Diagnosis Of Serious Mental Illness Research Articles

Choice Matters: The Moderating Effect of Choice on the Relationship Between Mental Health Personal Recovery and Symptomatology

PurposeLimited research examines how choice surrounding treatment impacts mental health recovery among young adults with serious mental illness (SMI) who are navigating symptom management, complex mental health systems, and developmental expectations of increased independence. This study examines whether perceived choice related to mental health treatment impacts the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI. MethodsSurveys were conducted with 121 young adults with SMI attending a community-based personal recovery-oriented program. Data included covariates (demographics and social support), psychiatric symptomatology, personal recovery, and choice. Ordinary least squares regressions tested whether choice predicts symptomatology and personal recovery, and whether choice moderates the relationship between symptomatology and personal recovery. ResultsMost participants were Black, Latino/e, or multiracial (96%) and male (67%) with an SMI diagnosis receiving services through Medicaid. Holding demographics and social support constant, a strong sense of choice was positively associated with personal recovery, (χ2 (7, N = 112) = 17.5, p = .01), but not symptomatology (χ2 (7, N = 112) = 12.5, p = .09). Furthermore, perceived choice moderated the relationship between symptomatology and personal recovery (β = −0.48, 95% CI [-0.79, −0.17], p = .012), where the association between symptomatology and personal recovery ceased to exist at lower levels of perceived choice in treatment. DiscussionThis study suggests perceived choice can influence the relationship between symptomatology and personal recovery among Black, Latino/e, and multiracial young adults with SMI. Implications for clinical practice include further evidence for enhancing shared decision-making and transition-focused care for young adults of color.

Associations between household overcrowding and adult mental illness in an ethnically diverse urban population: cross-sectional study using linked primary care and housing records.

ObjectiveWe hypothesised that adults living in overcrowded households were more likely to be diagnosed with Serious Mental Illness (SMI) or depression after accounting for individual, household and area-level factors. ApproachWe linked primary care records of adults currently registered with all general practices in the north-east London region on 21/03/2021 to housing data using pseudonymised unique property reference numbers (pUPRNs), giving a sample of 762,718 adults in 329,948 households. Primary outcomes were a primary care diagnosis of SMI or depression. Overcrowding was defined as <32.5m2 per person. We estimated the adjusted odds (aOR) and 95% confidence intervals (CI) of SMI or depression when living in an overcrowded household, adjusting for individual (age, sex, ethnic group), household (size, composition), and area (Index of Multiple Deprivation) characteristics. We conducted logistic regression models with robust standard errors in RStudio. ResultsSMI and depression were diagnosed in 6,492 (0.9%) and 45,053 (5.9%) adults respectively; 584,515 (76.6%) adults lived in overcrowded households. In univariable analyses, household overcrowding was inversely related to risk of SMI or depression (aOR[CI]: 0.42 [0.39,0.44]; 0.62 [0.61,0.64]). The direction of effect reversed on adjustment for household size, composition, and area-level deprivation: 1.22 [1.12,1.33]; 1.07 [1.04,1.10] for SMI and depression respectively. ConclusionsWe found significant associations between SMI and depression and household overcrowding, using a novel method of record linkage to estimate household overcrowding but are not able to establish causality of observed associations in this cross-sectional study. ImplicationsMore research is needed to understand how housing conditions affect mental health.

The Impact of the Global Pandemic on Veterans with Serious Mental Illness (SMI): Healthcare Utilization and Mortality.

Individuals with serious mental illness (SMI) experience barriers to accessing and engaging with healthcare, which may have been exacerbated during the emergence of the global pandemic and the rapid shift to telemedicine platforms, substantially decreasing healthcare utilization for non-COVID-19 disorders. Important repercussions on morbidity and mortality may be seen in the months and years to come, which may disproportionately affect high-risk populations, such as patients with SMI, with reduced access to technology platforms. In this study, we explored the impact of the pandemic on healthcare utilization and all-cause mortality rate in SMI compared to non-SMI individuals for the months of March-September 2020 and the same two quarters in 2019. Data were obtained from the VA Corporate Data Warehouse (CDW), a data repository from clinical and administrative VA systems. The sample included veterans with ≥1 outpatient clinical encounter nationally between 1 January 2019 and 31 December 2020. The cohort for this study included 1,018,047 veterans receiving care through the Veterans Health Administration between 2019 and 2020. Of those, 339,349 had a diagnosis of SMI. Patients with SMI had a significantly larger pre-post-pandemic decrease in outpatient (49.7%, p < 0.001), inpatient (14.4%, p < 0.001), and ED (14.5%, p < 0.001) visits compared to non-SMI patients. Overall, 3752 (1.59%) veterans without SMI and 4562 (1.93%) veterans with SMI died during our observation period. Veterans without SMI who died during the observation period were more likely to have had a positive COVID-19 test compared to veterans with SMI. Unadjusted analyses showed that veterans with SMI were approximately 2.5 times more likely to die than veterans without SMI during the first 6 months of the pandemic, compared to the same two quarters of the previous year. However, after adjustment by pertinent covariates, the predictors associated with an increased risk of death from SMI were older age, being male, a higher CAN score, more inpatient stays in the pre period compared to post, and a positive COVID-19 test. Consistent with our initial hypothesis, all the indices of healthcare utilization, namely the number of outpatient, inpatient, and ED visits, significantly decreased between pre- and post-pandemic and did more so for veterans with SMI, despite having more chronic medical illnesses and being prescribed more medications than veterans without SMI. On the other hand, while mortality was greater post-pandemic, factors such as age, morbidity, and having a positive COVID-19 test predicted mortality above and beyond having an SMI diagnosis.

Serious Mental Illness in Assisted Living Communities: Association with Nursing Home Placement

ObjectivesAssess prevalence of serious mental illness (SMI) alone, and co-occurring with Alzheimer disease and related dementias (ADRD), among Medicare beneficiaries in assisted living (AL). Examine the association between permanent nursing home (NH) placement and SMI, among residents with and without ADRD. Design2018-2019 retrospective cohort of Medicare beneficiaries in AL. Residents were followed for up to 2 years to track their NH placement. We used data from the Medicare Enrollment Database, the Medicare Beneficiary Summary File, Minimum Data Set, and a national directory of state-licensed AL communities. AL residents were identified using a validated, previously reported 9-digit zip code methodology. Setting and ParticipantsA cross-sectional study sample included 289,350 Medicare beneficiaries in 17,265 AL communities across 50 states and in the District of Columbia. MethodsThe outcome was permanent NH placement: a continuous stay for more than 90 days. Key independent variable was presence of SMI—schizophrenia, bipolar disorder, and major depression. Other covariates included sociodemographic factors and presence of other chronic conditions, including ADRD. A linear probability model with robust SEs, and AL-level random effects, was used to test the association between SMI diagnoses, ADRD, and their interactions on NH placement. ResultsMore than half (55.65%) of AL residents had a diagnosis of SMI, among them 93.2% had major depression, 28.5% schizophrenia, and 22.2% bipolar disorder. Individuals with schizophrenia and bipolar disorder had a significantly lower probability of NH placement, a 32% and a 15% decrease relative to the cohort mean, respectively. Placement risk was significantly greater for residents with ADRD compared to those without, increasing for those who also had schizophrenia or bipolar disorder, 12.9% and 1.5% relative to the sample mean, respectively. Conclusion and ImplicationsPresence of schizophrenia and bipolar disorder, in conjunction with ADRD, significantly increases the risk of long-term NH placement, suggesting that ALs may not be well prepared to care for these residents.

Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness.

To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.

Participation limitations as a transdiagnostic feature in serious mental illness: confirmatory modeling

IntroductionParticipation in daily life occupations of personal and community meaning is an important component of health and recovery from mental illness. Limitations in participation were found to be a hallmark of serious mental illness (SMI). Still, previous research has mainly focused on objective dimensions of participation, largely neglecting the subjective aspects that hold particular relevance for health outcomes. Next, participation was addressed by specific diagnoses, approach which is divergent from the recovery model, a transdiagnostic approach and clinical practice. Hence, further research into participation is warranted to broaden our understanding.ObjectivesWe investigated objective and subjective patterns of participation across a range of SMI diagnoses to delineate differences, and to identify personal and illness-related factors associated with participation dimensions.MethodsA secondary analysis of cross-sectional studies (N=14). The analysis included data from 489 men (40.7%) and women (59.3%) diagnosed with one of 4 SMI conditions: psychotic, affective (AD), post-traumatic (PTSD) or personality (PD) disorders. The participants were aged 18 to 60 (M=34.41; SD=10.9) and were in contact with intensive mental health services. All participants completed the Adult Subjective Assessment of Participation (ASAP), which comprised participation intensity, diversity, satisfaction and enjoyment, and standard evaluations of cognitive functioning, symptom severity, and functional capacity. Z-scores were calculated for independent variables to enable comparison. Demographic and illness-related (IR) information was also collected.ResultsFrequency of participation was found to be significantly different between diagnostic groups, but not participation diversity, enjoyment and satisfaction. Participation diversity was altered by range of demographic variables (5.26&lt;F&lt;10.6, p&lt;.01, 0.3&lt;&lt;0.4) while participation frequency differs by employment status (t (485) =-2.84, p&lt;0.05, Cohen’s d=0.25). No differences were found between groups in symptoms’ severity. Regression analysis indicates that cognition, functional capacity and employment status explain in a significant way integrated index of objective participation (χ2 =47.52, p&lt;0.001). For the subjective dimension, the logistic regression was not found statistically significant (χ2 =20.99, p=0.51).ConclusionsLimitations in diversity, enjoyment and satisfaction with participation, were demonstrated to be a transdiagnostic feature in SMI. Objective participation dimensions can be explained with demographic, personal and illness related factors, while modeling of subjective dimensions should be further investigated.Disclosure of InterestNone Declared

Reproductive psychiatric advance directives: promoting autonomy for perinatal people with serious mental illness diagnoses.

People with serious mental illness (SMI) diagnoses who become pregnant are particularly vulnerable to symptom recurrence and resulting potential lack of decision-making capacity (Taylor et al. J Psychiatr Res 104:100-107, 2018; Bagadia et al. Int J Soc Psychiatry 66:792-798, 2020). In these situations, prenataland behavioral health providers have little legally viable guidance on what medical and/or psychiatric care the patient desires (Aneja and Arora Indian J Med Ethics V:133-139, 2020). We created a "Reproductive Psychiatric Advance Directive (PAD)," grounded in Reproductive Justice principles, that promotes patient autonomy by proactively articulating perinatal medical and psychiatric care preferences. We conducted a medical and legal literature review using two sets of terms related to (1) PADs and (2) reproductive health. We convened an expert working group of legal, medical, psychiatric, peer, and advocacy leaders and community-based organizations to develop a Reproductive PAD. Our literature review yielded no results about Reproductive PADs. We created de novo a Reproductive PAD template with sections on medical and psychiatric history, informed consent for critical medical and psychiatric care, family planning and custody preferences, and optional sections on abortion and on electroconvulsive therapy. The Reproductive PAD provides a possible legal mechanism for people of childbearing age with SMI diagnoses to articulate their medical and psychiatric care choices around reproduction and pregnancy. Future research should evaluate the Reproductive PAD as an effective tool for protecting patient autonomy during pregnancy and postpartum and guiding medical and psychiatric providers.

BRIDGE: A randomized trial of person-centered collaborative care for adults with serious mental illness (SMI) and newly diagnosed cancers.

216 Background: Individuals with SMI experience increased cancer mortality due to inequities in cancer care. Proactive psychiatry care may improve cancer care outcomes for patients with SMI, yet access to mental health care remains inadequate. The BRIDGE trial assessed the impact of person-centered collaborative care vs enhanced usual care (EUC) on cancer care disruptions for adults with SMI and newly diagnosed cancers. Methods: Eligible patients had SMI (schizophrenia spectrum, bipolar, or severe major depressive disorders) and potentially curable head/neck, lung, breast, or gastrointestinal cancers. Patients were randomized 1:1 to BRIDGE (person-centered collaborative care: proactive psychiatry consultation, linkage to a social work/navigator team, and co-management with oncology across care settings) or EUC (proactive identification at cancer diagnosis using an algorithm to inform the oncology team of the SMI diagnosis and patient of psychosocial resources). The primary outcome was clinically significant cancer care disruptions over 24 weeks (delays in treatment initiation, deviations from guideline-concordant care recommended/received, or interruptions in planned cancer treatment). Oncologists blinded to intervention arm determined the presence of disruptions (yes/no) using NCCN guidelines; discrepancies were resolved by a consensus panel. Secondary outcomes included psychiatric illness severity according to the Brief Psychiatric Rating Scale (BPRS), Clinical Global Severity (CGI), and depression/anxiety measures (Patient Health Questionnaire [PHQ] 9, Generalized Anxiety [GAD] 7) at 24 weeks. The rate of disruption was compared using Fisher’s exact test, and secondary outcomes were compared using ANCOVA and logistic regression. Results: From May 2019-December 2021,120 of 141 eligible patients enrolled in the trial. Participants had a mean age of 63 years, were 65% female, 87.5% reported White race, 52.5% had income &lt;25,000, 51.7% had Medicaid, 38.3% were on disability, 39.4% reported current smoking, and 49% reported past/current substance use disorder. Patients assigned to BRIDGE were significantly less likely to experience cancer care disruptions compared to those receiving EUC (17.2% vs 35.1%, p=.035). BRIDGE patients had significantly improved psychiatric illness severity and anxiety (BPRS: 31.91 vs 36.65, p=.02; CGI: 15% vs 25%, p=.02; GAD: 4.86 vs 6.86, p=.02) compared to EUC patients. Differences in PHQ were not significant (6.62 vs 7.72, p=.28). Conclusions: In this randomized trial of person-centered collaborative care for adults with SMI and cancer, the BRIDGE intervention led to significantly fewer disruptions in cancer care and improvement in psychiatric illness severity. Findings support the need for multi-site trials that include community settings to enhance generalizability. Clinical trial information: NCT03360695 .

Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.

Individuals with schizophrenia exposed to second-generation antipsychotics (SGA) have an increased risk for diabetes, with aripiprazole purportedly a safer drug. Less is known about the drugs' mortality risk or whether serious mental illness (SMI) diagnosis or race/ethnicity modify these effects. Authors created a retrospective cohort of non-elderly adults with SMI initiating monotherapy with an SGA (olanzapine, quetiapine, risperidone, and ziprasidone, aripiprazole) or haloperidol during 2008-2013. Three-year diabetes incidence or all-cause death risk differences were estimated between each drug and aripiprazole, the comparator, as well as effects within SMI diagnosis and race/ethnicity. Sensitivity analyses evaluated potential confounding by indication. 38 762 adults, 65% White and 55% with schizophrenia, initiated monotherapy, with haloperidol least (6%) and quetiapine most (26·5%) frequent. Three-year mortality was 5% and diabetes incidence 9.3%. Compared with aripiprazole, haloperidol and olanzapine reduced diabetes risk by 1.9 (95% CI 1.2-2.6) percentage points, or a 18.6 percentage point reduction relative to aripiprazole users' unadjusted risk (10.2%), with risperidone having a smaller advantage. Relative to aripiprazole users' unadjusted risk (3.4%), all antipsychotics increased mortality risk by 1.1-2.2 percentage points, representing 32.4-64.7 percentage point increases. Findings within diagnosis and race/ethnicity were generally consistent with overall findings. Only quetiapine's higher mortality risk held in sensitivity analyses. Haloperidol's, olanzapine's, and risperidone's lower diabetes risks relative to aripiprazole were not robust in sensitivity analyses but quetiapine's higher mortality risk proved robust. Findings expand the evidence on antipsychotics' risks, suggesting a need for caution in the use of quetiapine among individuals with SMI.

Serious Mental Illness, Glycemic Control, and Neighborhood Factors within an Urban Diabetes Cohort.

Serious mental illness (SMI) may compromise diabetes self-management. This study assessed the association between SMI and glycemic control, and explored sociodemographic predictors and geographic clustering of this outcome among patients with and without SMI. We used electronic health record data for adult primary care patients with diabetes from 2 San Francisco health care delivery systems. The primary outcome was poor glycemic control (hemoglobin A1c >9.0%), which was modeled on SMI diagnosis status and sociodemographics. Geospatial analyses examined hotspots of poor glycemic control and neighborhood characteristics. The study included 11 694 participants with diabetes, 21% with comorbid SMI, of whom 22% had a schizophrenia spectrum or bipolar disorder. Median age was 62 years; 52% were female and 79% were Asian, Black, or Hispanic. In adjusted models, having schizophrenia spectrum disorder or bipolar disorder was associated with greater risk for poor glycemic control (vs participants without SMI, adjusted relative risk [aRR] = 1.24; 95% confidence interval, 1.02, 1.49), but having broadly defined SMI was not. People with and without SMI had similar sociodemographic correlates of poor glycemic control including younger versus older age, Hispanic versus non-Hispanic White race/ethnicity, and English versus Chinese language preference. Hotspots for poor glycemic control were found in neighborhoods with more lower-income, Hispanic, and Black residents. Poor diabetes control was significantly related to having a schizophrenia spectrum or bipolar disorder, and to sociodemographic factors and neighborhood. Community-based mental health clinics in hotspots could be targets for implementation of diabetes management services.

A qualitative evaluation of a telehealth healthy lifestyle intervention for people with serious mental illness.

There are high levels of nutritional and metabolic, cardiovascular, and respiratory tract diseases among people diagnosed with serious mental illness (SMI). Consequently, we developed a pragmatic, affordable nutritional and exercise intervention: Choices4Health. Due to the COVID-19 pandemic, we modified this intervention so it could be delivered online. The aim of this study was to explore the experience of participating in online Choices4Health, in a real-world clinical setting, from the perspectives of service users with SMI. The study aim was addressed using thematic analysis. Service users who had attended online Choices4Health, received a SMI diagnosis (defined as a schizophrenia spectrum disorder or an affective disorder), and resided in a South Dublin catchment were invited to participate. Nine participants were purposefully sampled. Semi-structured interviews were conducted by telephone. Data analysis was guided by thematic analysis procedures. Six themes were generated: Being ready and not overburdened (Engagement); Gaining knowledge and implementing it (Learning and doing); Viewing the intervention as appropriate and effective (Targeted impact); Being at home with others online (Belonging); Having a positive affective attitude towards the intervention (Feeling); and Perceiving problems with intervention delivery (Recommended change). Findings suggest that online Choices4Health is, broadly speaking, acceptable from a service user perspective, but that further refinement is required to address specific issues participants identified. These relate to follow-up or programme extension, technology access, in-person contact preference, and participant inclusion criteria. Further research is required into online Choices4Health efficacy, innovations to reduce digital exclusion, and managing group dynamics in telehealth interventions.

HbA1c recording in patients following a first diagnosis of serious mental illness: the South London and Maudsley Biomedical Research Centre case register

ObjectivesTo investigate factors associated with the recording of glycated haemoglobin (HbA1c) in people with first diagnoses of serious mental illness (SMI) in a large mental healthcare provider, and factors associated...

Quality of life and psychiatric distress in people with serious mental illness, the role of personal recovery.

When considering the personal recovery of people with serious mental illness (SMI), it is essential to examine their reported psychiatric distress and quality of life (QoL). However, there is no consolidated model in the literature that clearly relates these variables. In this study we first analysed the relationships between QoL, psychiatric distress and recovery, and several sociodemographic variables. Second, we analysed the linear effects of psychiatric distress and recovery on QoL. Third, and most important, we tested two hypotheses that considered personal recovery as a moderator or mediator of the relationship between psychiatric distress and QoL. 234 volunteers with a diagnosis of SMI completed three self-report questionnaires, The Recovery Assessment Scale-24, The World Health Organization QoL and the Clinical Outcomes in Routine Evaluation-Outcome Measure, which showed very good levels of validity and reliability. The PROCESS macro for SPSS developed by Hayes (Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, The Guilford Press, 2022) was applied using the Bootstrap method to verify our moderation and mediation hypotheses. We found a negative linear effect of psychiatric distress on QoL, as well as a positive effect of recovery on said variable. Our results do not confirm the moderating effect of recovery on the relationship between distress and QoL. However, we do confirm the second hypothesis; recovery functioned as a mediating variable between psychiatric distress and QoL. These findings allow us to reflect on how personal recovery affect the relationship between psychiatric distress and QoL and discuss its theoretical and practical implications as public policies.

TRENDS IN MENTAL ILLNESS ACROSS ASSISTED LIVING SETTINGS: RESIDENT AND COMMUNITY FACTORS

Abstract Although rates of serious mental illness (SMI), depression, and anxiety are becoming more common among assisted living (AL) and residential care (RC) residents, few studies have investigated resident and community-level factors to ensure that the settings and resources are adequate to meet residents’ mental health needs. Using a representative sample of Oregon AL/RC residents (n = 1,013), this study uses descriptive cross-sectional analysis to examine intrastate variation in the prevalence of SMI, depression, and anxiety related to: (1) resident-level characteristics (e.g., mental illness comorbidity, psychotropic medication use, and Medicaid status); (2) community-level characteristics (e.g., facility type and urban/rural geographic designation); and (3) health services utilization (e.g., emergency room visits and hospital admission). Results indicate that 12% of AL/RC residents had an SMI diagnosis, nearly half of whom also had depression and anxiety, and 80% were Medicaid eligible. One in six residents with SMI received at least three psychotropic medications in the last week. Residents with SMI were also more likely to live in RC facilities than AL facilities, in facilities with Medicaid contracts, and in urban rather than rural settings. Compared to residents without SMI, a larger share of residents with SMI utilized hospital emergency rooms (32% vs. 18%) and were admitted to the hospital overnight (15% vs. 9%). Findings underscore characteristics associated with potentially higher needs among AL/RC residents with SMI compared to their counterparts, with implications for the high quality provision of mental health services and quality of life and care in these settings.

Patients With Serious Mental Illness Can Engage in Tobacco Treatment Trials and Tobacco Cessation Interventions During Cancer Treatment.

More than half of individuals with serious mental illness (SMI) smoke, contributing to premature cancer mortality. A cancer diagnosis provides an opportunity to assist with smoking cessation; however, supportive oncology trials frequently exclude patients with SMI. To fill this gap, we examined differences in engagement and tobacco cessation in a pragmatic clinical trial. We recruited 303 participants from two National Cancer Institute-designated Comprehensive Cancer Centers, of which 10% had prior diagnoses of SMI (major depressive disorder, bipolar disorder, and schizophrenia spectrum disorders). We compared self-reported smoking behaviors, patient attitudes and beliefs about cessation, and rates of trial completion, engagement, and smoking abstinence among recently diagnosed patients with cancer with and without SMI. Six months after trial completion, we completed qualitative interviews on barriers and facilitators to tobacco cessation in a random sample of participants with SMI. Trial participants with SMI had similar motivation to quit smoking as those without SMI. Additionally, participants with SMI had a similar ability to engage in a tobacco treatment trial (6.5 counseling sessions completed v 7.3 sessions) and benefit from tobacco treatment as those without SMI (32.3% v 27.8% 6-month quit rates). Patients with cancer and SMI were able to engage in and benefit from a tobacco cessation trial integrated into cancer care. A cancer diagnosis provides an opportunity to assist patients with SMI with smoking cessation referrals and treatment. Pragmatic supportive oncology trials that include a diverse population of adults with SMI are needed to inform care delivery and improve cancer outcomes for patients with SMI and cancer.

Mother’s and Father’s Serious Mental Illness and Risk of Child Injury in a Taiwanese Birth Cohort

Objective: Parental serious mental illness (SMI) is associated with childhood injury. This study investigated whether child injury risk differs according to which parent is affected, SMI diagnosis, or timing of SMI onset.Methods: This cohort study included 1,999,322 singletons born in 2004-2014 identified from the national Taiwanese registries. General estimating equation Poisson models were used to estimate incidence rate ratios (IRRs) of injury events and hospitalizations before the age of 5 years among children according to which parent was affected, SMI diagnosis (schizophrenia [ICD-9-CM codes: 295, 297, 298.3, 298.4, 298.9], bipolar disorder [296.00-296.16, 296.40-296.81, 296.89-296.99, 298.1, 648.4], or major depressive disorder [MDD; 296.20-296.36, 296.82, 298.0]), and timing of diagnosis (before or after childbirth, as a proxy of timing of onset). Data analysis was performed on data obtained from April 20, 2017, to May 6, 2020.Results: Relative to unexposed children, the IRRs of injury hospitalizations for children with two SMI-affected parents, maternal SMI only, and paternal SMI only were 1.85 (95% CI, 1.38-2.48), 1.58 (95% CI, 1.48-1.68), and 1.34 (95% CI, 1.23-1.46), respectively. The IRRs of injury hospitalizations for maternal schizophrenia, bipolar disorder, and MDD were 2.09 (95% CI, 1.82-2.40), 1.77 (95% CI, 1.56-2.00), and 1.38 (95% CI, 1.26-1.50), respectively. The IRRs for paternal schizophrenia, bipolar disorder, and MDD were 1.39 (95% CI, 1.20-1.60), 1.61 (95% CI, 1.39-1.87), and 1.19 (95% CI, 1.05-1.36), respectively. The magnitude of excess risk was similar for children whose parent(s) experienced SMI diagnosed before and after childbirth.Conclusions: We found children with two SMI-affected parents or at least one parent with schizophrenia or bipolar disorder to be at greatest risk of severe injury requiring hospitalization. These parents may benefit from extra parenting support and injury prevention coaching.

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in Community Mental Health: Comorbidity and Use of Modules Under the Microscope

Sleep and circadian problems are intertwined with serious mental illness (SMI). Thus, optimizing treatments that target comorbid sleep and circadian problems and SMI is critical. Among adults with sleep and circadian problems and SMI, the present study conducted a secondary data analysis of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C targets a range of sleep and circadian problems and SMI with 15 modules, 7 of which are optional. In a real-world sample recruited from a community setting (N = 121, 52.07% female, 42.97% African American or Black), we aimed to (1) elucidate patterns of sleep and circadian problems that met criteria for full diagnoses and subdiagnostic symptoms across (a) the full sample and (b) SMI diagnoses; and (2) determine whether TranS-C optional modules were delivered as intended based on participants’ sleep and circadian problems. Results indicated that most participants (>85.0%) had full diagnoses or subdiagnostic symptoms of two or more sleep and circadian problems. Further, participants exhibited heterogeneous comorbidities between sleep and circadian problems and SMI diagnoses. Specifically, participants with a schizophrenia spectrum disorder (n = 50), bipolar disorder (n = 35), and major depressive disorder (n = 26) exhibited 25, 24, and 21 patterns of sleep and circadian comorbidity, respectively. Notably, most participants with insomnia, hypersomnia, and an advanced or delayed circadian rhythm phase disorder did not receive the intended TranS-C optional modules designed to target these problems. Results underscore sleep and circadian and SMI diagnostic complexity in the community. Additionally, findings reveal discrepancies between intended and real-world use of treatment modules. Future research investigating clinician decision-making—particularly when treating patients with comorbidities or using modularized treatments—is needed.

Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation.

Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.

Deinstitutionalization Through Optimism: The Community Mental Health Act of 1963.

Deinstitutionalization Through Optimism: The Community Mental Health Act of 1963.

Vascular surgery receipt and outcomes for people with serious mental illnesses: Retrospective cohort study using a large mental healthcare database in South London

ObjectiveVascular surgery can be common among people with serious mental illness (SMI) given the high prevalence of cardiovascular disease. However, post-operative outcomes following vascular surgery have received little investigation, particularly in a subpopulation of SMI. MethodsWe conducted a retrospective observational study using data from the South London and Maudsley NHS Foundation Trust (SLaM) via its Clinical Record Interactive Search (CRIS) platform and linkage with Hospital Episode Statistic (HES). Vascular surgery recipients were identified using OPCS version 4 codes. Length of stay (LOS) was modelled using Incidence Rate Ratios (IRRs), and 30-day emergency hospital readmissions using Odds Ratios (ORs) for people with SMI compared with the general population. ResultsVascular surgery was received by 152 patients with SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) and 8821 catchment residents without any mental health conditions. People with active SMI symptoms more likely to be admitted to hospital via emergency route OR: 1.80 (95% CI: 1.06, 3.07) and more likely to stay longer in the hospital for vascular surgery IRR: 1.35 (1.01, 1.80) and more likely to be readmitted to hospital via emergency route within 30 days OR: 1.53 (1.02, 2.67). People with SMI who had major open vascular surgery and peripheral endovascular surgery more likely to have worse post-operative outcomes. ConclusionOur study highlights the risks faced by people with SMI following vascular surgery. These suggest tailored guidelines and policies are needed, based on the identification of pre-operative risk factors, allowing for focused post-vascular surgery care to minimise adverse outcomes.