Presence Of Mental Health Disorders Research Articles

Factor analysis and normative scores of Alcohol Use Disorders Identification Test (AUDIT) in a representative sample of the general population of Greece.

The most widely used screening instrument for alcohol use disorders (AUD) is the Alcohol Use Disorders Identification Test (AUDIT) which, although initially developed for use in primary care, is increasingly used in general population studies. Previous studies that have assessed the screening properties and the factorial structure of AUDIT were mostly based on clinical samples and did not take into consideration the possible differences in AUDIT factorial properties between subgroups according to age, sex and mental health status. Aim of the current study was to explore the distribution of AUDIT and AUDIT-Consumption (AUDIT-C) scores and the factorial structure of AUDIT in subgroups of participants according to sex, age and the presence of mental health disorder. Descriptive statistics and Exploratory/Confirmatory Factor Analysis of AUDIT were extracted in a general population representative sample of 4,894 Greek participants. Different cut-offs are suggested in order to screen 10% of the population with the highest severity of AUD into the aforementioned subgroups. Generally, a cut-off between 10-12 at AUDIT score is suggested for screening the 10% with the highest severity of alcohol use problems in subgroups of frequent alcohol consumers (e.g. younger males) and a cut-off between 4-5 would screen the 5% with the highest severity of alcohol use problems in subgroups of low alcohol-consumers (e.g. older women). A cut-off of 3 in AUDIT-C score is suggested for screening 25% of individuals with the heaviest alcohol consumption. The traditional three-factor model does not explain better the factorial structure of AUDIT compared to the 2-factors model. The AUDIT is a reliable instrument for assessing AUD and heavy alcohol consumption in the Greek general population. Age, sex and the presence of mental health disorders should be taken into consideration when selecting cut-offs for screening purposes in non-clinical samples.

PDG42 OPIOID USE FOR TREATMENT OF ACUTE PAIN AMONG CHILDREN AND ADOLESCENTS ENROLLED IN THE MISSISSIPPI MEDICAID PROGRAM

Abuse of opioids among children and adolescents has become a major public concern. Understanding the epidemiology of opioid use in this vulnerable population is critical to address opioid abuse. This study aimed to characterize patterns of opioid use for treatment of acute pain (such as postoperative pain of tonsillectomy and/or adenoidectomy, burns, and common acute non-cancer pain) among children and adolescents enrolled in Mississippi Medicaid. A retrospective cohort study was conducted using the Mississippi Medicaid data from July 2015 through December 2017. The proportion of children and adolescents less than 21 years of age using opioids within seven days following any qualifying acute pain episode was examined. Dose, duration, and type of opioid therapy were recorded in each case. A three-month washout period prior to the prescription index date was used to identify presence of mental health disorders, obstructive sleep apnea, and other comorbidities. Bivariate analyses were used to test differences in opioid use characteristics among various demographic variables and preexisting clinical characteristics. A total of 164,787 beneficiaries with a qualifying acute pain episode were included in the study. Of these, 8,448 (5.1%) received an opioid prescription within seven days following an acute pain episode. Beneficiaries between the ages of 18 and 21, caucasians, and males were more likely to receive opioids. The majority received Schedule II or III-IV short-acting opioids. There was no significant association between the use of opioids for acute pain and the presence of MH disorders. The results provide evidence that can help develop strategies for encouraging appropriate use of opioids following acute pain among children and adolescents. Further studies are needed to investigate the influence of clinical risk factors such as mental health disorders and obstructive sleep apnea on the prescription of opioids for treatment of acute pain in this population.

PND7 A LONGITUDINAL EXAMINATION OF PROGRESSION-RELATED EVENTS AMONG MEDICARE BENEFICIARIES WITH AND WITHOUT PARKINSON'S DISEASE

Prior Parkinson’s disease (PD) studies are limited by short follow-up and have not reported on events associated with PD progression. The purpose of this study was to characterize PD progression-related events over time among PD cases and compare to PD controls. This retrospective cohort study utilized administrative medical and pharmacy claims data from 2005 to 2015 for Medicare beneficiaries represented in the Medicare Chronic Condition Data Warehouse (CCW) 5% sample. We matched cases to controls based on age, race, gender and comorbidities. Cases and controls were required to have at least 7 years of follow-up. We captured the presence of mental health disorders, autonomic dysfunction, falls or fractures (FoF), and fatigue in each year of follow-up. We compared these progression-related events between cases and controls using Pearson’s chi-square tests. The matched sample consisted of 3,570 individuals with 7 years of follow-up. The occurrence of events among cases in years 1, 3, 5 and 7 was as follows. Autonomic dysfunction: 69%, 68%, 73%, 75%; mental health disorders: 53%, 52%, 59%, 66%; FoF: 21%, 18% 20%, 22%; fatigue: 41%, 35%, 36%, 38%, respectively. The occurrence of all four events was higher among cases compared to controls in each year. The largest difference between cases and controls was observed in year 1: autonomic dysfunction (69% vs. 45%, p<0.01); mental health disorders (53% vs. 18%, p<0.01); FoF (21% vs. 9%, p<0.01); fatigue (41% vs. 23%, p<0.01). The differences between cases and controls dropped in year 3, but increased in years 5 and 7. Progression-related events occurred at significantly higher rates among PD cases compared to controls in each year of follow-up. The differences between cases and controls were highest in year 1. Among cases, the largest increase in autonomic dysfunction and mental health disorders occurred between years 3 and 5.

Building Resilience Against the Sequelae of Adverse Childhood Experiences: Rise Up, Change Your Life, and Reform Health Care.

A reformed approach to health care tackles health at its roots. Adverse childhood experiences (ACEs) in those exposed to them may contribute significantly to the root causes of many diseases of lifestyle. ACEs are traumatic experiences, such as physical and emotional abuse and exposure to risky family environments. In 1998, a ground-breaking study found that nearly 70% of Americans experience at least 1 ACE in their lifetime, and graded exposure is associated with the presence of mental health disorders, heart disease, cancer, and other chronic diseases. Over the past 20 years, evidence has demonstrated further disease risk, outcomes, and epigenetic underpinnings in children and adults with ACEs. Building resilience-the capacity to adapt in healthy ways to traumatic experiences-through lifestyle modification offers potential to combat the negative health effects associated with ACEs. Emerging research demonstrates resilience is cultivated through individual skills (emotional intelligence, coping, and fostering healthy lifestyle choices), and nurturing supportive relationships. Being mindful of the impact and prevalence of ACEs and diversity of individuals' experiences in society will help build resilience and combat the root cause of chronic disease. This review aims to cultivate that awareness and will discuss 3 objectives: to discuss the effects and hypothesized pathophysiological underpinnings of traumatic experiences in childhood on health and wellbeing throughout life, to present ways we can promote resilience in our daily lives and patient encounters, and to demonstrate how advocacy for the reduction of ACEs and promotion of resilient, trauma-informed environments are fundamental to health care reform.

Brain Function in Gulf War Illness (GWI) and Associated Mental Health Comorbidities

GWI has affected a substantial number of Gulf War (GW) veterans. The disease involves several organ systems among which the brain is most prominent. Neurological, cognitive and mood-related (NCM) symptoms frequently dominate and are at the root of chronic ill-health and disability in veterans suffering from GWI. In addition, such symptoms frequently co-occur with diagnosable mental health disorders, predominantly posttraumatic stress disorder (PTSD). Here we investigated the possibility that increased GWI severity leads, above a threshold, to a diagnosable mental health disorder (excluding psychosis). For this purpose, we used, in separate analyses, symptom severity scores and resting-state brain functional connectivity patterns, as determined by magnetoencephalography (MEG). Two-hundred-thirty GW-era veterans participated in this study. They completed diagnostic interviews to establish the presence of GWI and assess mental health status. This distinguished 3 groups: healthy controls (N = 41), veterans with GWI and no mental illness (GWI group, N = 91), and veterans with both GWI and mental health disorder (GWI+MH, N = 98). For each veteran, symptom severity scores in the 6 GWI domains (fatigue, pain, NCM, skin, gastrointestinal, respiratory) were available as well as 9 summary measures of the distribution of Synchronous Neural Interactions (SNI) derived from the MEG recordings. We tested the hypothesis that, in the presence of GWI, the appearance of a diagnosable mental health disorder may depend on GWI symptom severity. For that purpose, we performed a logistic regression on the GWI population, where the presence (or absence) of the MH disorder was the dependent variable and the age- and gender-adjusted GWI severity in the 6-symptom domains were the predictors. The outcome was the probability that a participant will have MH disorder or not. Similarly, we tested the hypothesis that the presence of the MH disorder can be predicted by the SNI distribution patterns by performing a second logistic regression as above but with the 9 SNI measures as predictors. We found GWI symptom severity differed significantly across groups (GWI+MH > GWI > Control). SNI distributions of the GWI group also differed significantly from the other groups in a systematic hemispheric pattern, such that the presence of GWI involved predominantly the left hemisphere, and presence of mental health disorders involved, in addition, the right hemisphere. Both logistic regressions yielded highly significant outcomes, demonstrating that both GWI symptom severity and SNI distribution measures can predict the presence of MH disorder in GWI. Remarkably, the prediction probabilities for MH presence derived from the symptom-based and SNI-based logistic regressions were positively and highly statistically significantly correlated. Taken together, both objective (neural) and subjective (symptoms) indices suggest that GWI is distinct from healthy controls and varies in severity in a continuum that leads, at the higher end, to a diagnosable MH disorder. The positive correlation between the GWI symptom-based and brain-based predicted classifications provides a key link between GWI symptom severity and synchronous neural interactions in the context of mental illness.

Abstract 117: Presence of Mental Health Disorders, Low Socioeconomic Status, More Closely Associated With Adverse Cardiovascular Outcomes After a Recent Hospitalization

Background: BRIDGE is a cardiac transitional care program. In previous studies, lower socioeconomic status (SES) and mental health disorders (MHD) have been associated with higher readmission rates. No research has been done on the combined effects of low SES and MHD on outcomes. This study sought to describe outcomes (ED Visits, readmission, and death) of patients by SES and MHD. Methods: All patients referred to BRIDGE between 2008-2015 were included in this study. Data were analyzed in three ways: 1) by SES and then by presence (or absence) of MHD (depression, anxiety, substance abuse), 2) by MHD and then by SES, and 3) patients of low SES without MHD compared to patients of high SES with a MHD (data not shown in Table 1). High and low SES were defined as above or below the state of Michigan median household income ($46,859), estimated by patients’ home zip code. Demographics and outcomes were compared within and between groups. Results: Among 3051 patients divided first by SES, there were a number of significant differences in demographics and outcomes between patients with and without MHD. Regardless of SES, patients with MHD were more often younger, female, single, and had higher rates of ED visits and readmissions at 180 days post-discharge than patients without MHD. Among high SES patients, patients with MHD had higher rates of ED visits within 30 days despite lower Charlson Comorbidity scores. In contrast, when divided by presence or absence of MHD first, fewer differences existed between SES groups. Regardless of presence or absence of MHDs, patients of low SES were younger and more racially diverse than patients of high SES; however, there were no differences in outcomes between these SES groups. Among patients without a MHD, low SES patients were less likely to attend BRIDGE. Patients of low SES without MHD were more likely than patients of high SES with MHD to be male (61.4% v. 51.2%, p&lt;0.001), married (60.8% v. 52.2%, p=0.013), and non-White (75.3% v. 89.5%, p&lt;0.001), and were less likely to have an ED visit within 180 days (31.9% v. 43.9%, p&lt;0.001). Conclusions: The presence of MHDs appears to be more strongly associated with negative outcomes than low SES. Efforts to develop and improve interventional care strategies that target patients with MHDs should be made to reduce these health disparities.

The Impact of Mental Illness on Uptake of Genetic Counseling for Hereditary Breast Cancer and Ovarian Cancer in a Multiethnic Cohort of Breast Cancer Patients.

We evaluated whether mental illness is a barrier to genetic counseling for hereditary breast and ovarian cancer (HBOC) in multiethnic breast cancer patients. We conducted a retrospective analysis of 308 women with newly diagnosed breast cancer and eligible for HBOC genetic testing seen in the breast clinic of an academic, urban medical center from 2007 to 2015. Uptake of genetic services and history of mental health disorder (MHD), defined as a psychiatric diagnosis or treatment with an antidepressant, mood stabilizer, anxiolytic, or antipsychotic medication, were ascertained by medical chart review. The mean age at breast cancer diagnosis was 56 years, with 44% non-Hispanic whites, 37% Hispanics, and 15% non-Hispanic blacks. Ninety-nine (32%) women met study criteria for MHD, 73% had a genetics referral, 57% had genetic counseling, and 54% completed BRCA testing. Uptake of genetic counseling services did not differ by race/ethnicity or presence of MHD. In multivariable analysis, younger age at diagnosis, Ashkenazi Jewish heritage, and family history of breast cancer were associated with HBOC genetic counseling. A relatively high proportion of breast cancer patients eligible for HBOC genetic testing were referred to a genetic counselor and referral status did not vary by MHD or race/ethnicity.

Desórdenes psiquiátricos de los inmigrantes chinos del siglo XIX. Segunda parte: Condiciones de vida y salud mental de los inmigrantes chinos entre 1865 y 1900

Se indagó sobre los desórdenes de la salud mental de los inmigrantes chinos (culíes) que llegaron al Perú en el siglo XIX, entre 1849 y 1874, para suplir la carencia de mano de obra después de la abolición de la esclavitud. Se revisó las publicaciones históricas sobre las condiciones de vida de esa población; los datos se sustentan en registros provenientes de sus centros de trabajo. Los informes, que abarcan el período entre 1865 y 1900, permitieron delinear alteraciones emocionales y de conducta relacionadas con estrés prolongado (reclutamiento traumático, larga e insalubre travesía marítima, sin familia, con trabajo en condiciones de semiesclavitud y encierro en galpones). Se colige la presencia de estados asteniformes somatógenos, depresivos, hipocondríacos o de simulación en los trabajadores calificados como ‘mañosos’. La literatura refiere prácticas homosexuales en el encierro obligado de varones solteros y enfermedades de transmisión sexual que incluye a la sífilis; un elevado consumo de opio que trató de ser reemplazado por alcohol y coca; actitudes de desesperanza, resistencia y rebeldía que condujeron a suicidios y homicidios así como a rebeliones grupales y a colaboracionismo durante la Guerra del Pacífico. Estos hallazgos históricos, confrontados con las estadísticas hospitalarias del Manicomio del Cercado (primera parte), coinciden en señalar el alto consumo de opio, por los cuadros diagnosticados en el hospital psiquiátrico como ‘locura tóxica’ asociada a ese estupefaciente. Hay una discrepancia entre los informes históricos de frecuentes enfermedades de transmisión sexual, incluyendo sífilis, y la escasa prevalencia hospitalaria de parálisis general progresiva (PGP), la forma psiquiátrica de la neurosífilis revelada en la primera parte de este estudio. En la discusión de esta incongruencia se plantea la posibilidad de una malarioterapia ecológica como factor influyente en la baja prevalencia hospitalaria de PGP.

Interpersonal polyvictimization and mental health in males

A consistent conclusion within the extant literature is that victimization and in particular polyvictimization leads to adverse mental health outcomes. A large body of literature exists as it pertains to the association between victimisation and mental health in studies utilising samples of childhood victims, female only victims, and samples of male and female victims; less research exists as it relates to males victims of interpersonal violence. The aim of the current study was therefore to identify profiles of interpersonal victimizations in an exclusively male sample and to assess their differential impact on a number of adverse mental health outcomes. Using data from 14,477 adult males from Wave 2 of the NESARC, we identified interpersonal victimization profiles via Latent Class Analysis. Multinomial Logistic Regression was subsequently utilized to establish risk across mental health disorders. A 4-class solution was optimal. Victimisation profiles showed elevated odds ratios for the presence of mental health disorders; suggesting that multiple life-course victimisation typologies exists, and that victimization is strongly associated with psychopathology. Several additional notable findings are discussed.

Study of perception and help seeking behaviour among parents for their children with psychiatric disorder: a community based cross-sectional study

Background: Child mental health problems present a health challenge for all societies, which are aggravated by lack of knowledge in parents regarding them as well as suboptimal response to them with reference to the help seeking behaviour by parents of these cases. We tried to find out perception of child mental health problems in parents and also the help seeking behaviour of parents residing in an urban slum of Mumbai because understanding impediments to perceiving these disorders and thereby having optimal health seeking behaviour could greatly contribute to reducing the impact of these problems on children's growth and development overall. Study design &amp; setting: A cross‑sectional study was conducted in urban slum of Mumbai. Materials &amp; Methods: Systematic random sampling technique was used to select 257 respondents which were interviewed for presence of mental health disorder using semi-structured questionnaire. Parents of 38 children who were diagnosed for mental health disorder were interviewed with the help of pre-tested questionnaire for perception and help seeking behaviour for psychiatric disorder in their children. Interviews were conducted after getting informed consent. Two focus group discussions with the parents of the cases about their child’s mental health were also conducted. Results: 47.4% parents perceived the problems in behaviour of their child and of these, only 10.5% parents sought treatment voluntarily before the interview. Major reasons given for not taking treatment were unawareness, no felt need, stigma attached to mental health. Parents’ perception and help seeking behaviour were better for male gender, higher education of parents, employed parents, having 5-10 members’ family and stress-free family. Conclusion: Present study outlined the need of awareness in parents regarding child mental health problems. Parents also need to be addressed in intervention and education programs related to child mental health.

Mental Health Disorders in General Practice in France: A Cross-Sectional Survey

Background: Mental health disorders constitute a large and growing disease burden in Europe. Almost all patients with mental health disorders consulted their general practitioner in a single year. The aim of this study was to assess the frequency and the socio-demographic factors associated with the mental health disorders encountered in general medicine in France. Method: The study participants were selected from the French national cross-sectional multi-centric ECOGEN study. The study was carried out with all of the patients who consulted with their general practitioner either at their medical practice or as a home visit in 128 medical centers, affiliated with 27 university general medicine departments. Data were collected from 28 November 2011 to 29 April 2012, based on the second version of International Classification of Primary Care. Univariate and multivariate analyses were conducted using logistic regression analyses. Results: 20 613 patients were included in the study. The frequency of mental health disorders was 17.6% [CI 95% 17.1-18.1]. The main disorders were depressive disorders, anxiety disorders, sleep disorders, and substance abuse disorders. With children, the frequency of mental disorders was 0.2%. The most common disorder was in regard to specific learning problems. Socio-demographic and medical factors were for the most part strongly associated with the presence of mental health disorders but in different ways. Conclusion: Mental health disorders are among the most common reasons for consultations in general practice.Efforts are needed to increase mental health evaluation in a bio-psycho-social approach.

Assessing attentional biases with stuttering.

Many adults who stutter presenting for speech treatment experience social anxiety disorder. The presence of mental health disorders in adults who stutter has been implicated in a failure to maintain speech treatment benefits. Contemporary theories of social anxiety disorder propose that the condition is maintained by negative cognitions and information processing biases. Consistent with cognitive theories, the probe detection task has shown that social anxiety is associated with an attentional bias to avoid social information. This information processing bias is suggested to be involved in maintaining anxiety. Evidence is emerging for information processing biases being involved with stuttering. This study investigated information processing in adults who stutter using the probe detection task. Information processing biases have been implicated in anxiety maintenance in social anxiety disorder and therefore may have implications for the assessment and treatment of stuttering. It was hypothesized that stuttering participants compared with control participants would display an attentional bias to avoid attending to social information. Twenty-three adults who stutter and 23 controls completed a probe detection task in which they were presented with pairs of photographs: a face displaying an emotional expression-positive, negative or neutral-and an everyday household object. All participants were subjected to a mild social threat induction being told they would speak to a small group of people on completion of the task. The stuttering group scored significantly higher than controls for trait anxiety, but did not differ from controls on measures of social anxiety. Non-socially anxious adults who stutter did not display an attentional bias to avoid looking at photographs of faces relative to everyday objects. Higher scores on trait anxiety were positively correlated with attention towards photographs of negative faces. Attentional biases as assessed by the probe detection task may not be a characteristic of non-socially anxious adults who stutter. A vigilance to attend to threat information with high trait anxiety is consistent with findings of studies using the emotional Stroop task in stuttering and social anxiety disorder. Future research should investigate attentional processing in people who stutter who are socially anxious. It will also be useful for future studies to employ research paradigms that involve speaking. Continued research is warranted to explore information processing and potential biases that could be involved in the maintenance of anxiety and failure to maintain the benefits of speech treatment outcomes.

Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma

Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p<0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.

Survey of an Australian general emergency department: estimated prevalence of mental health disorders.

Compared to the general population, people with mental health disorders have an increased risk of morbidity and mortality, and are associated with higher health-care costs and lost societal productivity. Evidence indicates that more people are presenting to emergency departments with mental health disorders and that this group represents a disproportionately large number of emergency department attendees. The study results indicate that around a third of people who attended the emergency department may have had a mental health disorder, which is more than that found in the general adult Australian population. The results also suggest that the majority of emergency department attendees that have a mental health disorder are not identified at this opportunistic point of contact. The emergency department is an ideal point of contact to screen people for mental health problems. If problems are identified early, and treatment is started early, then it is likely that more people would be helped before their mental health problem became severe. However, increased identification of mental health problems may have implications for mental health services in terms of workload and delivery. The aim of this study was to estimate the prevalence of mental health disorders in an Australian general emergency department. A cross-sectional survey was used to screen a sample of 708 patients, using the Kessler Psychological Distress Scale (K10). The mean age of participants was 50.2 years, and their mean K10 score was 19.96 (SD 7.83), with 24% categorized as having high or very high psychological distress. Seventeen per cent self-reported having a mental health issue. Post-probability calculations based on observed K10 scores estimated that 37% of participants had an actual mental health disorder. The results suggest the prevalence of mental health disorder is significantly higher in emergency department attendees than Australian population norms, supporting the contention that a substantial proportion of ED attendees has a mental health disorder that, in the majority of cases, is not investigated at this point of contact. There is potential to screen all emergency department attendees for the presence of mental health disorder; early identification of mental illness would enable early referral for treatment. However, if all patients are screened, then it is likely that more mental health conditions will be picked up. The implications for mental health nursing are that this may increase workload.

Evaluation of the Significance of Pretreatment Liver Biopsy and Baseline Mental Health Disorder Diagnosis on Hepatitis C Treatment Completion Rates at a Veterans Affairs Medical Center

Objectives. This study was performed to define the overall treatment response rates and treatment completion rates among the population of Hepatitis C infected patients at an urban VA Medical Center. Additionally, we examined whether pretreatment liver biopsy is a positive predictor for treatment completion and if the presence of mental health disorders is a negative predictor for treatment completion. Methods. Retrospective chart review was performed on the 375 patients that were treated for HCV and met the study inclusion parameters between January 1, 2003 and April 1, 2008 at our institution. Clinical data was obtained from the computerized patient record system and was analyzed for respective parameters. Results. Sustained virological response was achieved in 116 (31%) patients. 169 (45%) patients completed a full treatment course. Also, 44% of patients who received a pre-treatment liver biopsy completed treatment versus 46% completion rates for patients who did not receive a pretreatment liver biopsy. Baseline ICD9 diagnosis of a mental health disorder was not associated with higher treatment discontinuation rates. Conclusions. In conclusion, pretreatment liver biopsy was not a positive predictor for treatment completion, and the presence of mental health disorders was not a negative predictor for treatment completion.

Effect of External Variables on the Performance of the Geriatric Comorbidity Score Derived from Prescription Claims in the Community-Dwelling Elderly

Comorbidity scores based on medical or prescription claims data are frequently used to control for confounding in pharmacoepidemiological studies. Performance of such scores in predicting the risk of death in community-dwelling elderly adults may be compromised by the absence of mental health and socioeconomic characteristics not captured in claims data. The aim of the study was to assess the impact of adding mental health status and sociodemographic characteristics to the Geriatric Comorbidity Score (GCS), a score derived from prescription claims data in the Quebec community-dwelling elderly population. We used the cohort study from the longitudinal Quebec Seniors' Health Survey (n = 1,494) conducted between 2005 and 2006. For each participant, we obtained mental health and socioeconomic characteristics through validated questionnaires, which we linked with the medical and prescription claims databases of the Quebec Health Insurance Agency [Régie de l'assurance maladie du Québec (RAMQ)]. The main study outcome was death within 1 year, ascertained using the Quebec death registry. The GCS was calculated from prescription claims data, with the c statistic as a measure of performance. Using backward stepwise selection, external variables (marital status, region, family income, social support, daily hassles, perceived physical and mental health status, presence of mental health disorders) were added to the logistic regression model and the marginal effect assessed by comparing the c statistic with and without each covariate. Over 1 year, 77 deaths (5.15 %) were reported. The c statistic for the GCS was calculated as 0.67 (95 % confidence interval 0.64, 0.70). Addition of sex and age to the score yielded a 2.4 % increase. The variable with the greatest impact on the c statistic was marital status (6.1 % increase). Though important contributors, social support and perceived mental health status did not significantly improve performance of the score. While sex, age and marital status significantly improved performance of a predictive score in the community-dwelling elderly population, the absence of data on mental and physical health status did not appear to compromise the validity of claims-based scores. Combining comorbidity scores with other methods to control for confounding thus remains a useful tool in pharmacoepidemiological research.

Effects of mental health disorders on the risk of juvenile justice system involvement and recidivism among children placed in out-of-home care.

This study examined the effect of specific mental health disorders on the risk of juvenile justice system involvement and subsequent recidivism among maltreated children placed in out-of-home care. The sample was comprised of all children in Florida aged 7-17 years who were investigated for maltreatment and subsequently placed in out-of-home care between July 1, 2004, and June 30, 2005 (N = 5,720). Presence of mental health disorders and absence of a caregiver were both significantly associated with juvenile justice involvement. Among all examined mental health disorders, conduct disorder was the strongest predictor of juvenile justice involvement. Findings also indicated that, compared to children who did not have identified mental health disorders, children diagnosed with mental health disorders were approximately 80% more likely to experience recidivism. Implications of these findings are discussed.

Patient-Related Risks for Nonadherence to Antiretroviral Therapy among HIV-Infected Youth in the United States: A Study of Prevalence and Interactions

Adherence continues to be a major barrier to successful treatment with highly active antiretroviral therapy (HAART) for HIV-infected individuals. HIV-infected adolescents and young adults face a lifetime of treatment with HAART. Often, individuals who struggle with adherence to HAART face multiple barriers that would therefore impact on the success of any single modality intervention. Thus, we conducted a cross-sectional, observational study to determine the prevalence of personal barriers to adherence and to identify associations between these barriers in HIV-infected subjects, 12 to 24. We studied the following personal barriers to adherence: mental health barriers, high/low self-efficacy and outcome expectancy, and the presence of specific structural barriers. There were 396 subjects infected after age 9 recruited from sites from the Adolescent Trials Network for HIV/AIDS Interventions or the Pediatric AIDS Clinical Trials Group. Of the 396 subjects, 148 (37.4%) self-identified as nonadherent. No significant differences were found between adherent and nonadherent subjects for the presence of mental health disorders. Adherence was significantly associated with all but one structural barrier. Both self-efficacy and outcome expectancy were higher among adherent versus nonadherent subjects (p < 0.0001). Grouping subjects according to low self-efficacy and outcome expectancy for adherence, adherence differed according to the presence or absence of mental health disorders and structural barriers (p < 0.0001). Our data suggest that adolescents have significant rates of non-adherence and face multiple personal barriers. Adherence interventions must address multiple barriers to have the maximum chance for positive effects.

The relationship between mental health disorders and treatment outcomes among adults who stutter

The ability to reduce stuttering in everyday speaking situations is the core component of the management plan of many who stutter. However, the ability to maintain the benefits of speech-restructuring treatment is known to be compromised, with only around a third of clients achieving this [Craig, A. R., & Hancock, K. (1995). Self-reported factors related to relapse following treatment for stuttering. Australian Journal of Human Communication Disorders, 23, 48–60; Martin, R. (1981). Introduction and perspective: Review of published research. In E. Boberg (Ed.), Maintenance of fluency. New York: Elsevier]. The aim of this study was to determine whether the presence of mental health disorders contributes to this failure to maintain fluency after treatment. Assessments for mental health disorders were conducted with 64 adults seeking speech-restructuring treatment for their stuttering. Stuttering frequency, self-rated stuttering severity and self-reported avoidance were measured before treatment, immediately after treatment and 6 months after treatment. Stuttering frequency and situation avoidance were significantly worse for those participants who had been identified as having mental health disorders. The only subgroup that maintained the benefits of the treatment for 6 months was the third of the participants without a mental health disorder. These results suggest that prognosis for the ability to maintain fluency after speech restructuring should be guarded for clients with mental health disorders. Further research is needed to determine the benefits of treating such disorders prior to, or in combination with, speech-restructuring. Educational objectives: The reader will (1) evaluate the impact of one or more mental health disorders on medium-term outcomes from speech-restructuring treatment for stuttering, (2) describe how this finding affects prognosis for certain groups of stuttering clients, (3) evaluate how these finding are consistent with estimates of post-treatment relapse after speech-restructuring treatment, (4) describe two test instruments for detecting mental health disorders, and (5) outline the findings about the relation between pre-treatment stuttering severity and mental health disorders.

Reliability and Validity of the Kessler 10 and Patient Health Questionnaire among Injecting Drug Users

To examine the reliability and validity of the Kessler 10 (K10) and the Patient Health Questionnaire (PHQ) in a sample of injecting drug users (IDUs). Participants were 103 IDUs with a current substance use disorder accessing a needle and syringe programme. Presence of mental health disorders was assessed using the Mini International Neuropsychiatric Interview (MINI). Both the K10 and PHQ had high levels of internal consistency and concurrent validity. Individuals with a positive screen on the K10 were ten lines more likely to have a current affective disorder, while those with a positive PHQ screen had nearly 14 times the risk. The K10 and PHQ are recommended as brief screening and diagnostic tools for current affective disorders among IDUs.