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Patel SR, La Fleur R, Margolies PJ, Simpson HB, Dixon LB, Myers RW, Bond GR, Drake RE. Evidence-Based Supported Employment for Individuals With Obsessive-Compulsive Disorder. Psychiatr Serv 2024; 75:381-383. [PMID: 38018152 DOI: 10.1176/appi.ps.20230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Individuals with obsessive-compulsive disorder (OCD), a chronic and disabling psychiatric disorder, experience high rates of occupational impairment. OCD symptoms commonly affect individuals' vocational aspirations and result in disability and the need for financial support, problems that are not addressed by current clinical practice guideline recommendations for treating OCD. This Open Forum highlights the need to address occupational impairment caused by OCD and makes the case for formally evaluating whether evidence-based supported employment can help individuals with OCD find and succeed in meaningful work.
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Affiliation(s)
- Sapana R Patel
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Rhea La Fleur
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Paul J Margolies
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - H Blair Simpson
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Lisa B Dixon
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Robert W Myers
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Gary R Bond
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
| | - Robert E Drake
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Patel, Margolies, Simpson, Dixon, Drake); Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York City (Patel, La Fleur, Margolies, Simpson, Dixon); New York State Office of Mental Health, Albany (Myers); Westat, Lebanon, New Hampshire (Bond, Drake)
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Lopes FV, Bakx P, Harper S, Ravesteijn B, Van Ourti T. The effects of supported housing for individuals with mental disorders. HEALTH ECONOMICS 2022; 31 Suppl 2:115-133. [PMID: 35983703 PMCID: PMC9805038 DOI: 10.1002/hec.4579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
Societies face the challenge of providing appropriate arrangements for individuals who need living support due to their mental disorders. We estimate the effects of eligibility to the Dutch supported housing program (Beschermd Wonen), which offers a structured living environment in the community as an intermediate alternative to independent housing and inpatient care. For this, we use exogenous variation in eligibility based on conditionally random assignment of applications to assessors, and the universe of applications to supported housing in the Netherlands, linked to rich administrative data. Supported housing eligibility increases the probability of moving into supported housing and decreases the use of home care, resulting in higher total care expenditures. This increase is primarily due to the costs of supported housing, but potentially also higher consumption of curative mental health care. Supported housing eligibility reduces the total personal income and income from work. Findings do also suggest lower participation in the labor market by the individuals granted eligibility, but the labor participation of their parents increases in the long-run. Our study highlights the trade-offs of access to supported housing for those at the margin of eligibility, informing the design of long-term mental health care systems around the world.
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Affiliation(s)
- Francisca Vargas Lopes
- Department of Public HealthErasmus MCRotterdamThe Netherlands
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
| | - Pieter Bakx
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Sam Harper
- Department of Public HealthErasmus MCRotterdamThe Netherlands
- Department of Epidemiology, Biostatistics & Occupational HealthMcGill UniversityMontrealQuebecCanada
| | - Bastian Ravesteijn
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
| | - Tom Van Ourti
- Erasmus Centre for Health Economics RotterdamErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of Health Policy and ManagementRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
- Tinbergen InstituteRotterdamThe Netherlands
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Group Metacognitive Therapy for Obsessive-Compulsive Disorder in a Routine Clinical Setting: An Open Trial. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Obsessive-compulsive disorder (OCD) is often a chronic disorder characterised by uncontrollable, reoccurring thoughts (obsessions), and/or behaviours (compulsions). Accumulating evidence suggests that metacognitive beliefs may underlie many of the processes implicated in the formation and perpetuation of OCD. Metacognitive therapy (MCT) for OCD aims to modify these maladaptive metacognitive beliefs and processes to treat this debilitating disorder. The current study examines the outcome of a pilot trial of MCT for OCD in 26 (17 females; 9 males) adults (18–64 years) referred to a specialist outpatient service. Results were promising, with significant decreases in OCD and depression symptoms, which were maintained at the 3-month follow-up. The improvement in Yale-Brown Obsessive-Compulsive Scale scores between pre-treatment and follow-up in the completer sample (n=22) was large (d=1.29), and comparable to outcomes of well-established treatments. These encouraging results add to early empirical support for the effectiveness of group MCT as an OCD treatment alternative, as well as reinforcing the role of metacognitions contributing to this disorder.
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Borger C, Marrow J, Drake RE, Taylor J. Characteristics of Enrollees in the Supported Employment Demonstration. Psychiatr Serv 2021; 72:1400-1406. [PMID: 34015952 DOI: 10.1176/appi.ps.202000826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Supported Employment Demonstration (SED), a multiyear (2016-2022), randomized controlled trial funded by the Social Security Administration, recruited a nontraditional sample of benefits applicants with self-reported or documented mental health conditions who were denied disability benefits and who expressed a desire for employment. This study describes the characteristics of the SED sample at baseline. METHODS The authors analyzed baseline data from the 2,960 eligible enrollees, including responses to the Composite International Diagnostic Interview, the 12-item Short-Form Health Survey (SF-12), and the Work Disability Functional Assessment Battery (WD-FAB). RESULTS A majority of SED enrollees self-identified as female (57%), White (56%), and non-Hispanic (87%). Many were 35 years or older (58%), reported at least a high school education (81%), lived with relatives (69%), had never married (55%), were unemployed (81%), and were poor. Median monthly household income was $1,200. Anxiety disorders (71%), personality disorders (65%), and mood disorders (61%) were prevalent. Enrollees reported a mean±SD of 2.5±1.3 mental health conditions and 3.5±2.1 general medical conditions. Health-related quality of life was low, relative to national norms: mean scores for the sample were 32.6±12.5 on the SF-12 mental component summary and 38.3±13.0 on the physical component summary. Mean scores on the WD-FAB subdomains were more than a SD below norms. CONCLUSIONS At baseline, the SED sample had multiple mental health and general medical conditions, low quality of life, and low functional ability. Despite these challenges, the ongoing SED intervention seeks to build on enrollees' expressed desire for employment.
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Senter MS, Patel SR, Dixon LB, Myers RW, Simpson HB. Defining and Addressing Gaps in Care for Obsessive-Compulsive Disorder in the United States. Psychiatr Serv 2021; 72:784-793. [PMID: 33957763 DOI: 10.1176/appi.ps.202000296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) can be a chronic and disabling illness with a lifetime prevalence of 2%, twice that of schizophrenia. Although effective treatments exist, OCD often remains underdetected and undertreated. METHODS The authors performed a scoping review of the literature (of articles in PubMed and PsycINFO published from January 1, 2000, to February 1, 2020) to define gaps in OCD diagnosis and treatment among U.S. adults. Interventions at the patient, clinician, and health care system levels used to address these gaps are described, and promising approaches from around the world are highlighted. RESULTS Of 102 potential studies identified in the search, 27 (including five non-U.S. studies) were included. The studies revealed that lack of clinician and patient knowledge about OCD and misdiagnosis contributes to its underdetection. Suboptimal prescribing of selective serotonin reuptake inhibitor medications and limited use of exposure and response prevention, as a first-line psychotherapy, contribute to OCD undertreatment. Digital health technologies show promise in increasing OCD detection and delivery of evidence-based care and in ensuring continuity of care (including during the COVID-19 pandemic). CONCLUSIONS Given the significant rates of disability, morbidity, and mortality associated with OCD, addressing gaps in OCD care will reduce the U.S. burden of mental illness. Further research is needed to determine how the use of digital health technologies can increase the detection and management of OCD.
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Affiliation(s)
- Meredith S Senter
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript
| | - Sapana R Patel
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript
| | - Robert W Myers
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript
| | - H Blair Simpson
- New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript
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Examining Psychological Self-Sufficiency Among Low-Income Jobseekers with Mental Health Barriers. Community Ment Health J 2021; 57:178-188. [PMID: 32447508 DOI: 10.1007/s10597-020-00630-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
The study is to investigate psychological self-sufficiency-the force within someone that activates cognitive and non-cognitive process of shifting perceived barriers into hope actions-as it relates to economic self-sufficiency among jobseekers with mental health barriers. Among a sample of 2455 low-income jobseekers in job readiness programs at six community-based agencies in Chicago, a subsample of 424 who self-identified as having mental illness barriers are selected to analyze the relationships between employment hope, employment barriers, and economic self-sufficiency using structural equation modeling. Results indicate that employment hope mediates the path between perceived employment barriers and economic self-sufficiency. The study further highlights the positive effects of employment barriers on employment hope among jobseekers with perceived mental illnesses. The findings support growing evidence that psychological self-sufficiency is positively associated with gaining economic self-sufficiency in workforce development programs.
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Velloso P, Piccinato C, Ferrão Y, Aliende Perin E, Cesar R, Fontenelle L, Hounie A, do Rosário M. The suicidality continuum in a large sample of obsessive–compulsive disorder (OCD) patients. Eur Psychiatry 2020; 38:1-7. [DOI: 10.1016/j.eurpsy.2016.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 01/24/2023] Open
Abstract
AbstractBackgroundObsessive–compulsive disorder (OCD) has a chronic course leading to huge impact in the patient’s functioning. Suicidal thoughts and attempts are much more frequent in OCD subjects than once thought before.AimTo empirically investigate whether the suicidal phenomena could be analyzed as a suicidality severity continuum and its association with obsessive–compulsive (OC) symptom dimensions and quality of life (QoL), in a large OCD sample.MethodsCross-sectional study with 548 patients diagnosed with OCD according to the DSM-IV criteria, interviewed in the Brazilian OCD Consortium (C-TOC) sites. Patients were evaluated by OCD experts using standardized instruments including: Yale-Brown Obsessive–Compulsive Scale (YBOCS); Dimensional Yale-Brown Obsessive–Compulsive Scale (DYBOCS); Beck Depression and Anxiety Inventories; Structured Clinical Interview for DSM-IV (SCID); and the SF-36 QoL Health Survey.ResultsThere were extremely high correlations between all the suicidal phenomena. OCD patients with suicidality had significantly lower QoL, higher severity in the “sexual/religious”, “aggression” and “symmetry/ordering” OC symptom dimensions, higher BDI and BA scores and a higher frequency of suicide attempts in a family member. In the regression analysis, the factors that most impacted suicidality were the sexual dimension severity, the SF-36 QoL Mental Health domain, the severity of depressive symptoms and a relative with an attempted suicide history.ConclusionsSuicidality could be analyzed as a severity continuum and patients should be carefully monitored since they present with suicidal ideation. Lower QoL scores, higher scores on the sexual dimension and a family history of suicide attempts should be considered as risk factors for suicidality among OCD patients.
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Murdoch M, Kehle-Forbes S, Spoont M, Sayer NA, Noorbaloochi S, Arbisi P. Changes in Post-traumatic Stress Disorder Service Connection Among Veterans Under Age 55: An 18-Year Ecological Cohort Study. Mil Med 2019; 184:715-722. [PMID: 30938816 DOI: 10.1093/milmed/usz052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mandatory, age-based re-evaluations for post-traumatic stress disorder (PTSD) service connection contribute substantially to the Veterans Benefits Administration's work load, accounting for almost 43% of the 168,013 assessments for PTSD disability done in Fiscal Year 2017 alone. The impact of these re-evaluations on Veterans' disability benefits has not been described. MATERIALS AND METHODS The study is an 18-year, ecological, ambispective cohort of 620 men and 970 women receiving Department of Veterans Affairs PTSD disability benefits. Veterans were representatively sampled within gender; all were eligible for PTSD disability re-evaluations at least once because of age. Outcomes included the percentage whose PTSD service connection was discontinued, reduced, re-instated, or restored. We also examined total disability ratings among those with discontinued or reduced PTSD service connection. Subgroup analyses examined potential predictors of discontinued PTSD service connection, including service era, race/ethnicity, trauma exposure type, and chart diagnoses of PTSD or serious mental illness. Our institution's Internal Review Board reviewed and approved the study. RESULTS Over the 18 years, 32 (5.2%) men and 180 (18.6%) women had their PTSD service connection discontinued; among them, the reinstatement rate was 50% for men and 34.3% for women. Six men (1%) and 23 (2.4%) women had their PTSD disability ratings reduced; ratings were restored for 50.0% of men and 57.1% of women. Overall, Veterans who lost their PTSD service connection tended to maintain or increase their total disability rating. Predictors of discontinued PTSD service connection for men were service after the Vietnam Conflict and not having a Veterans Health Administration chart diagnosis of PTSD; for women, predictors were African American or black race, Hispanic ethnicity, no combat or military sexual assault history, no chart diagnosis of PTSD, and persistent serious mental illness. However, compared to other women who lost their PTSD service connection, African American and Hispanic women, women with no combat or military sexual assault history, and women with persistent serious illness had higher mean total disability ratings. For both men and women who lost their PTSD service connection, those without a PTSD chart diagnosis had lower mean total disability ratings than did their counterparts. CONCLUSIONS Particularly for men, discontinuing or reducing PTSD service connection in this cohort was rare and often reversed. Regardless of gender, most Veterans with discontinued PTSD service connection did not experience reductions in their overall, total disability rating. Cost-benefit analyses could help determine if mandated, age-based re-evaluations of PTSD service connection are cost-effective.
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Affiliation(s)
- Maureen Murdoch
- Section of General Internal Medicine, Minneapolis VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN 55417.,Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417.,Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Shannon Kehle-Forbes
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417.,Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455.,National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130
| | - Michele Spoont
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417.,Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455.,National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs 3375 Koapaka Street, Suite I-560; Honolulu, HI 96819.,Department of Psychiatry, University of Minnesota Medical School, F282/2 A West Building, 2450 Riverside Avenue S, Minneapolis, MN 55454
| | - Nina A Sayer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417.,Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455.,Department of Psychiatry, University of Minnesota Medical School, F282/2 A West Building, 2450 Riverside Avenue S, Minneapolis, MN 55454
| | - Siamak Noorbaloochi
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, One Veterans Drive (152), Minneapolis, MN 55417.,Department of Internal Medicine, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455
| | - Paul Arbisi
- Department of Psychiatry, University of Minnesota Medical School, F282/2 A West Building, 2450 Riverside Avenue S, Minneapolis, MN 55454.,Department of Psychology, College of Liberal Arts, University of Minnesota, 75 E River Rd, Minneapolis, MN 55455.,Psychology Service, Minneapolis VA Health Care System, One Veterans Drive (116-B), Minneapolis, MN 55417
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Velloso P, Piccinato C, Ferrão Y, Perin EA, Cesar R, Fontenelle LF, Hounie AG, do Rosário MC. Clinical predictors of quality of life in a large sample of adult obsessive-compulsive disorder outpatients. Compr Psychiatry 2018; 86:82-90. [PMID: 30086510 DOI: 10.1016/j.comppsych.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND OCD causes impairment in different areas of the patients' quality of life (QoL), such as sociability, family relationships, and occupational performance. The literature has emphasized the relevance of assessing QoL as a critical outcome in mental health studies. AIMS The aim of this study was to investigate sociodemographic and clinical predictors of QoL, including treatment response, in a large sample of OCD subjects. PROCEDURES 575 adult OCD outpatients were interviewed as part of the Brazilian OCD Consortium (CTOC). A smaller number of subjects (N = 143) participated on a clinical trial conducted by one of the CTOC sites. RESULTS OCD patients were more impaired in their QoL when compared to the Brazilian normative data. Obsessive-compulsive symptoms (OCS) severity had significant correlations with all Medical Outcome Short-Form questionnaire (SF-36) domains. Different OCS dimensions had specific correlations with each SF-36 domain. OCS, depression and anxiety severity significantly increased the impairment risk for the SF-36 domains. Suicidality increased the relative risks for impairment in the Role-Functioning and the Vitality domains by 51% and 17%, respectively. There was a significant improvement in some SF-36 dimensions after treatment. CONCLUSIONS QoL domains are highly compromised in OCD patients. Each SF-36 domain had distinct associations with sociodemographic and clinical variables, including OCS dimensions, suicidality and treatment response. These findings emphasize the OCD heterogeneity and the need for including QoL assessment in clinical practice and research studies.
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Affiliation(s)
- Patricia Velloso
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, SP, Brazil; Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil.
| | - Cinthia Piccinato
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, SP, Brazil; Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil
| | - Ygor Ferrão
- Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil; Department of Psychiatry, Health Sciences Federal University of Porto Alegre, Brazil
| | - Eduardo Aliende Perin
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, SP, Brazil; Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil
| | - Raony Cesar
- Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil
| | - Leonardo F Fontenelle
- Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil; Anxiety, Obsessive, and Compulsive Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB), Rio de Janeiro, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil; Brain and Mental Health Research Hub, Monash Institute of Cognitive and Clinical Neurosciences, MONASH University, Melbourne, Australia
| | - Ana G Hounie
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, SP, Brazil; Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil
| | - Maria Conceição do Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, SP, Brazil; Obsessive-Compulsive Spectrum Disorder Research Consortium (C-TOC), Brazil; Child Study Center at Yale University, New Haven, CT, USA.
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Kehle-Forbes SM, Harwood EM, Spoont MR, Sayer NA, Gerould H, Murdoch M. Experiences with VHA care: a qualitative study of U.S. women veterans with self-reported trauma histories. BMC WOMENS HEALTH 2017; 17:38. [PMID: 28558740 PMCID: PMC5450063 DOI: 10.1186/s12905-017-0395-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 05/24/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Women veterans in the United States, particularly those with posttraumatic stress disorder (PTSD) or a history of military sexual assault, have unique health care needs, but their minority status in the US Veterans Health Administration (VHA) has led to documented healthcare disparities when compared to men. This study's objective was to obtain a richer understanding of the challenges and successes encountered by women veterans with self-reported service-related trauma histories (particularly those with a history of military sexual assault and/or posttraumatic stress symptomology) receiving VHA care. METHODS Thirty-seven female Vietnam and post-Vietnam (1975-1998) era veterans were randomly selected from a cohort of PTSD disability benefit applicants to complete semi-structured interviews in 2011-2012. Grounded-theory informed procedures were used to identify interview themes; differences between veterans with and without a history of military sexual assault were examined through constant comparison. RESULTS At the time of the interviews, many women believed that VHA was falling short of meeting women veterans' needs (e.g., lack of women-only mental health programming). Also common, but particularly among those with a military sexual assault history, was the perception that VHA's environment was unwelcoming; being "surrounded by men" yielded emotions ranging from discomfort and mistrust to severe anxiety. A few veterans reported recent positive changes and offered additional suggestions for improvement. CONCLUSIONS Findings suggest that while at the time of the interviews gains had been made in the delivery of gender-sensitive outpatient medical care, women veterans with a history of military sexual assault and/or posttraumatic stress symptomology perceived that they were not receiving the same quality of care as male veterans.
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Affiliation(s)
- Shannon M Kehle-Forbes
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA. .,Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, 55455, USA. .,, One Veterans Drive (152), Minneapolis, MN, 55417, USA.
| | - Eileen M Harwood
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, 55455, USA
| | - Michele R Spoont
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, 55455, USA.,Pacific Islands Division, National Center for PTSD, Honolulu, HI, 96819, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, 55454, USA.,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Nina A Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, 55455, USA.,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, 55454, USA.,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Heather Gerould
- National Center for PTSD Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Maureen Murdoch
- Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, 55455, USA.,Section of General Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, MN, 55417, USA
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11
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Murdoch M, Spoont MR, Kehle-Forbes SM, Harwood EM, Sayer NA, Clothier BA, Bangerter AK. Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long-Term Outcomes: Symptoms, Functioning, and Employment. J Trauma Stress 2017; 30:36-44. [PMID: 28099769 PMCID: PMC6487633 DOI: 10.1002/jts.22162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022]
Abstract
UNLABELLED Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans' recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self-reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. POPULATION The implications of these findings are discussed.
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Affiliation(s)
- Maureen Murdoch
- Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis MN, USA,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michele Roxanne Spoont
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs, Honolulu, HI, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Shannon Marie Kehle-Forbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eileen Mae Harwood
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis MN, USA
| | - Nina Aileen Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Barbara Ann Clothier
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Ann Kay Bangerter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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12
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Abstract
The purpose of this paper is to review scientific evidence for the co-occurrence of major depressive illness and disability, and to examine this phenomenon specifically for women in the United States today. Following a discussion of different ways of operationalizing the concept of disability, the analysis addresses gender biases in disability measurement as well as in recent research on depression and functional impairment. Next, the results of research regarding co-occurrence of disability and depression are reviewed, highlighting those studies focused specifically on women. Turning to research on rehabilitation services for those with psychiatric disabilities, studies suggest that service delivery models fail to address needs specific to women with mental illness in general, as well as those women experiencing severe depression. Thus, the analysis concludes with a series of suggestions and future directions for investigators seeking to better understand the linkages between depression, disability, and rehabilitation services for women.
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13
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Abstract
There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).
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Affiliation(s)
- Gunnel Hensing
- The Sahlgrenska Academy at Göteborg University, Department of Social Medicine, Sweden.
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14
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Perna G, Cavedini P, Harvey PD, Di Chiaro NV, Daccò S, Caldirola D. Does neuropsychological performance impact on real-life functional achievements in obsessive-compulsive disorder? A preliminary study. Int J Psychiatry Clin Pract 2016; 20:224-31. [PMID: 27608507 DOI: 10.1080/13651501.2016.1223856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We investigated the association between neuropsychological performance and real-life functioning in obsessive-compulsive disorder (OCD). As a secondary aim, we investigated the association between neuropsychological performance and self-reported quality of life (QoL). METHODS We retrospectively selected 68 of 240 inpatients with OCD, who had been hospitalised for a 4-week psychiatric rehabilitation programme. We used clinical information recorded in the patients' electronic medical records. We considered the following variables: neuropsychological performance (verbal/visual memory, sustained attention, visual-constructive ability, and language fluency; in a sub-sample of 37 subjects, divided attention, working memory, and attentional shifting were also available); real-life functional achievements (social/vocational outcomes and independent living); subjectively reported QoL (WHOQOL-BREF); obsessive-compulsive (OC) symptoms severity (DY-BOCS). RESULTS We found significant associations between poorer neuropsychological performance and poorer achievements in independent living and vocational outcomes. Among the different neuropsychological tests, we found significant associations between language fluency/executive processing and independent living, and between divided attention, attentional shifting, working memory and vocational outcome. We found no significant associations between neuropsychological performance and subjectively reported QoL. OC symptoms severity was not associated with real-life functional achievements. CONCLUSIONS Our preliminary results suggest that poorer neuropsychological performance may be associated with impaired real-life functioning in subjects with OCD.
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Affiliation(s)
- Giampaolo Perna
- a Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Albese con Cassano, Como , Italy ;,b Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences , University of Maastricht , Maastricht , the Netherlands ;,c Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - Paolo Cavedini
- a Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Albese con Cassano, Como , Italy
| | - Philip D Harvey
- c Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine , University of Miami , Miami , FL , USA
| | - Nunzia Valentina Di Chiaro
- a Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Albese con Cassano, Como , Italy
| | - Silvia Daccò
- a Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Albese con Cassano, Como , Italy
| | - Daniela Caldirola
- a Department of Clinical Neurosciences , Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi , Albese con Cassano, Como , Italy
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15
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Mechanic D. More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Aff (Millwood) 2016; 33:1416-24. [PMID: 25092844 DOI: 10.1377/hlthaff.2014.0504] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The high prevalence of mental illness and substance abuse disorders and their significant impact on disability, mortality, and other chronic diseases have encouraged new initiatives in mental health policy including important provisions of the Affordable Care Act and changes in Medicaid. This article examines the development and status of the behavioral health services system, gaps in access to and quality of care, and the challenges to implementing aspirations for improved behavioral and related medical services. Although many more people than ever before are receiving behavioral health services in the United States-predominantly pharmaceutical treatments-care is poorly allocated and rarely meets evidence-based standards, particularly in the primary care sector. Ideologies, finances, and pharmaceutical marketing have shaped the provision of services more than treatment advances or guidance from a growing evidence base. Among the many challenges to overcome are organizational and financial realignments and improved training of primary care physicians and the behavioral health workforce.
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Affiliation(s)
- David Mechanic
- David Mechanic is the René Dubos University Professor at the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, in New Brunswick, New Jersey
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16
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Umene-Nakano W, Yoshimura R, Hoshuyama T, Yoshii C, Hayashi K, Nakano H, Hori H, Ikenouchi-Sugita A, Katsuki A, Atake K, Nakamura J. Current smoking rate in patients with psychiatric disorders in Japan: questionnaire survey. Psychiatry Res 2013; 210:268-73. [PMID: 23601794 DOI: 10.1016/j.psychres.2013.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/25/2022]
Abstract
The association between smoking and psychiatric disorders (PD) has been known for many years. Support for smoking cessation among patients with PD is provided in advanced nations, but there is a little support for smoking cessation among patients with PD in Japan, where few studies have investigated the smoking rate. The aim of the present study is to determine the smoking rate and smoking habits of Japanese patients with PD. The subjects included outpatients who visited the outpatient psychiatric clinic at a University hospital between January and March of 2011. They answered a questionnaire consisting of questions about their sociodemographic background and smoking habits. In an analysis of 733 subjects, the overall smoking rate was 25.1%. The smoking rates among the patients with schizophrenia and depression were 17.3% and 23.9%, respectively, and these rates were lower than the results of previous studies. Among the current smokers, 43.4% had experienced smoking cessation, and only 26.1% were not interested in smoking cessation. Of the current smokers, 37.5% spent between US$128.88 and US$257 per month on cigarettes.
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Affiliation(s)
- Wakako Umene-Nakano
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, Japan.
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17
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Ebrahim S, Guyatt GH, Walter SD, Heels-Ansdell D, Bellman M, Hanna SE, Patelis-Siotis I, Busse JW. Association of psychotherapy with disability benefit claim closure among patients disabled due to depression. PLoS One 2013; 8:e67162. [PMID: 23840614 PMCID: PMC3696037 DOI: 10.1371/journal.pone.0067162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
Background Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure. Methods Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression. Results We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI] = 0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure. Conclusions We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.
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Affiliation(s)
- Shanil Ebrahim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada.
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18
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The Autonomic Nervous System Questionnaire and the Brief Patient Health Questionnaire as screening instruments for panic disorder in Finnish primary care. Eur Psychiatry 2013; 28:442-7. [PMID: 23273422 DOI: 10.1016/j.eurpsy.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE As panic disorder often remains unrecognized in the health care system, some screening methods have been developed to enhance its recognition. The aim of this study was to test and compare the Autonomic Nervous System Questionnaire (ANS) and the Brief Patient Health Questionnaire (BPHQ) in primary care. SUBJECTS AND METHODS A total sample of 211 primary care outpatients was studied. The Structured Clinical Interview for DSM-IV was the criterion standard for the presence of panic disorder. Indices of diagnostic utility for both screening methods were calculated and compared. RESULTS The AUC (area under the ROC curve) was 0.885 for the ANS and 0.877 for the BPHQ. At the optimal cut-off level, the ANS had the sensitivity of 0.88 and specificity of 0.77; the BPHQ had the sensitivity of 0.79 and the specificity of 0.87. There was not any statistically significant difference between the screens. CONCLUSIONS Both screening methods can be recommended both for clinical practice and research use. In busy primary care practice, the BPHQ may be more useful, as it can be used together with the depression module of the BPHQ.
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19
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Ebrahim S, Montoya L, Truong W, Hsu S, Kamal El Din M, Carrasco-Labra A, Busse JW, Walter SD, Heels-Ansdell D, Couban R, Patelis-Siotis I, Bellman M, de Graaf LE, Dozois DJA, Bieling PJ, Guyatt GH. Effectiveness of cognitive behavioral therapy for depression in patients receiving disability benefits: a systematic review and individual patient data meta-analysis. PLoS One 2012; 7:e50202. [PMID: 23209672 PMCID: PMC3510249 DOI: 10.1371/journal.pone.0050202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 10/17/2012] [Indexed: 11/27/2022] Open
Abstract
Objectives To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits. Data Sources All relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org), electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles. Study Eligibility Criteria, Participants and Intervention Adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual. Study Appraisal and Synthesis Methods Three teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data. Results Of 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI]) = −2.61 (−5.28, 0.07), p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI) = −4.46 (−12.21, 3.30), p = 0.26. Conclusions Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.
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Affiliation(s)
- Shanil Ebrahim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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20
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Moitra E, Dyck I, Beard C, Bjornsson AS, Sibrava NJ, Weisberg RB, Keller MB. Impact of stressful life events on the course of panic disorder in adults. J Affect Disord 2011; 134:373-6. [PMID: 21658775 PMCID: PMC3170458 DOI: 10.1016/j.jad.2011.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/04/2011] [Accepted: 05/17/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Panic disorder with/without agoraphobia (PD/PDA) is a prevalent anxiety disorder, associated with impairment in quality of life and functionality, as well as increased healthcare utilization. Extant research shows a relationship between stressful life events (SLEs) and the onset of panic attacks in adults who ultimately develop PD/PDA. However, limited attention has been paid to how SLEs might affect the severity of panic symptoms in individuals with PD/PDA. In this study, we examined the relationship between SLEs and panic symptom severity in adults with PD/PDA. METHODS Four hundred-eighteen adults with PD/PDA from the Harvard/Brown Anxiety Research Program (HARP), a long-term prospective longitudinal observational multicenter study of adults with a current or past history of anxiety disorders were included in this study. We examined occurrence of SLEs and their impact on panic symptom severity 12-weeks pre- and post-SLE. RESULTS A time-slope effect showed that participants had worsened panic symptoms over the course of the 12-weeks after family/friends/household and work SLEs. That is, their symptoms worsened progressively after the event, rather than immediately thereafter (i.e., significant symptom change within the same week of the event). LIMITATIONS The sample may not be representative of the general population. CONCLUSIONS These findings provide new insights into how SLEs affect panic symptoms in adults with PD/PDA in that household-related SLEs, such as serious family arguments, and work-related SLEs, such as being fired, put some adults at risk for worsened panic symptoms within 12-weeks of the event.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, United States.
| | - Ingrid Dyck
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Courtney Beard
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Andri S. Bjornsson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Nicholas J. Sibrava
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Risa B. Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Department of Family Medicine, Alpert Medical School of Brown University
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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21
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Kiviniemi M, Suvisaari J, Pirkola S, Läksy K, Häkkinen U, Isohanni M, Hakko H. Five-year follow-up study of disability pension rates in first-onset schizophrenia with special focus on regional differences and mortality. Gen Hosp Psychiatry 2011; 33:509-17. [PMID: 21802735 DOI: 10.1016/j.genhosppsych.2011.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/24/2011] [Accepted: 05/27/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the rate and regional determinants of disability pension in first-admission schizophrenia. In addition, we investigated whether patients with disability pension had increased mortality rates during follow-up. METHOD A nationwide register-based 5-year follow-up study of all patients with onset of schizophrenia between 1998 and 2001 (n=3,875). RESULTS A total of 1944 (50.2%) first-onset schizophrenia patients retired on disability pension during the 5-year follow-up. Males retired on pension at an earlier age and more often than females. Regional disability pension rates and retirement times for schizophrenia varied between hospital districts. Patients on disability pension had lower overall and suicide mortality, and they had less physical illness, depression and more psychotropic medication use than patients without disability pension. In regions with a short median time from onset time to retirement, there was significantly higher regional overall mortality and suicide mortality. Disability pension rates were also higher in regions with high involuntary treatment rate. CONCLUSION Half of the schizophrenia patients were pensioned off in 5 years. Lower mortality, especially suicide mortality among disability pensioners, suggests that the decision on a permanent disability pension, indicating for its part the activation of the service system, might be a relief to schizophrenic patients, helping them cope with illness. The retirement process has regional differences, which may be caused by the regional nature of treatment and resources.
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22
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Saxena S, Ayers CR, Maidment KM, Vapnik T, Wetherell JL, Bystritsky A. Quality of life and functional impairment in compulsive hoarding. J Psychiatr Res 2011; 45:475-80. [PMID: 20822778 PMCID: PMC3009837 DOI: 10.1016/j.jpsychires.2010.08.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Revised: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 11/21/2022]
Abstract
Compulsive hoarding patients have been found in previous studies to have substantial disability and functional impairment. However, no prior study has examined subjective and objective quality of life (QOL) in patients with compulsive hoarding. This present study compared compulsive hoarders and non-hoarding OCD patients across a variety of QOL domains. Subjects were 171 consecutive adult patients (34 compulsive hoarders, 137 non-hoarding patients with DSM-IV OCD) treated openly between 1998 and 2004 in the UCLA OCD Partial Hospitalization Program (OCD PHP), a specialized, intensive, multi-modal treatment program for treatment-refractory patients. Scores on the Quality of Life Scale and other symptom severity measures on admission were compared between compulsive hoarders and non-hoarding OCD patients. Compulsive hoarders were older and had lower global functioning than non-hoarding OCD patients. Both groups had low overall QOL scores across multiple domains. Compulsive hoarders had significantly lower levels of satisfaction with their safety than non-hoarding OCD patients, were more often the victims of both violent and non-violent crime, felt less safe in their neighborhoods, and felt less protected against attack. Compulsive hoarders were also much less satisfied with their living arrangements than non-hoarding OCD patients. No differences were found on financial variables, but the vast majority of patients in both groups were unemployed. Compulsive hoarders have lower QOL than non-hoarding OCD patients in the domains of safety and living situation. Psychosocial rehabilitation that focuses on problems with victimization, safety, employment, and financial areas may be a beneficial augmentation to treatment for compulsive hoarding.
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Affiliation(s)
- Sanjaya Saxena
- Department of Psychiatry, University of California at San Diego, 140 Arbor Drive, San Diego, CA 92103, United States.
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23
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Bystritsky A, Kerwin L, Niv N, Natoli JL, Abrahami N, Klap R, Wells K, Young AS. Clinical and subthreshold panic disorder. Depress Anxiety 2010; 27:381-9. [PMID: 20013957 PMCID: PMC3094576 DOI: 10.1002/da.20622] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Panic disorder (PD) is a highly prevalent and disabling condition, and subthreshold cases may be even more prevalent. This study examined psychiatric comorbidities, work functioning, and health-care utilization of individuals with subthreshold panic. The purpose of this study was to add to the accumulating evidence of significant comorbidity and disability associated with subthreshold PD. METHODS Data are drawn from the Health Care for Communities study, a national household survey of the United States' adult, civilian, noninstitutionalized population (N=9585). Data assessing psychiatric disorders, employment and work productivity, and health-care utilization were collected. Seven categories of panic and subthreshold panic were created. RESULTS The prevalence of clinical and subthreshold panic in the general population was 40%. Subthreshold panic was associated with increased odds of several comorbid disorders, including depression, dysthymia, psychosis, generalized anxiety disorder, bipolar disorder, and alcohol and drug use disorders. Subthreshold panic was also associated with greater likelihood of health-care service utilization but not with the intensity of mental health services. CONCLUSION Psychiatric comorbidities and health-care utilization are common among patients with subthreshold panic. The relationship between varying degrees of panic symptomology and other mental health problems and indices of functioning impairment warrants further investigation. These results inform further research focusing on the course of subthreshold PD and its impact on quality of life.
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Affiliation(s)
- Alexander Bystritsky
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90095-8346, USA.
| | - Lauren Kerwin
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Noosha Niv
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jaime L. Natoli
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Natalie Abrahami
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Ruth Klap
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Kenneth Wells
- The Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California
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Drake RE, Skinner JS, Bond GR, Goldman HH. Social security and mental illness: reducing disability with supported employment. Health Aff (Millwood) 2009; 28:761-70. [PMID: 19414885 DOI: 10.1377/hlthaff.28.3.761] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Social Security Administration disability programs are expensive, growing, and headed toward bankruptcy. People with psychiatric disabilities now constitute the largest and most rapidly expanding subgroup of program beneficiaries. Evidence-based supported employment is a well-defined, rigorously tested service model that helps people with psychiatric disabilities obtain and succeed in competitive employment. Providing evidence-based supported employment and mental health services to this population could reduce the growing rates of disability and enable those already disabled to contribute positively to the workforce and to their own welfare, at little or no cost (and, depending on assumptions, a possible savings) to the government.
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Affiliation(s)
- Robert E Drake
- Dartmouth Medical School in Hanover, New Hampshire, USA.
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Gjesdal S, Ringdal PR, Haug K, Maeland JG. Long-term sickness absence and disability pension with psychiatric diagnoses: a population-based cohort study. Nord J Psychiatry 2008; 62:294-301. [PMID: 18622882 DOI: 10.1080/08039480801984024] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sickness absence certified with psychiatric diagnoses is increasing in many Western countries. A substantial proportion of the sickness absentees never return to work, but ends up with a permanent disability pension (DP). This study investigated the incidence of long-term sickness absence (LTSA) with different psychiatric diagnoses, and tested predictors of the transition to permanent DP. A special objective was to explore previously reported gender differences, using a population-based cohort study. The population at risk of LTSA was 106,674 occupational active men and 89,356 women in a Norwegian county in 1994; 314 women and 203 men with LTSA >8 weeks, certified with a psychiatric diagnosis, were followed to the end of 1999, with DP as the endpoint. Diagnoses on sickness certificates, age, gender and income were used as explanatory variables in Cox regression analysis. Annual incidence of LTSA with a psychiatric diagnosis was 7.0/1000/year for women and 3.8/1000 for men; 72% of the women and 50% of the men had a diagnosis indicating depression. During follow-up, 32% of the men and 25% of the women obtained DP. Increasing age, male gender, low income and a diagnosis of psychosis or "other" increased the DP risk. Separate analysis for men indicated a different effect of age and a larger role of serious mental illness. The study verified that women more often than men had LTSA with psychiatric diagnoses, especially with depression. Men were at higher risk of transition to DP, and the study suggested some possible explanations.
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Affiliation(s)
- Sturla Gjesdal
- Section for Social Medicine, Department of Public Health and Primary Health Care and Programme for Health Economics, University of Bergen, Norway.
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Batelaan N, Smit F, de Graaf R, van Balkom A, Vollebergh W, Beekman A. Economic costs of full-blown and subthreshold panic disorder. J Affect Disord 2007; 104:127-36. [PMID: 17466380 DOI: 10.1016/j.jad.2007.03.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/26/2007] [Accepted: 03/26/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Data on the societal costs of mental disorders are necessary to inform health policies. METHODS This study assessed the costs of panic disorder and subthreshold panic disorder, compared these with costs of other mental disorders, and assessed the effects of (psychiatric and somatic) comorbidity and agoraphobia on the costs of panic. Using a large, population-based study in The Netherlands (n=5504), both medical and production costs were estimated from a societal perspective within a one-year timeframe. RESULTS Annual per capita costs of panic disorder were 10,269 euros, while subthreshold panic disorder generated 6384 euros. These costs were higher than those of the other mental disorders studied. About one quarter of the costs could be attributed to comorbidity. Agoraphobia was associated with higher costs. LIMITATIONS Methodological choices influence cost estimates. In the present study most of these will result in conservative cost estimates. CONCLUSIONS Panic thus causes substantial societal costs. Given the availability of effective treatment, treatment may not only benefit individual patients, but also have economic returns for society.
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Affiliation(s)
- Neeltje Batelaan
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Borras L, Mohr S, Boucherie M, Dupont-Willemin S, Ferrero F, Huguelet P. Patients with schizophrenia and their finances: how they spend their money. Soc Psychiatry Psychiatr Epidemiol 2007; 42:977-83. [PMID: 17901909 DOI: 10.1007/s00127-007-0257-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 09/03/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although most patients with schizophrenia rely on state financial support, little is known about their expenses and how they use the money at their discretion. However, the ability to budget is a predictive factor in rehabilitation. An assessment of financial management skills could make it possible to develop more appropriate psycho-social assistance. METHOD Fifty-seven outpatients with schizophrenia treated in the public sector in Geneva, Switzerland took part in the study. Psychosocial, diagnostic, neurocognitive and symptomatological measures were collected. Data were gathered on patients' incomes and quality of life. A prospective analysis of their expenses during a 1-month period was also performed. RESULTS Median income was 4,125 Swiss francs per month (i.e., 3,372 US dollars). After paying fixed expenses (which were handled with or without the assistance of a representative payee), a mean of 400 Swiss francs remained at their disposal to use as they wished. Seventy-two percent of this money was devoted to the use of psychoactive substances (e.g., cigarettes, alcohol, cannabis) or various drinks in coffee houses, and 28% on leisure activities (trips, sports and other recreational activities). Eighty-four percent of patients would have liked to have more money for leisure activities. The study was well-accepted and led to modification of the treatment plan in 84% of cases. CONCLUSION Most of the discretionary money patients received was used for buying substances with addictive properties; this may hinder the practice of activities favouring recovery. Thus, it appears essential to guide patients in the management of their budgets.
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Affiliation(s)
- Laurence Borras
- Division of adult psychiatry, Dept. of Psychiatry, University Hospital of Geneva, 36, rue du 31 Décembre, 1207, Geneva, Switzerland
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LARSON JONATHONE, BARR LEAHK, KUWABARA SACHIKOA, BOYLE MICHAELG, GLENN TRICIAL. Process and Outcome Analysis of a Supported Employment Program for People with Psychiatric Disabilities. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2007. [DOI: 10.1080/15487760701680604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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GIOIA DEBORAH. Examining Work Delay in Young Adults with Schizophrenia. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2006. [DOI: 10.1080/15487760600961543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
OBJECTIVE Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs. METHODS We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years. RESULTS Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited. CONCLUSIONS Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment.
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Affiliation(s)
- Alan M Langlieb
- Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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Harding TP. Psychiatric disability and clinical decision making: The impact of judgment error and bias. Clin Psychol Rev 2004; 24:707-29. [PMID: 15385095 DOI: 10.1016/j.cpr.2004.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 06/07/2004] [Accepted: 06/28/2004] [Indexed: 10/26/2022]
Abstract
The psychiatric disability adjudicator is presented, with multiple types of evidence regarding claimants, and, utilizing primarily clinical judgment, must weigh and integrate this information before rendering a disability decision. The need to process large amounts of evidence in this fashion can result in the use of cognitive simplification strategies in the form of heuristics or specific types of decisional bias which can produce judgment error. The purpose of this review is to increase awareness regarding the role that bias can play in determining an individual's psychiatric disability status, using a large federal disability program for context purposes. Recommendations are also made regarding steps that can be taken to anticipate and reduce decision-making bias.
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Sayer NA, Spoont M, Nelson D. Veterans seeking disability benefits for post-traumatic stress disorder: who applies and the self-reported meaning of disability compensation. Soc Sci Med 2004; 58:2133-43. [PMID: 15047072 DOI: 10.1016/j.socscimed.2003.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Assumptions about the characteristics and motivations of individuals pursuing disability status are well known. However, policy, programming and interventions need to be based on information about the actual sociodemographic characteristics of disabled individuals, as well as their goals in seeking disability status. In this study, we focus on veterans seeking disability compensation for post-traumatic stress disorder (PTSD) from the United States Department of Veterans Affairs. We present information on their life circumstances and their self-reported reasons for valuing the obtainment of veterans' disability status on the basis of PTSD. There was considerable variability in the background of veterans seeking disability status on the basis of PTSD. Of concern, only about half of these individuals were receiving any mental health treatment at the time of application. Most claimants reported seeking disability compensation for symbolic reasons, especially for acknowledgement, validation and relief from self-blame. Reasons having to do with improved finances were less frequently endorsed, although the importance of obtaining improved solvency through disability status decreased as income increased. The sense of investment in obtaining a sense of self-acceptance and acceptance from others through disability status varied by sociodemographic variables. Overall, findings suggest that individuals seeking disability benefits may have unmet mental health care needs, and that policy makers, investigators and providers should consider material benefit as one of many possible reasons for engaging in a disability compensation system.
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Affiliation(s)
- Nina A Sayer
- Center for Chronic Diseases Outcomes Research, Veterans Affairs Medical Center 116A6, One Veterans Drive, Minneapolis, MN 55417, USA.
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Abstract
BACKGROUND This article reviews the clinical features, epidemiology, pathophysiology, dental findings, and dental and medical management of the care of patients with panic disorder, or PD. TYPES OF STUDIES REVIEWED The authors conducted a MEDLINE search for the period 1998 through 2003, using the key term "panic disorder" to define the pathophysiology of the disorder, its epidemiology and dental implications. The articles they selected for further review included those published in peer-reviewed journals. RESULTS PD is a common and debilitating psychiatric disease in which a person experiences sudden and unpredictable panic attacks, or PAs, with symptoms of overwhelming anxiety, chest pain, palpitations and shortness of breath. Persistent concern about having another attack and worry that it may indicate a heart attack or "going crazy" impairs the person's social, family and working lives. Frequently accompanying the disorder is agoraphobia, depression and mitral valve prolapse, or MVP. CLINICAL IMPLICATIONS In patients with PD, the prevalence of dental disease may be extensive because of the xerostomic effects of psychiatric medications used to treat it. Dental treatment consists of preventive dental education and prescribing saliva substitutes and anticaries agents. Precautions must be taken when prescribing or administering analgesics, antibiotics or sedative agents that may have an adverse interaction with the psychiatric medications. Because there is a connection between PAs and MVP, the dentist needs to consult with the patient's physician to determine the presence of MVP and whether there is associated mitral valve regurgitation. Patients with MVP and accompanying mitral valve regurgitation require prophylactic antibiotics when undergoing dental procedures known to cause a bacteremia and heightened risk of endocarditis.
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Roy-Byrne PP, Russo J, Cowley DS, Katon WJ. Panic disorder in public sector primary care: clinical characteristics and illness severity compared with "mainstream" primary care panic disorder. Depress Anxiety 2003; 17:51-7. [PMID: 12621592 DOI: 10.1002/da.10082] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The prevalence of anxiety disorders is increased among low-income individuals, who are more likely to seek mental health care in medical as opposed to specialty settings because of limited insurance access and restricted availability of public sector mental health resources. However, little is known about the clinical characteristics and illness severity of anxiety disorders in this setting. We studied the clinical characteristics of low-income compared with middle-income primary care panic patients. Clinical, functional, and service use measures obtained at baseline interview in 39 panic disorder patients seen in one public sector medical clinic were compared with 76 patients seen in two middle-income clinics. All patients were participants in a randomized effectiveness pharmacotherapy trial [Roy Byrne et al., Arch Gen Psychiatry 2001;58:869-876]. Public sector patients were more often older, male, single, unemployed, of lower income, and non-Caucasian ethnicity. They had more severe clinical symptoms, more medical comorbidity, worse physical and role health status, and more emergency room visits. Low income and unemployment accounted for most of the differences in non-anxiety-related measures. However, type of clinic still contributed independently to the greater severity of specific measures of panic/anxiety (Panic Disorder Severity Scale and Marks Fear Scale scores), suggesting that the increased stress and limited social resources associated with low-income and disadvantaged status may have more specific effects on anxiety than other aspects of psychopathology.
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Affiliation(s)
- Peter P Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104-2499, USA.
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Murdoch M, Hodges J, Cowper D, Fortier L, van Ryn M. Racial disparities in VA service connection for posttraumatic stress disorder disability. Med Care 2003; 41:536-49. [PMID: 12665717 DOI: 10.1097/01.mlr.0000053232.67079.a5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND "Service connected" veterans are those with documented, compensative conditions related to or aggravated by military service, and they receive priority for enrollment into the Veterans Affairs (VA) health care system. For some veterans, service connection represents the difference between access to VA health care facilities and no access. OBJECTIVES To determine whether there are racial discrepancies in the granting of service connection for posttraumatic stress disorder (PTSD) by the Department of Veterans Affairs and, if so, to determine whether these discrepancies could be attributed to appropriate subject characteristics, such as differences in PTSD symptom severity or functional status. RESEARCH DESIGN Mailed survey linked to administrative data. Claims audits were conducted on 11% of the sample. SETTING AND SUBJECTS The study comprised 2700 men and 2700 women randomly selected from all veterans filing PTSD disability claims between January 1, 1994 and December 31, 1998. RESULTS A total of 3337 veterans returned usable surveys, of which 17% were black. Only 16% of respondents carried private health insurance, and 44% reported incomes of 20,000 US dollars or less. After adjusting for respondents' sociodemographic characteristics, symptom severity, functional status, and trauma histories, black persons' rate of service connection for PTSD was 43% compared with 56% for other respondents (P = 0.003). CONCLUSION Black persons' rates of service connection for PTSD were substantially lower than other veterans even after adjusting for differences in PTSD severity and functional status.
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Affiliation(s)
- Maureen Murdoch
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minnesota 55417, USA.
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Bilder S, Mechanic D. Navigating the disability process: persons with mental disorders applying for and receiving disability benefits. Milbank Q 2003; 81:75-106, table of contents. [PMID: 12669652 PMCID: PMC2690202 DOI: 10.1111/1468-0009.00039] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Persons with mental disorders are less likely to be working and more likely to apply for and receive SSDI and/or SSI benefits than are those without such disorders. Data from the National Health Interview Survey on Disability (NHIS-D) were examined to identify the predictors of SSDI/SSI application and receipt among persons with self-reported mental disorders. Compared with nonapplicants, applicants had higher levels of disability, fewer financial and interpersonal resources, and better access to information about the disability programs. Among applicants, similar factors distinguished recipients from those who did not receive benefits. Navigating the disability process is associated with the extent of impairment, economic and social disadvantage, and linkage to the disability determination process.
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Affiliation(s)
- Scott Bilder
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 30 College Avenue, New Brunswick, NJ 08901, USA.
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Gallo LC, Matthews KA. Understanding the association between socioeconomic status and physical health: do negative emotions play a role? Psychol Bull 2003; 129:10-51. [PMID: 12555793 DOI: 10.1037/0033-2909.129.1.10] [Citation(s) in RCA: 663] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this article, the authors evaluate the possible roles of negative emotions and cognitions in the association between socioeconomic status (SES) and physical health, focusing on the outcomes of cardiovascular diseases and all-cause mortality. After reviewing the limited direct evidence, the authors examine indirect evidence showing that (a) SES relates to the targeted health outcomes, (b) SES relates to negative emotions and cognitions, and (c) negative emotions and cognitions relate to the targeted health outcomes. The authors present a general framework for understanding the roles of cognitive-emotional factors, suggesting that low-SES environments are stressful and reduce individuals' reserve capacity to manage stress, thereby increasing vulnerability to negative emotions and cognitions. The article concludes with suggestions for future research to better evaluate the proposed model.
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Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, California 92120, USA.
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Dremsa TL, Engel CC, Liu X, Johantgen M, Smith S. Do mental disorders matter? A study of absenteeism among care seeking Gulf War veterans with ill defined conditions and musculoskeletal disorders. Occup Environ Med 2002; 59:532-6. [PMID: 12151609 PMCID: PMC1740339 DOI: 10.1136/oem.59.8.532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To investigate the extent that common psychological conditions contribute to lost work among individuals with musculoskeletal and ill defined conditions. METHODS Cross sectional health and work related survey evaluating Gulf War veterans seeking Department of Defense health care for Gulf War related health concerns. Ordered probit models were used to study whether a provider diagnosed musculoskeletal condition (ICD-9 codes 710-739) or "signs, symptoms, and ill defined conditions" (ICD-9 codes 780-799) have an effect on recent lost work over the previous 90 days in the presence of one or more psychological conditions (ICD-9 codes 290-320) after controlling for sociodemographic variables. RESULTS Bivariate analyses revealed that musculoskeletal conditions, ill defined conditions, and psychological conditions were positively associated with lost work. Multivariate analyses showed an independent effect of both psychological conditions and musculoskeletal conditions. A significant interaction existed between psychological conditions and musculoskeletal conditions: the presence of a coexisting psychological condition considerably increased the likelihood that a musculoskeletal disorder resulted in lost work, or vice versa. CONCLUSIONS Psychological conditions appear to be an important contributor to absenteeism among individuals with musculoskeletal and ill defined conditions. A limitation of the cross sectional design was the inability to sequence the onset of conditions.
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Affiliation(s)
- T L Dremsa
- United States Air Force, San Antonio, Texas 78253, USA.
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Abstract
OBJECTIVE To determine the association between respiratory disease and panic attacks among adults in the US population. METHOD Data were drawn from the Midlife Development in the United States Survey (n = 3,032), a representative sample of adults aged 25 to 74 years. Multivariate logistic regression analyses were used to determine the relationship between self-reported respiratory and other lung disease and panic attacks, major depression, generalized anxiety disorder, and alcohol/substance use disorders. RESULTS After adjusting for demographic characteristics, comorbid mental disorders, and comorbid physical disorders, self-reported respiratory disease (ie, asthma, chronic bronchitis, or emphysema) was associated with a significantly increased likelihood of panic attacks (odds ratio, 1.7; confidence interval, 1.2 to 2.4). Other self-reported lung disease was also associated with a significantly increased odds of panic attacks (odds ratio, 2.3; confidence interval, 1.2 to 4.2), and having both self-reported respiratory disease and another lung disease was associated with increased likelihood of panic attacks (odds ratio, 4.1; confidence interval, 1.7, 9.9). These associations also persisted after adjusting for demographic characteristics, comorbid mental disorders, and physical comorbidity. CONCLUSION These findings are consistent with and extend previous clinical and epidemiologic data by showing a specific association between self-reported respiratory disease and panic attacks among adults. Future studies that investigate the relationship between respiratory disease and panic attacks, and other mental disorders, using prospectively collected data on respiratory functioning, may help to improve our understanding of the mechanism of this association.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA.
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