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Johnson JE, Hailemariam M, Zlotnick C, Richie F, Wiltsey-Stirman S. Analysis of implementation processes in a hybrid effectiveness-implementation trial of interpersonal psychotherapy (IPT) for major depressive disorder in prisons: Training, supervision, and recommendations. PLoS One 2024; 19:e0288182. [PMID: 38743716 PMCID: PMC11093331 DOI: 10.1371/journal.pone.0288182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND There are 10 million admissions to U.S. prisons and jails each year. More than half of those admitted have mental health problems. The goal of this article is to inform: (1) implementation of evidence-based mental health treatments in prisons and jails, an important effort that needs more evidence to guide it; (2) psychotherapy and interpersonal psychotherapy (IPT) training efforts, especially in low-resource settings. METHODS A randomized hybrid effectiveness-implementation trial of group IPT for major depressive disorder (MDD) in state prisons found that IPT increased rates of MDD remission and lowered posttraumatic stress disorder symptoms relative to prison treatment as usual. The trial used prison counselors, only some of whom had prior psychotherapy training/experience, to deliver IPT. IPT treatment adherence was high (96%), but trial training and supervision were too costly to be scalable outside the trial. The current article reports results from a planned qualitative analysis of 460 structured implementation and supervision documents in that trial to describe training and supervision processes and lessons learned, inform training recommendations, and facilitate future work to optimize training and supervision for under-resourced settings. RESULTS Themes identified in implementation and supervision process notes reflected: work on psychotherapy basics (reflective listening, focusing on emotions, open-ended questions, specific experiences), IPT case conceptualization (forming a conceptualization, what is and is not therapeutic work, structure and limit setting, structure vs. flexibility), IPT techniques (enhancing social support, role plays, communication analysis), psychotherapy processes (alliance repair, managing group processes), and managing difficult situations (avoidance, specific clients, challenging work settings). Counselors were receptive to feedback; some relied on study supervisors for support in managing stressful prison working conditions. CONCLUSIONS Findings can be used to make future training and supervision more efficient. Based on our results, we recommend that initial and refresher training focus on IPT case conceptualization, steps for addressing each IPT problem area, and reflective listening. We also recommend supervision through at least counselors' first two rounds of groups. More low-cost, scalable training methods are needed to get mental health treatment to individuals who need it most, who are often served in challenging, low-resource settings such as prisons. This is a mental health access and equity issue. TRIAL REGISTRATION The trial was registered at clinicaltrials.gov (NCT01685294).
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Affiliation(s)
- Jennifer E. Johnson
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan, United States of America
| | - Maji Hailemariam
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, Michigan, United States of America
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
- Butler Hospital, Providence, Rhode Island, United States of America
- University of Cape Town, Cape Town, South Africa
| | - Fallon Richie
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Shannon Wiltsey-Stirman
- Dissemination and Training Division, National Center for PTSD, Menlo Park, California, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, California, United States of America
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Solbakken LE, Bergvik S, Wynn R. Breaking down barriers to mental healthcare access in prison: a qualitative interview study with incarcerated males in Norway. BMC Psychiatry 2024; 24:292. [PMID: 38632543 PMCID: PMC11025238 DOI: 10.1186/s12888-024-05736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Mental health problems are highly prevalent in prison populations. Incarcerated persons generally come from disadvantaged backgrounds and are living under extraordinary conditions while in prison. Their healthcare needs are complex compared to the general population. Studies have found that incarcerated individuals are reluctant to seek help and that they experience challenges in accessing mental healthcare services. To some extent, seeking treatment depends on the degree of fit between potential users and health services, and actual use might be a better indication of accessibility than the fact that services are available. This study aimed to explore individual and systemic facilitators and barriers to accessing mental healthcare in a prison context. METHODS An analytical approach drawing on elements of constructivist Grounded theory was the methodological basis of this study. Fifteen male participants were recruited from three prisons in Northern Norway. Data was collected through in-depth interviews on topics such as help-seeking experiences, perceived access to services and availability of health information. RESULTS We found that distrust in the system, challenges with the referral routines, worries about negative consequences, and perceived limited access to mental healthcare were barriers to help-seeking among incarcerated individuals. How prison officers, and healthcare personnel respond to incarcerated persons reporting mental distress could also be critical for their future willingness to seek help. Providing information about mental health and available services, initiating outreaching mental health services, and integrating mental health interventions into treatment programs are examples of efforts that might reduce barriers to accessing services. CONCLUSIONS Facilitating access to mental health services is crucial to accommodate the mental health needs of those incarcerated. This study provides insights into the complex interplay of individual, social and systemic factors that may contribute to the utilization of mental health care among incarcerated persons. We suggest that correctional and healthcare systems review their practices to facilitate access to healthcare for people in prison.
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Affiliation(s)
- Line Elisabeth Solbakken
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, N-9038, Norway
- Division of Mental Health and Substance Use, University Hospital of North, Tromsø, Norway
| | - Svein Bergvik
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, N-9038, Norway.
- Department of Education, ICT and Learning, Østfold University College, Tromsø, Norway.
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Martínez-Lanz P, Cuevas-Covarrubias C, Hernández-Valdez P. Principal Component Analysis of Male Criminal Behavior. Health (London) 2021. [DOI: 10.4236/health.2021.1310083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Medication is integral in treating alcohol use disorder. However, because of the small to medium effect size, much effort is being exerted to identify predicting factors for effective pharmacological treatment in alcohol abuse disorder. Rather than focusing on abstinence days, alcohol craving, or frequency of drinking, which has been the focus of previous studies. Recently, there have been several studies which focused on follow-up length as an indicator of pharmacological treatment effe ctiveness. The purpose of this study was to investigate the predicting factors of long-term follow-up in treating Korean alcoholics with naltrexone or acamprosate. A retrospective study was conducted. Medical records of all patients diagnosed from November 2008 to May 2017 with alcohol abuse or alcohol dependence at psychiatric clinics at PNUYH were reviewed. We examined total days of which naltrexone or acamprosate were prescribed, and investigated if there were predicting factors maintaining follow-up at least 180 days or more. With these data, logistic regression analysis was conducted. In naltrexone long group compared to naltrexone short group, factors of having medical comorbidities [odds ratio (OR) = 5.477, P = 0.012] showed higher OR. In acamprosate long group, factors of age (OR = 1.083, P = 0.030), and use of more than four psychotropic medications (OR = 7.107, P = 0.030), showed higher OR. In both medications, predicting factors were different from the other. Further study to investigate the reasons would provide us with a new insight.
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Johnson JE, Hailemariam M, Zlotnick C, Richie F, Sinclair J, Chuong A, Stirman SW. Mixed Methods Analysis of Implementation of Interpersonal Psychotherapy (IPT) for Major Depressive Disorder in Prisons in a Hybrid Type I Randomized Trial. Adm Policy Ment Health 2019; 47:410-426. [PMID: 31797190 DOI: 10.1007/s10488-019-00996-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article describes a mixed methods evaluation of implementation of interpersonal psychotherapy (IPT) in the first fully-powered trial of any treatment for major depressive disorder in an incarcerated population. Assessments in this Hybrid Type I trial included surveys of prison providers and administrators (n = 71), measures of feasibility and acceptability to prison patients (n = 90), and a planned document review (n = 460) to assess potential determinants of implementation. Quantitative and qualitative results indicated that IPT was a good fit for prisoners, and that prisoners and providers were enthusiastic about IPT. Providers were open to feedback, open to learning evidence-based practices, and committed to helping their clients. Limited treatment staff and variable supervision and collegial support may pose implementation challenges. For widespread prison implementation, scalable models for ongoing IPT training and supervision are needed.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA. .,Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Room 366, Flint, MI, 48502, USA.
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI, 02906, USA.,University of Cape Town, Cape Town, South Africa
| | - Fallon Richie
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Joshua Sinclair
- Division of Public Health, College of Human Medicine, Michigan State University, 200 East 1st Street, Flint, MI, 48502, USA
| | - Adam Chuong
- Brown University, 700 Butler Dr, Providence, RI, 02906, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, National Center for PTSD, Stanford University, 795 Willow Road (NC-PTSD 334), Menlo Park, CA, 94025, USA
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Johnson JE, Stout RL, Miller TR, Zlotnick C, Cerbo LA, Andrade JT, Nargiso J, Bonner J, Wiltsey-Stirman S. Randomized cost-effectiveness trial of group interpersonal psychotherapy (IPT) for prisoners with major depression. J Consult Clin Psychol 2019; 87:392-406. [PMID: 30714749 PMCID: PMC6482450 DOI: 10.1037/ccp0000379] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study tested the effectiveness and cost-effectiveness of interpersonal psychotherapy (IPT) for major depressive disorder (MDD) among prisoners. It is the first fully powered randomized trial of any treatment (pharmacological or psychosocial) targeting MDD among incarcerated individuals. METHOD One hundred eighty-one male (n = 117) and female (n = 64) prisoners from prison facilities in 2 states were randomized to group IPT (delivered by master's-level and nonspecialist prison counselors) for MDD plus prison treatment as usual (TAU) or to TAU alone. Participants' average age was 39 (range = 20-61); 20% were African American and 19% were Hispanic. Outcomes assessed at posttreatment and 3-month follow-up included depressive symptoms (primary; assessed using the Hamilton Rating Scale for Depression), suicidality (assessed with the Beck Scale for Suicide Ideation and Beck Hopelessness Scale), in-prison functioning (i.e., enrollment in correctional programs; discipline reports; aggression/victimization; and social support), remission from MDD, and posttraumatic stress disorder symptoms. RESULTS IPT reduced depressive symptoms, hopelessness, and posttraumatic stress disorder symptoms, and increased rates of MDD remission relative to prison TAU alone. Effects on hopelessness were particularly strong. Cost per patient was $2,054 including costs for IPT training and supervision or $575 without these costs. For providers running their second or subsequent IPT group, cost per additional week in remission from MDD (relative to TAU alone) was $524 ($148 excluding training and supervision costs, which would not be needed for established programs). CONCLUSIONS IPT is effective and cost-effective and we recommend its use for MDD among prisoners. It is currently the only treatment for MDD evaluated among incarcerated individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jennifer E. Johnson
- National Center for PTSD, Dissemination and Training Division, 795 Willow Road (NC-PTSD 334), Menlo Park, CA 94025.
| | - Robert L. Stout
- Decision Sciences Institute, 1005 Main Street Unit 8120, Pawtucket, RI 02860.
| | - Ted R. Miller
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705; School of Public Health, Curtin University, Perth, Australia.
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd, Providence, RI 02906; University of Cape Town, South Africa.
| | - Louis A. Cerbo
- Rhode Island Department of Corrections, 39 Howard Avenue, Cranston, RI 02920.
| | - Joel T. Andrade
- MHM Services, Inc. 110 Turnpike Road, Suite 308, Westborough, MA 01581.
| | - Jessica Nargiso
- Massachusetts General Hospital, 6th floor, 151 Merrimac St, Boston MA 02114.
| | - Joseph Bonner
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St, Flint, MI 48502.
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Mbaba M, Brown SE, Wooditch A, Kiss M, Murphy A, Kumari S, Taxman F, Altice F, Lawson WB, Springer SA. Prevalence, Diagnosis, and Treatment Rates of Mood Disorders among Opioid Users under Criminal Justice Supervision. Subst Use Misuse 2018; 53:1519-1528. [PMID: 29333954 PMCID: PMC6432769 DOI: 10.1080/10826084.2017.1416400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Individuals involved in the criminal justice system have disproportionately high rates of psychiatric disorders when compared to the general U.S. POPULATION If left untreated, the likelihood of subsequent arrest increases and risk for adverse health consequences is great, particularly among opioid users. OBJECTIVES To explore the prevalence, characteristics, and treatment of mood disorders among justice involved opioid-dependent populations. METHODS The current study enrolled 258 treatment-seeking opioid-dependent individuals under community-based criminal justice supervision (e.g., probation, parole) screened from the larger parent study, Project STRIDE, a seek/test/treat randomized control trial (RCT) examining HIV and opioid use treatment. During baseline, individuals were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) and screened for bipolar disorder using the Mood Disorder Questionnaire (MDQ) tool. RESULTS Overall, 78 (30%) participants screened positive for moderate to severe depression and 54 (21%) screened positive for bipolar disorder. Participants self-reported mood disorders at higher rates than they screened positive for these conditions. Participants screening positive for these conditions experienced significantly greater family, legal, and medical problems on the Addiction Severity Index-Lite (ASI-Lite) than those who did not screen positive. Incidence of a lifetime suicide attempt was found to be associated with a positive screen for both mood disorders. Prescribed psychotropic treatment utilization was similar among those who screened positive for depression or bipolar disorder with approximately 38% reporting taking medication. IMPORTANCE Findings suggest universal mood disorder screening to improve comprehensive psychiatric care and treatment of opioid-dependent justice-involved individuals.
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Affiliation(s)
- Mary Mbaba
- George Washington University, Department of Psychology, Washington, D.C. 20052
| | - Shan-Estelle Brown
- Yale University School of Medicine, AIDS Program, Section of Infectious Disease, New Haven, CT 06510
| | - Alese Wooditch
- Department of Criminal Justice, Temple University, Philadelphia, PA 19122
| | - Marissa Kiss
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA 22030
| | - Amy Murphy
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA 22030
| | - Suneeta Kumari
- Howard University College of Medicine and Hospital, Washington, D.C. 20059
| | - Faye Taxman
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA 22030
| | - Frederick Altice
- Yale University School of Medicine, AIDS Program, Section of Infectious Disease, New Haven, CT 06510
- Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT 06510
| | - William B. Lawson
- Dell Medical School, The University of Texas at Austin, Austin, TX 78701
| | - Sandra A. Springer
- Yale University School of Medicine, AIDS Program, Section of Infectious Disease, New Haven, CT 06510
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Calhoun S. The clinician-patient working alliance: Is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees? J Forens Psychiatry Psychol 2018; 29:782-793. [PMID: 30524208 PMCID: PMC6277031 DOI: 10.1080/14789949.2018.1477976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persistent psychiatric symptoms can serve as a major barrier to the successful reintegration of parolees with mental illness. Thus, it is important to identify factors that might impact their mental health recovery, such as low adherence to their treatment regimen. Although many studies have examined the issue of psychiatric medication nonadherence, very few studies have focused specifically on justice-involved individuals. The strength of the clinician/patient working alliance has been found to be significantly associated with psychiatric medication adherence in prior research, but this relationship has not been assessed in a parolee population. Logistic regression analysis was used to determine if patient-rated working alliance was a significant predictor of low psychiatric medication adherence while taking into account alcohol/illegal drug use, age, and ethnicity in a sample of recently released parolees with mental illness (N=49). Patient-rated working alliance, age, and ethnicity were not significant predictors of low adherence. Alcohol/illegal drug use during the follow-up period was associated with a significantly increased likelihood of meeting the criteria for low medication adherence (OR=8.36; 95% CI=1.60, 43.66). The findings from this study highlight the importance of addressing alcohol and illegal drug use issues as part of the psychiatric treatment plan for returning prisoners with mental illness.
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Affiliation(s)
- Stacy Calhoun
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025
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Mulay AL, Kelly E, Cain NM. Psychodynamic Treatment of the Criminal Offender: Making the Case for Longer-Term Treatment in a Longer-Term Setting. Psychodyn Psychiatry 2017; 45:143-173. [PMID: 28590205 DOI: 10.1521/pdps.2017.45.2.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.
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Johnson JE, Miller TR, Stout RL, Zlotnick C, Cerbo LA, Andrade JT, Wiltsey-Stirman S. Study protocol: Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depression. Contemp Clin Trials 2016; 47:266-74. [PMID: 26845030 DOI: 10.1016/j.cct.2016.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/25/2016] [Accepted: 01/31/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE This article describes the protocol for a Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depressive disorder (MDD). The goal is to promote uptake of evidence-based treatments in criminal justice settings by conducting a randomized effectiveness study that collects implementation data, including a full cost-effectiveness analysis. BACKGROUND More than 2.3 million people are incarcerated in the United States on any given day. MDD is the most common severe mental illness among incarcerated individuals. Despite the prevalence and consequences of MDD among incarcerated populations, this study will be the first fully-powered randomized trial of any treatment for MDD in an incarcerated population. DESIGN Given the politically charged nature of the justice system, advantageous health outcomes are often not enough to get an intervention implemented in prisons. To increase the policy impact of this trial, we sought advice from prison providers and administrators about outcomes that would be persuasive to policy-makers and defensible to the public. In this trial, effectiveness questions will be answered using a randomized clinical trial design comparing IPT plus prison treatment as usual (TAU) to TAU alone, with outcomes including depressive symptoms (primary), suicidality, and in prison functioning (enrollment and completion of correctional programs; disciplinary and incident reports; aggression/victimization; social support). Implementation outcomes will include cost-effectiveness; feasibility and acceptability of IPT to clients, providers, and administrators; prison provider intervention fidelity, attitudes, and competencies; and barriers and facilitators of implementation assessed through surveys, interviews, and process notes.
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Affiliation(s)
- Jennifer E Johnson
- Division of Public Health, Michigan State University College of Human Medicine, 200 East 1st St Room 332, Flint, MI 48503, United States.
| | - Ted R Miller
- Pacific Institute of Research and Evaluation, 11720 Beltsville Drive, Suite 900, Calverton, MD 20705, United States.
| | - Robert L Stout
- Decision Sciences Institute, 1005 Main Street Unit 8120, Pawtucket, RI 02860, United States.
| | - Caron Zlotnick
- Butler Hospital and Brown University, 345 Blackstone Blvd., Providence, RI 02906, United States.
| | - Louis A Cerbo
- Rhode Island Department of Corrections, 39 Howard Avenue, Cranston, RI 02920, United States.
| | - Joel T Andrade
- MHM Services, Inc., 110 Turnpike Road, Suite 308, Westborough, MA 01581, United States.
| | - Shannon Wiltsey-Stirman
- National Center for PTSD, Dissemination and Training Division, 795 Willow Road (NC-PTSD 334), Menlo Park, CA 94025, United States.
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Bilderbeck AC, Brazil IA, Farias M. Preliminary Evidence That Yoga Practice Progressively Improves Mood and Decreases Stress in a Sample of UK Prisoners. Evid Based Complement Alternat Med 2015; 2015:819183. [PMID: 26294928 PMCID: PMC4534616 DOI: 10.1155/2015/819183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 01/09/2023]
Abstract
Objectives. In the first randomized controlled trial of yoga on UK prisoners, we previously showed that yoga practice was associated with improved mental wellbeing and cognition. Here, we aimed to assess how class attendance, self-practice, and demographic factors were related to outcome amongst prisoners enrolled in the 10-week yoga intervention. Methods. The data of 55 participants (52 male, 3 female) who completed a 10-week yoga course were analysed. Changes in pre- and postyoga measures of affect, perceived stress, and psychological symptoms were entered into linear regression analyses with bias-corrected and accelerated bootstrap confidence intervals. Class attendance, self-practice, demographic variables, and baseline psychometric variables were included as regressors. Results. Participants who attended more yoga classes and those who engaged in frequent (5 times or more) self-practice reported significantly greater decreases in perceived stress. Decreases in negative affect were also significantly related to high frequency self-practice and greater class attendance at a near-significant level. Age was positively correlated with yoga class attendance, and higher levels of education were associated with greater decreases in negative affect. Conclusions. Our results suggest that there may be progressive beneficial effects of yoga within prison populations and point to subpopulations who may benefit the most from this practice.
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Affiliation(s)
| | - Inti A. Brazil
- Donders Institute for Brain, Cognition and Behaviour, 6525 EZ Nijmegen, Netherlands
- Pompestichting, Nijmegen, 6532 CN Nijmegen, Netherlands
| | - Miguel Farias
- Research Centre for Psychology, Behaviour and Achievement, Coventry University, Coventry CV1 5FB, UK
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Hassan L, Frisher M, Senior J, Tully M, Webb R, While D, Shaw J. A cross-sectional prevalence survey of psychotropic medication prescribing patterns in prisons in England. Health Services and Delivery Research 2014. [DOI: 10.3310/hsdr02330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe prevalence of mental illness is significantly higher among prisoners than among people in the wider community. Psychotropic prescribing in prisons is a complex and controversial area, where prescribers balance individual health needs against security and safety risks. However, there are no current data on prescribing patterns in prisons or how these compare with those in the wider community.AimsThe study aimed to determine the prevalence, appropriateness and acceptability of psychotropic prescribing in prisons. The objectives were to determine rates of prescribing for psychotropic medications, compared with those in the wider community; the appropriateness of psychotropic prescribing in prisons; and the perceived satisfaction and acceptability of prescribing decisions to patients and general practitioners (GPs).MethodEleven prisons, housing 6052 men and 785 women, participated in a cross-sectional survey of psychotropic prescribing. On census days, data were extracted from clinical records for all patients in receipt of hypnotics, anxiolytics, antipsychotics, antimanics, antidepressants and central nervous system stimulants. The Clinical Practice Research Datalink supplied an equivalent data set for a random sample of 30,602 patients prescribed psychotropic medicines in the community. To determine the acceptability of prescribing decisions, patients attending GP consultations at three prisons were surveyed (n = 156). Pre- and post-consultation questionnaires were administered, covering expectations and satisfaction with outcomes, including prescribing decisions. Doctors (n = 6) completed post-consultation questionnaires to explore their perspectives on consultations.ResultsOverall, 17% of men and 48% of women in prison were prescribed at least one psychotropic medicine. After adjusting for age differences, psychotropic prescribing rates were four times higher among men [prevalence ratio (PR) 4.02, 95% confidence interval (CI) 3.75 to 4.30] and six times higher among women (PR 5.95, 95% CI 5.36 to 6.61) than among community patients. There were significant preferences for certain antidepressant and antipsychotic drugs in prison, compared with in the community. In 65.3% of cases, indications for psychotropic drugs were recorded and upheld in theBritish National Formulary. Antipsychotic prescriptions were less likely than other psychotropics to be supported by a valid indication in the patient notes (PR 0.75, 95% CI 0.67 to 0.83). In the acceptability study, patients who identified mental health as their primary problem were more likely than individuals who identified other types of health problems to want to start, stop and/or change their medication (PR 1.46, 95% CI 1.23 to 1.74), and to report dissatisfaction following the consultation (PR 1.76, 95% CI 1.01 to 3.08). Doctors were more likely to issue prescriptions when they thought that the patient wanted a prescription (PR 4.2, 95% CI 2.41 to 7.28), they perceived pressure to prescribe (PR 1.66, 95% CI 1.26 to 2.19), and/or the problem related to mental health (PR 1.67, 95% CI 1.27 to 2.20).ConclusionsPsychotropic medicines were prescribed more frequently in prisons than in the community. Without current and robust data on comparative rates of mental illness, it is not possible to fully assess the appropriateness of psychotropic prescribing. Nonetheless, psychotropic medicines were prescribed for a wider range of clinical indications than currently recommended, with discernible differences in drug choice. Complex health and security concerns exist within prisons. Further research is necessary to determine the effect of psychotropic prescribing on physical health, and to determine the optimum balance between medicines and alternative treatments in prisons.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Lamiece Hassan
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Martin Frisher
- School of Pharmacy and Medicines Management, Keele University, Keele, UK
| | - Jane Senior
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Mary Tully
- Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Roger Webb
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - David While
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
| | - Jenny Shaw
- Centre for Mental Health and Risk, Institute of Brain and Behaviour, The University of Manchester, Manchester, UK
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Abstract
Correctional facilities are a major provider of mental health care throughout the United States. In spite of the numerous benefits of providing care in this setting, clinicians are sometimes concerned about entering into correctional care because of uncertainty in prescribing practices. This article provides an introduction to prescription drug use, abuse, and diversion in the correctional setting, including systems issues in prescribing, commonly abused prescription medications, motivation for and detection of prescription drug abuse, and the use of laboratory monitoring. By understanding the personal and systemic factors that affect prescribing habits, the clinician can develop a more rewarding correctional practice and improve care for inmates with mental illness.
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Affiliation(s)
- Patricia D Pilkinton
- 1Research and Development, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
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14
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Muzina DJ, Malone DA, Bhandari I, Lulic R, Baudisch R, Keene M. Rate of non-adherence prior to upward dose titration in previously stable antidepressant users. J Affect Disord 2011; 130:46-52. [PMID: 20950862 DOI: 10.1016/j.jad.2010.09.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 09/03/2010] [Accepted: 09/18/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-adherence to antidepressant medications is a contributing factor to disease relapse and may result in needless increases in antidepressant dosing. METHODS We analyzed de-identified patient claims data from Medco Health Solutions, Inc.'s information database and measured adherence as the medication possession ratio (MPR), with adequate adherence as MPR ≥80%. Adherence was calculated for patients in whom antidepressants were dose escalated and who were on the same antidepressant medication for at least 180 days before the upward dosage titration. Statistical analysis was performed on subgroups comparing adherence with mail vs. retail channels, differences in age and gender, generic prescription vs. brand only, and prescription by psychiatrist vs. non-psychiatrist. RESULTS 29.7% of patients were non-adherent to their antidepressant medication during the 6 months prior to a prescribed increase in dosage. Non-adherence was significantly lower among patients using the Medco Therapeutic Resource Centers® mail order vs. retail channel. Younger age correlated with poorer adherence. Rates of non-adherence were also significantly greater among women, those receiving generic medications, and among patients with overall lower disease comorbidity. Adherence was not significantly impacted by prescription from a psychiatrist or a non-psychiatrist. LIMITATIONS Retrospective design and use of an administrative patient claims database. CONCLUSIONS Suboptimal medication adherence commonly precedes an upward dosage titration of antidepressant medications. Utilization of a mail order channel may improve adherence. Clinicians prescribing antidepressants should explore adherence issues carefully prior to recommending an increase in dosage.
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15
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Abstract
Despite the high percentage of incarcerated persons with mental illness, surprisingly little is known about effective ways to increase psychotropic medication adherence in prison and upon release. Currently, there are limited definitive data regarding psychotropic medication adherence patterns among incarcerated persons, and the data that exist often miss specific information on changes in behaviour, symptom management and adherence patterns over the length of a person's sentence, which has implications for post-release ability to live in the community. This paper presents the current literature regarding psychotropic medication adherence among mentally ill persons who are incarcerated. The factors identified in support of medication adherence, future clinical research and care strategies are provided.
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Affiliation(s)
- D Shelton
- Professor, School of Nursing, University of Connecticut, Storrs, CT 06269-2026, USA.
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16
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Lafortune D, Vacheret M. La prescription de médicaments psychotropes aux personnes incarcérées dans les prisons provinciales du Québec. ACTA ACUST UNITED AC 2010; 34:147-70. [DOI: 10.7202/039130ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dans cet article, les auteurs tentent de mieux cerner la pratique de la prescription de médicaments psychotropes auprès des personnes incarcérées dans les prisons provinciales du Québec. Bien que la prescription de ces médicaments s’avère le « traitement psychiatrique » le plus utilisée, rares sont les études qui portent sur sa prévalence. L’étude porte sur un échantillon de 671 personnes détenues, soit 500 hommes et 171 femmes. Globalement, 40,3 % des incarcérés ont reçu au moins une ordonnance de médicament psychotrope dans la période comprise entre 2002 et 2007. Les résultats démontrent que les femmes sont plus susceptibles d’avoir fait usage de médicaments que les hommes. Les personnes incarcérées ayant reçu au moins une prescription sont en moyenne plus âgés que les autres. Une majorité d’ordonnances a été émise par des omnipraticiens et les cas de polypharmacie sont nombreux. Sur une période de cinq ans, la classe de médicaments la plus prescrite est celle des anxiolytiques/hypnotiques, suivie des antidépresseurs et des antipsychotiques. Les auteurs concluent qu’il faudra analyser davantage les facteurs associés à la prescription de cette classe de médicaments auprès des personnes criminalisées.
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Baillargeon J, Borucki MJ, Zepeda S, Jenson HB, Leach CT. Antiretroviral prescribing patterns in the Texas prison system. Clin Infect Dis 2000; 31:1476-81. [PMID: 11096015 DOI: 10.1086/317478] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2000] [Revised: 04/21/2000] [Indexed: 11/04/2022] Open
Abstract
Although the prevalence of human immunodeficiency virus (HIV) infection among prison inmates is reported to be high, little is known about anti-HIV treatment patterns in correctional institutions. The present study assessed antiretroviral prescribing patterns for 2360 Texas Department of Criminal Justice (TDCJ) inmates infected with HIV. In 1998, 66.8% of all TDCJ inmates infected with HIV who had CD4 lymphocyte counts < 500 cells/mm(3) were treated with highly active antiretroviral therapy (HAART). However, no substantial differences in the use of HAART were exhibited according to the sociodemographic factors under study. While the majority of inmates receiving HAART in 1998 were prescribed a combination of 2 nucleoside reverse transcriptase inhibitors (NRTIs) and 1 protease inhibitor, 11.2% were prescribed a combination of 2 NRTIs and 1 non-NRTI. In view of the elevated rate of HIV infection in correctional settings, it will be important to continue to document the pharmacotherapy patterns among prison inmates, both during and following incarceration.
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Affiliation(s)
- J Baillargeon
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX 78284-7802, USA.
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