Outpatient Mental Health Clinic Research Articles

"I had no idea there were psychiatric clinics for children": A qualitative study of how migrant parents reach Swedish mental health services for their children.

Migrant children have repeatedly been shown to underutilize psychiatric services and to face barriers to care, yet few studies have examined the experience of migrant parents who are successful in their help-seeking efforts for their children's mental health. The aim of this study was to gain a deeper understanding of facilitators and obstacles to reaching care among migrant parents in contact with child psychiatric services. We explored how migrant parents in Stockholm, Sweden, experienced the process of reaching child mental health services. Participants were recruited from out-patient mental health clinics. Ten in-depth interviews were conducted; qualitative analysis of transcripts was undertaken using thematic content analysis. Parents described a desire to reach services but difficulties doing so on their own. We identified a strong dependence on referring agents, such as schools and child health centers, for parents to gain contact. Informants expressed a high degree of trust toward these agents. Contrary to previous studies, stigma was not described as an obstacle to help-seeking but was recognized by informants as a potential barrier to care had they not emigrated. Although participants in our study had differing educational backgrounds and residency times in Sweden, a common experience of reliance on others for reaching services was evident in the data. Our findings highlight the role of referring agents as bridging contacts between different welfare services. Understanding the specific local resources and services that are available to migrant parents, and strengthening these across different sectors, could potentially help reduce barriers to care.

Regressive autism with autoimmune encephalitis: case report and literature review of subtype of autism spectrum disorder

About one-third of individuals with autism spectrum disorder (ASD) show a sudden loss of acquired skills between the 2nd or 3rd years of life. The primary areas of loss were grouped into language skills, social interest, adaptive functioning, and motor skills. A 4-year and 2-month-old boy presented to the child and adolescent mental health and disease outpatient clinic with his parents with complaints of decreased eye contact, and regression in speech. His developmental milestones were within the typical range of three years and two months. During the investigation into the organic etiology of regression, serum anti-CASPR2 positivity was detected, and intravenous immunoglobulin administration was initiated. After 6 months of treatment and special education, there was a slight decrease in the CARS score along with improvements in adaptation to change, visual response, and non-verbal communication. This rare case of regressive autism accompanied by autoimmune encephalitis provides further evidence in the field that autoimmune encephalitis may influence the development of the regressive subtype of ASD. Differential diagnosis is crucial because additional immunotherapy may be beneficial in these cases. Further investigation is needed to identify the relationship.

The Association of Central Sensitisation with Depression, Anxiety, and Somatic Symptoms: A Cross-Sectional Study of a Mental Health Outpatient Clinic in Japan.

For patients with chronic pain and persistent physical symptoms, understanding the mechanism of central sensitisation may help in understanding how symptoms persist. This cross-sectional study investigated the association of central sensitisation with depression, anxiety, and somatic symptoms. Four hundred and fifteen adults attending an outpatient psychosomatic clinic were evaluated. Participants completed the Hospital Anxiety and Depression Scale, Somatic Symptom Scale 8, and the Central Sensitisation Inventory. The relationships between these factors were examined using descriptive statistics and multiple logistic regression analyses. The mean age was 42.3 years, and 59% were female. The disorders included adjustment disorders (n = 70), anxiety disorders (n = 63), depressive disorders (n = 103), feeding and eating disorders (n = 30), sleep-wake disorders (n = 37), somatic symptoms and related disorders (n = 84), and others (n = 28). In multiple logistic regression analyses, higher central sensitisation was associated with more severe anxiety, depression, and somatic symptoms after controlling for potential confounders. In the disease-specific analysis, somatic symptoms correlated more positively with central sensitisation than with depression or anxiety. Central sensitisation and depression, anxiety, and somatic symptoms were associated with patients attending an outpatient clinic. These findings highlight the importance of evaluating depression, anxiety, and somatic symptoms when assessing central sensitisation.

Increasing Restorative Sleep Among Adults With Depressive Symptoms: A Quality Improvement Project.

The Centers for Disease Control and Prevention estimates that 34.8% of adults in the United States experience non-restorative sleep. The restorative theory of sleep is based on sleep as a means for the restoration of cellular function that is needed for activities when awake. Non-restorative sleep leads to awakening feeling unrefreshed and not ready for the activities of the day three or more times weekly. Aims: The aim of this quality improvement project was to increase restorative sleep by increasing the average amount of sleep over units of 24 h, decreasing perceived insufficient sleep, and decreasing episodes of unintended daytime sleep among patients with depressive symptoms ages 18 to 80 years in an outpatient mental health clinic. Methods: Ten patients with depressive symptoms and reporting non-restorative sleep volunteered to participate in the project. Participants kept a sleep diary and followed principles of healthy sleep such as limiting time in bed and going to bed at the same time nightly. The change in and the average amount of sleep over 24 h and daytime sleepiness were evaluated using the Behavioral Risk Factor Surveillance System. Results: All participants achieved at least one more day of restorative sleep, with nine increasing restorative sleep by at least 30 min per day, and nine having no episodes of unintentionally falling asleep.

A Comprehensive Approach to Addressing the Burnout Crisis Among US Health Care Workers: The Houston Methodist Experience.

Health care workers experience high rates of burnout and psychiatric distress. A large health care system in the southwest United States developed a comprehensive mental health service model for employees. Services offered range from traditional benefits (eg, Employee Assistance Program), resiliency and well-being initiatives, and innovative technology solutions, to access to peer support services for professional practice issues. The latest innovation in services is a free, self-insured outpatient mental health clinic designed exclusively for health care workers and their dependents. In this article, the authors describe the development of expanded mental health programming for health care workers and discuss how this unique service model proactively reduces common barriers to the receipt of high-quality care. This approach to caring for the workforce may serve as a model for other health care organizations across the United States. By providing mental health support to employees, health care organizations are mitigating the risk of burnout and related consequences to the system.

Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial

BackgroundTheory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI’s hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI’s effect on implementation climate, which in turn will (3) mediate LOCI’s effect on MBC fidelity.MethodsTwenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders’ implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses.ResultsLOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI’s effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI’s improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [pm] = 0.82, p = .004). Transformational leadership did not mediate LOCI’s effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI’s effect on MBC fidelity during the same period (pm = 0.71, p = .045).ConclusionsLOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.Trial registrationClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4years after implementation support had concluded. We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

Autistic traits, sensory sensitivity and eating disturbances in a sample of young adults referring to a generalized mental health clinic

PurposeThe relationship between autistic traits and eating disturbances has been given considerable attention over the last decades. The rise of a dimensional approach to psychopathology has expanded the way we think about autism, acknowledging that subthreshold autistic manifestations span across the general population and are more pronounced in psychiatric patients. Here we investigated the prevalence of eating disorders and its potential relationship with autistic traits and sensory sensitivity in a group of patients who were referred for the first time to a mental health outpatient clinic, without a formal diagnosis yet.Methods259 young adults (between 18 and 24 years old) completed: the Eating Attitude Test (EAT-26), the Swedish Eating Assessment for Autism Spectrum Disorders (SWEAA), the Autism Quotient (AQ), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and the Sensory Perception Quotient—Short Form 35 item (SPQ-SF35).Results23.55% of participants scored above the cut-off at the EAT-26, suggesting that they presented a risk for eating disorders and should be assessed by a specialized clinician; associations emerged between hypersensitivity in the touch and vision domain and both the EAT-26 and the SWEAA; the presence of autistic traits was largely associated with eating disturbances.ConclusionsThis study underlines the significance of the eating domain as a central psychopathological feature in the distress experienced by young adults with general psychiatric symptoms and psychological suffering; it adds evidence to the association between autistic traits and eating disorders and opens to new research questions about the role of subthreshold autistic traits in general psychopathology.Level of evidence: Level I: Evidence obtained from experimental studies.

Significant contribution of chronotype to emotional well-being in chronic psychiatric outpatients in Greece

Circadian rhythms are pivotal for human functioning, and their disruption holds significant implications for well-being. One common source for circadian disruptions is circadian misalignment that can be related to chronotypes. Chronotypes refer to an individual's preferred timing for sleep and wakefulness. Individuals with late chronotypes are at a disadvantage in the morning-oriented modern world and are demonstrated to have negative consequences in many aspects of life. In the context of psychiatric disorders, chronotypes are related to prevalence of disorders and to treatment effects but less attention is given to the relationship between chronotype and well-being in chronic psychiatric patients. The current study aims to elucidate the extent to which individual chronotypes contribute to emotional well-being within a cohort of individuals with chronic psychiatric disorder in outpatient clinic.Participants (n = 100) were recruited from the outpatient clinic of the 3rd Department of Psychiatry, AHEPA University Hospital, Thessaloniki, Greece, and the AX Mental Health Outpatient Clinic in Heraklion, Crete, Greece. Most participants were diagnosed within the F2 cluster, Psychotic disorders (n = 38), or F3 cluster, Mood (affective) disorders (n = 48). The Morningness-Eveningness Questionnaire (MEQ) was employed to assess chronotype. The STAI-Y1, CES-D, QoL Uniscale and RASS Questionnaires were used to assess aspects of emotional well-being. A single measure of emotional well-being was generated using Z-score transformation. Student's t-test, ANOVAs and Pearson's correlations were used to identify parameters contributing to emotional well-being, followed by a comprehensive regression model.Results show a significant contribution to emotional well-being by “psychiatric diagnosis” with schizophrenia/schizoaffective patients showing better emotional well-being compared with the “other” group, “receiving treatment” with patients receiving treatment showing higher score than ones who do not receive treatment, and “morningness/eveningness preference” where morningness was associated with higher score of emotional well-being. No other demographic or health-related parameters were significantly associated with emotional well-being score.These findings clearly indicate the critical importance of chronotypes to the emotional well-being of chronic psychiatric patients. Additional thought and research should explore possible chronotherapy interventions that will address this issue in patients.

From Pathways to Partnerships: Building Patient-Centered Clinical Tracks (PCCT) in Outpatient Community Mental Health Settings.

Clinical pathways are structured multidisciplinary care plans used by treatment providers to detail essential steps in the care of patients based on assessment of their current health care needs and motivation and commitment for treatment. Reducing unnecessary variations in care and streamlining treatment processes in mental health settings may promote efficiency and help support quality improvement efforts. (Rotter et al., 2019) In this article we will describe the development of clinical pathways, coined Patient Centered Clinical Tracks (PCCT) in an outpatient community mental health clinic in an academic medical center in New York City. PCCT is comprised of six different clinical pathways that include: Medication & Engagement, Supportive Therapy, Dialectal-Behavior Therapy, Cognitive-Behavioral Therapy/Acceptance Commitment-Therapy, Relational Therapy and THRIVE (a Trauma Specialty Program). We will present the six Clinical Tracks and describe the early implementation of this model. We will explore how this programmatic infrastructure can connect evidence to practice and address multiple systemic challenges faced in a community mental healthsetting with a strong emphasis on training.

Improvement of access to mental health care through implementing telehealth services by clinical pharmacist practitioners

AbstractThe nationwide shortage of psychiatric providers delays patients from receiving vital mental health (MH) treatments. Mental Health clinical pharmacist practitioners (CPPs) are qualified to provide comprehensive medication management (CMM) services and expand care; however, many MH interdisciplinary teams have not incorporated MH CPPs or have not optimized their role. The purpose of this paper is to highlight how MH CPPs leveraged telemedicine to provide CMM to outpatient MH clinics requiring provisional coverage for other prescribing providers. This paper also reviews supplemental services and barriers to implementation. The Veterans Integrated Services Network (VISN) 6 Clinical Resource Hub‐Telemental Health (CRH‐TMH) is a centralized interdisciplinary team that provides telemental health services to veterans through coordination with their local Veterans Health Administration Health Care Systems located in North Carolina and Virginia. The MH CPPs serve as advanced practice providers with a scope of practice that authorizes prescriptive authority including controlled substances. The VISN 6 CRH‐TMH program was initiated in 2020 and expanded from one MH CPP to include three MH CPPs and a MH CPP supervisor. Since initiation, the MH CPPs have supported 10 outpatient MH clinics. From October 2021 to March 2023, the MH CPPs have completed 5080 clinical encounters. The MH CPPs decreased phone appointments and increased the percentage of video‐to‐home encounters from 56% in fiscal year 2021 to 91% by March fiscal year 23. Virtual same‐day access was implemented at three locations and the substance use disorder program provided timely access to life‐saving treatments. The joint intake clinic optimized veterans' intake into the MH clinic by the therapist providing diagnostic services and the CPP performing CMM during the same appointment. The telehealth learning experience increased training opportunities for residents. The success of this initiative further supports the expansion of MH CPPs as advanced practice providers.

The Prevalence and Treatment of Adjustment Disorders Among Children at Outpatient Mental Health Clinics

ABSTRACT Adjustment disorder is commonly diagnosed in children, yet few studies have explored the types of treatment and outcomes for this disorder in routine clinical care. Cognitive-behavioral therapies (CBT) are evidence-based treatments (EBTs) for many mental health disorders but there is limited research evaluating the use of CBT in usual care for children with adjustment disorders. This study used administrative data from a statewide system of outpatient clinics to examine 1) intake differences between children with adjustment disorders and other common diagnoses, 2) how often children with adjustment disorders received CBT, and 3) outcome differences amongst children with adjustment disorders who received CBT, non-cognitive-behavioral EBTs, or no EBT. The sample included 22,353 children ages 3–17 with a primary diagnosis of adjustment disorder, conduct problem, depression, anxiety, or post-traumatic stress disorder. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity and functioning based on the Ohio Scales. Children with adjustment disorders had lower problem severity and higher functioning at intake, and were less likely to receive cognitive-behavioral EBTs than children with other disorders. However, in the subsample of children diagnosed with adjustment disorders (n = 8,966), those who received cognitive-behavioral EBTs improved the most, highlighting the applicability of cognitive-behavioral therapies for children with adjustment disorders.

Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health

Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of mental health treatment in youth when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics. In a cluster randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation strategy plus training and technical assistance in MBC (k= 11, n= 117) or training and technical assistance only (k= 10, n= 117). Primary outcomes of MBC fidelity (assessed via electronic metadata) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youths (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Outcomes of each youth were assessed for 6 months following baseline. A total of 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition in clinic, clinician, or youth characteristics. Youths in clinics using the Leadership and Organizational Change for Implementation strategy experienced significantly higher MBC fidelity compared with youths in control clinics (23.1% vs 3.4%, p= .014), and exhibited significantly greater reductions in symptoms from baseline to 6 months (d= 0.31, 95% CI: 0.04-0.58, p= .023). Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services. Working to Implement and Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/; NCT04096274.

Risky business: Considerations of emotion regulation and high-risk behaviors in anxious adolescents

A growing body of empirical literature connects anxiety symptoms and high-risk suicidal and self-harming behaviors in youth. Emotion regulation (ER) processes and deficits have been identified as important factors in the etiology, maintenance, and treatment of both youth anxiety and high-risk behaviors. The present study assessed the association between these variables using an acute, socio-demographically diverse clinical sample of youth presenting to an outpatient mental health clinic. Ninety-nine youth aged 12–20 years old completed measures of anxiety symptoms, ER difficulties, and lifetime history of high-risk behaviors including non-suicidal self-injury (NSSI) and suicide attempts. Unadjusted analyses show that more severe anxiety symptoms were associated with more ER difficulties and history of risk behavior. Multivariate linear regression models considering age, sex, race/ethnicity, and risk history show that more severe anxiety symptoms remained significantly associated with more ER difficulties (p < 0.0001) and positive suicide attempt history (p < 0.01). Findings highlight the importance of integrating considerations of ER into the case conceptualization and treatment planning of high-risk, anxious youth to inform evidenced-based care with this population. The need for targeted, ongoing risk assessment with anxious youth to identify and mitigate risk is also demonstrated.

Diagnostic accuracy of the Dutch version of the Somatic Symptom Disorder – B Criteria Scale (SSD-12) compared to the Whiteley Index (WI) and PHQ-15 in a clinical population

ObjectiveSomatic Symptom and Related Disorders(SSRD) are characterised by an intense focus on somatic symptoms that causes significant distress. A self-report scale developed to assess distress as symptom-related thoughts, feelings, and behaviors (SSD-12) has proved to be a reliable, valid and time-efficient measure for Somatic Symptom Disorder(SSD). This cross-sectional study aimed to compare the SSD-12 with psychiatric assessment as gold standard in a Dutch clinical population for SSRD compared to other widely used measures. MethodsData were collected from adult patients visiting a specialised mental health outpatient clinic for SSRD in the Netherlands, between 2015 and 2017. Analyses included item evaluation, scale reliability, construct validity, diagnostic utility and cut points. Performance of SSD-12, Whiteley Index(WI) and PHQ-15 were compared in Receiver operating characteristics (ROC) curves. Results223 patients with SSD, Functional Neurological Disorder, Illness Anxiety(IA) and no SSRD participated. SSD-12 items were normally distributed; total scores correlated with measures of health anxiety, anxiety and depression. The optimal cut point for the SSD-12 was 22 (sensitivity 75.9%, specificity 63.6%). The ROC area under the curve for SSD-12 was 0.75 compared to 0.68 for the WI and 0.65 for the PHQ-15. Combinations of those questionnaires did not yield better results than for the SSD-12 alone. ConclusionThe SSD-12 alone outperformed the WI and PHQ-15 and combined scales in effectively distinguishing SSRDs from other mental disorders. This may suggest that distress is a more accurate indicator of SSRD than earlier diagnostic criteria as operationalised in the WI and PHQ-15.

Generic Group Metacognitive Therapy for Patients with Major Depressive Disorder and Related Problems: a Preliminary Evaluation in Specialized Mental Health Care

Metacognitive therapy (MCT) is a transdiagnostic treatment approach with substantial empirical support that is well suited to be delivered in a group format. The present study reports on data from a service evaluation of generic group metacognitive therapy delivered to individuals seeking treatment for major depressive disorder (MDD) at a specialized mental health outpatient clinic. A total of 17 patients diagnosed with MDD where comorbidity was frequent received 10 sessions of generic group MCT delivered by two therapists. Group MCT was associated with large effect sizes for symptoms of depression, anxiety, interpersonal problems, self-esteem, general functioning, dysfunctional metacognitions, and treatment satisfaction was very high. The average number of therapist sessions used to treat each patient was seven. These preliminary findings support the continued use and evaluation of group MCT for patients seeking treatment for depression in specialized mental health care which likely is a cost-effective treatment option.

Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics.

An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.

Exploring the relationship between insomnia and depression: a cross-sectional prospective study.

A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic using a cross-sectional design. The participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) to measure sleep disturbances and depressive symptoms, respectively. Ethical approval was obtained from the Institutional Review Board at Ninevah University. Descriptive statistics, bivariate correlations, and multivariate regression analysis were used to analyze the data. The data collected in the study was analyzed using SPSS v0.26. A total of 416 participants were recruited from the psychiatric and mental health outpatient clinic in Iraq through convenience sampling. The sample included 227 (54.6%) females and 189 (45.4%) males, with a mean age of 35.4 years (SD=9.8, range=18-65). Participants had a mean PSQI score of 11.6 (SD=3.7, range=2-21) and a mean BDI score of 21.8 (SD=11.1, range=0-54). Bivariate correlations showed a significant positive relationship between sleep disturbances (as measured by the PSQI) and depressive symptoms (as measured by the BDI) (r=0.67, P<0.001). The study provides valuable insights into the relationship between insomnia and depression in a sample of individuals from Iraq. These findings could contribute to the development of interventions to improve mental health outcomes among this population.

Factors Influencing Patient and Caregiver Preferences for Antipsychotic Treatment of Schizophrenia in China: A Discrete Choice Experiment.

This study aimed to quantify the preferences of Chinese patients with schizophrenia and their caregivers for antipsychotic treatment. Patients with schizophrenia (aged 18-35) and their caregivers were recruited via six outpatient mental health clinics in Shanghai, People's Republic of China. In a discrete choice experiment (DCE), participants chose between two hypothetical treatment scenarios that varied regarding the type of treatment, rate of hospitalization, severity of positive symptoms, treatment cost and rates of improvement in daily and social functioning. Data for each group were analyzed using the modelling approach that yielded the lower deviance information criterion. The relative importance score (RIS) for each treatment attribute was also determined. A total of 162 patients and 167 caregivers participated. Frequency of hospital admission was the most important treatment attribute for patients (average scaled RIS=27%), followed by mode and frequency of treatment administration (24%). Improvement in ability to carry out daily activities (8%) and improvement in social functioning (8%) were least important. Patients in full-time employment placed more importance on the frequency of hospital admission than unemployed patients (p<0.01). Frequency of hospital admission was also the most important attribute for caregivers (RIS=33%), followed by improvement in positive symptoms (20%), while improvement in daily activities (7%) was the least important. Patients with Schizophrenia in China prefer treatments that help reduce the number of times they are admitted to hospital, as do their caregivers. These results may bring insight for physicians and health authorities in China regarding the treatment characteristics that patients value the most.

Mental healthcare services in Kenyan counties: a descriptive survey of four counties in Western Kenya

BackgroundThe government of Kenya has made progressive efforts towards improving mental health services in the country. However there is little documentation of mental health services in the counties that would support actualization of the legislative frameworks in the context of a devolved healthcare system. This study sought to document existing mental health services within 4 counties in Western Kenya.MethodsWe conducted a cross sectional descriptive survey of four counties using the World Health Organization, Assessment Instrument for Mental Health Systems (WHO-AIMS). Data was collected in 2021, with 2020 being the year of reference. We collected data from the facilities offering mental healthcare within the counties as well as from County health policy makers and leaders.ResultsMental healthcare was provided at higher level facilities within the counties, with minimal structures at primary care facilities. No county had a stand-alone policy on mental health services or dedicated budget for mental healthcare. The national referral hospital, within Uasin-Gishu county, had a clear mental health budget for mental health. The national facility in the region had a dedicated inpatient unit while the other three counties admitted patients in general medical wards but had mental health outpatient clinics. The national hospital had a variety of medication for mental health care while the rest of the counties had very few options with antipsychotics being the most available. All the four counties reported submitting data on mental health to Kenya health information system (KHIS). There were no clearly defined mental healthcare structures in the primary care level except for funded projects under the National referral hospital and the referral mechanism was not well defined. There was no established mental health research in the counties except that which was affiliated to the national referral hospital.ConclusionIn the four counties in Western Kenya, the mental health systems are limited and not well structured, are faced with limited human and financial resources and there is lack of county specific legistrative frameworks to support mental healthcare. We recommend that counties invest in structures to support provision of quality mental healthcare to the people they serve.