Understanding preventive health screening services use in persons with serious mental illness: how does integrated behavioral health primary care compare?

Influenza, pneumococcal, and COVID-19 vaccination coverage and hesitancy in adults with psychiatric disorders

Background/Objectives

Patients with psychiatric disorders have high mortality and morbidity rates from infectious diseases, but low vaccination rates compared to the normal population. This study aimed to evaluate the vaccination rates for influenza, pneumococcal, and COVID-19 vaccines, and the levels of vaccine hesitancy among individuals with psychiatric disorders.

Methods

The study was a cross-sectional study among patients with psychiatric disorders. Participants' vaccination statuses for influenza, pneumococcal, and COVID-19 vaccines during the pandemic were assessed, along with their vaccine hesitancy levels using a vaccine hesitancy scale. Data were collected between 01.03.2024 and 27.11.2024.

Results

The study included 500 patients diagnosed with psychiatric disorders. Only 3.6% of the participants had received the influenza vaccine in the previous year, 3.0% reported regular influenza vaccinations, and 76.2% had received the COVID-19 vaccine during the pandemic. Among the participants at risk for pneumococcal infection (14%), the vaccination rate was only 2%. Patients with attention deficit hyperactivity disorder (ADHD) (45.0%) and anxiety disorder (17.2%) had the highest rates of regular influenza vaccination, while those with psychosis (13.6%) and depression (14.6%) had the lowest (p=0.010). COVID-19 vaccination rates during the pandemic were highest in ADHD (90.0%), bipolar disorder (81.1%), and depression (80.8%), and lowest in psychosis (54.5%) and obsessive-compulsive disorder (64.3%)(p=0.002). Women (p=0.001), participants with below university education levels (p=0.009), and patients with psychosis showed greater vaccine hesitancy. Patients with ADHD and bipolar disorder had the most positive attitudes toward vaccination (p=0.021). Positive attitudes were also linked to recent or regular influenza vaccinations and COVID-19 or pneumococcal vaccinations (p<0.05).

Conclusions

Low vaccination rates and high vaccine hesitancy in psychiatric patients, particularly those with psychosis, necessitate targeted strategies to improve immunization coverage in this population.

Bridging the Gap: Interventions to Increase Cancer Screening Adherence in Individuals with Mental Disorders-A Systematic Review

Patients with mental illnesses adhere to organized cancer screening programs less frequently than the general population. This systematic review aims to examine the literature to identify studies that evaluate interventions designed to increase cancer screening adherence in people with mental disorders. The review protocol was registered (CRD42024510431) and Pubmed and Scopus were searched up to January 2024. Breast, colorectal, or cervical cancer screening were considered. We adhered to the PROSPERO guidelines. Study quality was assessed. Overall, six articles were included: two RCT studies, two before-after studies, and two cohort studies. Four interventions were conducted in the USA, one in Canada, and one in Japan. Two studies evaluated all three cancer screening programs, two studies evaluated breast cancer screenings, and two studies evaluated colorectal cancer screenings. The proposed interventions included patient navigation, case management, and support from staff members along with educational modules, decision counselling sessions, and enhanced primary care. The most consistent improvements in screening adherence were observed in breast and colorectal cancer screenings compared to usual care, particularly through interventions like patient navigation (colorectal cancer: 47.1% vs. 11.8%, p < 0.001) and case management. Further evaluations of interventions and their costs are still needed.

Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services

BACKGROUND

Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion.

METHODS

We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article.

RESULTS

Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities.

CONCLUSION

Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.

The Health Improvement Profile for people with severe mental illness: Feasibility of a secondary analysis to make international comparisons

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates. No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: It appears feasible to use the HIP to profile and compare physical health-related risks in people with SMI across different international settings. The HIP tool identified significant differences in areas of risk across the four countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The HIP could be used to identify unique clusters of health promotion needs in different countries. Use of HIP health checks may support implementation of individualized interventions. ABSTRACT: Introduction To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi-national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources.

The Cost Effectiveness of Mental Health Treatment in the Lifetime of Older Adults with HIV in New York City: A Markov Approach

BACKGROUND

There are noticeable gaps in knowledge regarding the cost and effectiveness of integrated medical and behavioral services for older adults with HIV. Their lifespan is close to the population's level but their quality of life has sharply declined due to depression and substance use. Mental health disorders are widespread among an aging population with HIV.

OBJECTIVE

The aim of this study was to build a decision analytic model to evaluate medical interventions with and without mental health treatment using primary data of 139 older adults with HIV and health outcomes from the literature.

METHODS

We tracked the progression of depression and cumulative deaths among older adults with HIV using a Markov model with 50 annual cycles through three health states. Deterministic and probabilistic sensitivity analyses addressed uncertainty in estimating the parameters and around the model's assumptions.

RESULTS

An integrated medical and behavioral care system is cost effective at a willingness to pay of $50,000 per QALY compared with medical care only. The incremental cost was $516,452 and the incremental effectiveness was 38.8 quality-adjusted life-years (QALY), with an incremental cost-effectiveness ratio of $13,316 per QALY.

CONCLUSIONS

Appropriate and efficacious referrals to integrated medical + behavioral services, either in the same facility or connected to their primary care doctor, are instrumental to reverse loses in quality of life and avoid premature death. If mental health is left unattended, HIV would progress, causing declines in quality of life and ultimately triggering premature death. Reliable data on the cost and effectiveness of different types of HIV integrated services are needed.

Colorectal Cancer Screening Completion Among Individuals With and Without Mental Illnesses: A Comparison of 2 Screening Methods

PURPOSE

Cancer mortality is worse among people with psychiatric disorders. The purpose of this study was to compare facilitators and rates of colorectal cancer (CRC) screening between people with and without mental illnesses.

DESIGN

We conducted a secondary analysis using data from a general population cohort study (N = 92 445) that assessed effects of 2 types of CRC screening test kits-guaiac fecal occult blood testing (gFOBT) and fecal immunochemical testing (FIT)-on CRC screening completion.

SETTING

The setting was a health system that served approximately 485 000 members in urban and suburban Oregon and Washington.

PARTICIPANTS

Participants were health system members, categorized by mental illness diagnosis (psychotic disorders, non-psychotic unipolar depression, and no mental illness), who were age-eligible, at average risk of CRC, and were at least 366 days past their last gFOBT with no evidence of other CRC screening.

MEASURES

The outcome was time until completion of CRC screening.

ANALYSIS

We used Cox proportional hazard models.

RESULTS

FIT reduced CRC screening barriers for all the groups. Compared to people without mental illness diagnoses, those with psychotic disorders were equally likely to screen using FIT (hazard ratio [HR] = .95, p = .679) and those with depression were more likely (HR = 1.17, p = .006).

CONCLUSIONS

FIT can improve CRC screening rates among people with mental illnesses, particularly depression.