Pre-existing Mental Health Disorders Research Articles

Mental Health and Substance Use Disorders in Patients Diagnosed With Cancer: An Integrative Review of Healthcare Utilization.

The impact of mental health disorders (MHDs) and substance use disorders (SUDs) on healthcare utilization (HCU) in patients with cancer is an understudied phenomenon. A literature search of studies published prior to January 2018 that examined HCU in patients with preexisting MHDs or SUDs diagnosed with cancer was conducted. The research team evaluated 22 studies for scientific rigor and examined significant trends in HCU, as well as types of the MHD, SUD, and cancer studied. The heterogeneity of HCU outcome measures, MHD, SUD, sample sizes, and study settings contributed to inconsistent study findings. However, study trends indicated higher rates of HCU by patients with depression and lower rates of HCU by patients with schizophrenia. In addition, the concept of HCU measures is evolving, addressing not only volume of health services, but also quality and efficacy. Oncology nurses are essential to improving HCU in patients with MHDs and SUDs because of their close connections with patients throughout the stages of cancer care. Additional prospective studies are needed to examine specific MHDs and different types of SUDs beyond alcohol use, improving cancer care and the effectiveness of HCU in this vulnerable population.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

Disparities in Bladder Cancer Treatment and Survival Amongst Elderly Patients with a Pre-existing Mental Illness

BackgroundPre-existing mental illness is known to adversely impact cancer care and outcomes, but this is yet to be assessed in the bladder cancer setting. ObjectiveTo characterize the patterns of care and survival of elderly patients with a pre-existing mental illness diagnosed with bladder cancer. Design, setting, and participantsWe conducted a retrospective analysis of patients enrolled in Surveillance, Epidemiology, and End Results (SEER)-Medicare. A population-based sample was considered. Elderly patients (≥68 yr old) with localized bladder cancer from 2004 to 2011 were stratified by the presence of a pre-existing mental illness at the time of cancer diagnosis: severe mental illness (consisting of bipolar disorder, schizophrenia, and other psychotic disorders), anxiety, and/or depression. Outcome measurements and statistical analysisWe performed multivariable logistic regression analyses to compare the stage of presentation and receipt of guideline-concordant therapies (radical cystectomy for muscle-invasive disease). Survival between patients with a pre-existing mental disorder and those without were compared using Kaplan–Meier analyses with log-rank tests. Results and limitationsOf 66 476 cases included for analysis, 6.7% (n=4468) had a pre-existing mental health disorder at the time of cancer diagnosis. These patients were significantly more likely to present with muscle-invasive disease than those with no psychiatric diagnosis (23.0% vs 19.4%, p–<0.01). In patients with muscle-invasive disease, those with severe mental illness (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.37–0.81) and depression only (OR 0.71, 95% CI 0.58–0.88) were significantly less likely to undergo radical cystectomy or trimodality therapy. Patients in this subgroup who underwent radical cystectomy had significantly superior overall (hazard ratio [HR] 0.54, 95% CI 0.43–0.67) and disease-specific survival (HR 0.76, 95% CI 0.58–0.99) compared with those who did not receive curative treatment. ConclusionsElderly patients with muscle-invasive bladder cancer and a pre-existing mental disorder were less likely to receive guideline-concordant management, which led to poor overall and disease-specific survival. Patient summaryPatients with severe mental illness and depression were only significantly less likely to undergo radical cystectomy for muscle-invasive disease, that is, to receive guideline-concordant treatment. Overall survival and disease-specific survival were inferior in patients with a pre-existing mental disorder, and were especially low in those who did not receive guideline-concordant care.

Mental health outcomes after major trauma in Ontario: a population-based analysis.

Major injury continues to be a common source of morbidity and mortality; improving the functional recovery of survivors of major trauma requires a better understanding of the mental health outcomes that may occur in this population. We assessed the association between major trauma and the development of a new mental health diagnosis or death by suicide. We completed a population-based, self-controlled, longitudinal cohort analysis using linked administrative data on patients treated for major trauma in Ontario between 2005 and 2010. All survivors were included and composite rates of mental health diagnoses during inpatient admissions were compared between the 5 years after injury and the 5 years before injury, using Poisson regression with generalized estimating equations. The incidence of suicide was calculated for the 5 years after injury. Risk factors for suicide were calculated using Cox proportional hazard regression analyses. The analysis included 19 338 patients, predominantly men (70.7%) from urban areas (82.6%), with unintentional (89%), blunt injuries (93.4%). Overall, trauma was associated with a 40% increase in the postinjury rate of mental health diagnoses (incidence rate ratio [IRR] 1.4, 95% [confidence interval] CI 1.1 to 1.8). The suicide rate was 70 per 100 000 patients per year, substantially higher than the population average. Risk factors for completing suicide were prior inpatient diagnosis of mood disorder (hazard ratio [HR] 4.3, 95% CI 2.1 to 8.8) and self-inflicted injury (HR 7.8, 95% CI 3.9 to 15.4). Survivors of major trauma are at a heightened risk of developing mental health conditions or death by suicide in the years after their injury. Patients with pre-existing mental health disorders or who are recovering from a self-inflicted injury are at particularly high risk.

Suicidal ideation in the perinatal period: A systematic review

ObjectiveTo examine literature surrounding suicidal ideation and suicidality in the perinatal period. DesignSystematic Literature Review of published 15 research studies. FindingsThere is a scarcity of prospective studies conducted in suicidal ideation during the perinatal period. More research is needed to ensure childbearing women at risk of suicidal ideation during pregnancy receive the appropriate care and maternity services required to support them throughout this period. Key conclusionsMidwives play an important role in screening women for possible emotional distress and mood disorders during pregnancy. Therefore, midwives need to have knowledge of risk factors so vulnerable women are monitored and supportive maternity services can be implemented if indicated. Implications for practiceSuicidal ideation can have serious consequences for the women and the product if left untreated. Screening for suicidal ideation, antenatal and postnatal depression is imperative. Women with a pre-existing mental health disorders are a particularly vulnerable population group and should be monitored closely for suicidal ideation. Women who experience intimate partner violence or are from low socioeconomic backgrounds also present a risk of suicidal ideation, all of which require complex mental-health care.

Risk Factors for Prolonged Opioid Use Following Spine Surgery, and the Association with Surgical Intensity, Among Opioid-Naive Patients.

There is a growing concern that the use of prescription opioids following surgical interventions, including spine surgery, may predispose patients to chronic opioid use and abuse. We sought to estimate the proportion of patients using opioids up to 1 year after discharge following common spinal surgical procedures and to identify factors associated with sustained opioid use. This study utilized 2006 to 2014 data from TRICARE insurance claims obtained from the Military Health System Data Repository. Adults who underwent 1 of 4 common spinal surgical procedures (discectomy, decompression, lumbar posterolateral arthrodesis, or lumbar interbody arthrodesis) were identified. Patients with a history of opioid use in the 6 months preceding surgery were excluded. Posterolateral arthrodesis and interbody arthrodesis were considered procedures of high intensity, and discectomy and decompression, low intensity. Covariates included demographic factors, preoperative diagnoses, comorbidities, postoperative complications, and mental health disorders. Risk-adjusted Cox proportional hazard models were used to evaluate the time to opioid discontinuation. This study included 9,991 patients. Eighty-four percent filled at least 1 opioid prescription on discharge. At 30 days following discharge, 8% continued opioid use; at 3 months, 1% continued use; and at 6 months, 0.1%. In the adjusted analysis, the low-intensity surgical procedures were associated with a higher likelihood of discontinuing opioid use (discectomy: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.36 to 1.50; and decompression: HR = 1.34, 95% CI = 1.25 to 1.43). Depression (HR = 0.84, 95% CI = 0.77 to 0.90) was significantly associated with a decreased likelihood of discontinuing opioid use (p < 0.001). By 6 months following discharge, nearly all patients had discontinued opioid use after spine surgery. As only 0.1% of the patients continued opioid use at 6 months following surgery, these results indicate that spine surgery among opioid-naive patients is not a major driver of long-term prescription opioid use. Socioeconomic status and pre-existing mental health disorders may be factors associated with sustained opioid use following spine surgery. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System.

Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed preexisting mental health disorders and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with non-small cell lung cancer (NSCLC) in the U.S. MHS. The study used data from the linked database from the Department of Defense's Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007. Patients with a preexisting mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without [adjusted HR, 1.11; 95% confidence interval (CI), 1.03-1.20]. Poor survival in NSCLC in patients with a preexisting mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment. This study contributes to the current understanding that health care access may not be sufficient to explain the poor survival among patients with NSCLC with preexisting mental health disorders. Cancer Epidemiol Biomarkers Prev; 25(12); 1564-71. ©2016 AACR.

The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study.

Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time. Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis. The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship. Our study findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. Copyright © 2016 John Wiley & Sons, Ltd.

In their hour of need - addressing issues of psyche and soma at end of life

In their hour of need - addressing issues of psyche and soma at end of life

The Feasibility of an E-Learning Program to Improve First Line Law Enforcement Responders Recognition of Emotionally Disturbed Persons

Introduction: With deinstitutionalization, there are higher demands placed on police in dealing with “emotionally disturbed persons or EDPs” (e.g., those in an agitated state due to any or several of the following reasons: pre-existing mental health disorder; emerging mental health disorder; extreme situational stress; substance abuse). The need for training of first responders in the management of EDPs and/or those suffering from mental illness is well documented in the literature. We are evaluating the feasibility of an e-learning course which trains first responders to recognize emotionally disturbed persons and adopt effective strategies to deescalate a crisis situation. Methods: Mental health experts and senior law enforcement personnel collaborated to pilot a program designed to improve law enforcement officers’ skills in recognizing, categorizing and managing EDPs, “Recognition of Emotionally Disturbed Persons”. Following a successful training pilot Dalhousie University Department of Psychiatry entered into a partnership with Canadian Police Knowledge Network (CPKN)—Canada’s leading provider of online training solutions for police officers—in order to provide a 2-hour online program available across Canada and internationally, currently known as Recognition of Emotionally Disturbed Persons (REDP) e-learning course. Results: The authors will discuss the feasibility of an on-line learning program, the benefits and challenges learners have faced over the 4-year period since its inception. Attendees’ satisfaction levels regarding the relevance and utility of this learning model was high. The REDP-e-learning course has proven to be a practical and useful approach for first responders dealing with emotionally disturbed persons. This model is a viable and cost-effective option especially in public service organizations where time efficiencies and reducing budgets are a priority. Organizations developing training programs for such target audiences need to take these factors into account in order to ensure long term sustainability.

Psychiatric clearance for patients started on interferon-alpha-based therapies.

Increasingly, psychiatrists are asked to provide “psychiatric clearance” for patients who are to be treated with a regimen that includes recombinant preparations of interferon-alpha (IFN-a), often in combination with other antiviral medications. The most common use for IFN-a is in the treatment of chronic hepatitis C, which affects about 2% of the general U.S. population and about 20% of people with severe mental illness (1). Each year, more people in the United States die from hepatitis C complications, such as severe cirrhosis and hepatocellular cancer, than from HIV. IFN-a is also used, in combination with other medications, to treat some cancers, such as metastatic melanoma. This recombinant inflammatory cytokine has been associated with adverse effects on mental health, worse quality of life, increased risk for suicide, and treatment discontinuation. Most patients develop some fatigue and loss of appetite during treatment, which can be severe but is usually tolerable. However, 10%–40% additionally develop a full depressive disorder syndrome that can include suicidal ideation, amotivation, social withdrawal, guilt, anhedonia, irritability, anxiety, and crying (2–8). Untreated depression is a major contributor to dosage reductions or treatment discontinuations and consequent risk for viral relapse (9–11). Additionally, many patients with hepatitis C already have preexisting mental health disorders (12) that often go unrecognized (13). Such disorders can adversely affect a person’s ability to tolerate a 24to 48-week course of antiviral IFN-a therapy. In addition to depression during IFN-a treatment, many patients (up to 25%) may develop anger and irritability (14–17), which can be independent of depression. These symptoms can occasionally be serious enough to result in road rage, spousal discord, and problems at work. Another common side effect of IFN-a is severe fatigue. Less commonly, mania, delirium, and psychosis can occur. Monitoring for these various psychiatric side effects, as well as distinguishing among these distinct conditions, is one role for the psychiatrist. Also, coadministered medications such as telaprevir and boceprevir (antiviral protease inhibitors) can inhibit cytochrome P450 (CYP) 3A4, resulting in increased blood levels of many psychiatric medications. A knowledge of psychopharmacology and potential medication interactions is thus also important. Finally, IFN-a treatment commonly has mild side effects such as nausea and malaise and occasionally is complicated by severe hematologic abnormalities. Both sustained adherence and psychosocial stability are necessary, even in patients who do not develop frank neuropsychiatric syndromes.

Prevalence of challenging behaviour among older in-patients: a pilot study

Older people occupy two-thirds of in-patient beds in acute general hospitals. Pre-existing mental health disorders are independent predictors of poor outcomes such as increased mortality and length of stay, loss of independent function and higher rates of institutionalisation.[1][1] Disruptive

Rehabilitation outcomes in people with pre-morbid mental health disorders following spinal cord injury

Case series, consecutive sample. To investigate the rehabilitation outcomes of patients with spinal cord injury (SCI) suffering from preexisting mental health disorders (MHD). National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, UK. Twenty-eight newly injured SCI patients: 14 with preexisting MHD and a matched cohort of 14 patients without MHD who were admitted between 2000 and 2006. All patients were involved in a multidisciplinary Goal Planning and Needs Assessment Rehabilitation Programme. Rehabilitation outcomes were measured using the Needs Assessment Checklist (NAC), which has been specifically designed for use with people with SCI. It is a reliable and valid clinical assessment tool, which provides a means to assess and facilitate the delivery of an individually tailored rehabilitation programme. No significant difference was found between the MHD and non-MHD groups for rehabilitation outcomes. The MHD group showed higher achieved independence scores in psychology for the first needs assessment. Overall, both groups were found to make significant improvements in their level of independence for all nine areas of need between the first and second NAC administration. Results suggest that rehabilitation can be tailored to meet the individual needs of patients with SCI having MHD; however, further research comparing these outcomes with other rehabilitation approaches is required. The function of timely psychological support for MHD patients on admission to the NSIC has been suggested as a potential explanation for rehabilitation performance. Most importantly, rehabilitation outcomes of patients with MHD have not been found to differ significantly compared with those without MHD.