Co-occurring Mental Health Conditions Research Articles

Targeting Higher-Order Dimensions of Personality in Treatment as a Parsimonious Means to Address Co-Occurring Psychopathology

People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive-behavioral treatment developed to target broad personality domains (i.e., negative affectivity, antagonism, disinhibition) associated with BPD and related conditions. The purpose of the present study was to explore the extent to which BPD Compass can serve as a transdiagnostic intervention for these comorbid conditions. Participants (N = 100; Mage = 28.13, 73.7% female, 79.6% White, 66% sexual minority) were assigned to either immediately begin treatment (randomized and naturalistic) or receive treatment after an 18-week waiting period. At baseline, participants met criteria for an average of 3.28 (SD = 2.02, range: 0-8) comorbid diagnoses ranging in clinical severity from 3.30 (for substance use disorder) to 4.91 (for persistent depressive disorder). Post-treatment clinical severity ratings (CSRs) for those randomized to receive BPD Compass were below clinical thresholds for all assessed conditions except premenstrual dysphoric disorder, whereas post-waitlist CSRs remained above clinical thresholds for all disorders except bipolar II, agoraphobia, and major depressive disorder. Collapsed across all patients who received BPD Compass, pre- to post-treatment improvements in were significant and large in magnitude for most disorders assessed. These results suggest that BPD Compass may be an efficacious transdiagnostic intervention, though our small sample and high rate of dropout warrant further study.

Longitudinal Analyses of Mental Health in Autistic Individuals: A Systematic Review.

Co-occurring mental health conditions affect autistic individuals at high rates, impacting their well-being and quality of life. Mental health conditions are often appropriate treatment targets that can improve the lives of autistic individuals. Because of this, there is growing interest in predictors of mental health and behavioral outcomes. Given the rapidly evolving evidence base and growing literature using longitudinal cohorts, it is unclear which predictors of symptoms of anxiety and depression are consistent, and which are not. Additionally, it is difficult to deduce which predictors of mental health symptoms at a given time also predict change over time. This can be partially due to the different statistical approaches that are implemented, including trajectory vs. non-trajectory methodologies. We conducted a systematic review to evaluate how non-trajectory and trajectory analyses inform our knowledge of how symptoms of anxiety and depression change over time. Additionally, we aimed to identify important predictors of change and later anxiety and depressive symptoms in autistic individuals. There is variability in symptoms of anxiety and depression in autistic individuals. Adaptive skills arose as significant predictors of change and of later symptoms of both anxiety and depression. Peer relationships in school age seem to be particularly important in predicting later symptoms of depression. This review provides evidence that there are different trajectories and different patterns of mental health symptoms over the lifespan, providing further evidence that autism is a developmental condition that changes over time in different ways for different people. Implications and future directions are further discussed.

Modelling Co-Occurring Mental Health Conditions Among Autistic Individuals Using Polygenic Scores

Modelling Co-Occurring Mental Health Conditions Among Autistic Individuals Using Polygenic Scores

Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders’ Perspectives

Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.

Interdisciplinary Treatment Approach to Youth with Intellectual or Developmental Disabilities and Co-occurring Mental Health Conditions

Interdisciplinary Treatment Approach to Youth with Intellectual or Developmental Disabilities and Co-occurring Mental Health Conditions

Impact of increasing number of mental health conditions on healthcare costs and resource utilization among individuals with type 2 diabetes: a cross-sectional study

Abstract Objectives To evaluate the association between the number of mental health conditions among individuals with type 2 diabetes (T2D) and healthcare expenditures in the USA. Methods A cross-sectional study was conducted to evaluate the relationship between multiple mental health conditions (0, 1, and 2 or more mental health conditions) among individuals with T2D on healthcare expenditures using data from the 2019 US Medical Expenditure Panel Survey. Key findings A total of 24,091,931 weighted individuals with T2D were included for analysis; 76.8% had no co-occurring mental health conditions, 15.5% had one mental health condition, and 7.7% had two or more mental health conditions. Individuals with one and two or more mental health conditions had significantly greater total healthcare costs (+$7135 and +$7168), office-based costs (+$1196 and +$1483), prescription costs (+$2091 and +$3757), office-based visits (+3.55 and +6.46), and prescriptions fills (+13.97 and +26.77) than individuals with no mental health conditions. Conclusions Individuals with T2D and an increasing number of co-occurring mental health conditions were associated with increased healthcare costs and resource utilization. Underlying mechanisms for this relationship remain unclear, and further investigations are needed to accurately assess the impact this may have on health outcomes.

Title: Frontal-pole Neuromodulation for Impulsivity and Suicidality in Veterans with Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (Preprint)

Title: Frontal-pole Neuromodulation for Impulsivity and Suicidality in Veterans with Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (Preprint)

Hypersexual Disorder: A Comprehensive Review of Conceptualization, Etiology, Assessment and Treatment

Hypersexual disorder, also known as compulsive sexual behavior or sex addiction, is a complex and clinically significant condition characterized by intense and recurrent sexual fantasies, urges, or behaviors that significantly disrupt an individual’s daily life and overall well-being. Despite its importance, hypersexual disorder remains a controversial and debated topic, lacking standardized diagnostic criteria in major classification systems. This review paper provides a comprehensive examination of hypersexual disorder, encompassing its definition, conceptualization, etiology, co-occurring conditions, effects on mental and physical health, assessment, treatment approaches, cultural and ethical considerations, and future research directions. By synthesizing information from existing literature and research, this review aims to deepen our understanding of hypersexual disorder and contribute to the development of evidence-based interventions. The review begins by exploring the evolution of the term “hypersexual disorder” and its current status in diagnostic classifications. It then delves into the potential etiological factors contributing to the development of hypersexual behaviors, including neurobiological, genetic, and psychosocial factors. Furthermore, the review discusses the common comorbidities associated with hypersexual disorder, emphasizing the importance of addressing co-occurring mental health conditions in treatment planning. The psychological and physiological effects of hypersexual behaviors on affected individuals are examined, underscoring the urgency of early intervention and comprehensive treatment. The assessment and diagnosis of hypersexual disorder are thoroughly examined, considering the challenges and methodologies involved in identifying and evaluating affected individuals. Cultural and ethical considerations are highlighted, stressing the significance of providing culturally sensitive and ethical care to diverse populations. In the context of treatment, the review discusses various therapeutic approaches, including psychotherapy, medication, support groups, and harm-reduction strategies. The need for evidence-based treatments tailored to hypersexual disorder is underscored while recognizing the challenges of developing standardized protocols in this evolving field. Finally, future research directions are outlined, focusing on the standardization of diagnostic criteria, prevalence studies, neurobiological investigations, and the integration of cultural competency in treatment approaches. In conclusion, this review paper aims to contribute to a comprehensive understanding of hypersexual disorder and its implications for affected individuals and society. By exploring the multifaceted aspects of the condition, this review seeks to provide insights into effective treatment approaches and inspire further research in the study of hypersexual disorder.

More Than a Headache: Lived Experience of Migraine in Youth

BackgroundMigraine is the leading cause of disability among adolescents and young adults. We aimed to characterize the impact of migraine on the experience of children, adolescents, and caregivers. MethodsThis descriptive qualitative study recruited youth aged four to 18 years with migraine and their caregivers from the multicenter, prospective Pediatric Migraine Registry between 2020 and 2021. Participants completed semistructured interviews targeting the lived experience of migraine. A conventional content analysis approach was used to analyze data. ResultsThirty enrolled dyads (n = 30 children and adolescents, n = 29 caregivers) completed 59 interviews (n = 29 child and adolescent interviews, n = 30 caregiver interviews). Children and adolescents had a median age of 15 years and experienced a median of 13.5 headache days per month. Caregivers had a median age of 44 years and predominantly identified as mothers (n = 28). We identified three themes: (1) Impact on emotional well-being: participants described how their migraine experience included feelings of isolation, depression, and irritability alongside the need for social support; (2) Impact on daily life: participants described how symptoms and unpredictability impacted their ability to perform activities of daily living; and (3) Impact on school: participants described how migraine impacted their school experience, including threatened attendance and worsened performance. ConclusionsIn this cohort of youth and their caregivers, we identified salient themes to characterize the experience of migraine. Our findings underscore the urgent need for effective migraine treatments and interventions targeting co-occurring mental health conditions, peer relationships, and school support.

Emotion regulation and executive function: Associations with depression and anxiety in autism

BackgroundAdolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention. MethodFifty-seven autistic adolescents and adults (16–25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms. ResultsASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety. ConclusionsAlthough preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.

Homelessness and Gender: Differences in Characteristics and Comorbidity of Substance Use Disorders at Admission to Services

Background: Substance use disorders and homelessness are two closely related behavioral health issues. This study examines associations between homelessness and severity of substance use disorder (SUD) characteristics (inclusive of alcohol and other legal and illegal drugs) and presence of mental health comorbidity among individuals entering treatment for SUD. We also examine differences in SUD and mental health comorbidity by gender within a sample of clients experiencing homelessness upon admission to treatment. Methods: Using the 2017 Treatment Episodes Data Set, we used logistic regression models to examine the association between homelessness and indicators of severity (e.g., frequency of use, route of transmission) and the presence of mental health conditions, and to examine the association between gender and these dependent variables among only individuals experiencing homelessness at treatment admission. Results: After controlling for covariates, homelessness is significantly associated with increased odds of cocaine and methamphetamine use compared to all other substances, higher frequency of use, younger age of first use, use of more substances, injection drug use, and co-occurring mental health conditions. Female gender is inversely associated with younger age at first use and highly associated with co-occurring mental health conditions among those experiencing homelessness at admission to treatment. Conclusions: Individuals experiencing homelessness enter substance use services with different characteristics of substance use disorders, different patterns of use, and with higher rates of mental health comorbidity. Within homeless admissions, women have significant differences in substance use and higher likelihood of mental health comorbidity than men. Future research should focus on the specific treatment needs of individuals experiencing homelessness, and how the combination of homelessness and gender affects barriers and challenges to treatment.

The impact of the COVID-19 pandemic and associated public health response on people with eating disorder symptomatology: an Australian study

ObjectivePeople with lived experience of eating disorders (ED) may be particularly vulnerable to the COVID-19 pandemic and associated public health response due to exasperating situations such as social isolation, presence of other mental and physical health conditions, disruptions to treatment, etc. This study investigates the association of the pandemic with ED symptomatology to consider impact and identify risk factors for clinical consideration.MethodsParticipants with self-reported ED diagnosis and/or symptomatology over 16 years were invited to complete an online survey during the first months of the pandemic in Australia. Questions included history of ED, occurrence of co-occurring mental health conditions, change in ED symptoms since the start of the pandemic, and validated measures of ED illness, state mental health and loneliness.ResultsOf 1723 participants (mode age 24.9 years, 91.6% identifying as female, EDE-Q Global Score x = 4.08, SD = 1.18, 79.0% reporting co-occurring mental health condition, predominantly obsessive–compulsive disorder and/or anxiety), 88.0% reported an increase in body image concerns, 74.1% in food restriction, 66.2% binge eating and 46.8% driven exercise during the pandemic. Increased ED symptomatology was associated with poorer state mental health (i.e., depression, anxiety, and stress) and loneliness across the ED symptom profile. Most participants were negatively impacted by various aspects of the public health response, more so for those with more acute ED illness as measured by the Eating Disorder Examination Questionnaire (EDE-Q).ConclusionsAssociated with the COVID-19 pandemic is a mental health crisis, particularly for those with a lived experience of an eating disorder. With 40.5% of participants not having sought formal diagnostic assessment and less than half in treatment, this study provides evidence for the detrimental impact of the pandemic on people with a lived experience of an eating disorder, especially for those not yet supported by the health care system.

A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum.

Most adults on the autism spectrum have co-occurring mental health conditions, creating a high demand for mental health services – including psychotherapy – in autistic adults. However, autistic adults have difficulties accessing mental health services. The most-reported barriers to accessing treatment are therapists’ lack of knowledge and expertise surrounding autism, as well as unwillingness to treat autistic individuals. This study was conducted by a participatory autism research group and examined 498 adult-patient psychotherapists on knowledge about autism and self-perceived competency to diagnose and treat autistic patients without intellectual disability compared to patients with other diagnoses. Psychotherapists rated their education about autism in formal training, and competency in the diagnosis and treatment of patients with autism, lowest compared to patients with all other diagnoses surveyed in the study, including those with comparable prevalence rates. Many therapists had misconceptions and outdated beliefs about autism. Few had completed additional training on autism, but the majority were interested in receiving it. Greater knowledge about autism was positively linked to openness to accept autistic patients. The results point to an alarming gap in knowledge necessary for adequate mental health care for individuals with autism.Lay abstractMost autistic adults experience mental health problems. There is a great demand for psychotherapeutic support that addresses the specific needs of autistic individuals. However, people with autism encounter difficulties trying to access diagnostic and therapeutic services. This study was conducted by a participatory autism research group: a group in which autistic individuals and scientists collaborate. The group developed a questionnaire for psychotherapists in Germany to assess their knowledge about autism. Psychotherapists also rated their ability to diagnose and treat autistic patients without intellectual disability, and patients with other psychological diagnoses. Many of the 498 psychotherapists that responded reported little knowledge and outdated beliefs about autism, as well as little training on treating patients with autism. Their expertise about other psychological conditions was more comprehensive. However, many psychotherapists were interested in professional training on autism. Those with more knowledge were also more open to treating autistic patients. In conclusion, psychotherapists’ lack of knowledge and expertise seem to be a major barrier for adults with autism to receiving helpful psychotherapeutic support. The results demonstrate the need for an advancement in autism education during psychotherapists’ training and in continuous education.

Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder.

Previous research has highlighted the importance of mental health treatment for autistic youth. In that research base, most studies focus on demonstrating the efficacy of a particular intervention with a sample of autistic youth. However, understanding the characteristics of samples used within these studies (i.e. demographics) is an important avenue for expanding this research to a more diverse, representative sample of autistic youth in community settings. As such, the current review examined and characterized participants included within mental health treatment research. We coded studies for various demographics among the youth sample, caregivers, and providers participants. Results indicated that while efforts have been made to increase diversity in research, very few studies including transition-aged youth, those identifying as female, and/or those identifying as non-Caucasian. Clinically, a few studies included youth with lower cognitive abilities and/or those with specific mental health problems (e.g. trauma and depression) or more than one co-occurring mental health conditions. Overall, our results highlight several critical gaps in our current evidence base regarding mental health treatment for autistic youth, including the limited clinical representativeness of both provider and child participants.

Feasibility of a Peer-Mentoring Intervention for Young Adults With Intellectual and Developmental Disabilities and Co-Occurring Mental Health Conditions

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Peer mentoring (PM) is an evidence-based approach that may support young adults with intellectual and developmental disabilities and co-occurring mental health conditions (YA-IDD-MH) to cope with MH challenges. Feasibility testing of PM suggested that YA-IDD-MH learned, enjoyed PM, and had increased self-efficacy for managing emotions, but smaller changes in MH symptoms, suggesting a longer intervention period, may be needed. OTs may utilize peer-delivered interventions as a client-centered approach to support YA-IDD-MH. Primary Author and Speaker: Ariel E. Schwartz Additional Authors and Speakers: Tara Loeper Contributing Authors: Melissa Levin

Melatonin dispensing among New Zealand children aged 0–18 years with autism: a nationwide cross-sectional study

Objective/backgroundSleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. MethodsThis nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0–18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. ResultsMelatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. ConclusionsFindings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.

Predicting Community-based Employment of Young Adults with Intellectual Disability and Co-occurring Mental Health Conditions

Identify predictors of community-based employment for individuals ages 23-30 with intellectual disability and co-occurring mental health conditions (IDMH).

Management of Complex Co-occurring Psychiatric Disorders and High-Risk Behaviors in Adolescence.

Adolescents often present to treatment with multiple psychiatric diagnoses. The presence of certain co-occurring mental health conditions can significantly affect an individual's treatment course. Adolescence is also a time of developmentally appropriate risk taking and experimenting with novel behaviors. Difficulties in accurate diagnosis and lack of effective treatment options create obstacles to helping this vulnerable patient population. Appropriate management of adolescents' complex symptoms and high-risk behaviors during a developmentally sensitive period can be challenging, even for the most skilled of clinicians. This article focuses on the assessment and management of complex, co-occurring psychiatric disorders during adolescence, with specific guidance on how to manage high-risk behaviors, such as self-harm and suicidality. Controversial topics, including antidepressants and youth suicide risk, as well as "off-label" use of mood stabilizers and antipsychotics, are also reviewed.

1.27 PREVALENCE OF CO-OCCURRING MENTAL HEALTH DIAGNOSES IN THE ASD POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Co-occurring mental health conditions (CMHCs) are common in ASD, impeding quality of life. Reported prevalence rates range widely. Accurate prevalence estimates and identification of moderators are needed to enhance recognition and care and to guide future research. This study aims to summarize the current literature on the prevalence of CMHCs in people with ASD and identify factors associated with heterogeneity across studies.

Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis

Co-occurring mental health or psychiatric conditions are common in autism, impairing quality of life. Reported prevalences of co-occurring mental health or psychiatric conditions in people with autism range widely. Improved prevalence estimates and identification of moderators are needed to enhance recognition and care, and to guide future research. In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and grey literature for publications between Jan 1, 1993, and Feb 1, 2019, in English or French, that reported original research using an observational design on the prevalence of co-occurring mental health conditions in people with autism and reported confirmed clinical diagnoses of the co-occurring conditions and autism using DSM or ICD criteria. For co-occurring mental health conditions reported with at least 15 datapoints (studies), we assessed risk of bias and we determined pooled estimates of prevalence for different co-occurring conditions in autism using random-effects models, and descriptively compared these with prevalence estimates for the general population from the literature (post hoc). We investigated heterogeneity in prevalence estimates using random-effects meta-regression models. This systematic review is registered with PROSPERO, CRD42018103176. Of 9746 unique studies identified, 432 were selected for full-text review. 100 studies were eligible for inclusion in our qualitative synthesis, of which 96 were included in our meta-analyses. 11 categories of co-occurring conditions were investigated, of which eight conditions were included in the meta-analyses and three were descriptively synthesised (ie, trauma and stressor-related disorders, substance-related and addictive disorders, and gender dysphoria). From our meta-analyses, we found overall pooled prevalence estimates of 28% (95% CI 25-32) for attention-deficit hyperactivity disorder; 20% (17-23) for anxiety disorders; 13% (9-17) for sleep-wake disorders; 12% (10-15) for disruptive, impulse-control, and conduct disorders; 11% (9-13) for depressive disorders; 9% (7-10) for obsessive-compulsive disorder; 5% (3-6) for bipolar disorders; and 4% (3-5) for schizophrenia spectrum disorders. Estimates in clinical sample-based studies were higher than in population-based and registry-based studies, and these estimates were mostly higher than those in the general population (post hoc). Age, gender, intellectual functioning, and country of study were associated with heterogeneity in prevalence estimates, yet remaining heterogeneity not explained was still substantial (all I2 >95%). Co-occurring mental health conditions are more prevalent in the autism population than in the general population. Careful assessment of mental health is an essential component of care for all people on the autism spectrum and should be integrated into clinical practice. Academic Scholars Awards, Department of Psychiatry, University of Toronto; O'Brien Scholars Program, Slaight Family Child and Youth Mental Health Innovation Fund, and The Catherine and Maxwell Meighen Foundation via the Centre for Addiction and Mental Health Foundation.