating skill refers to the standard method of kid parenting straight and after that to self-managing and severe method reversely. Conclusion: based on the significant relationship of kid parenting styles and self-managing in foretelling mental health, the need of notice to these parts is felt in describing the mental health of pupils as many as feasible. Therefore, it is suggested that education of kid parenting techniques is examined as a defensive and serving method for mental health in mental wellness plans for all teens particularly scholars therefore that parents could be satisfied in supporting their kids' emotional health and stopping their mental troubles via data and utilizing peculiar kid parenting techniques and withdrawing ineffective systems of kid parenting (as severe behavior). PMID:28316684

The utility of MMPI-2-RF substantive scales in prediction of negative treatment outcomes in a community mental health center.

PubMed

Anestis, Joye C; Gottfried, Emily D; Joiner, Thomas E

2015-02-01

This study examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) substantive scales in the prediction of premature termination and therapy no-shows while controlling for other relevant predictors in a university-based community mental health center, a sample at high risk of both premature termination and no-show appointments. Participants included 457 individuals seeking services from a university-based psychology clinic. Results indicated that Juvenile Conduct Problems (JCP) predicted premature termination and Behavioral/Externalizing Dysfunction and JCP predicted number of no-shows, when accounting for initial severity of illness, personality disorder diagnosis, therapist experience, and other related MMPI-2-RF scales. The MMPI-2-RF Aesthetic-Literary Interests scale also predicted number of no-shows. Recommendations for applying these findings in clinical practice are discussed. © The Author(s) 2014.

Theory-Based Interventions Combining Mental Simulation and Planning Techniques to Improve Physical Activity: Null Results from Two Randomized Controlled Trials.

PubMed

Meslot, Carine; Gauchet, Aurélie; Allenet, Benoît; François, Olivier; Hagger, Martin S

2016-01-01

Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants ( n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees ( n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators.

Theory-Based Interventions Combining Mental Simulation and Planning Techniques to Improve Physical Activity: Null Results from Two Randomized Controlled Trials

PubMed Central

Meslot, Carine; Gauchet, Aurélie; Allenet, Benoît; François, Olivier; Hagger, Martin S.

2016-01-01

Interventions to assist individuals in initiating and maintaining regular participation in physical activity are not always effective. Psychological and behavioral theories advocate the importance of both motivation and volition in interventions to change health behavior. Interventions adopting self-regulation strategies that foster motivational and volitional components may, therefore, have utility in promoting regular physical activity participation. We tested the efficacy of an intervention adopting motivational (mental simulation) and volitional (implementation intentions) components to promote a regular physical activity in two studies. Study 1 adopted a cluster randomized design in which participants (n = 92) were allocated to one of three conditions: mental simulation plus implementation intention, implementation intention only, or control. Study 2 adopted a 2 (mental simulation vs. no mental simulation) × 2 (implementation intention vs. no implementation intention) randomized controlled design in which fitness center attendees (n = 184) were randomly allocated one of four conditions: mental simulation only, implementation intention only, combined, or control. Physical activity behavior was measured by self-report (Study 1) or fitness center attendance (Study 2) at 4- (Studies 1 and 2) and 19- (Study 2 only) week follow-up periods. Findings revealed no statistically significant main or interactive effects of the mental simulation and implementation intention conditions on physical activity outcomes in either study. Findings are in contrast to previous research which has found pervasive effects for both intervention strategies. Findings are discussed in light of study limitations including the relatively small sample sizes, particularly for Study 1, deviations in the operationalization of the intervention components from previous research and the lack of a prompt for a goal intention. Future research should focus on ensuring uniformity in the format of the intervention components, test the effects of each component alone and in combination using standardized measures across multiple samples, and systematically explore effects of candidate moderators. PMID:27899904

Mental Health and Subjective Well-being of Individuals With Ménière's: Cross-sectional Analysis in the UK Biobank.

PubMed

Tyrrell, Jessica; White, Mathew P; Barrett, George; Ronan, Natalie; Phoenix, Cassandra; Whinney, David J; Osborne, Nicholas J

2015-06-01

Ménière's disease significantly impacts on an individual's mental health and subjective well-being (SWB). Ménière's disease is an unpredictable illness that impacts on mental health. The symptom triad of vertigo, tinnitus, and hearing loss all contribute to the disabling nature of the condition. To date, limited research has investigated the mental health and SWB impact of Ménière's disease. We investigated the mental health and SWB of 1,376 Ménière's sufferers in the UK Biobank and compared this to over 500,000 controls. Participants in the Biobank were asked 38 questions pertaining to mental health and SWB. We utilized crude and adjusted linear and logistic regression to investigate the association between Ménière's and mental health and SWB. We also investigated how mental health and SWB might be related to length of diagnosis to see whether people might adapt to Ménière's over time. Ménière's was associated with increased frequency of depression, tiredness, tenseness, and unenthusiasm in the 2 weeks before recruitment. Ménière's was associated with longer periods of depression than controls (10.2 wk [95% CI: 5.2-15.2 wk]). Reduced health satisfaction was associated with Ménière's, but in other aspects of life (general happiness, work, family, friends, financial), individuals with Ménière's were as happy as controls. Mental health and SWB in individuals diagnosed for longer was better than in those who were recently diagnosed suggesting at least partial adaptation. This is the largest population study investigating the mental health impact of Ménière's. Our findings suggest that Ménière's adversely impacts on mental health, an individual's emotional state, and their life satisfaction. However, our findings raise the importance of supporting social relations for people with Ménière's and that although a cure is not currently available, we can still learn much about the adaptation strategies developed by long-term sufferers to help individuals with new diagnoses.

An approach to integrating interprofessional education in collaborative mental health care.

PubMed

Curran, Vernon; Heath, Olga; Adey, Tanis; Callahan, Terrance; Craig, David; Hearn, Taryn; White, Hubert; Hollett, Ann

2012-03-01

This article describes an evaluation of a curriculum approach to integrating interprofessional education (IPE) in collaborative mental health practice across the pre- to post-licensure continuum of medical education. A systematic evaluation of IPE activities was conducted, utilizing a combination of evaluation study designs, including: pretest-posttest control group; one-group pre-test-post-test; and one-shot case study. Participant satisfaction, attitudes toward teamwork, and self-reported teamwork abilities were key evaluative outcome measures. IPE in collaborative mental health practice was well received at both the pre- and post-licensure levels. Satisfaction scores were very high, and students, trainees, and practitioners welcomed the opportunity to learn about collaboration in the context of mental health. Medical student satisfaction increased significantly with the introduction of standardized patients (SPs) as an interprofessional learning method. Medical students and faculty reported that experiential learning in practice-based settings is a key component of effective approaches to IPE implementation. At a post-licensure level, practitioners reported significant improvement in attitudes toward interprofessional collaboration in mental health care after participation in IPE. IPE in collaborative mental health is feasible, and mental health settings offer practical and useful learning experiences for students, trainees, and practitioners in interprofessional collaboration.

Self-reported utilization of mental health services in the adult German population--evidence for unmet needs? Results of the DEGS1-Mental Health Module (DEGS1-MH).

PubMed

Mack, Simon; Jacobi, Frank; Gerschler, Anja; Strehle, Jens; Höfler, Michael; Busch, Markus A; Maske, Ulrike E; Hapke, Ulfert; Seiffert, Ingeburg; Gaebel, Wolfgang; Zielasek, Jürgen; Maier, Wolfgang; Wittchen, Hans-Ulrich

2014-09-01

This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd.

PTSD Trajectory, Co-morbidity, and Utilization of Mental Health Services among National Guard Forces

DTIC Science & Technology

2011-10-01

constructed a survey for initial data collection as well as subsequent waves that contains modules on (1) risk or protective factors for psychological ...morbidity over the life course (general traumas, psychological resources, life and family concerns), (2) mental health (depression, PTSD, emotional...protective factors for psychological morbidity among National Guard force members, (b) mental health, and (c) service utilization patterns among

How Perceptions of Mental Illness Impact EAP Utilization.

PubMed

McRee, Jayme

2017-01-01

Studies of employee assistance program (EAP) clinical use across multiple industries and multiple EAP delivery models range from highs greater than 5% to lows of less than 1 %. Despite the range in utilization, the rates of employee behaviors that indicate a behavioral health issue are significantly higher, suggesting far too little use of EAPs overall. Studies of the costs to an employer for an employee with a mental health issue are as high as 37% lost annual productivity. EAPs have attempted to raise utilization through a variety of efforts, with mixed results. Most EAP utilization initiatives fail to address the impact of stigma, misunderstandings about mental illness and the reluctance of many employees to seek counseling as an option for better management of stress, work-life balance and overall mental wellness. For both employers and EAPs, addressing the impact of stigma and perceptions of mental illness is costly, requiring greater direct employee engagement and education. However, it is a more effective means of increasing EAP use than current practices and, ultimately, can result in significantly higher net gains in productivity while reducing employers' direct costs.

Reducing barriers to mental health and social services for Iraq and Afghanistan veterans: outcomes of an integrated primary care clinic.

PubMed

Seal, Karen H; Cohen, Greg; Bertenthal, Daniel; Cohen, Beth E; Maguen, Shira; Daley, Aaron

2011-10-01

Despite high rates of post-deployment psychosocial problems in Iraq and Afghanistan veterans, mental health and social services are under-utilized. To evaluate whether a Department of Veterans Affairs (VA) integrated care (IC) clinic (established in April 2007), offering an initial three-part primary care, mental health and social services visit, improved psychosocial services utilization in Iraq and Afghanistan veterans compared to usual care (UC), a standard primary care visit with referral for psychosocial services as needed. Retrospective cohort study using VA administrative data. Five hundred and twenty-six Iraq and Afghanistan veterans initiating primary care at a VA medical center between April 1, 2005 and April 31, 2009. Multivariable models compared the independent effects of primary care clinic type (IC versus UC) on mental health and social services utilization outcomes. After 2007, compared to UC, veterans presenting to the IC primary care clinic were significantly more likely to have had a within-30-day mental health evaluation (92% versus 59%, p < 0.001) and social services evaluation [77% (IC) versus 56% (UC), p < 0.001]. This exceeded background system-wide increases in mental health services utilization that occurred in the UC Clinic after 2007 compared to before 2007. In particular, female veterans, younger veterans, and those with positive mental health screens were independently more likely to have had mental health and social service evaluations if seen in the IC versus UC clinic. Among veterans who screened positive for  ≥ 1 mental health disorder(s), there was a median of 1 follow-up specialty mental health visit within the first year in both clinics. Among Iraq and Afghanistan veterans new to primary care, an integrated primary care visit further improved the likelihood of an initial mental health and social services evaluation over background increases, but did not improve retention in specialty mental health services.

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among "carve-out" enrollees.

PubMed

Ettner, Susan L; M Harwood, Jessica; Thalmayer, Amber; Ong, Michael K; Xu, Haiyong; Bresolin, Michael J; Wells, Kenneth B; Tseng, Chi-Hong; Azocar, Francisca

2016-12-01

Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008 to 2013 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-2013) periods. The sample included 1,812,541 individuals ages 27-64 (49,968,367 person-months) in 10,010 Optum "carve-out" plans. Two-part regression models with Generalized Estimating Equations were used to estimate expenditures by payer and outpatient, intermediate and inpatient service use. We found little evidence that MHPAEA increased utilization significantly, but somewhat more robust evidence that costs shifted from patients to plans. Thus the primary impact of MHPAEA among carve-out enrollees may have been a reduction in patient financial burden. Copyright © 2016 Elsevier B.V. All rights reserved.

Design considerations to improve cognitive ergonomic issues of unmanned vehicle interfaces utilizing video game controllers.

PubMed

Oppold, P; Rupp, M; Mouloua, M; Hancock, P A; Martin, J

2012-01-01

Unmanned (UAVs, UCAVs, and UGVs) systems still have major human factors and ergonomic challenges related to the effective design of their control interface systems, crucial to their efficient operation, maintenance, and safety. Unmanned system interfaces with a human centered approach promote intuitive interfaces that are easier to learn, and reduce human errors and other cognitive ergonomic issues with interface design. Automation has shifted workload from physical to cognitive, thus control interfaces for unmanned systems need to reduce mental workload on the operators and facilitate the interaction between vehicle and operator. Two-handed video game controllers provide wide usability within the overall population, prior exposure for new operators, and a variety of interface complexity levels to match the complexity level of the task and reduce cognitive load. This paper categorizes and provides taxonomy for 121 haptic interfaces from the entertainment industry that can be utilized as control interfaces for unmanned systems. Five categories of controllers were based on the complexity of the buttons, control pads, joysticks, and switches on the controller. This allows the selection of the level of complexity needed for a specific task without creating an entirely new design or utilizing an overly complex design.

Assessing the Relationship Between Mental Distress and Tobacco Use in Post-Katrina and Rita Louisiana.

PubMed

Mukherjee, Snigdha; Canterberry, Melanie; Yore, Jennifer B; Ledford, Edward Cannon; Carton, Thomas W

2017-08-24

The relationship between mental health status and smoking is complicated and often confounded by bi-directionality, yet most research on this relationship assumes exogeneity. The goal of this article is to implement an instrumental variable approach to (1) test the exogeneity assumption and (2) report on the association between mental health status and smoking post-disaster. This analysis utilizes the 2006 and 2007 Louisiana Behavioral Risk Factor Surveillance Survey to examine the link between mental distress and smoking in areas affected by Hurricanes Katrina and Rita. Residence in a hurricane-affected parish (county) was used as an instrumental variable for mental distress. Just over 22% of the sample resided in a hurricane-affected parish. Residents of hurricane-affected parishes were significantly more likely to report occasional and frequent mental distress. Residence in a hurricane-affected parish was not significantly associated with smoking status. With residence established as a salient instrumental variable for mental distress, the exogeneity assumption was tested and confirmed in this sample. A dose-response relationship existed between mental distress and smoking, with smoking prevalence increasing directly (and non-linearly) with mental distress. In this sample, the relationship between mental distress and smoking status was exogenous and followed a dose-response relationship, suggesting that the disasters did not result in an uptake of smoking initiation, but that the higher amounts of mental distress may lead to increased use among smokers. The findings suggest that tobacco control programs should devise unique strategies to address mentally distressed populations.

Frames of mental illness in the Yoruba genre of Nigerian movies: implications for orthodox mental health care.

PubMed

Atilola, Olayinka; Olayiwola, Funmilayo

2013-06-01

This study examines the modes of framing mental illness in the Yoruba genre of Nigerian movies. All Yoruba films on display in a convenient sample of movie rental shops in Ibadan (Nigeria) were sampled for content. Of the 103 films studied, 27 (26.2%) contained scenes depicting mental illness. Psychotic symptoms were the most commonly depicted, while effective treatments were mostly depicted as taking place in unorthodox settings. The most commonly depicted aetiology of mental illness was sorcery and enchantment by witches and wizards, as well as other supernatural forces. Scenes of mental illness are common in Nigerian movies and these depictions-though reflecting the popular explanatory models of Yoruba-speaking Nigerians about mental illness- may impede utilization of mental health care services and ongoing efforts to reduce psychiatry stigma in this region. Efforts to reduce stigma and improve service utilization should engage the film industry.

Mental health symptoms and treatment utilization among trauma-exposed college students.

PubMed

Artime, Tiffany M; Buchholz, Katherine R; Jakupcak, Matthew

2018-05-21

Universities have demonstrated growing awareness of students impacted by interpersonal violence (e.g., sexual and physical assault) and veterans/service-members with combat-related trauma because of their sizable presence on campuses and unique vulnerabilities. This study sought to describe impacts of these two forms of trauma exposure on students' mental health and academic functioning and to compare mental health service utilization among students based on their experiences of trauma exposure. To acquire a large, national sample of college students, we examined archival data from the Fall 2015 American College Health Association National College Health Assessment, a yearly, web-based survey which represented a sample of 19,861 students from 40 institutions. Twenty percent of the students had experienced interpersonal victimization in the last 12 months, combat exposure, or both. Compared with other groups, interpersonal violence survivors reported the most negative impacts on mental health and interference with academic performance. Service utilization rates among trauma-exposed students ranged from 52% to 84%, and students who had experienced recent interpersonal violence were the most likely to have received services. With a national sample, this study confirms that trauma-exposed students report poor mental health. Service utilization is high among this population, but campus-based mental health services appear to remain underutilized. Outreach efforts by student life professionals and campus clinicians targeting demographic subgroups could enhance utilization and accessibility of campus resources. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Police and mental health clinician partnership in response to mental health crisis: A qualitative study.

PubMed

McKenna, Brian; Furness, Trentham; Oakes, Jane; Brown, Steve

2015-10-01

Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one-to-one semistructured interviews. Themes emerged about the challenge created by a stand-alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer 'down-time', improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition. © 2015 Australian College of Mental Health Nurses Inc.

Ethnic differences in the utilization of mental health services in Lombardy (Italy): an epidemiological analysis.

PubMed

Spinogatti, Franco; Civenti, Graziella; Conti, Valentino; Lora, Antonio

2015-01-01

To analyze the differences in mental health service utilization by immigrant and native populations of Lombardy, an Italian region that hosts one-fourth of the immigrants living in Italy. The data are drawn from the regional mental health information system (based on the case register model), which supplies information on the users and mental health activities of the Departments of Mental Health, Lombardy, a region of about 10 million people; 139,775 adult users were treated in mental health services in 2010. Mental health services are used by 11.3 immigrant users out of 1,000 immigrants (with marked differences depending on country of origin) compared with 17.0 native users. Acute mental health services are used more frequently by immigrant patients; the types of intervention provided to immigrants differ from those provided to the native population (mainly as far as psychotherapeutic interventions is concerned), while gender differences are substantial. The number of immigrant users using mental health services has increased notably in recent years, and in Lombardy it has been observed that the use of such services differs from service unit to service unit. This raises the problem of how to increase the cultural awareness of mental health professionals dealing with the mental health needs of the immigrant population. On the whole, immigrants use community mental health services less than the native population; however, immigrants tend to be more frequently admitted to general hospital psychiatric units during acute phases and both the utilization rates and gender differ greatly, depending on the country of origin.

Deficits in episodic memory and mental time travel in patients with post-traumatic stress disorder.

PubMed

Zlomuzica, Armin; Woud, Marcella L; Machulska, Alla; Kleimt, Katharina; Dietrich, Lisa; Wolf, Oliver T; Assion, Hans-Joerg; Huston, Joseph P; De Souza Silva, Maria A; Dere, Ekrem; Margraf, Jürgen

2018-04-20

Post-traumatic stress disorder (PTSD) is characterized by impairments in mnestic functions, especially in the domain of episodic memory. These alterations might affect different aspects of episodic memory functioning. Here we tested PTSD patients and healthy controls (matched for age, sex and education) in a newly developed virtual reality episodic memory test (VR-EMT), a test for mental time travel, episodic future thinking, and prospective memory (M3xT). In a cross-validation experiment, their performance was further evaluated in the Rivermead Behavioral Memory Test (RBMT). PTSD patients demonstrated impairments in episodic memory formation and mental time travel and showed difficulties in utilizing information from episodic memory to solve problems. Diminished attention and concentration in PTSD did not account for performance deficits in these tasks but higher levels of negative arousal were found in PTSD patients. Furthermore, performance in the VR-EMT and RBMT in PTSD patients correlated negatively with self-reported measures of stress and depression. Our results suggest that deficits in episodic memory formation and mental time travel in PTSD lead to difficulties in utilizing the content of episodic memories for solving problems in the present or to plan future behavior. Clinical implications of these findings and suggestions for cognitive-behavioral treatment of PTSD are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Effects of wellness programs in family medicine.

PubMed

McGrady, Angele; Brennan, Julie; Lynch, Denis

2009-06-01

The objective of this research was to determine the effects of wellness programs on quality of life and utilization in an academic family medicine practice in two small controlled studies. One offered stress management and problem solving; the second offered a broader wellness intervention. Outcome measures consisted of scores on the Beck Anxiety Inventory, Hamilton Depression Inventory, CES-D (depression), Health Related Quality of Life, SF-12, and the number of office visits in 6 months. Subjects were randomly assigned to intervention or control groups. Statistical analysis compared pre-test and post-test values of the dependent variables between groups. In study one, where the focus was on relaxation, significant differences between groups were observed in anxiety at post-test (p < .03); the intervention group had lower anxiety levels. In study two which had a more general focus, significant group differences were found in days of poor mental health and number of days of depressed mood; the intervention group had fewer days of poor mental health (p < .05) and depression (p < .05) at post-test. No differences were found in utilization in either study. Based on the results of this research, short term wellness programs can be implemented in family practice and are effective in improving quality of life, but not in deceasing utilization in family practice patients. Matching the design of the program to specific patient needs may increase retention and effectiveness.

Diagnostic specificity and mental health service utilization among veterans with newly diagnosed anxiety disorders.

PubMed

Barrera, Terri L; Mott, Juliette M; Hundt, Natalie E; Mignogna, Joseph; Yu, Hong-Jen; Stanley, Melinda A; Cully, Jeffrey A

2014-01-01

This study examined rates of specific anxiety diagnoses (posttraumatic stress disorder, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and specific phobia) and anxiety disorder not otherwise specified (anxiety NOS) in a national sample of Veterans and assessed their mental health service utilization. This study used administrative data extracted from Veteran Health Administration outpatient records to identify patients with a new anxiety diagnosis in fiscal year 2010 (N = 292,244). Logistic regression analyses examined associations among diagnostic specificity, diagnostic location, and mental health service utilization. Anxiety NOS was diagnosed in 38% of the sample. Patients in specialty mental health were less likely to receive an anxiety NOS diagnosis than patients in primary care (odds ratio [OR] = 0.36). Patients with a specific anxiety diagnosis were more likely to receive mental health services than those with anxiety NOS (OR = 1.65), as were patients diagnosed in specialty mental health compared with those diagnosed in primary care (OR = 16.29). Veterans diagnosed with anxiety NOS are less likely to access mental health services than those with a specific anxiety diagnosis, suggesting the need for enhanced diagnostic and referral practices, particularly in primary care settings. Published by Elsevier Inc.

Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization.

PubMed

Lo, Celia C; Yang, Fan; Ash-Houchen, William; Cheng, Tyrone C

2018-06-07

Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

Parent Groups, Preventive Mental Health in the Schools

ERIC Educational Resources Information Center

Beck, Frances W.; Bornman, Kemper L.

1978-01-01

This paper describes an approach utilized by Margaret Dumas Mental Health Center to produce an effective preventive mental health program with the school incorporating the concept of clear communication and consultation between the school and mental health personnel. (Author)

Characteristics of HIV-infected adults in the Deep South and their utilization of mental health services: A rural vs. urban comparison.

PubMed

Reif, Susan; Whetten, Kathryn; Ostermann, Jan; Raper, James L

2006-01-01

Insufficient utilization of mental health services has been described among HIV-infected individuals in urban areas; however, little is known about utilization of mental health services among rural-living HIV-infected individuals. This article examines use of mental health services by HIV-infected adults in the Southern U.S., where approximately two-thirds of rural HIV cases reside, and compares mental health services use between those in rural and urban areas. Data were obtained from surveys of HIV-infected individuals receiving care at tertiary Infectious Diseases clinics in the Southern U.S. (n = 474). Study findings indicated that participants living in areas with a higher proportion of rural-living individuals were less likely to report seeing a mental health provider (p < .001) in the last year even though there were no differences in level of psychological distress by degree of rurality. Participants living in more rural areas also reported significantly fewer mental health visits in the previous month (p = .025). Furthermore, rural living was significantly associated with being African-American, heterosexual, less educated, and having minor children in the home. Due to differences in characteristics and mental health services use by degree of rurality, efforts are needed to assess and address the specific mental health and other needs of HIV-infected individuals in rural areas.

Statistical procedures for analyzing mental health services data.

PubMed

Elhai, Jon D; Calhoun, Patrick S; Ford, Julian D

2008-08-15

In mental health services research, analyzing service utilization data often poses serious problems, given the presence of substantially skewed data distributions. This article presents a non-technical introduction to statistical methods specifically designed to handle the complexly distributed datasets that represent mental health service use, including Poisson, negative binomial, zero-inflated, and zero-truncated regression models. A flowchart is provided to assist the investigator in selecting the most appropriate method. Finally, a dataset of mental health service use reported by medical patients is described, and a comparison of results across several different statistical methods is presented. Implications of matching data analytic techniques appropriately with the often complexly distributed datasets of mental health services utilization variables are discussed.

Socio-demographic, clinical characteristics and utilization of mental health care services associated with SF-6D utility scores in patients with mental disorders: contributions of the quantile regression.

PubMed

Prigent, Amélie; Kamendje-Tchokobou, Blaise; Chevreul, Karine

2017-11-01

Health-related quality of life (HRQoL) is a widely used concept in the assessment of health care. Some generic HRQoL instruments, based on specific algorithms, can generate utility scores which reflect the preferences of the general population for the different health states described by the instrument. This study aimed to investigate the relationships between utility scores and potentially associated factors in patients with mental disorders followed in inpatient and/or outpatient care settings using two statistical methods. Patients were recruited in four psychiatric sectors in France. Patient responses to the SF-36 generic HRQoL instrument were used to calculate SF-6D utility scores. The relationships between utility scores and patient socio-demographic, clinical characteristics, and mental health care utilization, considered as potentially associated factors, were studied using OLS and quantile regressions. One hundred and seventy six patients were included. Women, severely ill patients and those hospitalized full-time tended to report lower utility scores, whereas psychotic disorders (as opposed to mood disorders) and part-time care were associated with higher scores. The quantile regression highlighted that the size of the associations between the utility scores and some patient characteristics varied along with the utility score distribution, and provided more accurate estimated values than OLS regression. The quantile regression may constitute a relevant complement for the analysis of factors associated with utility scores. For policy decision-making, the association of full-time hospitalization with lower utility scores while part-time care was associated with higher scores supports the further development of alternatives to full-time hospitalizations.

Resilients, overcontrollers and undercontrollers: A systematic review of the utility of a personality typology method in understanding adult mental health problems.

PubMed

Bohane, Laura; Maguire, Nick; Richardson, Thomas

2017-11-01

The person-centred typological approach to personality makes the distinction between overcontrolled and undercontrolled personality types. This review systematically searched for research on the utility of these personality types in adult mental health. A total of 43 papers were included, which were divided broadly into cross-sectional studies, longitudinal studies and studies with clinical populations. Three personality types have been largely replicated in both normal and clinical populations: resilients, overcontrollers and undercontrollers. These types show utility in predicting long-term functioning and mental health, understanding heterogeneous personalities within clinical subgroups and have implications for treatment. Some disagreement on the number of personality types deemed replicable across samples and differing methodologies do exist, with some finding a dimensional approach to personality to have greater predictive utility. These personality types have been shown to be important in a number of mental health problems such as eating disorders, which may prove helpful in developing new psychological interventions. These studies point to the importance of overcontrolled personality types as well as undercontrolled in mental health. More research is needed with a greater range of clinical populations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings

PubMed Central

Cangas, Adolfo J.; Navarro, Noelia; Parra, José M. A.; Ojeda, Juan J.; Cangas, Diego; Piedra, Jose A.; Gallego, Jose

2017-01-01

This paper presents the results from the application of a serious game called Stigma-Stop among a group of high school students with the aim of reducing the stigma toward mental illnesses. The video game features characters with various mental disorders (schizophrenia, depression, bipolar disorder, and panic disorder with agoraphobia) and provides information about these problems. Additionally, the game asks players about whether they have ever felt the same as the characters, if they believe the characters are psychologically well, and if they think they could help these individuals. Similarly, a variety of reactions are provided for players to choose from when they encounter the characters with these problems. A total of 552 students between the ages of 14 and 18 participated in the study, and they were randomly assigned to either the experimental group, which used Stigma-Stop, or the control group, which utilized a video game completely unrelated to mental health. Both video games were used for similar lengths of time. Following the application of Stigma-Stop, a statistically significant decrease was obtained in levels of stigma toward schizophrenia, both in terms of stereotypes and, to a greater extent, its potential dangerousness. However, this was not the case in the control group. Results thus demonstrate the video game’s usefulness toward eradicating erroneous notions about serious mental disorders like schizophrenia. PMID:28878702

Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings.

PubMed

Cangas, Adolfo J; Navarro, Noelia; Parra, José M A; Ojeda, Juan J; Cangas, Diego; Piedra, Jose A; Gallego, Jose

2017-01-01

This paper presents the results from the application of a serious game called Stigma-Stop among a group of high school students with the aim of reducing the stigma toward mental illnesses. The video game features characters with various mental disorders (schizophrenia, depression, bipolar disorder, and panic disorder with agoraphobia) and provides information about these problems. Additionally, the game asks players about whether they have ever felt the same as the characters, if they believe the characters are psychologically well, and if they think they could help these individuals. Similarly, a variety of reactions are provided for players to choose from when they encounter the characters with these problems. A total of 552 students between the ages of 14 and 18 participated in the study, and they were randomly assigned to either the experimental group, which used Stigma-Stop, or the control group, which utilized a video game completely unrelated to mental health. Both video games were used for similar lengths of time. Following the application of Stigma-Stop, a statistically significant decrease was obtained in levels of stigma toward schizophrenia, both in terms of stereotypes and, to a greater extent, its potential dangerousness. However, this was not the case in the control group. Results thus demonstrate the video game's usefulness toward eradicating erroneous notions about serious mental disorders like schizophrenia.

Human Rights-Based Approaches to Mental Health

PubMed Central

Bradley, Valerie J.; Sahakian, Barbara J.

2016-01-01

Abstract The incidence of human rights violations in mental health care across nations has been described as a “global emergency” and an “unresolved global crisis.” The relationship between mental health and human rights is complex and bidirectional. Human rights violations can negatively impact mental health. Conversely, respecting human rights can improve mental health. This article reviews cases where an explicitly human rights-based approach was used in mental health care settings. Although the included studies did not exhibit a high level of methodological rigor, the qualitative information obtained was considered useful and informative for future studies. All studies reviewed suggest that human-rights based approaches can lead to clinical improvements at relatively low costs. Human rights-based approaches should be utilized for legal and moral reasons, since human rights are fundamental pillars of justice and civilization. The fact that such approaches can contribute to positive therapeutic outcomes and, potentially, cost savings, is additional reason for their implementation. However, the small sample size and lack of controlled, quantitative measures limit the strength of conclusions drawn from included studies. More objective, high quality research is needed to ascertain the true extent of benefits to service users and providers. PMID:27781015

Human Rights-Based Approaches to Mental Health: A Review of Programs.

PubMed

Porsdam Mann, Sebastian; Bradley, Valerie J; Sahakian, Barbara J

2016-06-01

The incidence of human rights violations in mental health care across nations has been described as a "global emergency" and an "unresolved global crisis." The relationship between mental health and human rights is complex and bidirectional. Human rights violations can negatively impact mental health. Conversely, respecting human rights can improve mental health. This article reviews cases where an explicitly human rights-based approach was used in mental health care settings. Although the included studies did not exhibit a high level of methodological rigor, the qualitative information obtained was considered useful and informative for future studies. All studies reviewed suggest that human-rights based approaches can lead to clinical improvements at relatively low costs. Human rights-based approaches should be utilized for legal and moral reasons, since human rights are fundamental pillars of justice and civilization. The fact that such approaches can contribute to positive therapeutic outcomes and, potentially, cost savings, is additional reason for their implementation. However, the small sample size and lack of controlled, quantitative measures limit the strength of conclusions drawn from included studies. More objective, high quality research is needed to ascertain the true extent of benefits to service users and providers.

Religious practices, beliefs, and mental health: Variations across Ethnicity

PubMed Central

Sternthal, Michelle J.; Williams, David R.; Musick, Marc A.; Buck, Anna C.

2012-01-01

Objectives We examined whether Black Americans and Hispanic Americans experienced greater mental health benefits from religious involvement than White Americans, and whether these benefits would be mediated through three psychosocial factors—social support, meaning and forgiveness. Methods Utilizing data from a probability sample of Chicago-based adults (n=3103), ethnicity-stratified multivariate regression models estimated the association of religiosity with depressive symptoms, anxiety symptoms, and major depressive disorder. Models controlled for potential confounders and psychosocial mediators. Results Contrary to our hypotheses, religiously involved Black Americans and Hispanic Americans did not experience greater mental health benefits than their White counterparts. For White Americans alone, service attendance was inversely related to depressive symptoms, anxiety symptoms, and major depressive disorder. Religious saliency was consistently associated with worse mental health for Hispanic Americans only. However, both meaning and forgiveness conferred mental health benefits for all three groups. Conclusions The benefits of specific aspects of religious involvement vary across ethnicity. Caution is necessary in any effort to bring religion into the health domain. Our findings, if replicated, suggest that initiatives that facilitate a sense of purpose or forgiveness are likely to prove promising in improving mental health, regardless of race or ethnicity. PMID:22296590

Mental healthcare need and service utilization in older adults living in public housing.

PubMed

Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

2012-05-01

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

The Use of Biofeedback in Treating the Self-Mutilative Behaviors of a Child with Lesch-Nyhan Syndrome: A Pilot Study.

ERIC Educational Resources Information Center

Carmen, Jeffrey A.; And Others

The pilot study focused on the effective design of adaptive biofeedback equipment for use in the control of self-mutilating behaviors in individuals with Lesch-Nyhan syndrome, typically characterized by apasticity, mental retardation, and violent biting of the lips and fingers. Utilizing an electromyographic (EMG) monitor and a custom-designed…

Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework.

PubMed

Robinson, Allysha C; Knowlton, Amy R; Gielen, Andrea C; Gallo, Joseph J

2016-02-01

We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1-3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

Indianization of psychiatry utilizing Indian mental concepts

PubMed Central

Avasthi, Ajit; Kate, Natasha; Grover, Sandeep

2013-01-01

Most of the psychiatry practice in India is guided by the western concepts of mental health and illness, which have largely ignored the role of religion, family, eastern philosophy, and medicine in understanding and managing the psychiatric disorders. India comprises of diverse cultures, languages, ethnicities, and religious affiliations. However, besides these diversities, there are certain commonalities, which include Hinduism as a religion which is spread across the country, the traditional family system, ancient Indian system of medicine and emphasis on use of traditional methods like Yoga and Meditation for controlling mind. This article discusses as to how mind and mental health are understood from the point of view of Hinduism, Indian traditions and Indian systems of medicine. Further, the article focuses on as to how these Indian concepts can be incorporated in the practice of contemporary psychiatry. PMID:23858244

Providing intensive addiction/housing case management to homeless veterans enrolled in addictions treatment: A randomized controlled trial.

PubMed

Malte, Carol A; Cox, Koriann; Saxon, Andrew J

2017-05-01

This study sought to determine whether homeless veterans entering Veterans Affairs (VA) substance use treatment randomized to intensive addiction/housing case management (AHCM) had improved housing, substance use, mental health, and functional outcomes and lower acute health care utilization, compared to a housing support group (HSG) control. Homeless veterans (n = 181) entering outpatient VA substance use treatment were randomized to AHCM and HSG and received treatment for 12 months. AHCM provided individualized housing, substance use and mental health case management, life skills training, and community outreach. The control condition was a weekly drop-in housing support group. Adjusted longitudinal analyses compared groups on baseline to month 12 change in percentage of days housed and functional status, substance use, and mental health outcomes (36-Item Short-Form Health Survey; Addiction Severity Index [ASI]). Negative binomial regression models compared groups on health care utilization. Both conditions significantly increased percentage of days housed, with no differences detected between conditions. In total, 74 (81.3%) AHCM and 64 (71.1%) HSG participants entered long-term housing (odds ratio = 1.9, 95% confidence interval [0.9, 4.0], p = .088). HSG participants experienced a greater decrease in emergency department visits than AHCM (p = .037), whereas AHCM participants remained in substance use treatment 52.7 days longer (p = .005) and had greater study treatment participation (p < .001) than HSG. ASI alcohol composite scores improved more for HSG than AHCM (p = .006), and both conditions improved on ASI drug and psychiatric scores and alcohol/drug abstinence. AHCM did not demonstrate overarching benefits beyond standard VA housing and substance use care. For those veterans not entering or losing long-term housing, different approaches to outreach and ongoing intervention are required. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The incremental value of self-reported mental health measures in predicting functional outcomes of veterans.

PubMed

Eisen, Susan V; Bottonari, Kathryn A; Glickman, Mark E; Spiro, Avron; Schultz, Mark R; Herz, Lawrence; Rosenheck, Robert; Rofman, Ethan S

2011-04-01

Research on patient-centered care supports use of patient/consumer self-report measures in monitoring health outcomes. This study examined the incremental value of self-report mental health measures relative to a clinician-rated measure in predicting functional outcomes among mental health service recipients. Participants (n = 446) completed the Behavior and Symptom Identification Scale, the Brief Symptom Inventory, and the Veterans/Rand Short Form-36 at enrollment in the study (T1) and 3 months later (T2). Global Assessment of Functioning (GAF) ratings, mental health service utilization, and psychiatric diagnoses were obtained from administrative data files. Controlling for demographic and clinical variables, results indicated that improvement based on the self-report measures significantly predicted one or more functional outcomes (i.e., decreased likelihood of post-enrollment psychiatric hospitalization and increased likelihood of paid employment), above and beyond the predictive value of the GAF. Inclusion of self-report measures may be a useful addition to performance measurement efforts.

Sectorized psychiatry. A methodological study of the effects of reorganization on patients treated at a mental hospital.

PubMed

Lindholm, H

1983-01-01

The aim of the study was to find relevant methods and use them to investigate the effects of sectorized psychiatry on former mental hospital patients. Seventeen hypotheses were formulated, concerning both positive and negative effects of sectorized psychiatry. Relevance and expected availability decided the variables, which were based on information from medical registers, case records, death certificates, social authorities, courts of law, public health insurance, census office and personal interviews. The hypotheses were tested by the use of two groups of patients, 377 in one experimental group, and 377 in one control group. A matched control method was used. The study patients were domiciled in the catchment area for the first complete trial of sectorized psychiatric service in the Stockholm area. The control patients were domiciled in the catchment area for the remaining divisions of Beckomberga Mental Hospital. During the actual years, an experimental situation was at hand. Comparisons in each pair were performed, regarding the experimental year 1980. A methodological description of variables for measurement of the effects and changes in psychiatric care is presented. The comparison showed no significant differences in the analyses, regarding utilization of inpatient care at Beckomberga Hospital in 1980. Study patients had significantly more outpatient visits and day-care days compared to controls. Study patients reported significantly shorter time of public transportation between home and psychiatric service. Study patients were significantly more often discharged to the division's own agencies compared to controls. Study patients reported significantly less satisfaction with ward staff than controls. No significant differences in direct cost of treatment during the experimental year were registered. The conclusion is, that there are no consistent tendencies proving the new organization superior to the traditional one for these former mental hospital patients.

Mental Health Services Utilization and Expenditures Among Children Enrolled in Employer-Sponsored Health Plans.

PubMed

Walter, Angela Wangari; Yuan, Yiyang; Cabral, Howard J

2017-05-01

Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans. Copyright © 2017 by the American Academy of Pediatrics.

Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders.

PubMed

Abbas, Sascha; Ihle, Peter; Adler, Jürgen-Bernhard; Engel, Susanne; Günster, Christian; Holtmann, Martin; Kortevoss, Axel; Linder, Roland; Maier, Werner; Lehmkuhl, Gerd; Schubert, Ingrid

2017-04-01

Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.

Capitation of public mental health services in Colorado: a five-year follow-up of system-level effects.

PubMed

Bloom, Joan R; Wang, Huihui; Kang, Soo Hyang; Wallace, Neal T; Hyun, Jenny K; Hu, Teh-wei

2011-02-01

Capitated Medicaid mental health programs have reduced costs over the short term by lowering the utilization of high-cost inpatient services. This study examined the five-year effects of capitated financing in community mental health centers (CMHCs) by comparing not-for-profit with for-profit programs. Data were from the Medicaid billing system in Colorado for the precapitation year (1994) and a shadow billing system for the postcapitation years (1995-1999). In a panel design, a random-effect approach estimated the impact of two financing systems on service utilization and cost while adjusting for all the covariates. Consistent with predictions, in both the for-profit and the not-for-profit CMHCs, relative to the precapitation year, there were significant reductions in each postcapitation year in high-cost treatments (inpatient treatment) for all but one comparison (not-for-profit CMHCs in 1999). Also consistent with predictions, the for-profit programs realized significant reductions in cost per user for both outpatient services and total services. In the not-for-profit programs, there were no significant changes in cost per user for total services; a significant reduction in cost per user for outpatient services was found only in the first two years, 1995 and 1996). The evidence suggests that different strategies were used by the not-for-profit and for-profit programs to control expenditures and utilization and that the for-profit programs were more successful in reducing cost per user.

Increasing Counseling Center Utilization: Yeshiva University's Experience

ERIC Educational Resources Information Center

Schwartz, Victor; Nissel, Chaim; Eisenberg, Daniel; Kay, Jerald; Brown, Joshua T.

2012-01-01

Yeshiva University established a counseling center during the 2004-2005 academic year. As a religiously based institution, the administration recognized that there would likely be significant impediments to utilization of on-campus mental health services as a result of negative attitudes about mental illness and its treatment--stigma. To combat…

The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

PubMed Central

Kartha, Anand; Brower, Victoria; Saitz, Richard; Samet, Jeffrey H.; Keane, Terence M.; Liebschutz, Jane

2009-01-01

Background Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. Objectives To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. Research Design Cross-sectional study. Subjects English speaking patients at an academic, urban primary care clinic. Measures Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. Results Among 592 subjects, 80% had ≥1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1–14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9–11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4–3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4–5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1–4.1) but no increase in outpatient and emergency department visits. Conclusions PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association. PMID:18362818

Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.

PubMed

Koo, Kelly H; Madden, Erin; Maguen, Shira

2015-05-01

The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.

Veterans' Mental Health in Higher Education Settings: Services and Clinician Education Needs.

PubMed

Niv, Noosha; Bennett, Lauren

2017-06-01

Utilization of the GI Bill and attendance at higher education institutions among student veterans have significantly increased since passage of the Post-9/11 GI Bill. Campus counseling centers should be prepared to meet the mental health needs of student veterans. This study identified the mental health resources and services that colleges provide student veterans and the education needs of clinical staff on how to serve student veterans. Directors of mental health services from 80 California colleges completed a semistructured phone interview. Few schools track the number, demographic characteristics, or presenting needs of student veterans who utilize campus mental health services or offer priority access or special mental health services for veterans. Directors wanted centers to receive education for an average of 5.8 veteran-related mental health topics and preferred workshops and lectures to handouts and online training. Significant training needs exist among clinical staff of campus mental health services to meet the needs of student veterans.

High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country

PubMed Central

Eustache, Eddy; Gerbasi, Margaret E.; Smith Fawzi, Mary C.; Fils-Aimé, J. Reginald; Severe, Jennifer; Raviola, Giuseppe J.; Legha, Rupinder; Darghouth, Sarah; Grelotti, David J.; Thérosmé, Tatiana; Pierre, Ermaze L.; Affricot, Emmeline; Alcindor, Yoldie; Becker, Anne E.

2017-01-01

Background The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. Aims To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. Methods We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth (n=120, ages 18–22) using a modified SCID-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. Results The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Conclusions Findings demonstrate a high mental health burden among Haiti’s youth and that many youth with MDE and PTSD are not accessing mental health care. PMID:28367719

The effect of cognitive impairment on mental healthcare costs for individuals with severe psychiatric illness.

PubMed

Mackin, R Scott; Delucchi, Kevin L; Bennett, Robert W; Areán, Patricia A

2011-02-01

This study was conducted to determine the effect of cognitive impairment (CI) on mental healthcare costs for older low-income adults with severe psychiatric illness. Data were collected from 62 ethnically diverse low-income older adults with severe psychiatric illness who were participating in day programming at a large community mental health center. CI was diagnosed by a neuropsychologist utilizing the Mattis Dementia Rating Scale-Second Edition and structured ratings of functional impairment (Clinical Dementia Rating Scale). Mental healthcare costs for 6, 12, and 24-month intervals before cognitive assessments were obtained for each participant. Substance abuse history was evaluated utilizing a structured questionnaire, depression symptom severity was assessed utilizing the Hamilton Depression Rating Scale, and psychiatric diagnoses were obtained through medical chart abstraction. CI was exhibited by 61% of participants and was associated with significantly increased mental healthcare costs during 6, 12, and 24-month intervals. Results of a regression analysis indicated that ethnicity and CI were both significant predictors of log transformed mental healthcare costs over 24 months with CI accounting for 13% of the variance in cost data. CI is a significant factor associated with increased mental healthcare costs in patients with severe psychiatric illness. Identifying targeted interventions to accommodate CI may lead to improving treatment outcomes and reducing the burden of mental healthcare costs for individuals with severe psychiatric illness.

Open-access evidence database of controlled trials and systematic reviews in youth mental health.

PubMed

De Silva, Stefanie; Bailey, Alan P; Parker, Alexandra G; Montague, Alice E; Hetrick, Sarah E

2018-06-01

To present an update to an evidence-mapping project that consolidates the evidence base of interventions in youth mental health. To promote dissemination of this resource, the evidence map has been translated into a free online database (https://orygen.org.au/Campus/Expert-Network/Evidence-Finder or https://headspace.org.au/research-database/). Included studies are extensively indexed to facilitate searching. A systematic search for prevention and treatment studies in young people (mean age 6-25 years) is conducted annually using Embase, MEDLINE, PsycINFO and the Cochrane Library. Included studies are restricted to controlled trials and systematic reviews published since 1980. To date, 221 866 publications have been screened, of which 2680 have been included in the database. Updates are conducted annually. This shared resource can be utilized to substantially reduce the amount of time involved with conducting literature searches. It is designed to promote the uptake of evidence-based practice and facilitate research to address gaps in youth mental health. © 2017 John Wiley & Sons Australia, Ltd.

Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.

PubMed

Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto

2013-01-01

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics.

PubMed

Torous, John; Chan, Steven Richard; Yee-Marie Tan, Shih; Behrens, Jacob; Mathew, Ian; Conrad, Erich J; Hinton, Ladson; Yellowlees, Peter; Keshavan, Matcheri

2014-01-01

Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. To provide data on psychiatric outpatients' prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States' rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications.

Are implicit policy assumptions about climate adaptation trying to push drinking water utilities down an impossible path?

NASA Astrophysics Data System (ADS)

Klasic, M. R.; Ekstrom, J.; Bedsworth, L. W.; Baker, Z.

2017-12-01

Extreme events such as wildfires, droughts, and flooding are projected to be more frequent and intense under a changing climate, increasing challenges to water quality management. To protect and improve public health, drinking water utility managers need to understand and plan for climate change and extreme events. This three year study began with the assumption that improved climate projections were key to advancing climate adaptation at the local level. Through a survey (N = 259) and interviews (N = 61) with California drinking water utility managers during the peak of the state's recent drought, we found that scientific information was not a key barrier hindering adaptation. Instead, we found that managers fell into three distinct mental models based on their interaction with, perceptions, and attitudes, towards scientific information and the future of water in their system. One of the mental models, "modeled futures", is a concept most in line with how climate change scientists talk about the use of information. Drinking water utilities falling into the "modeled future" category tend to be larger systems that have adequate capacity to both receive and use scientific information. Medium and smaller utilities in California, that more often serve rural low income communities, tend to fall into the other two mental models, "whose future" and "no future". We show evidence that there is an implicit presumption that all drinking water utility managers should strive to align with "modeled future" mental models. This presentation questions this assumption as it leaves behind many utilities that need to adapt to climate change (several thousand in California alone), but may not have the technical, financial, managerial, or other capacity to do so. It is clear that no single solution or pathway to drought resilience exists for water utilities, but we argue that a more explicit understanding and definition of what it means to be a resilient drinking water utility is necessary. By highlighting, then questioning, the assumption that all utility managers should strive to have "modeled future" mentalities, this presentation seeks to foster an open dialogue around which pathway or pathways are most feasible for supporting drinking water utility managers planning for climate change.

Mental Health-Related Healthcare Use Following Bilateral Deep Brain Stimulation For Parkinson's Disease.

PubMed

Westbay, Lauren C; Cao, Lishan; Burnett-Zeigler, Inger; Reizine, Natalie; Barton, Brandon; Ippolito, Dolores; Weaver, Frances M; Stroupe, Kevin T

2015-01-01

The subthalamic nucleus (STN) and the globus pallidus internus (GPi) are both effective targets for deep brain stimulation (DBS) to relieve motor symptoms of Parkinson's disease. However, studies have reported varied effects on mental health-related adverse events and depressed mood following DBS. The current observational study sought to compare mental health healthcare utilization and costs for three years following STN or GPi DBS. For a cohort of Veterans (n = 161) with Parkinson's disease who participated in a larger multi-site randomized trial, we compared mental health outpatient visits, medication use, inpatient admissions, and associated costs by DBS target site (STN vs. GPi). Neither group nor time differences were significant for mental health outpatient or inpatient utilization following DBS. Overall costs associated with mental health visits and medications did not differ by time or by group. However, the percentage of patients with mental health medication use increased in the 6-month and 6 to 12 month periods post-surgery. The STN group had significantly greater increase in medication use at 6 to 12 months post-surgery compared to the GPi group (p <  0.05). Despite a brief increase in medication use following surgery, this study suggests that mental health healthcare use and costs are stable over time and similar between DBS targets. Prior research findings of mental health-related adverse events and mood following DBS did not translate to greater mental health service utilization in our cohort. The changes seen in the year following surgery may reflect temporary adjustments with stabilization over time.

Training and Utilizing Teaching Aides for Trainable Mentally Retarded Children. Evaluation Report.

ERIC Educational Resources Information Center

Joiner, Lee M.

Evaluated was a program utilizing aides to assist in the instruction of 40 trainable mentally retarded children in the areas of self help skills, arts and crafts, motor development, and language development. Evaluation was by an external observer for the purpose of providing program planning information. Approximately 70 questions were formulated…

Application of the PRECEDE Model to Understanding Mental Health Promoting Behaviors in Hong Kong

ERIC Educational Resources Information Center

Mo, Phoenix K. H.; Mak, Winnie W. S.

2008-01-01

The burdens related to mental illness have been increasingly recognized in many countries. Nevertheless, research in positive mental health behaviors remains scarce. This study utilizes the Predisposing, Reinforcing, and Enabling Causes in Education Diagnosis and Evaluation (PRECEDE) model to identify factors associated with mental health…

Eriksonian intimacy development, relationship satisfaction, and depression in gay male couples

PubMed Central

Starks, Tyrel J.; Doyle, Kendell M.; Millar, Brett M.; Parsons, Jeffrey T.

2017-01-01

Research suggests connections or links between the mental health of both partners in a romantic relationship, as partners often report similar mental health problems, with implications for relationship functioning. The current study utilized the framework of interdependence theory to explore associations among intimacy development, as conceptualized by Erikson, relationship satisfaction, and depression in a sample of 128 same-sex male couples. In each couple, one partner was recruited first through active or passive outreach conducted online and in-person, and after completion of the online survey, was then invited to send his partner a link to the study. The 256 male respondents (mean age = 32.6 years) all reported a U.S. residence and had an average relationship length of five years. Utilizing the Actor-Partner Interdependence Model, analyses indicated that participants’ intimacy development directly predicted their own relationship satisfaction (B = 1.84, p< .01) as well as their partner’s relationship satisfaction (B = 1.61, p<.01). Similarly, both the actor (B = -0.04, p< .01) and partner (B = -0.04, p< .05) effects of relationship satisfaction on depression were significant. Consistent with the interdependent concept of joint control, three indirect pathways linked Eriksonian intimacy to depression through relationship satisfaction. These findings suggest that individual development may become linked to mental health through pathways involving dyadic functioning. This pattern implies highly inter-connected links between the intra-personal and inter-personal, which have implications for mental health intervention with gay men in relationships. PMID:29805985

Are Posttraumatic Stress Symptoms Related to Mental Health Service Use? A Prospective Study of Danish Soldiers Deployed to Afghanistan.

PubMed

Madsen, Trine; Andersen, Søren Bo; Karstoft, Karen-Inge

2016-10-01

Investigating the use of mental health services by combat veterans can help illuminate utilization and unmet needs of this population. The aims of this study were to estimate the use of mental health services and to examine how such use is associated with self-reported symptoms of posttraumatic stress disorder (PTSD) in soldiers before and after deployment to Afghanistan. Prospectively, 703 Danish soldiers who deployed from January 2009 to August 2009 were followed up with 6 assessments from predeployment to 2.5 years postdeployment in 2012. At assessments, the soldiers responded to a comprehensive questionnaire including a measure of PTSD symptoms (the PTSD Checklist-Civilian version). These self-reported data were combined with individual-level records of receiving psychotherapy from the Military Psychological Division at the Danish Defense and psychiatric treatment from the Danish registers. The prevalence of PTSD symptoms increased over time, and almost 10% of the sample reported high levels of PTSD symptoms 2.5 years postdeployment. Overall, 37% of the soldiers utilized mental health services; 6% utilized psychiatric services, and 12.4% redeemed a prescription for psychiatric medicine. Approximately one-third received psychotherapy at the Military Psychological Division. In those reporting high PTSD symptomatology, 83% utilized 1 or more types of mental health service. At predeployment and homecoming, high PTSD symptomatology was significantly (P < .01) associated with attending psychotherapy, but not with psychiatric treatment or redemption of psychiatric medicine. With time, more soldiers report high PTSD symptoms. Among Danish soldiers with high symptomatology, the utilization of mental health services was high. Most frequently, soldiers with high PTSD symptomatology received psychotherapy at the Military Psychological Division and less frequently received psychiatric treatment. © Copyright 2016 Physicians Postgraduate Press, Inc.

A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol.

PubMed

Young, Alexander S; Cohen, Amy N; Chang, Evelyn T; Flynn, Anthony W P; Hamilton, Alison B; Oberman, Rebecca; Vinzon, Merlyn

2018-06-07

People with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results. While people with SMI often do poorly with usual primary care arrangements, research suggests that integrated care and medical care management may improve treatment and outcomes, and reduce treatment costs. This hybrid implementation-effectiveness study is a prospective, cluster controlled trial of a medical home, the SMI Patient-Aligned Care Team (SMI PACT), to improve the healthcare of patients with SMI enrolled with the Veterans Health Administration. The SMI PACT team includes proactive medical nurse care management, and integrated mental health treatment through regular psychiatry consultation and a collaborative care model. Patients are recruited to receive primary care through SMI PACT based on having a serious mental illness that is manageable with treatment, and elevated risk for hospitalization or death. In a site-level prospective controlled trial, this project studies the effect, relative to usual care, of SMI PACT on provision of appropriate preventive and medical treatments, health-related quality of life, satisfaction with care, and medical and mental health treatment utilization and costs. Research includes mixed-methods formative evaluation of usual care and SMI PACT implementation to strengthen the intervention and assess barriers and facilitators. Investigators examine relationships among organizational context, intervention factors, and patient and clinician outcomes, and identify patient factors related to successful patient outcomes. This will be one of the first controlled trials of the implementation and effectiveness of a patient centered medical home for people with serious mental illness. It will provide information regarding the value of this strategy, and processes and tools for implementing this model in community healthcare settings. ClinicalTrials.gov, NCT01668355 . Registered August 20, 2012.

Building the infrastructure: the effects of role identification behaviors on team cognition development and performance.

PubMed

Pearsall, Matthew J; Ellis, Aleksander P J; Bell, Bradford S

2010-01-01

The primary purpose of this study was to extend theory and research regarding the emergence of mental models and transactive memory in teams. Utilizing Kozlowski, Gully, Nason, and Smith's (1999) model of team compilation, we examined the effect of role identification behaviors and posited that such behaviors represent the initial building blocks of team cognition during the role compilation phase of team development. We then hypothesized that team mental models and transactive memory would convey the effects of these behaviors onto team performance in the team compilation phase of development. Results from 60 teams working on a command-and-control simulation supported our hypotheses. Copyright 2009 APA, all rights reserved.

Shared decision making and serious mental illness.

PubMed

Mahone, Irma H

2008-12-01

This study examined medication decision making by 84 persons with serious mental illness, specifically examining relationships among perceived coercion, decisional capacity, preferences for involvement and actual participation, and the outcomes of medication adherence and quality of life (QoL). Multiple and logistic regression analysis were used in this cross-sectional, descriptive study, controlling for demographic, socioeconomic, and utilization variables. Appreciation was positively related to medication adherence behaviors for the past 6 months. Women, older individuals, and those living independently were more likely to have taken all their medications over the past 6 months. Neither client participation, preference, nor preference-participation agreement was found to be associated with better medication adherence or QoL.

Exploring virtual mental practice in maintenance task training.

PubMed

Bauerle, Tim; Brnich, Michael J; Navoyski, Jason

- This paper aims to contribute to a general understanding of mental practice by investigating the utility of and participant reaction to a virtual reality maintenance training among underground coal mine first responders. - Researchers at the National Institute for Occupational Safety and Health's Office of Mine Safety and Health Research (OMSHR) developed software to provide opportunities for mine rescue team members to learn to inspect, assemble and test their closed-circuit breathing apparatus and to practice those skills. In total, 31 mine rescue team members utilized OMSHR's BG 4 Benching Trainer software and provided feedback to the development team. After training, participants completed a brief post-training questionnaire, which included demographics, perceived training climate and general training evaluation items. - The results overall indicate a generally positive reaction to and high perceived utility of the BG 4 benching software. In addition, the perceived training climate appears to have an effect on the perceived utility of the mental practice virtual reality game, with benchmen from mines with more positive training climates reporting greater perceived efficacy in the training's ability to prepare trainees for real emergencies. - This paper helps to broaden current applications of mental practice and is one of the few empirical investigations into a non-rehabilitation virtual reality extension of mental practice. This paper also contributes to the growing literature advocating for greater usage of accurate and well-informed mental practice techniques, tools and methodologies, especially for occupational populations with limitations on exposure to hands-on training.

Relationships of working conditions, health problems and vehicle accidents in bus rapid transit (BRT) drivers.

PubMed

Gómez-Ortiz, Viviola; Cendales, Boris; Useche, Sergio; Bocarejo, Juan P

2018-04-01

The aim of this study was to estimate accident risk rates and mental health of bus rapid transit (BRT) drivers based on psychosocial risk factors at work leading to increased stress and health problems. A cross-sectional research design utilized a self-report questionnaire completed by 524 BRT drivers. Some working conditions of BRT drivers (lack of social support from supervisors and perceived potential for risk) may partially explain Bogota's BRT drivers' involvement in road accidents. Drivers' mental health problems were associated with higher job strain, less support from co-workers, fewer rewards and greater signal conflict while driving. To prevent bus accidents, supervisory support may need to be increased. To prevent mental health problems, other interventions may be needed such as reducing demands, increasing job control, reducing amount of incoming information, simplifying current signals, making signals less contradictory, and revising rewards. © 2018 Wiley Periodicals, Inc.

Predicting Help-Seeking Attitudes Toward Mental Health Services Among American Indian Older Adults: Is Andersen's Behavioral Model a Good Fit?

PubMed

Roh, Soonhee; Burnette, Catherine E; Lee, Kyoung Hag; Lee, Yeon-Shim; Martin, James I; Lawler, Michael J

2017-01-01

American Indian (AI) older adults are vulnerable to mental health disparities, yet very little is known about the factors associated with help-seeking for mental health services among them. The purpose of this study was to investigate the utility of Andersen's Behavioral Model in explaining AI older adults' help-seeking attitudes toward professional mental health services. Hierarchical regression analysis was used to examine predisposing, enabling, and need variables as predictors of help-seeking attitudes toward mental health services in a sample of 233 AI older adults from the Midwest. The model was found to have limited utility in the context of older AI help-seeking attitudes, as the proportion of explained variance was low. Gender, perceived stigma, social support, and physical health were significant predictors, whereas age, perceived mental health, and health insurance were not. © The Author(s) 2014.

Utilizing a Positive Behavior Support Approach to Achieve Integrated Mental Health Services

ERIC Educational Resources Information Center

Frey, Andy; Young, Scott; Gold, Allene; Trevor, Earl

2008-01-01

Although experts in early childhood mental health services make clear the need to infuse mental health services into all program components, many have suggested that the mental health services in the majority of Head Start programs are narrowly focused and that mental health consultants are often used in limited ways (see D. J. Cohen, Solnit, &…

Health provider perspectives on mental health service provision for Chinese people living in Christchurch, New Zealand

PubMed Central

ZHANG, Qiuhong; GAGE, Jeffrey; BARNETT, Pauline

2013-01-01

Background Migration imposes stress and may contribute to the incidence of mental illness among natives of mainland China living overseas. Both cultural norms and service inadequacies may act as barriers to accessing needed mental health services. Objective Assess New Zealand health providers' perspectives on the utilization of mental health services by immigrants from mainland China. Methods A qualitative study in Christchurch, New Zealand involved in-depth interviews with nine mental health professionals with experience in providing services to Chinese clients. The interviews were transcribed and thematically analysed. Results Four main themes emerged from the interviews: (1) specific mental health concerns of Chinese migrants; (2) subgroups of migrants most likely to manifest mental health problems; (3) barriers to accessing services; and (4) the centrality of social support networks to the mental health of Chinese migrants. Conclusions Qualitative research with health providers in high-income countries who provide mental health services to the growing numbers of migrants from mainland China can identify areas where improved cultural sensitivity could increase both the utilization of mental health services by Chinese immigrants and the effectiveness of these services. PMID:24991180

A comparative study of family functioning, health, and mental health awareness and utilization among female Bedouin-Arabs from recognized and unrecognized villages in the Negev.

PubMed

Al-Krenawi, Alean; Graham, John R

2006-02-01

A good portion of geography is contested by the Israeli state and the country's Bedouin-Arab population. There are two categories of Bedouin villages: those areas that are "officially" recognized by the state and those that are not. In this article we determine utilization and awareness of health and mental health services among 376 Bedouin-Arab women in recognized and unrecognized villages in the Negev. Although there are differences between them, primary health care (PHC) services usually are available within recognized villages, accessible to those from unrecognized villages, and tend to precipitate user satisfaction. We conclude with various suggestions for improving health service delivery and making PHC and mental health delivery more accessible. Through this article we intend to help mental health practitioners on two levels: the policy level, regarding the design of mental health services for societies in transition, such as the Bedouin Arab, and the practical level by helping practitioners better appreciate the psychosocial status of women in Bedouin-Arab societies and the factors associated with Bedouin-Arab PHC utilization.

A Randomized, Controlled Pilot Study of a Single-Session Psychoeducation Treatment for Urban, Culturally Diverse, Trauma-Exposed Adults.

PubMed

Ghafoori, Bita; Fisher, Dennis; Korosteleva, Olga; Hong, Madelyn

2016-06-01

This randomized pilot study aimed to determine whether a single session of psychoeducation improved mental health outcomes, attitudes toward treatment, and service engagement among urban, impoverished, culturally diverse, trauma-exposed adults. Sixty-seven individuals were randomly assigned to a single-session psychoeducation treatment or a delayed treatment comparison control group. The control group was found to be superior to the treatment group at posttest with respect to symptoms of posttraumatic stress disorder, anxiety, and occupational and family disability. At follow-up, all participants had completed the psychoeducation treatment, and a mixed-effects model indicated significant improvements over time in symptoms of posttraumatic stress disorder, anxiety, depression, somatization, and attitudes toward treatment. Ninety-eight percent of the participants reported the psychoeducation was helpful at follow-up. Participants also reported a 19.1% increase in mental health service utilization at follow-up compared with baseline. Implications for treatment and future research are discussed.

The long-term impact of employment on mental health service use and costs for persons with severe mental illness.

PubMed

Bush, Philip W; Drake, Robert E; Xie, Haiyi; McHugo, Gregory J; Haslett, William R

2009-08-01

Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study. Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost. A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years. Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation.

[Evaluation of the ICAR program--Internet communication and active rehabilitation for people with mental disorders].

PubMed

Załuska, Maria; Bronowski, Paweł; Panasiuk, Katarzyna; Brykalski, Jan; Paszko, Jolanta

2008-01-01

Prevalence of Internet use indicates, that introducing internet to people with mental disorders might have a positive impact on their social integration. There are concerns about negative effects of dealing with virtual reality on the mental health of Internet users. Evaluation of the ICAR program--"Internet communication and active rehabilitation for people with mental disorders" concerning its utility in psychiatric rehabilitation. 22 participants of the ICAR programme and 22 controls (people with mental disorders not participating in the programme) were investigated before and after the completion of the programme. There following were compared: their computer and Internet use skills, social functioning (Birchwood Scale), self-estimation of the mental health (Frankfurt Scale FBS), self-reported quality of life (WHO QOL BREV) and number of psychiatric hospitalisations during 11 months of the observation period. Among participants, their reported skills and motivation increased significantly following the programme. During 11 months of the observation there were less hospitalisations (1 fulltime and 1 daily) in the study group than in the control group (3 and 1). An increase of symptoms was observed in the Frankfurt Scale in 10 participants and 13 controls. The level of social functioning and severity of symptoms was not significantly different and did not change during observation. The self-reported quality of life increased in both groups during this period. ICAR training programme for the mentally ill, increases participants skills and motivation towards computer and Internet use, as well as their self-reported quality of life. The participation in the programme doesn't have any significant effect on the overall social functioning and number of psychiatric hospitalisations during the 11 months of observation. A positive effect of the ICAR programme on the quality of life, as well as some activating effect leading to exacerbation of the psychopatological symptoms--has an unspecific character and is therefore similar to the other community rehabilitation programmes. Wider spreading of computer training workshops similar to the ICAR programme might have a positive effect on social integration of people with mental disorders.

Understanding Cognitive Performance During Robot-Assisted Surgery.

PubMed

Guru, Khurshid A; Shafiei, Somayeh B; Khan, Atif; Hussein, Ahmed A; Sharif, Mohamed; Esfahani, Ehsan T

2015-10-01

To understand cognitive function of an expert surgeon in various surgical scenarios while performing robot-assisted surgery. In an Internal Review Board approved study, National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire with surgical field notes were simultaneously completed. A wireless electroencephalography (EEG) headset was used to monitor brain activity during all procedures. Three key portions were evaluated: lysis of adhesions, extended lymph node dissection, and urethro-vesical anastomosis (UVA). Cognitive metrics extracted were distraction, mental workload, and mental state. In evaluating lysis of adhesions, mental state (EEG) was associated with better performance (NASA-TLX). Utilizing more mental resources resulted in better performance as self-reported. Outcomes of lysis were highly dependent on cognitive function and decision-making skills. In evaluating extended lymph node dissection, there was a negative correlation between distraction level (EEG) and mental demand, physical demand and effort (NASA-TLX). Similar to lysis of adhesion, utilizing more mental resources resulted in better performance (NASA-TLX). Lastly, with UVA, workload (EEG) negatively correlated with mental and temporal demand and was associated with better performance (NASA-TLX). The EEG recorded workload as seen here was a combination of both cognitive performance (finding solution) and motor workload (execution). Majority of workload was contributed by motor workload of an expert surgeon. During UVA, muscle memory and motor skills of expert are keys to completing the UVA. Cognitive analysis shows that expert surgeons utilized different mental resources based on their need. Copyright © 2015 Elsevier Inc. All rights reserved.

High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country.

PubMed

Eustache, Eddy; Gerbasi, Margaret E; Smith Fawzi, Mary C; Fils-Aimé, J Reginald; Severe, Jennifer; Raviola, Giuseppe J; Legha, Rupinder; Darghouth, Sarah; Grelotti, David J; Thérosmé, Tatiana; Pierre, Ermaze L; Affricot, Emmeline; Alcindor, Yoldie; Becker, Anne E

2017-05-01

The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.

Structure, Intent and Conformance Monitoring in ATC

NASA Technical Reports Server (NTRS)

Reynolds, Tom G.; Histon, Jonathan M.; Davison, Hayley J.; Hansman, R. John

2004-01-01

Infield studies of current Air Traffic Control operations it is found that controllers rely on underlying airspace structure to reduce the complexity of the planning and conformance monitoring tasks. The structure appears to influence the controller's working mental model through abstractions that reduce the apparent cognitive complexity. These structure-based abstractions are useful for the controller's key tasks of planning, implementing, monitoring, and evaluating tactical situations. In addition, the structure-based abstractions appear to be important in the maintenance of Situation Awareness. The process of conformance monitoring is analyzed in more detail and an approach to conformance monitoring which utilizes both the structure-based abstractions and intent is presented.

Housing First, Consumer Choice, and Harm Reduction for Homeless Individuals With a Dual Diagnosis

PubMed Central

Tsemberis, Sam; Gulcur, Leyla; Nakae, Maria

2004-01-01

Objectives. We examined the longitudinal effects of a Housing First program for homeless, mentally ill individuals’ on those individuals’ consumer choice, housing stability, substance use, treatment utilization, and psychiatric symptoms. Methods. Two hundred twenty-five participants were randomly assigned to receive housing contingent on treatment and sobriety (control) or to receive immediate housing without treatment prerequisites (experimental). Interviews were conducted every 6 months for 24 months. Results. The experimental group obtained housing earlier, remained stably housed, and reported higher perceived choice. Utilization of substance abuse treatment was significantly higher for the control group, but no differences were found in substance use or psychiatric symptoms. Conclusions. Participants in the Housing First program were able to obtain and maintain independent housing without compromising psychiatric or substance abuse symptoms. PMID:15054020

Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics

PubMed Central

Chan, Steven Richard; Yee-Marie Tan, Shih; Behrens, Jacob; Mathew, Ian; Conrad, Erich J; Hinton, Ladson; Yellowlees, Peter; Keshavan, Matcheri

2014-01-01

Background Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective To provide data on psychiatric outpatients’ prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States’ rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). Conclusions These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. PMID:26543905

A case report using the mental state examination scale (MSES): a tool for measuring change in mental state.

PubMed

Fernando, Irosh; Carter, Gregory

2016-02-01

There is a need for a simple and brief tool that can be used in routine clinical practice for the quantitative measurement of mental state across all diagnostic groups. The main utilities of such a tool would be to provide a global metric for the mental state examination, and to monitor the progression over time using this metric. We developed the mental state examination scale (MSES), and used it in an acute inpatient setting in routine clinical work to test its initial feasibility. Using a clinical case, the utility of MSES is demonstrated in this paper. When managing the patient described, the MSES assisted the clinician to assess the initial mental state, track the progress of the recovery, and make timely treatment decisions by quantifying the components of the mental state examination. MSES may enhance the quality of clinical practice for clinicians, and potentially serve as an index of universal mental healthcare outcome that can be used in clinical practice, service evaluation, and healthcare economics. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Kindergarten Screening and Parent Engagement to Enhance Mental Health Service Utilization

ERIC Educational Resources Information Center

Girio, Erin L.

2010-01-01

The majority of youth in need of mental health services do not receive intervention as many are not identified as having a problem or their families experience practical or attitudinal barriers that interfere with service utilization. The school environment provides a unique point of access to reach all children, yet this setting has been…

Major Differences: Variations in Undergraduate and Graduate Student Mental Health and Treatment Utilization across Academic Disciplines

ERIC Educational Resources Information Center

Lipson, Sarah Ketchen; Zhou, Sasha; Wagner, Blake, III; Beck, Katie; Eisenberg, Daniel

2016-01-01

This article explores variations in mental health and service utilization across academic disciplines using a random sample of undergraduate and graduate students (N = 64,519) at 81 colleges and universities. We report prevalence of depression, anxiety, suicidality, and self-injury, and rates of help-seeking across disciplines, including results…

Reengagement in PTSD psychotherapy: A case-control study.

PubMed

Buchholz, Katherine R; Bohnert, Kipling M; Pfeiffer, Paul N; Valenstein, Marcia; Ganoczy, Dara; Anderson, RaeAnn E; Sripada, Rebecca K

2017-09-01

This study sought to identify patient characteristics and care processes related to reengagement in VA psychotherapy. Using national VA data, a retrospective cohort was constructed (N=24,492) of veterans who received a new PTSD diagnosis in FY08/FY09 and attended only one to five PTSD psychotherapy sessions. A nested case-control study was conducted comparing veterans who reengaged in psychotherapy (n=9649) in a 1:5 ratio with those who did not reengage by the end of FY12. Conditional logistic regression models were run to examine differences in sociodemographic, mental health, and service utilization factors between cases and controls. Among veterans in the study cohort, 39.4% reengaged in psychotherapy. In adjusted analyses, all measured types of health system encounters (primary care [OR=1.61], primary care mental health [OR=1.61], non-PTSD psychotherapy [OR=1.76], other non-PTSD mental health care [OR=1.43], other non-psychotherapy PTSD care [OR=3.31], emergency room [OR=1.14], and psychiatric hospitalization [OR=1.56]) were related to greater odds of reengagement in PTSD psychotherapy. Veterans' receipt of a broad range of care services may play an important role in reengagement in PCT psychotherapy, suggesting providers across care settings should be knowledgeable in how to support a Veteran's return to psychotherapy for PTSD. Published by Elsevier Inc.

Effects of optimism on recovery and mental health after a tornado outbreak.

PubMed

Carbone, Eric G; Echols, Erin Thomas

2017-05-01

Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being. Data for this study come from the Centers for Disease Control and Prevention's Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama. This study assesses the effect of dispositional optimism on post-disaster recovery and mental health. Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage. The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.

Effects of optimism on recovery and mental health after a tornado outbreak

PubMed Central

Carbone, Eric G.; Echols, Erin Thomas

2017-01-01

Objective Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being. Design Data for this study come from the Centers for Disease Control and Prevention’s Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama. Main outcome measures This study assesses the effect of dispositional optimism on post-disaster recovery and mental health. Results Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage. Conclusions The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events. PMID:28156138

School-Based Mental Health Program Evaluation: Children's School Outcomes and Acute Mental Health Service Use

ERIC Educational Resources Information Center

Kang-Yi, Christina D.; Mandell, David S.; Hadley, Trevor

2013-01-01

Background: This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services. Methods: The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area…

Features of hypochondriasis and illness worry in the general population in Germany.

PubMed

Martin, Alexandra; Jacobi, Frank

2006-01-01

Although hypochondriasis is considered to be of high relevance in the healthcare sector, its prevalence in the general population has been investigated in few studies. The aims of this study were to estimate prevalence rates of hypochondriasis and of subthreshold conditions and to describe their associated features such as quality of life and healthcare utilization in a representative community sample. Analyses of the present study are based on the German Health Interview and Examination Survey-Mental Health Supplement (N = 4181, representative for the German population from 18-65 years). The assessment included interviews for somatic conditions and mental disorders and self-report ratings on health-related quality of life, healthcare utilization, disability days, and physical activity. Only three cases (0.05%) were identified as meeting full criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. The prevalence rate of the less restrictively defined form of hypochondriasis, ("subthreshold hypochondriasis") was 0.58% and an additional 2.12% reported having had illness worries for at least 6 months but did not meet further hypochondriasis criteria. The two subthreshold diagnostic groups provided strong evidence of difference from the nonhypochondriac controls: comorbidity with psychiatric and medical disorders and healthcare utilization were higher, and quality of life was markedly reduced. The results provide additional support to not only consider "full" DSM-IV hypochondriasis, which is a very rare disorder in the general population, but also to include less restrictive hypochondriac conditions--associated with a clinically relevant degree of psychological and physical impairment--into clinical and scientific considerations.

Gender Differences in Mental Health Outcomes before, during, and after the Great Recession.

PubMed

Dagher, Rada K; Chen, Jie; Thomas, Stephen B

2015-01-01

We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities.

Parity for mental health and substance abuse care under managed care.

PubMed

Frank, Richard G.; McGuire, Thomas G.

1998-12-01

BACKGROUND: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services. AIMS: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage. METHOD: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance. RESULTS: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less with respect to providing a remedy to problems related to adverse selection.

Macrolevel Stressors, Terrorism, and Mental Health Outcomes: Broadening the Stress Paradigm

PubMed Central

Richman, Judith A.; Cloninger, Lea; Rospenda, Kathleen M.

2008-01-01

Objectives. We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study. Methods. Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11. Results. Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre–September 11 distress and drinking. Conclusions. The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm. PMID:18687593

Macrolevel Stressors, Terrorism, and Mental Health Outcomes: Broadening the Stress Paradigm

PubMed Central

Richman, Judith A.; Cloninger, Lea; Rospenda, Kathleen M.

2008-01-01

Objectives. We examined the extent to which the stress paradigm linking psychosocial stressors to mental health status has focused disproportionate attention on microlevel social stressors to the detriment of macrolevel stressors. Also, we assessed the effects of the terrorist attacks of September 11, 2001, on subsequent mental health among participants in a Midwestern cohort study. Methods. Respondents in a 6-wave longitudinal mail survey completed questionnaires before September 11, 2001, and again in 2003 and 2005. Regression analyses focused on measures of negative terrorism-related beliefs and fears, as well as psychological distress and deleterious alcohol use outcomes measured both before and after September 11. Results. Negative terrorism-related beliefs and fears assessed in 2003 predicted distress and drinking outcomes in 2005 after control for sociodemographic characteristics and pre–September 11 distress and drinking. Conclusions. The events of September 11 continue to negatively affect the mental health of the American population. Our results support the utility of according greater attention to the effects of such macrolevel social stressors in population studies embracing the stress paradigm. PMID:18172139

Behavioral Health in the Gulf Coast Region Following the Deepwater Horizon Oil Spill: Findings from Two Federal Surveys

PubMed Central

Gould, Deborah W.; Pemberton, Michael R.; Pierannunzi, Carol; Larson, Sharon

2015-01-01

This article summarizes findings from two large-scale, population-based surveys conducted by Substance Abuse and Mental Health Services Administration (SAMHSA) and Centers for Disease Control and Prevention (CDC) in the Gulf Coast region following the 2010 Deepwater Horizon oil spill, to measure the prevalence of mental and substance use disorders, chronic health conditions, and utilization of behavioral health services. Although many area residents undoubtedly experienced increased levels of anxiety and stress following the spill, findings suggest only modest or minimal changes in behavioral health at the aggregate level before and after the spill. The studies do not address potential long-term effects of the spill on physical and behavioral health nor did they target subpopulations that might have been most affected by the spill. Resources mobilized to reduce the economic and behavioral health impacts of the spill on coastal residents—including compensation for lost income from BP and increases in available mental health services—may have resulted in a reduction in potential mental health problems. PMID:25339594

Applicability of the Dual-Factor Model of Mental Health for College Students

ERIC Educational Resources Information Center

Eklund, Katie; Dowdy, Erin; Jones, Camille; Furlong, Michael

2011-01-01

This study explores the utility of a dual-factor model of mental health in which the concepts of mental illness and mental wellness are integrated. Life satisfaction, emotional symptoms, personal adjustment, and clinical symptoms were assessed with a sample of 240 college students. Participants were organized into four groups based on levels of…

Exploring virtual mental practice in maintenance task training

PubMed Central

Bauerle, Tim; Brnich, Michael J.; Navoyski, Jason

2016-01-01

Purpose – This paper aims to contribute to a general understanding of mental practice by investigating the utility of and participant reaction to a virtual reality maintenance training among underground coal mine first responders. Design/methodology/approach – Researchers at the National Institute for Occupational Safety and Health's Office of Mine Safety and Health Research (OMSHR) developed software to provide opportunities for mine rescue team members to learn to inspect, assemble and test their closed-circuit breathing apparatus and to practice those skills. In total, 31 mine rescue team members utilized OMSHR's BG 4 Benching Trainer software and provided feedback to the development team. After training, participants completed a brief post-training questionnaire, which included demographics, perceived training climate and general training evaluation items. Findings – The results overall indicate a generally positive reaction to and high perceived utility of the BG 4 benching software. In addition, the perceived training climate appears to have an effect on the perceived utility of the mental practice virtual reality game, with benchmen from mines with more positive training climates reporting greater perceived efficacy in the training's ability to prepare trainees for real emergencies. Originality/value – This paper helps to broaden current applications of mental practice and is one of the few empirical investigations into a non-rehabilitation virtual reality extension of mental practice. This paper also contributes to the growing literature advocating for greater usage of accurate and well-informed mental practice techniques, tools and methodologies, especially for occupational populations with limitations on exposure to hands-on training. PMID:27594801

The Utility of the Montreal Cognitive Assessment as a Mental Capacity Assessment Tool for Patients with a Learning Disability

ERIC Educational Resources Information Center

Edge, Daniel; Oyefeso, Adenekan; Evans, Carys; Evans, Amber

2016-01-01

Objective: To determine the psychometric properties of the Montreal Cognitive Assessment (MoCA) in patients with a learning disability and examine it's utility for conducting mental capacity assessment. Method: This study was a cross-sectional, instrument validation study in an inpatient hospital setting, located in the East of England. The sample…

[Mental Health Stigma: An Influencing Factor in Healthcare Utilization by Veterans of the German Armed Forces].

PubMed

Schuy, Katrin; Brants, Loni M; Dors, Simone; Ströhle, Andreas; Zimmermann, Peter Lutz; Willmund, Gerd Dieter; Rau, Heinrich; Siegel, Stefan

2018-05-14

 Mental illness stigma is a barrier to healthcare utilization. This study is the first to research the connection between mental illness stigma and the use of healthcare by veterans of the German Armed Forces. An overview of perceived stigma components in this sample is provided that should help understand how these factors influence healthcare utilization.  43 interviews with veterans of the German Armed Forces were conducted. The resulting data were analyzed in several coding steps. It was investigated whether the stigma experience of veterans of the German Armed Forces could be well illustrated by the theory-based stigmatization model of Link and Phelan. A set of hypotheses on stigma and healthcare utilization based on the data were developed.  All stigma components according to the model of Link and Phelan were found in the sample. Internalized stigma, perceived public stigmatization, vocational disadvantage and social exclusion as well as feared misunderstanding of the military past in the civilian sector were reported as main stigma-relevant barriers to the use of healthcare.  Recommendations for interventions are given to decrease mental illness stigma in this specific group of former soldiers. © Georg Thieme Verlag KG Stuttgart · New York.

Mental Task Classification Scheme Utilizing Correlation Coefficient Extracted from Interchannel Intrinsic Mode Function.

PubMed

Rahman, Md Mostafizur; Fattah, Shaikh Anowarul

2017-01-01

In view of recent increase of brain computer interface (BCI) based applications, the importance of efficient classification of various mental tasks has increased prodigiously nowadays. In order to obtain effective classification, efficient feature extraction scheme is necessary, for which, in the proposed method, the interchannel relationship among electroencephalogram (EEG) data is utilized. It is expected that the correlation obtained from different combination of channels will be different for different mental tasks, which can be exploited to extract distinctive feature. The empirical mode decomposition (EMD) technique is employed on a test EEG signal obtained from a channel, which provides a number of intrinsic mode functions (IMFs), and correlation coefficient is extracted from interchannel IMF data. Simultaneously, different statistical features are also obtained from each IMF. Finally, the feature matrix is formed utilizing interchannel correlation features and intrachannel statistical features of the selected IMFs of EEG signal. Different kernels of the support vector machine (SVM) classifier are used to carry out the classification task. An EEG dataset containing ten different combinations of five different mental tasks is utilized to demonstrate the classification performance and a very high level of accuracy is achieved by the proposed scheme compared to existing methods.

THE REASONING METHODS AND REASONING ABILITY IN NORMAL AND MENTALLY RETARDED GIRLS AND THE REASONING ABILITY OF NORMAL AND MENTALLY RETARDED BOYS AND GIRLS.

ERIC Educational Resources Information Center

CAPOBIANCO, RUDOLPH J.; AND OTHERS

A STUDY WAS MADE TO ESTABLISH AND ANALYZE THE METHODS OF SOLVING INDUCTIVE REASONING PROBLEMS BY MENTALLY RETARDED CHILDREN. THE MAJOR OBJECTIVES WERE--(1) TO EXPLORE AND DESCRIBE REASONING IN MENTALLY RETARDED CHILDREN, (2) TO COMPARE THEIR METHODS WITH THOSE UTILIZED BY NORMAL CHILDREN OF APPROXIMATELY THE SAME MENTAL AGE, (3) TO EXPLORE THE…

Randomized controlled trial of a cognitive-behavioral intervention for HIV-positive persons: an investigation of treatment effects on psychosocial adjustment.

PubMed

Carrico, Adam W; Chesney, Margaret A; Johnson, Mallory O; Morin, Stephen F; Neilands, Torsten B; Remien, Robert H; Rotheram-Borus, Mary Jane; Lennie Wong, F

2009-06-01

Questions remain regarding the clinical utility of psychological interventions for HIV-positive persons because randomized controlled trials have utilized stringent inclusion criteria and focused extensively on gay men. The present randomized controlled trial examined the efficacy of a 15-session, individually delivered cognitive-behavioral intervention (n = 467) compared to a wait-list control (n = 469) in a diverse sample of HIV-positive persons who reported HIV transmission risk behavior. Five intervention sessions that dealt with executing effective coping responses were delivered between baseline and the 5 months post-randomization. Additional assessments were completed through 25 months post-randomization. Despite previously documented reductions in HIV transmission risk, no intervention-related changes in psychosocial adjustment were observed across the 25-month investigation period. In addition, there were no intervention effects on psychosocial adjustment among individuals who presented with mild to moderate depressive symptoms. More intensive mental health interventions may be necessary to improve psychosocial adjustment among HIV-positive individuals.

Mental Health Service Utilization Among Lesbian, Gay, Bisexual, and Questioning or Queer College Students.

PubMed

Dunbar, Michael S; Sontag-Padilla, Lisa; Ramchand, Rajeev; Seelam, Rachana; Stein, Bradley D

2017-09-01

College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization. A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health-related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status. Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p < .001) and mental health-related academic impairment (11% vs. 17%, p < .001) but were 1.87 (95% confidence interval: 1.50-2.34) times more likely to use any mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services). Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Effects of mindfulness meditation on occupational functioning and health care utilization in individuals with anxiety.

PubMed

Hoge, Elizabeth A; Guidos, Brittany M; Mete, Mihriye; Bui, Eric; Pollack, Mark H; Simon, Naomi M; Dutton, Mary Ann

2017-04-01

To examine the effect of mindfulness meditation on occupational functioning in individuals with Generalized anxiety disorder (GAD). Fifty-seven individuals with GAD (mean (SD) age=39 (13); 56% women) participated in an 8-week clinical trial in which they were randomized to mindfulness-based stress reduction (MBSR) or an attention control class. In this secondary analysis, absenteeism, entire workdays missed, partial workdays missed, and healthcare utilization patterns were assessed before and after treatment. Compared to the attention control class, participation in MBSR was associated with a significantly greater decrease in partial work days missed for adults with GAD (t=2.734, df=51, p=0.009). Interestingly, a dose effect was observed during the 24-week post-treatment follow-up period: among MBSR participants, greater home mindfulness meditation practice was associated with less work loss and with fewer mental health professional visits. Mindfulness meditation training may improve occupational functioning and decrease healthcare utilization in adults with GAD. Copyright © 2017 Elsevier Inc. All rights reserved.

Associations between physical activity and mental health among bariatric surgical candidates

PubMed Central

King, Wendy C.; Kalarchian, Melissa A.; Steffen, Kristine J.; Wolfe, Bruce M.; Elder, Katherine A.; Mitchell, James E.

2013-01-01

Objective This study aimed to examine associations between physical activity (PA) and mental health among adults undergoing bariatric surgery. Methods Cross sectional analysis was conducted on pre-operative data of 850 adults with ≥ class 2 obesity. PA was measured with a step activity monitor; mean daily steps, active minutes, and high-cadence minutes (proxy for moderate-vigorous intensity PA) were determined. Mental health functioning, depressive symptoms and treatment for depression or anxiety were measured with the Medical Outcomes Study 36-item Short Form, Beck Depression Inventory, and a study-specific questionnaire, respectively. Logistic regression analyses tested associations between PA and mental health indicators, controlling for potential confounders. Receiver operative characteristic analysis determined PA thresholds that best differentiated odds of each mental health indicator. Results Each PA parameter was significantly (P<.05) associated with a decreased odds of depressive symptoms and/or treatment for depression or anxiety, but not with impaired mental health functioning. After controlling for sociodemographics and physical health, only associations with treatment for depression and anxiety remained statistically significant. PA thresholds that best differentiated those who had vs. had not recently received treatment for depression or anxiety were <191 active minutes/day, <4750 steps/day, and <8 high-cadence minutes/day. Utilizing high-cadence minutes, compared to active minutes or steps, yielded the highest classification accuracy. Conclusion Adults undergoing bariatric surgery who meet relatively low thresholds of PA (e.g., ≥ 8 high-cadence minutes/day, representative of approximately one hour/week of moderate-vigorous intensity PA) are less likely to have recently received treatment for depression or anxiety compared to less active counterparts. PMID:23332532

Patterns of mental health service utilization.

PubMed

Howard, K I; Cornille, T A; Lyons, J S; Vessey, J T; Lueger, R J; Saunders, S M

1996-08-01

How many and which individuals, with which psychiatric disorders, receive (and do not receive) mental health services from which professionals in what settings? This question falls within the purview of mental health services research, which is a multidisciplinary field that brings together the methodologies of epidemiology, econometrics, and clinical research. First, in this article, we present an explication of what is known about those individuals in need of psychotherapy and how they access services. Next, we describe the numbers, professional affiliations, and service sites of professionals who are engaged in the practice of psychotherapy. We summarize our current knowledge about the actual utilization of psychotherapy services relative to the needs of patients and the professional background of therapists. Finally, we identify aspects of psychotherapy service utilization that are, as yet, unaddressed.

Convergent Validity of the Early Memory Index in Two Primary Care Samples.

PubMed

Porcerelli, John H; Cogan, Rosemary; Melchior, Katherine A; Jasinski, Matthew J; Richardson, Laura; Fowler, Shannon; Morris, Pierre; Murdoch, William

2016-01-01

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.

Using the MAYSI-2 to identify mental disorder among Latino juvenile offenders.

PubMed

Eno Louden, Jennifer; Kang, Tamara; Ricks, Elijah P; Marquez, Lorae

2017-06-01

Many juvenile justice agencies have adopted the Massachusetts Youth Screening Inventory-Version 2 (MAYSI-2; Grisso & Barnum, 2006) to facilitate appropriate programming for young offenders with mental illness. Although Latinos are the fastest-growing ethnic group in the criminal justice system, there is scant research on the utility of the MAYSI-2 among Latino adolescents. The present study examined the utility of the MAYSI-2 in detecting diagnosable mental illness among 398 Latino and 60 European American adolescents in a juvenile justice agency. In addition to testing the scoring configuration used by the agency to identify adolescents in need of further attention, we tested 2 additional scoring configurations of the MAYSI-2. We found that the MAYSI-2 had similar utility at identifying serious mood and anxiety disorders for both ethnic groups, but was less sensitive to behavioral and substance use disorders among Latinos than it was among European Americans. In addition, the MAYSI-2 overall was less sensitive to mental illness among Latino boys compared with Latina girls. We discuss these findings within the context of best practices for identifying adolescents with mental illness in juvenile justice agencies. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Professional and collegiate team assistance programs: services and utilization patterns.

PubMed

McDuff, David R; Morse, Eric D; White, Robert K

2005-10-01

Elite professional and collegiate athletes underuse stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.

Mental Health Services for Children and Youth in the Child Welfare System: A Focus on Caregivers as Gatekeepers.

PubMed

Villagrana, Margarita

2010-05-01

Caregivers serve as gatekeepers for children while in the child welfare system, but few studies have focused on the caregiver and the factors that influence the use of mental health services for the children under their care. The purpose of this study was to examine the child's mental health need, the caregiver's level of stress, depression, and social support, and the utilization of mental health services by children using the three most common types of caregivers in the child welfare system (i.e., birth parent, relative caregiver, and foster parent). Data comes from the Patterns of Care (POC) study of five public sectors of care. The present study examined parents/caregivers and youth from the child welfare sector. Findings suggest that while birth parents were more likely to endorse more risk factors for themselves, and the children under their care had a higher level of mental health need, they were the least likely to utilize mental health services for the children under their care. Implications for the child welfare and mental health systems are discussed.

Utilization of Mental Health Services in School-Based Health Centers.

PubMed

Bains, Ranbir M; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen

2017-08-01

We summarize utilization patterns for mental health services in school-based health centers. Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%-49%) in the 13-15 age range. Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8-year-old boys. © 2017, American School Health Association.

Using the K6 to Assess the Mental Health of Jailed Women

ERIC Educational Resources Information Center

Kubiak, Sheryl Pimlott; Beeble, Marisa L.; Bybee, Deborah

2009-01-01

Despite high prevalence rates, many jails lack validated measures or consistent processes for detecting mental illness. In this study, we examined the utility of the K6, an internationally used brief mental health screening measure within an urban jail. The K6 and several other mental health measures were administered to 515 jailed women. The K6…

Mental Health Professionals' Suicide Risk Assessment and Management Practices.

PubMed

Roush, Jared F; Brown, Sarah L; Jahn, Danielle R; Mitchell, Sean M; Taylor, Nathanael J; Quinnett, Paul; Ries, Richard

2018-01-01

Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. The study utilized a cross-sectional design and self-report questionnaires. Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.

Mental health professionals' natural taxonomies of mental disorders: implications for the clinical utility of the ICD-11 and the DSM-5.

PubMed

Reed, Geoffrey M; Roberts, Michael C; Keeley, Jared; Hooppell, Catherine; Matsumoto, Chihiro; Sharan, Pratap; Robles, Rebeca; Carvalho, Hudson; Wu, Chunyan; Gureje, Oye; Leal-Leturia, Itzear; Flanagan, Elizabeth H; Correia, João Mendonça; Maruta, Toshimasa; Ayuso-Mateos, José Luís; de Jesus Mari, Jair; Xiao, Zeping; Evans, Spencer C; Saxena, Shekhar; Medina-Mora, María Elena

2013-12-01

To examine the conceptualizations held by psychiatrists and psychologists around the world of the relationships among mental disorders in order to inform decisions about the structure of the classification of mental and behavioral disorders in World Health Organization's International Classification of Diseases and Related Health Problems 11th Revision (ICD-11). 517 mental health professionals in 8 countries sorted 60 cards containing the names of mental disorders into groups of similar disorders, and then formed a hierarchical structure by aggregating and disaggregating these groupings. Distance matrices were created from the sorting data and used in cluster and correlation analyses. Clinicians' taxonomies were rational, interpretable, and extremely stable across countries, diagnostic system used, and profession. Clinicians' consensus classification structure was different from ICD-10 and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV), but in many respects consistent with ICD-11 proposals. The clinical utility of the ICD-11 may be improved by making its structure more compatible with the common conceptual organization of mental disorders observed across diverse global clinicians. © 2013 Wiley Periodicals, Inc.

EPA guidance on building trust in mental health services.

PubMed

Gaebel, W; Muijen, M; Baumann, A E; Bhugra, D; Wasserman, D; van der Gaag, R J; Heun, R; Zielasek, J

2014-02-01

To advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system. We performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process. We developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization. Trust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust. Evidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The Communities First (ComFi) study: protocol for a prospective controlled quasi-experimental study to evaluate the impact of area-wide regeneration on mental health and social cohesion in deprived communities

PubMed Central

White, James; Greene, Giles; Dunstan, Frank; Rodgers, Sarah; Lyons, Ronan A; Humphreys, Ioan; John, Ann; Webster, Chris; Palmer, Stephen; Elliott, Eva; Phillips, Ceri J; Fone, David

2014-01-01

Introduction Recent systematic reviews have highlighted the dearth of evidence on the effectiveness of regeneration on health and health inequalities. ‘Communities First’ is an area-wide regeneration scheme to improve the lives of people living in the most deprived areas in Wales (UK). This study will evaluate the impact of Communities First on residents’ mental health and social cohesion. Methods and analysis A prospective controlled quasi-experimental study of the association between residence in Communities First regeneration areas in Caerphilly county borough and change in mental health and social cohesion. The study population is the 4226 residents aged 18–74 years who responded to the Caerphilly Health and Social Needs Study in 2001 (before delivery) and 2008 (after delivery of Communities First). Data on the location, type and cost of Communities First interventions will be extracted from records collected by Caerphilly county borough council. The primary outcome is the change in mental health between 2001 and 2008. Secondary outcomes are changes: in common mental disorder case status (using survey and general practice data), social cohesion and mental health inequalities. Multilevel models will examine change in mental health and social cohesion between Communities First and control areas, adjusting for individual and household level confounding factors. Further models will examine the effects of (1) different types of intervention, (2) contamination across areas, (3) length of residence in a Communities First area, and (4) population migration. We will carry out a cost-consequences analysis to summarise the outcomes generated for participants, as well as service utilisation and utility gains. Ethics and dissemination This study has had approval from the Information Governance Review Panel at Swansea University (Ref: 0266 CF). Findings will be disseminated through peer-review publications, international conferences, policy and practice partners in local and national government, and updates on our study website (http://medicine.cardiff.ac.uk/clinical-study/communities-first-regeneration-programme/). PMID:25314962

The communities first (ComFi) study: protocol for a prospective controlled quasi-experimental study to evaluate the impact of area-wide regeneration on mental health and social cohesion in deprived communities.

PubMed

White, James; Greene, Giles; Dunstan, Frank; Rodgers, Sarah; Lyons, Ronan A; Humphreys, Ioan; John, Ann; Webster, Chris; Palmer, Stephen; Elliott, Eva; Phillips, Ceri J; Fone, David

2014-10-14

Recent systematic reviews have highlighted the dearth of evidence on the effectiveness of regeneration on health and health inequalities. 'Communities First' is an area-wide regeneration scheme to improve the lives of people living in the most deprived areas in Wales (UK). This study will evaluate the impact of Communities First on residents' mental health and social cohesion. A prospective controlled quasi-experimental study of the association between residence in Communities First regeneration areas in Caerphilly county borough and change in mental health and social cohesion. The study population is the 4226 residents aged 18-74 years who responded to the Caerphilly Health and Social Needs Study in 2001 (before delivery) and 2008 (after delivery of Communities First). Data on the location, type and cost of Communities First interventions will be extracted from records collected by Caerphilly county borough council. The primary outcome is the change in mental health between 2001 and 2008. Secondary outcomes are changes: in common mental disorder case status (using survey and general practice data), social cohesion and mental health inequalities. Multilevel models will examine change in mental health and social cohesion between Communities First and control areas, adjusting for individual and household level confounding factors. Further models will examine the effects of (1) different types of intervention, (2) contamination across areas, (3) length of residence in a Communities First area, and (4) population migration. We will carry out a cost-consequences analysis to summarise the outcomes generated for participants, as well as service utilisation and utility gains. This study has had approval from the Information Governance Review Panel at Swansea University (Ref: 0266 CF). Findings will be disseminated through peer-review publications, international conferences, policy and practice partners in local and national government, and updates on our study website (http://medicine.cardiff.ac.uk/clinical-study/communities-first-regeneration-programme/). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Utility of the Kessler Screening Scale for Psychological Distress (K6) in Two American Indian Communities

ERIC Educational Resources Information Center

Mitchell, Christina M.; Beals, Janette

2011-01-01

The Kessler Screening Scale for Psychological Distress (K6; Kessler et al., 2002) has been used widely as a screener for mental health problems and as a measure of severity of impact of mental health problems. However, the applicability and utility of this measure for assessments within American Indian communities has not been explored. Data were…

A National Mental Retardation Manpower Model.

ERIC Educational Resources Information Center

National Inst. on Mental Retardation, Toronto (Ontario).

The report of the Task Force established by the Canadian National Institute on Mental Retardation concerns a comprehensive planning and organization program for training personnel, especially associate professionals, in the field of mental retardation to provide a more effective utilization of manpower. Summarized are results of surveys of…

Gender and health services use for a mental health problem

PubMed Central

Albizu-Garcia, Carmen E.; Alegría, Margarita; Freeman, Daniel; Vera, Mildred

2013-01-01

This study addresses whether the predictors of seeking help for a mental health problem differ by gender. An adaptation of Andersen’s Socio-Behavioral Model is used to identify factors associated with seeking care for a mental health problem. Data are derived from two waves of a community survey undertaken in 1992–1993 and in 1993–1994 among a probability sample of adults (18–69 years), residing in poor areas of Puerto Rico. Paired data was used from those individuals who responded to both waves of the survey for a total of 3221 community respondents. Responses from wave 1 were used to predict mental health service use in wave 2. The dependent variable is any use of outpatient mental health services in the year preceding the second interview. Logistic regression was used to model the effects of the independent variables on use. Males and females were found to use mental health services in nearly equal proportions. Gender did not have a main effect on use when other covariates were controlled. Significant interactions with gender were found for several predictors of use. The largest intervention effects were encountered in our need for care indicators. Having a definite need for mental health care and poor self-rated mental health had a larger effect on predicting use of services for men than they do for women. It is concluded that strategies designed to improve access to mental health services for minority disadvantaged populations ought to take into account gender differences in the predictors of use. Studies addressing factors influencing health services utilization for a mental health problem should consider stratifying their sample by gender. Future research should establish whether or not these findings are sustained with other population groups. PMID:11522134

Empirical evidence on the demand for carve-outs in employment group mental health coverage.

PubMed

Salkever, David S.; Shinogle, Judith A.

2000-06-01

BACKGROUND AND AIMS OF THE STUDY: The use of specialized behavioral health companies to manage mental/health benefits has become widespread in recent years. Recent studies have reported on the cost and utilization impacts of behavioral health carve-outs. Yet little previous research has examined the factors which lead employer-based health plans to adopt a carve-out strategy for mental health benefits. The examination of these factors is the main focus of our study. Our empirical analysis is also intended to explore several hypotheses (moral hazard, adverse selection, economies of scale and alternate utilization management strategies) that have recently been advanced to explain the popularity of carve-outs. METHODS: The data for this study are from a survey of employers who have long-term disability contracts with one large insurer. The analysis uses data from 248 employers who offer mental health benefits combined with local market information (e.g. health care price proxies, state tax rates etc), state regulations (mental health and substance abuse mandate and parity laws) and employee characteristics. Two different measures of carve-out use were used as dependent variables in the analysis: (1) the fraction of health plans offered by the employer that contained carve-out provisions and (2) a dichotomous indicator for those employers who included a carve-out arrangement in all the health plans they offered. RESULTS: Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs. Our results gave less consistent support to the argument that carve-outs are demanded to control adverse selection, though only a few variables provided a direct test of this hypothesis. The role of economies of scale (i.e., group size) and the effectiveness of alternative strategies for managing moral hazard costs (i.e., HMOs) were confirmed by our results. DISCUSSION: We considered a number of different hypotheses concerning employers' demands for mental health carve-outs and found varying degrees of support for these hypotheses in our data. Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs. LIMITATIONS: Our database includes a small number of relatively large employers and is not representative of employers nationally. Our selection criteria, concerning size and the requirement that some employees are covered by LTD insurance, probably resulted in a study sample that offers richer benefits than do employers nationally. Our employers also report a higher percentage of salaried employees relative to the national data. Another deficiency in the current study is the lack of detailed information on the socio-demographic and behavioral characteristics of covered employees. Finally, the cross-sectional nature of our analysis raises concerns about susceptibility of our findings to omitted variables bias. IMPLICATIONS FOR FURTHER RESEARCH: Research with more information on covered employee characteristics will allow for a stronger test of the general hypothesis that factors associated with a higher demand for services are also associated with a higher demand for carve-outs. Also, future analyses that capture the experience of states that have recently passed mandate and parity laws, and that use pooled data to control for omitted variables bias, will provide more definitive evidence on the relationship between these laws and carve-out demand.

VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles.

PubMed

Gabrielian, Sonya; Yuan, Anita H; Andersen, Ronald M; Rubenstein, Lisa V; Gelberg, Lillian

2014-05-01

The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

VA Health Service Utilization for Homeless and Low-income Veterans

PubMed Central

Gabrielian, Sonya; Yuan, Anita H.; Andersen, Ronald M.; Rubenstein, Lisa V.; Gelberg, Lillian

2016-01-01

Background The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. Objectives We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. Research Design We performed a secondary database analysis of Veterans (n = 62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. Results HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Conclusions Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. PMID:24714583

Texas Medication Algorithm Project: development and feasibility testing of a treatment algorithm for patients with bipolar disorder.

PubMed

Suppes, T; Swann, A C; Dennehy, E B; Habermacher, E D; Mason, M; Crismon, M L; Toprac, M G; Rush, A J; Shon, S P; Altshuler, K Z

2001-06-01

Use of treatment guidelines for treatment of major psychiatric illnesses has increased in recent years. The Texas Medication Algorithm Project (TMAP) was developed to study the feasibility and process of developing and implementing guidelines for bipolar disorder, major depressive disorder, and schizophrenia in the public mental health system of Texas. This article describes the consensus process used to develop the first set of TMAP algorithms for the Bipolar Disorder Module (Phase 1) and the trial testing the feasibility of their implementation in inpatient and outpatient psychiatric settings across Texas (Phase 2). The feasibility trial answered core questions regarding implementation of treatment guidelines for bipolar disorder. A total of 69 patients were treated with the original algorithms for bipolar disorder developed in Phase 1 of TMAP. Results support that physicians accepted the guidelines, followed recommendations to see patients at certain intervals, and utilized sequenced treatment steps differentially over the course of treatment. While improvements in clinical symptoms (24-item Brief Psychiatric Rating Scale) were observed over the course of enrollment in the trial, these conclusions are limited by the fact that physician volunteers were utilized for both treatment and ratings. and there was no control group. Results from Phases 1 and 2 indicate that it is possible to develop and implement a treatment guideline for patients with a history of mania in public mental health clinics in Texas. TMAP Phase 3, a recently completed larger and controlled trial assessing the clinical and economic impact of treatment guidelines and patient and family education in the public mental health system of Texas, improves upon this methodology.

Community Determinants of Latinos’ Use of Mental Health Services

PubMed Central

Aguilera, Adrian; Regeser López, Steven

2014-01-01

Objective This study examined the role of community in understanding Latino adults’ (18–64 years of age) use of community mental health services. Methods Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. Results Community of residence and foreign-born status were significantly associated with Latinos’ service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (β=.001, p<.001). Conclusions The findings point out the importance of locale and community determinants in understanding Latinos’ use of public mental health services. PMID:18378840

The association of food insecurity with health outcomes for adults with disabilities.

PubMed

Brucker, Debra L

2017-04-01

Adults with disabilities are more likely to live in households that are food insecure and are more likely to experience health disparities than adults without disabilities. Research examining the intersection of food insecurity and health outcomes for adults with disabilities has so far been lacking, however. The research presented here tests whether living in a food insecure household is associated with poorer self-reported health and mental health and different health care utilization, controlling for disability status and other sociodemographic characteristics. Multivariate regression analyses are conducted using linked data from the 2011 National Health Interview Survey and the 2012 Medical Expenditures Panel Survey. Adults with and without disabilities who live in food insecure households have higher odds of reporting fair or poor health or mental health in either the current year or the subsequent year. Health care utilization patterns differ for adults who are food insecure as well, both within and across years. Efforts to address health disparities among adults with disabilities should consider the possible additional impact of food insecurity on health outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of perceived discrimination on mental health and mental health services utilization among gay, lesbian, bisexual and transgender persons.

PubMed

Burgess, Diana; Tran, Alisia; Lee, Richard; van Ryn, Michelle

2007-01-01

Previous research has found that lesbian, gay, bisexual and transgender (LGBT) individuals are at risk for a variety of mental health disorders. We examined the extent to which a recent experience of a major discriminatory event may contribute to poor mental health among LGBT persons. Data were derived from a cross-sectional strata-cluster survey of adults in Hennepin County, Minnesota, who identified as LGBT (n=472) or heterosexual (n=7,412). Compared to heterosexuals, LGBT individuals had poorer mental health (higher levels of psychological distress, greater likelihood of having a diagnosis of depression or anxiety, greater perceived mental health needs, and greater use of mental health services), more substance use (higher levels of binge drinking, greater likelihood of being a smoker and greater number of cigarettes smoked per day), and were more likely to report unmet mental healthcare needs. LGBT individuals were also more likely to report having experienced a major incident of discrimination over the past year than heterosexual individuals. Although perceived discrimination was associated with almost all of the indicators of mental health and utilization of mental health care that we examined, adjusting for discrimination did not significantly reduce mental health disparities between heterosexual and LGBT persons. LGBT individuals experienced more major discrimination and reported worse mental health than heterosexuals, but discrimination did not account for this disparity. Future research should explore additional forms of discrimination and additional stressors associated with minority sexual orientation that may account for these disparities.

Stigma as a barrier to seeking health care among military personnel with mental health problems.

PubMed

Sharp, Marie-Louise; Fear, Nicola T; Rona, Roberto J; Wessely, Simon; Greenberg, Neil; Jones, Norman; Goodwin, Laura

2015-01-01

Approximately 60% of military personnel who experience mental health problems do not seek help, yet many of them could benefit from professional treatment. Across military studies, one of the most frequently reported barriers to help-seeking for mental health problems is concerns about stigma. It is, however, less clear how stigma influences mental health service utilization. This review will synthesize existing research on stigma, focusing on those in the military with mental health problems. We conducted a systematic review and meta-analysis of studies between 2001 and 2014 to examine the prevalence of stigma for seeking help for a mental health problem and its association with help-seeking intentions/mental health service utilization. Twenty papers met the search criteria. Weighted prevalence estimates for the 2 most endorsed stigma concerns were 44.2% (95% confidence interval: 37.1, 51.4) for "My unit leadership might treat me differently" and 42.9% (95% confidence interval: 36.8, 49.0) for "I would be seen as weak." Nine studies found no association between anticipated stigma and help-seeking intentions/mental health service use and 4 studies found a positive association. One study found a negative association between self-stigma and intentions to seek help. Counterintuitively, those that endorsed high anticipated stigma still utilized mental health services or were interested in seeking help. We propose that these findings may be related to intention-behavior gaps or methodological issues in the measurement of stigma. Positive associations may be influenced by modified labeling theory. Additionally, other factors such as self-stigma and negative attitudes toward mental health care may be worth further attention in future investigation. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comparing Mental Health Issues among Undergraduate and Graduate Students

ERIC Educational Resources Information Center

Wyatt, Tammy; Oswalt, Sara B.

2013-01-01

Background: Stress and other mental health issues can negatively impact the health and academic performance of college students. Purpose: Examine relationships among stress, mental health, and academic classification in a national sample of college students. Methods: Analyses utilized secondary data from 27 387 college students responding to the…

The Context of Thought Experiments in Physics Learning

ERIC Educational Resources Information Center

Reiner, Miriam

2006-01-01

This paper takes a cognitive perspective in an attempt to analyze mental mechanisms involved in contextual learning. In the following, it is suggested that contextualized environments evoke mental mechanisms that support reasoning about "what if", imaginary situations--utilizing a powerful mental mechanism known from the history of physics as…

Mental Models: Knowledge in the Head and Knowledge in the World.

ERIC Educational Resources Information Center

Jonassen, David H.; Henning, Philip

1999-01-01

Explores the utility of mental models as learning outcomes in using complex and situated learning environments. Describes two studies: one aimed at eliciting mental models in the heads of novice refrigeration technicians, and the other an ethnographic study eliciting knowledge and models within the community of experienced refrigeration…

Women's use of online resources and acceptance of e-mental health tools during the perinatal period.

PubMed

Fonseca, Ana; Gorayeb, Ricardo; Canavarro, Maria Cristina

2016-10-01

The women's professional help-seeking rate for perinatal depression is low, despite the prevalent and disabling nature of this condition. Therefore, new approaches should be implemented to increase women's access and utilization of treatment resources, namely e-mental health tools. This study aimed to characterize women's current pattern of use of online resources for mental heal issues and women's acceptance of e-mental health tools during the perinatal period, and to investigate its main determinants. This study used an online cross-sectional survey that was completed by 546 women during the perinatal period. 31.3% had prior knowledge of websites targeting mental health illness. Women presenting an actual need for help (i.e., a positive screen for depression) reported greater use of online resources and greater engagement in e-health behaviors related to mental health (d=0.46-0.61), and being more accepting of e-mental health tools, particularly of informative websites. Women's perceptions concerning the e-mental tools were found to predict their intentions to use them. The results seem to globally support Portuguese women's acceptance of e-mental health tools. To improve the level of acceptance, women should be involved as stakeholders in the development of new e-mental health tools and provided with specific information before their utilization. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Exploring Perceptions about and Behaviors Related to Mental Illness and Mental Health Service Utilization among College Students Using the Health Belief Model (HBM)

ERIC Educational Resources Information Center

Nobiling, Brandye D.; Maykrantz, Sherry Azadi

2017-01-01

Background: Mental health service is underutilized in the United States. Adolescent and young adults, including college students, are especially unlikely to seek professional help for mental illness. This issue presents a concern, because signs and symptoms commonly appear during this part of growth and development. Purpose: The Health Belief…

Gender differences in service utilization among Operations Enduring Freedom, Iraqi Freedom, and New Dawn Veterans Affairs patients with severe mental illness and substance use disorders.

PubMed

Painter, Janelle M; Brignone, Emily; Gilmore, Amanda K; Lehavot, Keren; Fargo, Jamison; Suo, Ying; Simpson, Tracy; Carter, Marjorie E; Blais, Rebecca K; Gundlapalli, Adi V

2018-02-01

Severe mental illness (SMI) and substance use disorders (SUD) are among the more chronic and costly mental health conditions treated in the Department of Veterans Affairs (VA). Service use patterns of returning veterans with SMI and SUD have received little attention. We examined gender differences in the utilization of VA services among a national sample of Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND) VA patients with SMI, SUD, and their comorbidity (SMI/SUD) in their first year of established VA care (N = 24,166). Outpatient services and acute-residential stays were modeled using negative binomial and logistic regression, respectively. Among all diagnostic categories, men used outpatient services less often than did women, including primary care (adjusted rate ratio [ARR] = .71, 95% confidence interval CI [.68, .74]), mental health (ARR = .85, 95% CI [.80, .91]), and addiction (ARR = .91, 95% CI [.83, .99]) services. For emergency department (ED) and psychiatric inpatient services, gender interacted significantly with diagnosis. The combination of SMI/SUD compared to either SMI or SUD conferred greater risk of ED utilization among men than women (adjusted odds ratio [AOR] = 2.09, 95% CI [1.24, 3.51], and 1.95, 95% CI [1.17, 3.26], respectively). SMI versus SUD conferred greater risk of psychiatric inpatient utilization among men than women (AOR = 1.83, 95% CI [1.43, 2.34]). Our findings point to gender differences in outpatient and acute service utilization among OEF/OIF/OND VA patients with some of the more chronic and costly mental health conditions. Further investigation of health care utilization patterns is needed to understand factors driving these gender differences to ensure that veterans have appropriate access to the services they need. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Factor structure of the autonomy preference index in people with severe mental illness.

PubMed

Bonfils, Kelsey A; Adams, Erin L; Mueser, Kim T; Wright-Berryman, Jennifer L; Salyers, Michelle P

2015-08-30

People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Methods for measuring utilization of mental health services in two epidemiologic studies

PubMed Central

NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.

2015-01-01

Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205

Utilization of Routine Primary Care Services Among Dancers.

PubMed

Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth

2016-01-01

This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.

Individual-level factors related to better mental health outcomes following child maltreatment among adolescents.

PubMed

Cheung, Kristene; Taillieu, Tamara; Turner, Sarah; Fortier, Janique; Sareen, Jitender; MacMillan, Harriet L; Boyle, Michael H; Afifi, Tracie O

2018-05-01

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,123; data collection 2001-2004); a large, cross-sectional, nationally representative sample of adolescents aged 13-17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Food security among individuals experiencing homelessness and mental illness in the At Home/Chez Soi Trial.

PubMed

O'Campo, Patricia; Hwang, Stephen W; Gozdzik, Agnes; Schuler, Andrée; Kaufman-Shriqui, Vered; Poremski, Daniel; Lazgare, Luis Ivan Palma; Distasio, Jino; Belbraouet, Slimane; Addorisio, Sindi

2017-08-01

Individuals experiencing homelessness are particularly vulnerable to food insecurity. The At Home/Chez Soi study provides a unique opportunity to first examine baseline levels of food security among homeless individuals with mental illness and second to evaluate the effect of a Housing First (HF) intervention on food security in this population. At Home/Chez Soi was a 2-year randomized controlled trial comparing the effectiveness of HF compared with usual care among homeless adults with mental illness, stratified by level of need for mental health services (high or moderate). Logistic regressions tested baseline associations between food security (US Food Security Survey Module), study site, sociodemographic variables, duration of homelessness, alcohol/substance use, physical health and service utilization. Negative binomial regression determined the impact of the HF intervention on achieving levels of high or marginal food security over an 18-month follow-up period (6 to 24 months). Community settings at five Canadian sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver). Homeless adults with mental illness (n 2148). Approximately 41 % of our sample reported high or marginal food security at baseline, but this figure varied with gender, age, mental health issues and substance use problems. High need participants who received HF were more likely to achieve marginal or high food security than those receiving usual care, but only at the Toronto and Moncton sites. Our large multi-site study demonstrated low levels of food security among homeless experiencing mental illness. HF showed promise for improving food security among participants with high levels of need for mental health services, with notable site differences.

Student Discipline Intervention Strategies: A Case Study of Two Institutions' Processes Utilized to Resolve Misconduct of Students Who Concomitantly Experience a Mental Health Crisis

ERIC Educational Resources Information Center

Dickstein, Gary G.

2011-01-01

This study contributes to the research regarding processes and procedures utilized by two institutions of higher education to respond to students who participate in inappropriate behavior and who are concomitantly experiencing a mental health crisis. A case study analysis of two institutions of higher education was used to examine this issue. The…

Associations Between Perceived Weight Discrimination and the Prevalence of Psychiatric Disorders in the General Population

PubMed Central

Hatzenbuehler, Mark L.; Keyes, Katherine M.; Hasin, Deborah S.

2013-01-01

Despite the increased prevalence of weight discrimination, few studies have examined the association between perceived weight discrimination and the prevalence of current psychiatric disorders in the general population. This study utilized a subsample of overweight and obese individuals (N = 22,231) from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a cross-sectional nationally representative study of noninstitutionalized US adults. Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity. These results remained significant after adjusting for a potential confound, perceived stress. Moreover, social support did not buffer against the adverse effects of perceived weight discrimination on mental health. Controlling for BMI did not diminish the associations, indicating that perceived weight discrimination is potentially harmful to mental health regardless of weight. These results highlight the urgent need for a multifaceted approach to address this important public health issue, including interventions to assist overweight individuals in coping with the mental health sequelae of perceived weight discrimination. PMID:19390520

Predicting self-rated mental and physical health: the contributions of subjective socioeconomic status and personal relative deprivation

PubMed Central

Callan, Mitchell J.; Kim, Hyunji; Matthews, William J.

2015-01-01

Lower subjective socioeconomic status (SSS) and higher personal relative deprivation (PRD) relate to poorer health. Both constructs concern people's perceived relative social position, but they differ in their emphasis on the reference groups people use to determine their comparative disadvantage (national population vs. similar others) and the importance of resentment that may arise from such adverse comparisons. We investigated the relative utility of SSS and PRD as predictors of self-rated physical and mental health (e.g., self-rated health, stress, health complaints). Across six studies, self-rated physical and mental health were on the whole better predicted by measures of PRD than by SSS while controlling for objective socioeconomic status (SES), with SSS rarely contributing unique variance over and above PRD and SES. Studies 4–6 discount the possibility that the superiority of PRD over SSS in predicting health is due to psychometric differences (e.g., reliability) or response biases between the measures. PMID:26441786

[Mental Health Care Utilization of First Generation Vietnamese Migrants in Germany].

PubMed

Ta, Thi Minh Tam; Neuhaus, Andres H; Burian, Ronald; Schomerus, Georg; von Poser, Anita; Diefenbacher, Albert; Röttger-Rössler, Birgitt; Dettling, Michael; Hahn, Eric

2015-07-01

Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany. We analyzed migration related and clinical data for all first-time Vietnamese migrants seeking psychiatric help, within the first 30 months of a newly established outpatient clinic, offering culture-sensitive psychiatric treatment in native Vietnamese language. Most first time patients were female, first generation Vietnamese migrants with poor German language skills. Only 1 /3 of all patients had a psychiatric history, while this number was higher in patients with schizophrenia. Over time, more first time patients with depression were seeking psychiatric care, accompanied with an increase of non-professional referrals within the Vietnamese communities. This first study on mental health care utilization in Vietnamese migrants in Germany points towards the fact that "migrants" cannot be considered as a homogeneous group. Mental health care utilization must be evaluated for specific migrant groups, and can be initially improved if offered in native language and when it is referred to by members of migrant communities. © Georg Thieme Verlag KG Stuttgart · New York.

Quality of life of persons with severe mental illness living in an intermediate care facility.

PubMed

Anderson, R L; Lewis, D A

2000-04-01

This study examined resident characteristics, clinical factors, and mental health service utilization associated with quality of life (QOL) for residents living in an Intermediate Care Facility (ICF). This study also utilized published literature to compare the QOL of ICF residents to persons with psychiatric disorders living in other residential settings. Chart review and interviews were used to study 100 randomly selected residents living in an ICF with a chart diagnosis of schizophrenia. Multivariate analyses suggest that higher levels of QOL are associated with reports that psychological problems did not interfere with work and activities and with lower levels of being a danger to others. Also, a comparison of the QOL scores reported by ICF residents to other published mentally ill populations suggests that residents of the ICF report somewhat higher QOL scores than state hospital patients, but lower scores as compared to other community samples. Data provide insight into the types of problems faced by residents of an intermediate care facility. These findings have implications for understanding the importance of mental health service utilization on QOL.

Factors Associated with Assignment of Therapeutic Homework in a Large Public Children's Mental Health System.

PubMed

Trask, Emily Velazquez; Barounis, Kya; Carlisle, Brandon L; Garland, Ann F; Aarons, Gregory A

2018-03-24

Therapeutic homework is a fundamental skill-building component of the majority of evidence-based therapies and is associated with better treatment outcomes. However, it is rarely utilized in public mental health settings. To determine barriers to homework use and identify predictors of clinicians' assignment of homework, an online survey was administered to 267 clinicians in a large diverse public mental health system. Clinicians who were younger, licensed, whose supervisors asked about homework and whose clients completed their homework more frequently were predictors of greater homework utilization. The survey results are discussed and a novel idea to increase the use of homework is introduced.

Spatio-temporal brain activity related to rotation method during a mental rotation task of three-dimensional objects: an MEG study.

PubMed

Kawamichi, Hiroaki; Kikuchi, Yoshiaki; Ueno, Shoogo

2007-09-01

During mental rotation tasks, subjects perform mental simulation to solve tasks. However, detailed neural mechanisms underlying mental rotation of three-dimensional (3D) objects, particularly, whether higher motor areas related to mental simulation are activated, remain unknown. We hypothesized that environmental monitoring-a process based on environmental information and is included in motor execution-is as a key factor affecting the utilization of higher motor areas. Therefore, using magnetoencephalography (MEG), we measured spatio-temporal brain activities during two types (two-dimensional (2D) and 3D rotation tasks) of mental rotation of 3D objects. Only the 3D rotation tasks required subjects to mentally rotate objects in a depth plane with visualization of hidden parts of the visual stimuli by acquiring and retrieving 3D information. In cases showing significant differences in the averaged activities at 100-ms intervals between the two rotations, the activities were located in the right dorsal premotor (PMd) at approximately 500 ms. In these cases, averaged activities during 3D rotation were greater than those during 2D rotation, implying that the right PMd activities are related to environmental monitoring. During 3D rotation, higher activities were observed from 200 to 300 ms in the left PMd and from 400 to 700 ms in the right PMd. It is considered that the left PMd is related to primary motor control, whereas the right PMd plays a supplementary role during mental simulation. Further, during 3D rotation, late higher activities related to mental simulation are observed in the right superior parietal lobule (SPL), which is connected to PMd.

Self-Reported Mental Health Predicts Acute Respiratory Infection.

PubMed

Maxwell, Lizzie; Barrett, Bruce; Chase, Joseph; Brown, Roger; Ewers, Tola

2015-06-01

Poor mental health conditions, including stress and depression, have been recognized as a risk factor for the development of acute respiratory infection. Very few studies have considered the role of general mental health in acute respiratory infection occurrence. The aim of this analysis is to determine if overall mental health, as assessed by the mental component of the Short Form 12 Health Survey, predicts incidence, duration, or severity of acute respiratory infection. Data utilized for this analysis came from the National Institute of Health-funded Meditation or Exercise for Preventing Acute Respiratory Infection (MEPARI) and MEPARI-2 randomized controlled trials examining the effects of meditation or exercise on acute respiratory infection among adults aged > 30 years in Madison, Wisconsin. A Kendall tau rank correlation compared the Short Form 12 mental component, completed by participants at baseline, with acute respiratory infection incidence, duration, and area-under-the-curve (global) severity, as assessed by the Wisconsin Upper Respiratory Symptom Survey. Participants were recruited from Madison, Wis, using advertisements in local media. Short Form 12 mental health scores significantly predicted incidence (P = 0.037) of acute respiratory infection, but not duration (P = 0.077) or severity (P = 0.073). The Positive and Negative Affect Schedule (PANAS) negative emotion measure significantly predicted global severity (P = 0.036), but not incidence (P = 0.081) or duration (P = 0.125). Mindful Attention Awareness Scale scores significantly predicted incidence of acute respiratory infection (P = 0.040), but not duration (P = 0.053) or severity (P = 0.70). The PHQ-9, PSS-10, and PANAS positive measures did not show significant predictive associations with any of the acute respiratory infection outcomes. Self-reported overall mental health, as measured by the mental component of Short Form 12, predicts acute respiratory infection incidence.

Research utilization among children's mental health providers.

PubMed

Barwick, Melanie A; Boydell, Katherine M; Stasiulis, Elaine; Ferguson, H Bruce; Blase, Karen; Fixsen, Dean

2008-04-09

Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

Exploring Perceptions of the Mental Health of Youth in Mexico: A Qualitative Study

ERIC Educational Resources Information Center

Wells, Lisa; Varjas, Kris; Cadenhead, Catherine; Morillas, Catalina; Morris, Ashley

2012-01-01

Limited information is available regarding the mental health of children and adolescents in Mexico (Paula, Duarte, & Bordin, 2007). The purpose of this exploratory qualitative study was to examine the construct of mental health of children and adolescents from the emic perspective of key informants in Mexico. Utilizing qualitative methods of…

Looking beyond Psychopathology: The Dual-Factor Model of Mental Health in Youth

ERIC Educational Resources Information Center

Suldo, Shannon M.; Shaffer, Emily J.

2008-01-01

In a dual-factor model of mental health (cf. Greenspoon & Saklofske, 2001), assessments of positive indicators of wellness (i.e., subjective well-being--SWB) are coupled with traditional negative indicators of illness (i.e., psychopathology) to comprehensively measure mental health. The current study examined the existence and utility of a…

Public Knowledge and Assessment of Child Mental Health Problems: Findings from the National Stigma Study-Children

ERIC Educational Resources Information Center

Pescosolido, Bernice A.; Jensen, Peter S.; Martin, Jack K.; Perry, Brea L.; Olafsdottir, Sigrun; Fettes, Danielle

2008-01-01

The study examines the general public's perceptions of, and response to, mental disorders in children by using the National Stigma Study-Children. Results concluded that lack of knowledge, skepticism, and misinformed beliefs are the reasons for low utilization rates for children's mental health problems.

Variations in Student Mental Health and Treatment Utilization across US Colleges and Universities

ERIC Educational Resources Information Center

Ketchen Lipson, Sarah; Gaddis, S. Michael; Heinze, Justin; Beck, Kathryn; Eisenberg, Daniel

2015-01-01

Objective: On US college campuses, mental health problems are highly prevalent, appear to be increasing, and are often untreated. Concerns about student mental health are well documented, but little is known about potential variations across the diversity of institutions of higher education. Participants: Participants were 43,210 undergraduates at…

Mental health utilization among older Veterans with coexisting depression and dementia

PubMed Central

DiNapoli, Elizabeth A; Mott, Juliette M; Hundt, Natalie E; Mignogna, Joseph; Sansgiry, Shubhada; Yu, Hong Jen; Trahan, Lisa H; Kunik, Mark E

2015-01-01

Objective: We compared mental health service utilization among older, depressed Veterans (60 years or older) with and without coexisting dementia. Methods: This retrospective study examined data from the 2010 Veterans Health Administration National Patient Care Database outpatient treatment files of Veterans with a newly recognized diagnosis of depression (N = 177,710). Results: Approximately 48.84% with coexisting depression and dementia and 32.00% with depression only received mental health services within 12 months of diagnosis (p < .0001). Veterans with coexisting depression and dementia were more likely to receive medication-management appointments (33.40% vs 20.62%), individual therapy (13.39% vs 10.91%), and family therapy (3.77% vs 1.19%) than depressed Veterans without dementia. Conclusion: In general, Veterans with recently diagnosed depression are significantly underusing Veterans Affairs mental health treatment services. Those Veterans who have comorbid dementia are more likely than those with just depression to be enrolled in mental health treatments. Systemic improvements are needed to increase use of mental health services for older, depressed Veterans. PMID:26770761

Social determinants of mental health service utilization in Switzerland.

PubMed

Dey, Michelle; Jorm, Anthony Francis

2017-01-01

To investigate whether mental health services utilization in Switzerland is equitably distributed (i.e., predicted only by the need of a person). Data on 17,789 participants of the Swiss Health Survey 2012 (≥15 years) was analysed. Logistic regression analyses were conducted to predict: having been in treatment for a psychological problem; having used psychotropic medication; having had medical treatment for depression; and having visited a psychologist or psychotherapist. Need (depression severity and risky alcohol consumption) and socio-demographic variables were used as independent variables. Depression severity was the strongest predictor for using mental health services. In contrast, risky alcohol consumption was not associated with an increased likelihood of using mental health services. After adjusting for need, the following groups were less likely to use (some of) the mental health services: males, young people, participants who (almost) work full-time, single/unmarried, non-Swiss people and those living in rural areas. Education and income were not significantly associated with the outcomes in the adjusted analyses. Some socio-demographic subgroups are less likely to use mental health services despite having the same need.

Mental health care use in adolescents with and without mental disorders.

PubMed

Jörg, Frederike; Visser, Ellen; Ormel, Johan; Reijneveld, Sijmen A; Hartman, Catharina A; Oldehinkel, Albertine J

2016-05-01

The aim of the study was to estimate the proportion of adolescents with and without a psychiatric diagnosis receiving specialist mental health care and investigate their problem levels as well as utilization of other types of mental health care to detect possible over- and undertreatment. Care utilization data were linked to psychiatric diagnostic data of 2230 adolescents participating in the TRAILS cohort study, who were assessed biannually starting at age 11. Psychiatric diagnoses were established at the fourth wave by the Composite International Diagnostic Interview. Self-, parent- and teacher-reported emotional and behavioral problems and self-reported mental health care use were assessed at all four waves. Of all diagnosed adolescents, 35.3 % received specialist mental health care. This rate increased to 54.5 % when three or more disorders were diagnosed. Almost a third (28.5 %) of specialist care users had no psychiatric diagnosis; teachers gave them relatively high ratings on attention and impulsivity subscales. Diagnosed adolescents without specialist mental health care also reported low rates of other care use. We found no indication of overtreatment. Half of the adolescents with three or more disorders do not receive specialist mental health care nor any other type of care, which might indicate unmet needs.

Sociodemographic, perceived and objective need indicators of mental health treatment use and treatment-seeking intentions among primary care medical patients.

PubMed

Elhai, Jon D; Voorhees, Summer; Ford, Julian D; Min, Kyeong Sam; Frueh, B Christopher

2009-01-30

We explored sociodemographic and illness/need associations with both recent mental healthcare utilization intensity and self-reported behavioral intentions to seek treatment. Data were examined from a community sample of 201 participants presenting for medical appointments at a Midwestern U.S. primary care clinic, in a cross-sectional survey study. Using non-linear regression analyses accounting for the excess of zero values in treatment visit counts, we found that both sociodemographic and illness/need models were significantly predictive of both recent treatment utilization intensity and intentions to seek treatment. Need models added substantial variance in prediction, above and beyond sociodemographic models. Variables with the greatest predictive role in explaining past treatment utilization intensity were greater depression severity, perceived need for treatment, older age, and lower income. Robust variables in predicting intentions to seek treatment were greater depression severity, perceived need for treatment, and more positive treatment attitudes. This study extends research findings on mental health treatment utilization, specifically addressing medical patients and using statistical methods appropriate to examining treatment visit counts, and demonstrates the importance of both objective and subjective illness/need variables in predicting recent service use intensity and intended future utilization.

Ethno-cultural variations in the experience and meaning of mental illness and treatment: implications for access and utilization.

PubMed

Carpenter-Song, Elizabeth; Chu, Edward; Drake, Robert E; Ritsema, Mieka; Smith, Beverly; Alverson, Hoyt

2010-04-01

We conducted a study to investigate how understandings of mental illness and responses to mental health services vary along ethno-racial lines. Participants were 25 African American, Latino, and Euro-American inner-city residents in Hartford Connecticut diagnosed with severe mental illness and currently enrolled in a larger study of a community mental health center. Data were collected through 18 months of ethnographic work in the community. Overall, Euro-Americans participants were most aligned with professional disease-oriented perspectives on severe mental illness and sought the advice and counsel of mental health professionals. African-American and Latino participants emphasized non-biomedical interpretations of behavioral, emotional, and cognitive problems and were critical of mental health services. Participants across the sample expressed expectations and experiences of psychiatric stigma. Although Euro-Americans were aware of the risk of social rejection because of mental illness, psychiatric stigma did not form a core focus of their narrative accounts. By contrast, stigma was a prominent theme in the narrative accounts of African Americans, for whom severe mental illness was considered to constitute private "family business." For Latino participants, the cultural category of nervios appeared to hold little stigma, whereas psychiatric clinical labels were potentially very socially damaging. Our findings provide further empirical support for differences in symptom interpretation and definitions of illness among persons from diverse ethno-racial backgrounds. First-person perspectives on contemporary mental health discourses and practices hold implications for differential acceptability of mental health care that may inform variations in access and utilization of services in diverse populations.

An innovative approach to reducing medical care utilization and expenditures.

PubMed

Orme-Johnson, D W; Herron, R E

1997-01-01

In a retrospective study, we assessed the impact on medical utilization and expenditures of a multicomponent prevention program, the Maharishi Vedic Approach to Health (MVAH). We compared archival data from Blue Cross/Blue Shield Iowa for MVAH (n = 693) with statewide norms for 1985 through 1995 (n = 600,000) and with a demographically matched control group (n = 4,148) for 1990, 1991, 1994, and 1995. We found that the 4-year total medical expenditures per person in the MVAH group were 59% and 57% lower than those in the norm and control groups, respectively; the 11-year mean was 63% lower than the norm. The MVAH group had lower utilization and expenditures across all age groups and for all disease categories. Hospital admission rates in the control group were 11.4 times higher than those in the MVAH group for cardiovascular disease, 3.3 times higher for cancer, and 6.7 times higher for mental health and substance abuse. The greatest savings were seen among MVAH patients older than age 45, who had 88% fewer total patients days compared with control patients. Our results confirm previous research supporting the effectiveness of MVAH for preventing disease. Our evaluation suggests that MVAH can be safely used as a cost-effective treatment regimen in the managed care setting.

Time Preferences, Mental Health and Treatment Utilization.

PubMed

Eisenberg, Daniel; Druss, Benjamin G

2015-09-01

In all countries of the world, fewer than half of people with mental disorders receive treatment. This treatment gap is commonly attributed to factors such as consumers' limited knowledge, negative attitudes, and financial constraints. In the context of other health behaviors, such as diet and exercise, behavioral economists have emphasized time preferences and procrastination as additional barriers. These factors might also be relevant to mental health. We examine conceptually and empirically how lack of help-seeking for mental health conditions might be related to time preferences and procrastination. Our conceptual discussion explores how the interrelationships between time preferences and mental health treatment utilization could fit into basic microeconomic theory. The empirical analysis uses survey data of student populations from 12 colleges and universities in 2011 (the Healthy Minds Study, N=8,806). Using standard brief measures of discounting, procrastination, and mental health (depression and anxiety symptoms), we examine the conditional correlations between indicators of present-orientation (discount rate and procrastination) and mental health symptoms. The conceptual discussion reveals a number of potential relationships that would be useful to examine empirically. In the empirical analysis depression is significantly associated with procrastination and discounting. Treatment utilization is significantly associated with procrastination but not discounting. The empirical results are generally consistent with the idea that depression increases present orientation (reduces future orientation), as measured by discounting and procrastination. These analyses have notable limitations that will require further examination in future research: the measures are simple and brief, and the estimates may be biased from true causal effects because of omitted variables and reverse causality. There are several possibilities for future research, including: (i) observational, longitudinal studies with detailed data on mental health, time preferences, and help-seeking; (ii) experimental studies that examine immediate or short-term responses and connections between these variables; (iii) randomized trials of mental health therapies that include outcome measures of time preferences and procrastination; and, (iv) intervention studies that test strategies to influence help-seeking by addressing time preferences and present orientation.

Mental energy: Assessing the motivation dimension.

PubMed

Barbuto, John E

2006-07-01

Content-based theories of motivation may best uti lize the meta-theory of work motivation. Process-based theories may benefit most from adopting Locke and Latham's goal-setting approaches and measures. Decision-making theories should utilize the measurement approach operationalized by Ilgen et al. Sustained effort theories should utilize similar approaches to those used in numerous studies of intrinsic motivation, but the measurement of which is typically observational or attitudinal. This paper explored the implications of the four approaches to studying motivation on the newly estab ished model of mental energy. The approach taken for examining motivation informs the measurement of mental energy. Specific recommendations for each approach were developed and provided. As a result of these efforts, it will now be possible to diagnose, measure, and experimentally test for changes in human motivation, which is one of the three major components of mental energy.

Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults

PubMed Central

Conner, Kyaien O.; Copeland, Valire Carr; Grote, Nancy K.; Rosen, Daniel; Albert, Steve; McMurray, Michelle L.; Reynolds, Charles F.; Brown, Charlotte; Koeske, Gary

2011-01-01

Objective Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. Method A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. Results Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans: (2) Barriers to Seeking Treatment for Older African-Americans: and (3) Cultural Coping Strategies for Depressed African-American Older Adults. Conclusion Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors. which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services. PMID:21069603

Modifying mental health help-seeking stigma among undergraduates with untreated psychiatric disorders: A pilot randomized trial of a novel cognitive bias modification intervention.

PubMed

Stanley, Ian H; Hom, Melanie A; Joiner, Thomas E

2018-04-01

Help-seeking stigma is a potent barrier to the utilization of mental health services. This study aimed to determine if, compared to a psychoeducation condition, individuals randomized to a novel cognitive bias modification intervention for help-seeking stigma (CBM-HS) demonstrate greater reductions in help-seeking stigma, as well as increases in readiness to change and help-seeking behaviors. Participants included 32 undergraduates with a DSM-5 psychiatric disorder who denied past-year mental health treatment. Post-randomization, three intervention sessions were delivered in one-week intervals (45 min total). Participants were assessed at baseline, mid-intervention, one-week post-intervention, and two-month follow-up. RM-ANOVAs were utilized among the intent-to-treat sample. There were no significant differences across time points between the intervention groups for help-seeking stigma and readiness to change. At two-month follow-up, 25% of participants initiated mental health treatment (29.4% CBM-HS, 20.0% psychoeducation). Strikingly, across groups, there was a statistically significant reduction in help-seeking self-stigma (F[2.214,66.418] = 5.057, p = 0.007, η p 2  = 0.144) and perceived public stigma (F[3,90] = 6.614, p < 0.001, η p 2  = 0.181) from baseline to two-month follow-up, indicating large effects; 18.8% achieved clinically significant change, among whom two-thirds were in the CBM-HS condition. Two brief, scalable interventions appear to reduce help-seeking stigma among undergraduates with untreated psychiatric disorders. Studies are needed to evaluate these interventions against an inactive control. Copyright © 2018 Elsevier Ltd. All rights reserved.

Mental Health Professionals and Behavioral Interventions for Obesity: A Systematic Literature Review.

PubMed

Prost, Stephanie Grace; Ai, Amy L; Ainsworth, Sarah E; Ayers, Jaime

2016-01-01

Adult obesity in the United States has risen to epidemic proportions, and mental health professionals must be called to action. The objectives of this article were to (a) synthesize outcomes of behavioral health interventions for adult obesity in recent meta-analyses and systematic reviews (MAs/SRs) as well as randomized controlled trials (RCTs) and further, (b) evaluate the role of mental health professionals in these behavioral health interventions. Articles were included if published in English between January 1, 2004, and May 1, 2014, in peer-reviewed journals examining behavioral health interventions for adults with obesity. Data were subsequently extracted and independently checked by two authors. Included MAs/SRs utilized motivational interviewing, financial incentives, multicomponent behavioral weight management programs, as well as dietary and lifestyle interventions. Behavioral health interventions in randomized controlled trials (RCTs) were discussed across 3 major intervention types (educational, modified caloric intake, cognitive-based). Regarding the 1st study objective, multiple positive primary (e.g., weight loss) and secondary outcomes (e.g., quality of life) were found in both MAs/SRs and RCTs. However, the majority of included studies made no mention of interventionist professional background and little inference could be made regarding the effects of professional background on behavioral health intervention outcomes for adults facing obesity; an important limitation and direction for future research. Future studies should assess the effects of interventionist profession in addition to primary and secondary outcomes for adults facing obesity. Implications for mental health professionals' educational curricula, assessment, and treatment strategies are discussed.

Improving the outcome of infants born at <30 weeks' gestation - a randomized controlled trial of preventative care at home

PubMed Central

2009-01-01

Background Early developmental interventions to prevent the high rate of neurodevelopmental problems in very preterm children, including cognitive, motor and behavioral impairments, are urgently needed. These interventions should be multi-faceted and include modules for caregivers given their high rates of mental health problems. Methods/Design We have designed a randomized controlled trial to assess the effectiveness of a preventative care program delivered at home over the first 12 months of life for infants born very preterm (<30 weeks of gestational age) and their families, compared with standard medical follow-up. The aim of the program, delivered over nine sessions by a team comprising a physiotherapist and psychologist, is to improve infant development (cognitive, motor and language), behavioral regulation, caregiver-child interactions and caregiver mental health at 24 months' corrected age. The infants will be stratified by severity of brain white matter injury (assessed by magnetic resonance imaging) at term equivalent age, and then randomized. At 12 months' corrected age interim outcome measures will include motor development assessed using the Alberta Infant Motor Scale and the Neurological Sensory Motor Developmental Assessment. Caregivers will also complete a questionnaire at this time to obtain information on behavior, parenting, caregiver mental health, and social support. The primary outcomes are at 24 months' corrected age and include cognitive, motor and language development assessed with the Bayley Scales of Infant and Toddler Development (Bayley-III). Secondary outcomes at 24 months include caregiver-child interaction measured using an observational task, and infant behavior, parenting, caregiver mental health and social support measured via standardized parental questionnaires. Discussion This paper presents the background, study design and protocol for a randomized controlled trial in very preterm infants utilizing a preventative care program in the first year after discharge home designed to improve cognitive, motor and behavioral outcomes of very preterm children and caregiver mental health at two-years' corrected age. Clinical Trial Registration Number ACTRN12605000492651 PMID:19954550

Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.

PubMed

Fasoli, DiJon R; Glickman, Mark E; Eisen, Susan V

2010-04-01

Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.

Overcoming learning barriers through knowledge management.

PubMed

Dror, Itiel E; Makany, Tamas; Kemp, Jonathan

2011-02-01

The ability to learn highly depends on how knowledge is managed. Specifically, different techniques for note-taking utilize different cognitive processes and strategies. In this paper, we compared dyslexic and control participants when using linear and non-linear note-taking. All our participants were professionals working in the banking and financial sector. We examined comprehension, accuracy, mental imagery & complexity, metacognition, and memory. We found that participants with dyslexia, when using a non-linear note-taking technique outperformed the control group using linear note-taking and matched the performance of the control group using non-linear note-taking. These findings emphasize how different knowledge management techniques can avoid some of the barriers to learners. Copyright © 2010 John Wiley & Sons, Ltd.

Mental health, concurrent disorders, and health care utilization in homeless women.

PubMed

Strehlau, Verena; Torchalla, Iris; Kathy, Li; Schuetz, Christian; Krausz, Michael

2012-09-01

This study assessed lifetime and current prevalence rates of mental disorders and concurrent mental and substance use disorders in a sample of homeless women. Current suicide risk and recent health service utilization were also examined in order to understand the complex mental health issues of this population and to inform the development of new treatment strategies that better meet their specific needs. A cross-sectional survey of 196 adult homeless women in three different Canadian cities was done. Participants were assessed using DSM-IV-based structured clinical interviews. Current diagnoses were compared to available mental health prevalence rates in the Canadian female general population. Current prevalence rates were 63% for any mental disorder, excluding substance use disorders; 17% for depressive episode; 10% for manic episode; 7% for psychotic disorder; 39% for anxiety disorders, 28% for posttraumatic stress disorder; and 19% for obsessive-compulsive disorder; 58% had concurrent substance dependence and mental disorders. Lifetime prevalence rates were notably higher. Current moderate or high suicide risk was found in 22% of the women. Participants used a variety of health services, especially emergency rooms, general practitioners, and walk-in clinics. Prevalence rates of mental disorders among homeless participants were substantially higher than among women from the general Canadian population. The percentage of participants with moderate or high suicide risk and concurrent disorders indicates a high severity of mental health symptomatology. Treatment and housing programs need to be accompanied by multidisciplinary, specialized interventions that account for high rates of complex mental health conditions.

The Influence of Psychological Symptoms on Mental Health Literacy of College Students

PubMed Central

Kim, Jin E.; Saw, Anne; Zane, Nolan

2015-01-01

Psychological problems, such as depression and anxiety, are common among college students, but few receive treatment for it. Mental health literacy may partially account for low rates of mental health treatment utilization. We report two studies that investigated mental health literacy among individuals with varying degrees of psychological symptoms, using cross-sectional online survey methodology. Study 1 involved 332 college students, of which 32% were categorized as high depressed using an established measure of depression, and mental health literacy for depression was assessed using a vignette. Logistic regression results showed that high depressed individuals were less likely to recognize depression compared to low depressed individuals, and depression recognition was associated with recommendations to seek help. Study 2 replicated and extended findings of Study 1 using a separate sample of 1,321 college students with varying degrees of psychological distress (32% no/mild distress, 55% moderate distress, and 13% serious distress) and examining mental health literacy for anxiety in addition to depression. Results indicated that compared to those with no/mild distress, those with moderate distress had lower recognition of depression, and those with moderate and serious distress were less likely to recommend help-seeking. In contrast, there were no differences in mental health literacy for anxiety, which was low across all participants. These findings suggest that psychological symptoms can impact certain aspects of mental health literacy, and these results have implications for targeting mental health literacy to increase mental health services utilization among individuals in need of help. PMID:26052815

The chronic impact of work on suicides and under-utilization of psychiatric and psychosocial services.

PubMed

Law, Yik Wa; Yip, Paul S F; Zhang, Yi; Caine, Eric D

2014-10-01

Work-related stress appears to be a contributing factor in the lives of employed people who kill themselves, particularly during economic downturns. However, few studies have compared them with working community controls who may be experiencing similar strains, in order to explore the role of mental disorders in these deaths and the implication of such strains on their service use pattern. We hypothesized that both work stress and mental illness were associated with suicides, and that mental illness served as the mediator between work stress and suicide. Based on the Behavioral Model, we also assumed work stress associated with their use of services. A sample of 175 employed individuals (suicides=63; controls=112) drawn from a psychological autopsy (PA) dataset was examined based on demographics and socioeconomic factors, psychiatric diagnoses and use of services, psychosocial factors, and life events. A mediator analysis was conducted to examine the impact of work on suicides. Suicides generally had depression and anxiety, debts, higher impulsivity and poorer social support in comparison to controls. Chronic impact from work, which was fully mediated by psychiatric illness, was found higher among those suicides that did not seek contact with clinical service providers. PA is a post-hoc cross-sectional comparison method which does not allow causal analyses. It is important to develop new approaches for engaging vulnerable individuals in the workplace before they become suicidal, as their depression and social isolation can serve to cut them off from help when they are most in need. Occupational mental health programs should be made available for employees and their families. Copyright © 2014 Elsevier B.V. All rights reserved.

A randomized controlled trial of ethyl glucuronide-based contingency management for outpatients with co-occurring alcohol use disorders and serious mental illness

PubMed Central

McDonell, Michael G.; Leickly, Emily; McPherson, Sterling; Skalisky, Jordan; Srebnik, Debra; Angelo, Frank; Vilardaga, Roger; Nepom, Jenny R.; Roll, John M.; Ries, Richard K.

2017-01-01

Objective To determine if a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine if contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. Method Seventy-nine (37% female, 44% non-white) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomized to 12-weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. Results Contingency management participants were 3.1 times (95% CI: 2.2, 4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional abstinence relative to controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, relative to controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. Conclusions This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness. PMID:28135843

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.

PubMed

McDonell, Michael G; Leickly, Emily; McPherson, Sterling; Skalisky, Jordan; Srebnik, Debra; Angelo, Frank; Vilardaga, Roger; Nepom, Jenny R; Roll, John M; Ries, Richard K

2017-04-01

The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior. Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement "prize draw" procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods. Contingency management participants were 3.1 times (95% CI=2.2-4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up. This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.

The Humanistic and Economic Burden of Narcolepsy.

PubMed

Flores, Natalia M; Villa, Kathleen F; Black, Jed; Chervin, Ronald D; Witt, Edward A

2016-03-01

To evaluate the burden of narcolepsy--with respect to psychiatric comorbidities, Health-Related Quality of Life (HRQoL), direct costs for healthcare resource utilization, and indirect costs for reported work loss-through comparison of patients to matched controls. This analysis was conducted on data from the 2011, 2012, and 2013 US National Health and Wellness Survey (NHWS; 2011 NHWS n = 75,000, 2012 NHWS n = 71,157, and 2013 NHWS n = 75,000). Patients who reported a narcolepsy diagnosis (n = 437) were matched 1:2 with controls (n = 874) on age, sex, race/ethnicity, marital status, education, household income, body mass index, smoking status, alcohol use, exercise, and physical comorbidity. Chi-square tests and one-way analyses of variance were used to assess whether the narcolepsy and control groups differed on psychiatric comorbidities, HRQoL, labor force participation, work productivity, and healthcare resource utilization. Patients with narcolepsy, in comparison to matched controls, reported substantially (two to four times) greater psychiatric comorbidity, HRQoL impairment, prevalence of long-term disability, absenteeism, and presenteeism, and greater resource use in the past 6 mo as indicated by higher mean number of hospitalizations, emergency department visits, traditional healthcare professional visits, neurologist visits, and psychiatrist visits (each p < 0.05). These population-based data suggest that a narcolepsy diagnosis is associated with substantial adverse impact on mental health, HRQoL, and key economic burdens that include work impairment, resource use, and both direct and indirect costs. Although this study is cross-sectional, the results highlight the magnitude of the potential opportunity to improve mental health, lower costs, and augment work-related productivity through effective assessment and treatment of narcolepsy. © 2016 American Academy of Sleep Medicine.

Associations of employment frustration with self-rated physical and mental health among Asian American immigrants in the U.S. Labor force.

PubMed

de Castro, A B; Rue, Tessa; Takeuchi, David T

2010-01-01

This study examined the associations between employment frustration and both self-rated physical health (SRPH) and self-rated mental health (SRMH) among Asian American immigrants. A cross-sectional quantitative analysis was conducted utilizing data from 1,181 Asian immigrants participating in the National Latino and Asian American Study. Employment frustration was measured by self-report of having difficulty finding the work one wants because of being of Asian descent. SRPH and SRMH were each assessed using a global one-item measure, with responses ranging from poor to excellent. Control variables included gender, age, ethnicity, education, occupation, income, whether immigrated for employment, years in the United States, English proficiency, and a general measure for everyday discrimination. Ordered logistic regression showed that employment frustration was negatively associated with SRPH. This relationship, however, was no longer significant in multivariate models including English proficiency. The negative association between employment frustration and SRMH persisted even when including all control variables. The findings suggest that Asian immigrants in the United States who experience employment frustration report lower levels of both physical and mental health. However, English proficiency may attenuate the relationship of employment frustration with physical health. © 2010 Wiley Periodicals, Inc.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps.

PubMed

Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M; Koss, Kari; Perera, Kanchana U; Rowan, Anderson; VanSickle, Marcus R; Novak, Laura A; Trieu, Theresa H

2018-04-23

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines ( N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines ( N = 40) was matched to a non-treatment-seeking sample of Marines ( N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls ( p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed.

Service utilization following participation in cognitive processing therapy or prolonged exposure therapy for post-traumatic stress disorder.

PubMed

Meyers, Laura L; Strom, Thad Q; Leskela, Jennie; Thuras, Paul; Kehle-Forbes, Shannon M; Curry, Kyle T

2013-01-01

This study evaluated the impact of a course of prolonged exposure or cognitive processing therapy on mental health and medical service utilization and health care service costs provided by the Department of Veterans Affairs (VA). Data on VA health service utilization and health care costs were obtained from national VA databases for 70 veterans who completed prolonged exposure or cognitive processing therapy at a Midwestern VA medical center. Utilization of services and cost data were examined for the year before and after treatment. Results demonstrated a significant decrease in the use of individual and group psychotherapy. Direct costs associated with mental health care decreased by 39.4%. Primary care and emergency department services remained unchanged.

Healthcare utilization and mortality among veterans of the Gulf War

PubMed Central

Gray, Gregory C; Kang, Han K

2006-01-01

The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the1990–1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149 728 (19.8%) of 756 373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel. PMID:16687261

Assessing Psychological Symptoms and Well-Being: Application of a Dual-Factor Mental Health Model to Understand College Student Performance

ERIC Educational Resources Information Center

Antaramian, Susan

2015-01-01

A dual-factor mental health model includes measures of positive psychological well-being in addition to traditional indicators of psychopathology to comprehensively determine mental health status. The current study examined the utility of this model in understanding the psychological adjustment and educational functioning of college students. A…

Some National Developments in the Utilization of Nontraditional Mental Health Manpower.

ERIC Educational Resources Information Center

Matarazzo, Joseph D.

This paper presents a review of some of the new mental health manpower developments which have occurred in this country during the past two decades. The role played by the National Association for Mental Health (NAMH) in these developments is also viewed. Individuals working in state hospitals and related institutions have capitalized on the…

Does Ethno-Cultural Betrayal in Trauma Affect Asian American/Pacific Islander College Students' Mental Health Outcomes? An Exploratory Study

ERIC Educational Resources Information Center

Gómez, Jennifer M.

2017-01-01

Objectives: Interpersonal trauma has deleterious effects on mental health, with college students experiencing relatively high rates of lifetime trauma. Asian American/Pacific Islanders (AAPIs) have the lowest rate of mental healthcare utilization. According to cultural betrayal trauma theory, societal inequality may impact within-group violence in…

Early Childhood Mental Health Consultation: Common Questions and Answers

ERIC Educational Resources Information Center

Hughes, Mary-alayne; Spence, Christine M.; Ostrosky, Michaelene M.

2015-01-01

As the field of early childhood mental health continues to expand and evolve, the evidence base is growing, and early childhood mental health consultation is viewed as a promising practice. However, there continues to be a need for further research, with particular attention given to the utility and effectiveness of this approach with infants and…

Longitudinal Study of a Dual-Factor Model of Mental Health in Chinese Youth

ERIC Educational Resources Information Center

Xiong, Junmei; Qin, Yi; Gao, Miaomiao; Hai, Man

2017-01-01

By incorporating psychopathology and subjective well-being (SWB), the dual-factor model of mental health (DFM) can comprehensively measure psychological health. We examined the utility of the DFM among 1,293 Chinese adolescents (Grades 7-12). Furthermore, we examined the dynamics of mental health group membership via a two-wave longitudinal study…

Variation in outpatient mental health service utilization under capitation.

PubMed

Chou, Ann F; Wallace, Neal; Bloom, Joan R; Hu, Teh-Wei

2005-03-01

To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these providers decreased to converge to the FFS pattern. Findings also suggest substitution between group therapy and individual psychotherapy. Overall, more service integration was observed and less complex service packages were provided post capitation. IMPLICATION FOR HEALTH CARE PROVISION AND POLICIES: Financing models and organizational arrangements have an impact on mental health service delivery. Changes in utilization and costs of specific types of outpatient services reflect the effects of capitation. Understanding the mechanism for these changes may lead to more streamlined service delivery allowing extra funding for expanding the range of cost-effective treatment alternatives. These changes pose implications for improving the financing of public mental health systems, coordination of mental health services with other healthcare and human services, and provision of services through a more efficient financing system.

Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial.

PubMed

Kidorf, Michael; Brooner, Robert K; Gandotra, Neeraj; Antoine, Denis; King, Van L; Peirce, Jessica; Ghazarian, Sharon

2013-11-01

The benefits of integrating substance abuse and psychiatric care may be limited by poor service utilization. This randomized clinical trial evaluated the efficacy of using contingency management to improve utilization of psychiatric services co-located and integrated within a community-based methadone maintenance treatment program. Opioid-dependent outpatients (n=125) with any current psychiatric disorder were randomly assigned to: (1) reinforced on-site integrated care (ROIC), with vouchers (worth $25.00) contingent on full adherence to each week of scheduled psychiatric services; or (2) standard on-site integrated care (SOIC). All participants received access to the same schedule of psychiatrist and mental health counseling sessions for 12-weeks. ROIC participants attended more overall psychiatric sessions at month 1 (M=7.53 vs. 3.97, p<.001), month 2 (M=6.31 vs. 2.81, p<.001), and month 3 (M=5.71 vs. 2.44, p<.001). Both conditions evidenced reductions in psychiatric distress (p<.001) and similar rates of drug-positive urine samples. No differences in study retention were observed. These findings suggest that contingency management can improve utilization of psychiatric services scheduled within an on-site and integrated treatment model. Delivering evidenced-based mental health counseling, or modifying the contingency plan to include illicit drug use, may be required to facilitate greater changes in psychiatric and substance abuse outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Social networks, mental health problems, and mental health service utilization in OEF/OIF National Guard veterans.

PubMed

Sripada, Rebecca K; Bohnert, Amy S B; Teo, Alan R; Levine, Debra S; Pfeiffer, Paul N; Bowersox, Nicholas W; Mizruchi, Mark S; Chermack, Stephen T; Ganoczy, Dara; Walters, Heather; Valenstein, Marcia

2015-09-01

Low social support and small social network size have been associated with a variety of negative mental health outcomes, while their impact on mental health services use is less clear. To date, few studies have examined these associations in National Guard service members, where frequency of mental health problems is high, social support may come from military as well as other sources, and services use may be suboptimal. Surveys were administered to 1448 recently returned National Guard members. Multivariable regression models assessed the associations between social support characteristics, probable mental health conditions, and service utilization. In bivariate analyses, large social network size, high social network diversity, high perceived social support, and high military unit support were each associated with lower likelihood of having a probable mental health condition (p < .001). In adjusted analyses, high perceived social support (OR .90, CI .88-.92) and high unit support (OR .96, CI .94-.97) continued to be significantly associated with lower likelihood of mental health conditions. Two social support measures were associated with lower likelihood of receiving mental health services in bivariate analyses, but were not significant in adjusted models. General social support and military-specific support were robustly associated with reduced mental health symptoms in National Guard members. Policy makers, military leaders, and clinicians should attend to service members' level of support from both the community and their units and continue efforts to bolster these supports. Other strategies, such as focused outreach, may be needed to bring National Guard members with need into mental health care.

Engagement in mobile phone app for self-monitoring of emotional wellbeing predicts changes in mental health: MoodPrism.

PubMed

Bakker, David; Rickard, Nikki

2018-02-01

Mobile apps are being used increasingly for mental health purposes, but evidence of their efficacy remains limited. The mechanisms underlying any effects of such apps are also unclear. This study examined the effectiveness of a self-monitoring mobile phone app by investigating the relationships between app engagement and mental health outcomes. Participants downloaded the MoodPrism app from the iOS and Android app stores, completing in-app assessments at start of use and again 30days later. The app prompted participants daily to complete a short mood questionnaire and formulated their responses into a mood diary. Data from 234 assessment completers (73% female; M age = 34.8 years) were analysed via hierarchical and mediation regressions. In this community sample, app engagement ratings predicted decreases in depression and anxiety, and increases in mental well-being. These effects were mediated by increases in emotional self-awareness, but only for participants who were clinically depressed or anxious at the time of the baseline assessment. Mental health literacy and coping self-efficacy did not play mediating roles. Findings suggest that other influential mediators may have not been measured, and future studies could verify the findings by using alternative methodologies, such as comparison with a control group. Engaging with an emotional wellbeing self-monitoring app may reduce depressive and anxious symptoms, and increase mental well-being. Increases in emotional self-awareness may mediate these changes in clinical populations, and further research is needed to reveal other mechanisms that mental health apps can utilize. Copyright © 2017 Elsevier B.V. All rights reserved.

Examining related influential factors for dental calculus scaling utilization among people with disabilities in Taiwan, a nationwide population-based study.

PubMed

Lai, Hsien-Tang; Kung, Pei-Tseng; Su, Hsun-Pi; Tsai, Wen-Chen

2014-09-01

Limited studies with large samples have been conducted on the utilization of dental calculus scaling among people with physical or mental disabilities. This study aimed to investigate the utilization of dental calculus scaling among the national disabled population. This study analyzed the utilization of dental calculus scaling among the disabled people, using the nationwide data between 2006 and 2008. Descriptive analysis and logistic regression were performed to analyze related influential factors for dental calculus scaling utilization. The dental calculus scaling utilization rate among people with physical or mental disabilities was 16.39%, and the annual utilization frequency was 0.2 times. Utilization rate was higher among the female and non-aboriginal samples. Utilization rate decreased with increased age and disability severity while utilization rate increased with income, education level, urbanization of residential area and number of chronic illnesses. Related influential factors for dental calculus scaling utilization rate were gender, age, ethnicity (aboriginal or non-aboriginal), education level, urbanization of residence area, income, catastrophic illnesses, chronic illnesses, disability types, and disability severity significantly influenced the dental calculus scaling utilization rate. Copyright © 2014 Elsevier Ltd. All rights reserved.

Enhancing Self-Efficacy for Help-Seeking Among Transition-Aged Youth in Postsecondary Settings With Mental Health and/or Substance Use Concerns, Using Crowd-Sourced Online and Mobile Technologies: The Thought Spot Protocol

PubMed Central

Abi-Jaoude, Alexxa; Johnson, Andrew; Ferguson, Genevieve; Sanches, Marcos; Levinson, Andrea; Robb, Janine; Heffernan, Olivia; Herzog, Tyson; Chaim, Gloria; Cleverley, Kristin; Eysenbach, Gunther; Henderson, Joanna; S Hoch, Jeffrey; Hollenberg, Elisa; Jiang, Huan; Isaranuwatchai, Wanrudee; Law, Marcus; Sharpe, Sarah; Tripp, Tim; Voineskos, Aristotle

2016-01-01

Background Seventy percent of lifetime cases of mental illness emerge prior to age 24. While early detection and intervention can address approximately 70% of child and youth cases of mental health concerns, the majority of youth with mental health concerns do not receive the services they need. Objective The objective of this paper is to describe the protocol for optimizing and evaluating Thought Spot, a Web- and mobile-based platform cocreated with end users that is designed to improve the ability of students to access mental health and substance use services. Methods This project will be conducted in 2 distinct phases, which will aim to (1) optimize the existing Thought Spot electronic health/mobile health intervention through youth engagement, and (2) evaluate the impact of Thought Spot on self-efficacy for mental health help-seeking and health literacy among university and college students. Phase 1 will utilize participatory action research and participatory design research to cocreate and coproduce solutions with members of our target audience. Phase 2 will consist of a randomized controlled trial to test the hypothesis that the Thought Spot intervention will show improvements in intentions for, and self-efficacy in, help-seeking for mental health concerns. Results We anticipate that enhancements will include (1) user analytics and feedback mechanisms, (2) peer mentorship and/or coaching functionality, (3) crowd-sourcing and data hygiene, and (4) integration of evidence-based consumer health and research information. Conclusions This protocol outlines the important next steps in understanding the impact of the Thought Spot platform on the behavior of postsecondary, transition-aged youth students when they seek information and services related to mental health and substance use. PMID:27815232

"Together at school"--a school-based intervention program to promote socio-emotional skills and mental health in children: study protocol for a cluster randomized controlled trial.

PubMed

Björklund, Katja; Liski, Antti; Samposalo, Hanna; Lindblom, Jallu; Hella, Juho; Huhtinen, Heini; Ojala, Tiina; Alasuvanto, Paula; Koskinen, Hanna-Leena; Kiviruusu, Olli; Hemminki, Elina; Punamäki, Raija-Leena; Sund, Reijo; Solantaus, Tytti; Santalahti, Päivi

2014-10-07

Schools provide a natural context to promote children's mental health. However, there is a need for more evidence-based, high quality school intervention programs combined with an accurate evaluation of their general effectiveness and effectiveness of specific intervention methods. The aim of this paper is to present a study protocol of a cluster randomized controlled trial evaluating the "Together at School" intervention program. The intervention program is designed to promote social-emotional skills and mental health by utilizing whole-school approach and focuses on classroom curriculum, work environment of school staff, and parent-teacher collaboration methods. The evaluation study examines the effects of the intervention on children's socio-emotional skills and mental health in a cluster randomized controlled trial design with 1) an intervention group and 2) an active control group. Altogether 79 primary school participated at baseline. A multi-informant setting involves the children themselves, their parents, and teachers. The primary outcomes are measured using parent and teacher ratings of children's socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire and the Multisource Assessment of Social Competence Scale. Secondary outcomes for the children include emotional understanding, altruistic behavior, and executive functions (e.g. working memory, planning, and inhibition). Secondary outcomes for the teachers include ratings of e.g. school environment, teaching style and well-being. Secondary outcomes for both teachers and parents include e.g. emotional self-efficacy, child rearing practices, and teacher-parent collaboration. The data was collected at baseline (autumn 2013), 6 months after baseline, and will be collected also 18 months after baseline from the same participants. This study protocol outlines a trial which aims to add to the current state of intervention programs by presenting and studying a contextually developed and carefully tested intervention program which is tailored to fit a national school system. Identification of effective intervention elements to promote children's mental health in early school years is crucial for optimal later development. ClinicalTrials.gov register: NCT02178332.

Mental health service utilization of Somali adolescents: religion, community, and school as gateways to healing.

PubMed

Ellis, B Heidi; Lincoln, Alisa K; Charney, Meredith E; Ford-Paz, Rebecca; Benson, Molly; Strunin, Lee

2010-11-01

This mixed-method study examines the utility of the Gateway Provider Model (GPM) in understanding service utilization and pathways to help for Somali refugee adolescents. Somali adolescents living in the Northeastern United States, and their caregivers, were interviewed. Results revealed low rates of use of mental health services. However other sources of help, such as religious and school personnel, were accessed more frequently. The GPM provides a helpful model for understanding refugee youth access to services, and an elaborated model is presented showing how existing pathways to help could be built upon to improve refugee youth access to services.

Psychocultural Correlates of Mental Health Service Utilization Among African American and European American Girls

PubMed Central

Hipwell, Alison E.; Stepp, Stephanie D.; Keenan, Kate

2015-01-01

Structural equation modeling was used to examine the effects of cultural factors (ethnic identity, perceived discrimination), family relations, and child problem type on mental health service utilization in a community sample of 1,480 adolescent girls (860 African American, 620 European American) between ages 15 and 17 years enrolled in the Pittsburgh Girls Study. Results revealed ethnic identity, caregiver attachment, and conduct disorder were related to service use among African American girls. Among European American girls, correlate patterns differed by clinical need. Findings highlight the need for research on health disparities to examine racially specific influences on service utilization. PMID:25380787

Social Service Utilization, Sense of Community, Family Functioning and the Mental Health of New Immigrant Women in Hong Kong

PubMed Central

Wu, Qiaobing; Chow, Julian Chun-Chung

2013-01-01

Drawing upon a sample of 296 new immigrant women in Hong Kong, this study investigated how social service utilization, family functioning, and sense of community influenced the depressive symptoms of new immigrant women. Results of the structural equation modeling suggested that family functioning and sense of community were both significantly and negatively associated with the depression of new immigrant women. Utilization of community services also influenced the depression of immigrant women indirectly through the mediating effect of sense of community. Implications of the research findings for mental health intervention were discussed. PMID:23629592

There is no place for the psychoanalytic case report in the British Journal of Psychiatry.

PubMed

Wolpert, Lewis; Fonagy, Peter

2009-12-01

As evidence-based mental health and the randomised controlled trial come to dominate the content of major psychiatric journals, the status and clinical utility of single case reports have been increasingly questioned. Arguably, owing to their subjective, anecdotal nature and unsuitability for rigorous scientific testing, this is particularly true of psychoanalytic case studies. Professor Peter Fonagy and Professor Lewis Wolpert debate here whether or not there is a place for such case reports in the British Journal of Psychiatry.

Effects of a recovery management intervention on Chinese heroin users' community recovery through the mediation effect of enhanced service utilization

PubMed Central

Wu, F.; Fu, L.M.; Hser, Y.H.

2015-01-01

Background This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Methods Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Results Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Conclusions Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. PMID:24990956

Outreach in the Delivery of Mental Health Services to Hispanic Elders.

ERIC Educational Resources Information Center

Szapocznik, Jose; And Others

1979-01-01

The study investigated the effectiveness of two outreach/education modalities established to increase the utilization of mental health services by Hispanic elders: (1) a service delivery modality, and (2) a mass media modality. (NQ)

Residential segregation, geographic proximity and type of services used: Evidence for racial/ethnic disparities in mental health

PubMed Central

Dinwiddie, Gniesha Y.; Gaskin, Darrell J.; Chan, Kitty S.; Norrington, Janette; McCleary, Rachel

2014-01-01

Residential characteristics influence opportunities, life chances and access to health services in the United States but what role does residential segregation play in differential access and mental health service utilization? We explore this issue using secondary data from the 2006 Medical Expenditure Panel Survey, 2006 American Medical Association Area Research File and the 2000 Census. Our sample included 9737 whites, 3362 African Americans and 5053 Latinos living in Metropolitan Statistical Areas. Using logistic regression techniques, results show respondents high on Latino isolation and Latino centralization resided in psychiatrist shortage areas whereas respondents high on African American concentration had access to psychiatrists in their neighborhoods. Predominant race of neighborhood was associated with the type of mental health professional used where respondents in majority African American neighborhoods were treated by non-psychiatrists and general doctors whereas respondents in majority Latino neighborhoods saw general doctors. Respondents high on Latino Isolation and Latino Centralization were more likely to utilize non-psychiatrists. These findings suggest that living in segregated neighborhoods influence access and utilization of mental health services differently for race/ethnic groups which contradicts findings that suggest living in ethnic enclaves is beneficial to health. PMID:23312305

Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses.

PubMed

Townley, Greg; Brusilovskiy, Eugene; Snethen, Gretchen; Salzer, Mark S

2018-03-01

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self-report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non-urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses. © Society for Community Research and Action 2017.

Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement.

PubMed

Im, Hyojin; Ferguson, Aidan; Hunter, Margaret

2017-01-01

Westernized approaches to mental health care often place limited emphasis on refugees' own experiences and cultural explanations of symptoms and distress. In order to effectively assess community mental health needs and develop interventions grounded in local needs, mental health programs need to be informed by an understanding of cultural features of mental health, including cultural idioms of distress (CIDs). The current study aims to explore CIDs among Somali refugees displaced in Kenya to understand mental health needs in cultural context and serve the community in a culturally responsive and sensitive manner. This research was conducted as a two-phase qualitative study. First, key informant interviews with Somali mental health stakeholders generated a list of 7 common Somali CIDs: buufis, buqsanaan, welwel, murug, qaracan, jinn, and waali. Typologies of each CID were further explored through four focus group interviews with Somali community members. The findings from a template analysis revealed Somali lay beliefs on how trauma and daily stressors are experienced and discussed in the form of CIDs and how each term is utilized and understood in attributing symptoms to associated causes. This study highlights the need to incorporate colloquial terms in mental health assessment and to adopt a culturally relevant framework to encourage wider utilization of services and religious/spiritual support systems.

Patients With High Mental Health Costs Incur Over 30 Percent More Costs Than Other High-Cost Patients.

PubMed

de Oliveira, Claire; Cheng, Joyce; Vigod, Simone; Rehm, Jürgen; Kurdyak, Paul

2016-01-01

A small proportion of health care users, called high-cost patients, account for a disproportionately large share of health care costs. Most literature on these patients has focused on the entire population. However, high-cost patients whose use of mental health care services is substantial are likely to differ from other members of the population. We defined a mental health high-cost patient as someone for whom mental health-related services accounted for at least 50 percent of total health care costs. We examined these patients' health care utilization and costs in Ontario, Canada. We found that their average cost for health care, in 2012 Canadian dollars, was $31,611. In contrast, the cost was $23,681 for other high-cost patients. Mental health high-cost patients were younger, lived in poorer neighborhoods, and had different health care utilization patterns, compared to other high-cost patients. These findings should be considered when implementing policies or interventions to address quality of care for mental health patients so as to ensure that mental health high-cost patients receive appropriate care in a cost-effective manner. Furthermore, efforts to manage mental health patients' health care use should address their complex profile through integrated multidisciplinary health care delivery. Project HOPE—The People-to-People Health Foundation, Inc.

Smartphone Ownership and Interest in Mobile Applications to Monitor Symptoms of Mental Health Conditions

PubMed Central

Friedman, Rohn; Keshavan, Matcheri

2014-01-01

Background Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in “real time” and “real life.” However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. Objective This paper aims to provide data on psychiatric patients’ prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. Methods One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Results Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Conclusions Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions. PMID:25098314

Smartphone ownership and interest in mobile applications to monitor symptoms of mental health conditions.

PubMed

Torous, John; Friedman, Rohn; Keshavan, Matcheri

2014-01-21

Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in "real time" and "real life." However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. This paper aims to provide data on psychiatric patients' prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions.

A descriptive analysis of medical health services utilization of Veterans living in Ontario: a retrospective cohort study using administrative healthcare data.

PubMed

Aiken, Alice B; Mahar, Alyson L; Kurdyak, Paul; Whitehead, Marlo; Groome, Patti A

2016-08-04

Health services utilization by Veterans following release may be different than the general population as the result of occupational conditions, requirements and injuries. This study provides the first longitudinal overview of Canadian Veteran healthcare utilization in the Ontario public health system. This is a retrospective cohort study designed to use Ontario's provincial healthcare data to study the demographics and healthcare utilization of Canadian Armed Forces (CAF) & RCMP Veterans living in Ontario. Veterans were eligible for the study if they released between January 1, 1990 and March 31, 2013. Databases at the Institute for Clinical Evaluative Sciences were linked by a unique identifier to study non-mental health related hospitalizations, emergency department visits, and physician visits. Overall and age-stratified descriptive statistics were calculated in five-year intervals following the date of release. The cohort is comprised of 23, 818 CAF or RCMP Veterans. Following entry into the provincial healthcare system, 82.6 % (95 % CI 82.1-83.1) of Veterans saw their family physician at least once over the first five years following release, 60.7 % (95 % CI 60.0-61.3) saw a non-mental health specialist, 40.8 % (95 % CI 40.2-41.5) went to the emergency department in that same time period and 9.9 % (9.5-10.3) were hospitalized for non-mental health related complaints. Patterns of non-mental health services utilization appeared to be time and service dependant. Stratifying health services utilization by age of the Veteran at entry into the provincial healthcare system revealed significant differences in service use and intensity. This study provides the first description of health services utilization by Veterans, following release from the CAF or RCMP. This work will inform the planning and delivery of support to Veterans in Ontario.

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.

PubMed

Behr, Joshua G; Diaz, Rafael

2016-01-01

First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. Primary data collection over an eight week period within a level-1 trauma urban hospital's emergency department. Representative randomized sample of 1,443 adult patients triaged ESI levels 4-5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.

Work activity in the process of recovery - an interpretive phenomenological analysis of the experiences of people with a schizophrenia spectrum diagnosis.

PubMed

Pańczak, Anna; Pietkiewicz, Igor

2016-01-01

Having the opportunity to work has been found meaningful for individuals suffering from severe mental illness, in order to boost their self-esteem, provide a sense of control over their lives and of belonging to a community. There are no studies in Polish literature on the process of recovery from schizophrenia with reference to work activity. The objective of this research was to explore personal experiences of people employed in Vocational Development Centers. Eight semi-structured interviews were conducted with adult patients. Their transcripts were subject to interpretative phenomenological analysis (IPA). Having the opportunity to work was significant for participants because it mobilized them and encouraged self-care. G oing to work helped them overcome social isolation by meeting people with similar difficulties and those who did not suffer from mental illness. Financial gratification enables a sense of independence and the ability to develop skills to plan and control their budget. This study finds that patients who lost their jobs due to mental illness should be encouraged to utilize rehabilitation institutions to help them undertake work activity and use previously acquired qualifications or develop new skills. Access to appropriate psychological support should be provided during vocation reorientation and adaptation into new work environments. This helps patients regain a sense of control and purpose, and cope with losing valued social roles. We also highlight the need for further studies into challenges in the workplace and the strategies patients use to cope with them.

Interface design in the process industries

NASA Technical Reports Server (NTRS)

Beaverstock, M. C.; Stassen, H. G.; Williamson, R. A.

1977-01-01

Every operator runs his plant in accord with his own mental model of the process. In this sense, one characteristic of an ideal man-machine interface is that it be in harmony with that model. With this theme in mind, the paper first reviews the functions of the process operator and compares them with human operators involved in control situations previously studied outside the industrial environment (pilots, air traffic controllers, helmsmen, etc.). A brief history of the operator interface in the process industry and the traditional methodology employed in its design is then presented. Finally, a much more fundamental approach utilizing a model definition of the human operator's behavior is presented.

Field Plan and Implementation Package for the Ethnographic Component of the Child and Family Mental Health Project Evaluation.

ERIC Educational Resources Information Center

Macias, Jose; And Others

This report contains the field plan and implementation procedures which were utilized for the observational/focused ethnographic component of Head Start's Child and Family Mental Health (CFMH) Evaluation Project. The introductory section of the document provides the reader with an overview of the Head Start program, its mental health goals, the…

The Influence of Bush Identity on Attitudes to Mental Health in a Queensland Community

ERIC Educational Resources Information Center

McColl, Lisa

2007-01-01

There are many factors that impact on mental health and the utilization of these services in the bush. The results from a three year ethnographic study in a bush community indicate that attitudes to mental health in this area of Queensland are influenced by bush identity, defined by reference to historical and current characteristics which include…

Teacher Stress Related to Student Mental Health Promotion: The Match between Perceived Demands and Competence to Help Students with Mental Health Problems

ERIC Educational Resources Information Center

Ekornes, Stine

2017-01-01

The present study highlights teacher stress related to student mental health promotion through the relationship between perceived competence, perceived responsibility and negative emotions. Data were derived from a mixed methods design, utilizing three focus group interviews (n = 15), followed by survey research (n = 771) amongst Norwegian K-12…

Mental health measurement among women veterans receiving co-located, collaborative care services.

PubMed

Lilienthal, Kaitlin R; Buchholz, Laura J; King, Paul R; Vair, Christina L; Funderburk, Jennifer S; Beehler, Gregory P

2017-12-01

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration's electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.

Using systems of care to reduce incarceration of youth with serious mental illness.

PubMed

Erickson, Chris D

2012-06-01

Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths' symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered.

The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research.

PubMed

Deacon, Brett J

2013-11-01

The biomedical model posits that mental disorders are brain diseases and emphasizes pharmacological treatment to target presumed biological abnormalities. A biologically-focused approach to science, policy, and practice has dominated the American healthcare system for more than three decades. During this time, the use of psychiatric medications has sharply increased and mental disorders have become commonly regarded as brain diseases caused by chemical imbalances that are corrected with disease-specific drugs. However, despite widespread faith in the potential of neuroscience to revolutionize mental health practice, the biomedical model era has been characterized by a broad lack of clinical innovation and poor mental health outcomes. In addition, the biomedical paradigm has profoundly affected clinical psychology via the adoption of drug trial methodology in psychotherapy research. Although this approach has spurred the development of empirically supported psychological treatments for numerous mental disorders, it has neglected treatment process, inhibited treatment innovation and dissemination, and divided the field along scientist and practitioner lines. The neglected biopsychosocial model represents an appealing alternative to the biomedical approach, and an honest and public dialog about the validity and utility of the biomedical paradigm is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Characterizing the Mental Health Care of U.S. Cambodian Refugees.

PubMed

Wong, Eunice C; Marshall, Grant N; Schell, Terry L; Berthold, S Megan; Hambarsoomians, Katrin

2015-09-01

This study examined U.S. Cambodian refugees' utilization of mental health services across provider types, levels of minimally adequate care, and mode of communication with providers. Face-to-face household interviews about mental health service use in the past 12 months were conducted as part of a study of a probability sample of Cambodian refugees. The analytic sample was restricted to the 227 respondents who met past 12-month criteria for posttraumatic stress disorder (PTSD) or major depressive disorder or both. Analyses were weighted to account for complex sampling design effects and for attrition. Fifty-two percent of Cambodian refugees who met diagnostic criteria obtained mental health services in the past 12 months. Of those who obtained care, 75% visited a psychiatrist and 56% a general medical provider. Only 7% had obtained care from other mental health specialty providers. Virtually all respondents who had seen a psychiatrist (100%) or a general medical doctor (97%) had been prescribed a psychotropic medication. Forty-five percent had received minimally adequate care. Most relied on interpreters to communicate with providers. Cambodian refugees' rates of mental health service utilization and minimally adequate care were comparable to those of individuals in the general U.S. Cambodian refugees obtained care almost entirely from psychiatrists and general medical doctors, and nearly all were receiving pharmacotherapy; these findings differ from rates seen in a nationally representative sample. Given this pattern of utilization, and the persistently high levels of PTSD and depression found among Cambodian refugees, treatment improvements may require identification of creative approaches to delivering more evidence-based psychotherapy.

Kennedy Axis V: Clinimetric properties assessed by mental health nurses.

PubMed

Faay, Margo D M; van de Sande, Roland; Gooskens, Floor; Hafsteinsdóttir, Thóra B

2013-10-01

The Kennedy Axis V is a routine outcome measurement instrument which can assist the assessment of the short-term risk for violence and other adverse patient outcomes. The purpose of this study was to evaluate the interrater reliability and clinical utility of the instrument when used by mental health nurses in daily care of patients with mental illness. This cross-sectional study was conducted in inpatient and outpatient adult psychiatric care units and in one adolescent inpatient unit at a university hospital in the Netherlands. Interrater reliability was measured based on the independent scores of two different nurses for the same patients. The clinical utility of the instrument was evaluated by means of a clinical utility questionnaire. To gain a deeper understanding of rating difficulties at the adolescent unit, additional data were collected in two focus group interviews. The overall results revealed a substantial level of agreement between nurses (intraclass correlation coefficient and Pearson 0.79). Some rating challenges were identified, including difficulties with scoring the instrument and using tailor-made interventions related to the scores. These challenges can be resolved using refined training and implementation strategies. When the Kennedy Axis V is accompanied by a solid implementation strategy in adult mental health care, the instrument can be used for short-term risk assessment and thereby contribute in efforts to reduce violence, suicide, self-harm, severe self-neglect, and enhanced objectivity in clinical decision-making. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

Utilization of Mental Health Services and Mental Health Status Among Children Placed in Out-of-Home Care: A Parallel Process Latent Growth Modeling Approach.

PubMed

Yampolskaya, Svetlana; Sharrock, Patty J; Clark, Colleen; Hanson, Ardis

2017-10-01

This longitudinal study examined the parallel trajectories of mental health service use and mental health status among children placed in Florida out-of-home care. The results of growth curve modeling suggested that children with greater mental health problems initially received more mental health services. Initial child mental health status, however, had no effect on subsequent service provision when all outpatient mental health services were included. When specific types of mental health services, such as basic outpatient, targeted case management, and intensive mental health services were examined, results suggested that children with compromised functioning during the baseline period received more intensive mental health services over time. However, this increased provision of intensive mental health services did not improve mental health status, rather it was significantly associated with progressively worse mental health functioning. These findings underscore the need for regular comprehensive mental health assessments focusing on specific needs of the child.

Quality of life instruments used in mental health research: properties and utilization.

PubMed

Prigent, Amélie; Simon, Sandrine; Durand-Zaleski, Isabelle; Leboyer, Marion; Chevreul, Karine

2014-01-30

Quality of life (QoL) assessment is increasingly used in mental health. Multiple instruments exist, but the conditions for choosing one instrument over another for purposes of a specific study are not clear. We performed a systematic review to identify the QoL instruments used in mental health. The instruments were systematically described regarding their intrinsic properties (e.g., generic v. disease-specific) and their characteristics of utilization in studies (e.g., study objectives). Using cluster analyses, we investigated the existence of similar instruments with respect to each of these sets of characteristics and studied potential links between instruments' intrinsic properties and their characteristics of utilization. We included 149 studies in which 56 distinct instruments were used. Similarities were found among instruments in terms of their intrinsic properties as well as their characteristics of utilization, leading to the construction of four clusters of instruments in each case. However, no relevant links were identified between instruments' intrinsic properties and their characteristics of utilization, suggesting that the choice of QoL instruments did not depend on their properties. A consensus about common QoL instruments must be reached to facilitate the choice of instruments, the comparison of results and thus to have an impact on clinical and policy decision-making. © 2013 Published by Elsevier Ireland Ltd.

The influence of psychological symptoms on mental health literacy of college students.

PubMed

Kim, Jin E; Saw, Anne; Zane, Nolan

2015-11-01

Psychological problems, such as depression and anxiety, are common among college students, but few receive treatment for it. Mental health literacy may partially account for low rates of mental health treatment utilization. We report 2 studies that investigated mental health literacy among individuals with varying degrees of psychological symptoms, using cross-sectional online survey methodology. Study 1 involved 332 college students, of which 32% were categorized as high depressed using an established measure of depression, and mental health literacy for depression was assessed using a vignette. Logistic regression results showed that high depressed individuals were less likely to recognize depression compared to low depressed individuals, and depression recognition was associated with recommendations to seek help. Study 2 replicated and extended findings of Study 1 using a separate sample of 1,321 college students with varying degrees of psychological distress (32% no/mild distress, 55% moderate distress, and 13% serious distress) and examining mental health literacy for anxiety in addition to depression. Results indicated that compared to those with no/mild distress, those with moderate distress had lower recognition of depression, and those with moderate and serious distress were less likely to recommend help-seeking. In contrast, there were no differences in mental health literacy for anxiety, which was low across all participants. These findings suggest that psychological symptoms can impact certain aspects of mental health literacy, and these results have implications for targeting mental health literacy to increase mental health services utilization among individuals in need of help. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Domestic violence and treatment seeking: a longitudinal study of low-income women and mental health/substance abuse care.

PubMed

Cheng, Tyrone C; Lo, Celia C

2014-01-01

A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.

Self-compassion and emotional invalidation mediate the effects of parental indifference on psychopathology.

PubMed

Westphal, Maren; Leahy, Robert L; Pala, Andrea Norcini; Wupperman, Peggilee

2016-08-30

This study investigated whether self-compassion and emotional invalidation (perceiving others as indifferent to one's emotions) may explain the relationship of childhood exposure to adverse parenting and adult psychopathology in psychiatric outpatients (N=326). Path analysis was used to investigate associations between exposure to adverse parenting (abuse and indifference), self-compassion, emotional invalidation, and mental health when controlling for gender and age. Self-compassion was strongly inversely associated with emotional invalidation, suggesting that a schema that others will be unsympathetic or indifferent toward one's emotions may affect self-compassion and vice versa. Both self-compassion and emotional invalidation mediated the relationship between parental indifference and mental health outcomes. These preliminary findings suggest the potential utility of self-compassion and emotional schemas as transdiagnostic treatment targets. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sex differences in mental rotation with polygons of different complexity: Do men utilize holistic processes whereas women prefer piecemeal ones?

PubMed

Heil, Martin; Jansen-Osmann, Petra

2008-05-01

Sex differences in mental rotation were investigated as a function of stimulus complexity with a sample size of N = 72. Replicating earlier findings with polygons, mental rotation was faster for males than for females, and reaction time increased with more complex polygons. Additionally, sex differences increased for complex polygons. Most importantly, however, mental rotation speed decreased with increasing complexity for women but did not change for men. Thus, the sex effects reflect a difference in strategy, with women mentally rotating the polygons in an analytic, piecemeal fashion and men using a holistic mode of mental rotation.

The Effects of Religion and Locus of Control on Perception of Mental Illness.

PubMed

Amedome, Sedem Nunyuia; Bedi, Innocent Kwame

2018-06-23

The study investigated the influence of religion and locus of control on perception of mental illness. Specifically, the study explored the relationship between religiosity and perception of mental illness, differences in perception by internals and externals, the effect of knowledge on perception of mental illness and the interactive effect of religiosity and locus of control on perception of mental illness. Data were collected from 200 participants in the Volta Region of Ghana. Three hypotheses were tested in the study using a battery of tests. It was observed that people with internal locus of control perceive mental patients positively than those with external locus of control. A significant interactive effect between religiosity and locus of control on perception of mental illness was observed. Religiosity significantly relates to perception of mental illness. The results and implications are discussed for further studies.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

PubMed

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Mental health service utilization in the U.S. Army.

PubMed

McKibben, Jodi B A; Fullerton, Carol S; Gray, Christine L; Kessler, Ronald C; Stein, Murray B; Ursano, Robert J

2013-04-01

U.S. Army personnel experience significant burden from mental disorders, particularly during times of war and with multiple deployments. This study identified the rates and predictors of mental health service use by Army soldiers and examined the association of daily functioning with the various types of mental health service use. This study used the U.S. Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel, which sampled 10,400 Army soldiers, representing 508,088 soldiers. Mental health service utilization over a 12-month period included receiving counseling or therapy from a general medical doctor, receiving counseling or therapy from a mental health professional, and being prescribed medications for depression, anxiety, or sleep. Current functioning was assessed with the Health-Related Quality of Life-4 instrument. Of the active U.S. Army, 21% had used mental health services in the previous 12 months, and 48% of them had used two or more services. About 7% of soldiers saw a mental health specialist and were prescribed medication. Women (incidence rate ratio [IRR]=1.39, 95% confidence interval [CI]=1.19-1.63) and enlisted soldiers (IRR=1.93, CI=1.49-2.50) were more likely than others to use a greater number of services. Soldiers with higher versus lower levels of impaired functioning were 7.82 times more likely (CI=6.03-10.14) to use mental health services, 4.40 times more likely (CI=3.83-5.05) to use more services, and 3.18 times more likely (CI=1.85-5.49) to see a mental health specialist and to be prescribed medication. A substantial proportion of the Army accesses mental health services. Soldiers using the highest levels of care had the greatest impairment.

Intimate partner violence and alcohol, drug, and mental disorders among American Indian women in primary care.

PubMed

Duran, Bonnie; Oetzel, John; Parker, Tassy; Malcoe, Lorraine Halinka; Lucero, Julie; Jiang, Yizhou

2009-01-01

The relationship of intimate partner violence (IPV) with mental disorders was investigated among 234 American Indian/Alaska Native female primary care patients. Results indicated that unadjusted prevalence ratios for severe physical or sexual abuse (relative to no IPV) were significant for anxiety, PTSD, mood, and any mental disorder. Adjusted prevalence ratios showed severe physical or sexual IPV to be associated with any mood disorder. Patterns of IPV and mental health have implications for detection and service utilization.

Do soldiers seek more mental health care after deployment? Analysis of mental health consultations in the Netherlands Armed Forces following deployment to Afghanistan

PubMed Central

Taal, Elisabeth (Liesbeth) M.; Vermetten, Eric; van Schaik, Digna (Anneke) J. F.; Leenstra, Tjalling

2014-01-01

Background Military deployment to combat zones puts military personnel to a number of physical and mental challenges that may adversely affect mental health. Until now, few studies have been performed in Europe on mental health utilization after military deployment. Objective We compared the incidence of mental health consultations with the Military Mental Health Service (MMHS) of military deployed to Afghanistan to that of non-deployed military personnel. Method We assessed utilization of the MMHS by the full cohort of the Netherlands Armed Forces enlisted between 2008 and 2010 through linkage of mental health and human resource information systems. Results The total population consisted of 50,508 military (18,233 deployed, 32,275 non-deployed), who accounted for 1,906 new consultations with the MMHS. The follow-up was limited to the first 2 years following deployment. We observed higher mental health care utilization in deployed vs. non-deployed military personnel; hazard ratio (HR), adjusted for sex, military branch and time in service, 1.84 [95% CI 1.61–2.11] in the first and 1.28 [1.09–1.49] in the second year after deployment. An increased risk of adjustment disorders (HR 2.59 [2.02–3.32] and 1.74 [1.30–2.32]) and of anxiety disorders (2.22 [1.52–3.25] and 2.28 [1.50–3.45]) including posttraumatic stress disorder (5.15 [2.55–10.40] and 5.28 [2.42–11.50]), but not of mood disorders (1.33 [0.90–1.97] and 1.11 [0.68–1.82]), was observed in deployed personnel in the first- and second-year post-deployment, respectively. Military personnel deployed in a unit with a higher risk of confrontation with potentially traumatic events had a higher HR (2.13 [1.84–2.47] and 1.40 [1.18–1.67]). Conclusions Though absolute risk was low, in the first and second year following deployment to Afghanistan there was an 80 and 30% higher risk for mental health problems resulting in a consultation with the Dutch MMHS compared to military never deployed to Afghanistan. These observations underscore the need for an adequate mental health infrastructure for those returning from deployment. PMID:25206952

Information Alchemy: Transforming Information through Knowledge Utilization.

ERIC Educational Resources Information Center

Backer, Thomas E.

1993-01-01

Provides an overview of knowledge utilization, what it encompasses, and its three waves of activity in America. Basic principles and strategies to consider are listed, and an example of how knowledge utilization is applied by the Center for Mental Health Services is given. (17 references) (EA)

Individualized Educational Programming for the Mentally Retarded.

ERIC Educational Resources Information Center

Singh, Nirbhay N.; Ahrens, Michael G.

1980-01-01

The minimal components of a model which utilizes a computer for summarizing individual performance records for teaching educational skills to the mentally retarded are described. The most important components are assessment, individual and group programing, continuous data collection, and program evaluation. (Author)

Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial.

PubMed

Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M

2018-02-01

To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.

Attitudes, Skills and Knowledge Change in Child and Adolescent Mental Health Workers Following AOD Screening and Brief Intervention Training

ERIC Educational Resources Information Center

Christie, Grant; Black, Stella; Dunbar, Lucy; Pulford, Justin; Wheeler, Amanda

2013-01-01

Adolescent mental health workers are generally poor at identifying and treating co-existing alcohol and other drug (AOD) disorder. This study aimed to evaluate the utility and acceptability of an AOD screening and brief intervention (BI) training package delivered to child and adolescent mental health workers and its impact on relevant attitudes,…

Utilizing Ericksonian hypnosis in psychiatric-mental health nursing practice.

PubMed

Zahourek, Rothlyn P

2002-01-01

Ericksonian hypnosis conceptual framework. To acquaint psychiatric-mental health nurses with hypnotic principles and how these can be integrated into their practice. Published literature and author's clinical experience. Ericksonian hypnosis offers an array of potential interventions for psychiatric-mental health nurses to integrate into their practices in a framework familiar to nurses: holism, honoring and respecting individuality, and capitalizing on an individual's strengths.

Geography of Service Delivery: On the Role of Mental Health Service Structure in Community Senior Services for Puerto Rican Older Adults

ERIC Educational Resources Information Center

Velez Ortiz, Daniel

2009-01-01

The main purpose of this study was to examine the role of mental health services structure in community senior centers and how it interacts with Puerto Rican older adults' historical, social, and cultural experiences to relate to their perceptions, awareness, and utilization of mental health services. The study was carried out within a concurrent…

Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis

PubMed Central

Sweeney, Shaun; Air, Tracy; Zannettino, Lana; Galletly, Cherrie

2015-01-01

The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services. PMID:26636059

Latino suicidal adolescent psychosocial service utilization: The role of mood fluctuations and inattention.

PubMed

Alonzo, Dana; Conway, Anne; Modrek, Anahid S

2016-01-15

Little is known about the specific factors related to whether or not Latino adolescents with suicide ideation (SI) will seek services. Utilizing Andersen's Behavior Model of Health Services Use (2008) the goal of this study is to identify the factors related to utilization of mental health services by Latino adolescents with SI to inform and improve suicide prevention efforts. Data from Wave 1 of the National Longitudinal Study of Adolescent Health was examined. Predispositional (gender, age), enabling/disabling (income, lack of insurance, difficulty obtaining medical care), and need (depressed mood, suicide attempt, perceived health, impulsivity, mood fluctuations, difficulties with attention, etc.) variables were examined via logistic regression as potential correlates of mental health service utilization. Twenty-eight percent of the Latino adolescents with suicidal ideation (SI) in our sample received mental health services. Need factors such as daily mood fluctuations within the past 12 months (OR=4.78) and frequent difficulty focusing attention within the past week (OR=4.96), but not impulsivity, were associated with an increased likelihood of receiving mental health services. No additional associations were observed. The current study is based on cross-sectional data. Therefore, statements about causality cannot be made. These findings suggest that emotion regulation (e.g., daily mood fluctuations) and neurocognitive factors (e.g., difficulty with focusing attention) may be important factors to consider in the clinical assessment of Latino adolescents with SI. Copyright © 2015. Published by Elsevier B.V.

Utilization and Economic Contribution of Psychiatric Mental Health Nurse Practitioners in Public Behavioral Health Services.

PubMed

Chapman, Susan A; Phoenix, Bethany J; Hahn, Talia E; Strod, Deborah C

2018-06-01

Expanded insurance coverage through the Affordable Care Act and parity in behavioral health coverage have increased demand for services. Yet there is a persistent shortage in the behavioral health workforce. Psychiatric Mental Health Nurse Practitioners (PMHNPs) may be part of the solution to shortages but are not yet fully utilized. The purpose of this study was to describe how PMHNPs are utilized, identify barriers to full utilization, and assess PMHNPs' economic contribution in public behavioral health systems. This study used a mixed methods approach, selecting counties for use of PMHNPs, geography, population size, rural/urban, and availability of financial data. The authors conducted 1- to 2-day site visits in 2014-2015 including semi-structured interviews with management and clinical leaders and collected PMHNP staffing and billing data. Thematic analysis of interview data was conducted and aggregate staffing and billing data were analyzed to determine net PMHNP financial contribution. The primary billed service for PMHNPs is medication management. Barriers to full utilization included system-level barriers to hiring PMHNPs, lack of role-appropriate job descriptions, confusion related to scope of practice/supervision requirements, and challenges in recruitment and retention. Fiscal analysis showed a positive net contribution from PMHNP services. PMHNPs can make a significant contribution to behavioral healthcare delivery, particularly in public mental health settings, yet greater understanding of their role and addressing barriers to practice is needed. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Mental Imagery: Functional Mechanisms and Clinical Applications

PubMed Central

Pearson, Joel; Naselaris, Thomas; Holmes, Emily A.; Kosslyn, Stephen M.

2015-01-01

Mental imagery research has weathered both disbelief of the phenomenon and inherent methodological limitations. Here we review recent behavioral, brain imaging, and clinical research that has reshaped our understanding of mental imagery. Research supports the claim that visual mental imagery is a depictive internal representation that functions like a weak form of perception. Brain imaging work has demonstrated that neural representations of mental and perceptual images resemble one another as early as the primary visual cortex (V1). Activity patterns in V1 encode mental images and perceptual images via a common set of low-level depictive visual features. Recent translational and clinical research reveals the pivotal role that imagery plays in many mental disorders and suggests how clinicians can utilize imagery in treatment. PMID:26412097

Costs and Resource Utilization Among Medicaid Patients with Schizophrenia Treated with Paliperidone Palmitate or Oral Atypical Antipsychotics.

PubMed

Pesa, Jacqueline A; Muser, Erik; Montejano, Leslie B; Smith, David M; Meyers, Oren I

Non-adherence to antipsychotic therapy among patients with schizophrenia is a key driver of relapse, which can lead to costly inpatient stays. Long-acting injectables (LAIs) may improve adherence, thus reducing hospitalizations, but inpatient cost reductions need to be balanced against higher drug acquisition costs of LAIs. Real-world evidence is needed to help quantify the economic value of oral atypical antipsychotics compared with LAIs. The objective of this study was to compare healthcare costs and resource utilization between once-monthly paliperidone palmitate (PP) and oral antipsychotic therapy (OAT) in a population of Medicaid beneficiaries with schizophrenia. A retrospective, observational study was performed using Truven Health MarketScan Medicaid claims data from 2009 to 2012. Marginal structural modeling, a form of weighted repeated measures analysis to control for differences between cohorts and time-varying confounding, was used to estimate monthly costs of care in 2012 US dollars and resource utilization over a 12-month period for patients in each cohort. While per-month mental-health prescription costs were US$1019 higher in the PP cohort, approximately 55 % of this premium was offset by lower inpatient and outpatient care costs, producing a mean monthly total cost differential of US$434 (95 % CI 298-569, p  < 0.0001) for all-cause costs and US$463 (95 % CI 374-552, p  < 0.0001) for mental-health-related costs. Use of PP also resulted in a 0.44 and 0.47 reduction in the odds of all-cause and mental-health-related hospitalizations and a 0.09 reduction in the odds of all-cause emergency department visits ( p  < 0.0001, p  < 0.0001, and p  = 0.0134, respectively) over the 12-month follow-up period. Treatment with long-acting injectable antipsychotics, such as PP, may reduce inpatient and outpatient healthcare services utilization and associated costs. These findings also suggest that patients with schizophrenia taking once-monthly PP may stand a lower risk of hospitalization than patients on OAT.

The stigma of mental illness in the labor market.

PubMed

Hipes, Crosby; Lucas, Jeffrey; Phelan, Jo C; White, Richard C

2016-03-01

Mental illness labels are accompanied by devaluation and discrimination. We extend research on reactions to mental illness by utilizing a field experiment (N = 635) to test effects of mental illness labels on labor market discrimination. This study involved sending fictitious applications to job listings, some applications indicating a history of mental illness and some indicating a history of physical injury. In line with research indicating that mental illness leads to stigma, we predicted fewer callbacks to candidates with mental illness. We also predicted relatively fewer callbacks for applicants with mental illness when the jobs involved a greater likelihood for interpersonal contact with the employer. Results showed significant discrimination against applicants with mental illness, but did not indicate an effect of potential proximity to the employer. This contributes a valuable finding in a natural setting to research on labor market discrimination towards people with mental illness. Copyright © 2015 Elsevier Inc. All rights reserved.

The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies.

PubMed

Kohrt, Brandon A; Asher, Laura; Bhardwaj, Anvita; Fazel, Mina; Jordans, Mark J D; Mutamba, Byamah B; Nadkarni, Abhijit; Pedersen, Gloria A; Singla, Daisy R; Patel, Vikram

2018-06-16

Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan , the World Bank’s Disease Control Priorities , and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs.

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder.

PubMed

Sharif, Farkhondeh; Zarei, Shekufe; Alavi Shooshtari, Ali; Vossoughi, Mehrdad

2015-06-01

Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children. The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder. In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions. At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001). The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder.

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder

PubMed Central

Sharif, Farkhondeh; Zarei, Shekufe; Alavi Shooshtari, Ali; Vossoughi, Mehrdad

2015-01-01

Background: Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children. Objectives: The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder. Patients and Methods: In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions. Results: At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001). Conclusions: The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder. PMID:26199709

Mental and Physical Health Needs of Lesbian, Gay, and Bisexual Clients in Substance Abuse Treatment.

PubMed

Flentje, Annesa; Livingston, Nicholas A; Roley, Jason; Sorensen, James L

2015-11-01

Lesbian, gay, and bisexual (LGB) orientation predicts greater substance use, treatment utilization, and poorer mental and physical health, but health needs of LGB individuals in substance abuse treatment remain largely unknown. The purpose of this study was to identify differences in mental and physical health needs of LGB individuals in substance abuse treatment. Substance abuse treatment admissions data from the County of San Francisco were used in this investigation of differences in mental and physical health problems and service utilization between LGB (n=1,441) and heterosexual individuals (n=11,770). LGB individuals were more likely to have mental health diagnoses (adjORs ranging from 1.86 to 4.00) and current mental health prescription medications (adjORs from 1.79 to 4.99) than heterosexual counterparts. Gay and bisexual men and bisexual women but not lesbian women, were more likely to be receiving mental health treatment. Gay men and bisexual women were more likely than heterosexual counterparts to report physical health problems. Gay and bisexual men and bisexual women but not lesbian women were more likely to be receiving health care. There were no differences between LGB individuals and heterosexual counterparts in the number of emergency room visits or hospital overnight stays. This study found that LGB individuals entering substance abuse treatment have greater mental and physical health needs than heterosexual counterparts. Implications for healthcare integration, research, and practice are discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

A Feasibility Trial of Mental Health First Aid First Nations: Acceptability, Cultural Adaptation, and Preliminary Outcomes.

PubMed

Crooks, Claire V; Lapp, Andrea; Auger, Monique; van der Woerd, Kim; Snowshoe, Angela; Rogers, Billie Jo; Tsuruda, Samantha; Caron, Cassidy

2018-03-25

The Mental Health First Aid First Nations course was adapted from Mental Health First Aid Basic to create a community-based, culturally safe and relevant approach to promoting mental health literacy in First Nations contexts. Over 2.5 days, the course aims to build community capacity by teaching individuals to recognize and respond to mental health crises. This feasibility trial utilized mixed methods to evaluate the acceptability, cultural adaptation, and preliminary effectiveness of MHFAFN. Our approach was grounded in community-based participatory research principles, emphasizing relationship-driven procedures to collecting data and choice for how participants shared their voices. Data included participant interviews (n = 89), and surveys (n = 91) from 10 groups in four provinces. Surveys contained open-ended questions, retrospective pre-post ratings, and a scenario. We utilized data from nine facilitator interviews and 24 facilitator implementation surveys. The different lines of evidence converged to highlight strong acceptability, mixed reactions to the cultural adaptation, and gains in participants' knowledge, mental health first aid skill application, awareness, and self-efficacy, and reductions in stigma beliefs. Beyond promoting individual gains, the course served as a community-wide prevention approach by situating mental health in a colonial context and highlighting local resources and cultural strengths for promoting mental well-being. © 2018 The Authors American Journal of Community Psychology published by Wiley Periodicals, Inc. on behalf of Society for Community Research and Action.

Sexual trauma in the military: Exploring PTSD and mental health care utilization in female veterans.

PubMed

Kintzle, Sara; Schuyler, Ashley C; Ray-Letourneau, Diana; Ozuna, Sara M; Munch, Christopher; Xintarianos, Elizabeth; Hasson, Anthony M; Castro, Carl A

2015-11-01

Sexual trauma remains a pervasive problem in the military. The deleterious mental health outcomes related to incidents of sexual assault have been well-documented in the literature, with particular attention given to the development of posttraumatic stress disorder (PTSD) and utilization of mental health services. Much effort has focused on addressing issues of sexual trauma in the military. The purpose of this study was to examine the incidences of sexual assault in female veterans, the relationship to PTSD and mental health care utilization. The research explored differences in pre- and post-9/11 veterans. Data were collected using a 6-prong recruitment strategy to reach veterans living in Southern California. A total of 2,583 veterans completed online and in-person surveys, of which 325 female veterans were identified for inclusion in the analysis. Forty percent of the sample reported experiencing sexual assault during their military service. A history of military sexual trauma was found to be a substantial contributor to symptoms of PTSD. A majority of female veterans who indicated being sexually assaulted during their military service met the cutoff for a diagnosis of PTSD. Although only a minority of participants who indicated being a victim of sexual assault reported receiving immediate care after the incident, most had received mental health counseling within the past 12 months. Findings point to the need for additional prevention programs within the military and opportunities for care for victims of military sexual assault. (c) 2015 APA, all rights reserved).

Massively multiplayer online role-playing games (MMORPG): association between its addiction, self-control and mental disorders among young people in Vietnam.

PubMed

Son, Dinh Thai; Yasuoka, Junko; Poudel, Krishna C; Otsuka, Keiko; Jimba, Masamine

2013-09-01

To explore the association between MMORPG addiction and mental health status, and between self-control ability and mental health status among young male MMORPG players in Hanoi, Vietnam. In this cross-sectional study, 10 computer game rooms were randomly selected out of 77 in five communes in Hanoi. From these game rooms, 350 MMORPG players were purposively recruited as a study group, of whom 344 completed the questionnaire. In the same five communes, 344 non-players were selected as a control group. An online game addiction scale, a self-control scale and the Vietnamese SRQ-20 were used to measure the degree of MMORPG addiction, self-control ability and level of mental disorders. MMORPG players had significantly higher mental disorders scale scores than non-players (p < .001). The strongest positive correlation was detected between MMORPG addiction scale scores and mental disorders scale scores (r = 0.730, p < .001). Self-control scale scores were negatively associated with mental disorders scale scores (r = -0.345, p < .001). The average amount of money spent on games per month, MMORPG addiction scale score and self-control scale score were considered the best predictors of a higher mental disorders scale score. Young, male MMORPG players with higher addiction scores were more likely to have higher mental disorders scale scores, and such mental status was negatively associated with the level of self-control in Hanoi, Vietnam. Closer attention should be paid to prevent mental disorders among MMORPG players.

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study

PubMed Central

2016-01-01

Objectives First, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model. Data Source Primary data collection over an eight week period within a level-1 trauma urban hospital’s emergency department. Study Design Representative randomized sample of 1,443 adult patients triaged ESI levels 4–5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios. Principal Findings 70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance. Conclusions Interventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization. PMID:26784515

Organizational Characteristics of Veterans Affairs Clinics With High and Low Utilization of Clozapine.

PubMed

Gören, Jessica L; Rose, Adam J; Engle, Ryann L; Smith, Eric G; Christopher, Melissa L D; Rickles, Nathaniel M; Semla, Todd P; McCullough, Megan B

2016-11-01

Twenty to thirty percent of patients with schizophrenia experience treatment resistance. Clozapine is the only medication proven effective for treatment-resistant schizophrenia. However, in most settings less than 25% of patients with treatment-resistant schizophrenia receive clozapine. This study was conducted to identify facilitators of and barriers to clozapine use to inform development of interventions to maximize appropriate clozapine utilization. Seventy semistructured phone interviews were conducted with key informants of clozapine processes at U.S. Department of Veterans Affairs medical centers in various U.S. regions, including urban and rural areas, with high (N=5) and low (N=5) rates of clozapine utilization. Interviewees included members of mental health leadership, psychiatrists, clinical pharmacists, and advanced practice nurses. Interviews were analyzed by using an emergent thematic strategy to identify barriers and facilitators related to clozapine prescribing. High utilization was associated with integration of nonphysician psychiatric providers and clear organizational processes and infrastructure for treatment of severe mental illness, for example, use of clozapine clinics and mental health intensive case management. Low utilization was associated with a lack of champions to support clozapine processes and with limited-capacity care systems. Obstacles identified at both high- and low-utilization sites included complex, time-consuming paperwork; reliance on a few individuals to facilitate processes; and issues related to transportation for patients living far from care facilities. Implementation efforts to organize, streamline, and simplify clozapine processes; development of a multidisciplinary clozapine clinic; increased capacity of existing clinics; and provision of transportation are reasonable targets to increase clozapine utilization.

Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.

PubMed

Grove, Lexie R; Olesiuk, William J; Ellis, Alan R; Lichstein, Jesse C; DuBard, C Annette; Farley, Joel F; Jackson, Carlos T; Beadles, Christopher A; Morrissey, Joseph P; Domino, Marisa Elena

2017-07-01

Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home. We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence. A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence. Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia. Copyright © 2017 Elsevier Inc. All rights reserved.

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

PubMed

McManus, Moira C; Cramer, Robert J; Boshier, Maureen; Akpinar-Elci, Muge; Van Lunen, Bonnie

2018-01-13

Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. 'Other' ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal 'need', including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

Family culture in mental health help-seeking and utilization in a nationally representative sample of Latinos in the United States: The NLAAS.

PubMed

Villatoro, Alice P; Morales, Eduardo S; Mays, Vickie M

2014-07-01

Considering the central role of familismo in Latino culture, it is important to assess the extent to which familismo affects mental health help-seeking. This study examined the role of behavioral familismo, the level of perceived family support, in the use of mental health services of Latinos in the United States. Data come from the National Latino and Asian American Study (NLAAS), a representative household survey examining the prevalence of mental disorders and services utilization among Latinos and Asian Americans. Analyses were limited to Latino adults with a clinical need for mental health services, indexed by meeting DSM-IV diagnostic criteria for any mood, anxiety, or substance use disorder during the past 12 months (N = 527). One-third of Latinos with a clinical need used any type of service in the past year, including specialty mental health, general medical, and informal or religious services. High behavioral familismo was significantly associated with increased odds of using informal or religious services, but not specialty or medical services. Self-perceived need and social perceptions of need for care within close networks (i.e., told by family/friends to seek professional help) also were significant predictors of service use. These results carry important implications toward expansions of the mental health workforce in the informal and religious services settings.

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services.

PubMed

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J; Sardinha, Lynnmarie; Feder, Gene Solomon

2016-01-01

Domestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Our goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse. Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70-81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services.

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services

PubMed Central

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J.; Sardinha, Lynnmarie; Feder, Gene Solomon

2016-01-01

Background Domestic violence and abuse (DVA) are associated with increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Objective Our goal was to characterise the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Design Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors were analysed. We report the prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. The following mental health measures were used: Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalised Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale to measure posttraumatic stress disorder (PTSD). The Composite Abuse Scale (CAS) measured abuse. Results Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70–81%). Depression and anxiety levels were high, with means close to clinical thresholds, and more than three-quarters of respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Conclusions Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services. PMID:26860876

Domestic violence and mental health: a cross-sectional survey of women seeking help from domestic violence support services

PubMed Central

Ferrari, Giulia; Agnew-Davies, Roxane; Bailey, Jayne; Howard, Louise; Howarth, Emma; Peters, Tim J.; Sardinha, Lynnmarie; Feder, Gene

2014-01-01

Background Domestic violence and abuse (DVA) are associated with an increased risk of mental illness, but we know little about the mental health of female DVA survivors seeking support from domestic violence services. Objective To characterize the demography and mental health of women who access specialist DVA services in the United Kingdom and to investigate associations between severity of abuse and measures of mental health and health state utility, accounting for important confounders and moderators. Design Baseline data on 260 women enrolled in a randomized controlled trial of a psychological intervention for DVA survivors was analyzed. We report prevalence of and associations between mental health status and severity of abuse at the time of recruitment. We used logistic and normal regression models for binary and continuous outcomes, respectively. Mental health measures used were: Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM), Patient Health Questionnaire, Generalized Anxiety Disorder Assessment, and the Posttraumatic Diagnostic Scale (PDS) to measure posttraumatic stress disorder. The Composite Abuse Scale (CAS) measured abuse. Results Exposure to DVA was high, with a mean CAS score of 56 (SD 34). The mean CORE-OM score was 18 (SD 8) with 76% above the clinical threshold (95% confidence interval: 70–81%). Depression and anxiety levels were high, with means close to clinical thresholds, and all respondents recorded PTSD scores above the clinical threshold. Symptoms of mental illness increased stepwise with increasing severity of DVA. Conclusions Women DVA survivors who seek support from DVA services have recently experienced high levels of abuse, depression, anxiety, and especially PTSD. Clinicians need to be aware that patients presenting with mental health conditions or symptoms of depression or anxiety may be experiencing or may have experienced DVA. The high psychological morbidity in this population means that trauma-informed psychological support is needed for survivors who seek support from DVA services. PMID:25319597

Mental health needs of children and adolescents at camp: are they being assessed and treated appropriately by the camp nurse?

PubMed

Courey, Tamra J

2006-11-01

Increasingly, more children and adolescents are attending camps with mental health concerns. This can pose a challenge for camp nurses who may lack experience in assessment and treatment of mental health issues. To focus on the importance of addressing and treating mental health needs of children and adolescents at camp utilizing the Scope and Standards of Psychiatric Mental Health Nursing Practice. Personal observations, camp nursing experience, and scholarly published literature. It is paramount that mental health needs of children and adolescents at camp are addressed and managed appropriately by the camp nurse. Education of camp nurses and camp administrators is also a vital part of providing care.

Unique Characteristics of High-Cost Users of Medical Care With Comorbid Mental Illness or Addiction in a Population-Based Cohort.

PubMed

Hensel, Jennifer M; Taylor, Valerie H; Fung, Kinwah; de Oliveira, Claire; Vigod, Simone N

To understand whether high-cost users of medical care with and without comorbid mental illness or addiction differ in terms of their sociodemographic and health characteristics. Unique characteristics would warrant different considerations for interventions and service design aimed at reducing unnecessary health care utilization and associated costs. From the top 10% of Ontarians ranked by total medical care costs during fiscal year 2011/2012 (N = 314,936), prior 2-year mental illness or addiction diagnoses were determined from administrative data. Sociodemographics, medical illness characteristics, medical costs, and utilization were compared between those high-cost users of medical care with and without comorbid mental illness or addiction. Odds of being a frequent user of inpatient (≥3 admissions) and emergency (≥5 visits) services were compared between groups, adjusting for age, sex, socioeconomic status and medical illness characteristics. High-cost users of medical care with comorbid mental illness or addiction were younger, had a lower socioeconomic status, had greater historical medical morbidity, and had higher total medical care costs (mean excess of $2,031/user) than those without. They were more likely to be frequent users of inpatient (12.8% vs 10.2%; adjusted OR, 1.14; 95% CI: 1.12-1.17) and emergency (8.4% vs 4.8%; adjusted OR, 1.55; 95% CI: 1.50-1.59) services. Effect sizes were larger in major mood, psychotic, and substance use disorder subgroups. High-cost medical care users with mental illness or addiction have unique characteristics with respect to sociodemographics and service utilization patterns to consider in interventions and policies for this patient group. Copyright © 2018 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.

Mental health nurses and mental health peer workers: Self-perceptions of role-related clinical competences.

PubMed

Debyser, Bart; Duprez, Veerle; Beeckman, Dimitri; Vandewalle, Joeri; Van Hecke, Ann; Deproost, Eddy; Verhaeghe, Sofie

2018-06-01

In a mental healthcare that embraces a recovery-oriented practice, the employment of mental health peer workers is encouraged. Although peer workers are increasingly working together with nurses, there is a lack of research that explores how nurses and peer workers perceive their role-related competences in clinical practice. The aim of this study was to clarify and understand these self-perceptions in order to identify the specificity and potential complementarity of both roles. This insight is needed to underpin a successful partnership between both vocations. A qualitative descriptive research design based on principles of critical incident methodology was used. Twelve nurses and eight peer workers from different mental healthcare organizations participated. A total of 132 reported cases were analysed. Rigour was achieved through thick description, audit trail, investigator triangulation and peer review. Nurses relate their role-related competences predominantly with being compliant with instructions, being a team player and ensuring security and control. Peer workers relate their role-related competences with being able to maintain themselves as a peer worker, building up a relationship that is supportive for both the patient and themselves, and to utilize their lived experience. Both nurses and peer workers assign a major role to the team in determining their satisfaction with their competences. Consequently, what is perceived as important for the team appears to overshadow their self-assessment of competences. The findings highlighted the importance of paying more attention to identity construction, empowerment and role competence development of nurses and peer workers in their respective education and ongoing training. © 2017 Australian College of Mental Health Nurses Inc.

Coping skills and mental health status in adolescents when a parent has cancer: a multicenter and multi-perspective study.

PubMed

Krattenmacher, Thomas; Kühne, Franziska; Führer, Daniel; Beierlein, Volker; Brähler, Elmar; Resch, Franz; Klitzing, Kai v; Flechtner, Hans-Henning; Bergelt, Corinna; Romer, Georg; Möller, Birgit

2013-03-01

Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated. In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being. We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health. The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers.

PubMed

Brooks, Helen L; Lovell, Karina; Bee, Penny; Sanders, Caroline; Rogers, Anne

2018-06-01

It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services. Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users. Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

Improving the outcomes of children affected by parental substance abuse: a review of randomized controlled trials

PubMed Central

Calhoun, Stacy; Conner, Emma; Miller, Melodi; Messina, Nena

2015-01-01

Substance abuse is a major public health concern that impacts not just the user but also the user’s family. The effect that parental substance abuse has on children has been given substantial attention over the years. Findings from the literature suggest that children of substance-abusing parents have a high risk of developing physical and mental health and behavioral problems. A number of intervention programs have been developed for parents who have a substance abuse problem. There have also been a number of interventions that have been developed for children who have at least one parent with a substance abuse problem. However, it remains unclear how we can best mitigate the negative effects that parental substance abuse has on children due to the scarcity of evaluations that utilize rigorous methodologies such as experimental designs. The purpose of this study is to review randomized controlled trials of intervention programs targeting parents with substance abuse problems and/or children with at least one parent with a substance abuse problem in order to identify programs that show some promise in improving the behavioral and mental health outcomes of children affected by parental substance abuse. Four randomized controlled trials that met our eligibility criteria were identified using major literature search engines. The findings from this review suggest that interventions that focus on improving parenting practices and family functioning may be effective in reducing problems in children affected by parental substance abuse. However, further research utilizing rigorous methodologies are needed in order to identify other successful interventions that can improve the outcomes of these children long after the intervention has ended. PMID:25670915

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Villalobos, Bianca T.; Pastrana, Freddie A.; Cavell, Timothy A.; Gomez, Debbie

2014-01-01

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen’s d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos. PMID:25309845

Characteristics of an external employee assistance programme in Japan.

PubMed

Muto, Takashi; Fujimori, Yuiko; Suzuki, Keiko

2004-12-01

Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan. This study sought to clarify the characteristics of an external EAP in Japan. The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis. The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes. EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

Posttraumatic stress disorder in co-workers following exposure to a fatal construction accident in China.

PubMed

Hu, B S; Liang, Y X; Hu, X Y; Long, Y F; Ge, L N

2000-01-01

To assess the mental disturbances induced by accidents at work, 41 male workers who had witnessed a fatal work accident were evaluated utilizing the criteria for posttraumatic stress disorder (PTSD) from the ICD-10 Classification of Mental and Behavioral Disorders. The Hamilton Depression Rating Scale (HDRS) was also administered to the exposed workers, as well as to 47 non-exposed construction-worker controls. The two groups were well matched with respect to age, years of employment, and years of education. They were all of Han sect; and lifestyles, incomes, and living conditions were similar. The exposed workers had a high rate of PTSD: 11 of 41 (26.8%) at one month and five of 39 (12.9%) four months after the fatal accident. The exposed groups' scores for depressive symptoms were significantly higher than those of the controls, including: 1) depressed mood, 2) guilt, 3) initial insomnia, 4) middle insomnia, 5) delayed insomnia, 6) decreased interest in work and other activities, 7) anxiety, 8) somatization, and 9) gastrointestinal symptoms (p < 0.05, p < 0.01, p < 0.001). Fatal work accidents, a major hazard in the construction industry, affect not only the victims but also the mental health of other workers. PTSD and associated emotional disorders related to exposure to serious work accidents deserve more attention for clinical and research purposes.

Outpatient Mental Health Treatment Utilization and Military Career Impact in the United States Marine Corps

PubMed Central

Ghahramanlou-Holloway, Marjan; LaCroix, Jessica M.; Koss, Kari; Perera, Kanchana U.; VanSickle, Marcus R.; Novak, Laura A.

2018-01-01

Service members (SM) are at increased risk of psychiatric conditions, including suicide, yet research indicates SMs believe seeking mental health treatment may negatively impact their military careers, despite a paucity of research examining actual career impacts. This study examined the link between seeking outpatient mental health (MH) treatment and military career impacts within the United States Marine Corps. In Phase 1, a retrospective medical record review of outpatient MH treatment-seeking Marines (N = 38) was conducted. In Phase 2, a sample of outpatient MH treatment-seeking Marines (N = 40) was matched to a non-treatment-seeking sample of Marines (N = 138) to compare career-progression. In Phase 1, there were no significant links between demographic, military, and clinical characteristics and referral source or receipt of career-affecting treatment recommendations. In Phase 2, MH treatment-seeking Marines in outpatient settings were more likely than matched controls to be separated from the military (95.0% versus 63.0%, p = 0.002), but no more likely to experience involuntary separation. MH treatment-seeking Marines were more likely to have documented legal action (45.0% versus 23.9%, p = 0.008) and had a shorter time of military service following the index MH encounter than matched controls (p < 0.001). Clinical, anti-stigma, and suicide prevention policy implications are discussed. PMID:29690594

Mediating effects of emotional exhaustion on the relationship between job demand–control model and mental health.

PubMed

Huang, Yu-Hwa; Du, Pey-Ian; Chen, Chin-Hui; Yang, Chin-Ann; Huang, Ing-Chung

2011-04-01

This study attempted to investigate the role of emotional exhaustion as a mediator on the relationship between job demands-control (JDC) model and mental health. Three-wave data from 297 employees were collected. The results showed that job demands were positively related to emotional exhaustion, and increasing job demands will increase the level of emotional exhaustion. Job control was negatively associated with emotional exhaustion; therefore, increasing job control will decrease the level of emotional exhaustion. Emotional exhaustion was negatively related to mental health. Emotional exhaustion fully mediated the relationship between job demands and mental health, and partially mediated the positive relationship between job control and mental health. In addition, job control was positively associated with mental health directly. The remarkable finding of the present study was that emotional exhaustion served as the key mediator between the JDC model and mental health. Theoretical and managerial implications and limitations were discussed.

Improving Research Methods for the Study of Geography and Mental Health: Utilization of Social Networking Data and the ESRI GeoEvent Processor

ERIC Educational Resources Information Center

McLaughlin, Courtney L.

2017-01-01

The purpose of this article is to review the literature on geography and mental health, report on a case example using new methods for studying this topic, and provide recommendations for future research. Over 25 years ago, Holley (1988) conducted a review of the literature on geography and mental health and astutely stated, "… it is…

Normalizing Art Therapy.

ERIC Educational Resources Information Center

Congdon, Kristin G.

1990-01-01

Contends that art therapy promotes mental health beyond diagnosing and treating illness. Outlines four overlapping ways that art contributes to mental health: (1) giving people a sense of identity and place; (2) conferring status; (3) expanding and directing thought processes; and (4) utilizing the security of the rhythmic "takeover"…

Utilization of psychiatric services by postpartum women in a predominantly minority, low-socioeconomic-status, urban population.

PubMed

Seplowitz, Rhoda; Miller, Harold; Ostermeyer, Britta; Sangi-Haghpeykar, Haleh; Silver, Elana; Kunik, Mark E

2015-04-01

This study describes the utilization of health care services related to psychiatric diagnoses in an inner city community health organization with a largely Hispanic population of low socioeconomic status. We reviewed the frequency and timing of postpartum mental health diagnoses among 5,731 patients who delivered babies and were followed-up for postpartum care. 286 women (5 %) had at least one mental health diagnosis. The rates in white, black, and Hispanic women were 12, 8, and 5 % respectively (p < .05). White and black women were 2.5 (95 % CI 1.24, 5.07), and 1.62 (95 % CI 1.09, 2.40) times more likely to have a mental health diagnosis, respectively, compared to Hispanic women. The most common diagnoses were mood disorders (64 %) followed by anxiety disorders (29 %). 87 % of cases were diagnosed after 4 weeks postpartum. The postpartum mental health diagnosis rate seen here is lower than might be expected, particularly among Hispanic women. Possible explanations are discussed.

Application of the PRECEDE model to understanding mental health promoting behaviors in Hong Kong.

PubMed

Mo, Phoenix K H; Mak, Winnie W S

2008-08-01

The burdens related to mental illness have been increasingly recognized in many countries. Nevertheless, research in positive mental health behaviors remains scarce. This study utilizes the Predisposing, Reinforcing, and Enabling Causes in Education Diagnosis and Evaluation (PRECEDE) model to identify factors associated with mental health promoting behaviors and to examine the effects of these behaviors on mental well-being and quality of life among 941 adults in Hong Kong. Structural equation modeling shows that sense of coherence (predisposing factor), social support (reinforcing factor), and daily hassles (enabling factor) are significantly related to mental health promoting behaviors, which are associated with mental well-being and quality of life. Results of bootstrap analyses confirm the mediating role of mental health promoting behaviors on well-being and quality of life. The study supports the application of the PRECEDE model in understanding mental health promoting behaviors and demonstrates its relationships with well-being and quality of life.

Examining the Efficacy of a Family Peer Advocate Model for Black and Hispanic Caregivers of Children with Autism Spectrum Disorder.

PubMed

Jamison, J M; Fourie, E; Siper, P M; Trelles, M P; George-Jones, Julia; Buxbaum Grice, A; Krata, J; Holl, E; Shaoul, J; Hernandez, B; Mitchell, L; McKay, M M; Buxbaum, J D; Kolevzon, Alexander

2017-05-01

Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.

Nurses' tending instinct as a conduit for men's access to mental health counseling.

PubMed

Smith, Jeffrey M; Robertson, Steve

2006-06-01

No article has been found melding the phenomenon of nurses' tending instinct and men's mental health counseling access. This theoretical article presents nurses' tending instinct as a viable rationale to support men in utilizing mental health counseling services. Nurses can be the conduit that assists men in accessing mental health counseling when the need arises. An amalgamation of related topics, including nurses' tending instinct, men's illness/injury/disease profile, psychological medicine, and counselor skills, were forged together to unify this innovative theoretical consideration. Implications for nursing practice also were explored.

Implementation Science for closing the treatment gap for mental disorders by translating evidence base into practice: experiences from the PRIME project.

PubMed

Shidhaye, Rahul

2015-12-01

This paper utilizes the experience of PRIME (Programme for Improving Mental health care) to exemplify how implementation science provides key insights and approaches to closing the treatment gap for mental disorders. The real-world application of strategies described in the implementation science literature, accompanied by use of alternative, rigorous evaluation methods to assess their impact on patient outcomes, can help in closing the mental health treatment gap in disadvantaged populations. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Mental health and psychosocial support in humanitarian emergencies.

PubMed

van Ommeren, M; Hanna, F; Weissbecker, I; Ventevogel, P

2015-09-28

Armed conflicts and natural disasters impact negatively on the mental health and well-being of affected populations in the short- and long-term and affect the care of people with pre-existing mental health conditions. This paper outlines specific actions for mental health and psychosocial support by the health sector in the preparedness, response and recovery phases of emergencies. Broad recommendations for ministries of health are to: (1) embed mental health and psychosocial support in national health and emergency preparedness plans; (2) put in place national guidelines, standards and supporting tools for the provision of mental health and psychosocial support during emergencies; (3) strengthen the capacity of health professionals to identify and manage priority mental disorders during emergencies; and (4) utilize opportunities generated by the emergency response to contribute to development of sustainable mental health-care services.

Stress management training for military trainees returned to duty after a mental health evaluation: effect on graduation rates.

PubMed

Cigrang, J A; Todd, S L; Carbone, E G

2000-01-01

A significant proportion of people entering the military are discharged within the first 6 months of enlistment. Mental health related problems are often cited as the cause of discharge. This study evaluated the utility of stress inoculation training in helping reduce the attrition of a sample of Air Force trainees at risk for discharge from basic military training. Participants were 178 trainees referred for a psychological evaluation from basic training. Participants were randomly assigned to a 2-session stress management group or a usual-care control condition. Compared with past studies that used less rigorous methodology, this study did not find that exposure to stress management information increased the probability of graduating basic military training. Results are discussed in terms of possible reasons for the lack of treatment effects and directions for future research.

The inability to mentally represent action may be associated with performance deficits in children with developmental coordination disorder.

PubMed

Gabbard, Carl; Bobbio, Tatiana

2011-03-01

Several research studies indicate that children with developmental coordination disorder (DCD) show delays with an array of perceptual-motor skills. One of the explanations, based on limited research, is that these children have problems generating and/or monitoring a mental (action) representation of intended actions, termed the "internal modeling deficit" (IMD) hypothesis. According to the hypothesis, children with DCD have significant limitations in their ability to accurately generate and utilize internal models of motor planning and control. The focus of this review is on one of the methods used to examine action representation-motor imagery, which theorists argue provides a window into the process of action representation (e.g., Jeannerod, 2001 . Neural simulation of action: A unifying mechanism for motor cognition. Neuroimage, 14, 103-109.). Included in the review are performance studies of typically developing and DCD children, and possible brain structures involved.

Mental health related Internet use among psychiatric patients: a cross-sectional analysis.

PubMed

Kalckreuth, Sophie; Trefflich, Friederike; Rummel-Kluge, Christine

2014-12-24

The Internet is of great importance in today's health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants' type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet's role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.

Changes in morbidity and medical care utilization after the recent economic crisis in the Republic of Korea.

PubMed

Kim, Hanjoong; Chung, Woo Jin; Song, Young Jong; Kang, Dae Ryong; Yi, Jee Jeon; Nam, Chung Mo

2003-01-01

To examine and quantify the impact of the recent economic crisis on morbidity and medical care utilization in the Republic of Korea. 22 675 people from 6791 households and 43 682 people from 12 283 households were questioned for two nationwide surveys that took place in 1995 and 1998, respectively. A separate sample pretest-posttest design was used and we conducted c2 test and logistic regression analysis after controlling for the maturation effect of the morbidity and medical care utilization. The morbidity rates of chronic disease and acute disease increased significantly by 27.1% and 9.5%, respectively, whereas the utilization rates of outpatient and inpatient services decreased by 15.1% and 5.2%, respectively. In particular, the pace of decline in the utilization rate of outpatient services varied depending on the type of disease: morbidity rates for mental and behavioural disorders were 13.7%; for cardiovascular disease, 7.1%; and for injury, 31.6%. After the Republic of Korean economic crisis, the morbidity and medical care utilization rates changed significantly but the degree of change depended on the type of disease or service. The time-dependent relationship between the national economy and the morbidity and medical care utilization rates needs to be further investigated.

Towards a system-paced near-infrared spectroscopy brain-computer interface: differentiating prefrontal activity due to mental arithmetic and mental singing from the no-control state.

PubMed

Power, Sarah D; Kushki, Azadeh; Chau, Tom

2011-12-01

Near-infrared spectroscopy (NIRS) has recently been investigated as a non-invasive brain-computer interface (BCI) for individuals with severe motor impairments. For the most part, previous research has investigated the development of NIRS-BCIs operating under synchronous control paradigms, which require the user to exert conscious control over their mental activity whenever the system is vigilant. Though functional, this is mentally demanding and an unnatural way to communicate. An attractive alternative to the synchronous control paradigm is system-paced control, in which users are required to consciously modify their brain activity only when they wish to affect the BCI output, and can remain in a more natural, 'no-control' state at all other times. In this study, we investigated the feasibility of a system-paced NIRS-BCI with one intentional control (IC) state corresponding to the performance of either mental arithmetic or mental singing. In particular, this involved determining if these tasks could be distinguished, individually, from the unconstrained 'no-control' state. Deploying a dual-wavelength frequency domain near-infrared spectrometer, we interrogated nine sites around the frontopolar locations (International 10-20 System) while eight able-bodied adults performed mental arithmetic and mental singing to answer multiple-choice questions within a system-paced paradigm. With a linear classifier trained on a six-dimensional feature set, an overall classification accuracy of 71.2% across participants was achieved for the mental arithmetic versus no-control classification problem. While the mental singing versus no-control classification was less successful across participants (62.7% on average), four participants did attain accuracies well in excess of chance, three of which were above 70%. Analyses were performed offline. Collectively, these results are encouraging, and demonstrate the potential of a system-paced NIRS-BCI with one IC state corresponding to either mental arithmetic or mental singing.

Towards a system-paced near-infrared spectroscopy brain-computer interface: differentiating prefrontal activity due to mental arithmetic and mental singing from the no-control state

NASA Astrophysics Data System (ADS)

Power, Sarah D.; Kushki, Azadeh; Chau, Tom

2011-10-01

Near-infrared spectroscopy (NIRS) has recently been investigated as a non-invasive brain-computer interface (BCI) for individuals with severe motor impairments. For the most part, previous research has investigated the development of NIRS-BCIs operating under synchronous control paradigms, which require the user to exert conscious control over their mental activity whenever the system is vigilant. Though functional, this is mentally demanding and an unnatural way to communicate. An attractive alternative to the synchronous control paradigm is system-paced control, in which users are required to consciously modify their brain activity only when they wish to affect the BCI output, and can remain in a more natural, 'no-control' state at all other times. In this study, we investigated the feasibility of a system-paced NIRS-BCI with one intentional control (IC) state corresponding to the performance of either mental arithmetic or mental singing. In particular, this involved determining if these tasks could be distinguished, individually, from the unconstrained 'no-control' state. Deploying a dual-wavelength frequency domain near-infrared spectrometer, we interrogated nine sites around the frontopolar locations (International 10-20 System) while eight able-bodied adults performed mental arithmetic and mental singing to answer multiple-choice questions within a system-paced paradigm. With a linear classifier trained on a six-dimensional feature set, an overall classification accuracy of 71.2% across participants was achieved for the mental arithmetic versus no-control classification problem. While the mental singing versus no-control classification was less successful across participants (62.7% on average), four participants did attain accuracies well in excess of chance, three of which were above 70%. Analyses were performed offline. Collectively, these results are encouraging, and demonstrate the potential of a system-paced NIRS-BCI with one IC state corresponding to either mental arithmetic or mental singing.

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R; Hurlburt, Michael S

2015-01-16

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs. Participants were 12 mental health service team leaders and their staff (n = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees. Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes. The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

Aberrant within- and between-network connectivity of the mirror neuron system network and the mentalizing network in first episode psychosis.

PubMed

Choe, Eugenie; Lee, Tae Young; Kim, Minah; Hur, Ji-Won; Yoon, Youngwoo Bryan; Cho, Kang-Ik K; Kwon, Jun Soo

2018-03-26

It has been suggested that the mentalizing network and the mirror neuron system network support important social cognitive processes that are impaired in schizophrenia. However, the integrity and interaction of these two networks have not been sufficiently studied, and their effects on social cognition in schizophrenia remain unclear. Our study included 26 first-episode psychosis (FEP) patients and 26 healthy controls. We utilized resting-state functional connectivity to examine the a priori-defined mirror neuron system network and the mentalizing network and to assess the within- and between-network connectivities of the networks in FEP patients. We also assessed the correlation between resting-state functional connectivity measures and theory of mind performance. FEP patients showed altered within-network connectivity of the mirror neuron system network, and aberrant between-network connectivity between the mirror neuron system network and the mentalizing network. The within-network connectivity of the mirror neuron system network was noticeably correlated with theory of mind task performance in FEP patients. The integrity and interaction of the mirror neuron system network and the mentalizing network may be altered during the early stages of psychosis. Additionally, this study suggests that alterations in the integrity of the mirror neuron system network are highly related to deficient theory of mind in schizophrenia, and this problem would be present from the early stage of psychosis. Copyright © 2018 Elsevier B.V. All rights reserved.

A systematic review of the role of school-based healthcare in adolescent sexual, reproductive, and mental health

PubMed Central

2012-01-01

Background Accessible sexual, reproductive, and mental healthcare services are crucial for adolescent health and wellbeing. It has been reported that school-based healthcare (SBHC) has the potential to improve the availability of services particularly for young people who are normally underserved. Locating health services in schools has the potential to reduce transport costs, increase accessibility and provide links between schools and communities. Methods A systematic review of the literature was undertaken. Pubmed, Psychinfo, Psychnet, Cochrane CENTRAL, and Web of Science were searched for English language papers published between January 1990 and March 2012 Results Twenty-seven studies were found which fitted the criteria, of which, all but one were from North America. Only three measured adolescent sexual, reproductive, or mental health outcomes related to SBHC and none of the studies were randomized controlled trials. The remaining studies explored accessibility of services and clinic utilization or described pertinent contextual factors. Conclusions There is a paucity of high quality research which evaluates SBHC and its effects on adolescent sexual, reproductive, and mental health. However, there is evidence that SBHC is popular with young people, and provides important mental and reproductive health services. Services also appear to have cost benefits in terms of adolescent health and society as a whole by reducing health disparities and attendance at secondary care facilities. However, clearer definitions of what constitutes SBHC and more high quality research is urgently needed. PMID:23098138