Rates Of Serious Mental Illness Research Articles

713-P: The Concomitant Health Needs and Health Care Utilization Patterns of U.S. Women with Lifetime Criminal Legal Involvement and Diabetes, 2015–2019

Background: Over 100 million Americans have a history of criminal legal involvement (CLI), which is increasingly recognized as a risk for poor disease outcomes. Women with diabetes and CLI may have unique needs and utilization patterns, but this population has not been studied. Methods: Using nationally representative data, we examined a sample of respondents with lifetime CLI and self-reported diabetes. We compared rates by gender of physical conditions, mental health conditions, and substance use disorders using multivariate logistic regression considering relevant sociodemographic confounders. We then estimated the adjusted odds of outpatient, emergency department and inpatient hospitalization using similar models. Stata 16.1 was used. Results: In our sample of US adults with diabetes and CLI (N=2,742), 28% were women. Women were generally of lower socioeconomic status but more likely to have insurance. Compared to men, women reported higher rates of comorbid physical conditions, including having ≥2 conditions (aOR 1.5, 95% CI 1.2-1.9); higher rates of serious mental illness (aOR 2.5, 95% CI 1.8-3.6), any mental illness (aOR 2.1, 95% CI 1.6-2.6), and past year major depression (aOR 2.1, 95% CI 1.6-2.8). They were less likely to have a substance use disorder (aOR 0.7, 95% CI 0.5-0.9). Compared to men, women were more likely to use the emergency department (aOR 1.2, 95% CI 1.1-1.3) with a trend towards increased hospitalizations (aOR 1.2, 95% CI 0.9-1.5). They were also more likely to use outpatient care (aOR 2.1, 95% CI 1.3-3.5). Conclusions: Women with diabetes and CLI have higher rates of chronic disease and mental illness, but lower rates of substance use disorders, a pattern which is distinct. Additional research should consider if addressing the unique needs of this marginalized population could improve diabetes outcomes and decrease unnecessary acute care utilization. Disclosure L.Hawks: None. R.J.Walker: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK132505-01A1)

TRENDS IN MENTAL ILLNESS ACROSS ASSISTED LIVING SETTINGS: RESIDENT AND COMMUNITY FACTORS

Abstract Although rates of serious mental illness (SMI), depression, and anxiety are becoming more common among assisted living (AL) and residential care (RC) residents, few studies have investigated resident and community-level factors to ensure that the settings and resources are adequate to meet residents’ mental health needs. Using a representative sample of Oregon AL/RC residents (n = 1,013), this study uses descriptive cross-sectional analysis to examine intrastate variation in the prevalence of SMI, depression, and anxiety related to: (1) resident-level characteristics (e.g., mental illness comorbidity, psychotropic medication use, and Medicaid status); (2) community-level characteristics (e.g., facility type and urban/rural geographic designation); and (3) health services utilization (e.g., emergency room visits and hospital admission). Results indicate that 12% of AL/RC residents had an SMI diagnosis, nearly half of whom also had depression and anxiety, and 80% were Medicaid eligible. One in six residents with SMI received at least three psychotropic medications in the last week. Residents with SMI were also more likely to live in RC facilities than AL facilities, in facilities with Medicaid contracts, and in urban rather than rural settings. Compared to residents without SMI, a larger share of residents with SMI utilized hospital emergency rooms (32% vs. 18%) and were admitted to the hospital overnight (15% vs. 9%). Findings underscore characteristics associated with potentially higher needs among AL/RC residents with SMI compared to their counterparts, with implications for the high quality provision of mental health services and quality of life and care in these settings.

Rural-Urban Disparities in Quality of Inpatient Psychiatric Care.

Rural residents have higher rates of serious mental illness than urban residents, but little is known about the quality of inpatient psychiatric care available to them locally or how quality may have changed in response to federal initiatives. This study aimed to examine differences and changes in the quality of inpatient psychiatric care in rural and urban hospitals. This national retrospective study of 1,644 facilities examined facility-level annual quality-of-care data from the Inpatient Psychiatric Facility Quality Reporting program, 2015-2019. Facility location was categorized as urban, large rural, or small or isolated rural on the basis of zip code-level rural-urban commuting area codes. Generalized regression models were used to assess rural-urban differences in care quality (five continuity-of-care and two patient experience measures) and changes over time. Rural inpatient psychiatric units performed better than urban units in nearly all domains. Improvements in quality of care (excluding follow-up care) were similar in rural and urban units. Rates of 30- and 7-day postdischarge follow-up care decreased in all hospitals but faster in rural units. Timely transmission of transition records was more frequent in small or isolated rural versus urban units (mean marginal difference=22.5, 95% CI=6.3-38.8). Physical restraint or seclusion use was less likely in rural than in urban units (OR=0.6, 95% CI=0.5-0.8). Rural psychiatric units had better care quality at baseline (better follow-up care, better timely transmission of transition records, and lower rates of physical restraint use) than urban units, but during 2015-2019, follow-up care performance decreased overall and more in rural than urban units.

The impact of misdemeanor arrests on forensic mental health services: A state-wide review of Virginia sanity evaluations.

We examined the prevalence of criminal defendants facing only misdemeanor charges and referred for forensic mental health evaluations of legal sanity (criminal responsibility) in a state-wide sample of sanity reports. We sought to describe this population of defendants, particularly as compared to defendants facing felony charges and referred for evaluation of legal sanity. We hypothesized that, among those referred for sanity evaluations, defendants facing only misdemeanor charges would have higher rates of serious mental illness than would defendants charged with felonies, as evidenced by their mental status during the evaluation and at the time of alleged offenses. We also hypothesized that defendants charged with only misdemeanors would be more often opined insane, as compared to those charged with felonies. We reviewed a statewide sample of 926 court-ordered sanity evaluation reports in Virginia and coded numerous variables describing the defendants, sanity evaluation process, resulting reports, and legal opinions offered within the reports. Approximately 22.3% of sanity evaluations involved defendants charged only with misdemeanor offenses. Defendants facing only misdemeanor charges were 1.82 times more likely to be opined insane than were defendants facing only felony charges, primarily due to their increased likelihood of experiencing psychotic symptoms at the time of the offense (1.83 times more likely than defendants facing felony charges). The merits of pursuing the insanity defense in response to misdemeanor charges are questionable given the cost- and resource-intensive outcomes associated with insanity acquittals. Diversion strategies may be a more efficient response to those defendants with serious mental illness facing only misdemeanor charges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Language ability and adult homelessness.

People experiencing homelessness are at increased risk of neurological disorder due to multiple factors such as substance abuse, infection, and higher rates of serious mental illness and traumatic brain injury. This could affect cognitive and language skills. Indeed, past research has suggested that certain language-related skills tend to be lower in people experiencing homelessness. However, that research has compared homeless samples with age-matched normative samples and not with samples of people from similar socio-economic backgrounds. Therefore, it is unclear whether homelessness is even a relevant factor, or if adults who are homeless tend to have appropriate linguistic skills relative to their social and educational background. To compare the language skills of a group of adults with histories of homelessness with an education-matched control group. It was hypothesized that participants with histories of homelessness would have worse language performance than their matched controls. A quasi-experimental design was employed involving 17 adults with histories of homelessness, mainly rough sleeping, in the city of Quito in Ecuador, and a sample of 16 adults who had never been homeless. All were assessed with measures of head injury, substance dependence, affective disorder and language skills. A paired-sample analysis was performed on homeless and control participants matched for educational background, used as an index of socio-economic background. The mean years of formal education was low in both the homeless sample (mean = 5.82 years) and the control sample (mean = 6.75 years). There were no differences between the groups for any demographic or clinical factors, nor for a measure of expected or 'premorbid' ability based on single-word reading, nor for current non-verbal cognitive functioning. In contrast, the homeless group scored significantly worse than the control group on measures of auditory comprehension and oral expression. Adults with histories of homelessness may have worse language skills than would be expected based on their educational backgrounds and non-verbal cognitive abilities. It is possible that some of this lower language ability is pathological, in the form of either a developmental language disorder or an acquired impairment. As such, some adults who are homeless may benefit from therapy directed at clinical language disorders.

Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018.

Objectives. To specify symptoms and measure prevalence of psychological distress among incarcerated people in long-term solitary confinement.Methods. We gathered data via semistructured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for 106 randomly selected people in solitary confinement in the Washington State Department of Corrections in 2017. We performed 1-year follow-up interviews and BPRS assessments with 80 of these incarcerated people, and we present the results of our qualitative content analysis and descriptive statistics.Results. BPRS results showed clinically significant symptoms of depression, anxiety, or guilt among half of our research sample. Administrative data showed disproportionately high rates of serious mental illness and self-harming behavior compared with general prison populations. Interview content analysis revealed additional symptoms, including social isolation, loss of identity, and sensory hypersensitivity.Conclusions. Our coordinated study of rating scale, interview, and administrative data illustrates the public health crisis of solitary confinement. Because 95% or more of all incarcerated people, including those who experienced solitary confinement, are eventually released, understanding disproportionate psychopathology matters for developing prevention policies and addressing the unique needs of people who have experienced solitary confinement, an extreme element of mass incarceration.

National estimates of behavioral health conditions and their treatment among adults newly insured under the ACA.

Approximately 25 million individuals are projected to gain insurance as a result of the Affordable Care Act (ACA). This study estimated the prevalence of behavioral health conditions and their treatment among individuals likely to gain coverage. Pooled 2008-2011 National Survey on Drug Use and Health data for adults (ages 18-64) were used. Estimates were created for all adults, current Medicaid beneficiaries, and uninsured adults with incomes that might make them eligible for the Medicaid expansion or tax credits for use in the health insurance marketplace. Individuals who may gain insurance under the ACA had lower rates of serious mental illnesses (5.4%, Medicaid expansion; 4.7%, marketplace) compared with current Medicaid beneficiaries (9.6%). They had higher rates of substance use disorders (13.6%, Medicaid expansion; 14.3%, marketplace) compared with Medicaid recipients (11.9%). There is significant need for behavioral health treatment among individuals who may gain insurance under the ACA.

Mental Health Diagnoses and Recidivism in Paroled Offenders

Although the issue of mental illness among offender populations has received attention in the last number of years, there are a number of issues related to mental illness among such groups that require more study. One such topic relates to the association between mental illness, actuarially assessed risk of recidivism, and observed rates of reoffending. In the present investigation, file information was reviewed to determine the presence of a variety of mental health conditions. Actuarially based risk assessment data were also collected for participants as well as information regarding suspension, new charges, and convictions. A sample of 136 offenders housed in a halfway house operated by Correctional Service of Canada was included in the present investigation. Results indicated very high rates of serious mental illness in this high-risk population. Offenders with borderline personality disorder and attention deficit hyperactivity disorder were significantly more likely to recidivate or be suspended. Suspensions refer to administrative decisions to place an offender in jail due to problematic behaviour (typically involving a breach of his release conditions or new charges/convictions). Offenders with a diagnosis of paraphilic disorder were significantly less likely to recidivate or be suspended. Results are discussed in light of the available literature.

Access to and utilization of health services as pathway to racial disparities in serious mental illness.

Often considered to fare better than White Americans in terms of mental health, African-Americans are nevertheless more vulnerable to chronic, persistent conditions should they become mentally ill, the literature suggests. The present study used data from the 2009 National Health Interview Survey to examine race differences in the prevalence rates of serious mental illness and race's role in relationships among such illness and variables of (a) social status and (b) health services. Results showed that non-Hispanic Blacks' level of reported chronic mental illness (in the past 30days) exceeded that of non-Hispanic Whites. The results indicate that variables describing respondents' mental health care, along with their age and alcohol consumption, affect serious mental illness differently among African-Americans compared to Whites. Implications concerning racial disparities in mental health are discussed.

Impact of Health Insurance Status and a Diagnosis of Serious Mental Illness on Whether Chronically Homeless Individuals Engage in Primary Care

We evaluated the impact of a diagnosis of serious mental illness on use of a primary care provider (vs the emergency department [ED]) as a source of care by people who were chronically homeless. We used data from 750 chronically homeless adults enrolled in the 11-site Collaborative Initiative to Help End Chronic Homelessness and identified demographic and clinical characteristics independently associated with using a primary care provider rather than an ED. The factor most strongly associated with using the ED as a regular source of medical care was previous-year lack of health insurance. Despite high rates of serious mental illness, neither a diagnosis of serious mental illness nor increased severity of psychiatric symptoms was associated with such use. Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states' deciding not to expand Medicaid coverage will likely have a tremendous impact on the health outcomes and health care costs associated with this and other vulnerable populations.

Disparities in the geography of serious mental illness in Israel

ObjectiveThe aim of this research is to test and apply a model of the disparities and variations in serious mental illness (SMI) to estimating prevalence in local areas throughout Israel. MethodsThis study employs a secondary analysis of data from the 2003/2004 Israel National Health Survey of 4859 adults aged 21 and over from the household population of legal residents and citizens. It uses small area estimation methods (SAE), specifically to: (i) estimate and test a multivariate logistic model of disparities in the risk of serious mental illness; (ii) use the foregoing model for computing estimates, using census data, for local areas; (iii) validate these estimates against the rate of psychiatric hospitalizations. ResultsThe model uses standard demographic and socioeconomic variables to successfully predict 92.5% of respondents’ statuses as SMI, with a sensitivity of 26.9%, specificity of 95.9%, and an AUC index of .797. The resulting estimates of the percentage of adults with an SMI in the 16 subdistricts ranged between 3.7% and 7.7%, with a national mean of 5.0%. The estimates have a partial correlation of .63 with rates of psychiatric hospitalization in Jewish localities, but elevated rates have not been validated in Arab localities. ConclusionThe use of small area estimation methods demonstrated the capacity for deriving local prevalence rates of serious mental illness, ones that can be validated against psychiatric hospitalization for the majority population group in Israel.

University Students’ Views on the Utility of Psychiatric Advance Directives

Objective: Rates of serious mental illnesses (SMIs) among university students are increasing, and universities are struggling with how to respond to students who show SMI symptoms. Psychiatric advance directives (PADs) allow individuals, when well, to document their wishes for treatment during a psychiatric crisis. This project explored the feasibility of using PADs in university settings by examining students’ views towards PADs. Participants: Forty university students with SMIs were recruited for this study from 1 large university. Methods: A mixed-methods design was used, with both quantitative survey instruments and qualitative interviews with students. Results: Respondents were positive about PAD utility for students. Respondents saw PADs as beneficial because PADs gave students control over their treatment. However, students also considered PADs potentially problematic because PAD use raised a risk of breaching student privacy and stigmatizing students with SMIs. Conclusions: Although a promising intervention for students with SMI, this approach requires further research.

Mental Illness Data Show Geographic Variations

Back to table of contents Previous article Next article Professional NewsFull AccessMental Illness Data Show Geographic VariationsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:18 Nov 2011https://doi.org/10.1176/pn.46.22.psychnews_46_22_6_1AbstractPsychiatrists looking for work might consider Rhode Island. State-level results from the National Survey of Drug Use and Health (NSDUH) show that the Ocean State, with 7.2 percent of respondents reporting a serious mental illness and 24.2 percent reporting any mental illness, led all states in both categories. Previously, the NSDUH provided only national data, but this report, issued in October by the Substance Abuse and Mental Health Services Administration (SAMHSA), provides for the first time state-level estimates of mental health indicators, said the agency. SAMHSA defines "any mental illness" among adults aged 18 or older as the presence of any mental, behavioral, or emotional disorder in the past year that met DSM-IV criteria. Among adults with a disorder, those whose disorder substantially interfered with or limited one or more major life activities are defined as having serious mental illness. The estimates were derived from data collected in 2008 and 2009 as part of the survey prepared by SAMHSA and by RTI International of Research Triangle Park, N.C.Nationally, the rate of serious mental illness was 4.6 percent, and the rate of any mental illness was 19.7 percent.Overall, more than 10 million American adults had a serious mental illness, and 44.5 million experienced any mental illness in the year prior to the survey. Arkansas, Idaho, Utah, and West Virginia also recorded high percentages in both categories. Hawaii and South Dakota were tied for the lowest rates of serious mental illness (3.5 percent). Maryland reported the lowest rate of any mental illness, 16.7 percent. "States with high and low rates of [serious mental illness] and any mental illness are located in all regions of the United States," said the report. "Factors that potentially contribute to the variation are not well understood and need further study." Perhaps that uncertainty will bring a little relief to the folks in Providence. The role of place is becoming one of the strongest predictors of outcomes, more so than "person" or "time," said Linda Cottler, Ph.D., M.P.H., a professor and chair of epidemiology in the College of Public Health and Health Professions and the College of Medicine at the University of Florida. Hypotheses for geographic variations abound, Cottler told Psychiatric News. Perhaps people with serious mental illness move to where the services are, which leads to increasing availability of services based on need, she suggested. Methodological issues might also have an effect on results, as well. "I would want to know if there are imputations for missing data, or if people in some parts of the country are more likely to acknowledge their symptoms, then there could be differences," said Cottler. In fact, statistical imputation was used to replace values for substance use, demographic, and other variables, noted the report. "However, the mental health variables used in this report were not imputed." Rhode Island's ranking may not be of much greater concern than that of any other state, said Brady Case, M.D., director of Health Services Research at the Bradley Hospital and an assistant professor of psychiatry and human behavior at the Alpert School of Medicine at Brown University in Rhode Island. "It's difficult to make much of the findings," Case told Psychiatric News. "You have to remember that this is not a comprehensive epidemiological study, but is a quick snapshot, a fairly limited measure of mental illness." For one thing, the SAMHSA data are raw estimates of prevalence. "They did not factor in age, gender, race, employment status, and so on," said Case. Also, confidence intervals were rather wide, and the numbers sampled within a given state did not provide sufficient power to give an accurate ranking, he said. That would have to await several more years of data. Nor did the report provide insight into treatment rates, a more important measure for states than prevalence, said Case."The states can actually do something about treatment," he said.There may be yet another, more positive factor, said one Rhode Island health official. "We have done a great deal of work to reduce the stigma of mental illness in Rhode Island," said Craig Stenning, director of the state's Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. "And so we always rank high on these types of surveys since people are more open to admitting their illness." "Rhode Island has had among the lowest suicide rates in the country for years, and at times the lowest for young people," said Case. "Mental illness and suicide are not the same thing, but it goes to show how these rankings can be difficult to interpret." A summary of the NSDUH report is posted at <http://oas.samhsa.gov/2k11/078/WEB_SR_078_HTML.pdf>. The full report is posted at <www.oas.samhsa.gov/NSDUH/2k9NSDUH/MH/2K9MHResults.pdf>. ISSUES NewArchived

Validation of Brief Screening Tools for Mental Disorders Among New Zealand Prisoners

Validation of Brief Screening Tools for Mental Disorders Among New Zealand Prisoners

Shift Sex-Trade Focus Away From Victims, Advocates Urge

Shift Sex-Trade Focus Away From Victims, Advocates Urge

Recent Changes in the Prevalence of Psychiatric Disorders Among VA Nursing Home Residents

This study identified recent changes in the prevalence of psychiatric disorders among Department of Veterans Affairs (VA) nursing home residents. Psychiatric diagnoses in administrative databases were summarized for nursing home residents in 1998, 2002, and 2006. Census prevalence rates were compared with findings from earlier VA nursing home surveys. Prevalence rates were compared for age groups and birth cohorts of VA nursing home admissions in 1998 (N=27,734) and 2006 (N=32,543). Among residents in the census samples, prevalence rates for dementia and schizophrenia fluctuated moderately from 1990 to 2006, depression prevalence increased sharply, alcohol use disorder prevalence declined, and drug use disorder prevalence increased. Among 1998 and 2006 admissions, dementia prevalence increased for most birth cohorts but declined for most age groups (35% to 32% overall). Depression prevalence increased for all age groups and birth cohorts (27% to 37% overall), as did posttraumatic stress disorder prevalence (5% to 12% overall). Serious mental illness prevalence increased among the oldest residents and birth cohorts (19% to 22% overall). Alcohol use disorder prevalence declined for all birth cohorts and most age groups (18% to 16% overall), but drug use disorder prevalence increased substantially for younger age groups (6% to 9% overall). Examining differences in prevalence between birth cohorts and age groups can clarify trends in nursing home resident characteristics and improve projections of their future needs.

Datapoints: Racial and Ethnic Patterns in Claim-Identified Mental Disorders Among Disabled Medicare Beneficiaries

T column examines racial-ethnic differences in the prevalence of serious mental illness and other mental disorders among disabled Medicare beneficiaries younger than 65. Although prevalence of serious mental illness and other mental disorders in this population is known to be high, little is known about the variation among racial-ethnic subgroups. Data are from Medicare-paid fee-forservice claims in 2004 for a 5% random sample of beneficiaries who qualified for coverage because of permanent disability (N=231,980). Nearly one-third (N=71,914, 31%) of the sample had a diagnosed mental disorder during the year (ICD-9 codes CM 295–316). Diagnoses were lowest among blacks (25%) and Native Americans (7%). Rates among whites, Hispanics, and Asians were similar (30%–32% each). Nearly one in five beneficiaries (N=43,360, 19%) had a diagnosed serious mental illness (major depressive disorder, bipolar disorder, or schizophrenia). Overall rates of serious mental illness were similar across racial-ethnic groups. The racial-ethnic groups, however, showed different patterns of diagnosis when disorders were categorized into schizophrenia and affective disorders (major depressive disorder and bipolar disorder). Although affective disorders were more prevalent than schizophrenia among whites and Hispanics, the reverse was true for blacks, Asians, and Native Americans. The high prevalence of serious mental illness across racial-ethnic categories among disabled Medicare beneficiaries highlights the importance of providing effective mental health care for this population. Because mental illness often co-occurs with general medical health problems, increased integration of mental Racial and Ethnic Patterns in ClaimIdentified Mental Disorders Among Disabled Medicare Beneficiaries

Screening and Access to Services for Individuals with Serious Mental Illnesses in Jails

High rates of serious mental illnesses (SMI) among jail inmates pose challenges for the criminal justice system and risks for the individual with SMI. Research has identified actions to address these issues; it is unclear to what extent they have been operationalized. This study examines jails in one state, exploring how individuals with SMI are identified and treated, and comparing these with research-based recommendations. Results indicate that jails are not using evidence-based screenings, staff require training in SMI, access to services and medications for jailed individuals with SMI is often slow, and coordination between community providers and jails is limited.

Education, Funding Crucial to Reduce Number of Mentally Ill Inmates

Education, Funding Crucial to Reduce Number of Mentally Ill Inmates

Prevalence of Serious Mental Illness Among Jail Inmates

Prevalence of Serious Mental Illness Among Jail Inmates