Showing papers by "Robert A. Rosenheck published in 2020"

Increasing Emergency Department Visits for Mental Health Conditions in the United States

Abstract: OBJECTIVE The Affordable Care Act (ACA) of 2010 was fully implemented in 2014, expanding access to outpatient mental health services and potentially reducing reliance on emergency (ED) services. This study examined trends and correlates of ED visits for mental health conditions from 2007 to 2016, with attention to changes in ED use after 2014. METHODS Nationally representative samples of ED visits in the United States were assessed using a repeated cross-sectional analysis of National Hospital Ambulatory Medical Care Survey data. This study used diagnoses associated with each ED visit to identify changes in proportions in mental health diagnostic categories (psychiatric diagnoses only, substance use-related diagnoses only, or both, based on ICD-9-CM or ICD-10-CM criteria). These trends were further examined by age, sex, race/ethnicity, and insurance status. The statistical significance of temporal patterns was evaluated with multivariate logistic regression analyses. RESULTS Between 2007 and 2016, about 8.4 million (8.3%) of 100.9 million ED visits nationwide were for psychiatric or substance use-related diagnoses. Over the 10-year study period, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001). Visits for alcohol and "other" substance use and psychiatric diagnoses classified as "other" accounted for an increasing portion of mental health-related ED visits during this time (P < .001). ED visits in which Medicaid was the primary source of insurance coverage showed the largest increase, nearly doubling from 27.2% in 2007-2008 to 42.8% in 2015-2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15). CONCLUSIONS ED utilization for mental health conditions-and especially substance use conditions-significantly increased in the last decade. The increasing use of EDs by patients with mental health conditions may indicate suboptimal delivery of effective or acceptable outpatient mental health care, particularly for substance use-related conditions.

Initiating opioid agonist treatment for opioid use disorder nationally in the Veterans Health Administration: Who gets what?

Abstract: Background: Despite substantial benefits associated with opioid agonist treatment (OAT) with buprenorphine and methadone for opioid use disorder (OUD), only a small proportion of patients w...

Suicide Attempts and Homelessness: Timing of Attempts Among Recently Homeless, Past Homeless, and Never Homeless Adults.

Abstract: Objective:Homelessness is associated with increased risk of suicide attempts. This study examined whether suicide attempts typically precede or occur during episodes of homelessness in a representa...

Prevalence of Treatment for Depression Among US Adults Who Screen Positive for Depression, 2007-2016.

Abstract: This cohort study uses data from the National Health and Nutrition Examination Survey to examine changes in the prevalence of mental health treatment among US adults who screened positive for depression between 2007 and 2016

A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy: Development and Psychometric Properties.

Abstract: Objectives Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment. Methods The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform. Results Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence. Conclusions Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.

Gender differences in outcomes following specialized intensive PTSD treatment in the Veterans Health Administration.

Abstract: OBJECTIVES Posttraumatic stress disorder (PTSD) among female veterans is a problem of growing importance. Comparison of treatment outcomes and measures of program participation between female and male veterans receiving treatment in specialized intensive Veterans Health Administration (VHA) programs may identify potential gaps in service. METHOD National program evaluation data were collected at program entry and 4 months after discharge. The study sample consists of N = 3,370 veterans who were successfully followed up. With adjustment for differences in baseline characteristics outcomes of women and men were compared on changes in PTSD symptoms, substance use, and other outcomes using Cohen's d to evaluate effect sizes. Further analyses examined gender differences in program participation and their effect on differences in outcomes by gender. RESULTS Compared to males, females showed greater improvement (i.e., greater reduction) in total PTSD symptom scores (p < .001, Cohen's d = -.29) and in several subscales including Numbness (p < .001, d = -.34), Arousal (p = .01, d = -.22), Reexperiencing Past Traumas (p < .01, d = -.23), and Irritability (p = .01, d = -.18), with small to medium effect size differences. These gender-based differences were partially explained by differences in program participation such as greater length of stay among women. CONCLUSIONS In spite of the predominantly male environment of these VHA PTSD programs, women experienced greater improvement than men in PTSD symptoms and subscales. The differences were partially explained by positive indicators of program participation. Further studies are needed to better understand these differences. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration.

Abstract: Since deinstitutionalization in the 1950s–1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems. National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills. An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care. Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.

A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States.

Abstract: Objective:Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment.Meth...

Do Sex Differences Among Adults With Opioid Use Disorder Reflect Sex-specific Vulnerabilities? A Study of Behavioral Health Comorbidities, Pain, and Quality of Life.

Abstract: Objectives: Studies suggest that men and women have different vulnerabilities to a number of substance use disorders (SUDs). We examined whether differences between women and men with opioid use disorder (OUD) are significantly different from those without OUD for selected sociodemographic and health outcomes. Methods: We used a cross-sectional survey design using data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III, which surveyed nationally representative samples of non-institutionalized adults (n = 36,309 unweighted). Past-year OUD and other behavioral co-morbidities were defined using DSM-5 criteria. In bivariate analyses, we investigated sex differences in socio-demographic factors, behavioral co-morbidities, pain, and health-related quality of life (HRQOL) between women and men with past-year OUD, and then those without past-year OUD. We further used logistic regression analyses to evaluate interactions between effect of sex and past-year OUD status on behavioral co-morbidities, pain, and HRQOL. Results: When extrapolated, about 2.1 million US adults met diagnostic criteria for past-year OUD. Women with OUD had a higher likelihood of having several past-year psychiatric disorders, and a lower likelihood of having any past-year SUDs compared to male counterparts. However, similar relationships were observed among those without OUD and significant interaction effects were not found on behavioral co-morbidities, pain, and HRQOL, indicating that general sex differences are not specific to OUD. Conclusions: Although sex differences are not specific to OUD, concurrent disorders are not uncommon among women, as well as men, with OUD. There is a need to treat concurrent behavioral health conditions from a multimorbidity perspective in the treatment of OUD in both sexes.

Effectiveness of electroconvulsive therapy in patients with "less treatment-resistant" depression by the Maudsley Staging Model.

Abstract: INTRODUCTION Electroconvulsive therapy (ECT) is an effective treatment for patients with mood disorders and is most often used for treatment-resistant cases. This study aimed to examine the effectiveness of ECT in a real-world treatment sample in a Chinese psychiatric hospital which included both treatment-resistant and nontreatment-resistant patients. METHODS An observational study of symptom outcomes from admission to the time of discharge was conducted with 37 inpatients diagnosed with unipolar or bipolar depression treated with ECT. Symptom severity was assessed with the 17-item Hamilton Rating Scales for Depression (HRSD-17) and treatment-resistance with the Maudsley Staging Model (MSM). Stratifying at the MSM median admission characteristics and symptom change was compared between patients who were treatment-resistant (n = 18) and who were not (n = 19). The outcome difference between groups was compared using analyses of covariance adjusted for baseline characteristics including symptom severity, followed by linear regression to identify factors associated symptom improvement in the entire sample. RESULTS The sample (n = 37) showed moderate treatment-resistance (MSM = 7.30 ± 1.13) at admission and both groups received 8.3 ± 2 ECT sessions. The treatment-resistant group had a smaller proportion of bipolar patients and more severe symptoms, but showed no significant difference from the nontreatment-resistant group in HDRS-17 scores at the time of discharge (adjusted means = 6.23 ± 1.00 vs. 5.94 ± 0.97, Partial η2 = 0.001, p = .845). Baseline symptom severity was the strongest correlate of reduction in HDRS-17 scores (β = 0.891, p < .001). CONCLUSIONS Symptom change with ECT in depression did not differ by level of treatment-resistance but was greatest among those with more severe baseline symptoms. Correlates of ECT effectiveness should be further evaluated in stratified randomized trials.

Alcohol Use Disorder Among Adults Recovered From Substance Use Disorders.

Abstract: BACKGROUND AND OBJECTIVES Alcohol use is often overlooked and underestimated among patients recovered from substance dependence. The prevalence and correlates of alcohol use disorder (AUD) among adults recovered from substance use disorders (SUDs) are estimated in this study. METHODS A nationally representative cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions Wave-III was used in this study. Survey respondents, aged 18 or older, who recovered from SUDs, based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria (n = 2061 unweighted), were included. A total of three comparison groups were identified using DSM-5 criteria (1) current AUD, (2) former AUD, and (3) never had AUD. The prevalence of these groups was estimated; medical and psychiatric comorbidities and health-related quality of life were compared; and factors associated with having a current AUD when compared with those with former AUD and those who never had AUD were examined, controlling for other covariates. RESULTS About 5.7% of US adults, nationally representative of 14.2 million, have been reported to have recovered from past SUDs. Of these, 28.9% met criteria for current AUD and 48.4% had former AUD. When compared with those who never had AUD, factors associated with having a current AUD included the following: living in urban areas (P = .019), having a bipolar 1 disorder (P < .001), and a history of lifetime incarceration (P = .004). DISCUSSION AND CONCLUSION Nearly one-third of adults recovered from SUDs had current AUD, and several behavioral factors were associated with having a current AUD when compared with those who never had AUD. SCIENTIFIC SIGNIFICANCE Our study highlights the substantial risk of AUD in adults who have successfully recovered from SUDs. (Am J Addict 2020;00:00-00).

Why are black adults over-represented among individuals who have experienced lifetime homelessness? Oaxaca-Blinder decomposition analysis of homelessness among US male adults.

Abstract: Background Non-Hispanic black adults experience homelessness at higher rates than non-Hispanic white adults in many studies. We aim to identify factors that could account for this disparity. Methods We used national survey data on non-Hispanic black and white men with complete data from the National Epidemiological Survey on Alcohol and Related Conditions Wave III. Using the Oaxaca-Blinder decomposition analysis, we examined race-based disparities in correlates of risk for lifetime homelessness. Results In our analysis, 905 of 11 708 (7.7%) respondents, representing 6 million adults nationwide, reported lifetime homelessness. Black adults were 1.41 times more likely to have been homeless than white adults (95% CI 1.14 to 1.73; p=0.002). Overall, 81.6% of race-based inequality in lifetime homelessness were explained by three main variables with black adults having: lower incomes, greater incarceration histories since age of 18 and a greater risk of traumatic events (p Conclusion Although previous studies suggested that black homeless men have higher rates of drug abuse than white homeless men, our findings highlight the fact that black–white disparities in lifetime homeless risk are associated with socio-structural factors (eg, income and incarceration) and individual adverse events (eg, traumatic events), and not associated with psychiatric or substance use disorders.

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs

Abstract: Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women...

Correlates of Concurrent Morbid Obesity and Tobacco Use Disorder Nationally in the Veterans Health Administration.

Abstract: The aim of this study was to examine health, demographic, and service utilization characteristics of veterans with multimorbid tobacco use disorder (TUD) and morbid obesity compared to those with e...

Impact of cannabis on non-medical opioid use and symptoms of posttraumatic stress disorder: a nationwide longitudinal VA study.

Abstract: Multiple states have authorized cannabis as an opioid substitution agent and as a treatment for posttraumatic stress disorder (PTSD).This study sought to investigate the relationship between cannab...

Mental Health Programs Serving Deaf and Hard of Hearing Adults

Abstract: Few studies have investigated mental health services specifically serving deaf and hard of hearing people. This study summarizes data reported by 40 specialized mental health programs for deaf and hard of hearing adults in the United States between 2001-2003. Deaf programs within larger mental health organizations were significantly more likely to serve clients diagnosed with a psychotic disorder. These integrated service programs were less likely to serve clients who are Caucasian and those who pay for services using private insurance. Integrated programs serve clients with more serious psychiatric disorders. Further comparisons of medical records, service quality, and outcomes are needed.

Online video psychoeducation for electroconvulsive therapy in India: A randomized controlled trial.

Abstract: Despite its effectiveness, electroconvulsive therapy (ECT) has been widely but diminishingly used in India. The current study evaluated a video psychoeducation on ECT offered to adults in India who screened positive for depression. Participants were randomly assigned to receive either video or brochure psychoeducation. Both video and brochure psychoeducation significantly improved participants' perceptions, knowledge, and willingness to receive ECT with only a few significant differences between the two modalities. Together, these findings suggest that psychoeducation is effective. Video psychoeducation which can be inexpensive and widely distributed may represent an important way to encourage patients to consider ECT as an option.