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Rahimpour Jounghani A, Kumar A, Moreno Carbonell L, Aguilar EPL, Picardi TB, Crawford S, Bowden AK, Hosseini SMH. Wearable fNIRS platform for dense sampling and precision functional neuroimaging. NPJ Digit Med 2025; 8:271. [PMID: 40355575 PMCID: PMC12069634 DOI: 10.1038/s41746-025-01690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 04/29/2025] [Indexed: 05/14/2025] Open
Abstract
Precision mental health aims to improve care by tailoring interventions based on individual neurobiological features. Functional near-infrared spectroscopy (fNIRS) is a cost-effective and portable alternative to traditional neuroimaging, making it a promising tool for this purpose. This study evaluates a self-administered, wearable fNIRS platform designed for precision mental health applications, focusing on its reliability and specificity in capturing individualized functional connectivity patterns. The platform incorporates a wireless, portable multichannel fNIRS device, augmented reality guidance for reproducible device placement, and a cloud-based system for remote data access. In this proof-of-concept study, eight adults completed ten dense-sampled sessions involving cognitive tasks and resting-state measurements. Results demonstrated high test-retest reliability and within-participant consistency in functional connectivity and activation patterns. These findings support the platform's feasibility for individualized functional mapping. Future research with larger and more diverse cohorts, including clinical populations, is necessary to explore its potential for disorder-specific applications.
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Affiliation(s)
- Ali Rahimpour Jounghani
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Computational Brain Research and Intervention (C-BRAIN) Laboratory, Stanford University, Palo Alto, CA, USA
| | - Anupam Kumar
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Laura Moreno Carbonell
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Computational Brain Research and Intervention (C-BRAIN) Laboratory, Stanford University, Palo Alto, CA, USA
- Department of Bioengineering, Stanford University, Palo Alto, CA, USA
| | - Ester Patrize Lopez Aguilar
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Computational Brain Research and Intervention (C-BRAIN) Laboratory, Stanford University, Palo Alto, CA, USA
| | - Tulla Bee Picardi
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Computational Brain Research and Intervention (C-BRAIN) Laboratory, Stanford University, Palo Alto, CA, USA
| | - Seth Crawford
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Audrey K Bowden
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Computational Brain Research and Intervention (C-BRAIN) Laboratory, Stanford University, Palo Alto, CA, USA.
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Ishaq S, Zahid S, Ahmed T. Sex-specific effects of neuromodulatory drugs on normal and stress-induced social dominance and aggression in rats. Psychopharmacology (Berl) 2025; 242:1011-1024. [PMID: 37994914 DOI: 10.1007/s00213-023-06503-7] [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] [Received: 05/10/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social hierarchies are important for individual's well-being, professional and domestic growth, harmony of the society, as well as survival and morbidity. Studies have revealed sexual dimorphism in the social abilities; however, data is limited on the sex-specific effects of various drugs used to treat psychiatric disorders and social deficits. OBJECTIVE The present study aimed at evaluating the sex-dependent effects of Risperidone (antipsychotic that targets D2 dopaminergic, 5HT2A serotonergic, and α-adrenergic receptors), Donepezil (a reversible acetylcholinesterase inhibitor), and Paroxetine (a selective serotonin reuptake inhibitor) on social hierarchy in rats under normal and stressed states. METHODS 8-12 weeks old male and female Wistar rats were divided into sex-wise 4-4 groups, i.e., 1. control group, 2. Risperidone treated group (3 mg/kg/day), 3. Donepezil treated group (5 mg/kg/day), and Paroxetine treated group (10 mg/kg/day). Rats were treated with these drugs in phase I for 21 days in distilled drinking water, followed by a no (drugs) treatment break of 10 days. After the break phase II started with the administration of drugs (same as in phase I) along with tilt-cage stress for 21 days. Home cage activity assessment was performed once a week during both phases (I & II), while tube dominance and resident intruder tests were performed at the end of each phase. RESULTS In phase I in both sexes, Risperidone treatment decreased social interaction and motor activity while Paroxetine treatment increased these in both sexes compared to their respective control groups. Social dominance and aggression were reduced after treatment with both of these drugs. In contrast, Donepezil treatment caused an increase in motor activity in females whereas reduced motor activity in males. Furthermore, Donepezil treatment caused reduction in interaction but increased social dominance and aggression were observed in both sexes. In phase II, stress led to an overall decrease in motor activity and social interaction of animals. Treatment with Risperidone, Paroxetine, and Donepezil caused a sex-specific effect on, motor activity, social interaction, and social exploration. CONCLUSION These results showed that Risperidone has stronger effects on male social behavior whereas Paroxetine and Donepezil differentially affect social abilities in both sexes during normal and stressed situations.
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Affiliation(s)
- Sara Ishaq
- Neurobiology Laboratory, Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, 44000, Pakistan
| | - Saadia Zahid
- Neurobiology Laboratory, Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, 44000, Pakistan
| | - Touqeer Ahmed
- Neurobiology Laboratory, Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, 44000, Pakistan.
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Ballard DW, Lodge GC, Pike KM. Mental health at work: a practical framework for employers. Front Public Health 2025; 13:1552981. [PMID: 40352843 PMCID: PMC12061880 DOI: 10.3389/fpubh.2025.1552981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2024] [Accepted: 04/09/2025] [Indexed: 05/14/2025] Open
Abstract
Mental health is a universal issue critical not only to individual health and well-being, but also to workforce sustainability and organizational performance. Leaders increasingly understand the imperative to support workers' mental health but are often unsure of where to start or how to prioritize their actions. Numerous guidance documents for employers have emerged in recent years, but without conducting their own needs and risk assessment and evaluating the policies and practices they have in place, employers are left unaware of specific risks their workers face, effectiveness of their current practices, and actions they could take that would have the greatest positive impact. To address this gap, Columbia University's Mental Health + Work Design Lab, mental health non-profit One Mind at Work, and corporate ethical standards measurement company Ethisphere partnered to develop a comprehensive framework and corresponding self-assessment to help employers evaluate their organizational-level workforce mental health efforts and strategically invest in evidence-based practices. In this article, we detail the range of organizational-level practices necessary to effectively support and advance workforce mental health and present a framework for assessing and improving these efforts.
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Affiliation(s)
| | | | - Kathleen M. Pike
- Mental Health and Work Design Lab, Columbia University, New York, NY, United States
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Lee JL, Chen SY, Wickham RE, Wang P, Wu MS, Varra AA, Chen CE, Lungu A. Clinical outcomes from blended care therapy for anxiety and depression in the year after treatment. Internet Interv 2025; 39:100798. [PMID: 39834477 PMCID: PMC11743894 DOI: 10.1016/j.invent.2024.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 12/19/2024] [Accepted: 12/23/2024] [Indexed: 01/22/2025] Open
Abstract
Background Scalable evidence-based treatments for anxiety and depression, such as blended care therapy (BCT) that integrate digital tools are effective, but reporting on long-term outcomes is limited. Method This pragmatic observational study examined the symptom stability and trajectories of individuals in the year following engagement in a BCT program. Participants included adults with clinical anxiety and/or depression measured by the Generalized Anxiety Disorder-7 (GAD-7) or Patient Health Questionnaire-9 (PHQ-9). Assessments were sent during the initial episode of care and in the year following. Results Participants included 27,835 adults (depression: 17,686 and anxiety: 24,853). Of these, 11,465 (41 % of those who received initial care; depression: 7223; anxiety: 10,218) completed at least one follow-up assessment (FUA). Average age was 34 years, 68-69 % were female, and 48-49 % were White across subsamples. Among FUA respondents, rates of reliable improvement or recovery on the PHQ-9 or GAD-7 for those who did not receive additional therapy were above 81 % across follow-up periods. Growth curve analysis for those who did not return for additional therapy revealed that both depression and anxiety groups demonstrated a statistically significant yet small linear effect of time in the year following treatment, with a 1.6-2.1 point increase in scores over the 12-month period. Conclusions Among clients who completed FUAs and received no additional therapy, reliable improvement and recovery rates were high. Growth curve analysis demonstrated a small increase in symptoms over the 12-month interval, providing pragmatic evidence of long-term stability of treatment gains from BCT for anxiety and depression in a real-world setting.
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Affiliation(s)
- Jennifer L. Lee
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
- Emory University, 1405 Clifton Rd. NE, Atlanta, GA 30307, United States of America
| | - Shih-Yin Chen
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
| | - Robert E. Wickham
- Department of Psychological Sciences, Northern Arizona University, 1100 S Beaver St, Student Academic Services, Flagstaff, AZ 86011, United States of America
| | - Pam Wang
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
| | - Monica S. Wu
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
| | - Alethea A. Varra
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
| | - Connie E. Chen
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
| | - Anita Lungu
- Lyra Health, 270 East Lane Burlingame, CA 94010, United States of America
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Rittiphairoj T, Bulstra C, Ruampatana C, Stavridou M, Grewal S, Reddy CL, Atun R. The economic burden of ischaemic heart diseases on health systems: a systematic review. BMJ Glob Health 2025; 10:e015043. [PMID: 39939107 PMCID: PMC11822391 DOI: 10.1136/bmjgh-2024-015043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 11/25/2024] [Indexed: 02/14/2025] Open
Abstract
INTRODUCTION There is a dearth of evidence regarding the global economic burden of ischaemic heart diseases (IHDs). This systematic review aims to synthesise national-level studies worldwide quantifying the economic burden of IHDs from a provider's perspective. METHODS We searched PubMed, Embase, Cochrane, DARE and EconLit databases from 1 January 2000 to 29 June 2022. We included observational, cost-of-illness and economic modelling studies reporting direct healthcare cost data for IHDs at the national level. At least two reviewers independently screened titles and abstracts and full texts, extracted data and assessed quality using a seven-question assessment tool. We synthesised findings by country, focusing on three key economic estimates: total annual costs of IHDs, costs of managing acute IHD episodes and chronic IHD care. We correlated these costs with country-specific macroeconomic measures and disease burden. RESULTS We included 65 national-level studies conducted in 21 countries worldwide, with a majority in high-income countries. The median direct healthcare cost per episode of IHDs was 8062 Int$ 2019 (IQR: 5770-9580), and the median direct healthcare cost of IHDs per patient-year was 10 064 Int$ 2019 (IQR: 7619-14 818). These estimates positively correlated with country-specific macroeconomic and DALY measures. CONCLUSION IHDs impose a substantial economic burden on health systems globally. Economic costs in countries exceed per capita public health expenditure, primarily driven by acute episodes. National-level data were available for only 21 countries, and none from low-middle-income and low-income countries. Economic costs of IHDs need to be quantified to inform resource allocation decisions at national and global levels.CRD42022337577.
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Affiliation(s)
- Thanitsara Rittiphairoj
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Division of Health Systems Management, Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Caroline Bulstra
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Chochat Ruampatana
- Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maria Stavridou
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sagar Grewal
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Che L Reddy
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Rifat Atun
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Almeida-Souza TH, Silva RS, Franco HS, Santos LM, Melo JEC, Oliveira E Silva AMD, Menezes ECD, Santos JRD, Teixeira-Silva F, Goes TC, Marchioro M. Involvement of the serotonergic, GABAergic and glutamatergic systems of the rostral anterior cingulate cortex in the trait and state anxiety of adult male Wistar rats. Behav Brain Res 2025; 477:115298. [PMID: 39433219 DOI: 10.1016/j.bbr.2024.115298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/16/2024] [Accepted: 10/16/2024] [Indexed: 10/23/2024]
Abstract
Despite significant advancements to understand of the neural circuitry involved in anxiety, the neurobiology of trait anxiety remains unclear. The rostral anterior cingulate cortex (rACC) and various pathways have been implicated in its regulation, making it a key to trait anxiety. The present study aimed to investigate the role of these neurotransmitter systems in the rACC in trait anxiety. Since trait anxiety is known to modulate state anxiety, we further investigated this relationship. Specifically, in Experiment I, we used animals with high trait anxiety; in Experiment II, we used animals with low trait anxiety; and in Experiment III, we used animals with medium trait anxiety. Before each behavioral assessment, drugs that either increased or decreased serotonergic (Fluoxetine or WAY-100635), GABAergic (Muscimol or Bicuculline), and glutamatergic (NMDA or Ketamine) neurotransmission in the rACC were administered, along with their respective controls. Additionally, in Experiment IV, all animals from the previous experiments were subjected to the Elevated Plus Maze (EPM) and Hole board (HB) test and evaluated without taking into account their trait anxiety levels. The results of the present study showed that, in Exp I, the modulation of the serotonergic, GABAergic and glutamatergic systems in the rACC decreased trait anxiety in highly anxious rats, while by submitting the animals to HB, the administration of fluoxetine increased state anxiety. In Exp II, the modulation of all systems increased trait anxiety in rats with low trait anxiety, whereas, in HB, state anxiety levels were increased with the administration of NMDA. In Exp III, only the modulation of the glutamatergic system, with NMDA, increased both trait and state anxiety levels. However, none of the evaluated neurotransmitter systems altered the state anxiety modeled in the EPM. Overall, the results of the present study provide new insights into the role of the neurotransmitter systems in the rACC in the regulation of trait anxiety and state anxiety.
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Affiliation(s)
- Thiago Henrique Almeida-Souza
- Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil; Department of Nutrition, Federal University of Sergipe, São Cristovão, Sergipe, Brazil; Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada.
| | - Rodolfo Santos Silva
- Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
| | - Heitor Santos Franco
- Department of Biosciences, Federal University of Sergipe, Itabaiana, Sergipe, Brazil
| | | | | | | | - Edênia Cunha de Menezes
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States; Department of Child and Adolescent Psychiatry at NYU Grossman School of Medicine, New York University, New York, United States
| | | | - Flavia Teixeira-Silva
- Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
| | - Tiago Costa Goes
- Department of Health Education, Federal University of Sergipe, Lagarto, Sergipe, Brazil
| | - Murilo Marchioro
- Department of Physiology, Federal University of Sergipe, São Cristovão, Sergipe, Brazil
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Hymel PA, Stave GM, Burton WN, Schultz AB, Jones N, Liva J, Price RD, Loeppke R, Stout R, Saito K. Incorporating Lifestyle Medicine Into Occupational Medicine Practice: ACOEM Guidance Statement. J Occup Environ Med 2025; 67:e72-e84. [PMID: 39511831 DOI: 10.1097/jom.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
ABSTRACT Lifestyle medicine (LM) utilizes evidence-based therapeutic lifestyle changes to address lifestyle factors that impact health, performance, and injury risk and recovery. By integrating LM principles into clinical care, workplace policies, and programs, along with other evidence-based methods, occupational and environmental medicine clinicians and medical directors can enhance worker health and performance, manage chronic disease, and facilitate faster recovery from injury and illness. This guidance addresses approaches that can be used in the clinic and workplace to address tobacco, substance misuse, nutrition, physical activity, overweight/obesity, sleep, mental well-being, and social connectedness.
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Affiliation(s)
- Pamela A Hymel
- From the American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Tanaka S, Matsubayashi T. The light of life: The effects of sunlight on suicide. JOURNAL OF HEALTH ECONOMICS 2025; 99:102947. [PMID: 39671959 DOI: 10.1016/j.jhealeco.2024.102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/18/2024] [Accepted: 11/26/2024] [Indexed: 12/15/2024]
Abstract
This study examines the causal effects of sunlight exposure on suicide rates. Leveraging county-month-year data on solar insolation and suicide rates in the U.S. from 1979 to 2004, we provide first robust evidence that insufficient sunlight increases suicide rates. We also find that insufficient sunlight increases Google searches containing depressive language, suggesting a potential adverse impact on mental well-being. Importantly, our findings favor a biological pathway over alternative mechanisms. The estimated effect of sunlight on suicide, often exceeding other interventions in magnitude, sheds new light on sunlight as a significant risk factor in suicide incidence.
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Affiliation(s)
- Shinsuke Tanaka
- University of Connecticut, 1376 Storrs Road, Unit 4021 Storrs, CT 06269, USA.
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de Lacy N, Ramshaw M, Lam WY. RiskPath: Explainable deep learning for multistep biomedical prediction in longitudinal data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.19.24313909. [PMID: 39371168 PMCID: PMC11451668 DOI: 10.1101/2024.09.19.24313909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Many diseases are the end outcomes of multifactorial risks that interact and increment over months or years. Timeseries AI methods have attracted increasing interest given their ability to operate on native timeseries data to predict disease outcomes. Instantiating such models in risk stratification tools has proceeded more slowly, in part limited by factors such as structural complexity, model size and explainability. Here, we present RiskPath, an explainable AI toolbox that offers advanced timeseries methods and additional functionality relevant to risk stratification use cases in classic and emerging longitudinal cohorts. Theoretically-informed optimization is integrated in prediction to specify optimal model topology or explore performance-complexity tradeoffs. Accompanying modules allow the user to map the changing importance of predictors over the disease course, visualize the most important antecedent time epochs contributing to disease risk or remove predictors to construct compact models for clinical applications with minimal performance impact.
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Affiliation(s)
- Nina de Lacy
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Michael Ramshaw
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Wai Yin Lam
- Scientific Computing Institute, University of Utah, Salt Lake City, Utah
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Crosland P, Marshall DA, Hosseini SH, Ho N, Vacher C, Skinner A, Nguyen KH, Iorfino F, Rosenberg S, Song YJC, Tsiachristas A, Tran K, Occhipinti JA, Hickie IB. Incorporating Complexity and System Dynamics into Economic Modelling for Mental Health Policy and Planning. PHARMACOECONOMICS 2024; 42:1301-1315. [PMID: 39354214 PMCID: PMC11564312 DOI: 10.1007/s40273-024-01434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/03/2024]
Abstract
Care as usual has failed to stem the tide of mental health challenges in children and young people. Transformed models of care and prevention are required, including targeting the social determinants of mental health. Robust economic evidence is crucial to guide investment towards prioritised interventions that are effective and cost-effective to optimise health outcomes and ensure value for money. Mental healthcare and prevention exhibit the characteristics of complex dynamic systems, yet dynamic simulation modelling has to date only rarely been used to conduct economic evaluation in this area. This article proposes an integrated decision-making and planning framework for mental health that includes system dynamics modelling, cost-effectiveness analysis, and participatory model-building methods, in a circular process that is constantly reviewed and updated in a 'living model' ecosystem. We describe a case study of this approach for mental health system policy and planning that synergises the unique attributes of a system dynamics approach within the context of economic evaluation. This kind of approach can help decision makers make the most of precious, limited resources in healthcare. The application of modelling to organise and enable better responses to the youth mental health crisis offers positive benefits for individuals and their families, as well as for taxpayers.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia.
- Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia.
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Kim-Huong Nguyen
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Frank Iorfino
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kristen Tran
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. Factors Associated With Discharge Against Medical Advice in US Adolescents Hospitalized for Suicidal Ideation or Suicide Attempt. J Am Acad Child Adolesc Psychiatry 2024; 63:908-918. [PMID: 38280417 DOI: 10.1016/j.jaac.2023.09.554] [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] [Received: 01/08/2023] [Revised: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population. METHOD This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA. RESULTS Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85). PLAIN LANGUAGE SUMMARY This study utilized retrospective data from the National Inpatient Sample (2015 to 2019) to determine predictive factors for discharge against medical advice (DAMA) for youth, aged 10 to 19 years old, hospitalized for suicidal ideation or suicide attempt. Of 476,755 hospitalizations for suicidality, 3,825 (0.8%) were discharged against medical advice. Correlates of discharge against medical advice included age 16 to 19 years, self-pay status, admission to an urban non-teaching hospital, or a hospital located in the South or West Regions of the United States. Hispanic patients were less likely to be discharged against medical advice with no other racial/ ethnic differences observed. CONCLUSION Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
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Abdel-Rahman SM, Farrell AJ, Berry NS, Burckart GJ. Optimizing Dosage in Pharmacotherapy-Missing the Forest for the Trees. Clin Pharmacol Ther 2024; 116:511-514. [PMID: 38618676 DOI: 10.1002/cpt.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Affiliation(s)
| | | | | | - Gilbert J Burckart
- Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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13
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Kafetzopoulos V, Kokras N, Katsaitis F, Sousa N, Leite-Almeida H, Sotiropoulos I, Dalla C. Prefrontal cortex-nucleus reuniens-hippocampus network exhibits sex-differentiated responses to stress and antidepressant treatment in rats. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06667-w. [PMID: 39162717 DOI: 10.1007/s00213-024-06667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 08/02/2024] [Indexed: 08/21/2024]
Abstract
RATIONALE Depression is a serious psychiatric disease, which is diagnosed twice as frequently in women than men. We have recently shown that lesioning or inactivation of the nucleus reuniens (RE), which interconnects the prefrontal cortex (PFC) and hippocampus, promoted resilience to stress in males, exerts an antidepressant effect in the Forced Swim Test (FST) and prevents the development of behavioral and neurobiological alterations induced by the chronic mild stress model of depression. OBJECTIVES In this study, we expand our findings on the FST in female rats and we investigate whether RE lesion presents sex differences following treatment with two distinct antidepressants, a selective serotonin reuptake inhibitor, i.e. sertraline and a tricyclic antidepressant, i.e. clomipramine. METHODS Male and female rats received either a surgical lesion of the RE or sham operation, then treated with vehicle, sertraline (10mg/kg) or clomipramine (10mg/kg) and were subjected to the FST. Activation of key brain areas of interest (PFC, Hippocampus and RE) were measured by c-Fos immunoreactivity. RESULTS RE lesion induced an antidepressant-like phenotype in both female and male rats, confirming its crucial role in the stress response. Similarly to RE lesion, sertraline treatment resulted in increased swimming and decreased immobility duration, as well as enhanced head shake frequency, in both sexes. Notably, climbing behavior was increased only following clomipramine treatment. RE area was less active in females compared to male rats and in clomipramine-treated males compared to their corresponding vehicle-group. Activation of the PFC and the CA1 hippocampal area was reduced in clomipramine-treated females, in comparison to vehicle-treated female rats. This effect was not evident in males, which exhibited less activation in the PFC and the hippocampus than females. CONCLUSION Re lesion proves equally effective in female and male rats, but sex is highlighted as a pivotal factor in behavioral and treatment response in FST, as well as in related circuit connectivity and activation.
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Affiliation(s)
- V Kafetzopoulos
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias St, Athens, 11527, Greece
- Department of Psychiatry, Medical School, University of Cyprus, Nicosia, Cyprus
| | - N Kokras
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippos Katsaitis
- Laboratory of Brain Exosomes & Pathology, Institute of Biosciences & Applications, NCSR Demokritos, Athens, Greece
| | - N Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Clinical Academic Center (2CA), Braga, Portugal
| | - H Leite-Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - I Sotiropoulos
- Laboratory of Brain Exosomes & Pathology, Institute of Biosciences & Applications, NCSR Demokritos, Athens, Greece
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - C Dalla
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias St, Athens, 11527, Greece.
- Second Department of Obstetrics - Gynecology, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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14
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Nothelle S, Kleijwegt H, Bollens-Lund E, Covinsky K, Ankuda C. The effect of dementia on patterns of healthcare use in older adults with diabetes. J Am Geriatr Soc 2024; 72:2391-2401. [PMID: 38819620 PMCID: PMC11323160 DOI: 10.1111/jgs.19010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/01/2024] [Accepted: 05/04/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND For persons with diabetes, incidence of dementia has been associated with increased hospitalization; however, little is known about healthcare use preceding and following incident dementia. We describe healthcare utilization in the 3 years pre- and post-incident dementia among older adults with diabetes. METHODS We used the National Health and Aging Trends Study (NHATS) linked to Medicare fee-for-service claims from 2011 to 2018. We included community-dwelling adults ≥65 years who had diabetes without dementia. We matched older adults with dementia (identified with validated NHATS algorithm) at the year of incident dementia to controls using coarsened exact matching. We examined annual outpatient visits, emergency department (ED) visits, hospitalization, and post-acute skilled nursing facility (SNF) use 3 years preceding and 3 years following dementia onset. RESULTS We included 195 older adults with diabetes with incident dementia and 1107 controls. Groups had a similar age (81.6 vs 81.7 years) and were 56.4% female. Persons with dementia were more likely to be of minority racial and ethnic groups (26.7% vs 21.3% Black, non-Hispanic, 15.3% vs 6.7% other race or Hispanic). We observed a larger decrease in outpatient visits among persons with dementia, primarily due to decreasing specialty visits (mean outpatient visits: 3 years pre-dementia/matching 6.8 (SD 2.6) dementia vs 6.4 (SD 2.6) controls, p < 0.01 to 3 years post-dementia/matching 4.6 (SD 2.3) dementia vs 5.5 (SD 2.7) controls, p < 0.01). Hospitalization, ED visits, and post-acute SNF use were higher for persons with dementia and rose in both groups (e.g., ED visits 3 years pre-dementia/matching 3.9 (SD 5.4) dementia vs 2.2 (SD 4.8) controls, p < 0.001; 3 years post-dementia/matching 4.5 (SD 4.7) dementia vs 3.5 (SD 6.1) controls, p = 0.04). CONCLUSIONS Older adults with diabetes with incident dementia have higher rates of acute and post-acute care use, but decreasing outpatient use over time, primarily due to a decrease in specialty visits.
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Affiliation(s)
- Stephanie Nothelle
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah Kleijwegt
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kenneth Covinsky
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Claire Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Moraes ACN, Wijaya C, Freire R, Quagliato LA, Nardi AE, Kyriakoulis P. Neurochemical and genetic factors in panic disorder: a systematic review. Transl Psychiatry 2024; 14:294. [PMID: 39025836 PMCID: PMC11258274 DOI: 10.1038/s41398-024-02966-0] [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] [Received: 09/20/2023] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 07/20/2024] Open
Abstract
This systematic review addresses the complex nature of Panic Disorder (PD), characterized by recurrent episodes of acute fear, with a focus on updating and consolidating knowledge regarding neurochemical, genetic, and epigenetic factors associated with PD. Utilizing the PRISMA methodology, 33 original peer-reviewed studies were identified, comprising 6 studies related to human neurochemicals, 10 related to human genetic or epigenetic alterations, and 17 animal studies. The review reveals patterns of altered expression in various biological systems, including neurotransmission, the Hypothalamic-Pituitary-Adrenal (HPA) axis, neuroplasticity, and genetic and epigenetic factors leading to neuroanatomical modifications. Noteworthy findings include lower receptor binding of GABAA and serotonin neurotransmitters in the amygdala. The involvement of orexin (ORX) neurons in the dorsomedial/perifornical region in triggering panic reactions is highlighted, with systemic ORX-1 receptor antagonists blocking panic responses. Elevated Interleukin 6 and leptin levels in PD patients suggest potential connections between stress-induced inflammatory changes and PD. Brain-derived neurotrophic factor (BDNF) and tyrosine receptor kinase B (TrkB) signaling are implicated in panic-like responses, particularly in the dorsal periaqueductal gray (dPAG), where BDNF's panicolytic-like effects operate through GABAA-dependent mechanisms. GABAergic neurons' inhibitory influence on dorsomedial and posterior hypothalamus nuclei is identified, potentially reducing the excitability of neurons involved in panic-like responses. The dorsomedial hypothalamus (DMH) is highlighted as a specific hypothalamic nucleus relevant to the genesis and maintenance of panic disorder. Altered brain lactate and glutamate concentrations, along with identified genetic polymorphisms linked to PD, further contribute to the intricate neurochemical landscape associated with the disorder. The review underscores the potential impact of neurochemical, genetic, and epigenetic factors on the development and expression of PD. The comprehensive insights provided by this systematic review contribute to advancing our understanding of the multifaceted nature of Panic Disorder and pave the way for targeted therapeutic strategies.
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Affiliation(s)
| | - Clarissa Wijaya
- School of Psychology, Swinburne University, Melbourne, VIC, Australia
| | - Rafael Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | | | | | - Peter Kyriakoulis
- School of Psychology, Swinburne University, Melbourne, VIC, Australia
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Hoisington AJ, Stearns-Yoder KA, Kovacs EJ, Postolache TT, Brenner LA. Airborne Exposure to Pollutants and Mental Health: A Review with Implications for United States Veterans. Curr Environ Health Rep 2024; 11:168-183. [PMID: 38457036 PMCID: PMC12070290 DOI: 10.1007/s40572-024-00437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE OF REVIEW Inhalation of airborne pollutants in the natural and built environment is ubiquitous; yet, exposures are different across a lifespan and unique to individuals. Here, we reviewed the connections between mental health outcomes from airborne pollutant exposures, the biological inflammatory mechanisms, and provide future directions for researchers and policy makers. The current state of knowledge is discussed on associations between mental health outcomes and Clean Air Act criteria pollutants, traffic-related air pollutants, pesticides, heavy metals, jet fuel, and burn pits. RECENT FINDINGS Although associations between airborne pollutants and negative physical health outcomes have been a topic of previous investigations, work highlighting associations between exposures and psychological health is only starting to emerge. Research on criteria pollutants and mental health outcomes has the most robust results to date, followed by traffic-related air pollutants, and then pesticides. In contrast, scarce mental health research has been conducted on exposure to heavy metals, jet fuel, and burn pits. Specific cohorts of individuals, such as United States military members and in-turn, Veterans, often have unique histories of exposures, including service-related exposures to aircraft (e.g. jet fuels) and burn pits. Research focused on Veterans and other individuals with an increased likelihood of exposure and higher vulnerability to negative mental health outcomes is needed. Future research will facilitate knowledge aimed at both prevention and intervention to improve physical and mental health among military personnel, Veterans, and other at-risk individuals.
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Affiliation(s)
- Andrew J Hoisington
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Aurora, CO, 80045, USA.
- Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, 80045, USA.
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, Dayton, OH, 45333, USA.
| | - Kelly A Stearns-Yoder
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Aurora, CO, 80045, USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, 80045, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Elizabeth J Kovacs
- Department of Surgery, Division of GI, Trauma and Endocrine Surgery, and Burn Research Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Veterans Affairs Research Service, RMR VAMC, Aurora, CO, 80045, USA
| | - Teodor T Postolache
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Aurora, CO, 80045, USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, 80045, USA
- Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Veterans Affairs, VISN 5 MIRECC, Baltimore, MD, 21201, USA
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Aurora, CO, 80045, USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, 80045, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Departments of Psychiatry & Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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17
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Kowalec K, Harder A, Dolovich C, Fitzgerald KC, Salter A, Lu Y, Bernstein CN, Bolton JM, Cutter G, Fisk JD, Gelernter J, Graff LA, Hägg S, Hitchon CA, Levey DF, Lublin FD, McKay KA, Patten S, Patki A, Stein MB, Tiwari HK, Wolinsky JS, Marrie RA. Polygenic liability for anxiety in association with comorbid anxiety in multiple sclerosis. Ann Clin Transl Neurol 2024; 11:1393-1404. [PMID: 38715244 PMCID: PMC11187942 DOI: 10.1002/acn3.52025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/03/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Comorbid anxiety occurs often in MS and is associated with disability progression. Polygenic scores offer a possible means of anxiety risk prediction but often have not been validated outside the original discovery population. We aimed to investigate the association between the Generalized Anxiety Disorder 2-item scale polygenic score with anxiety in MS. METHODS Using a case-control design, participants from Canadian, UK Biobank, and United States cohorts were grouped into cases (MS/comorbid anxiety) or controls (MS/no anxiety, anxiety/no immune disease or healthy). We used multiple anxiety measures: current symptoms, lifetime interview-diagnosed, and lifetime self-report physician-diagnosed. The polygenic score was computed for current anxiety symptoms using summary statistics from a previous genome-wide association study and was tested using regression. RESULTS A total of 71,343 individuals of European genetic ancestry were used: Canada (n = 334; 212 MS), UK Biobank (n = 70,431; 1,390 MS), and the USA (n = 578 MS). Meta-analyses identified that in MS, each 1-SD increase in the polygenic score was associated with ~50% increased odds of comorbid moderate anxious symptoms compared to those with less than moderate anxious symptoms (OR: 1.47, 95% CI: 1.09-1.99). We found a similar direction of effects in the other measures. MS had a similar anxiety genetic burden compared to people with anxiety as the index disease. INTERPRETATION Higher genetic burden for anxiety was associated with significantly increased odds of moderate anxious symptoms in MS of European genetic ancestry which did not differ from those with anxiety and no comorbid immune disease. This study suggests a genetic basis for anxiety in MS.
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Affiliation(s)
- Kaarina Kowalec
- Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Arvid Harder
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Casandra Dolovich
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | | | - Amber Salter
- Department of NeurologyUT SouthwesternDallasTexasUSA
| | - Yi Lu
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Charles N. Bernstein
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - James M. Bolton
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John D. Fisk
- Nova Scotia Health and Departments of Psychiatry, Psychology & Neuroscience, and MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Joel Gelernter
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Lesley A. Graff
- Department of Clinical Health PsychologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Sara Hägg
- Department of Medical Epidemiology & BiostatisticsKarolinska InstitutetSolnaSweden
| | - Carol A. Hitchon
- Department of RheumatologyMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
| | - Daniel F. Levey
- Department of PsychiatryYale University, School of MedicineNew HavenConnecticutUSA
- Department of PsychiatryVA Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Fred D. Lublin
- Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Kyla A. McKay
- Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
| | - Scott Patten
- Department of Community Health SciencesCumming School of Medicine, University of CalgaryCalgaryCanada
| | - Amit Patki
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Murray B. Stein
- Department of PsychiatryMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Hemant K. Tiwari
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Jerry S. Wolinsky
- Department of NeurologyMcGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth)HoustonTexasUSA
| | - Ruth A. Marrie
- Department of Internal MedicineMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
- Department of Community Health SciencesMax Rady College of Medicine, Rady Faculty of Health Sciences, University of ManitobaWinnipegCanada
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Ferwana I, Varshney LR. The impact of COVID-19 lockdowns on mental health patient populations in the United States. Sci Rep 2024; 14:5689. [PMID: 38454064 PMCID: PMC10920688 DOI: 10.1038/s41598-024-55879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
During the start of the COVID-19 pandemic in 2020, lockdowns and movement restrictions were thought to negatively impact population mental health, since depression and anxiety symptoms were frequently reported. This study investigates the effect of COVID-19 mitigation measures on mental health across the United States, at county and state levels using difference-in-differences analysis. It examines the effect on mental health facility usage and the prevalence of mental illnesses, drawing on large-scale medical claims data for mental health patients joined with publicly available state- and county-specific COVID-19 cases and lockdown information. For consistency, the main focus is on two types of social distancing policies, stay-at-home and school closure orders. Results show that lockdown has significantly and causally increased the usage of mental health facilities in regions with lockdowns in comparison to regions without such lockdowns. Particularly, resource usage increased by 18% in regions with a lockdown compared to 1% decline in regions without a lockdown. Also, female populations have been exposed to a larger lockdown effect on their mental health. Diagnosis of panic disorders and reaction to severe stress significantly increased by the lockdown. Mental health was more sensitive to lockdowns than to the presence of the pandemic itself. The effects of the lockdown increased over an extended time to the end of December 2020.
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Affiliation(s)
- Ibtihal Ferwana
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Lav R Varshney
- Coordinated Science Laboratory, University of Illinois Urbana-Champaign, Urbana, IL, 61801, USA
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19
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Davoutis E, Panou C, Stachika N, Dalla C, Kokras N. Drug-drug interactions between COVID-19 drug therapies and antidepressants. Expert Opin Drug Metab Toxicol 2023; 19:937-950. [PMID: 37934891 DOI: 10.1080/17425255.2023.2280750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Antidepressants are widely used for the pharmacological treatment of anxiety and mood disorders. Since the eruption of the SARS-COV-2 pandemic and the later development of targeted treatments against COVID-19, inevitably many patients receive antidepressants as well as targeted treatments against COVID-19 against COVID-19. Co-administration of antidepressants with COVID-19 therapeutics has the potential of drug-drug interactions, of varying severity and clinical significance. AREAS COVERED This is a curated narrative review of the current state of the art regarding drug-drug interactions between COVID-19 therapeutics and medications licensed for the pharmacotherapy of depression. A systematic search of electronic databases, using as keywords the international nonproprietaty names of currently approved COVID-19 therapeutics and antidepressants was performed, and additionally online interaction checker tools were consulted. Derived data were synthesized for each COVID-19 therapeutic and presented with up-to-date guidance. EXPERT OPINION Several COVID-19 therapeutics have potential for drug-drug interactions with antidepressants. Remdesivir and Nirmatrelvir-Ritonavir have the higher risk, whereas several monoclonal antibodies appear safer. The most serious drug-drug interactions (serotonin syndrome and QTc prolongation) require close monitoring; however, DDI toward reducing the efficacy of antidepressants may be difficult to recognize. As COVID-19 treatment protocols take precedence, psychiatrists should exert flexibility in antidepressant use and proactively monitor treatment progress.
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Affiliation(s)
- Efstathia Davoutis
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysa Panou
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolina Stachika
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Dalla
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kokras
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dai X, Gao M, Liu Y, Lv R, Chen H, Miao H, Zhang Y. Analysis of inpatient cost burden and influencing factors of seniors' patients with mental illness in Dalian, China. BMC Geriatr 2023; 23:739. [PMID: 37957599 PMCID: PMC10644489 DOI: 10.1186/s12877-023-04424-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND As China's aging population continues to grow, the prevalence of mental illness among the seniors has been steadily increasing. The aim of this study is to reveal the changing trends and characteristics of economic burden among seniors patients with long-term hospitalization for mental illness, and to analyze the influencing factors. METHODS The data for this study were gathered from seniors' patients with mental illness who were hospitalized and aged 60 years or older. The patients were admitted to four specialized and general hospitals located in Dalian city between January 2018 and December 2020. The types of diseases include affective mental disorders (mood disorders), Schizophrenia, schizotypal, and delusional disorders, Organic (including symptomatic) mental disorders, Neurotic, stress-related and somatoform disorders, Mental retardation, Mental and behavioral disorders due to substance use. (Identify the main diagnosis at discharge using ICD-10 coding). This study analyzed the basic characteristics and disease-related information of seniors patients with long-term psychiatric disorders who were hospitalized, and explored the factors influencing hospitalization costs among patients with different illnesses. RESULTS Among the 3871 study subjects, the average length of hospital stay was 127.51 days. The average hospitalization expenses per case were 33,656.07 yuan. Seniors' patients with mental illness who receives treatment in specialized hospitals have higher hospitalization costs. Long-term hospitalization increases the total hospitalization costs. Age has an impact on hospitalization costs for patients with organic mental disorders. Patients with affective disorders (mood disorders) and neurotic, stress-related, and somatoform disorders who are covered by urban employee medical insurance have higher hospitalization costs.Patients with severe psychiatric disorders who have a 31-day readmission plan, as well as senior patients with somatoform disorders comorbid with other illnesses, incur higher hospitalization costs. CONCLUSIONS We should take corresponding measures to reduce the number of readmissions for patients with severe mental illnesses. The impact of treatment methods and differences in healthcare institutions on total hospitalization costs deserves further research. It is necessary to strengthen the prevention and diagnosis of comorbid physical illnesses in patients with mental disorders. The burden of mental illnesses in the seniors is significant, and medical insurance policies should be inclined towards providing support.
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Affiliation(s)
- Xin Dai
- School of Public Health, Dalian Medical University, Dalian, China
| | - Mingcheng Gao
- School of Public Health, Dalian Medical University, Dalian, China
| | - Yue Liu
- School of Public Health, Dalian Medical University, Dalian, China
| | - Run Lv
- School of Public Health, Dalian Medical University, Dalian, China
| | - Huanhong Chen
- School of Public Health, Dalian Medical University, Dalian, China
| | - Huayi Miao
- School of Public Health, Dalian Medical University, Dalian, China
| | - Ying Zhang
- School of Public Health, Dalian Medical University, Dalian, China.
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Stucki M, Schärer X, Trottmann M, Scholz-Odermatt S, Wieser S. What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age. BMC Health Serv Res 2023; 23:1149. [PMID: 37880733 PMCID: PMC10598929 DOI: 10.1186/s12913-023-10124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND High and increasing spending dominates the public discussion on healthcare in Switzerland. However, the drivers of the spending increase are poorly understood. This study decomposes health care spending by diseases and other perspectives and estimates the contribution of single cost drivers to overall healthcare spending growth in Switzerland between 2012 and 2017. METHODS We decompose total healthcare spending according to National Health Accounts by 48 major diseases, injuries, and other conditions, 20 health services, 21 age groups, and sex of patients. This decomposition is based on micro-data from a multitude of data sources such as the hospital inpatient registry, health and accident insurance claims data, and population surveys. We identify the contribution of four main drivers of spending: population growth, change in population structure (age/sex distribution), changes in disease prevalence, and changes in spending per prevalent patient. RESULTS Mental disorders were the most expensive major disease group in both 2012 and 2017, followed by musculoskeletal disorders and neurological disorders. Total health care spending increased by 19.7% between 2012 and 2017. An increase in spending per prevalent patient was the most important spending driver (43.5% of total increase), followed by changes in population size (29.8%), in population structure (14.5%), and in disease prevalence (12.2%). CONCLUSIONS A large part of the recent health care spending growth in Switzerland was associated with increases in spending per patient. This may indicate an increase in the treatment intensity. Future research should show if the spending increases were cost-effective.
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Affiliation(s)
- Michael Stucki
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 8, Winterthur, 8401, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Xavier Schärer
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 8, Winterthur, 8401, Switzerland
| | | | | | - Simon Wieser
- ZHAW Zurich University of Applied Sciences, Winterthur Institute of Health Economics, Gertrudstrasse 8, Winterthur, 8401, Switzerland
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22
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Anderson MN, Gallo CA, Passalugo SW, Nimeh JM, Buckley TA. Self-Reported Mental Health Measures of Incoming Collegiate Student-Athletes With a History of COVID-19. J Athl Train 2023; 58:895-901. [PMID: 37248550 PMCID: PMC11215711 DOI: 10.4085/1062-6050-0554.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND People with a history of COVID-19 may experience persistent neuropsychological disruptions such as lower satisfaction with life, depression, and anxiety. Although student-athletes are at low risk for severe COVID-19 complications, the effect of COVID-19 on mental health has not been elucidated. OBJECTIVE To compare patient-reported mental health outcomes for incoming collegiate athletes with (COVID+) or without (COVID-) a history of COVID-19. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 178 student-athletes, consisting of 79 in the COVID+ group (44.3%; age = 18.90 ± 0.16 years) and 99 in the COVID- group (55.6%; age = 18.95 ± 0.16 years). MAIN OUTCOME MEASURE(S) Participants completed the Satisfaction With Life Scale (SWLS), the Hospital Anxiety and Depression Scale (HADS), and the State-Trait Anxiety Inventory (STAI). Unadjusted 1-way analyses of variance were conducted across all patient-reported outcomes. Analyses of covariance were calculated to determine the interaction of COVID-19 group, sex, and race and ethnicity on outcomes. Post hoc Bonferroni testing was performed to identify specific differences between groups. A χ2 analysis was computed to compare the number of athletes in each group who met the standard clinical cut points. RESULTS We observed a between-groups difference for HADS depression (P = .047), whereby athletes in the COVID+ group had higher ratings (2.86 ± 0.26). We found group differences for the SWLS (P = .02), HADS anxiety (P = .003), and STAI state anxiety (P = .01) such that all scores were higher for the COVID+ group in the adjusted model. Post hoc testing revealed that female student-athletes in the COVID+ group had worse HADS anxiety (P = .01) and STAI trait anxiety (P = .002) scores than individuals in all other groups. We did not demonstrate differences between groups in the percentage of responses below established diagnostic thresholds. CONCLUSIONS Incoming collegiate student-athletes who reported a previous COVID-19 diagnosis displayed higher depression scores, suggesting that clinicians may need to provide appropriate identification and referral for mental health conditions. However, we were encouraged that most participants, regardless of a history of COVID-19 diagnosis, had mental health scores that did not exceed established diagnostic threshold values.
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Affiliation(s)
- Melissa N. Anderson
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Caitlin A. Gallo
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Scott W. Passalugo
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Jake M. Nimeh
- Department of Biological Sciences, University of Delaware, Newark. Dr Anderson is now with the Ohio Musculoskeletal and Neurological Institute and the College of Health Sciences and Professions, Ohio University, Athens
| | - Thomas A. Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
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23
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Sleeper C, Cartwright K, van der Goes DN. The relationship between mental health and public attention to the Brett Kavanaugh hearings and confirmation. Soc Sci Med 2023; 335:116131. [PMID: 37777305 DOI: 10.1016/j.socscimed.2023.116131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 07/04/2023] [Accepted: 07/27/2023] [Indexed: 10/02/2023]
Abstract
RATIONALE Researchers have rarely considered how public attention surrounding political events influences mental health. Specifically, in a politically polarized nation like the United States, it is possible that these events have a public mental health effect. OBJECTIVE This study examines the mental health effects associated with the 2018 U.S. Senate hearing and confirmation of Supreme Court Justice Brett Kavanaugh using public survey data. METHODS We use the interview date included in CDC data from the 2014-2018 Behavioral Risk Factor Surveillance System (BRFSS) to identify the effects of increased public attention on the Kavanaugh hearings and confirmation on the mental health of individuals who identify as female. We employ a triple difference model to control for possible confounding effects and target causality. RESULTS We find meaningful increases in both the number of "not good" mental health days reported and the probability of reporting any "not good" mental health days. On average, females reported 0.24 more poor mental health days during the one-month period surrounding the Kavanaugh confirmation and hearings than women did in the same 1-month period in 2014. This change represents a nearly 10% increase in mental health burden. The results are robust to the inclusion of a range of covariates as well as alternate specifications. In addition, we derive estimates of the societal costs associated with the increased mental health burden linked to Brett Kavanaugh's confirmation. CONCLUSION This study demonstrates that the Kavanaugh confirmation and hearings were associated with a notable rise in mental health challenges, especially among women. These results extend beyond personal experience and illustrate the societal costs linked to the resulting increased mental health burden. Further research on similar events is warranted.
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Affiliation(s)
- Colin Sleeper
- University of New Mexico, Department of Economics, 1915 Roma Ave NE, Albuquerque, NM, 87131, USA.
| | - Kate Cartwright
- University of New Mexico, School of Public Administration, MSC05, 3100, Social Sciences Bldg #78, 3rd Floor, USA.
| | - David N van der Goes
- University of New Mexico, Department of Economics, 1915 Roma Ave NE, Albuquerque, NM, 87131, USA.
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24
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Ivanova MY, Hall A, Weinberger S, Buckingham SL, Copeland WE, Crockett P, Dainer-Best J, D'Alberto C, Dewey L, Foret D, Galano M, Goodrich L, Holly L, Lane N, Leahey M, Lerner M, Marsh J, McGinnis E, Paiva-Salisbury M, Shaw JS, Swift P, Tinker R, Hudziak JJ. The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life. Child Psychiatry Hum Dev 2023; 54:1297-1308. [PMID: 35246775 PMCID: PMC9793330 DOI: 10.1007/s10578-022-01329-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/30/2023]
Abstract
This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.
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Affiliation(s)
- Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Allison Hall
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Sara L Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Phoenix Crockett
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | | | - Lauren Dewey
- Department of Psychological Sciences, University of Vermont, Burlington, VT, USA
| | - DeShan Foret
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Maria Galano
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
| | - Lisa Goodrich
- University of Vermont Medical Center, Burlington, VT, USA
| | - Lindsay Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nalini Lane
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maureen Leahey
- University of Vermont Medical Center, Burlington, VT, USA
| | - Mathew Lerner
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jasmine Marsh
- University of Vermont Medical Center, Burlington, VT, USA
| | - Ellen McGinnis
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Judith S Shaw
- Department of Pediatrics, University of Vermont, Burlington, VT, USA
| | - Pamela Swift
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Rebekah Tinker
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - James J Hudziak
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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25
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Ishaq S, Ahmed T. Sexually Dimorphic Effects of Neuromodulatory Drugs on Normal and Stress-Induced Social Interaction in Rats. Brain Sci 2023; 13:1378. [PMID: 37891747 PMCID: PMC10604924 DOI: 10.3390/brainsci13101378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Social behavior is a complex term which involves different interactions between various individuals of a community. It is controlled by different neurotransmitter systems in a sexually dimorphic way. Certain environmental factors, like stress, cause various neurological disorders with associated social abnormalities in a sexually dimorphic way. Multiple drugs are used in clinical settings to treat behavioral disorders. However, the sexually dimorphic effects of these drugs, particularly on social behavior, still need to be studied. The present study was designed to investigate the sex-dependent effects of Risperidone, Donepezil, and Paroxetine in 8-12 weeks old male and female rats under normal and stressed conditions. There were four male and four female groups, i.e., control group (no drug treatment), Risperidone (3 mg/kg/day) treated group, Donepezil (5 mg/kg/day) treated group, and Paroxetine (10 mg/kg/day) treated group. Each group received its respective drug during phase 1 for 21 days, followed by a 10-day break with no drug treatment. After the break, same groups received the same drugs along with tilt-cage stress for an additional 21 days during phase 2. A social preference and novelty test was performed at the end of both phases (1 and 2). During phase 1, Risperidone treatment caused impaired social behavior and reduced locomotion in the male group only, compared to its control group. Donepezil treatment caused a reduction in social interaction, while Paroxetine treatment caused increased social interaction and locomotion in a sex-dependent manner. During phase 2, social novelty was affected in both male and female stress groups. Treatment with drugs along with stress showed differential sex-dependent effects. The study showed a predominant effect of Risperidone on males while there were differential effects of Donepezil and Paroxetine on both sexes. This study has paved the way for the development of more targeted and effective neuromodulatory drugs for use against various psychiatric and social deficits.
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Affiliation(s)
- Sara Ishaq
- Neurobiology Laboratory, Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan
| | - Touqeer Ahmed
- Neurobiology Laboratory, Department of Healthcare Biotechnology, Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad 44000, Pakistan
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26
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Breuer E, Morris A, Blanke L, Pearsall M, Rodriguez R, Miller BF, Naslund JA, Saxena S, Balsari S, Patel V. A theory of change for community-initiated mental health care in the United States. Glob Ment Health (Camb) 2023; 10:e56. [PMID: 37854428 PMCID: PMC10579655 DOI: 10.1017/gmh.2023.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 10/20/2023] Open
Abstract
Mental health service delivery needs radical reimagination in the United States where unmet needs for care remain large and most metrics on the burden of mental health problems have worsened, despite significant numbers of mental health professionals, spending on service provision and research. The COVID-19 pandemic has exacerbated the need for mental health care. One path to a radical reimagination is "Community Initiated Care (CIC)" which equips and empowers communities to address by providing brief psychosocial interventions by people in community settings. We co-developed a theory of change (ToC) for CIC with 24 stakeholders including representatives from community-based, advocacy, philanthropic and faith-based organizations to understand how CIC could be developed and adapted for specific contexts. We present a ToC which describes ways in which the CIC initiative can promote and strengthen mental health in communities in the United States with respect to community organization and leadership; community care and inclusion and normalizing mental health. We propose 10 strategies as part of CIC and propose a way forward for implementation and evaluation. This CIC model is a local, tailored approach which can expand the role of community members to strengthen our response to mental health needs in the United States.
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Affiliation(s)
- Erica Breuer
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Angelika Morris
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Miriam Pearsall
- National Academy for State Health Policy (NASHP), Portland, ME, USA
| | | | - Benjamin F. Miller
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shekhar Saxena
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Satchit Balsari
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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27
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Wertis L, Sugg MM, Runkle JD, Rao D. Socio-Environmental Determinants of Mental and Behavioral Disorders in Youth: A Machine Learning Approach. GEOHEALTH 2023; 7:e2023GH000839. [PMID: 37711362 PMCID: PMC10499369 DOI: 10.1029/2023gh000839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Growing evidence indicates that extreme environmental conditions in summer months have an adverse impact on mental and behavioral disorders (MBD), but there is limited research looking at youth populations. The objective of this study was to apply machine learning approaches to identify key variables that predict MBD-related emergency room (ER) visits in youths in select North Carolina cities among adolescent populations. Daily MBD-related ER visits, which totaled over 42,000 records, were paired with daily environmental conditions, as well as sociodemographic variables to determine if certain conditions lead to higher vulnerability to exacerbated mental health disorders. Four machine learning models (i.e., generalized linear model, generalized additive model, extreme gradient boosting, random forest) were used to assess the predictive performance of multiple environmental and sociodemographic variables on MBD-related ER visits for all cities. The best-performing machine learning model was then applied to each of the six individual cities. As a subanalysis, a distributed lag nonlinear model was used to confirm results. In the all cities scenario, sociodemographic variables contributed the greatest to the overall MBD prediction. In the individual cities scenario, four cities had a 24-hr difference in the maximum temperature, and two of the cities had a 24-hr difference in the minimum temperature, maximum temperature, or Normalized Difference Vegetation Index as a leading predictor of MBD ER visits. Results can inform the use of machine learning models for predicting MBD during high-temperature events and identify variables that affect youth MBD responses during these events.
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Affiliation(s)
- Luke Wertis
- Department of Geography and PlanningAppalachian State UniversityBooneNCUSA
| | - Margaret M. Sugg
- Department of Geography and PlanningAppalachian State UniversityBooneNCUSA
| | | | - Douglas Rao
- NC Institute for Climate StudiesNC State UniversityRaleighNCUSA
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28
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Prescott SL, D’Adamo CR, Holton KF, Ortiz S, Overby N, Logan AC. Beyond Plants: The Ultra-Processing of Global Diets Is Harming the Health of People, Places, and Planet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6461. [PMID: 37569002 PMCID: PMC10419141 DOI: 10.3390/ijerph20156461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Global food systems are a central issue for personal and planetary health in the Anthropocene. One aspect of major concern is the dramatic global spread of ultra-processed convenience foods in the last 75 years, which is linked with the rising human burden of disease and growing sustainability and environmental health challenges. However, there are also calls to radically transform global food systems, from animal to plant-derived protein sources, which may have unintended consequences. Commercial entities have moved toward this "great plant transition" with vigor. Whether motivated by profit or genuine environmental concern, this effort has facilitated the emergence of novel ultra-processed "plant-based" commercial products devoid of nutrients and fiber, and sometimes inclusive of high sugar, industrial fats, and synthetic additives. These and other ingredients combined into "plant-based" foods are often assumed to be healthy and lower in calorie content. However, the available evidence indicates that many of these products can potentially compromise health at all scales-of people, places, and planet. In this viewpoint, we summarize and reflect on the evidence and discussions presented at the Nova Network planetary health meeting on the "Future of Food", which had a particular focus on the encroachment of ultra-processed foods into the global food supply, including the plant-sourced animal protein alternatives (and the collective of ingredients therein) that are finding their way into global fast-food chains. We contend that while there has been much uncritical media attention given to the environmental impact of protein and macronutrient sources-meat vs. novel soy/pea protein burgers, etc.-the impact of the heavy industrial processing on both human and environmental health is significant but often overlooked, including effects on cognition and mental health. This calls for a more nuanced discourse that considers these complexities and refocuses priorities and value systems towards mutualistic solutions, with co-benefits for individuals, local communities, and global ecology.
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Affiliation(s)
- Susan L. Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Christopher R. D’Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kathleen F. Holton
- Departments of Health Studies and Neuroscience, Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA;
| | - Selena Ortiz
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA 16802, USA;
| | - Nina Overby
- Department of Nutrition and Public Health, Centre for Lifecourse Nutrition, University of Agder, 4630 Kristiansand, Norway;
| | - Alan C. Logan
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
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29
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Adepoju OE, Valdez MR. Trends in Mental Health Utilization Before and During the COVID-19 Pandemic: Federally Qualified Health Centers As a Case Study. Popul Health Manag 2023. [PMID: 37184901 DOI: 10.1089/pop.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
This study examined differential mental health utilization patterns before and during the COVID-19 pandemic. Data were obtained from 12 Federally Qualified Health Center (FQHC)-behavioral health clinics and included 65,561 visits between February 2019 and November 2020 for adults aged 18-64 years. To allow for a year-over-year comparison, the pre-COVID-19 period was flagged as visits between February 2019 and November 2019 and the peri-COVID-19 period as visits between February 2020 and November 2020. A difference-in-difference model with Poisson regression was used to predict racial/ethnic differences in the number of visits between the pre- and peri-COVID-19 periods. Overall, the average number of visits per patient increased from 5.45 visits in the pre-COVID period to 5.78 visits in the peri-COVID-19 period. Hispanics had +0.6 visits, Blacks had +0.3 visits, and other racial groups had +0.9 visits during the peri-COVID-19 period than the pre-COVID-19 period. In contrast, Whites (-0.6 visits) and Asians (-1.7 visits) were less likely to use mental health services in these FQHC clinics in the peri-COVID-19 period as compared with the pre-COVID-19 period. Peri-COVID-19 utilization rates were significantly higher for virtual visits (incident-rate ratio [IRR] = 1.15, P < 0.01) and residence in a metropolitan area (IRR = 1.14, P < 0.01), but lower for persons aged 55+ years (IRR = 0.92, P < 0.01) and males (IRR = 0.87, P < 0.01). Racial/ethnic minority patients, except Asians, were more likely to use mental health services during the COVID-19 pandemic than in the preceding year. This may be attributable to policy changes such as the CARES Act, which expanded health care access options to include telemedicine.
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Affiliation(s)
- Omolola E Adepoju
- Department of Health Systems and Population Health Sciences, University of Houston, College of Medicine, Houston, Texas, USA
- Humana Integrated Health Systems Sciences Institute, Houston, Texas, USA
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30
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Widge AS. Closed-Loop Deep Brain Stimulation for Psychiatric Disorders. Harv Rev Psychiatry 2023; 31:162-171. [PMID: 37171475 PMCID: PMC10188203 DOI: 10.1097/hrp.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
ABSTRACT Deep brain stimulation (DBS) is a well-established approach to treating medication-refractory neurological disorders and holds promise for treating psychiatric disorders. Despite strong open-label results in extremely refractory patients, DBS has struggled to meet endpoints in randomized controlled trials. A major challenge is stimulation "dosing"-DBS systems have many adjustable parameters, and clinicians receive little feedback on whether they have chosen the correct parameters for an individual patient. Multiple groups have proposed closed loop technologies as a solution. These systems sense electrical activity, identify markers of an (un)desired state, then automatically deliver or adjust stimulation to alter that electrical state. Closed loop DBS has been successfully deployed in movement disorders and epilepsy. The availability of that technology, as well as advances in opportunities for invasive research with neurosurgical patients, has yielded multiple pilot demonstrations in psychiatric illness. Those demonstrations split into two schools of thought, one rooted in well-established diagnoses and symptom scales, the other in the more experimental Research Domain Criteria (RDoC) framework. Both are promising, and both are limited by the boundaries of current stimulation technology. They are in turn driving advances in implantable recording hardware, signal processing, and stimulation paradigms. The combination of these advances is likely to change both our understanding of psychiatric neurobiology and our treatment toolbox, though the timeframe may be limited by the realities of implantable device development.
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Affiliation(s)
- Alik S Widge
- From the Department of Psychiatry & Behavioral Sciences and Medical Discovery Team on Addictions, University of Minnesota
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31
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Basu I, Yousefi A, Crocker B, Zelmann R, Paulk AC, Peled N, Ellard KK, Weisholtz DS, Cosgrove GR, Deckersbach T, Eden UT, Eskandar EN, Dougherty DD, Cash SS, Widge AS. Closed-loop enhancement and neural decoding of cognitive control in humans. Nat Biomed Eng 2023; 7:576-588. [PMID: 34725508 PMCID: PMC9056584 DOI: 10.1038/s41551-021-00804-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/02/2021] [Indexed: 12/20/2022]
Abstract
Deficits in cognitive control-that is, in the ability to withhold a default pre-potent response in favour of a more adaptive choice-are common in depression, anxiety, addiction and other mental disorders. Here we report proof-of-concept evidence that, in participants undergoing intracranial epilepsy monitoring, closed-loop direct stimulation of the internal capsule or striatum, especially the dorsal sites, enhances the participants' cognitive control during a conflict task. We also show that closed-loop stimulation upon the detection of lapses in cognitive control produced larger behavioural changes than open-loop stimulation, and that task performance for single trials can be directly decoded from the activity of a small number of electrodes via neural features that are compatible with existing closed-loop brain implants. Closed-loop enhancement of cognitive control might remediate underlying cognitive deficits and aid the treatment of severe mental disorders.
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Affiliation(s)
- Ishita Basu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ali Yousefi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Departments of Computer Science and Neuroscience, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Britni Crocker
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Noam Peled
- Department of Radiology, MGH/HST Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - G Rees Cosgrove
- Department of Neurological Surgery, Brigham & Womens Hospital, Boston, MA, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Uri T Eden
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Emad N Eskandar
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
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Thakkar-Samtani M, Heaton LJ, Kelly AL, Taylor SD, Vidone L, Tranby EP. Periodontal treatment associated with decreased diabetes mellitus-related treatment costs: An analysis of dental and medical claims data. J Am Dent Assoc 2023; 154:283-292.e1. [PMID: 36841690 DOI: 10.1016/j.adaj.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 02/26/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) and periodontal disease have a suggested bidirectional relationship. Researchers have reported decreases in DM-related health care costs after periodontal treatment. The authors examined the relationship between periodontal disease treatment and DM health care costs in commercial insurance and Medicaid claims data. METHODS This study of IBM MarketScan commercial insurance and Medicaid databases included overall outpatient, inpatient, and drug costs for patients with DM. The authors examined associations between overall health care costs per patient in 2019 according to use of periodontal services from 2017 through 2018 using generalized linear modeling. The average treatment effect on treated was calculated by means of propensity score matching using a logistic model for periodontal treatment on covariates. RESULTS For commercial insurance enrollees, periodontal treatment was associated with reduced overall health care costs of 12% compared with no treatment ($13,915 vs $15,739; average treatment effect on treated, -$2,498.20; 95% CI, -$3,057.21 to -$1,939.19; P < .001). In the Medicaid cohort, periodontal treatment was associated with a 14% decrease in costs compared with patients with DM without treatment ($14,796 vs $17,181; average treatment effect on treated, -$2,917.84; 95% CI, -$3,354.48 to -$2,480.76; P < .001). There were no significant differences in inpatient costs (commercial insurance) or drug costs (Medicaid). CONCLUSIONS Undergoing periodontal treatment is associated with reduced overall and outpatient health care costs for patients with DM in Medicaid and commercial insurance claims data. There were no significant differences in inpatient costs for commercial insurance enrollees or in drug costs for Medicaid beneficiaries. PRACTICAL IMPLICATIONS A healthy mouth can play a key role in DM management. Expanding Medicaid benefits to include comprehensive periodontal treatment has the potential to reduce health care costs for patients with DM.
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Hart MJ, Sung JY, McQuillin SD, Schleider JL. Expanding the reach of psychosocial services for youth: Untapped potential of mentor-delivered single session interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1255-1272. [PMID: 36017616 DOI: 10.1002/jcop.22927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
At present, the mental healthcare system cannot meet the demand for services, and the need-to-access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism-targeted programs that have shown promise in increasing the reach of effective, evidence-based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor-delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre-existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence-based mental health services. In this paper, we discuss the anticipated benefits of mentor-delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications.
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Affiliation(s)
- Mackenzie J Hart
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
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Watson T, Tindall R, Patrick A, Moylan S. Mental health triage tools: A narrative review. Int J Ment Health Nurs 2023; 32:352-364. [PMID: 36176247 DOI: 10.1111/inm.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
Mental Health Triage (MHT) tools may be defined as any clinician administered scale that specifies psychiatric signs or symptoms, proposes a corresponding service response, and determines priority categories based on the level of perceived acuity. Multiple MHT tools are used across different jurisdictions and care settings. This article summarizes the literature on MHT tools, describes the available tools and the supportive evidence, evaluates the impact and clinical applications, and compares their strengths and weaknesses. This review utilized a systematic review process to identify articles examining MHT tools. Several benefits of using MHT tools are described; however, in general, the supportive evidence for their use is lacking. A modified Australasian Triage Scale has the strongest evidence base for use in emergency settings; however, further data are needed to establish improved outcomes. There is limited evidence for the use of MHT tools in ambulatory or primary care settings. No evidence was found supporting any one tool as effective in guiding service responses across the entire clinical spectrum. Future research could focus on developing and evaluating MHT tools that service all levels of illness presentation. Additionally, more robust studies are required to support the use of MHT tools in emergency settings. Finally, there is an impetus for the development and evaluation of MHT tools in ambulatory, community, and primary care settings.
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Affiliation(s)
- Tayler Watson
- Barwon Health, Mental Health, Drugs and Alcohol Service, Geelong, Victoria, Australia
| | - Rachel Tindall
- Barwon Health, Mental Health, Drugs and Alcohol Service, Geelong, Victoria, Australia
| | | | - Steven Moylan
- Barwon Health, Mental Health, Drugs and Alcohol Service, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
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Xiao Y, Yu Y, Zhou Z, Liu W, Luo Z, Tang C, Xiao P, Wen SW, Zeng X, Zhong W, Shen M. Hospital spending and length of hospital stay for mental disorders in Hunan, China. Heliyon 2023; 9:e14968. [PMID: 37025795 PMCID: PMC10070638 DOI: 10.1016/j.heliyon.2023.e14968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Objectives To describe hospital spending and length of stay for mental disorders in Hunan, China. Methods We extracted hospital care data for Hunan province from the Chinese National Health Statistics Network Reporting System. Patients with mental disorders (ICD-10 codes: F00 to F99) as the principal diagnosis and hospitalized between January 1, 2017 and December 31, 2019 were included. We retrieved information on age, sex, number of comorbidities, diagnosis, level of hospital, hospital costs, date of admission and discharge, length of stay (LOS), and method of payment of eligible participants. Spending at the provincial level, and spending and LOS at the individual level were described. Quantile regression and linear regression were conducted to investigate factors for hospital cost and LOS for major mental disorders. Results The 2019 annual spending on mental disorders in Hunan province was 160 million US dollars, and 71.7% was paid by insurance. The annual spending on schizophrenia was 84 million dollars, contributing to a primary burden of mental disorders. The median spending for mental disorders was $1,085 per patient, and the median hospital stay was 22 days. The study identified several significant factors associated with hospital cost and LOS, including age, sex, comorbidity, and level of the hospital. In particular, a higher level of the hospital was associated with a higher hospital spending but a shorter LOS. Women with schizophrenia had a comparable hospital spending but a significantly shorter LOS than men with schizophrenia. Conclusion Hospitalization spending for patients with mental disorders is substantial. Schizophrenia is the major burden of hospitalization for mental disorders. While patients treated at a higher level of hospital had higher spending, they stayed shorter in these hospitals.
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Penev T, Zhao S, Lee JL, Chen CE, Metcalfe L, Ozminkowski RJ. The Impact of a Workforce Mental Health Program on Employer Medical Plan Spend: An Application of Cost Efficiency Measurement for Mental Health Care. Popul Health Manag 2023; 26:60-71. [PMID: 36799934 PMCID: PMC9969895 DOI: 10.1089/pop.2022.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Mental health issues often result in significant impairment and financial challenges, both at home and in the workplace. Solutions vary widely in their usage and cost-effectiveness. This study presents an analysis of medical and prescription drug spending and utilization data for the employees of 4 companies who were eligible for an evidence-based workforce mental health program (WMHP). A variation of coarsened exact matching paired WMHP users to nonusers, based on demographics, location, and medical factors. Individuals included 2791 pairs of members whose medical claims were incurred in 2018 and 3883 pairs with claims in 2019. Using a cost efficiency measurement process, mean cost and utilization per person per year (PPPY) were compared. WMHP users had lower medical (-$2295 in 2018; -$2304 in 2019) and prescription drug spending (-$295 in 2018; -$312 in 2019). Over half of the cost reduction (-$1252 in 2018; -$1211 in 2019) resulted from shifting therapy services from the medical benefit to WMHP. WMHP users attended about 12 sessions PPPY, whereas the comparison group of nonusers attended about 7 mental health office visits PPPY under the medical benefit. WMHP users had more mental health-related visits in both years, but had fewer visits on the medical plan, and fewer emergency department visits for mental health than comparison group members. These results provide evidence that high-quality, evidence-based mental health services can reduce total expenditures and change utilization patterns. Evidence-based WMHP may represent a prudent investment for employers in providing mental health care to employees.
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Affiliation(s)
- Todor Penev
- Health Solutions, Aon plc, Atlanta, Georgia, USA
| | - Shelley Zhao
- Health Solutions, Aon plc, Portland, Oregon, USA
| | - Jennifer L Lee
- Lyra Health, Burlingame, California, USA.,Emory University School of Medicine, Atlanta, Georgia, USA
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Licinio J, Wong ML. Digital footprints as a new translational approach for mental health care: a commentary. DISCOVER MENTAL HEALTH 2023; 3:5. [PMID: 37861744 PMCID: PMC10501006 DOI: 10.1007/s44192-023-00032-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/20/2023] [Indexed: 10/21/2023]
Abstract
There is a crisis in mental health care, with more people suffering from psychiatric disorders than resources that are available for treatment, even though spending is substantial. Millions who suffer from addiction, psychosis, depression and suicidality are either untreated or inadequately treated and organized psychiatry is unable to reach them. Possibly as reflection of under-treatment of psychiatric disorders, the rates of suicide have risen: from 1999 through 2014, the age-adjusted suicide rate in the US increased 24%, from 10.5 to 13.0 per 100,000. Assessment of psychiatric symptoms in ongoing outpatient settings is costly, inadequate and unable to detect clinical changes over time. One's digital phenotype is assessed through footprints left over as result of our interface with technology, including automated assessments of quantity and quality of social media activity, patterns and speed of device usage, and physiological data that is automatically collected, such as location, quantity and type of movement, heart rate, and sleep patterns. The use of digital footprints has been advocated for large-scale data collection that can facilitate psychiatric research in naturalistic settings. We highlight recent papers in Discover Mental Health addressing digital approaches to mental health and we also advance here the concept that digital footprints are ready for clinical use. However, before that happens there needs to be discussion on the appropriate boundaries between care that is driven by signals from digital footprints and the rights to privacy and self-determination.
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Affiliation(s)
- Julio Licinio
- Precision Medicine Laboratory in Psychiatry (PMLP), Institute for Human Performance, State University of New York, Upstate Medical University, 505 Irving Ave 3302, Syracuse, NY, 13210, USA.
| | - Ma-Li Wong
- Precision Medicine Laboratory in Psychiatry (PMLP), Institute for Human Performance, State University of New York, Upstate Medical University, 505 Irving Ave 3302, Syracuse, NY, 13210, USA
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Dir AL, Pederson CA, Ouyang F, Monahan PO, Schwartz K, Wiehe SE, Aalsma MC. Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents. Psychiatr Serv 2023; 74:374-380. [PMID: 36597697 DOI: 10.1176/appi.ps.202100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. METHODS Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. RESULTS A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). CONCLUSIONS These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.
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Affiliation(s)
- Allyson L Dir
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Casey A Pederson
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Fangqian Ouyang
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Patrick O Monahan
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Katherine Schwartz
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Sarah E Wiehe
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
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Yom-Tov E, Lekkas D, Heinz MV, Nguyen T, Barr PJ, Jacobson NC. Digitally filling the access gap in mental health care: An investigation of the association between rurality and online engagement with validated self-report screens across the United States. J Psychiatr Res 2023; 157:112-118. [PMID: 36462251 PMCID: PMC9898139 DOI: 10.1016/j.jpsychires.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/21/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
Mental health disorders are highly prevalent, yet few persons receive access to treatment; this is compounded in rural areas where mental health services are limited. The proliferation of online mental health screening tools are considered a key strategy to increase identification, diagnosis, and treatment of mental illness. However, research on real-world effectiveness, especially in hard to reach rural communities, is limited. Accordingly, the current work seeks to test the hypothesis that online screening use is greater in rural communities with limited mental health resources. The study utilized a national, online, population-based cohort consisting of Microsoft Bing search engine users across 18 months in the United States (representing approximately one-third of all internet searches), in conjunction with user-matched data of completed online mental health screens for anxiety, bipolar, depression, and psychosis (N = 4354) through Mental Health America, a leading non-profit mental health organization in the United States. Rank regression modeling was leveraged to characterize U.S. county-level screen completion rates as a function of rurality, health-care availability, and sociodemographic variables. County-level rurality and mental health care availability alone explained 42% of the variance in MHA screen completion rate (R2 = 0.42, p < 5.0 × 10-6). The results suggested that online screening was more prominent in underserved rural communities, therefore presenting as important tools with which to bridge mental health-care gaps in rural, resource-deficient areas.
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Affiliation(s)
- Elad Yom-Tov
- Microsoft Research Israel, Herzeliya, Israel; Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States
| | - Michael V Heinz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | | | - Paul J Barr
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; The Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States; Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, NH, United States; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States; Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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What is known about mental health and US federal housing subsidy programs? A scoping review. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kaya C, Iwanaga K, Hsu S, Akpinar EN, Bezyak J, Chen X, Chan F. Demographic Covariates, Vocational Rehabilitation Services, and Employment Outcomes of Working-Age Adults with Anxiety Disorders: A Multivariate Logistic Regression Analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:743-752. [PMID: 35579667 PMCID: PMC9112255 DOI: 10.1007/s10926-022-10038-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to investigate the relationships between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of individuals with anxiety disorders. The specific research question for the current study investigate demographic variables and vocational rehabilitation services as predictors of competitive employment outcomes. METHODS Data for the present study were extracted from the most recent United States Rehabilitation Service Administration 2018 Case Service Report (RSA-911) data. A purposeful selection, multivariate logistic regression analysis was conducted to examine the case service report data of 9266 individuals with anxiety disorders who received vocational rehabilitation services based on their demographic variables and receipt of VR services. RESULTS The results indicated that African Americans and Latinx, people who have completed high school or more, people who do not receive disability-related benefits, and those who received more vocational rehabilitation services were more likely to be gainfully employed. In addition, receipt of financial support for life crises and occupational credentials (i.e., other services and maintenance services) and vocational rehabilitation counseling and guidance services were significant predictors of employment outcomes. Conversely, receipt of supported employment and transition services were negatively associated with employment outcome. CONCLUSIONS In the present study, we identified VR services that can improve and risk factors that can impede employment outcomes of people with anxiety disorders. We also identified medical, psychosocial, and vocational interventions that can lessen the effect of anxiety disorders on physical and mental health functioning.
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Affiliation(s)
- Cahit Kaya
- University of Texas-Rio Grande Valley, Edinburg, USA.
- Harran University, Sanliurfa, Turkey.
| | | | - Sharon Hsu
- National Changhua University of Education, Taiwan, Taiwan
| | | | - Jill Bezyak
- University of Northern Colorado, Greeley, USA
| | | | - Fong Chan
- University of Wisconsin-Madison, Madison, USA
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Dharmayani PNA, Mishra GD, Mihrshahi S. Fruit and vegetable consumption and depression symptoms in young women: results from 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health. Eur J Nutr 2022; 61:4167-4178. [PMID: 35864339 PMCID: PMC9596510 DOI: 10.1007/s00394-022-02926-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Growing evidence suggests that specific food groups may play an important role in improving mental health. However, very few studies explored the association between individual dietary factors and depression symptoms by following a large cohort of individuals over a long period. We examined the differential effects of fruit and vegetables in relation to depression symptoms over a 15-year follow-up period in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. METHODS Fruit and vegetable consumption was assessed using short questions. The Center for Epidemiologic Studies Depression-10 scale with a cut off ≥ 10 indicated depressive symptoms. Multiple imputations with generalised estimating equations models were performed to estimate odds ratio of depression symptoms according to fruit and vegetable consumption. RESULTS A total of 4241 participants with a mean age of 27.6 (SD 1.45) years at baseline were followed up at five surveys (2003-2018). Fruit and vegetable intake (≥ 2 servings) was cross-sectionally associated with lower odds of depressive symptoms. In longitudinal analysis, a higher intake of fruit (≥ 4 servings) and vegetable (≥ 5 servings) was consistently associated with lower odds of depressive symptoms, with a 25% lower odds (OR 0.75; 95% CI 0.57, 0.97; p = 0.031) and a 19% lower odds (OR 0.81; 95% CI 0.70, 0.94; p = 0.007) than consuming one serve or less fruit and vegetable, respectively. CONCLUSION These results suggest that a higher intake of fruit and vegetables was associated with a lower risk of depression symptoms over 15 years from a population-based prospective study of Australian women.
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Affiliation(s)
- Putu Novi Arfirsta Dharmayani
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Gita D Mishra
- School of Public Health, University of Queensland, Brisbane, QLD, 4006, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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Nurminen M. Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis. PLoS One 2022; 17:e0278198. [PMID: 36441702 PMCID: PMC9704676 DOI: 10.1371/journal.pone.0278198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013-2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children.
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Affiliation(s)
- Mikko Nurminen
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
- * E-mail:
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Schulte PA, Delclos GL, Felknor SA, Streit JMK, McDaniel M, Chosewood LC, Newman LS, Bhojani FA, Pana-Cryan R, Swanson NG. Expanding the Focus of Occupational Safety and Health: Lessons from a Series of Linked Scientific Meetings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15381. [PMID: 36430096 PMCID: PMC9690540 DOI: 10.3390/ijerph192215381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.
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Affiliation(s)
- Paul A. Schulte
- Advanced Technologies and Laboratories International, Inc., Gaithersburg, MD 20878, USA
| | - George L. Delclos
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA
| | - Sarah A. Felknor
- National Institute for Occupational Safety and Health, Atlanta, GA 30333, USA
| | - Jessica M. K. Streit
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
| | - Michelle McDaniel
- Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX 77030, USA
| | - L. Casey Chosewood
- National Institute for Occupational Safety and Health, Atlanta, GA 30333, USA
| | - Lee S. Newman
- Center for Health, Work & Environment and Department of Environmental and Occupational Health, Colorado School of Public Health, CU Anschutz, University of Colorado, Aurora, CO 80045, USA
| | | | - Rene Pana-Cryan
- National Institute for Occupational Safety and Health, Washington, DC 20024, USA
| | - Naomi G. Swanson
- National Institute for Occupational Safety and Health, Cincinnati, OH 45226, USA
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Disease and debt: Findings from the 2019 Panel Study of Income Dynamics in the United States. Prev Med 2022; 164:107248. [PMID: 36087623 PMCID: PMC10068838 DOI: 10.1016/j.ypmed.2022.107248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/18/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022]
Abstract
Medical debt has grown dramatically over the past few decades. While cancer and diabetes are known to be associated with medical debt, little is known about the impact of other medical conditions and health behaviors on medical debt. We analyzed cross-sectional data on 9174 households - spanning lower-income, middle-income, and higher-income based on the Census poverty threshold - participating in the 2019 wave of the nationally representative United States Panel Study of Income Dynamics (PSID). The outcomes were presence of any medical debt and presence of medical debt≥ $2000. Respondents reported on medical conditions (diabetes, cancer, heart disease, chronic lung disease, asthma, arthritis, anxiety disorders, mood disorders) and on health behaviors (smoking, heavy drinking). Medical debt was observed in lower-income households with heart disease (OR = 2.64, p-value = 0.006) and anxiety disorders (OR = 2.16, p-value = 0.02); middle-income households with chronic lung disease (OR = 1.73, p-value = 0.03) and mood disorders (OR = 1.53, p-value = 0.04); and higher-income households with a current smoker (OR = 2.99, p-value<0.001). Additionally, medical debt ≥$2000 was observed in lower-income households with asthma (OR = 2.16, p-value = 0.009) and a current smoker (OR = 1.62, p-value = 0.04); middle income households with hypertension (OR = 1.65, p-value = 0.05). These novel findings suggest that the harms of medical debt extend beyond cancer, diabetes and beyond lower-income households. There is an urgent need for policy and health services interventions to address medical debt in a wider range of disease contexts than heretofore envisioned. Intervention development would benefit from novel conceptual frameworks on the causal relationships between health behaviors, health conditions, and medical debt that center social-ecological influences on all three of these domains.
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Hall JP, Kurth NK, Ipsen C, Myers A, Goddard K. Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy. Health Aff (Millwood) 2022; 41:1433-1441. [DOI: 10.1377/hlthaff.2022.00395] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jean P. Hall
- Jean P. Hall , University of Kansas, Lawrence, Kansas
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Chaudhry MM, Banta JE, McCleary K, Mataya R, Banta JM. Psychological distress, structural barriers, and health services utilization among U.S. adults: National Health interview survey, 2011–2017. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2123694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Maham M. Chaudhry
- School of Public Health, Loma Linda University, Loma Linda, California, USA
- Loma Linda University, Loma Linda, California, USA
| | - Jim E. Banta
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Karl McCleary
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Ron Mataya
- School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - James M. Banta
- School of Business, La Sierra University, Riverside, California, USA
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Chen Z, Roy K, Khushalani JS, Puddy RW. Trend in rural-urban disparities in access to outpatient mental health services among US adults aged 18-64 with employer-sponsored insurance: 2005-2018. J Rural Health 2022; 38:788-794. [PMID: 35001435 PMCID: PMC9661493 DOI: 10.1111/jrh.12644] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE This study estimates the rural-urban differences in outpatient service utilization and expenditures for depression, anxiety disorder, and substance use disorder, and the evolving mental health provider mix for privately insured US adults aged 18-64 during 2005-2018. METHODS We used the IBM MarketScan Commercial Claims and Encounters Database for individuals covered by employer-sponsored health insurance, from 2005 to 2018, with a yearly total number of beneficiaries ranging from 17.5 to 53.1 million. Claims for nonelderly adults with mental health and substance abuse coverage are included. Outcomes include rates of outpatient service utilization for depression, anxiety disorder, and substance use disorder; counts of outpatient visits; expenditure and share of the out-of-pocket cost; and the mental health services provider mix. FINDINGS Rural enrollees were less likely than urban enrollees to use outpatient mental health services for depression by 1.2% (percentage points) in 2005 and 0.6% in 2018. Among those who used outpatient mental health services, rural enrollees had fewer outpatient visits than their urban counterparts (difference: 1.8-2.4 visits for depression, 1.2-1.7 visits for anxiety disorder, and 0.7-2.1 visits for substance use disorder). Rural patients paid less per year for mental health outpatient visits of the 3 conditions but incurred a higher share of out-of-pocket expenses. Rural and urban patients differ in the mix of mental health providers, with rural enrollees relying more on primary care providers than urban enrollees. CONCLUSIONS Rural-urban disparities in access to mental health services persist during 2005-2018 among a population with private insurance.
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Affiliation(s)
- Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
- School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jaya Shankar Khushalani
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard W. Puddy
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy and Strategy, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Grunin L, Yu G, Cohen S. Combined Race and Gender Trend Disparities in Depressive Symptoms among U.S. High School Students: 1999-2019. Issues Ment Health Nurs 2022; 43:824-834. [PMID: 35468031 DOI: 10.1080/01612840.2022.2067274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In 2019, over 3.2 million adolescents in the U.S. reported depressive symptoms-a number that continues to increase annually. Not only can depression negatively impact an adolescent's academic performance, social development, and cognitive function, but it is also the most common condition associated with suicide. Previous studies have reported prevalence rates and statistical trends by either gender or race. We conducted an in-depth analysis of the current racial and gender trend disparities in adolescent depressive symptoms by examining linear and quadratic trends from the Youth Behavior Risk Survey (N = 158,601) over two decades (1999-2019), stratified by gender and race subgroups, both separately and combined. This novel quantitative method allows for a more nuanced approach when exploring social and cultural influences on adolescent depressive symptoms. We found a significant difference in the prevalence of depressive symptoms between males and females among Black, Hispanic, and multiracial adolescents in each separate year of pooled data. However, an increased prevalence trend over the 20-year period was only seen among the females of these three racial categories. White and Asian female adolescents also exhibited a statistical increase in prevalence of depressive symptoms over time. The only group of males with a significant trend increase over time were White adolescents. Understanding the intersection of gender and race in adolescent depressive symptoms trends enhances evidence for nurses and other healthcare professionals when developing and implementing targeted, effective prevention and intervention measures.
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Affiliation(s)
- Laura Grunin
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Gary Yu
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Sally Cohen
- NYU Rory Meyers College of Nursing, New York University, New York, New York, USA
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Rachas A, Gastaldi-Ménager C, Denis P, Barthélémy P, Constantinou P, Drouin J, Lastier D, Lesuffleur T, Mette C, Nicolas M, Pestel L, Rivière S, Tajahmady A, Gissot C, Fagot-Campagna A. The Economic Burden of Disease in France From the National Health Insurance Perspective: The Healthcare Expenditures and Conditions Mapping Used to Prepare the French Social Security Funding Act and the Public Health Act. Med Care 2022; 60:655-664. [PMID: 35880776 PMCID: PMC9365254 DOI: 10.1097/mlr.0000000000001745] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems. OBJECTIVES Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act. DESIGN Annual cross-sectional study (2015-2019) based on the French national health database. SUBJECTS National health insurance beneficiaries (97% of the French residents). MEASURES All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs). RESULTS In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. "Active lung cancer" (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital. CONCLUSIONS These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.
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Affiliation(s)
- Antoine Rachas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Christelle Gastaldi-Ménager
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pierre Denis
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Pauline Barthélémy
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Panayotis Constantinou
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Jérôme Drouin
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Dimitri Lastier
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Thomas Lesuffleur
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Corinne Mette
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Muriel Nicolas
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Laurence Pestel
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Sébastien Rivière
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Ayden Tajahmady
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Claude Gissot
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
| | - Anne Fagot-Campagna
- Direction de la stratégie, des études et des statistiques, Caisse Nationale d’Assurance Maladie, Paris, France
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