Co-occurring Severe Mental Illness Research Articles

Premature mortality associated with severe mental illness or substance use disorder in an integrated health care system

ObjectiveResearch has reported shortened lifespans (by 15–30 years) for those with severe mental illness (SMI) or substance use disorder (SUD), particularly among public mental health treatment consumers. We assessed SMI- and SUD-associated mortality in the understudied setting of a large, nonprofit integrated health care system. MethodThis retrospective cohort study examined 2010–2017 health system and death records for 564,592 adult patients. Half had SMI/SUD diagnosis; half were a demographically matched comparison group without SMI, other mental health, or SUD diagnoses. We estimated mortality risks, adjusting for demographic and physical health factors. ResultsHaving SMI or SUD was associated with higher odds of death (adjusted odds ratio = 1.87) and an average 6.3 years of earlier death relative to comparison individuals. Co-occurring SMI and SUD conferred higher mortality risk from major natural and unnatural causes than did SMI with no SUD. ConclusionsSome indicators of premature mortality were lower than those reported for U.S. public mental health consumers, but risk level varied widely by diagnosis. While patients' having insurance and broad access to care may lower risk, access to care may be insufficient to overcome the many patient-, provider-, and system-level factors contributing to poor physical health in SMI and SUD.

Principles and Strategies for Developing Effective Psychosocial Treatments for Persons with Intellectual Disabilities with Co-occurring Severe Mental Illness: Clinical Case Examples Based Evidence

Principles and Strategies for Developing Effective Psychosocial Treatments for Persons with Intellectual Disabilities with Co-occurring Severe Mental Illness: Clinical Case Examples Based Evidence

Cost-Effectiveness of a PTSD Intervention Tailored for Individuals With Severe Mental Illness.

This study examined the cost-effectiveness of a cognitive-behavioral therapy (CBT) intervention for posttraumatic stress disorder (PTSD) that is tailored for adults with a co-occurring severe mental illness. Data were from a randomized trial involving 183 adult clients of two outpatient clinics and three partial hospitalization programs. All had a severe mental illness diagnosis (major mood disorder, schizophrenia, or schizoaffective disorder) and severe PTSD. Participants were randomly assigned to the tailored 12- to 16-session CBT intervention for PTSD (CBT-P) or a three-session breathing retraining and psychoeducation intervention (BRF). Cost estimates included intervention costs for training, supervision, fidelity assessment, personnel, and overhead and related mental health care costs for outpatient, inpatient, and emergency department services and for medications. The incremental cost-effectiveness ratio comparing CBT-P with BRF measured the added cost or savings per remission from PTSD at 12 months postintervention. Generalized linear models were used to estimate intervention effects on annual mental health care costs and the likelihood of a remission from PTSD. Ten thousand bootstrap replications were used to assess uncertainty. Annual mean mental health care costs were $25,539 per client (in 2010 dollars) for BRF participants and $29,530 per client for CBT-P participants, a nonsignificant difference. The mean incremental cost-effectiveness ratio was $36,893 per additional PTSD remission yielded by CBT-P compared with BRF (95% confidence interval=-$33,523 to $158,914). Remissions were associated with improvements in quality of life and functioning. An effective CBT intervention tailored for adults with severe mental illness and PTSD was not found to be more cost-effective than a brief three-session intervention.

Personality in patients with substance use disorders according to the co-occurring severe mental illness: A study using the alternative five factor model

Personality plays an important role in individuals with Substance Use Disorder (SUD) and co-occurring Severe Mental Illness (SMI). However, the possible personality differences in SUD patients considering their co-occurring SMI remain unknown. We explored the personality in a sample of 104 male patients with SUD and SMI: 35 had co-occurring Schizophrenia (SZ+), 32 had Bipolar Disorder (BD+), and 35 had Major Depressive Disorder (MDD+). We followed the Alternative Five Factor Model and used the Zuckerman-Kuhlman Personality Questionnaire. Moreover, we examined the relationship among SUD and SMI variables, and personality. The type of co-occurring SMI modulates the Neuroticism-Anxiety, Sociability, and Impulsivity Sensation-Seeking personality traits. BD+ patients were characterized by a higher Neuroticism-Anxiety than MDD+, and a higher Impulsivity Sensation-Seeking than SZ+ and MDD+. Manic symptoms were positively linked to Neuroticism-Anxiety for BD+. Patients with SZ+ showed a lower Sociability than BD+, and an older age of SUD onset was related to a higher sociability for SZ+. Overall, SUD treatment for BD+ patients should emphasize strategies to manage negative emotions and impulsivity. Our results underline the importance of a dimensional understanding of personality among patients with SUD and co-occurring SMI, which could inform of specific approaches to improve their treatment and prognosis.

Predictors of Incarceration Among Urban Adults With Co-Occurring Severe Mental Illness and a Substance Use Disorder

People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders. This secondary analysis used data from a randomized controlled trial of assertive community treatment versus standard case management. In the parent study, researchers interviewed 198 people with co-occurring disorders from two urban mental health centers in Connecticut at baseline and every six months for three years. Researchers tracked incarceration, clinical engagement and status, employment, living situation, social relationships, and substance use. The study reported here used bivariate analyses and logistic regression analyses to compare individuals who were incarcerated during the study period with those who were not. The overall incarceration rate was 38% during the study period. In multivariate analyses, prior incarceration predicted incarceration during the study period (odds ratio [OR]=3.26). Two factors were associated with a reduced likelihood of incarceration: friendships with individuals who did not use substances (OR=.19) and substance use treatment engagement (OR=.60). Positive social relationships and engagement in substance use treatment are promising service and policy targets to prevent incarceration in this high-risk population.

Trends in Hospital Discharges and Dispositions for Episodes of Co-occurring Severe Mental Illness and Substance Use Disorders

This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short- or long-term facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services.

The Need to Develop Innovative Interventions to Improve Treatment Adherence in Co-Occurring Severe Mental Illness and Substance Use Disorders

Treatment nonadherence is a significant public health problem that spans medical and psychiatric populations, adding billions of dollars to healthcare costs [1]. Patients with chronic and severe mental illness (SMI), such as schizophrenia and bipolar disorder, as well as those with substance use disorders (SUDs) tend to exhibit high rates of nonadherence (e.g., 50% or greater) to their medication and psychosocial treatments [2-7]. Not surprisingly, then, nonadherence rates tend to be highest in SMI patients who also abuse drugs or alcohol compared with noncomorbid patients [8]. Nonadherence in co-occurring SMI and SUDs produces a host of negative consequences, including increased rates of relapse, hospitalization, suicide, and functional impairment [5,9-11]. Abrupt withdrawal from psychotropic medications for SMI can lead to a quick return of symptoms that is not just attributable to the original illness, but also due to potential rebound effects associated with withdrawal from medications [12,13]. Furthermore, premature treatment drop out averages 50% within the first few weeks of SUD treatment [4-6], which prevents early intervention that can alter illness trajectories and provide needed course corrections prior the development of clinical crises. Nonadherence also contributes to the so-called “efficacy-effectiveness gap” [14]. We spend large amounts of money and resources developing efficacious mental health treatments, but these interventions will have little public health impact unless patients view them as acceptable and adhere to them.

Course of Smoking and Quit Attempts Among Clients With Co-occurring Severe Mental Illness and Substance Use Disorders

Course of Smoking and Quit Attempts Among Clients With Co-occurring Severe Mental Illness and Substance Use Disorders

Course of Smoking and Quit Attempts Among Clients With Co-occurring Severe Mental Illness and Substance Use Disorders

Approximately three-quarters of people with severe mental illnesses smoke cigarettes, and the rate is even higher among those with co-occurring substance use disorders. This longitudinal study explored patterns of cigarette use and cessation attempts among mental health clients with co-occurring disorders. Clients participating in a longitudinal study of co-occurring disorders (N=174) were assessed yearly over 11 years for smoking and smoking cessation behaviors, psychiatric symptoms, and other substance use, as well as social, occupational, and other characteristics. Generalized linear mixed-effects models were used to examine smoking cessation outcomes. Eighty-nine percent of participants were current smokers at baseline. Seventy-five percent of participants tried to quit at least once over the 11 years of the study, although none received nicotine replacement therapy or bupropion. Only 17% were not smoking at the 11-year follow-up. The presence of a chronic general medical condition predicted a longer duration of not smoking in the past year. Being male and having a high school education or higher were associated with more attempts to quit smoking, as were higher scores on the activation subscale of the Brief Psychiatric Rating Scale, more social contact with non-substance-using friends, and more daily activities. Although many clients with co-occurring serious mental illness and substance use disorders tried to quit each year, few achieved sustained abstinence and none used evidence-based interventions (nicotine replacement therapy or bupropion). Treatment providers need to administer evidence-based interventions to help people quit successfully.

Community rehabilitation for schizophrenia patients: Is it feasible in South Africa?

No abstract available.

Risk of Reincarceration Among Prisoners with Co-occurring Severe Mental Illness and Substance Use Disorders

This study examined whether the presence of a comorbid substance use disorder increased the risk of criminal recidivism and reincarceration in prison inmates with a severe mental illness. Our analyses of more than 61,000 Texas prison inmates showed that those with a co-occurring psychiatric and substance use disorder exhibited a substantially higher risk of multiple incarcerations over a 6-year period compared to inmates with psychiatric disorders alone or substance use disorders alone. Further research is needed to identify the factors associated with criminal recidivism among released prisoners with co-occurring disorders.

Application of the Transtheoretical Model of change: Psychometric properties of leading measures in patients with co-occurring drug abuse and severe mental illness

People with severe mental illness (SMI) have high rates of substance use disorders. The Transtheoretical Model (TTM) is a framework for understanding behavior change. There are five leading measures associated with the TTM — University of Rhode Island Change Assessment, Processes of Change Scale, Decisional Balance Scale, Abstinence Self-Efficacy Scale, and Temptation to Use Drugs Scale. While these measures have been found to be reliable and valid in primary substance abusers, it is unknown if these measures are relevant in people with co-occurring SMI and substance use disorders (SUD). We evaluated the psychometric properties of these measures in a sample ( n = 240) of people with co-occurring disorders. Participants met DSM-IV criteria for schizophrenia/schizoaffective disorder or non-psychotic affective disorder, and current cocaine dependence or cocaine dependence in remission. All subscales showed good reliability and validity in the total sample. Analyses within diagnostic groups showed good reliability and validity in most groups, with some falling off in the affective disorders and remitted cocaine dependence groups. Overall, findings support the use of these measures in people with co-occurring disorders.

Evolving U.S. service model for patients with severe mental illness and co-occurring substance use disorder.

Co-occurring severe mental illness and substance use disorder has been recognized as a common problem in the U.S. since the early 1980s (1-3). For these individuals with co-occurring disorders, research demonstrates the effectiveness of various forms of combining, blending, or integrating mental health and substance abuse treatments (4). The evolving U.S. service model for integrated dual disorders treatment emphasizes several key elements: implementation, leadership, training, engagement, assessment, counseling for all patients, ancillary treatments for those with multiple needs, secondary treatments for patients who are nonresponders, and quality assurance regarding process and outcomes.

Co-occurring severe mental illness and substance use disorders: a review of recent research.

Understanding the complex diagnostic and treatment issues posed by the co-occurrence of severe mental illness and substance use disorders has become a necessary exercise in current psychiatric practice. The authors reviewed research studies from the past six years that have contributed to our knowledge about effective assessment, diagnosis, course of illness, and treatment approaches. Research on special populations, including women, persons infected with HIV, and violent patients, is highlighted. PsycINFO, Silver Platter, and MEDLINE were used to search for English-language studies published in the United States and other countries. To augment the search, selected bibliographies were reviewed with a focus on clinical standards. Information was sought on epidemiology, screening and assessment strategies, course of illness, models of treatment delivery, and cost of care. Although estimates of the prevalence of substance use disorders vary by population, a higher prevalence among persons with severe mental illness has been confirmed. Routine screening for and assessment of substance use disorders among persons with severe mental illness has become the accepted standard of care. The course of severe mental illness is negatively influenced by a substance use disorder, and an integrated approach to the treatment of both disorders is generally accepted to be the most promising treatment strategy. Components of this strategy include harm reduction, treatment in stages, motivational interviewing, cognitive-behavioral interventions, and modified 12-step self-help groups.