Use Of Psychiatric Services Research Articles

Modeling socio-demographic and clinical factors influencing psychiatric inpatient service use: a comparison of models for zero-Inflated and overdispersed count data

BackgroundPsychiatric disorders may occur as a single episode or be persistent and relapsing, sometimes leading to suicidal behaviours. The exact causes of psychiatric disorders are hard to determine but easy access to health care services can help to reduce their severity. The aim of this study was to investigate the factors associated with repeated hospitalizations among the patients with psychiatric illness, which may help the policy makers to target the high-risk groups in a more focused manner.MethodsA large linked administrative database consisting of 200,537 patients with psychiatric diagnosis in the years of 2008-2012 was used in this analysis. Various counts regression models including zero-inflated and hurdle models were considered for analyzing the hospitalization rate among patients with psychiatric disorders within three months follow-up since their index visit dates. The covariates for this study consisted of socio-demographic and clinical characteristics of the patients.ResultsThe results show that the odds of hospitalization are significantly higher among registered Indians, male patients and younger patients. Hospitalization rate depends on the patients’ disease types. Having previously visited a general physician served a protective role for psychiatric hospitalization during the study period. Patients who had seen an outpatient psychiatrist were more likely to have a higher number of psychiatric hospitalizations. This may indicate that psychiatrists tend to see patients with more severe illnesses, who require hospital-based care for managing their illness.ConclusionsProviding easier access to registered Indian people and youth may reduce the need for hospital-based care. Patients with mental health conditions may benefit from greater and more timely access to primary care.

The development and validation of a marginalization index for inpatient psychiatry.

Marginalization is a multidimensional social construct that influences the mental health status of individuals and their use of psychiatric services. However, its conceptualization and measurement are challenging due to inconsistencies in definitions, and the lack of standard data sources to measure this construct. To create an index for screening marginalization based on an existing comprehensive assessment system used in inpatient psychiatry. Items anticipated to be indicative of marginalization were identified from the Resident Assessment Instrument-Mental Health (RAI-MH) that is used in all inpatient mental health beds in Ontario, Canada. Principal Component Analysis (PCA) and cluster analysis of these items was performed on a sample of 81,232 patients admitted into psychiatric care in Ontario between 1 January 2011 and 31 December 2016 to identify dimensions being measured. Various weights and scoring methods were tested to assess convergent validity on multiple outcomes of marginalization. Receiver Operating Characteristic (ROC) curve analysis was utilized to determine optimal cut-offs for the index by modeling the likelihood of different marginalization outcomes, including homelessness. Fifteen items were identified for the development of the Marginalization Index (MI). PCA and cluster analysis identified that the items measured five dimensions. ROC curve analysis among homeless individuals identified an Area Under the Curve of 0.76 and an optimal cut-off of five on the MI. Frequency analysis of the index by different characteristics identified homeless individuals, frequent mental health service users, persons with a history of violence and police intervention, and persons with addictions issues, as groups with the highest scores, confirming the convergent validity of the index. The MI is a valid measure of marginalization and is strong predictor of risk of homelessness among psychiatric inpatients. MI provides a resource that can be used for social and health policy, decision-support and evaluation.

Pilot Study of Let’s Get Organized: A Group Intervention for Improving Time Management

Abstract Date Presented 03/27/20 The Let’s Get Organized–Swedish Part 1 pilot study shows feasibility for use in psychiatric and habilitation outpatient services. Participants took part in a 10-week manual-based group intervention for 1 ½ hours weekly. Each session has a separate theme, a common structure and goal (to implement use of a calendar), and cognitive strategies for managing time. This study uses OT standardized tools to measure results that were promising and need confirmation in further studies. Primary Author and Speaker: Suzanne White Additional Authors and Speakers: Kajsa Lidström Holmqvist, Marie Holmefur Contributing Authors: Gunnel Janeslätt, Afsaneh Roshanay, Patrik Arvidsson

S121. OPUS 20, 20 YEAR FOLLOW-UP ON THE OPUS TRIAL

BackgroundSince the first OPUS trial 20 years ago, structured clinical assessments have been collected from a cohort of first episode psychosis patients at 2, 5 and 10 years follow-up. They found that the symptomatology of patients clustered in distinct groups, and they were able to determine stable long-term trajectories of positive and negative symptoms. The Suffolk County Medical health project has followed patients after a first episode psychosis for 20 years. They also found a stable course of trajectories but with an overall significant worsening of symptom severity over time. The 20 year OPUS follow-up will give us the first opportunity to assess the long term outcome in a large representative cohort treated within modern mental health services with treatment available for all.MethodsFrom 1998 to 2000 578 participants were randomized to OPUS or TAU. Baseline characteristics of the cohort were as follows: mean age 26.6 years, 59% were males, 66% had a diagnosis of schizophrenia and 27% had a secondary diagnosis of alcohol or substance abuseAt the 20 year follow-up the investigators will be blinded to the original treatment allocation. The patients who wish to participate will be assessed using SAPS, SANS, SCAN, PSP and GAF. Socio-demographic factors and suicidal ideation will be register via self report. Cognitive function will be tested using BACS and all participants will be asked to fill out a number of self-rating questioners including WHO quality of life-BREF, self-perceived health, strengths and difficulties, the parenting scale and self-perceived negative symptoms.Using national Danish registers we can collect information on all former participants regarding the use of psychiatric and general healthcare services, medication, supported housing or homelessness, employment status, substance abuse and mortality.ResultsThe OPUS 20 study started collecting data in Jan 2018. We are attempting to contact as many patients as possible from the 578 participants in the original OPUS cohort. At the time of writing we had included data and attempted contact to 322 participants. Overall 104 people (31,7%) have agreed to participate in the interviews. In the follow-up 10 years ago, the participation-rate was 60% so this is a big drop in participation rate. 41 (14%) have died, 31 (9,5%) were lost due to emigration, homelessness or hidden identity and/or disempowerment. 70 (21,3%) didn’t wish to participate and 76 (23,2%) never responded.DiscussionPsychotic disorders and schizophrenia in particular are associated with progressive worsening of symptoms and profound social impairment, and as such are still very stigmatized. Results from the 10 year OPUS follow-up found stable trajectories of positive and negative symptoms over time, with a tendency of reduction and stabilization of positive symptoms but less variation of negative symptoms. They found poor but stable social functioning with a mean GAF score of 55 after 10 years. The Suffolk County mental health project also found stable trajectories of psychopathology measured with SAPS and SANS. They however found progressive worsening of GAF scores declining form 49 points at the beginning to 36 after 20 years.So far we have seen stable GAF scores and SAPS and SANS scores compared to OPUS 10. This gives rise to some optimism about the prognosis for schizophrenia compared to the findings of the Suffolk study.In our study the extensive interviews combined with the data collected form Danish registers give us a unique opportunity to look at the long term course of illness after FEP. The ability to test if previous findings are robust over time will be essential to the development of targeted interventions, differentiated to the needs of different patient groups.

Reasons for Frequent Psychiatric Emergency Service Use in a Large Urban Center.

Reasons for frequent use of psychiatric emergency services are complex and numerous, but research has largely depended on quantitative methods to describe the phenomenon. The goal of this study was to describe the reasons for frequent use in Singapore and the ways service seekers changed because of frequent use. Semistructured qualitative interviews were conducted with 44 adults between July 2016 and December 2017. These people visited the psychiatric emergency department of a large tertiary care institute in Singapore five or more times in 12 months. Thematic analysis was conducted to categorize the reasons for frequent use. Participants were 39 years old on average, and their median length of contact with emergency services was 3.5 years. Psychotic, depressive, adjustment, and personality disorders were most common. Reasons for frequent use included seeking psychiatric services outside of office hours, seeking the safety of admission, seeking the comfort of speaking with an empathetic professional, intoxication, contact with police, and families seeking respite. Because their frequent use gave them knowledge of standard operating procedures, participants censored their disclosure of symptoms instead of reporting the full depth of their crisis in order to reach their desired outcome of the visit. Frequent use of emergency services led to changes in people's willingness to disclose important details of their crisis. These adjustments allowed service users to reach their desired outcome. Service providers and policy makers must be mindful that the package of care they deliver may prescribe medical solutions to social distress because of a lack of better alternatives.

Health and work disability outcomes in parents of patients with schizophrenia associated with antipsychotic exposure by the offspring

This study aimed to identify if antipsychotic exposure in offspring is associated with psychiatric and non-psychiatric healthcare service use and work disability of their parents. This Swedish population-based cohort study was based on data comprising 10,883 individuals with schizophrenia, who had at least one identifiable parent in the nationwide registers, and their parents (N = 18,215). The register-based follow-up during 2006–2013 considered the level of antipsychotic exposure and persistence of use of the offspring, further categorized into first (FG) and second generation (SG) antipsychotics, and orals versus long-acting injections (LAIs). The main outcome measure was parental psychiatric healthcare service use, secondary outcomes were non-psychiatric healthcare use and long-term sickness absence. SG-LAI use was associated with a decreased risk (relative risks [RR] 0.81-0.85) of parental psychiatric healthcare use compared with not using SG-LAI, whereas oral antipsychotics were associated with an increased risk (RRs 1.10–1.29). Both FG- and SG-LAI use by the offspring were associated with a lower risk of long-term sickness absence (range of odds ratios 0.34–0.47) for the parents, compared with non-use of these drugs. The choice of antipsychotic treatment for the offspring may have an impact on work disability and healthcare service use of their parents.

Five-Year Cumulative Exposure to Antipsychotic Medication After First-Episode Psychosis and its Association With 19-Year Outcomes

Abstract Background The long-term effectiveness of antipsychotic maintenance treatment after first-episode psychosis (FEP) is contested. In this real-world observational study, we examined how cumulative exposure to antipsychotics within the first 5 years from FEP was associated with the 19-year outcome. Methods Finnish national registers were used to detect all patients who were hospitalized due to non-affective psychosis in the mid-1990s, and who were treatment naïve prior to the inclusion period (N = 1318). Generalized linear models with logit link function were used to estimate how cumulative exposure to antipsychotics within the first 5 years from onset was associated with mortality, work capability, and the use of psychiatric services at the end of the 19-year follow-up. To adjust for confounding by indication, the primary outcome analyses implemented stabilized inverse probability of treatment weighting using propensity scores. Results Persons with a higher cumulative exposure to antipsychotics within the first 5 years from FEP were more likely to still be receiving antipsychotics (adjusted odds ratio [OR] = 2.1; 95% CI: 1.5−2.8), psychiatric treatment (OR = 1.4; 95% CI: 1.1−1.7), and disability allowances (OR = 1.3; 95% CI: 1.01−1.6) at the end of the 19-year follow-up, as compared to low/zero-exposure. Higher cumulative exposure was also associated with higher mortality (OR = 1.5; 95% CI: 1.1–2.1). Conclusions After adjustment for confounders, moderate and high cumulative exposure to antipsychotics within the first 5 years from FEP was consistently associated with a higher risk of adverse outcomes during the 19-year follow-up, as compared to low or zero exposure. Due to potential unmeasured confounding, controlled trials are needed.

Risk of dementia following androgen deprivation therapy for treatment of prostate cancer.

Evidence for androgen deprivation therapy (ADT) and risk of dementia is both limited and mixed. We aimed to assess the association between ADT and risk of dementia among men with localized and locally advanced prostate cancer (PCa). We conducted a retrospective cohort study using SEER-Medicare-linked data among 100,414 men aged ≥ 66 years and diagnosed with localized and locally advanced PCa (cT1-cT4) between 1992 and 2009. We excluded men with a history of stroke, dementia, or use of psychiatric services. Men were followed until death or administrative end of follow-up at 36 months. Inverse-probability weighted Fine-Gray models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for Alzheimer's, all-cause dementia, and use of psychiatric services by duration of pharmacologic ADT (0, 1-6, and ≥ 7 months). Among 100,414 men with PCa (median age 73 [IQR: 69-77] years; 84% white, 10% black), 38% (n = 37,911) received ADT within 6 months of diagnosis. Receipt of any pharmacologic ADT was associated with a 17% higher risk of all-cause dementia (HR 1.17, 95% CI 1.07-1.27), 23% higher risk of Alzheimer's (HR 1.23, 95% CI 1.11-1.37), and 10% higher risk of psychiatric services use, though the confidence interval included the null (HR 1.10, 95% CI 1.00-1.22). Longer duration of ADT (≥7 months) was associated with a 25% higher risk of all-cause dementia, 34% higher risk of Alzheimer's, and 9% higher risk of psychiatric services, compared with no ADT. Our study supports an association between pharmacologic ADT and higher risk of all-cause dementia, Alzheimer's, and use of psychiatric services among men with localized and locally advanced PCa.

A register-based observational cohort study on persistent frequent users of emergency services in a Finnish emergency clinic

BackgroundThe focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits.MethodsA cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) –codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates.ResultsPatients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 –codes were inadequately documented.ConclusionsPatients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.

Incidence and determinants of mental health service use after bariatric surgery.

Bariatric surgery results in sustained weight loss and improvement in many obesity-related comorbidities. However, the effects of bariatric surgery on long-term mental health are less clear. A recent longitudinal cohort study shows that patients undergoing bariatric surgery seek mental health services at higher rates after surgery than before surgery and identifies specific risk factors for increased psychiatric service use.

Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management.

There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties. To pilot test the first part of the Let's Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders. One-group pretest-posttest design with 3-mo follow-up. Outpatient psychiatric and habilitation settings. Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life. Swedish version of Let's Get Organized (LGO-S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr. Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS-S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure. Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS-S results were sustained at 3-mo follow-up. LGO-S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further. This study shows that LGO-S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.

Psychiatric Assistance Dog Use for People Living With Mental Health Disorders.

A psychiatric assistance dog (PAD) is a service dog that is trained to assist its handler (owner) who has been diagnosed with a mental health condition such as post-traumatic stress disorder (PTSD), schizophrenia, depression, anxiety, or bipolar disorder. Literature searches reveal that little is known about the population of people who own PADs, the types of dogs used or the functions they provide. One third (n = 199) of PAD owners in Australia registered with the charity “mindDog” participated in an online survey designed to better understand the person and dog team. Participants learned about PADs through the internet (37%), health care practitioners (32%), or family/friends (30%). The dogs in the sample were of varying age, gender and breed. The most common reasons for people to choose a dog to be a PAD were temperament (60%) and size/weight (48%). Just under half (48%) of the dogs had been acquired by the owner specifically to be trained as a PAD, and the rest were existing pets. All the dogs were trained by the owner or a combination of the owner and a qualified trainer; none were trained exclusively by assistance/service dog provider organizations. The median age of the participants at the time of data collection was 47 years, ranging from 10 to 75 years. Most (77%) identified as female. Depression (84%), anxiety (social 61%; generalized 60%), PTSD (62%), and panic attacks (57%) were the most reported mental health diagnoses. Tasks the dogs performed for their owners included: reduction of anxiety through tactile stimulation (94%); nudging/pawing to bring back to the present (71%); interrupting undesirable behavior (51%); constant body contact (50%); deep pressure stimulation (45%) and blocking contact from other people (42%). PAD usage decreased (46%), increased (30%) or did not change (24%) participants' use of psychiatric or other health care services. Decrease in service use was mainly due to reduced suicide attempts, and less requirement for hospitalization and medication; increased use was mainly due to enhanced ability to attend appointments. Results of this study show that PAD owners have differing mental health diagnoses, and their dogs perform different tasks to support them in daily life. Every participant described the relationship with his/her PAD as positive, suggesting that a successful working partnership does not require the dog to have been bred or raised specifically for the role. A better understanding of this population and the person-dog relationship will inform the appropriate choice, training and use of PADs for people living with mental health problems.

Factors Associated With Use of Mental Health and Substance Use Treatment Services by Justice-Involved Youths.

Nonincarcerated (community-supervised) youths who are first-time offenders have high rates of mental and substance use disorders. However, little is known about their use of psychiatric services (mental health and substance use) or factors associated with service use. This study examined the prevalence, determinants, and barriers to service use among community-supervised youths. Data were from a longitudinal study of mental health and substance use outcomes among adolescents ages 12-18 from a northeastern family court in which caregivers and youths completed assessments (N=423 dyads). The Behavior Assessment System for Children, Second Edition, assessed youths' psychiatric symptoms. The Child and Adolescent Services Assessment assessed service use and barriers. Family functioning and caregiver-adolescent communication were assessed with the McMaster Family Assessment Device and the Parent-Adolescent General Communication Scale, respectively. Multivariable regression analyses examined the cross-sectional relationship between youths' service use and determinants of use at baseline. Of the 423 youths, 49% experienced psychiatric symptoms and 36% used psychiatric services in the past 4 months. The highest adjusted odds of service use were associated with youths' psychiatric symptoms and caregivers' history of a psychiatric diagnosis. The lowest odds were associated with caregivers' identifying as being from racial and ethnic minority groups. Caregiver-reported barriers to service use differed according to prior service use and by caregiver race-ethnicity. Results suggest a need for interventions to increase access to and engagement in psychiatric services for community-supervised youths and the importance of caregiver factors in designing such interventions.

Use, costs, and predictors of psychiatric healthcare services following an autism spectrum diagnosis: Population-based cohort study.

A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) Régie de l'assurance maladie du Québec administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.

Psychiatric Services Preceding Initiation of Antipsychotic Medication Among Youth in Foster Care.

Objectives: To characterize psychotropic use preceding antipsychotic initiation in a population of youth in foster care and to determine whether the use of intensive psychiatric services before initiating an antipsychotic differs across subgroup of youth defined by past psychotropic use. Methods: We identified youth in foster care in one U.S. State who initiated an antipsychotic from 2010 to 2015 and were aged ≤21 years at initiation. No antipsychotic use 1-year before the index prescription defined new use. Psychotropic class use in the year preceding the index antipsychotic prescription distinguished three subgroups: no psychotropic use, single-class use, and concomitant (>1 class) use. The temporal association of antipsychotic initiation with intensive services (psychiatric hospitalizations or emergency department visits) was estimated through regression models adjusted for psychiatric diagnoses and demographic characteristics. Logistic regression models assessed the interaction between psychotropic class subgroup and psychiatric diagnosis with the odds of hospitalization. Results: Of the 753 youth initiating an antipsychotic, 279 (37%) had no psychotropic use, 304 (40%) had single-class use, and 170 (23%) had concomitant use in the year before. In the year preceding antipsychotic initiation, 183 (24%) were hospitalized and 118 (16%) were hospitalized 1 month before antipsychotic initiation. The number of days between hospital discharge and antipsychotic initiation was 47 (SE = 19) days longer in concomitant users relative to youth with no psychotropic use (p = 0.01). In the year preceding antipsychotic initiation, concomitant users with severe mental illness were less likely to have a hospitalization (OR = 0.24; 95% CI = 0.06-0.93) than youth with no psychotropic use diagnosed with severe mental illness. Conclusions: Variation in psychotropic medication treatment, hospitalizations, and psychiatric diagnosis before antipsychotic initiation distinguished subgroups of youth initiating an antipsychotic. Single-class and concomitant users may have initiated an antipsychotic to augment existing regimen, whereas youth with no psychotropic use may have initiated an antipsychotic following a first episode crisis.

Predictors of Return to Work for Occupational Rehabilitation Users in Work-Related Injury Insurance Claims: Insights from Mental Health.

Purpose This study evaluates the Occupational Rehabilitation (OR) initiatives regarding return to work (RTW) and sustaining at work following work-related injuries. This study also identifies the predictors and predicts the likelihoods of RTW and sustainability for OR users. Methods The study is conducted on the compensation claim data for people who are injured at work in the state of Victoria, Australia. The claims which commenced OR services between the first of July 2012 and the end of June 2015 are included. The claims which used original employer services (OES) have been separated from claims which used new employer services (NES). We investigated a range of predictors categorised into four groups as claimant, injury, and employment characteristics and claim management. The RTW and sustaining at work are outcomes of interest. To evaluate the predictors, we use Chi-squared test and logistic regression modelling. Also, we prioritized the predictors using Akaike Information Criterion (AIC) measure and Cross-validation error. Four predictive models are developed using significant predictors for OES and NES users to predict RTW and sustainability. We examined the multicollinearity of the developed models using Variance Inflation Factor (VIF). Results About 75% and 60% of OES users achieved RTW and have been sustained at work respectively, whilst just approximately 30% of NES users have been placed at a new employer and 25% of them have been sustained at work. The predictors which have the most association with OES and NES outcomes are the use of psychiatric services and age groups respectively. We found that having mental conditions is as an important indicator to allocate injured workers into OES or NES initiatives. Our study shows that injured workers with mental issues do not always have lower RTW rate. They just need special consideration. Conclusion Understanding the predictors of RTW and sustainability helps to develop interventions to ensure sustained RTW. This study will assist decision makers to improve design and implementation of OR services and tailor services according to clients' needs.

Androgen deprivation therapy and depression in men with prostate cancer treated with definitive radiation therapy.

There is no consensus on the association between the use of androgen deprivation therapy (ADT) and the risk of developing depression. This study investigated the association between ADT use and the development of depression, outpatient psychiatric services, inpatient psychiatric services, and suicide in a homogeneous group of men with prostate cancer (PC) treated with definitive radiation therapy (RT) after controlling for multiple sources of selection bias. This was a retrospective, observational cohort study of 39,965 veterans with PC who were treated with definitive RT and were diagnosed by the US Department of Veterans Affairs health care system between January 1, 2001, and October 31, 2015. Exposure was ADT initiation within 1year of the PC diagnosis. The primary outcome was new development of depression. Secondary outcomes were outpatient psychiatric use, inpatient psychiatric use, and suicide. During follow-up, 934 patients were newly diagnosed with depression, 7825 patients used outpatient psychiatric services, 358 patients used inpatient psychiatric services, and 54 patients committed suicide. In the multivariable competing risks regression model, ADT was associated with the development of depression (subdistribution hazard ratio [SHR], 1.50; 95% confidence interval [CI], 1.32-1.71; P<.001). ADT was also associated with outpatient psychiatric utilization (SHR, 1.21; 95% CI, 1.16-1.27; P<.001). Finally, ADT was not associated with inpatient psychiatric utilization or suicide. An increase in the risk of depression and the use of outpatient psychiatric services was observed in a large cohort of men with PC who received ADT with definitive RT. These results may provide further evidence for the long-term risks of ADT for psychiatric health in the treatment of PC.

Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program

Objective Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method This naturalistic, prospective study covered a 26-month period and utilized a pre–post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 ( SD = 1.94) to 0.48 ( SD = 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.

Adolescent psychosis risk symptoms predicting persistent psychiatric service use: A 7-year follow-up study

BackgroundWe investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data. MethodsOur sample included 715 adolescents aged 15–18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use. ResultsStronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity. ConclusionsIn a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.

Associations of alcohol use disorder, alcohol use, housing, and service use in a homeless sample of 255 individuals followed over 2 years

Background: Homeless individuals with alcohol use disorders have multiple comorbidities and therefore various service needs. Despite need for services, homeless individuals face numerous barriers to treatment. Little is known about the associations of specific services in relation to homelessness in the context of alcohol problems. The current study analyzed 2-year prospective longitudinal data on a homeless sample, examining relationships between alcohol use disorder, alcohol use, housing status, and service use over time. Methods: Two hundred fifty-five of 400 individuals recruited systematically from shelters and street locations completed 3 annual assessments (69% completion). Data on lifetime and current psychiatric disorders, housing status, and past-year service use were obtained and merged with service use data gathered from local agencies. Generalized estimating equation (GEE) models were created to predict dependent outcome variables of stable housing, alcohol use, and service use in both follow-up years. Results: Lifetime alcohol use disorder was positively associated with substance and medical service use. Alcohol problems did not hinder attainment of stable housing, and placement in housing did not necessarily increase risk for alcohol use. Stable housing was negatively associated with psychiatric and substance service use. In the second year, when alcohol use was finally associated with receiving substance services, it appears that these services provided a gateway to psychiatric services. The psychiatric services in turn appeared to provide a gateway to medical services. Conclusions: Alcohol use behaved differently compared with lifetime alcohol use disorder in relation to service use. Lack of association between alcohol use and housing supports Housing First policy. Obtaining housing may have ameliorative effects on mental health, diminishing perceived need for psychiatric services. Services may also be more accessible during homelessness. Obtaining substance treatment may provide a gateway for those who use alcohol after becoming homeless to connect with psychiatric and medical services, informing policy and practice.