Mental Diagnoses Research Articles

Telemedicine catches on: changes in the utilization of telemedicine services during the COVID-19 pandemic

To determine the degree of telemedicine expansion overall and across patient subpopulations and diagnoses. We hypothesized that telemedicine visits would increase substantially due to the need for continuity of care despite the disruptive effects of COVID-19. A retrospective study of health insurance claims for telemedicine visits from January 1, 2018, through March 10, 2020 (prepandemic period), and March 11, 2020, through October 31, 2020 (pandemic period). We analyzed claims from 1,589,777 telemedicine visits that were submitted to Independence Blue Cross (Independence) from telemedicine-only providers and providers who traditionally deliver care in person. The primary exposure was the combination of individual behavior changes, state stay-at-home orders, and the Independence expansion of billing policies for telemedicine. The comparison population consisted of telemedicine visits in the prepandemic period. Telemedicine increased rapidly from a mean (SD) of 773 (155) weekly visits in prepandemic 2020 to 45,632(19,937) weekly visits in the pandemic period. During the pandemic period, a greater proportion of telemedicine users were older, had Medicare Advantage insurance plans, had existing chronic conditions, or resided in predominantly non-Hispanic Black or African American Census tracts compared with during the prepandemic period. A significant increase in telemedicine claims containing a mental health-related diagnosis was observed. Telemedicine expanded rapidly during the COVID-19 pandemic across a broad range of clinical conditions and demographics. Although levels declined later in 2020, telemedicine utilization remained markedly higher than 2019 and 2018 levels. Trends suggest that telemedicine will likely play a key role in postpandemic care delivery.

Hospitalisation patterns among children exposed to childhood adversity: a population-based cohort study of half a million children

Children who are exposed to adversities might be more susceptible to disease development during childhood and in later life due to impaired physiological and mental development. To explore this hypothesis, we assessed hospitalisation patterns through childhood and into adult life among those exposed to different trajectories of adversities during childhood. For this population-based cohort study, we used annually updated data from Danish nationwide registers covering more than half a million children (aged 0-15 years) born between 1994 and 2001. Children who were alive and resident in Denmark on their 16th birthday were included in the analysis. Cluster analysis was used to divide children into five distinct trajectories according to their experience of childhood adversities, including poverty and material deprivation, loss or threat of loss within the family, and aspects of family dynamics. To describe comprehensively the disease patterns experienced by these groups of children, we assessed the associations of each adversity trajectory with hospital admission patterns according to the entire spectrum of disease diagnoses in the International Classification of Diseases 10th edition, from birth to 24 years of age, using survival models. 508 168 children born between Jan 1, 1994, and Dec 31, 2001, were followed up until Dec 31, 2018, capturing more than 3·8 million hospital admissions from birth to early adulthood. Hospitalisation rates were consistently higher in all four adversity groups compared with the low adversity group. The high adversity group (14 577 children, 3%), who were exposed to adversities of deprivation, family loss, and negative family dynamics, had a markedly higher rate of hospitalisations across all ages. For example, we observed 243 additional hospital admissions per 1000 person-years (95% CI 238-248) in the high versus low adversity group for those aged 16-24 years. These associations were particularly strong for diagnoses related to injuries, unspecified symptoms, and factors influencing health service contacts (eg, health screening and observation). They also covered a considerable burden of respiratory and infectious diseases, congenital malformations, diseases of the nervous system (especially in early life), mental and behavioural diagnoses, and diagnoses related to pregnancy and childbirth in early adult life. The close linkage between childhood adversities and poor lifelong health outcomes highlights a need for public health and policy attention on improving the socioeconomic circumstances children are born into to prevent the early emergence of health inequalities. None.

Psychiatric and Substance Use Disorders and Related Service Use in the Diverse Black Sub-Populations in the United States.

Existing literature on the epidemiology of psychiatric and substance use disorders and service use among African Americans in the USA has not fully addressed the heterogeneity of Black populations. This study compares the proportions and diverse characteristics of these sub-populations, their mental and substance use diagnoses, and related service use. The data for this study was obtained from the restricted version of the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III). Participants who identified as Black/African Americans were categorized into four groups: African-born, Caribbean-born, US-born with at least one immigrant parent, and US-born with both parents born in the USA. Effect sizes were used to evaluate bivariate between-group differences and multinomial logistic regression analysis was used to identify factors that independently differentiated each of the first three groups from the reference group termed US-born. This exploratory analysis strengthened the notion of the immigrant paradox as African- and Caribbean-born Black individuals scored significantly higher on all measures of quality of life and had fewer mental health and substance use diagnoses, but this advantage was not observed in the children of immigrants born in the USA. There were few significant differences in service use across the groups after adjusting for clinical characteristics. The differences observed in the diverse Black populations of the USA, across measures of mental and physical health, and substance use, deserve attention in future research, policy, and program development.

Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations

Mental health conditions during delivery hospitalizations are not well characterized. This study aimed to characterize the prevalence of maternal mental health condition diagnoses and associated risk during delivery hospitalizations in the United States. The 2000 to 2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of women aged 15 to 54 years with and without mental health condition diagnoses, including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder, were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. The trends in chronic conditions associated with mental health condition diagnoses, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, were analyzed. The association between mental health conditions and the following adverse outcomes was determined: (1) severe maternal morbidity, (2) preeclampsia or gestational hypertension, (3) preterm delivery, (4) postpartum hemorrhage, (5) cesarean delivery, and (6) maternal mortality. Regression models for each outcome were performed with unadjusted and adjusted risk ratios as measures of effects. Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had ≥1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (average annual percent change, 11.4%; 95% confidence interval, 10.3%-12.6%). Among deliveries in women with a mental health condition diagnosis, chronic health conditions, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, increased from 14.9% in 2000 to 38.5% in 2018. Deliveries to women with a mental health condition diagnosis were associated with severe maternal morbidity (risk ratio, 1.88; 95% confidence interval, 1.86-1.90), preeclampsia and gestational hypertension (risk ratio, 1.59; 95% confidence interval, 1.58-1.60), preterm delivery (risk ratio, 1.35; 95% confidence interval, 1.35-1.36), postpartum hemorrhage (risk ratio, 1.37; 95% confidence interval, 1.36-1.38), cesarean delivery (risk ratio, 1.20; 95% confidence interval, 1.20-1.20), and maternal death (risk ratio, 1.31; 95% confidence interval, 1.12-1.56). The increased risk was retained in adjusted models. The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly throughout the study period. Mental health condition diagnoses were associated with other underlying chronic health conditions and a modestly increased risk of a range of adverse outcomes. The findings suggested that mental health conditions are an important risk factor in adverse maternal outcomes.

Somatic health care professionals\u2019 stigmatization of patients with mental disorder: a scoping review

BackgroundPatients with mental disorders have an increased risk of developing somatic disorders, just as they have a higher risk of dying from them. These patients often report feeling devaluated and rejected by health professionals in the somatic health care system, and increasing evidence shows that disparities in health care provision contribute to poor health outcomes. The aim of this review was to map and synthesize literature on somatic health professionals’ stigmatization toward patients with mental disorders.MethodsWe conducted a scoping review using Arksey and O’Malley’s framework and carried out a systematic search in three databases: Cinahl, MEDLINE, and PsycINFO in May–June 2019. Peer-reviewed articles published in English or Scandinavian languages during 2008–2019 were reviewed according to title, abstract and full-text reading. We organized and analyzed data using NVivo.ResultsA total of 137 articles meeting the eligibility criteria were reviewed and categorized as observational studies (n = 73) and intervention studies (n = 64). A majority of studies (N = 85) focused on patients with an unspecified number of mental disorders, while 52 studies focused on specific diagnoses, primarily schizophrenia (n = 13), self-harm (n = 13), and eating disorders (n = 9). Half of the studies focused on health students (n = 64), primarily nursing students (n = 26) and medical students (n = 25), while (n = 66) focused on health care professionals, primarily emergency staff (n = 16) and general practitioners (n = 13). Additionally, seven studies focused on both health professionals and students. A detailed characterization of the identified intervention studies was conducted, resulting in eight main types of interventions.ConclusionsThe large number of studies identified in this review suggests that stigmatizing attitudes and behaviors toward patients with mental disorders is a worldwide challenge within a somatic health care setting. For more targeted interventions, there is a need for further research on underexposed mental diagnoses and knowledge on whether specific health professionals have a more stigmatizing attitude or behavior toward specific mental disorders.

Quantifying self-quantification: A statistical study on individual characteristics and motivations for digital self-tracking in young- and middle-aged adults in Germany

This study presents a quantitative account of who uses or stops using digital self-tracking (ST). A representative sample of German adults aged 20–50 years ( N = 1022) completed an online survey on their ST practices, personality traits and attitudes toward numbers, on sociodemographic characteristics, mental disorders (particularly bulimia, burnout syndrome, and depression) and somatic disorders. A descriptive statistical analysis was performed on differences between self-trackers and non-trackers. Among others, they differ regarding age, civil status, social class, presence of mental and/or somatic diagnoses, performance-pressure, and strive for competition. A consequent binary logistic regression analysis suggests perfectionism, a somatic diagnosis within the last 5 years, a diagnosis of bulimia in the past, as well as a present mental diagnosis to be significant predictors for ST, though the predictive value of the factors was relatively low.

Workplace discrimination as risk factor for long-term sickness absence: Longitudinal analyses of onset and changes in workplace adversity.

Workplace discrimination may affect the health of the exposed employees, but it is not known whether workplace discrimination is also associated with an increased risk of long-term sickness absence. The aim of this study was to examine the longitudinal associations of changes in and onset of workplace discrimination with the risk of long-term sickness absence. Data on workplace discrimination were obtained from 29,597 employees participating in survey waves 2004, 2006, 2008 and/or 2010 of the Finnish Public Sector Study. Four-year changes in long-term sickness absence (≥10 days of medically certified absence with a mental or non-mental diagnosis) were assessed. This covered successive study waves in analyses of onset of workplace discrimination as well as fixed effect analyses of change in workplace discrimination (concurrent i.e. during the exposure year and 1-year lagged i.e. within one year following exposure), by using each employee as his/her own control. The risk of long-term sickness absence due to mental disorders was greater for employees with vs. without onset of workplace discrimination throughout the 4-year period, reaching a peak at the year when the onset of discrimination was reported (adjusted risk ratio 2.13; 95% confidence interval (CI) 1.80-2.52). The fixed effects analyses showed that workplace discrimination was associated with higher odds of concurrent, but not 1-year lagged, long-term sickness absence due to mental disorders (adjusted odds ratio 1.61; 95% CI 1.33-1.96 and adjusted odds ratio 1.02; 95% CI 0.83-1.25, respectively). Long-term sickness absence due to non-mental conditions was not associated with workplace discrimination. In conclusion, these findings suggest that workplace discrimination is associated with an elevated risk of long-term sickness absence due to mental disorders. Supporting an acute effect, the excess risk was confined to the year when workplace discrimination occurred.

36 Comparison of Mental Health Visits at a Military Treatment Facility Emergency Department Pre- And Post-COVID-19 Pandemic

There is a paucity of quantitative research regarding the effect of COVID-19 on emergency department (ED) visits in the United States, and specifically mental health-related ED visits. The small existing body of research describes an overall decline in ED visits worldwide; however, there are anecdotal reports that psychiatric complaints to the ED have increased during the pandemic. The primary objective of this study was to describe the volume of mental health ED visits at a single ED during the COVID-19 pandemic compared to previous years. This was a single-center, retrospective chart review of adult patients evaluated in the ED at an academic military medical facility from March-December of 2017-2020 for mental health. The electronic medical record was queried for 1,542 mental health ICD-10 diagnosis codes. Demographic data including age, sex, disposition, diagnosis, and beneficiary status were collected. Tests of association included Pearson Chi-square with Bonferroni correction for post-hoc tests and one-way ANOVA. There were a total of 1,486 mental health ED visits from March-December 2020, compared to an average of 1,668 visits from March-December 2017-2019. Statistically significant (p<0.05) differences, between 2020 and the prior three years combined, were identified in the categories of age, disposition, beneficiary status, and diagnosis. In 2020, there was a lower proportion of visits for patients aged ≥ 60 (1.2%) than in 2017-2019 (2.5%). Active duty patients comprised a lower proportion in 2020 (17.6%) versus 2017-2019 (23.0%). Proportionately fewer patients were admitted in 2020 (25.2%) versus 2017-2019 (29.2%). Adjustment disorders made up 19.0% of visits in 2020 versus 23.2% in 2017-2019 and suicidal ideation and intentional self-inflicted injury comprised 43.3% in 2020 compared with 40.4% in 2017-2019. There was a significant decline in ED visits for patients over the age of 60 and for active duty military patients. Overall, fewer patients were admitted compared to previous years. There was a significant increase in patients diagnosed with suicidal ideation and intentional self-inflicted injury in 2020 compared to previous years. The COVID-19 pandemic and associated quarantines have negatively affected mental health worldwide. Active duty military and elderly patients were uniquely impacted. Both groups have been subject to highly restrictive limitations during the pandemic. Alarmingly, this study shows increased rates of self-harm and suicidal ideation, yet a lower likelihood of these populations to present to the ED for mental health care. Further study is needed to determine why these effects were seen, and if there is a higher risk for suicide attempt or completion in these populations.

New-onset depression after colorectal cancer diagnosis: a population-based longitudinal study.

To date, no large studies examining the temporal relationship between colorectal cancer (CRC) and the subsequent development of depressive disorders exist. We aimed to assess the incidence of depression post-colorectal cancer (CRC) diagnosis. To conduct this longitudinal study, we searched the large US population-based database, Explorys (IBM), from January 1, 1999, to January 1, 2021. We investigated new-onset depression and its associated mortality as well as the role of the mental health provider post-CRC diagnosis. Confidence intervals were calculated for all outcomes and multivariate regression analysis was performed. Incident depression post-CRC diagnosis was 20.8 vs 8.9 per 100 person-years [OR 3.46, p < 0.0001] in the general population and conferred a 123% increased risk of all-cause mortality [P < 0.0001]. Male patients (OR: 1.89) were more likely to become depressed post-CRC diagnosis as compared to females. Moreover, the absolute number of male patients with post-CRC depression was significantly higher than that of females (68% vs 32%; P < 0.0001). In addition, depression after CRC was more common among Whites (OR: 1.68) and patients aged > 65years (OR: 5.17). Referral to a mental health provider resulted in significantly lower all-cause mortality (3.6% vs 26.9%; p < 0.0001). Our findings advocate for initiating depression screening for high-risk patients post-CRC diagnosis and prompt mental health provider referral.

Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

BackgroundThe Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders.MethodsThis was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance.ResultsOf the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register.ConclusionThere was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

Mental Healthcare Utilization of Transgender Youth Before and After Affirming Treatment

Transgender and gender-diverse (TGD) adolescents experience increased mental health risk compared to cisgender peers. Limited research suggests improved outcomes following gender-affirmation. This study examined mental healthcare and psychotropic medication utilization among TGD youth compared to their siblings without gender-related diagnoses and explored utilization patterns following gender-affirming care. This retrospective cohort study used military healthcare data from 2010-2018 to identify mental healthcare diagnoses and visits, and psychotropic medication prescriptions among TGD youth who received care for gender dysphoria before age 18, and their siblings. Logistic and Poisson regression analyses compared mental health diagnosis, visits, and psychotropic prescriptions of TGD youth to their siblings, and compared healthcare utilization pre- and post-initiation of gender-affirming pharmaceuticals among TGD adolescents. 3,754 TGD adolescents and 6,603 cisgender siblings were included. TGD adolescents were more likely to have a mental health diagnosis (OR 5.45, 95% CI [4.77-6.24]), use more mental healthcare services (IRR 2.22; 95% CI [2.00-2.46]), and be prescribed more psychotropic medications (IRR = 2.57; 95% CI [2.36-2.80]) compared to siblings. The most pronounced increases in mental healthcare were for adjustment, anxiety, mood, personality, psychotic disorders, and suicidal ideation/attempted suicide. The most pronounced increased in psychotropic medication were in SNRIs, sleep medications, anti-psychotics and lithium. Among 963 TGD youth (Mage: 18.2) using gender-affirming pharmaceuticals, mental healthcare did not significantly change (IRR = 1.09, 95% CI [0.95-1.25]) and psychotropic medications increased (IRR = 1.67, 95% CI [1.46-1.91]) following gender-affirming pharmaceutical initiation; older age was associated with decreased care and prescriptions. Results support clinical mental health screening recommendations for TGD youth. Further research is needed to elucidate the longer-term impact of medical affirmation on mental health, including family and social factors associated with the persistence and discontinuation of mental healthcare needs among TGD youth.

The role of familial confounding in the associations of physical activity, smoking and alcohol consumption with early exit from the labour market

We investigated the associations between health behaviors and sustainable working life outcomes including all-cause disability pension, disability pensions due to musculoskeletal and mental diagnoses and unemployment. The role of familial factors behind these associations was studied by analysing discordant twin pairs. Our data included Swedish twins born in 1925–1986 (51891 twin individuals). Baseline data based on two independent surveys in 1998–2003 and 2005–2006 for health behaviors were linked to national registers on disability pension and unemployment until 2016. Cox proportional hazards models for hazard ratios (HR) with 95% confidence intervals (CI) were estimated for the whole sample adjusting for covariates. Analyses of health behavior discordant twin pairs (n = 5903 pairs) were conducted using conditional Cox models. In the whole cohort, the combination of healthy behaviors was associated with lower risk for all-cause disability pension, disability pension due to musculoskeletal diagnoses or mental diagnoses, and for unemployment (HRs 0.56–0.86, 95% CIs 0.51–0.92) as did being physically active (HRs 0.69–0.87, 95% CI 0.65–0.92). The discordant pair analyses confirmed the lower risk among those having healthy behaviors (HR 0.70–0.86) or being physically active (HR 0.86–0.87) for all-cause disability pension, disability pension due to musculoskeletal diagnoses, and for unemployment. To conclude, controlling the effects of covariates or familial confounding (i.e. discordant twin pair analyses) shows that being physically active or having several healthy behaviors predict better working life outcomes. This points towards independent association between healthy behavior and longer working life.

Abstract 900: Mental health disorders among ovarian cancer survivors in a population-based cohort

Abstract Ovarian cancer is the fifth most common female cancer in the United States. Although there have been many studies on self-reported QOL among ovarian cancer patients, there have been very few studies investigating mental disease diagnoses among ovarian cancer survivors with long term follow up. The aim of this study is to examine the incidence of mental illness among ovarian cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for mental illnesses among ovarian cancer survivors. Cohorts of 1,689 ovarian cancer patients diagnosed between 1996 and 2012 and 7,038 women without cancer matched by age, birth state and follow up time from the general population were identified. Mental health diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Ovarian cancer survivors experienced increased risks of mental illnesses within the first two years after cancer diagnosis (HR=3.48, 95%CI=2.98-4.05) compared to the general population. The risks of depression among ovarian cancer survivors were 3-fold within the first two years of cancer diagnosis (HR=3.11, 95%CI=2.53-3.83), and 1.67-fold at 2-5 years after cancer diagnosis (HR=1.67, 95%CI=1.17-2.38). The risk of anxiety disorder among ovarian cancer survivors was 3.54-fold at 0-2 years (HR= 3.54, 95% CI= 2.87-4.38), and 1.86-fold at 2-5 years (HR= 1.86, 95% CI= 1.14-3.01). Elevated risk for adjustment disorders was observed among ovarian cancer survivors compared with the general population cohort between 0-2 years (HR= 3.96, 95% CI= 1.00-15.84) and between 2-5 years (HR= 3.96, 95% CI= 1.00-15.84). Cancer treatment and later diagnosis year were associated with increased risk of any mental illness at 0-2 years after cancer diagnosis among ovarian cancer survivors. Distant-stage cancer was an important risk factor compared to early-stage for both mental illness and depression among ovarian cancer survivors in all time periods. Ovarian cancer patients who had a mucinous histology subtype had 47% decreased risk of any mental illness and 67% decreased risk of depression at 0-2 years, compare to those with high-grade serous histology subtype. In addition, a baseline CCI score of 1+ and older age at diagnosis (&amp;gt;60 years old) were important for the increased risk of depression at 0-2 years or &amp;gt;5 year after cancer diagnosis, respectively. Ovarian cancer survivors experienced an 80% increased risk of death with a mental illness diagnosis (HR=1.80, 95% CI=1.48-2.18) and a 94% increased risk of death with a depression diagnosis (HR=1.94, 95% CI=1.56-2.40).Higher risks of mental illnesses were observed among ovarian cancer survivors throughout the follow-up periods of 0-2 years and 2-5 years after cancer diagnosis. Multidisciplinary care is needed to monitor and treat mental illnesses among ovarian cancer survivors. Citation Format: Siqi Hu, David Baraghoshi, Esther Chang, Kerry Rowe, John Snyder, Vikrant Deshmukh, Michael Newman, Alison Fraser, David Gaffney, Ken Smith, Kimberly Herget, Anita Peoples, Mia Hashibe. Mental health disorders among ovarian cancer survivors in a population-based cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 900.

Sickness absence and disability pension among injured car occupants, and associations with injury and car safety factors: A prospective cohort study

ObjectiveKnowledge regarding sickness absence (SA) and disability pension (DP) following a road traffic injury, is lacking. The aim of this study was to investigate SA and DP among injured car occupants before and after a crash, accounting for permanent medical impairment (PMI). Further, to explore associations between injured body region, car model year of introduction (MYI), and European New Car Assessment Programme (Euro NCAP) safety rating and number of SA/DP days in year two and four following the crash date. MethodsA longitudinal cohort study including 63,358 individuals injured when aged 17–62, in crashes occurring 2001–2013 and involving a car insured by the Folksam Insurance Group.Mean numbers of SA/DP net days per year were calculated, in total and by injury diagnosis category, for all, for those with SA or DP with the same diagnosis as the initial injury, and for those with and those without injuries resulting in PMI.Logistic regressions were performed to calculate odds ratios with 95% confidence intervals for having 90–180 or ≥181 combined SA/DP days, respectively, among those with injury diagnoses, in year two and four after the crash. Associations with injured body region, car model introduction year, and Euro NCAP star ratings, was investigated, with adjustments made for sociodemographics. ResultsThe mean number of SA/DP days/year was higher in the years following the crash (56–50 days) compared to the year prior (41). In year one and two the increase in days was mainly with SA due to injury diagnoses and musculoskeletal diagnoses, and in year three and four, with DP due to injury diagnoses, musculoskeletal diagnoses, and mental diagnoses, respectively. Individuals whose injuries resulted in PMI had more future SA/DP days compared to those without PMI.Individuals with injuries to the torso/back and with multiple injuries were more likely to have > 180 SA/DP days both year two (2.9 and 2.2 times, respectively) and year four (2.0 and 1.6 times), compared to individuals with head injuries. Injured occupants in Euro NCAP 2–3-star rated cars as well as in untested cars, were more likely to have > 180 days in year four (1.4 and 2.0 times, respectively), compared to 4–5 stars. ConclusionHigher levels of SA/DP remained throughout the four years following the crash, with substantial differences between those with PMI and those with no PMI. Low overall car safety level, injuries to the torso/back, and multiple injuries were associated with high SA/DP.

Utterance Level Feature Aggregation with Deep Metric Learning for Speech Emotion Recognition.

Emotion is a form of high-level paralinguistic information that is intrinsically conveyed by human speech. Automatic speech emotion recognition is an essential challenge for various applications; including mental disease diagnosis; audio surveillance; human behavior understanding; e-learning and human–machine/robot interaction. In this paper, we introduce a novel speech emotion recognition method, based on the Squeeze and Excitation ResNet (SE-ResNet) model and fed with spectrogram inputs. In order to overcome the limitations of the state-of-the-art techniques, which fail in providing a robust feature representation at the utterance level, the CNN architecture is extended with a trainable discriminative GhostVLAD clustering layer that aggregates the audio features into compact, single-utterance vector representation. In addition, an end-to-end neural embedding approach is introduced, based on an emotionally constrained triplet loss function. The loss function integrates the relations between the various emotional patterns and thus improves the latent space data representation. The proposed methodology achieves 83.35% and 64.92% global accuracy rates on the RAVDESS and CREMA-D publicly available datasets, respectively. When compared with the results provided by human observers, the gains in global accuracy scores are superior to 24%. Finally, the objective comparative evaluation with state-of-the-art techniques demonstrates accuracy gains of more than 3%.

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

BackgroundThis study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events.ResultsIn a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care.ConclusionsThe prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners’ penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.

Maternal Psychiatric Diagnosis and Comorbidities Around Pregnancy

Despite several physiological and behavioral changes during pregnancy, the pattern of comorbidities among pregnant women remains understudied. Current study systematically examined the associations between mental and physical diagnoses around pregnancy.

Clinical Practice Guidelines on the Diagnosis and Management of Polycystic Ovary Syndrome: A Systematic Review and Quality Assessment Study.

ContextClinical practice guidelines (CPGs) are key instruments to implement the practice of evidence-based medicine. We aimed to evaluate the methodological quality and variations in CPGs recommendations on the diagnosis and management of polycystic ovary syndrome (PCOS).Evidence AcquisitionWe searched MEDLINE, EMBASE, and CENTRAL until December 2020 for all evidence-based CPGs and consensus statements on PCOS. We extracted data in duplicate to map clinical recommendations across prespecified disease domains and assessed CPGs methodological quality of using the Appraisal of Guidelines, Research & Evaluation II tool.Evidence SynthesisWe included 13 PCOS CPGs published between 2007 and 2018. CPGs recommendations were mostly focused on screening for and managing metabolic disease (12/13, 92%), followed by cardiovascular risk assessment (10/13, 77%). Mental health (8/13, 62%) and diagnosis in adolescents (7/13, 54%) were the least reported domains. Most CPGs had a high quality for scope and purpose description (12/13, 92%) while stakeholder’s involvement and applicability of recommendations to clinical practice were appropriate in only 2 CPGs (2/13, 15%). We identified inconsistency in recommendations on PCOS diagnosis in adolescents, optimal lifestyle interventions, hirsutism and acne treatments, interventions to reduce the risk of ovarian hyperstimulation syndrome, the frequency and screening criteria for metabolic and cardiovascular disease, and optimal screening tools for mental health illness in women with PCOS.ConclusionCurrent CPGs on the diagnosis and management of PCOS vary in their scope and methodological quality, which may hinder evidence translation into clinical practice. We identified disease domains with existing evidence gap to guide future research and guideline updates.

Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden

BackgroundWomen’s return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors.MethodsA longitudinal register study of the 3536 women in Sweden aged 19–64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression.ResultsThe proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell.ConclusionsSA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.

Identifying and Characterizing Children of Parents with a Serious Illness Using Survey and Register Data.

PurposeTo estimate the prevalence and characterize children and adolescents aged 0–21 years with a physically or mentally ill parent based on registers. Further, to explore the use of register and survey data to identify parental serious illness.MethodsThe study is based on: 1) a 20% register sample of children and adolescents aged 0–21 in 2014; and 2) survey data from the Danish Youth Profile 2014 including 63,437 youth education students linked to registers. In registers, parental physical illness comprised hospital diagnoses included in the Charlson Comorbidity Index, and parental mental illness encompassed all mental diagnosis in the registers. Information about socioeconomic and demographic characteristics and use of health care services was retrieved from national registers. In the survey, students were asked if they had experienced serious illness of a parent.ResultsIn the register sample of 0–21-year-olds, 25.3% had a parent with a physical or mental diagnosis, the prevalence increasing with age of the child. Compared to children without parental illness, children with an ill parent more frequently had unemployed parents, lower parental educational level, and a chronic medical condition. Analyses of the discrepancies between register and survey data revealed that 9% of the adolescents were identified as having an ill parent in both data sources and 64.1% had no identified ill parents. Moreover, a higher frequency of parental primary health care service use was seen for adolescents with an ill parent, across identification method, indicating that both methods identify adolescents with an ill parent.ConclusionThe social inequality and elevated frequency of health problems among children and adolescents with an ill parent, underline the vulnerability of this population. Parental illness can be identified from both parental hospital diagnoses as well as self-reported by adolescents, however the two methods detect different populations. Both methods have several limitations and would benefit from further refinement and validation.