Outpatient Psychiatry Research Articles

Telehealth Brief Cognitive Behavioral Therapy for Suicide Prevention: A Randomized Clinical Trial.

Suicide rates continue to increase in the US. Evidence-based treatments for suicide risk exist, but their effectiveness when delivered via telehealth remains unknown. To test the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts and suicidal ideation among high-risk adults when delivered via telehealth. This 2-group parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT) was conducted from April 2021 to September 2023 with 1-year follow-up at an outpatient psychiatry and behavioral health clinic located in the midwestern US. Participants reporting suicidal ideation during the past week and/or suicidal behavior during the past month were recruited from clinic waiting lists, inpatient service, intermediate care, research match, and direct referrals from clinicians. A total of 768 participants were invited to participate, 112 were assessed for eligibility, and 98 were eligible and randomly assigned to a treatment condition. Data analysis was from April to September 2024. Participants received either BCBT, an evidence-based suicide-focused treatment that teaches emotion regulation and reappraisal skills, or PCT, a goal-oriented treatment that helps participants identify adaptive responses to stressors. Participants were randomized using a computerized stratified randomization algorithm with 2 strata (sex and history of suicide attempts). The primary outcome was suicide attempts as measured by the Self-Injurious Thoughts and Behaviors Interview-Revised. The secondary outcome was severity of suicidal ideation as measured by the Scale for Suicide Ideation. Participants included 96 adults (mean [SD] age, 31.8 [12.6] years; 64 female [66.7%] and 32 male [33.3%]), with 51 receiving BCBT and 45 receiving PCT. Of all participants, 85 (88.5%) completed at least 1 session. From baseline to 12 months, 12 participants receiving PCT (estimated percentage, 35.6%) made 56 suicide attempts and 11 participants receiving BCBT (estimated percentage, 30.0%) made 36 suicide attempts. Participants randomized to BCBT made significantly fewer suicide attempts than participants randomized to PCT (mean [range], 0.70 [0.00-8.00] attempts per participant vs 1.40 [0.00-10.00] per participant) and had a 41% reduced risk for suicide attempts (hazard ratio, 0.59; 95% CI, 0.36-0.96; P = .03). Severity of suicidal ideation significantly decreased in both treatments (F4,330 = 50.1; P < .001) but did not differ between groups (F4,330 = 0.2; P = .91). The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts among adults with recent suicidal thoughts and/or behaviors. ClinicalTrials.gov Identifier: NCT04844294.

Evaluation of routine health monitoring for metabolic disorders in patients with serious mental illness on psychotropic medications: a study from Ethiopia.

Compared to the overall population, patients with mental health problems are more likely to experience concurrent physical illnesses, poorer health outcomes, and mortality. Psychotropic medications, which are the pillars in the management of mental health conditions, are associated with adverse effects such as weight gain, an increased level of glucose, and elevated circulating lipid levels, all of which contribute to metabolic disorders. Inadequate health monitoring may led to suboptimal interventions and worsening of these conditions. However, there is a lack of studies assessing routine health monitoring practices for metabolic disorders and their determinants among patients with serious mental illnesses taking psychotropic medications in Ethiopia. This study aimed to evaluate routine health monitoring for metabolic disorders and its determinants in patients with serious mental illnesses on psychotropic medications in Ethiopia. A hospital based prospective follow-up study was conducted among patients with serious mental illness taking psychotropic medications who attended the outpatient psychiatry department at Debre Markos Comprehensive Specialized Hospital. Eligible participants were selected using a simple random sampling technique. Routine health monitoring was evaluated using guidelines and previous literature. Binary logistic regression was employed to identify the determinants of routine health monitoring, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval (CI). The overall routine health monitoring practice for metabolic disorders was found to be sub-optimal. Vital signs were the most commonly assessed parameters. Key determinants of routine health monitoring included participants aged 45 and above (AOR (95% CI): 2.82 (1.34-5.92), having social insurance (AOR (95% CI): 2.94 (1.86-4.64), availability of laboratory tests at the hospital (AOR (95% CI): 3.46 (2.16-5.55), and reporting of medication-related side effects (AOR (95% CI): 1.96 (1.21-3.17)). Routine health monitoring for metabolic disorders in patients with serious mental illnesses attending the outpatient psychiatry department was inadequate. Health care providers should give more attention to younger patients, those without health insurance, and who are not reported side effects. These findings provide crucial insights for improving routine health monitoring and promoting better health outcomes.

Teletherapy and Medication Management of Attention-Deficit/Hyperactivity Disorder with Co-occurring Internalizing Symptoms and Suicidality During the Pandemic.

Sam (he/him) is an 11-year-old cisgender white male with previous diagnoses of attention-deficit/hyperactivity disorder, anxiety, and major depressive disorder who was referred to an outpatient psychiatry clinic after hospitalization for suicidal ideation and agitation. Family history is significant for bipolar disorder, depression, anxiety, substance use/abuse, and suicidality. Sam started a trial of atomoxetine 10 mg po QAM in December 2019 due to increasing inattention in the backdrop of worsening anxiety. Sam received school-based counseling through his IEP, which Sam declined due to embarrassment from being pulled out of the classroom, and services were quickly discontinued. In January 2020, obsessive-compulsive symptoms emerged, specifically obsessions about cleanliness with related compulsions. He started biweekly cognitive behavioral therapy with an outpatient provider to target obsessive-compulsive disorder symptoms. Concomitantly, a developmental-behavioral pediatrician who diagnosed obsessive-compulsive disorder started Sam on fluoxetine 10 mg po QAM. Atomoxetine was also increased to 25 mg po QAM for 4 weeks and built up to 40 mg po QAM in February 2020.Depressive symptoms emerged in Spring 2020, around the time of the COVID-19 pandemic, despite ongoing treatment with fluoxetine. There was a significant increase in aggression, agitation, and compulsive cleaning, which did not respond to the addition of lorazepam 0.5 mg po daily. Owing to concerns that medication was exacerbating his presentation, his prescriber began to wean him off both atomoxetine and fluoxetine.Sam presented to the Emergency Department in the summer of 2020 due to worsening symptoms, including suicidal ideation and aggression, in the context of medication adjustment, social isolation, and academic difficulty with virtual schooling. He completed a 3-week inpatient hospitalization followed by a 2-week virtual partial hospitalization program, during which Sam struggled with attention and engagement. As part of his discharge plan, he was referred to the outpatient psychiatry department to continue outpatient therapy and medication management.During the virtual transfer appointment to outpatient therapy, his parents reported persistent concerns for ongoing attention-deficit/hyperactivity disorder, depression, anxiety, and obsessive-compulsive symptoms, along with a fear of a resurgence of suicidal thinking. Sam reported exhaustion from virtual partial hospitalization program sessions he attended earlier in the day and was eager to leave the appointment. He minimized concerns, denied suicidal ideation or intent, and reported a strong disinterest in doing "another virtual therapy." In-person sessions would be ideal for Sam, given his history of attention difficulties, clinical complexity, and acuity and his self-identified dislike for virtual settings. However, services needed to be done virtually due to the quarantine shutdown. How would you proceed with treating Sam?

The Thoughtful program: a randomized controlled study of a mentalization-based mental health education intervention in a psychiatric outpatient population

Background P-factor and mentalizing theory and research set perspectives for transdiagnostic psychiatric treatments. Aims To test the effects of a low-cost mentalization-based health education program (the Thoughtful program) in an unselected waiting list population, from a psychiatric outpatient clinic in North Norway. Methods Waiting list patients were randomized (1:1 allocation): 79 patients in the control group were offered standard individual assessment and treatment. Seventy-nine patients in the intervention group were offered a one-day (six-hour) group-based Thoughtful course, plus individual assessment, and treatment. Results During a 6-month follow-up period, the number of patients in active assessment and treatment was 66% higher in the control group than in the intervention group. Self-reported patient questionnaire scores on mentalizing, well-being and suicidal ideation scores showed no significant changes in the control group. In the intervention group, significant changes were reported: Mentalizing scores improved by 72% and well-being scores improved by 55%. Suicidal ideation scores were not significantly changed. No adverse effects were registered. Limitations The results from this study should be interpreted with caution because of a small population size and low questionnaire response rate. The follow up period was limited to 6 months. Transfer of program information from intervention group patients to control group patients could not be guaranteed. It may be considered a limitation that diagnostic pattern analysis was not included in the study. Conclusions A low-cost transdiagnostic mentalization-based educational program in an outpatient psychiatry clinic may improve patient mentalizing and wellbeing without adverse effects and reduce the use of hospital services.

Using Technology to Support Measurement-Based Care: Design and Implementation of the Measurement-Assisted Care Program.

The authors aimed to increase measurement-based care in an outpatient academic psychiatry service. The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program. After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care. MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

Predictors of No-Shows and Cancellations in an Outpatient Neuropsychology Clinic in a Large Healthcare System.

The purpose of this study was to evaluate potential predictors of no-shows and late cancellations in an outpatient clinic within a large healthcare system serving vulnerable communities. Demographic data and appointment status were recorded for 537 consecutive patients scheduled for neuropsychological evaluation in an outpatient psychiatry clinic. Patients include 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.20). The overall rate of no-shows or late cancellations was 20%. Of the 106 patients who no-showed/late cancelled, 41% rescheduled, and of those, 23% missed or late cancelled their second appointment. No-shows and late cancellations were associated with historical/prior no-show rate, while race/ethnicity and activation of MyChart had slight impacts. These data suggest that prior no-show rates and MyChart access may be targets for interventions to improve show rates. This is important for the patients' gaining access to care as well as minimizing financial strains for the system and increasing wait times/delays to care for other patients.

Correlates of Sexual Dysfunction in Male Patients with Alcohol Dependence Syndrome: A Cross-Sectional Study

Introduction: Sexual dysfunction and alcohol dependence syndrome are complex issues that significantly impact the overall well-being and quality of life of affected individuals. Sexual dysfunction, encompassing various issues such as erectile dysfunction, reduced libido, and orgasmic disorders, is a prevalent concern affecting a substantial proportion of the male population worldwide. Aim: To estimate prevalence of sexual dysfunction in patients admitted for Alcohol dependence and to identify various Clinical and Socio demographic correlates for sexual dysfunction in this population. Materials and Methods: The study involved fifty-eight male participants who had sought deaddiction treatment at the Psychiatry Outpatient Department of Tertiary Care Centre, Maduranthakam for alcohol dependence syndrome, diagnosed according to the ICD‑10. Information on sociodemographic, alcohol-related, and sexual dysfunction-related variables was gathered. Sexual dysfunction was assessed for the past year, ignoring temporary and situational complaints. The relationship between sexual dysfunction and various study variables was explored using relevant statistical tools. Results: Out of the total sample size evaluated using SAD-Q score, 71% are moderately dependent and 29 % are severely dependent. Sexual Dysfunction was present for 64% of patients in the study. For the 58 patients in the study, the most common sexual dysfunction reported was an absence of sexual desire in 19 patients, followed by erectile dysfunction which was present in 18 patients. The ability to reach orgasm was difficult for 6 patients. Satisfaction from orgasm was absent for 4 patients. Conclusion: This research seeks to advance our understanding of sexual dysfunction in male patients with alcohol dependence syndrome by unravelling the intricate web of factors influencing their sexual health.

A - 66 Factors Impacting Appointment No-Shows and Cancellations in Neuropsychology: Predictors for Improving Access to Care for a Diverse Patient Population

Abstract Objective Access to care can be impacted adversely by appointment adherence. We aimed to identify predictors of no-shows and cancellations for neuropsychological services offered by a healthcare system serving diverse communities. Method Demographics and appointment status were documented from a sample of 537 consecutive patients scheduled for neuropsychological evaluation at an outpatient psychiatry clinic. Patients included 220 males and 317 females with an average formal education of 11.01 years (SD = 3.87) and age of 55.64 years (SD = 16.2). Chi-square analyses were used to evaluate the association between appointment status and gender, race/ethnicity, payor, availability of a collateral, and MyChart access. Multivariate analysis of variance was used to assess the relationship between age, education, proxy income, and prior no-show rate with appointment status. Results The overall rate of no-shows or late cancellations was 20%, and some patients no-showed multiple times. No-shows and late cancellations were associated with historical no-show rates and older age (F = 14.60, p &amp;lt; 0.0001), while race/ethnicity and MyChart activation had slight impacts (χ2 = 5.572, p = 0.062 and χ2 = 3.69, p = 0.055, respectively). Being a monolingual Spanish speaker was associated negatively with MyChart activation, but positively with collateral availability (p &amp;lt; 0.05). Conclusions No-show rates, which impact access to care, are high and associated with prior history of no-shows. Other factors, such as MyChart activation and culturally-associated barriers may also impact access. Implementing interventions addressing prior no-show rates and enhancing MyChart access could significantly increase show rates; such improvements could increase patient access to care, reduce the system’s financial burden, and decrease wait times for other patients.

Examining The Care Pathways Patients Experience When Accessing Outpatient Psychiatric Care in British Columbia

The British Columbia (BC) mental health roadmap prioritizes equitable access to care. This study investigates the equity of care pathways experienced by BC residents accessing outpatient psychiatric care for the first time. Community-based care pathways are paramount as they indicate timely access to care and are less expensive for the health system. We analyzed linked administrative BC health data spanning April 1st 2013, to March 31st 2022, to study how sociodemographic factors relate to accessing psychiatric care pathways. Pathways to outpatient psychiatric care include a community-based pathway, hospitalization to primary care to outpatient psychiatry, and hospitalization directly to outpatient psychiatry. Sociodemographic factors considered were administrative sex, immigration recency and status, neighbourhood income quintile and being a recipient of a low-income drug plan. These relationships were analyzed using multinomial logistic regression, adjusting for age, location, fiscal year, and stratifying by mental disorder diagnoses. Being male, a low-income drug plan recipient, living in a lower income neighbourhood, or being a recent economic immigrant or permit holder was associated with increased odds of accessing outpatient psychiatric care via either hospitalization pathway. Having a diagnosis of schizophrenia/bipolar disorder was independently associated with both hospitalization pathways, and this diagnosis exacerbated the magnitude of the estimates for the sociodemographic characteristics. We find clear disparities in pathways to accessing outpatient psychiatric care. These disparities indicate health system failures in addressing specific population needs, highlighting the importance of targeted interventions, such as increasing the number of community health workers, to achieve equitable mental health care in BC.

Child mental health treatment access and retention in integrated primary care and traditional outpatient services.

There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity. This study compared treatment attendance in an outpatient psychiatry clinic (OPC) versus an IPC clinic to assess whether the IPC was associated with reduced disparities in access to care and treatment retention. This study assessed whether there were differences in who is connected to care from the intake appointment to first follow-up appointment. Results showed that the IPC clinic served a more diverse patient population than the OPC clinic in terms of SES, race, and ethnicity. Differences in treatment attendance in the IPC and OPC were also found. After controlling for race, ethnicity, insurance, and distance from patient's home zip code to clinic, the IPC treatment setting was associated with poorer intake and follow-up appointment attendance. The IPC model may be more accessible to historically underserved youth, but the treatment setting does not inherently eliminate disparities in child mental health treatment retention. Replication of this study has the potential to contribute to the external validity of study findings, improve quality assurance policies, and develop equitable workflow policies. Future research is needed to identify factors that can improve treatment attendance for populations who face greater retention barriers and to shine light on ways that healthcare systems may inadvertently maintain disparity in treatment retention.

ADHD-pain: Characteristics of chronic pain and association with muscular dysregulation in adults with ADHD.

A high incidence of attention-deficit hyperactivity disorder (ADHD) has been reported in chronic pain (ChP) patients. Furthermore, an association between ChP and muscular dysregulation has been reported in adults with ADHD. The present study investigated whether ADHD was more prevalent among psychiatric outpatients with ChP than those without ChP, and if there was an association between ChP, muscular dysregulation and characteristics of pain in patients with ADHD. One-hundred and twenty-one individuals remitted to an outpatient psychiatry unit took part in this naturalistic epidemiological cross-sectional study. They were assessed with a pain self-report form (localization, intensity, and onset) and a test of muscle dysregulation (the Motor Function Neurological Assessment). Prevalence of ADHD among patients with ChP, as well as the qualitative characteristics of ChP within the ADHDgroup are reported. Both ChP and pain intensity correlated with muscular dysregulation through Spearman's rho analysis. Additionally, the relationship between various diagnostic categories (ADHD, affective disorders, anxiety, or personality disorders) and incidence of axial pain was evaluated in logistic regression. ADHD was significantly more prevalent in patients with ChP, than in patients without ChP. In the ADHD group, ChP and pain intensity was associated with muscular dysregulation, particularly with high muscle tone. ChP was more axial and widespread, than for the patients without ADHD, and started at an early age. ADHD diagnosis predicted axial pain, whereas affective-, anxiety-, or personality disorders did not. The study suggests that ChP in ADHD is associated with muscular dysregulation and is qualitatively different from ChP in psychiatric patients without ADHD. These findings may lead to further understanding of potential mechanisms involved in ADHD and ChP, and in turn to new treatment strategies for both disorders.

Psychometric evaluation of the affiliate stigma scale for caregivers of people with mental illness in Uganda

BackgroundAffiliate stigma is common among caregivers of people with mental illness and impacts negatively on the caregivers’ quality of life and their ability to care for the patients. Although there is evidence of affiliate stigma in sub-Saharan Africa, the psychometric properties of commonly used tools are not available in the African context. The aim of this analysis was to evaluate the factor structure of the affiliate stigma scale among caregivers of people with mental illness in southwestern Uganda. Having a validated method to assess affiliate stigma in the Ugandan setting helps to appropriately evaluate affiliate stigma among caregivers of people with mental illnesses, which could inform the development of interventions to support such caregivers.MethodA total of 385 caregivers of people with mental illness attending outpatient psychiatry clinics in selected tertiary hospitals in southwestern Uganda were enrolled in the study. The affiliate stigma and depression were assessed using the affiliate stigma scale and the patient health questionnaire (PHQ-9) respectively. We conducted exploratory and confirmatory factor analysis to determine the factor structure, reliability and validity of the affiliate stigma scale. We also evaluated the convergent validity of the affiliate stigma scale by determining the correlation between affiliate stigma scale scores and the PHQ-9.ResultMore than half of participants were male (55.06%) and majority of caregivers were living in rural areas (80.26%). The sample size was adequate, as evidenced by the KMO of 0.91 and the inter-correlation was sufficient to conduct the factor analysis, according to the Bartlett test. Confirmatory factor analysis revealed four factors and all 22 items were retained as all of them had a factor loading > 0.4. The internal consistency of the total scale was excellent (alpha = 0.92). The affiliate stigma score correlated with depression which has been hypothesized to be associated with the stigma of mental illness.ConclusionThe study findings show the affiliate stigma scale as a valid measure of affiliate stigma among the caregivers of patients with mental illness in southwestern Uganda. Therefore, this scale provides an opportunity to mental health care providers to assess affiliate stigma and develop interventions aimed at prevention stigma among caregivers and improve outcomes among people with mental illness.

Efficacy of a Mobile App-Based Intervention for Young Adults With Anxiety Disorders: A Randomized Clinical Trial.

Anxiety disorders are prevalent and undertreated among young adults. Digital mental health interventions for anxiety are promising but limited by a narrow range of therapeutic components and low user engagement. To investigate the efficacy of and engagement with Maya, a scalable, self-guided, comprehensive mobile cognitive behavioral therapy (CBT) intervention with embedded engagement features, comparing the effects of 3 incentive conditions. This randomized clinical trial recruited young adults aged 18 to 25 years with anxiety disorders through online advertisements and outpatient psychiatry clinics at Weill Cornell Medicine. Enrollment was between June 16, 2021, and November 11, 2022. Data analysis was performed from December 21, 2022, to June 14, 2024. Participants received a 6-week program of the intervention and were randomized to 1 of 3 different text message-based incentive conditions (gain-framed, loss-framed, or gain-social support). The primary outcome was change in anxious symptoms from baseline to end of treatment, as measured by the Hamilton Anxiety Rating Scale (HAM-A). The Anxiety Sensitivity Index and the Leibowitz Social Anxiety Scale scores were secondary measures. The sample consisted of 59 participants (mean [SD] age, 23.1 [1.9] years; 46 [78%] female; 22 [37%] Asian, 3 [5%] Black, 5 [8%] Hispanic or Latino, 1 [2%] American Indian or Alaska Native, 25 [42%] White, and 6 [10%] >1 race; 32 [54%] college-educated and 12 [20%] graduate or professional school-educated; mean [SD] baseline HAM-A score, 15.0 [6.5]). Anxiety, measured by HAM-A, decreased across conditions from baseline to end of the intervention (mean difference, -5.64; 95% CI, -7.23 to -4.05), and symptomatic improvement was maintained at the week 12 follow-up (baseline to follow-up mean difference, -5.67; 95% CI, -7.29 to -4.04). However, there was no evidence that change in anxiety differed by incentive condition (loss-framed vs gain-social support mean difference, -1.40; 95% CI, -4.72 to 1.93; gain-framed vs gain-social support mean difference, 1.38; 95% CI, -1.19 to 3.96). Secondary anxiety measures (Anxiety Sensitivity Index and Liebowitz Social Anxiety Scale scores) showed a similar pattern of improvement, with no evidence of differences between incentive conditions. Participants completed most of the 12 sessions (mean [SD], 10.8 [2.1]; 95% CI, 10.3-11.4), and User Mobile Application Rating Scale app quality ratings exceeded the published threshold for acceptability at all study visits. There was no evidence that either session completion or app quality ratings differed by incentive condition. In this randomized clinical trial of an app-based intervention for anxiety, the primary hypothesis that improvement in anxiety would be greatest in the condition using gain of points plus social incentives was not supported; however, the results suggest that a CBT application incorporating a full suite of CBT skills and embedded user engagement features was efficacious in improving symptoms in young adults with anxiety disorders. Given these findings, digital interventions represent a promising step toward wider dissemination of high-quality, evidence-based interventions. ClinicalTrials.gov Identifier: NCT05130281.

Trends in Bundled Outpatient Behavioral Health Services in VA-Direct Versus VA-Purchased Care.

The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016-2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3million Veterans who registered 60million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services.

Intensity, Characteristics, and Factors Associated With Receipt of Care Coordination Among High-Risk Veterans in the Veterans Health Administration.

The Veterans Health Administration (VHA) has initiatives underway to enhance the provision of care coordination (CC), particularly among high-risk Veterans. Yet, evidence detailing the characteristics of and who receives VHA CC is limited. We examined intensity, timing, setting, and factors associated with VHA CC among high-risk Veterans. We conducted a retrospective observational cohort study, following Veterans for 1 year after being identified as high-risk for hospitalization or mortality, to characterize their CC. Demographic and clinical factors predictive of CC were identified via multivariate logistic regression. A total of 1,843,272 VHA-enrolled high-risk Veterans in fiscal years 2019-2021. We measured 5 CC variables during the year after Veterans were identified as high risk: (1) receipt of any service, (2) number of services received, (3) number of days to first service, (4) number of days between services, and (5) type of visit during which services were received. Overall, 31% of high-risk Veterans in the sample received CC during one-year follow-up. Among Veterans who received ≥1 service, a median of 2 [IQR (1, 6)] services were received. Among Veterans who received ≥2 services, there was a median of 26 [IQR (10, 57)] days between services. Most services were received during outpatient psychiatry (46%) or medicine (16%) visits. Veterans' sociodemographic and clinical characteristics were associated with receipt of CC. A minority of Veterans received CC in the year after being identified as high-risk, and there was variation in intensity, timing, and setting of CC. Research is needed to examine the fit between Veterans' CC needs and preferences and VHA CC delivery.

Seasonal variations in psychiatry outpatient service utilization in a tertiary health care center in subtropical arid regions of northwestern India

Background: Research on climatic parameters contributing to psychiatric disorder seasonality is limited, particularly in subtropical, arid climates like Rajasthan, necessitating investigation into seasonal variations in psychiatric disorder incidence in the region. This study investigates seasonal variations in psychiatric disorder prevalence over 2 years at a Rajasthan tertiary healthcare center, aiming to uncover links with climatic factors. Aims: To investigate seasonal variations in the utilization of outpatient psychiatry services and elucidate potential determinants contributing to these temporal variations. Settings and Design: This is a hospital-based study. A retrospective chart review of all new patients who utilized psychiatry outpatient services from July 2021 to July 2023 was conducted. Methods and Material: Data were gathered from psychiatric outpatient records of adults (July 2021 to July 2023), diagnosed using ICD-10. Seasons were categorized: winter (November–January), spring (February–April), summer (May–July), and rainy (August–October). Meteorological data, temperature, and day length were obtained. Statistical analyses, including Pearson correlation and Chi-square fitness, assessed seasonal associations with psychiatric disorders. Results: A total of 29,164 patient records were observed. Depression correlated with temperature and photoperiod. Mania peaked in August, linked to day length. Schizophrenia showed seasonal variation without environmental correlation. Anxiety peaked in March with no statistical significance. Obsessive compulsive disorder cases spiked in June, moderately correlated with temperature and photoperiod. Alcohol-related disorders peaked in December, while opioid dependence remained steady. Cannabis-induced psychosis peaked in summer, strongly correlated with temperature and day length. Headaches surged in August, positively correlated with temperature and day length. Conclusions: This study reveals complex relationships between seasonality, environmental factors, and psychiatric disorders, emphasizing their importance in mental health research and practice.

Negative emotionality and coping in forensic outpatients with sexually transgressive behaviour

ABSTRACT Negative emotionality has been consistently linked to an increased risk of sexual offending. Ninety-one Dutch males treated in outpatient forensic psychiatry for sexually transgressive behaviour were studied on self-reported negative emotionality, coping and sexual coping, and therapist assessed corresponding dynamic risk factors. Outpatients reported more prevalence of high negative emotionality than therapists. Correlation analyses showed, amongst others, a significant positive association between emotional coping and all subscales of negative emotionality: stress (strong), aggression (weak) and alienation (weak). Furthermore, regression analyses revealed that self-reported stress was a significant predictor of several types of self-reported coping (task, emotional, avoidant, and sexual consent and molest) and assessed sexual coping. Additionally, self-reported aggression predicted consent and rape-themed sexual coping. These results indicate a nuanced relationship between different aspects of negative emotionality and coping mechanisms, underscoring the relevance of careful consideration tailored to characteristics of the patient involved when addressed in forensic treatment. PRACTICE IMPACT STATEMENT The observed associations between (aspects of) negative emotionality and coping, promote the use of patient-tailored emotion regulation interventions in the forensic treatment of outpatients with sexually transgressive behaviour. Moreover, self-report appears to provide useful additional information for further tailoring therapy.

Heterogeneity in Antidepressant Treatment and Major Depressive Disorder Outcomes Among Clinicians

While abundant work has examined patient-level differences in antidepressant treatment outcomes, little is known about the extent of clinician-level differences. Understanding these differences may be important in the development of risk models, precision treatment strategies, and more efficient systems of care. To characterize differences between outpatient clinicians in treatment selection and outcomes for their patients diagnosed with major depressive disorder across academic medical centers, community hospitals, and affiliated clinics. This was a longitudinal cohort study using data derived from electronic health records at 2 large academic medical centers and 6 community hospitals, and their affiliated outpatient networks, in eastern Massachusetts. Participants were deidentified clinicians who billed at least 10 International Classification of Diseases, Ninth Revision (ICD-9) or Tenth Revision (ICD-10) diagnoses of major depressive disorder per year between 2008 and 2022. Data analysis occurred between September 2023 and January 2024. Heterogeneity of prescribing, defined as the number of distinct antidepressants accounting for 75% of prescriptions by a given clinician; proportion of patients who did not return for follow-up after an index prescription; and proportion of patients receiving stable, ongoing antidepressant treatment. Among 11 934 clinicians treating major depressive disorder, unsupervised learning identified 10 distinct clusters on the basis of ICD codes, corresponding to outpatient psychiatry as well as oncology, obstetrics, and primary care. Between these clusters, substantial variability was identified in the proportion of selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, and tricyclic antidepressants prescribed, as well as in the number of distinct antidepressants prescribed. Variability was also detected between clinician clusters in loss to follow-up and achievement of stable treatment, with the former ranging from 27% to 69% and the latter from 22% to 42%. Clinician clusters were significantly associated with treatment outcomes. Groups of clinicians treating individuals diagnosed with major depressive disorder exhibit marked differences in prescribing patterns as well as longitudinal patient outcomes defined by electronic health records. Incorporating these group identifiers yielded similar prediction to more complex models incorporating individual codes, suggesting the importance of considering treatment context in efforts at risk stratification.

Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services

There is a substantial gap between demand for and availability of mental health services. Digital mental health interventions (DMHIs) are promising tools for bridging this gap, yet little is known about their comparative effectiveness. To assess whether patients randomized to a cognitive behavioral therapy (CBT)-based or mindfulness-based DMHI had greater improvements in mental health symptoms than patients randomized to the enhanced personalized feedback (EPF)-only DMHI. SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between May 13, 2020, and December 12, 2022, with follow-up at 6 weeks. Adult patients of outpatient psychiatry services across various clinics within the University of Michigan Health System with a scheduled or recent outpatient psychiatry appointment were recruited. Eligible patients were randomized to an intervention arm. All analyses followed the intent-to-treat principle. Participants were randomized to 1 of 5 intervention arms: (1) EPF only; (2) Silvercloud only, a mobile application designed to deliver CBT strategies; (3) Silvercloud plus EPF; (4) Headspace only, a mobile application designed to train users in mindfulness practices; and (5) Headspace plus EPF. The primary outcome was change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9; score range: 0-27, with higher scores indicating greater depression symptoms). Secondary outcomes included changes in anxiety, suicidality, and substance use symptoms. A total of 2079 participants (mean [SD] age, 36.8 [14.3] years; 1423 self-identified as women [68.4%]) completed the baseline survey. The baseline mean (SD) PHQ-9 score was 12.7 (6.4) and significantly decreased for all 5 intervention arms at 6 weeks (from -2.1 [95% CI, -2.6 to -1.7] to -2.9 [95% CI, -3.4 to -2.4]; n = 1885). The magnitude of change was not significantly different across the 5 arms (F4,1879 = 1.19; P = .31). Additionally, the groups did not differ in decrease in anxiety or substance use symptoms. However, the Headspace arms reported significantly greater improvements on a suicidality measure subscale compared with the Silvercloud arms (mean difference in mean change = 0.63; 95% CI, 0.20-1.06; P = .004). This randomized clinical trial found decreases in depression and anxiety symptoms across all DMHIs and minimal evidence that specific applications were better than others. The findings suggest that DMHIs may provide support for patients during waiting list-related delays in care. ClinicalTrials.gov Identifier: NCT04342494.

Prevalence of Digital Technology Use in Individuals Applying to Psychiatry Outpatient Clinic

Abstract Objective: Digital technologies aid in remote patient monitoring, data collection, psychoeducation, self-help applications, disease recognition, and awareness enhancement. However, literature on the utilization of digital technologies among psychiatric patients is scarce. This study aimed to assess the prevalence of digital technology usage among patients attending psychiatric outpatient clinics and compare usage patterns across different diagnoses. Materials and Methods: Between September-November 2023, 500 patients who applied to XXXXX University Faculty of Medicine Psychiatry Outpatient Clinic as outpatients and volunteered to participate in the study were included in the study. After the psychiatric interviews were completed, a questionnaire was filled out asking about the characteristics of the use of mobile technologies, internet, social media, and health applications. Results: Of the study group, 69.4% were female (n=347) and the mean age was 33.9 (±13.01) years. The educational status of 50.4% of the participants was university or master's degree. While 96% of the participants used smartphones, 16% used wearable technology (n=80). Internet usage rate was 94.8% and social media usage rate was 91%. When 251 people who did not use any health application but would like to use one were asked which features they would like to have in the application they would like to use, 78.8% stated that they would like to create an appointment, 67.7% would like an appointment time reminder, 59.7% would like drug side effect query, 55.7% would like their physician to have access to their health information, and 54.9% would like online psychotherapy. Conclusions: The prevalence of smartphone and internet use among patients applying to psychiatry is similar to the national population. There is an unmet need in terms of health applications for the psychiatric patient group. When looking at the desired characteristics of health applications, it should be taken into account that there are different demands in psychiatric diagnosis groups.