Psychiatric Services Brief Reports

The Role of Patient Activation in Psychiatric Visits [Brief Reports]

Fri, 30 Oct 2009 05:01:27 PDT

OBJECTIVE: This study identified ways that consumers of mental health services are active participants in psychiatric treatment. METHODS: Four providers (three psychiatrists and one nurse practitioner) were recruited, and ten consumers with severe mental illness were recruited per provider (40 total). Consumers completed questionnaires on patient activation, illness self-management, and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers gave information on diagnosis, substance use disorder, and medication adherence. RESULTS: Consumer-rated patient activation was positively related to illness self-management and negatively related to substance use disorder. Transcripts of the psychiatric visit showed that consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, the relationship was weak between consumer-reported activation and observed activation behaviors. CONCLUSIONS: Consumers were found to be active participants in treatment in a variety of ways, but similar to other populations, the relationship between observed patient activation and consumer-reported desire for involvement was not direct.

Population-Based Service Planning for Implementation of MBCT: Linking Epidemiologic Data to Practice [Brief Reports]

Patten, S. B., Meadows, G. M. — Fri, 30 Oct 2009 05:01:27 PDT

OBJECTIVE: The study explored population-based service planning for mindfulness-based cognitive therapy (MBCT). Evidence suggests the usefulness of MBCT in relapse prevention for individuals reporting three or more major depressive episodes. METHODS: Depression data were from the Canadian Community Health Survey. A simulation model estimated recurrence rates and population sizes to sustain MBCT therapists (each conducting two ten-person groups per year). RESULTS: Approximately 4.2% of the population are candidates for MBCT, and about 13 candidates would arise annually per 10,000 population. If MBCT was acceptable to 20%, for example, a population of 200,000 could support two therapists. CONCLUSIONS: A large proportion of the population is eligible for MBCT introduction; however, after introduction, the rate of emergence of candidates would yield a smaller patient pool, which may limit implementation in small population centers. Treatment acceptability is a key variable. These analyses highlight the potential value of epidemiologic data and simulation modeling in planning.

Involuntary Admission of Emergency Psychiatric Patients: Report From the Amsterdam Study of Acute Psychiatry [Brief Reports]

Fri, 30 Oct 2009 05:01:27 PDT

OBJECTIVE: This brief report presents initial data from the Amsterdam Study of Acute Psychiatry (ASAP-I) about factors associated with the decision to admit patients compulsorily (involuntarily) to emergency psychiatric services in the Amsterdam region of the Netherlands. METHODS: The study was a prospective cohort study of 1,970 consecutive patients who came into contact with the Psychiatric Emergency Service Amsterdam. RESULTS: A history of more than 14 outpatient contacts the previous year was associated with a low risk of compulsory admission (OR=.3). An involuntary admission in the previous five years was associated with a higher risk (OR=3.7). Referral by a general practitioner was associated with a low risk compared with referral by police (OR=2.4) or by mental health services (OR=2.3). CONCLUSIONS: The hypothesis that outpatient treatment may help to prevent compulsory admission found some support in this study. More research is needed to understand the mechanisms of the associations so that an intervention study can be developed to test this hypothesis.

Burnout in Nonhospital Psychiatric Residential Facilities [Brief Reports]

Fri, 30 Oct 2009 05:01:28 PDT

OBJECTIVE: This study evaluated levels and risk factors of burnout in a sample of mental health professionals employed in nonhospital psychiatric residential facilities of northern Italy. METHODS: Nurses, nurse assistants, and educators completed a questionnaire evaluating demographic variables, burnout (Maslach Burnout Inventory), job characteristics (Job Diagnostic Survey), workload, relationships with colleagues, and support from supervising coordinators. A total of 202 (83% response rate) questionnaires were analyzed. Logistic linear regressions were used to estimate predictors of burnout dimensions. RESULTS: Burnout risk was widespread. Low feedback about job performance, poor support from coordinators, and young age predicted emotional exhaustion. Low feedback about job performance predicted feelings of depersonalization. Low task identity and young age predicted reduced feelings of personal accomplishment. CONCLUSIONS: Interventions to prevent burnout among employees should be developed. These include providing feedback about performance, clearly identifying the tasks of the job, and providing support.

Association of Perceived Quality of Life and Oral Health Among Psychiatric Outpatients [Brief Reports]

Persson, K., Axtelius, B., Soderfeldt, B., Ostman, M. — Fri, 30 Oct 2009 05:01:28 PDT

OBJECTIVES: The relationship between oral health and various aspects of quality of life has gone uninvestigated in psychiatric populations. The aim of this study was to investigate the correlation between the Oral Health Impact Profile-14 and subjective quality of life, perceptions about general health, and self-related variables. METHODS: A structured interview constructed from validated instruments was administered to 113 consumers attending outpatient psychiatric care. RESULTS: A lower perceived oral health-related quality of life had a correlation with decreased ratings of subjective quality of life, general health disabilities, and chance and internal locus of control. CONCLUSIONS: Correlations between subjective and general health-related quality of life and oral health-related quality of life had not been detected in this group before. In order to improve mental health consumers' total perceived quality of life, oral health problems should be regularly addressed in the course of psychiatric care.

Effect of Racial and Ethnic Composition of Neighborhoods in San Francisco on Rates of Mental Health-Related 911 Calls [Brief Reports]

Kessell, E. R., Alvidrez, J., McConnell, W. A., Shumway, M. — Thu, 01 Oct 2009 05:01:57 PDT

OBJECTIVE: This study investigated the association between the racial and ethnic residential composition of San Francisco neighborhoods and the rate of mental health-related 911 calls. METHODS: A total of 1,341,608 emergency calls (28,197 calls related to mental health) to San Francisco's 911 system were made from January 2001 through June 2003. Police sector data in the call records were overlaid onto U.S. census tracts to estimate sector demographic and socioeconomic characteristics. Negative binomial regression was used to estimate the association between the percentage of black, Asian, Latino, and white residents and rates of mental health-related calls. RESULTS: A one-point increase in a sector's percentage of black residents was associated with a lower rate of mental health-related calls (incidence rate ratio=.99, p<.05). A sector's percentage of Asian and Latino residents had no significant effect. CONCLUSIONS: The observed relationship between the percentage of black residents and mental health-related calls is not consistent with known emergency mental health service utilization patterns.

Inconsistencies in Diagnosis and Symptoms Among Bilingual and English-Speaking Latinos and Euro-Americans [Brief Reports]

Thu, 01 Oct 2009 05:01:57 PDT

OBJECTIVE: Little information is available about accuracy of diagnoses in clinical care for affective and other major mental disorders experienced by Latino patients. This study addressed two central research questions: Do Latinos have disproportionate rates of clinical diagnoses of major depression based on structured diagnostic interviews? Are diagnostic patterns consistent with patient profiles and medical record information? METHODS: A total of 259 bilingual Latino, monolingual English-speaking Latino, and Euro-American patients aged 18 to 45 years with a history of severe depression or psychotic symptoms were compared across three clinical sites by using structured interviews. RESULTS: Compared with Euro-Americans, bilingual Latinos had significantly higher rates of major depression and significantly lower levels of mania. No significant differences were found between monolingual English-speaking Latinos and Euro-Americans. CONCLUSIONS: Results suggest that the diagnostic process is affected by an apparent association with cultural-linguistic influences, notably speaking English as a second language.

Preferences for Psychiatric Advance Directives Among Latinos: Views on Advance Care Planning for Mental Health [Brief Reports]

Van Dorn, R. A., Swanson, J. W., Swartz, M. S. — Thu, 01 Oct 2009 05:01:57 PDT

OBJECTIVE: Psychiatric advance directives allow people to plan for future mental health care. Little is known about how minority groups, particularly Latinos, view these legal mechanisms. This study examined demand for, and attitudes toward, psychiatric advance directives among Latinos with mental illness (N=85), their family members (N=25), and their clinicians (N=30). METHODS: All participants were interviewed. RESULTS: Participants showed substantial interest in completing psychiatric advance directives, specifically involving family or other surrogates in the preparation and execution. There were few between-group differences in attitudes toward directives. CONCLUSIONS: Psychiatric advance directives provide an acceptable way to increase culturally appropriate services and family involvement for Latinos with mental illness. Psychiatric advance directive interventions should capitalize on the centrality of the family in Latino culture, which could provide an opportunity to reduce mental health crises in this population.

Service Utilization Patterns of Maltreated and Nonmaltreated Children From Low-Income, African-American Families [Brief Reports]

Smith, C. O., Thompson, M. P., Johnson, K., Nitsche, A. M., Kaslow, N. J. — Thu, 01 Oct 2009 05:01:57 PDT

OBJECTIVES: This study examined health care utilization patterns by maltreatment status among youths from low-income households across multiple service domains. METHODS: Face-to-face interviews were conducted with 153 African-American maltreated and nonmaltreated children (ages eight to 12). The youths were children of women recruited at a large inner-city public hospital for a study examining intimate partner violence and child maltreatment. Use of psychiatric, medical, child care, social support, and crisis health care services was assessed. RESULTS: Psychiatric and child care service utilization was significantly different between maltreated and nonmaltreated children across three categories of child maltreatment (emotional, physical, and sexual abuse). Maltreated youths were six to 13 times more likely than their nonmaltreated counterparts to use psychiatric and child care services. Medical service utilization was higher for emotionally abused youths. CONCLUSIONS: Results of this study may serve to facilitate improved screening, identify points of access for intervention, and enhance treatment for maltreated youths.

Perceived Coercion to Treatment and Housing Satisfaction in Housing-First and Supportive Housing Programs [Brief Reports]

Robbins, P. C., Callahan, L., Monahan, J. — Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVES: This study of five housing programs across the United States examined whether the type of program—housing first or supportive housing—is related to an explicit requirement that residents adhere to mental health and substance abuse treatment, to residents' subjective perceptions that treatment adherence was being coerced, and to residents' housing satisfaction. METHODS: Interviews were conducted with 136 residents of housing programs at five sites. RESULTS: Results showed that compared with residents in supportive housing programs, those in housing-first programs were significantly less likely to report that mental health treatment adherence was an explicit requirement of obtaining housing and less likely to report that mental health and substance abuse treatment was a requirement of retaining housing. There was no difference between the programs in residents' satisfaction with their housing. CONCLUSIONS: Housing-first programs achieved a level of client satisfaction comparable to that of supportive housing programs while apparently staying consistent with their guiding "no coerced treatment" philosophy.

Perceived Stigma and Help-Seeking Behavior: Longitudinal Evidence From the Healthy Minds Study [Brief Reports]

Golberstein, E., Eisenberg, D., Gollust, S. E. — Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVE: Despite considerable policy interest in the association between perceived public stigmatization of mental illness and use of mental health services, limited empirical evidence, particularly from longitudinal data, documents this relationship. This study used longitudinal data to estimate the association between perceived public stigmatization and subsequent mental health care seeking. METHODS: A Web-based survey was used to collect data from a random sample of undergraduate and graduate students at a university at baseline and two years later (N=732). Logistic regression models assessed the association between students' perceived public stigma at baseline and measures of subsequent help seeking for mental health problems (perceived need for help and use of mental health services) at follow-up. RESULTS: No significant associations were found between perceived public stigma and help-seeking behavior over the two-year period. CONCLUSIONS: In this population of college students, perceived stigma did not appear to pose a substantial barrier to mental health care.

A Literature Review of Studies of Depression and Treatment Outcomes Among U.S. College Students Since 1990 [Brief Reports]

Miller, E. J., Chung, H. — Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVE: The mental health of U.S. college students is a growing public health concern. Particularly alarming is the prevalence of depression and risk of suicide in this cohort. METHODS: A literature review of PsycINFO, MEDLINE, and CINAHL databases was conducted in order to identify and evaluate depression and treatment outcomes among U.S. college students since 1990. RESULTS: Four studies documenting depression and treatment outcomes among U.S. college students were identified and reviewed. CONCLUSIONS: Although research on the depression and treatment outcomes among U.S. college students exists, it is scarce and inconsistent, with varying inclusion and exclusion criteria and measurement of depression severity and its treatment. Future work needs to focus on the development of reasonable benchmarks of depression and treatment outcomes in the college population and the integration of such outcome data into college mental health practice.

Prenatal Care Visits and Associated Costs for Treatment-Seeking Women With Depressive Disorders [Brief Reports]

Lin, H.-C., Lin, Y.-J., Hsiao, F.-H., Li, C.-Y. — Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVES: This study aimed to determine whether a history of depressive disorders is associated with use and costs of prenatal care among pregnant women in Taiwan. METHODS: Participants were mothers with singleton births between 2004 and 2006 (N=23,290), some of whom (N=614) had received care for depression in the year before conception but not during pregnancy. RESULTS: The mean number of prenatal care visits was 8.50 and associated costs were $NT 51,187 for pregnant women with a history of depressive disorders and 9.17 visits and $NT 27,998, respectively, for those without such a history. After adjustment for age, monthly income, medical conditions, and obstetric complications, mothers with a history of depression were significantly less likely to receive prenatal care (relative risk=.94, 95% confidence interval=.92–.97, p<.001). However, women with a history of depression had $NT 22,494 higher prenatal care costs than mothers without a history of depression. CONCLUSIONS: Pregnant women with a history of depressive disorders had fewer prenatal care visits but higher prenatal care costs. Physicians should consider screening to identify pregnant women with a history of depressive disorders.

Use of the Internet and Other Media for Health Information Among Clinic Outpatients With Serious Mental Illness [Brief Reports]

Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVE: This study examined how people with serious mental illness access and use media to receive health information. METHODS: One hundred people with serious mental illness were interviewed regarding their media use, with a focus on how they get their health information. RESULTS: Among these participants, 91% had a television (M±SD=5.7±4.6 hours per day), and 74% indicated it was a primary health information source. One third of the sample had used the Internet. Of these participants, about half (53%) had gone online for health information. Younger participants and those with more education were significantly more likely to use the Internet. Among Internet nonusers, there was still interest in finding health information online; however, expense, lack of computer skills or knowledge, and difficulties with typing and reading prevented doing so. CONCLUSIONS: Although this sample used television more often than the Internet as a resource, there appears to be interest among persons with serious mental illness in using the Internet as a source of health information and support.

Prevalence of Hepatitis B, Hepatitis C, and HIV Infections Among Patients in a Psychiatric Hospital in Greece [Brief Reports]

Tue, 01 Sep 2009 05:01:25 PDT

OBJECTIVE: Psychiatric patients are considered to be at increased risk of infection with hepatitis B virus (HBV), hepatitis C virus (HCV), or HIV. METHODS: This study retrospectively assessed the seroprevalence of these infections among psychiatric patients who were referred for laboratory testing over a 24-month period in a 415-bed tertiary care psychiatric hospital in Greece. RESULTS: More than two-thirds of the 805 unique tested patients received care in short-term hospitalization units (patients receiving treatment for substance-related disorders were excluded from this analysis). Two percent tested positive for having the hepatitis B surface antigen, 9% for the HCV antibody, and 1% for HIV. Males were more likely than females to test positive for the HCV antibody (p=.04). CONCLUSIONS: Compared with rates in the general population, in this study population the rate of HCV was more than ten times as high, the rate of HIV was three times as high, and the rate of HBV was comparable.

Perceived Stigma and Barriers to Mental Health Care Utilization Among OEF-OIF Veterans [Brief Reports]

Fri, 31 Jul 2009 05:01:19 PDT

OBJECTIVE: This study examined whether social support and beliefs about mental health care are associated with stigma, barriers to care, and mental health care utilization in a sample of veterans of Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom (OEF-OIF). METHODS: A sample of 272 predominantly reservist and National Guard OEF-OIF veterans in Connecticut completed a needs assessment survey. RESULTS: Negative beliefs about mental health care, particularly psychotherapy, and decreased perceived unit support predicted increased perceptions of stigma and barriers to care. Negative beliefs about mental health care were also associated with decreased likelihood of mental health counseling and medication visits in the past six months, even after adjustment for demographic characteristics, psychiatric disorders, and support variables. CONCLUSIONS: Educational interventions for modifying negative beliefs about mental health care and bolstering unit support may help decrease stigma and barriers to care and increase mental health treatment seeking among OEF-OIF veterans.

Community Pharmacist Services for People With Mental Illnesses: Preferences, Satisfaction, and Stigma [Brief Reports]

Black, E., Murphy, A. L., Gardner, D. M. — Fri, 31 Jul 2009 05:01:19 PDT

OBJECTIVE: The aim of this study was to determine patient preferences, satisfaction, and perceived stigma related to community pharmacists. METHODS: A total of 79 persons receiving psychotropic medications from community pharmacies were recruited at mental health outpatient clinics in Canada to complete a cross-sectional survey. RESULTS: Traditional pharmacy services (providing medication information) were perceived to be of greater importance than some clinical services (such as medication and dosing recommendations). However, perceived importance of service was strongly correlated with its availability. Several gaps in service were identified, including advice on stopping medications, collaborating with other health providers, describing how medications work, addressing side effects, and discussing issues during prescription refills. Inquiries by pharmacists about chronic disease risk factors were uncommon. Perceived stigma was similar to stigma with other types of health providers and lower than that reported with other community members. CONCLUSIONS: The perceived value of community pharmacy services appears to be based on their availability. Participants identified some discomfort and stigma associated with community pharmacy services, but experiences were positive overall.

Effectiveness of Education Programs in Changing Clinicians' Attitudes Toward Treating Borderline Personality Disorder [Brief Reports]

Treloar, A. J. C. — Fri, 31 Jul 2009 05:01:19 PDT

OBJECTIVE: This exploratory study was conducted in Australia and New Zealand and examined the impact of two types of education programs (cognitive-behavioral and psychoanalytic) on clinicians' attitude toward deliberate self-harm behaviors in borderline personality disorder and toward working with patients with this disorder. METHODS: The Attitudes Towards Deliberate Self-Harm Questionnaire was used to assess the attitudes of mental health and emergency medicine clinicians (N=65) before and after attending an education program and at the six-month follow-up. RESULTS: Compared with participants in the control group (N=22), participants in the cognitive-behavioral program (N=18) showed significant improvement in attitudes immediately after attending the program (p=.02), as did participants in the psychoanalytic education program (N=25) (p<.01). However, the six-month follow-up revealed that only the psychoanalytic education group maintained significant changes in attitude (p<.05). CONCLUSIONS: Results are discussed in terms of the use of relatively brief educational interventions in facilitating enduring attitude change toward working with patients with borderline personality disorder.

Management of Psychosocial Distress by Oncologists [Brief Reports]

Fri, 31 Jul 2009 05:01:19 PDT

OBJECTIVE: Little is known about the nature of psychosocial care delivered by oncologists. The goal of this study was to survey oncologists about their management of psychosocial distress, referencing the National Comprehensive Cancer Network guidelines. METHODS: A random sample of 1,000 oncologists were sent an e-mail requesting their participation in an online survey; nonrespondents were sent the survey through postal mail. Regression analyses were conducted to identify independent predictors of care. RESULTS: Forty-six percent (448 of 965) of oncologists responded. Practice locations included: community (63%), cancer center (25%), and hospital (7%). Respondents estimated that over one-third of their patients (mean±SD=38%±22%) experience psychosocial distress warranting intervention, although only 225 of 447 (50%) indicated having mental health services affiliated with their practice. Nearly half (212 of 447, 47%) reported only initiating a referral for psychosocial services, and 214 of 447 (48%) reported both making a referral and starting psychiatric medications, mainly selective serotonin reuptake inhibitors and benzodiazepines. CONCLUSIONS: Most oncologists delivered some level of psychosocial care, although only half had affiliated mental health services.

Population-Attributable Risk of Suicide Conferred by Axis I Psychiatric Diagnoses in a Hong Kong Chinese Population [Brief Reports]

Fri, 31 Jul 2009 05:01:19 PDT

OBJECTIVE: This study was conducted to determine the population-attributable risk (PAR) of completed suicide among Hong Kong Chinese with axis I psychiatric diagnoses. METHODS: With a case-control psychological autopsy method, 150 suicide decedents aged 15–59 were compared for axis I psychiatric diagnoses and psychosocial variables with 150 randomly selected age- and gender-matched persons living in the community. RESULTS: In the presence of other, non-disease-related social risk factors (unemployment and unmanageable debt), past suicide attempt independently accounted for 44% of the PAR of suicide, followed by current major depressive disorder (27%), schizophrenia spectrum disorders (22%), and substance use disorder or pathological gambling (16%). Other diagnoses (such as anxiety and phobic disorders, dysthymia, adjustment disorders, and past major depressive episode) accounted for 24% of PAR. CONCLUSIONS: Psychiatric morbidity remains the major risk factor for suicide in Hong Kong despite well-developed psychiatric services. Mental health policy should be refined to target clinical groups at high risk of suicide.