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Ehntholt A, Rodgers IT, Lekas HM, Lewis-Fernández R, Samaranayake D, Anderson A, Capobianco L, Cohen DE, Feeney S, Leckman-Westin E, Marinovic S, Pritam R, Chen S, Smith TE, Dixon LB, Saake A. Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services. Psychiatr Serv 2024; 75:444-450. [PMID: 37960865 DOI: 10.1176/appi.ps.20230025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges. METHODS A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use. RESULTS Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64). CONCLUSIONS In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.
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Affiliation(s)
- Amy Ehntholt
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Ian T Rodgers
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Helen-Maria Lekas
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Roberto Lewis-Fernández
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Dhanushki Samaranayake
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Adrienne Anderson
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Linda Capobianco
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Dana E Cohen
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Suzanne Feeney
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Sonia Marinovic
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Riti Pritam
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Shuo Chen
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Thomas E Smith
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Lisa B Dixon
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
| | - Amanda Saake
- New York State Office of Mental Health, Albany (Ehntholt, Rodgers, Samaranayake, Anderson, Cohen, Feeney, Leckman-Westin, Marinovic, Pritam, Chen, Smith, Dixon, Saake); New York State Psychiatric Institute, New York City (Rodgers, Lewis-Fernández, Anderson, Cohen); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Ehntholt, Lewis-Fernández, Smith, Dixon); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Lekas, Capobianco)
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2
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Amsalem D, Fisch CT, Wall M, Liu J, Lazarov A, Markowitz JC, LeBeau M, Hinds M, Thompson K, Smith TE, Lewis-Fernández R, Dixon LB, Neria Y. The role of income and emotional engagement in the efficacy of a brief help-seeking video intervention for essential workers. J Psychiatr Res 2024; 173:232-238. [PMID: 38554618 DOI: 10.1016/j.jpsychires.2024.03.027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/23/2023] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Recently we showed that a brief video-based intervention can improve openness to help-seeking and decrease treatment-related stigma among essential workers, particularly for female and Black individuals viewing demographically matched protagonists. The current randomized controlled trial explored two additional factors which may enhance the efficacy of this intervention: income level, known to be associated with help-seeking, and emotional engagement, which may enhance a person's ability to engage with the intervention. We hypothesized that income level and emotional engagement would correlate with changes in openness to help-seeking ("openness") and stigma. METHODS Essential workers (N = 1405) randomly viewed a control video or a brief video of an actor portraying an essential worker describing COVID-19-related anxiety and depression and treatment benefits. Openness and stigma were assessed at baseline, post-intervention, and 30-day follow-up, with emotional engagement assessed post-intervention. RESULTS The brief video intervention demonstrated immediate increases in openness (p < 0.001, Cohen's d = 0.39) and decreases in stigma (p < 0.001, d = 0.14) compared to the control. Reported income level affected neither dependent variable. Participants who scored higher on the emotional engagement scale reported greater change in openness and stigma. LIMITATIONS Use of a crowdsourcing platform may limit generalizability. CONCLUSIONS The 3-min video showed modest effect sizes for immediate increased openness and reduced stigma, with greater emotional engagement heightening the effect, suggesting a possible mediator to the intervention. Income level did not affect intervention outcomes. Research should explore the role of income by adding income-related content to the brief-video interventions and assessing whether links to referrals could foster immediate behavioral change. TRIAL REGISTRATION NCT04964570.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.
| | - Chana T Fisch
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Melanie Wall
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Jun Liu
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Mariah LeBeau
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Melissa Hinds
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA
| | - Kip Thompson
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Thomas E Smith
- Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA; New York State Office of Mental Health, USA
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, New York, NY, USA; Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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3
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Compton MT, Frimpong EY, Ehntholt A, Zhu H, Chaudhry S, Ferdousi W, Rowan GA, Radigan M, Smith TE, Rotter M. Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses. Community Ment Health J 2024; 60:251-258. [PMID: 37395820 DOI: 10.1007/s10597-023-01165-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | | | - Amy Ehntholt
- New York State Psychiatric Institute, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Huilin Zhu
- New York State Office of Mental Health, Albany, NY, USA
| | | | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, NY, USA
| | | | - Thomas E Smith
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Merrill Rotter
- New York State Office of Mental Health, Albany, NY, USA
- Albert Einstein College of Medicine, New York, NY, USA
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4
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Tepper MC, Leckman-Westin E, Sosiak R, Smith TE. Workforce Monitoring: Staffing Patterns in the Public Mental Health Workforce in New York State, 2009-2021. Psychiatr Serv 2024; 75:81-82. [PMID: 37960867 DOI: 10.1176/appi.ps.20230308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Miriam C Tepper
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Tepper, Smith); Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York (Leckman-Westin); New York State Office of Mental Health, Albany, New York (Leckman-Westin, Sosiak, Smith)
| | - Emily Leckman-Westin
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Tepper, Smith); Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York (Leckman-Westin); New York State Office of Mental Health, Albany, New York (Leckman-Westin, Sosiak, Smith)
| | - Roman Sosiak
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Tepper, Smith); Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York (Leckman-Westin); New York State Office of Mental Health, Albany, New York (Leckman-Westin, Sosiak, Smith)
| | - Thomas E Smith
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York City (Tepper, Smith); Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Rensselaer, New York (Leckman-Westin); New York State Office of Mental Health, Albany, New York (Leckman-Westin, Sosiak, Smith)
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5
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Smith TE, Ledneva T, Cohen DE, Ramsey KS, Bauer MJ, Carruthers J, Conroy MB, Dreslin SR, Friedrich M, Sun M, Gould MS, Schoenbaum M, Olfson M. Ethnoracial Disparities in Rates of Non-Natural Causes of Death After the 2020 COVID-19 Outbreak in New York State. AJPM Focus 2023; 2:100151. [PMID: 37965496 PMCID: PMC10641108 DOI: 10.1016/j.focus.2023.100151] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Introduction COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natural mortality across ethnoracial groups during the 2020 COVID-19 surge in New York State. Methods We report monthly trends in non-natural cause mortality (overall and stratified by ethnoracial status) in New York State from January 2019 through December 2020, which included the COVID-19 onset in March 2020. Results Total mean monthly unintentional overdose rates per 100,000 increased from 17.45 (before surge: January 2019-February 2020) to 23.19 (after surge: March 2020-December 2020) (mean difference=5.73, 95% CI=3.82, 7.65; p<0.001). Mean monthly homicide death rates increased from 2.34 before surge to 3.55 after surge (mean difference=1.20, 95% CI=0.60, 1.81; p<0.001), with the increase seen primarily in the non-Latinx Black population. Although increasing unintentional overdose death rates before surge equally affected non-Latinx White, Latinx, and non-Latinx Black persons, they remained high for non-Latinx Black persons but dropped for the other 2 groups after the pandemic onset. None of the ethnoracial subgroups showed significant increases in suicide or motor vehicle crash death rates. Conclusions Non-Latinx Black persons showed disproportionately high and sustained increased rates of unintentional overdose and homicide death rates after the 2020 COVID-19 surge in New York State. Fatality review and death scene investigation research is needed to better understand these disparities.
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Affiliation(s)
| | | | - Dana E. Cohen
- New York State Office of Mental Health, Albany, New York
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports, Albany, New York
| | | | - Jay Carruthers
- New York State Office of Mental Health, Albany, New York
| | | | | | | | - Mingzeng Sun
- New York State Department of Health, Albany, New York
| | | | | | - Mark Olfson
- New York State Psychiatric Institute, New York, New York
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6
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Bareis N, Tepper MC, Wang R, Tang F, Olfson M, Dixon LB, Kimhy D, Wall MM, Medalia A, Finnerty MT, Anderson A, Smith TE. Engagement of individuals with serious mental illness in outpatient mental health services and telehealth use during the COVID-19 pandemic. Psychiatry Res 2023; 329:115497. [PMID: 37778232 PMCID: PMC10842636 DOI: 10.1016/j.psychres.2023.115497] [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: 07/01/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Questions remain regarding whether the transition and continued use of telehealth was associated with changes in treatment engagement among patients with serious mental illness (SMI). Using NYS Medicaid claims, we identified 116,497 individuals with SMI receiving outpatient mental health services from September 1, 2019-February 28, 2021 and a comparison cohort of 101,995 from September 1, 2017-February 28, 2019 to account for unmeasured and seasonal variation. We characterized engagement in three 6-month increments (T0-T1-T2) using clinically meaningful measures of high, partial, low, and none. Subgroup differences were compared, and telehealth users were compared to those with only in-person visits. Engagement, as characterized, was largely maintained during COVID. The 19.0 % with only in-person visits during COVID had different characteristics than telehealth users. Telehealth use was greater among younger people by T2 (33.1 %), women (57.7 %), non-Hispanic White people (38.9 %), and those with MDD (18.0 %), but lower among non-Hispanic Black people, in NYC, and those with schizophrenia or SUD. Most telehealth users were highly engaged (77.1 %); most using only in-person services had low engagement (47.5 %). The shift to telehealth preserved access to many outpatient services for this SMI population. Exploring reasons for not using telehealth may identify opportunities to increase care access.
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Affiliation(s)
- Natalie Bareis
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA.
| | - Miriam C Tepper
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - Rui Wang
- New York State Office of Mental Health, New York, USA
| | - Fei Tang
- New York State Office of Mental Health, New York, USA
| | - Mark Olfson
- Mailman School of Public Health, Columbia University, New York, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Melanie M Wall
- Mailman School of Public Health, Columbia University, New York, USA
| | - Alice Medalia
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA
| | | | | | - Thomas E Smith
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, USA; New York State Office of Mental Health, New York, USA
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7
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Compton MT, Frimpong EY, Fu E, Ehntholt A, Chaudhry S, Ferdousi W, Rowan GA, Swetnam H, Radigan M, Smith TE, Rotter M. Associations Between Cumulative Social Adversities and Substance Use Comorbidity in a Statewide Sample of Individuals in Treatment for Mental Illnesses. J Nerv Ment Dis 2023; 211:814-818. [PMID: 37552046 DOI: 10.1097/nmd.0000000000001703] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
ABSTRACT We sought to investigate associations of cumulative social adversities in four areas (low education, unemployment, homelessness, and criminal/legal involvement) with presence of comorbid alcohol and drug use disorders among individuals in treatment for mental illnesses. Using data from 103,416 adults in mental health treatment, generalized estimating equation modified Poisson models were used to estimate increased risk of having comorbid substance use disorders based on individual and/or cumulative number of social adversities present. Controlling for effects of sex, race/ethnicity, and region (New York City vs . the rest of the State), as well as for the other social adversities, each of four social adversities was associated with presence of substance use comorbidity. Relative to having none of the social adversities, the presence of one, two, three, or four was associated with an increased prevalence ratio (PR) of having substance use comorbidity: 1.44, 2.10, 2.66, and 2.92; all p 's < 0.0001. PRs were greater among female patients, and among Hispanics and those classified as other or multiracial compared with non-Hispanic Whites or non-Hispanic Blacks. Findings indicate substantial associations between four social adversities and presence of substance use comorbidity; the strength of association with the four social adversities is cumulative.
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Affiliation(s)
| | | | - En Fu
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | | | - Sahil Chaudhry
- New York State Office of Mental Health, Albany, New York
| | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, New York
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany, New York
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Amsalem D, Fisch CT, Wall M, Choi CJ, Lazarov A, Markowitz JC, LeBeau M, Hinds M, Thompson K, Fisher PW, Smith TE, Hankerson SH, Lewis-Fernández R, Dixon LB, Neria Y. Anxiety and Depression Symptoms Among Young U.S. Essential Workers During the COVID-19 Pandemic. Psychiatr Serv 2023; 74:1010-1018. [PMID: 37042105 DOI: 10.1176/appi.ps.20220530] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
OBJECTIVE Emerging cross-sectional data indicate that essential workers in the COVID-19 era face increased mental health risks. This study longitudinally examined clinical symptoms of generalized anxiety disorder, depression, and posttraumatic stress disorder (PTSD) among U.S. essential workers, including health care workers and workers in indispensable occupations such as manufacturing, food industry, construction, transportation, hospitality, and emergency services, during the COVID-19 pandemic. The authors anticipated high symptom levels and greater symptom severity among women versus men and among younger adults compared with older adults. Analyses also explored the association between COVID-19 vaccination status and clinical symptoms. METHODS This four-wave online survey study assessed clinical symptoms in a convenience sample of 4,136 essential workers at baseline and 14, 30, and 90 days between August and December 2021. Symptoms of anxiety, depression, and PTSD were measured with the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Primary Care PTSD Screen instruments, respectively. RESULTS At every time point, 74%-78% of respondents reported symptoms of anxiety and depression, which were highest among younger adults (ages 18-22 years), females, and transgender respondents. Vaccinated participants had slightly higher symptom levels than unvaccinated respondents. Rates of clinical symptoms did not change significantly over time. CONCLUSIONS Essential workers consistently reported symptoms of generalized anxiety, depression, or PTSD, especially younger adult, female, and transgender participants. The overwhelming and unprecedented nature of the COVID-19 pandemic underscores the need to offer mental health care to essential workers, especially those in these subgroups. Employers and administrators should support and proactively encourage employees to access care when needed.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Chana T Fisch
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Melanie Wall
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - C Jean Choi
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Amit Lazarov
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Mariah LeBeau
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Melissa Hinds
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Kip Thompson
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Prudence W Fisher
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Thomas E Smith
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Sidney H Hankerson
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry (Amsalem, Fisch, Wall, Choi, Markowitz, LeBeau, Hinds, Thompson, Fisher, Lewis-Fernández, Dixon, Neria) and Vagelos College of Physicians and Surgeons (Amsalem, Wall, Markowitz, Thompson, Fisher, Smith, Lewis-Fernández, Dixon, Neria), Columbia University, New York City; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith); Department of Population Health Sciences and Policy and Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Hankerson)
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Frimpong EY, Ferdousi W, Rowan GA, Chaudhry S, Swetnam H, Compton MT, Smith TE, Radigan M. Racial and Ethnic Disparities in Health Care Access and Utilization among Medicaid Managed Care Beneficiaries. J Behav Health Serv Res 2023; 50:194-213. [PMID: 35945481 DOI: 10.1007/s11414-022-09811-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/27/2022]
Abstract
This quasi-experimental study examined the impact of a statewide integrated special needs program Health and Recovery Plan (HARP) for individuals with serious mental illness and identified racial and ethnic disparities in access to Medicaid services. Generalized estimating equation negative binomial models were used to estimate changes in service use, difference-in-differences, and difference-in-difference-in-differences in the pre- to post-HARP periods. Implementation of the special needs plan contributed to reductions in racial/ethnic disparities in access and utilization. Notable among those enrolled in the special needs plan was the declining Black-White disparities in emergency room (ER) visits and inpatient stays, but the disparity in non-behavioral health clinic visits remains. Also, the decline of Hispanic-White disparities in ER, inpatient, and clinic use was more evident for HARP-enrolled patients. Health equity policies are needed in the delivery of care to linguistically and culturally disadvantaged Medicaid beneficiaries.
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Affiliation(s)
| | | | - Grace A Rowan
- New York State Office of Mental Health, New York, NY, USA
| | - Sahil Chaudhry
- New York State Office of Mental Health, New York, NY, USA
| | - Hannah Swetnam
- New York State Office of Mental Health, New York, NY, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Thomas E Smith
- New York State Office of Mental Health, New York, NY, USA.,Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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10
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Amsalem D, Wall M, Lazarov A, Markowitz JC, Fisch CT, LeBeau M, Hinds M, Liu J, Fisher PW, Smith TE, Hankerson S, Lewis-Fernández R, Dixon LB, Neria Y. Brief Video Intervention to Increase Treatment-Seeking Intention Among U.S. Health Care Workers: A Randomized Controlled Trial. Psychiatr Serv 2023; 74:119-126. [PMID: 36097721 DOI: 10.1176/appi.ps.20220083] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many health care workers avoid seeking mental health care, despite COVID-19-related increases in risk of psychopathology. This study assessed the effects of two versions (distinguished by the race of the protagonist) of a brief social contact-based video on treatment-seeking intention and stigma toward mental health services among U.S. health care workers. METHODS Participants (N=1,402) were randomly assigned to view a 3-minute video in which a Black or White female nurse described struggles with COVID-19-related anxiety and depression, barriers to care, and how therapy helped, or to view a control video unrelated to mental health. Half of the participants receiving the intervention watched the same video (i.e., booster) again 14 days later. Treatment-seeking intention and treatment-related stigma were assessed at baseline, postintervention, and 14- and 30-day follow-ups. RESULTS Both intervention videos elicited an immediate increase in treatment-seeking intention in the intervention groups (p<0.001, effect size [ES]=21%), with similar effects among those who watched the booster video (p=0.016, ES=13%) and larger effects among those who had never sought treatment (p<0.001, ES=34%). The increased effects were not sustained 14 days after the initial video or at 30-day follow-up. The results showed an immediate reduction in stigma, but with no booster effect. The race of the protagonist did not influence outcomes. CONCLUSIONS This easily administered intervention could increase the likelihood of care seeking by proactively encouraging health care workers with mental health challenges to pursue treatment. Future studies should examine whether the inclusion of linkable referrals to mental health services helps to increase treatment-seeking behavior.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Melanie Wall
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Amit Lazarov
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - John C Markowitz
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Chana T Fisch
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Mariah LeBeau
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Melissa Hinds
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Jun Liu
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Prudence W Fisher
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Thomas E Smith
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Sidney Hankerson
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
| | - Yuval Neria
- New York State Psychiatric Institute, New York City (Amsalem, Wall, Markowitz, Fisch, LeBeau, Hinds, Liu, Fisher, Hankerson, Lewis-Fernández, Dixon, Neria); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Amsalem, Wall, Markowitz, Liu, Fisher, Smith, Hankerson, Lewis-Fernández, Dixon, Neria); School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel (Lazarov); New York State Office of Mental Health, Albany (Smith)
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Smith TE, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Wang R, Rodgers I, Dixon LB, Olfson M, Lewis-Fernández R. Community, Hospital, and Patient Factors Contributing to Ethnoracial Disparities in Follow-Up After Psychiatric Hospitalization. Psychiatr Serv 2023:appips20220110. [PMID: 36651116 DOI: 10.1176/appi.ps.20220110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study used an ecosocial perspective to examine ethnoracial disparities in timely outpatient follow-up care after psychiatric hospitalization in a cohort of Medicaid recipients. METHODS This retrospective analysis used 2012-2013 New York State Medicaid claims data for 17,488 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. Claims data were linked to other administrative data sets capturing key social conditions and determinants of mental health for non-Latinx White (White hereafter), non-Latinx Black (Black), Latinx, non-Latinx Asian/Pacific Islander (Asian/Pacific Islander), non-Latinx American Indian or Native Alaskan (American Indian or Native Alaskan), and other ethnoracial groups. Regression models were used to estimate the variations in disparities in timely follow-up care that were attributable to community, organization (i.e., hospital), and individual patient characteristics. RESULTS Overall, 60.1% of patients attended an outpatient mental health visit within 30 days of discharge. Compared with the rate for White patients, the attendance rates were 9.5 percentage points lower for Black patients and 7.8 percentage points higher for Asian/Pacific Islander patients. No significant difference in attendance rates was found between Latinx and White patients. Community factors, specifically urban versus rural classification and county poverty status, accounted for the greatest variation in timely follow-up care in all comparisons. CONCLUSIONS Efforts to increase connection to outpatient mental health follow-up care after psychiatric hospitalization should incorporate cultural and structural competencies to address social conditions and determinants of mental health that underly ethnoracial disparities.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Tom Corbeil
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Fei Tang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Susan M Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Eric Frimpong
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Franco Mascayano
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Marleen Radigan
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Rui Wang
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ian Rodgers
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson, Lewis-Fernández); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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Smith TE, Bury D, Hendrick D, Morse G, Drake RE. Barriers to Client Engagement and Strategies to Improve Participation in Mental Health and Supported Employment Services. Psychiatr Serv 2023; 74:38-43. [PMID: 36065584 DOI: 10.1176/appi.ps.202200023] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). METHODS Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. RESULTS Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. CONCLUSIONS Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Debra Bury
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Delia Hendrick
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Gary Morse
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Robert E Drake
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
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13
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Compton MT, Zern A, Pope LG, Gesser N, Stagoff-Belfort A, Tan de Bibiana J, Watson AC, Wood J, Smith TE. Misdemeanor Charges Among Individuals With Serious Mental Illnesses: A Statewide Analysis of More Than Two Million Arrests. Psychiatr Serv 2023; 74:31-37. [PMID: 35795979 DOI: 10.1176/appi.ps.202000936] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Reducing the overrepresentation of individuals with serious mental illnesses in the criminal legal system requires a better understanding of the charges for which they are most commonly arrested. This study aimed to compare violent offenses, penal code classifications, Uniform Crime Reporting (UCR) codes, and specific charges in arrests among individuals with and individuals without serious mental illnesses. METHODS The authors analyzed all arrests (N=2,224,847) in New York State during 2010-2013. Medicaid data and the state mental health authority's records were used to create an indicator of serious mental illness for each arrest. RESULTS Among arrests involving individuals with the serious mental illness indicator (N=91,363), 7.3% were for violent offenses, compared with 7.6% of arrests involving individuals without the indicator. Among 10 penal code classifications, class B felonies and class A misdemeanors were more likely in arrests among those with the indicator than among those without it. Of the 14 UCR codes examined, seven were more common in arrests with the serious mental illness indicator. Criminal trespass was among the most common charges in arrests involving individuals with the indicator. CONCLUSIONS Most arrests involving people with serious mental illnesses were for misdemeanors, specifically class A misdemeanors, and this class comprised a larger proportion of arrests for those with the indicator than of arrests for those without it. New approaches are needed to address the situations-usually related to socioeconomic disadvantage-that result in individuals with mental illnesses receiving misdemeanor charges and cycling through the criminal legal system.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Nili Gesser
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Aaron Stagoff-Belfort
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Jason Tan de Bibiana
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Amy C Watson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Jennifer Wood
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
| | - Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Compton, Zern, Pope, Smith); New York State Psychiatric Institute, New York City (Compton, Pope); Department of Psychology, University of North Dakota, Grand Forks (Gesser); Vera Institute of Justice, New York City (Stagoff-Belfort, Tan de Bibiana); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood); New York State Office of Mental Health, Albany (Smith)
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Motta EVS, Gage A, Smith TE, Blake KJ, Kwong WK, Riddington IM, Moran N. Host-microbiome metabolism of a plant toxin in bees. eLife 2022; 11:82595. [PMID: 36472498 PMCID: PMC9897726 DOI: 10.7554/elife.82595] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
While foraging for nectar and pollen, bees are exposed to a myriad of xenobiotics, including plant metabolites, which may exert a wide range of effects on their health. Although the bee genome encodes enzymes that help in the metabolism of xenobiotics, it has lower detoxification gene diversity than the genomes of other insects. Therefore, bees may rely on other components that shape their physiology, such as the microbiota, to degrade potentially toxic molecules. In this study, we show that amygdalin, a cyanogenic glycoside found in honey bee-pollinated almond trees, can be metabolized by both bees and members of the gut microbiota. In microbiota-deprived bees, amygdalin is degraded into prunasin, leading to prunasin accumulation in the midgut and hindgut. In microbiota-colonized bees, on the other hand, amygdalin is degraded even further, and prunasin does not accumulate in the gut, suggesting that the microbiota contribute to the full degradation of amygdalin into hydrogen cyanide. In vitro experiments demonstrated that amygdalin degradation by bee gut bacteria is strain-specific and not characteristic of a particular genus or species. We found strains of Bifidobacterium, Bombilactobacillus, and Gilliamella that can degrade amygdalin. The degradation mechanism appears to vary since only some strains produce prunasin as an intermediate. Finally, we investigated the basis of degradation in Bifidobacterium wkB204, a strain that fully degrades amygdalin. We found overexpression and secretion of several carbohydrate-degrading enzymes, including one in glycoside hydrolase family 3 (GH3). We expressed this GH3 in Escherichia coli and detected prunasin as a byproduct when cell lysates were cultured with amygdalin, supporting its contribution to amygdalin degradation. These findings demonstrate that both host and microbiota can act together to metabolize dietary plant metabolites.
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Affiliation(s)
- Erick VS Motta
- Department of Integrative Biology, The University of Texas at AustinAustinUnited States
| | - Alejandra Gage
- Department of Integrative Biology, The University of Texas at AustinAustinUnited States
| | - Thomas E Smith
- Department of Integrative Biology, The University of Texas at AustinAustinUnited States
| | - Kristin J Blake
- Mass Spectrometry Facility, Department of Chemistry, The University of Texas at AustinAustinUnited States
| | | | - Ian M Riddington
- Mass Spectrometry Facility, Department of Chemistry, The University of Texas at AustinAustinUnited States
| | - Nancy Moran
- Department of Integrative Biology, The University of Texas at AustinAustinUnited States
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Ehntholt A, Frimpong EY, Compton MT, Rowan GA, Ferdousi W, Swetnam H, Chaudhry S, Radigan M, Smith TE, Rotter M. Prevalence and Correlates of Four Social Determinants in a Statewide Survey of Licensed Mental Health Services. Psychiatr Serv 2022; 73:1282-1285. [PMID: 35538747 DOI: 10.1176/appi.ps.202100380] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This analysis examined the distribution of four social determinants of health among recipients of state-licensed mental health services and analyzed relationships between determinants and individuals' clinical and demographic characteristics. METHODS With data from the New York State Office of Mental Health 2017 Patient Characteristics Survey (N=103,416), prevalences of four social determinants (education, employment, housing, and criminal legal involvement) among mental health service recipients were described. Results were stratified to explore differences by diagnosis, gender, race and ethnicity, and region of residence. RESULTS High proportions had low education (20.9%), unemployment (79.1%), homelessness (8.2%), and criminal legal involvement (12.2%), surpassing statistics for the general state population. Prevalences of alcohol-related, drug-related, and psychotic disorders were higher among these groups than were prevalences of other diagnoses. People of color and male recipients were overrepresented among those with adverse social determinants. CONCLUSIONS Results highlight the magnitude of social adversity among those receiving mental health services, as well as potential inequities.
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Affiliation(s)
- Amy Ehntholt
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Eric Y Frimpong
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Michael T Compton
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Grace A Rowan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Wahida Ferdousi
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Hannah Swetnam
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Sahil Chaudhry
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Marleen Radigan
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Thomas E Smith
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
| | - Merrill Rotter
- New York State Office of Mental Health, Albany (Ehntholt, Frimpong, Rowan, Ferdousi, Swetnam, Chaudhry, Radigan, Smith, Rotter); New York State Psychiatric Institute, New York City (Ehntholt, Compton, Smith); Vagelos College of Physicians and Surgeons, Columbia University, New York City (Compton); Albert Einstein College of Medicine, New York City (Rotter)
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Amsalem D, Wall M, Lazarov A, Markowitz JC, Fisch CT, LeBeau M, Hinds M, Liu J, Fisher PW, Smith TE, Hankerson S, Lewis-Fernández R, Neria Y, Dixon LB. Destigmatising mental health treatment and increasing openness to seeking treatment: randomised controlled trial of brief video interventions. BJPsych Open 2022; 8:e169. [PMID: 36111611 PMCID: PMC9534926 DOI: 10.1192/bjo.2022.575] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity. AIMS We examined intervention efficacy on treatment-related stigma ('stigma') and openness to seeking treatment ('openness'), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness. METHOD Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570. RESULTS All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings. CONCLUSIONS Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.
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Affiliation(s)
- Doron Amsalem
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Melanie Wall
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - John C Markowitz
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Chana T Fisch
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Mariah LeBeau
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Melissa Hinds
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Jun Liu
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Prudence W Fisher
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Thomas E Smith
- Columbia University Vagelos College of Physicians & Surgeons, New York, and New York State Office of Mental Health, NY, USA
| | - Sidney Hankerson
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Yuval Neria
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa B Dixon
- Department of Psychiatry, New York State Psychiatric Institute, and Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
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Mascayano F, Bello I, Andrews H, Arancibia D, Arratia T, Burrone MS, Conover S, Fader K, Jorquera MJ, Gomez M, Malverde S, Martínez-Alés G, Ramírez J, Reginatto G, Restrepo-Henao A, Rosencheck RA, Schilling S, Smith TE, Soto-Brandt G, Tapia E, Tapia T, Velasco P, Wall MM, Yang LH, Cabassa LJ, Susser E, Dixon L, Alvarado R. OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial. Trials 2022; 23:751. [PMID: 36064643 PMCID: PMC9444092 DOI: 10.1186/s13063-022-06661-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION www. CLINICALTRIALS gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).
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Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Iruma Bello
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Howard Andrews
- New York State Psychiatric Institute, New York, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, United States
| | - Diego Arancibia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile.,Research and Postgraduate Institute, Faculty of Health Sciences, Universidad Central, Santiago, Chile
| | - Tamara Arratia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | - Sarah Conover
- Silberman School of Social Work, Hunter College, New York, USA
| | - Kim Fader
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Maria Jose Jorquera
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Mauricio Gomez
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Sergio Malverde
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Jorge Ramírez
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Gabriel Reginatto
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Alexandra Restrepo-Henao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Epidemiology Research Group, National School of Public Health, Universidad de Antioquia, Medellin, Colombia
| | - Robert A Rosencheck
- Research, Education and Clinical Center, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sara Schilling
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Thomas E Smith
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Gonzalo Soto-Brandt
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Eric Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Tamara Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | | | - Lawrence H Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,School of Global Public Health, New York University, New York, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,New York State Psychiatric Institute, New York, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile. .,Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
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18
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Rotter M, Compton M, Samaranayake D, Ehntholt A, Baldwin E, Schaeffer L, Feeney S, Smith TE. The Social Determinants of Mental Health: A Descriptive Study of State Mental Health Agencies' Priorities. Community Ment Health J 2022; 58:1121-1129. [PMID: 35059936 PMCID: PMC8776369 DOI: 10.1007/s10597-021-00921-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Social determinants are receiving renewed attention as research demonstrates the effects of social factors on individuals' physical and mental health and elucidates the biological and psychological mechanisms underlying those effects. Through spheres of influence from policy and regulation development to direct service provision, state mental health agencies are in a unique position to lead primary and secondary prevention efforts aimed at addressing social determinants with both client-level and structural-level interventions. A survey of social determinants-related activity was sent to the Medical Directors of the state offices of mental health in all 50 states. The survey results suggest consensus among respondents as to the importance of addressing specific social determinants. However, few state mental health agencies have taken on a comprehensive and intentional approach to addressing social determinants as a unique area of activity. Specific activities are reviewed, and implications for future work is discussed.
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Affiliation(s)
- Merrill Rotter
- Bronx Psychiatric Center, NYS Office of Mental Health, Albert Einstein College of Medicine, 1500 Waters Place, Bronx, NY, 10461, USA.
| | - Michael Compton
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | | | - Amy Ehntholt
- NYS Office of Mental Health, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Emily Baldwin
- NYS Office of Mental Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Lynne Schaeffer
- NYS Office of Mental Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Suzanne Feeney
- NYS Office of Mental Health, 44 Holland Avenue, Albany, NY, 12229, USA
| | - Thomas E Smith
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
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19
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Rodgers IT, Samaranayake D, Anderson A, Capobianco L, Cohen DE, Ehntholt A, Feeney S, Leckman-Westin E, Marinovic S, Smith TE, Dixon LB, Lekas HM, Lewis-Fernández R, Saake A. The Impacts of COVID-19 on a Statewide Population With Mental Illness. Psychiatr Serv 2022; 73:674-678. [PMID: 34587787 DOI: 10.1176/appi.ps.202100328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This survey examined the experiences of individuals receiving treatment in a large public mental health system during the early months of the COVID-19 pandemic. METHODS The survey, conducted between May and June 2020, assessed four domains: impacts on mental health, experiences with telehealth, access to care and resources, and sources and adequacy of support. Descriptive analyses were conducted. RESULTS Of 4,046 respondents, 70% reported increases in their anxiety and stress because of the pandemic. A majority (55%) reported experiencing challenges related to the social determinants of health and functional needs. Most respondents reported that their care went undisrupted, with 92% using telehealth and 90% reporting feeling adequately supported. CONCLUSIONS The pandemic substantially affected individuals with mental illness, particularly with regard to mental health related to the social determinants of health and functional needs. However, respondents felt that their mental health care was maintained and that they were adequately supported.
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Affiliation(s)
- Ian T Rodgers
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Dhanushki Samaranayake
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Adrienne Anderson
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Linda Capobianco
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Dana E Cohen
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Amy Ehntholt
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Suzanne Feeney
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Emily Leckman-Westin
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Sonia Marinovic
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Thomas E Smith
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Helen-Maria Lekas
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
| | - Amanda Saake
- New York State Psychiatric Institute, New York City (Rodgers, Anderson, Cohen, Ehntholt, Smith, Dixon, Lewis-Fernández); New York State Office of Mental Health, Albany (Samaranayake, Feeney, Leckman-Westin, Marinovic, Saake); Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Capobianco, Lekas). Benjamin G. Druss, M.D., M.P.H., served as decision editor during the peer review of this report
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20
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Nemani K, Williams SZ, Olfson M, Leckman-Westin E, Finnerty M, Kammer J, Smith TE, Silverman DJ, Lindenmayer JP, Capichioni G, Clelland J, Goff DC. Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State-wide Psychiatric Hospital System. JAMA Netw Open 2022; 5:e2210743. [PMID: 35522282 PMCID: PMC9077485 DOI: 10.1001/jamanetworkopen.2022.10743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population. OBJECTIVE To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020. EXPOSURES Psychotropic medications prescribed prior to COVID-19 testing. MAIN OUTCOMES AND MEASURES COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction or antibody test result. The secondary outcome was COVID-19-related death among patients with laboratory-confirmed infection. RESULTS Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12). CONCLUSIONS AND RELEVANCE In this cohort study of adults hospitalized with serious mental illness, the use of second-generation antipsychotic medications was associated with decreased risk of COVID-19 infection, whereas the use of valproic acid was associated with increased risk. Further research is needed to assess the mechanisms that underlie these findings.
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Affiliation(s)
- Katlyn Nemani
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
| | | | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | | | | | | | | | | | - Jean-Pierre Lindenmayer
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - Gillian Capichioni
- Department of Psychiatry, New York University Langone Medical Center, New York
| | - James Clelland
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Donald C. Goff
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Psychiatry, New York University Langone Medical Center, New York
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21
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Smith TE, Li Y, Perreau J, Moran NA. Elucidation of host and symbiont contributions to peptidoglycan metabolism based on comparative genomics of eight aphid subfamilies and their Buchnera. PLoS Genet 2022; 18:e1010195. [PMID: 35522718 PMCID: PMC9116674 DOI: 10.1371/journal.pgen.1010195] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 05/18/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
Pea aphids (Acyrthosiphon pisum) are insects containing genes of bacterial origin with putative functions in peptidoglycan (PGN) metabolism. Of these, rlpA1-5, amiD, and ldcA are highly expressed in bacteriocytes, specialized aphid cells that harbor the obligate bacterial symbiont Buchnera aphidicola, required for amino acid supplementation of the host's nutrient-poor diet. Despite genome reduction associated with endosymbiosis, pea aphid Buchnera retains genes for the synthesis of PGN while Buchnera of many other aphid species partially or completely lack these genes. To explore the evolution of aphid horizontally-transferred genes (HTGs) and to elucidate how host and symbiont genes contribute to PGN production, we sequenced genomes from four deeply branching lineages, such that paired aphid and Buchnera genomes are now available for 17 species representing eight subfamilies. We identified all host and symbiont genes putatively involved in PGN metabolism. Phylogenetic analyses indicate that each HTG family was present in the aphid shared ancestor, but that each underwent a unique pattern of gene loss or duplication in descendant lineages. While four aphid rlpA gene subfamilies show no relation to symbiont PGN gene repertoire, the loss of aphid amiD and ldcA HTGs coincides with the loss of symbiont PGN metabolism genes. In particular, the coincident loss of host amiD and symbiont murCEF in tribe Aphidini, in contrast to tribe Macrosiphini, suggests either 1) functional linkage between these host and symbiont genes, or 2) Aphidini has lost functional PGN synthesis and other retained PGN pathway genes are non-functional. To test these hypotheses experimentally, we used cell-wall labeling methods involving a d-alanine probe and found that both Macrosiphini and Aphidini retain Buchnera PGN synthesis. Our results imply that compensatory adaptations can preserve PGN synthesis despite the loss of some genes considered essential for this pathway, highlighting the importance of the cell wall in these symbioses.
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Affiliation(s)
- Thomas E. Smith
- Department of Integrative Biology, University of Texas at Austin, Austin, Texas, United States of America
| | - Yiyuan Li
- Department of Integrative Biology, University of Texas at Austin, Austin, Texas, United States of America
| | - Julie Perreau
- Department of Integrative Biology, University of Texas at Austin, Austin, Texas, United States of America
| | - Nancy A. Moran
- Department of Integrative Biology, University of Texas at Austin, Austin, Texas, United States of America
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22
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Abstract
Numerous reports describe how individual hospitals responded to the COVID-19 pandemic, but few describe how these changes occurred across a large public health system of care. As the early epicenter of the pandemic, New York State's response, particularly the New York City metropolitan area, included a range of coordinated planning and regulatory efforts to preserve and create medical and intensive care unit capacity where needed; maintain access to acute psychiatric services; and redefine inpatient psychiatric care through strict infection control, easing of regulatory requirements, and use of telehealth. These strategies reflected similar efforts across the United States.
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Affiliation(s)
- Joshua Berezin
- New York State Office of Mental Health, 330 Fifth Avenue – 9th Floor, New York, NY 10001, USA
| | | | - Matthew D. Erlich
- New York State Office of Mental Health, 330 Fifth Avenue – 9th Floor, New York, NY 10001, USA
| | | | - Thomas E. Smith
- New York State Office of Mental Health,Corresponding author. 1051 Riverside Drive, Unit 100, New York, NY 10032
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23
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Rodgers I, Dixon LB, Olfson M. The Effectiveness of Discharge Planning for Psychiatric Inpatients With Varying Levels of Preadmission Engagement in Care. Psychiatr Serv 2022; 73:149-157. [PMID: 34157859 PMCID: PMC8695636 DOI: 10.1176/appi.ps.202000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined the extent to which prehospital treatment engagement is related to posthospital follow-up treatment among psychiatric inpatients and whether the effects of inpatient discharge planning on posthospital follow-up treatment vary by level of pretreatment engagement in care. METHODS New York State Medicaid and other administrative databases were used to examine service use by 18,793 adult patients discharged to the community after inpatient psychiatric care in 2012-2013. Outcomes included attending an outpatient mental health service within 7 days and within 30 days after discharge. The sample was stratified by whether patients had high, partial, low, or no engagement in outpatient psychiatric services in the 6 months before admission. RESULTS Scheduling an outpatient appointment as part of the patient's discharge plan was significantly associated with attending outpatient psychiatric appointments, regardless of the patient's level of engagement in care before admission. The differences were most pronounced for patients who had not received any outpatient care in the 6 months before admission. When an appointment was scheduled, these patients were three times more likely to follow up with care within 7 days and more than twice as likely to follow up within 30 days than were patients without a scheduled appointment. CONCLUSIONS The likelihood of psychiatric inpatients following up with outpatient psychiatric care was directly related to their level of outpatient care engagement before hospital admission. Even among those who had not been engaged in outpatient care, inpatient discharge planning was associated with a greater likelihood of receiving follow-up outpatient care.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Ian Rodgers
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Mascayano, Rodgers, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Radigan, Wang); Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider)
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Smith TE, Pangilinan M, Rodgers I, Li X, Claverie G, Katagiri J. Mental health service utilization review patterns in a Medicaid managed care program. Am J Manag Care 2022; 28:81-84. [PMID: 35139293 DOI: 10.37765/ajmc.2022.88824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program. STUDY DESIGN Retrospective analysis of utilization review data reported by MMCOs in New York State. METHODS Data from the utilization review practices of 15 MMCOs were collected and analyzed for calendar years 2017 and 2018. The data reported are specific to mental health services and include the number of authorization requests, number of clinical denials, and the reasons specified for each denial. Analyses were undertaken to determine the UR denial rates and most common reasons for denials. RESULTS A total of 264,901 requests for inpatient mental health service authorizations and 53,687 requests for outpatient mental health service authorizations were made in 2017 and 2018. Of these, 1.5% of inpatient authorization requests and 0.4% of outpatient authorization requests were denied for reasons related to medical necessity. The most common reason for inpatient mental health service denials was that the patient no longer met the standard for the requested level of care. CONCLUSIONS Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.
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Affiliation(s)
| | | | - Ian Rodgers
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032.
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Erlich MD, Casoy F, Berezin J, Hernandez Y, Smith TE. Building and Landing the Plane While Flying: How New York State Addressed the Needs of People With Serious Mental Illness During the COVID-19 Pandemic. Schizophrenia Bulletin Open 2022; 3:sgac035. [PMID: 36348646 PMCID: PMC9620771 DOI: 10.1093/schizbullopen/sgac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
New York State was the epicenter for COVID-19 in Spring 2020 when little was known about the pandemic. Dire circumstances necessitated New York State’s (NYS) public mental health system to rapidly pivot, adapt, and innovate its policies and procedures to ensure continuous high-level care to individuals with serious mental illness (SMI), a population especially vulnerable to both the physical and psychosocial sequelae of COVID-19. NYS rapidly adopted emergency measures to support community providers, expanded the capacity of its State-Operated facilities, created policies to promote improved infection control access, collaborated to enhance the public–private continuum of service to support people with SMI, and broadened the use of new technologies to ensure continued engagement of care.
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Affiliation(s)
| | - Flavio Casoy
- New York State Office of Mental Health , New York, NY , USA
| | - Joshua Berezin
- New York State Office of Mental Health , New York, NY , USA
| | | | - Thomas E Smith
- New York State Office of Mental Health , New York, NY , USA
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26
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Amsalem D, Lazarov A, Markowitz JC, Smith TE, Dixon LB, Neria Y. Video intervention to increase treatment-seeking by healthcare workers during the COVID-19 pandemic: randomised controlled trial. Br J Psychiatry 2022; 220:14-20. [PMID: 35045900 DOI: 10.1192/bjp.2021.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many healthcare workers do not seek help, despite their enormous stress and greater risk for anxiety, depression and post-traumatic stress disorder (PTSD). AIMS This study screened for psychopathology and evaluated the efficacy of a brief, social contact-based video intervention in increasing treatment-seeking intentions among healthcare workers (trial registration: NCT04497415). We anticipated finding high rates of psychopathology and greater treatment-seeking intentions post-intervention. METHOD Healthcare workers (n = 350) were randomised to (a) a brief video-based intervention at day 1, coupled with a booster video at day 14; (b) the video at day 1 only; or (c) a non-intervention control. In the 3 min video, a female nurse described difficulty coping with stress, her anxieties and depression, barriers to care and how therapy helped her. Assessments were conducted pre- and post-intervention and at 14- and 30-day follow-ups. RESULTS Of the 350 healthcare workers, 281 (80%) reported probable anxiety, depression and/or PTSD. Participants were principally nurses (n = 237; 68%), physicians (n = 52; 15%) and emergency medical technicians (n = 30; 9%). The brief video-based intervention yielded greater increases in treatment-seeking intentions than the control condition, particularly among participants in the repeat-video group. Exploratory analysis revealed that in both video groups, we found greater effect among nurses than non-nurses. CONCLUSIONS A brief video-based intervention increased treatment-seeking intention, possibly through identification and emotional engagement with the video protagonist. A booster video magnified that effect. This easily disseminated intervention could increase the likelihood of seeking care and offer employers a proactive approach to encourage employees to search for help if needed.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - John C Markowitz
- New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Thomas E Smith
- New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York; and New York State Office of Mental Health, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Yuval Neria
- New York State Psychiatric Institute; and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York; and Department of Epidemiology, Columbia University Irving Medical Center, New York, USA
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Amsalem D, Lazarov A, Markowitz JC, Naiman A, Smith TE, Dixon LB, Neria Y. Psychiatric symptoms and moral injury among US healthcare workers in the COVID-19 era. BMC Psychiatry 2021; 21:546. [PMID: 34740357 PMCID: PMC8571005 DOI: 10.1186/s12888-021-03565-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Emerging cross-sectional data indicate that healthcare workers (HCWs) in the COVID-19 era face particular mental health risks. Moral injury - a betrayal of one's values and beliefs, is a potential concern for HCWs who witness the devastating impact of acute COVID-19 illness while too often feeling helpless to respond. This study longitudinally examined rates of depression, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and moral injury among United States HCWs in the COVID-19 era. We anticipated finding high levels of clinical symptoms and moral injury that would remain stable over time. We also expected to find positive correlations between clinical symptoms and moral injury. METHODS This three-wave study assessed clinical symptoms and moral injury among 350 HCWs at baseline, 30, and 90 days between September and December 2020. Anxiety, depression, PTSD, and moral injury were measured using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Primary Care PTSD Screen (PC-PTSD), and Moral Injury Events Scale (MIES). RESULTS Of the 350 HCWs, 72% reported probable anxiety, depression, and/or PTSD disorders at baseline, 62% at day 30, and 64% at day 90. High level of moral injury was associated with a range of psychopathology including suicidal ideation, especially among healthcare workers self-reporting COVID-19 exposure. CONCLUSIONS Findings demonstrate broad, persisting, and diverse mental health consequences of the COVID-19 pandemic among United States HCWs. This study is the first to longitudinally examine the relationships between moral injury and psychopathology among HCWs, emphasizing the need to increase HCWs' access to mental healthcare.
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Affiliation(s)
- Doron Amsalem
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - John C Markowitz
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Aliza Naiman
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Thomas E Smith
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
- New York State Office of Mental Health, New York City, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Yuval Neria
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, USA
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Smith TE, Rodgers IT, Silverman DJ, Dreslin SR, Olfson M, Dixon LB, Wall MM. COVID-19 Case Rates After Surveillance and Vaccinations in a Statewide Psychiatric Hospital System. Am J Public Health 2021; 111:1780-1783. [PMID: 34529451 PMCID: PMC8561174 DOI: 10.2105/ajph.2021.306444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/04/2022]
Abstract
Individuals with serious mental illness are particularly vulnerable to COVID-19. The New York State (NYS) Office of Mental Health implemented patient and staff rapid testing, quarantining, and vaccination to limit COVID-19 spread in 23 state-operated psychiatric hospitals between November 2020 and February 2021. COVID-19 infection rates in inpatients and staff decreased by 96% and 71%, respectively, and the NYS population case rate decreased by 6%. Repeated COVID-19 testing and vaccination should be priority interventions for state-operated psychiatric hospitals. (Am J Public Health. 2021;111(10):1780-1783. https://doi.org/10.2105/AJPH.2021.306444).
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Affiliation(s)
- Thomas E Smith
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Ian T Rodgers
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Daniel J Silverman
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Sally R Dreslin
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Mark Olfson
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Lisa B Dixon
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
| | - Melanie M Wall
- Thomas E. Smith, Ian T. Rodgers, Mark Olfson, Lisa B. Dixon, and Melanie M. Wall are with the New York State Psychiatric Institute, New York, NY. Daniel J. Silverman and Sally R. Dreslin are with the New York State Office of Mental Health, Albany, NY
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29
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Zern A, Seserman M, Dacus H, Wallace B, Friedlander S, Manseau MW, Smalling MM, Smith TE, Williams JM, Compton MT. Screening and Treatment of Tobacco Use Disorder in Mental Health Clinics in New York State: Current Status and Potential Next Steps. Community Ment Health J 2021; 57:1023-1031. [PMID: 33083939 DOI: 10.1007/s10597-020-00726-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.
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Affiliation(s)
- Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Heather Dacus
- New York State Department of Health, Albany, NY, USA
| | | | | | | | | | - Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,New York State Office of Mental Health, Albany, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,New York State Psychiatric Institute, New York, NY, USA.
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Smith TE, Marino LA, Olfson M. Unmet Opportunity: Intensive Care Transition Intervention for Individuals With Serious Medical-Psychiatric Illnesses. Psychiatr Serv 2021; 72:856-858. [PMID: 33887955 PMCID: PMC8249312 DOI: 10.1176/appi.ps.202000286] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Individuals with serious mental illnesses and poorly managed medical conditions known as serious medical-psychiatric illnesses (SMPIs) are vulnerable to disruptions in care, resulting in poor outcomes. Intensive integrated care management approaches are indicated when these individuals are hospitalized on medical-surgical inpatient units in order to ensure continuity of medical and psychiatric services. This column describes a manualized intervention for hospitalized individuals with SMPIs that was developed in a National Institute of Mental Health ALACRITY research center. The approach uses a critical time intervention model incorporating motivational interviewing and shared decision making to maximize engagement and continuity of care for individuals with SMPIs.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Leslie A Marino
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
| | - Mark Olfson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City. Benjamin G. Druss, M.D., M.P.H., and Gail Daumit, M.D., M.H.S., are editors of this column
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Abstract
The COVID-19 pandemic has disrupted public mental health systems across the country, nowhere more than in New York State (NYS). The authors describe the NYS public health agency's response to the pandemic and offer ideas for redesigning public mental health systems post-COVID-19.
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Affiliation(s)
- Thomas E Smith
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Ann-Marie T Sullivan
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
| | - Benjamin G Druss
- New York State Office of Mental Health, Albany, New York (Smith, Sullivan); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Smith); Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City (Sullivan); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss). Marvin S. Swartz, M.D., and Steven Starks, M.D., are editors of this column
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Factors Associated With Discharge Planning Practices for Patients Receiving Inpatient Psychiatric Care. Psychiatr Serv 2021; 72:498-506. [PMID: 33657838 PMCID: PMC8102313 DOI: 10.1176/appi.ps.202000021] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined associations of patient, hospital, and service system factors with provision of discharge planning to individuals treated in hospital psychiatric units. METHODS This retrospective cohort analysis used 2012-2013 New York State Medicaid claims data of 18,185 patients ages <65 years who were treated in hospital psychiatric units and discharged to the community. The claims data were linked to data from managed behavioral health care organizations indicating whether inpatient staff scheduled a follow-up outpatient appointment with a mental health provider. Additional data regarding hospital and service system characteristics were obtained from the American Hospital Association Annual Survey, the Area Health Resource File, and other state administrative databases. Rates and adjusted odds ratios were assessed for the likelihood of inpatient staff scheduling a follow-up appointment. RESULTS Inpatient staff scheduled outpatient appointments for 79.8% of discharges. The adjusted odds of not having an outpatient appointment scheduled as part of the patient's discharge plan were significantly associated with several factors, including being homeless on admission, having a diagnosis of a co-occurring substance use disorder, having high levels of medical comorbid conditions, and not being engaged in psychiatric outpatient services in the month prior to admission. CONCLUSIONS Patient characteristics were more strongly associated with failure to receive discharge planning than were hospital and service system characteristics.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Morgan Haselden
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Tom Corbeil
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie M Wall
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Fei Tang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Susan M Essock
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Eric Frimpong
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew L Goldman
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Marleen Radigan
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Matthew Schneider
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Rui Wang
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Mark Olfson
- New York State Psychiatric Institute, New York City (Smith, Haselden, Corbeil, Wall, Essock, Mascayano, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith, Haselden, Wall, Essock, Dixon, Olfson); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Frimpong, Goldman, Wang); Department of Psychiatry, University of California-San Francisco, San Francisco (Radigan); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Schneider). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Bao Y, Li Y, Jeng PJ, Scodes J, Papp MA, Humensky JL, Wall M, Lee R, Ancker JS, Pincus HA, Smith TE, Dixon LB. Design of a Payment Decision-Support Tool for Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2021; 72:180-185. [PMID: 33267653 PMCID: PMC8317229 DOI: 10.1176/appi.ps.202000129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A strengthened evidence base and earmarked federal funding have spurred the implementation of coordinated specialty care (CSC) for people experiencing early psychosis. However, existing funding mechanisms are insufficient and unsustainable to support population-wide deployment of CSC. This article describes the design framework of an innovative payment model for CSC that includes a bundled case rate payment and an optional outcome-based payment. To assist CSC payer and provider organizations in designing payment systems tailored to local preferences and circumstances, the research team is developing a decision-support tool that allows users to define design choices and provide input. The authors document the analytical algorithms underlying the tool and discuss how it could be further developed or expanded for CSC and other behavioral health interventions that feature an interdisciplinary team of clinicians and nonclinical professionals, public education and outreach, patient centeredness, and a recovery orientation.
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Affiliation(s)
- Yuhua Bao
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Yan Li
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Philip J Jeng
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer Scodes
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Michelle A Papp
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jennifer L Humensky
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Melanie Wall
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Rufina Lee
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Jessica S Ancker
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Harold Alan Pincus
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Thomas E Smith
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
| | - Lisa B Dixon
- Department of Population Health Sciences (Bao, Jeng, Papp, Ancker) and Department of Psychiatry (Bao), Weill Cornell Medicine, New York City; Department of Population Health Science and Policy and Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York City (Li); New York State Psychiatric Institute, New York City (Scodes, Humensky, Wall, Pincus, Smith, Dixon); Department of Psychiatry, Irving Medical Center (Scodes, Humensky, Wall, Pincus, Smith, Dixon), and Department of Biostatistics, Mailman School of Public Health (Wall), Columbia University, New York City; Silberman School of Social Work at Hunter College, City University of New York, New York City (Lee)
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Algotar AM, Kumar R, Babiker HM, Dougherty ST, Hsu CH, Chow HH, Smith TE, Marrero DG, Courneya KS, Abraham I, Ligibel JA, Thomson CA. Protocol for a feasibility and early efficacy study of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2). Contemp Clin Trials Commun 2021; 21:100701. [PMID: 33511299 PMCID: PMC7815988 DOI: 10.1016/j.conctc.2021.100701] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/18/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although androgen deprivation therapy (ADT) for prostate cancer demonstrates improved overall and disease-free survival, it is associated with adverse effects such as obesity and metabolic syndrome that increase risk of cardiometabolic disease and diabetes type 2. ADT also leads to fatigue, depression and erectile dysfunction, which reduce quality of life (QoL). Lifestyle modification has shown promise in reducing obesity, metabolic syndrome and diabetes type 2 in other disease types. However, there is a paucity of data regarding the utility of lifestyle modification in men receiving ADT for prostate cancer. Methods The primary aim of the Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2) is to test the feasibility of conducting a 24-week lifestyle modification intervention in men on ADT for prostate cancer. Additionally, it will also determine the effect of this intervention on weight loss, cardiometabolic markers (secondary aim and markers of interest: serum glucose, insulin resistance, hemoglobin A1C and lipid panel), and QoL (tertiary aim). The intervention will be delivered weekly via telephone for the first 10 weeks and bi-weekly for the remaining 14 weeks. Questionnaires and serum samples will be collected at baseline, week 12, and week 24. Anthropometric measurements will be collected at baseline, week 6, week 12, week 18 and week 24. Results We hypothesize that the CLIPP2 intervention will produce a 7% weight loss that will result in improved markers associated with cardiometabolic disease and type 2 diabetes in the study population. Conclusion Results will provide insight into the role of lifestyle modification in addressing ADT adverse effects as well as provide preliminary data to inform the development of future lifestyle interventions in this area. Trial registration NCT04228055 Clinicaltrials. gov.
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Affiliation(s)
- A M Algotar
- Department of Family and Community Medicine, University of Arizona, USA.,The University of Arizona Cancer Center, USA
| | - R Kumar
- Radiation Oncology, Banner MD Anderson Cancer Center, USA
| | - H M Babiker
- The University of Arizona Cancer Center, USA.,Department of Hematology-Oncology, University of Arizona, USA
| | - S T Dougherty
- The University of Arizona Cancer Center, USA.,Department of Radiation Oncology, University of Arizona, USA
| | - C H Hsu
- The University of Arizona Cancer Center, USA.,Department of Epidemiology and Biostatistics, Mel and Enid College of Public Health, University of Arizona, USA
| | - H-H Chow
- The University of Arizona Cancer Center, USA
| | - T E Smith
- Department of Family and Community Medicine, University of Arizona, USA
| | - D G Marrero
- Department of Health Promotion Science, Mel and Enid College of Public Health, University of Arizona, USA
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Canada
| | - I Abraham
- Department of Family and Community Medicine, University of Arizona, USA.,College of Pharmacy, University of Arizona, USA
| | - J A Ligibel
- Dana Farber Cancer Institute, Harvard Medical School, USA
| | - C A Thomson
- The University of Arizona Cancer Center, USA.,Department of Health Promotion Science, Mel and Enid College of Public Health, University of Arizona, USA
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Mascayano F, van der Ven E, Martinez-Ales G, Henao AR, Zambrano J, Jones N, Cabassa LJ, Smith TE, Yang LH, Susser E, Dixon LB. Disengagement From Early Intervention Services for Psychosis: A Systematic Review. Psychiatr Serv 2021; 72:49-60. [PMID: 33234052 DOI: 10.1176/appi.ps.201900375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Therapeutic benefits associated with early services for psychosis are influenced by the degree to which participants engage in treatment. The main objective of this review was to analyze rates of disengagement in early psychosis services and identify predictors of disengagement in these settings. METHODS A systematic search for studies published in the 1966-2019 period was conducted in PubMed, Google Scholar, EBSCO, Ovid, and Embase. The Observational Cohort and Cross-Sectional Studies scale was used to assess the methodological quality of reports identified in this search. A revised version of the behavioral model of health service use was employed to evaluate and understand predictors of disengagement (categorized as predisposing, enabling, and need factors) identified in the studies with the highest quality. RESULTS Twenty studies met the inclusion criteria. Disengagement rates (12% to 53%) and definitions of disengagement varied widely across these studies. Most did not find a compelling association between predisposing factors (e.g., age) and disengagement. Enabling factors, such as lack of family support and living alone, were consistently found to be related to increased disengagement across studies. Finally, need factors, such as lower medication adherence and higher drug misuse, were associated with higher risk for disengagement. CONCLUSIONS Enabling and need factors seemed to be the most predictive of disengagement from early psychosis services. Substantial between-study variation in identified predictors of disengagement may be addressed by developing and applying a consensus definition of disengagement in future research.
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Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Els van der Ven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Gonzalo Martinez-Ales
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Alexandra Restrepo Henao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Juliana Zambrano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Nev Jones
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Leopoldo J Cabassa
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Thomas E Smith
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Lawrence H Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
| | - Lisa B Dixon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano, van der Ven, Martinez-Ales, Restrepo Henao, Zambrano, Yang, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Mascayano, Smith, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Epidemiology Group, National School of Public Health, Universidad of Antioquia, Medellín, Colombia (Restrepo Henao); Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa (Jones); George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Cabassa); Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York City (Yang)
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Mascayano F, van der Ven E, Martinez-Ales G, Basaraba C, Jones N, Lee R, Bello I, Nossel I, Smith S, Smith TE, Wall M, Susser E, Dixon LB. Predictors of Early Discharge From Early Intervention Services for Psychosis in New York State. Psychiatr Serv 2020; 71:1151-1157. [PMID: 32933413 PMCID: PMC8237377 DOI: 10.1176/appi.ps.202000025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 11/30/2022]
Abstract
OBJECTIVE Although specialized early intervention services (EISs) for psychosis promote engagement in care, a substantial number of individuals who receive these services are discharged from care earlier than expected. The main goal of this study was to examine predictors of early discharge in a large sample of individuals enrolled in an EIS program in the United States. METHODS This cohort study (N=1,349) used programmatic data from OnTrackNY, an EIS program that delivers evidence-based interventions to youths across New York State experiencing a first episode of nonaffective psychosis. The main outcome was "early discharge," which was operationalized as discharge prior to completing 12 months of treatment. Cox proportional hazard regression models were used to assess the association between sociodemographic, clinical, and support system predictors and early discharge. RESULTS The estimated probability of discharge before 1 year was 32%. Participants who at baseline had poor medication adherence, had no health insurance, were living alone or with nonparental family, or were using cannabis were at higher risk of leaving services within the first 12 months after enrollment. Individuals with higher social functioning were at lower risk of being discharged early from OnTrackNY, but those with higher occupational functioning were at a higher risk. CONCLUSIONS Predictors of early discharge from EISs largely overlapped with previously identified predictors of poor prognosis in early psychosis. However, the association between early discharge and high occupational functioning indicates that trajectories leading up to discharge are heterogeneous.
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Affiliation(s)
- Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Els van der Ven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Gonzalo Martinez-Ales
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Cale Basaraba
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Nev Jones
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Rufina Lee
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Iruma Bello
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Ilana Nossel
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Stephen Smith
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Thomas E Smith
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie Wall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (Mascayano, van der Ven, Martinez-Ales, Susser); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York (Mascayano, Basaraba, Bello, Nossel, S. Smith, T. Smith, Wall, Susser, Dixon); School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands (van der Ven); Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa (Jones); Silberman School of Social Work, Hunter College, City University of New York, New York (Lee). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Smith TE, Haselden M, Corbeil T, Wall MM, Tang F, Essock SM, Frimpong E, Goldman ML, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M. Effect of Scheduling a Post-Discharge Outpatient Mental Health Appointment on the Likelihood of Successful Transition From Hospital to Community-Based Care. J Clin Psychiatry 2020; 81:20m13344. [PMID: 32936543 PMCID: PMC10476606 DOI: 10.4088/jcp.20m13344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. METHODS 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. RESULTS Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. CONCLUSIONS Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032.
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Morgan Haselden
- New York State Psychiatric Institute, New York, New York, USA
| | - Tom Corbeil
- New York State Psychiatric Institute, New York, New York, USA
| | - Melanie M Wall
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Susan M Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Matthew L Goldman
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York, USA
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany, New York, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mark Olfson
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York
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Abstract
Genome structural variations, including duplications, deletions, insertions, and inversions, are central in the evolution of eukaryotic genomes. However, structural variations present challenges for high-quality genome assembly, hampering efforts to understand the evolution of gene families and genome architecture. An example is the genome of the pea aphid (Acyrthosiphon pisum) for which the current assembly is composed of thousands of short scaffolds, many of which are known to be misassembled. Here, we present an improved version of the A. pisum genome based on the use of two long-range proximity ligation methods. The new assembly contains four long scaffolds (40-170 Mb), corresponding to the three autosomes and the X chromosome of A. pisum, and encompassing 86% of the new assembly. Assembly accuracy is supported by several quality assessments. Using this assembly, we identify the chromosomal locations and relative ages of duplication events, and the locations of horizontally acquired genes. The improved assembly illuminates the mode of gene family evolution by providing proximity information between paralogs. By estimating nucleotide polymorphism and coverage depth from resequencing data, we determined that many short scaffolds not assembling to chromosomes represent hemizygous regions, which are especially frequent on the highly repetitive X chromosome. Aligning the X-linked aphicarus region, responsible for male wing dimorphism, to the new assembly revealed a 50-kb deletion that cosegregates with the winged male phenotype in some clones. These results show that long-range scaffolding methods can substantially improve assemblies of repetitive genomes and facilitate study of gene family evolution and structural variation.
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Affiliation(s)
- Yiyuan Li
- Department of Integrative Biology, University of Texas at Austin, Austin, TX
| | - Hyunjin Park
- Department of Integrative Biology, University of Texas at Austin, Austin, TX
| | - Thomas E Smith
- Department of Integrative Biology, University of Texas at Austin, Austin, TX
| | - Nancy A Moran
- Department of Integrative Biology, University of Texas at Austin, Austin, TX
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Goldman ML, Mangurian C, Corbeil T, Wall MM, Tang F, Haselden M, Essock SM, Frimpong E, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M, Smith TE. Medical comorbid diagnoses among adult psychiatric inpatients. Gen Hosp Psychiatry 2020; 66:16-23. [PMID: 32593912 PMCID: PMC8684817 DOI: 10.1016/j.genhosppsych.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
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Affiliation(s)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital
| | | | - Melanie M. Wall
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Morgan Haselden
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Lisa B. Dixon
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Mark Olfson
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. Smith
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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Smith TE, Haselden M, Corbeil T, Tang F, Radigan M, Essock SM, Wall MM, Dixon LB, Wang R, Frimpong E, Lamberti S, Schneider M, Olfson M. Relationship Between Continuity of Care and Discharge Planning After Hospital Psychiatric Admission. Psychiatr Serv 2020; 71:75-78. [PMID: 31590622 PMCID: PMC7008713 DOI: 10.1176/appi.ps.201900233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether communication between inpatient and outpatient mental health providers during patients' inpatient stays was associated with whether patients attended postdischarge appointments. METHODS Psychiatric inpatient medical records of 189 Medicaid recipients at two hospitals were reviewed to document whether inpatient staff had communicated with current or prior outpatient providers. Medicaid claims provided demographic, clinical, and outpatient attendance data. Associations between provider communications and follow-up care for patients who had or had not received outpatient mental health care within the 30 days prior to admission were evaluated. RESULTS Inpatient staff communicated with outpatient providers for 118 (62%) patients. For patients who had not received outpatient care within 30 days of admission, compared with those who had, communication was associated with increased odds of attending timely outpatient appointments (odds ratio=2.73, 95% confidence interval=1.09-6.84). CONCLUSIONS Communication with outpatient providers may be especially important for patients who were not engaged in outpatient care prior to admission.
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Affiliation(s)
- Thomas E Smith
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Morgan Haselden
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Tom Corbeil
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Fei Tang
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Marleen Radigan
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Susan M Essock
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Rui Wang
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Eric Frimpong
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Steven Lamberti
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Matthew Schneider
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
| | - Mark Olfson
- New York State Psychiatric Institute, New York (Smith, Haselden, Corbeil, Wall, Dixon, Olfson); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Essock, Dixon); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Wang, Frimpong); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York (Schneider)
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Haselden M, Corbeil T, Tang F, Olfson M, Dixon LB, Essock SM, Wall MM, Radigan M, Frimpong E, Wang R, Lamberti S, Schneider M, Smith TE. Family Involvement in Psychiatric Hospitalizations: Associations With Discharge Planning and Prompt Follow-Up Care. Psychiatr Serv 2019; 70:860-866. [PMID: 31310186 PMCID: PMC6773477 DOI: 10.1176/appi.ps.201900028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Involving family in the care of inpatients with serious mental illness is known to be beneficial. This study examined frequencies of involvement by family in the care and discharge planning for 179 psychiatric inpatients. METHODS Involvement by family in care and discharge planning was assessed from randomly selected medical records of inpatients with Medicaid and severe mental illness at two New York hospitals from 2012 to 2013. "Family" also included anyone close to the patient who provided support. Medicaid claims were reviewed for patient demographic and clinical characteristics and for postdischarge outpatient attendance data. Multiple regression models were used to test whether involvement by family was associated with comprehensive discharge planning (contacting outpatient providers, scheduling follow-up appointments, and forwarding a discharge summary to a provider) and initiation of outpatient treatment. RESULTS Inpatient staff contacted a family member for 134 (75%) patients. Sixty-seven (37%) patients received comprehensive discharge planning, and 96 (53%) and 139 (78%) attended an outpatient appointment within 7 and 30 days of discharge, respectively. Inpatient staff contacting family, communicating about the patient's health and/or mental health, and communicating about the discharge plan were significantly associated with entry into follow-up care by 7 and 30 days postdischarge. Family phone calls and/or visits with patients, attendance at family therapy sessions, and communication with inpatient staff about services available to families were significantly associated with patients receiving comprehensive discharge planning. When analyses controlled for demographic and clinical factors, having any involvement between family members and inpatient staff was significantly associated with patients' attending an outpatient appointment by 7 days (odds ratio [OR]=2.79, 95% confidence interval [CI]=1.28-6.08) or 30 days (OR=3.07, 95% CI=1.29-7.32) after discharge. CONCLUSIONS The association of family involvement with comprehensive discharge planning and prompt entry into outpatient care underscores the importance of family contact and communication with staff during inpatient hospitalizations.
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Affiliation(s)
- Morgan Haselden
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Tom Corbeil
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Fei Tang
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Mark Olfson
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Lisa B Dixon
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Susan M Essock
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Melanie M Wall
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Marleen Radigan
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Eric Frimpong
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Rui Wang
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Steven Lamberti
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Matthew Schneider
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
| | - Thomas E Smith
- New York State Psychiatric Institute, New York (Haselden, Corbeil, Olfson, Wall, Smith); Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany (Tang, Radigan, Frimpong, Wang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Olfson, Dixon, Essock, Wall, Smith); New York-Presbyterian Hospital, New York (Dixon, Essock); Department of Psychiatry, University of Rochester Medical Center, Rochester, New York (Lamberti); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (Schneider)
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Al-Kaisy A, Palmisani S, Smith TE, Carganillo R, Houghton R, Pang D, Burgoyne W, Lam K, Lucas J. Long-Term Improvements in Chronic Axial Low Back Pain Patients Without Previous Spinal Surgery: A Cohort Analysis of 10-kHz High-Frequency Spinal Cord Stimulation over 36 Months. Pain Med 2019; 19:1219-1226. [PMID: 29077889 DOI: 10.1093/pm/pnx237] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective This prospective, open-label study was designed to evaluate the long-term effectiveness of 10-kHz high-frequency spinal cord stimulation (SCS) in the treatment of chronic axial low back pain with no history of spinal surgery. Methods Patients with chronic low back pain without previous spinal surgery underwent assessment by a multidisciplinary pain and surgical team to confirm eligibility. After a successful temporary trial of 10-kHz HF-SCS therapy, defined by ≥50% back pain reduction, enrolled subjects underwent permanent system implantation and were followed up for 36 months. Outcome measures consisted of a 100-mm visual analog scale (VAS) for pain intensity, the Oswestry Disability Index (ODI), and a standard measure of health-related quality of life. Results Twenty-one patients satisfied the inclusion/exclusion criteria. Following a temporary trial, 20 of 21 (95%) subjects were implanted with a pulse generator, and 17 of 20 reached the 36-month time point. From baseline to 36 months, the average VAS pain intensity decreased from 79 ± 12 mm to 10 ± 12 mm, the average ODI score decreased from 53 ± 13 to 19.8 ± 13, and use of opioids decreased from 18 subjects to two subjects. One subject was deceased, unrelated to the study, one subject was explanted due to loss of effectiveness, and one subject was lost to follow-up. Conclusions These results suggest that 10-kHz high-frequency SCS may provide significant, long-term back pain relief, improvement in disability and quality of life, and reduction in opioids for nonsurgical refractory back pain.
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Affiliation(s)
| | | | | | | | | | - David Pang
- Guy's and St Thomas' NHS Trust, London, UK
| | | | - Khai Lam
- Guy's and St Thomas' NHS Trust, London, UK
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Smith TE, Kurk M, Sawhney R, Bao Y, Nossel I, Cohen DE, Dixon LB. Estimated Staff Time Effort, Costs, and Medicaid Revenues for Coordinated Specialty Care Clinics Serving Clients With First-Episode Psychosis. Psychiatr Serv 2019; 70:425-427. [PMID: 30914002 DOI: 10.1176/appi.ps.201900039] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As coordinated specialty care for first-episode psychosis is implemented nationally, questions arise regarding financial sustainability. To address this, New York State undertook a time study in which 13 coordinated specialty care sites reported all activities provided to 75 randomly selected Medicaid clients with first-episode psychosis over a 2-week period. The average estimated cost was $1,375 per client per month, yet under optimal billing conditions, estimated revenues were only $662 per client per month, or 48% of the costs. These results underscore the need for continued subsidies and novel payment schemes for coordinated specialty care.
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Affiliation(s)
- Thomas E Smith
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Margaret Kurk
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Rishi Sawhney
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Yuhua Bao
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Ilana Nossel
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Dana E Cohen
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
| | - Lisa B Dixon
- New York State Office of Mental Health, New York (Smith, Cohen); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Nossel, Dixon); New York State Psychiatric Institute, New York (Nossel, Dixon, Kurk); Texas Health and Human Services Commission, Austin (Sawhney); Department of Healthcare Policy and Research, Weill Cornell Medical College, New York (Bao). Steven S. Sharfstein, M.D., Haiden A. Huskamp, Ph.D., and Alison Evans Cuellar, Ph.D., are editors of this column
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Smith TE, Abraham M, Berezin J, Cohen DE, Dixon LB, Fish DG, Lincourt P, Myers RW, Pincus HA, Radigan M. A Partnership to Develop Behavioral Health Quality and Performance Measures. Psychiatr Serv 2019; 70:247-249. [PMID: 30630399 DOI: 10.1176/appi.ps.201800256] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The New York State Medicaid program is pursuing reforms that would shift reimbursement from fee-for-service to value-based models. Behavioral health populations and services are key to these reforms, but important gaps exist in the breadth and relevance of available quality measures for the behavioral health field. This column describes how the state addressed these gaps by using both inter- and intra-agency collaborations. As part of this effort, the state convened a panel of consultants, including academics, providers, and consumers, to develop a behavioral health quality measurement agenda. Panel recommendations and ongoing partnerships are described as a model for states considering similar value-based reform initiatives.
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Affiliation(s)
- Thomas E Smith
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Maria Abraham
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Joshua Berezin
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Dana E Cohen
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Lisa B Dixon
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Douglas G Fish
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Pat Lincourt
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Robert W Myers
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Harold A Pincus
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
| | - Marleen Radigan
- New York State Office of Mental Health, New York (Smith, Abraham, Berezin, Cohen, Myers, Radigan); New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Smith, Dixon, Pincus); New York State Department of Health, Albany (Fish); New York State Office of Alcoholism and Substance Abuse Services, Albany (Lincourt)
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Nossel I, Wall MM, Scodes J, Marino LA, Zilkha S, Bello I, Malinovsky I, Lee R, Radigan M, Smith TE, Sederer L, Gu G, Dixon L. Results of a Coordinated Specialty Care Program for Early Psychosis and Predictors of Outcomes. Psychiatr Serv 2018; 69:863-870. [PMID: 29759055 DOI: 10.1176/appi.ps.201700436] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study prospectively evaluated outcomes of OnTrackNY, a statewide coordinated specialty care (CSC) program for treatment of early psychosis in community settings, as well as predictors of outcomes. METHODS The sample included 325 individuals ages 16-30 with recent-onset nonaffective psychosis who were enrolled in OnTrackNY and who had at least one three-month follow-up. Clinicians provided data at baseline and quarterly up to one year. Domains assessed included demographic and clinical characteristics, social and occupational functioning, medications, suicidality and violence, hospitalization, and time to intervention. Primary outcomes included the symptoms, occupational functioning, and social functioning scales of the Global Assessment of Functioning (GAF), as adapted by the U.S. Department of Veterans Affairs Mental Illness Research, Education and Clinical Center; education and employment status; and psychiatric hospitalization rate. RESULTS Education and employment rates increased from 40% to 80% by six months, hospitalization rates decreased from 70% to 10% by three months, and improvement in GAF scores continued for 12 months. Female gender, non-Hispanic white race-ethnicity, and more education at baseline predicted better education and employment status at follow-up. CONCLUSIONS Individuals with early psychosis receiving CSC achieved significant improvements in education and employment and experienced a decrease in hospitalization rate. Demographic variables and baseline education predicted education and employment outcomes. CSC teams should make particular effort to support the occupational goals of individuals at increased risk of not engaging in work or school, including male participants and participants from racial and ethnic minority groups.
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Affiliation(s)
- Ilana Nossel
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Melanie M Wall
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Jennifer Scodes
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Leslie A Marino
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Sacha Zilkha
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Iruma Bello
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Igor Malinovsky
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Rufina Lee
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Marleen Radigan
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Thomas E Smith
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Lloyd Sederer
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Gyojeong Gu
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
| | - Lisa Dixon
- Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Marino, Dr. Zilkha, Dr. Bello, Dr. Malinovsky, and Dr. Dixon are with the New York State Psychiatric Institute, New York. Dr. Nossel, Dr. Wall, Ms. Scodes, Dr. Bello, Dr. Malinovsky, Dr. Smith, and Dr. Dixon are also with the Department of Psychiatry, Columbia University Medical Center, New York. Dr. Smith is also with the New York State Office of Mental Health, Albany, where Dr. Radigan, Dr. Sederer, and Mr. Gu are affiliated. Dr. Lee is with the Silberman School of Social Work, Hunter College, New York
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Smith TE, Pond CD, Pierce E, Harmer ZP, Kwan J, Zachariah MM, Harper MK, Wyche TP, Matainaho TK, Bugni TS, Barrows LR, Ireland CM, Schmidt EW. Accessing chemical diversity from the uncultivated symbionts of small marine animals. Nat Chem Biol 2018; 14:179-185. [PMID: 29291350 PMCID: PMC5771842 DOI: 10.1038/nchembio.2537] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/09/2017] [Indexed: 12/15/2022]
Abstract
Chemistry drives many biological interactions between the microbiota and host animals, yet it is often challenging to identify the chemicals involved. This poses a problem, as such small molecules are excellent sources of potential pharmaceuticals, pretested by nature for animal compatibility. We discovered anti-HIV compounds from small, marine tunicates from the Eastern Fields of Papua New Guinea. Tunicates are a reservoir for novel bioactive chemicals, yet their small size often impedes identification or even detection of the chemicals within. We solved this problem by combining chemistry, metagenomics, and synthetic biology to directly identify and synthesize the natural products. We show that these anti-HIV compounds, the divamides, are a novel family of lanthipeptides produced by symbiotic bacteria living in the tunicate. Neighboring animal colonies contain structurally related divamides that differ starkly in their biological properties, suggesting a role for biosynthetic plasticity in a native context where biological interactions take place.
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Affiliation(s)
- Thomas E Smith
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Christopher D Pond
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth Pierce
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Zachary P Harmer
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Jason Kwan
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Malcolm M Zachariah
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Mary Kay Harper
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Thomas P Wyche
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Teatulohi K Matainaho
- Discipline of Pharmacology, School of Medicine and Health Sciences, University of Papua New Guinea, National Capital District 111, Papua New Guinea
| | - Tim S Bugni
- Pharmaceutical Sciences Division, School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Louis R Barrows
- Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, Utah, USA
| | - Chris M Ireland
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
| | - Eric W Schmidt
- Department of Medicinal Chemistry, University of Utah, Salt Lake City, Utah, USA
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48
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Smith TE, Abraham M, Bivona M, Brakman MJ, Brown IS, Enders G, Goodman S, McNabb L, Swinford JW. "Just be a light": Experiences of peers working on acute inpatient psychiatric units. Psychiatr Rehabil J 2017; 40:387-394. [PMID: 27736114 DOI: 10.1037/prj0000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aimed to clarify the potential role and impact of behavioral health peer support providers on community hospital acute inpatient psychiatric units. METHOD Qualitative interviews were conducted to examine perspectives of peer support providers (peers) and individuals who initially received peer services (recipients) during an inpatient stay on a community hospital psychiatric unit. Interviews elicited perspectives on interactions between peers and recipients, the role of peers vis-à-vis the clinical treatment team, and involvement of peers in discharge planning and transitions to community-based care. Fourteen interviews were completed (6 peers and 8 recipients of peer services); all were recorded, transcribed, and coded using a thematic analysis approach. RESULTS Emergent themes were grouped into 3 domains: (a) initial impressions and client engagement, (b) peer interventions to support discharge planning, and (c) shared or sharing experiences in an inpatient setting. Recipients described inpatient experiences as disempowering and humiliating and reported powerful positive initial reactions to peers who had had similar experiences but who also displayed competence and professionalism. Peers and recipients described strong emotional connections that differed from traditional attitudes and relationships with clinical staff. Peers described challenges and obstacles related to interactions with the clinical treatment team, and both peers and recipients strongly endorsed the role of peers in facilitating successful care transitions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Behavioral health peers can play important roles in acute inpatient psychiatric care, supplementing clinical treatment team activities and filling important gaps related to engagement, discharge planning, and care transitions. (PsycINFO Database Record
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, Columbia University College of Physicians and Surgeons
| | | | | | | | | | - Gita Enders
- New York City Health + Hospitals, Division of Medical & Professional Affairs, Office of Behavioral Health
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49
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Smith TE, Panisch LS, Malespin T, Pereira MG. Evaluating Effectiveness of Abstinence Education. J Evid Inf Soc Work 2017; 14:360-367. [PMID: 28665180 DOI: 10.1080/23761407.2017.1340860] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE This study examined the effectiveness of an abstinence education program that was sensitive to federally mandated curriculum and measures. METHODS The intervention was delivered to 5,772 middle school and high school students. Effectiveness was assessed by a measure that was anchored on A-H themes, which are components of federally mandated curricular components of abstinence education. To better understand the relationship of different variables and determine the significance of student's improvements on the A-H measure scores, the ANCOVA was used with the pretest score and age as covariates and the use of gender and ethnicity as fixed factors in the analysis. RESULTS While controlling for the effects of the pretest, the analyses showed that age and gender were main effects but that ethnicity did not prove to be related to the outcome scores. Results demonstrated that the effectiveness of the program decreased as adolescent boys aged. There were no significant interactions in the gender and ethnicity variables. CONCLUSIONS The findings of this study will be beneficial to program developers in understanding what variations and demographics are most receptive to this particular abstinence-only education model. Further studies in this area are needed to evaluate the effectiveness of currently available programs.
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Affiliation(s)
- Thomas E Smith
- a College of Social Work , Florida State University , Tallahassee , Florida , USA
| | - Lisa S Panisch
- b School of Social Work , University of Texas at Austin , Austin , Texas , USA
| | - Thallia Malespin
- c School of Law , Villanova University , Villanova , Pennsylvania , USA
| | - M Graça Pereira
- d School of Psychology , University of Minho , Braga , Portugal
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50
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Jain P, Fierst TM, Han HJ, Smith TE, Vakil A, Storm PB, Resnick AC, Waanders AJ. CRAF gene fusions in pediatric low-grade gliomas define a distinct drug response based on dimerization profiles. Oncogene 2017; 36:6348-6358. [PMID: 28806393 PMCID: PMC5680138 DOI: 10.1038/onc.2017.276] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 01/07/2023]
Abstract
Pediatric low-grade gliomas (PLGGs) are commonly associated with BRAF gene fusions that aberrantly activate the mitogen-activated protein kinase (MAPK) signaling pathway. This has led to PLGG clinical trials utilizing RAF- and MAPK pathway-targeted therapeutics. Whole-genome profiling of PLGGs has also identified rare gene fusions involving another RAF isoform, CRAF/RAF1, in PLGGs and cancers occuring in adults. Whereas BRAF fusions primarily dysregulate MAPK signaling, the CRAF fusions QKI-RAF1 and SRGAP3-RAF1 aberrantly activate both the MAPK and phosphoinositide-3 kinase/mammalian target of rapamycin (PI3K/mTOR) signaling pathways. Although ATP-competitive, first-generation RAF inhibitors (vemurafenib/PLX4720, RAFi) cause paradoxical activation of the MAPK pathway in BRAF-fusion tumors, inhibition can be achieved with ‘paradox breaker’ RAFi, such as PLX8394. Here we report that, unlike BRAF fusions, CRAF fusions are unresponsive to both generations of RAFi, vemurafenib and PLX8394, highlighting a distinct responsiveness of CRAF fusions to clinically relevant RAFi. Whereas PLX8394 decreased BRAF-fusion dimerization, CRAF-fusion dimerization is unaffected primarily because of robust protein–protein interactions mediated by the N-terminal non-kinase fusion partner, such as QKI. The pan-RAF dimer inhibitor, LY3009120, could suppress CRAF-fusion oncogenicity by inhibiting dimer-mediated signaling. In addition, as CRAF fusions activate both the MAPK and PI3K/mTOR signaling pathways, we identify combinatorial inhibition of the MAPK/mTOR pathway as a potential therapeutic strategy for CRAF-fusion-driven tumors. Overall, we define a mechanistic distinction between PLGG-associated BRAF- and CRAF/RAF1 fusions in response to RAFi, highlighting the importance of molecularly classifying PLGG patients for targeted therapy. Furthermore, our study uncovers an important contribution of the non-kinase fusion partner to oncogenesis and potential therapeutic strategies against PLGG-associated CRAF fusions and possibly pan-cancer CRAF fusions.
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Affiliation(s)
- P Jain
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Cell and Molecular Graduate Group, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - T M Fierst
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurosurgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - H J Han
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - T E Smith
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Vakil
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - P B Storm
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center of Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Data Driven Discovery in Biomedicine (D3b), The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A C Resnick
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center of Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Data Driven Discovery in Biomedicine (D3b), The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A J Waanders
- Center of Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Data Driven Discovery in Biomedicine (D3b), The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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