Receiving Disability Benefits Research Articles

Understanding disability benefits decision-making among adults with self-reported work disabilities: A qualitative study

BackgroundTake-up gaps in safety net programs, long documented in the US, are an important policy problem as non-take up compromises the equity objectives and efficacy of programs. The Social Security Disability program is an example of this: more than 20 million adults report a work disability, but only around 11 million currently receive disability benefits through the Social Security Disability Insurance or Supplemental Security Income programs. ObjectivesWe examine decision-making around benefits application among adults with self-reported work disability who have never applied for disability benefits. MethodsWe conducted 39 interviews with work-disabled adults who have never applied for disability benefits. Thematic analysis identified key barriers and inhibitors to disability application. ResultsHigh transaction costs involved in disability applications coupled with the widespread perception of low approval rates was mentioned as a critical deterrent. Uncertain and lengthy medical processes after disability onset were also frequently reported as a key deterrent. Stigma about receiving disability benefits did not emerge as a factor in application behavior, although a change in self-concept involving an adjustment to benefit-receiving, work-disabled status was cited as a barrier to claiming. ConclusionOur results broadly align with those of other research that examined the information, transaction, and social costs of applying for benefits. Nevertheless, the qualitative data afford a more in-depth, grounded understanding of the primary factors affecting application decisions, and how those interact. These insights are important to inform targets for interventions to reduce barriers to take-up of benefits among potentially eligible adults with disabilities.

Artificial intelligence in Medicare: utilization, spending, and access to AI-enabled clinical software.

In 2018, CMS established reimbursement for the first Medicare-covered artificial intelligence (AI)-enabled clinical software: CT fractional flow reserve (FFRCT) to assist in the diagnosis of coronary artery disease. This study quantified Medicare utilization of and spending on FFRCT from 2018 through 2022 and characterized adopting hospitals, clinicians, and patients. Analysis, using 100% Medicare fee-for-service claims data, of the hospitals, clinicians, and patients who performed or received coronary CT angiography with or without FFRCT. We measured annual trends in utilization of and spending on FFRCT among hospitals and clinicians from 2018 through 2022. Characteristics of FFRCT-adopting and nonadopting hospitals and clinicians were compared, as well as the characteristics of patients who received FFRCT vs those who did not. From 2018 to 2022, FFRCT billing volume in Medicare increased more than 11-fold (from 1083 to 12,363 claims). Compared with nonbilling hospitals, FFRCT-billing hospitals were more likely to be larger, part of a health system, nonprofit, and financially profitable. FFRCT-billing clinicians worked in larger group practices and were more likely to be cardiac specialists. FFRCT-receiving patients were more likely to be male and White and less likely to be dually enrolled in Medicaid or receiving disability benefits. In the initial 5 years of Medicare reimbursement for FFRCT, growth was concentrated among well-resourced hospitals and clinicians. As Medicare begins to reimburse clinicians for the use of AI-enabled clinical software such as FFRCT, it is crucial to monitor the diffusion of these services to ensure equal access.

Temporary disability pension recipients: Contextual stress factors and their effect on return-to-work-intention.

In the last decades, Germany has experienced a vast increase in the number of individuals applying for or receiving disability benefit. Only a small proportion of them intends to return to work. The present study aims to identify and describe the percentage of temporary disability pensioners, who have the intention to return to working life. The final sample consisted of 496 insured individuals who were receiving temporary disability pension from the Regional German Pension Insurance (DRV) at that time. Participation was voluntary and anonymous. The following self-report instruments were administered: a. Evaluation of Contextual Factors; b. German Symptom Validation Test (BEVA); c. German Patient Health Questionnaire (PHQ-9); d. Readiness for Return-to-Work German Scale (RRTW). The results revealed that approximately 6% of participants were at the stage of "preparation", 31.9% at the stage of "contemplation", and more than half of the participants were at the stage of "pre-contemplation" according to the RRTW. Comparing the groups of "pre-contemplation" (Group 1) and "contemplation+preparation" (Group 2+3), no statistically significant differences were found, except for age. In conclusion, further research is required to identify possible factors which could predict the stage of RRTW. New interventions are needed that can raise the motivation for and success in the return to work of disability pensioners.

Unequal Effect of Educational Attainment on Reducing Poverty and Welfare; Diminished Returns of American Indian/Alaska Native Populations.

American Indian and Alaska Native (AIAN) communities face pronounced economic and health disparities compared to White Americans, a situation rooted in long-standing historical injustices and segregation. The theory of Minorities' Diminished Returns (MDR) provides insight beyond the traditional focus on socioeconomic status (SES) disparities, such as educational attainment. It suggests that the beneficial outcomes of educational achievements on health and economic status are less substantial for marginalized and racially non-White groups compared to White Americans. This study investigates the applicability of the MDR theory to AIAN populations by examining whether the positive effects of education on poverty reduction and the decreased risk of disability benefit dependency are weaker for AIAN adults relative to their White counterparts. Utilizing data from the 2022 National Health Interview Survey (NHIS), this cross-sectional study analyzed a cohort of 20,743 adults, comprising 20,474 White and 269 AIAN individuals. We assessed the relationships between educational attainment, poverty level, and the likelihood of receiving disability benefits. A structural equation model was employed, with receipt of disability benefits as a latent factor influenced by racial background (AIAN) as a potential moderator, education as the main predictor, and poverty level and self-rated health as mediators. Gender, age, employment status, marital status, and Hispanic ethnicity served as additional covariates. Findings indicate that higher educational levels are generally associated with a lower likelihood of receiving disability benefits, mediated by improved health and economic status. Nonetheless, the interaction between race (AIAN) and education significantly influenced economic outcomes, subsequently affecting the risk of receiving disability benefits. This suggests that Whites benefit more economically from education than AIAN individuals do. The study underscores the MDR theory's relevance to the disparities in educational outcomes related to poverty risk and receiving disability benefits among AIAN populations. The challenges AIAN individuals face in leveraging their educational achievements for economic gain relative to Whites may be attributed to pervasive racism and discrimination within various sectors, including employment and education. Addressing these disparities necessitates policy interventions that ensure educational returns are equitable across racial groups, with a focus on equal access to resources and opportunities.

Characteristics of Canadians Living With Long-Term Health Conditions or Disabilities Who Had Unmet Rehabilitation Needs During the First Wave of the COVID-19 Pandemic: A Cross-sectional Study.

This study aimed to describe the characteristics associated with unmet rehabilitation needs in a sample of Canadians with long-term health conditions or disabilities during the first wave of the COVID-19 pandemic. We used data from the Impacts of COVID-19 on Canadians Living With Long-Term Conditions and Disabilities, a national cross-sectional survey with 13,487 respondents. Unmet needs were defined as needing rehabilitation (ie, physiotherapy/massage/chiropractic, speech therapy, occupational therapy, counseling services, or support groups) but not receiving due to the pandemic. We used multivariable modified Poisson regression to examine the association between demographic, socioeconomic, and health-related characteristics and unmet rehabilitation needs. More than half of the sample were 50 years and older (52.3%), female (53.8%), and 49.3% reported unmet rehabilitation needs. Those more likely to report unmet needs were females, those with lower socioeconomic status (receiving disability benefits or social assistance, job loss, increased work hours, decreased household income or earnings), and those with lower perceived general health or mental health status. Among Canadians with disabilities or chronic health conditions, marginalized groups are more likely to report unmet rehabilitation needs. Understanding the systemic and upstream determinants is necessary to develop strategies to minimize unmet rehabilitation needs and facilitate the delivery of equitable rehabilitation services.

Visits to social and community establishments and services by persons experiencing homelessness after shelter decentralization

ABSTRACT Persons experiencing homelessness (PEH) are challenged by inadequate transportation and shelter locations that limit access to employment, healthcare, establishments, social and community services. Surveys were collected from 106 PEH in shelters in Salt Lake County, Utah, to examine the number of social and community establishment and service visits after a centralized downtown shelter location was changed to a scattered site model with three dispersed locations. This study used mixed clustering methods to examine if there was any change in establishment and service visits for PEH based on shelter locations and for PEH at-risk health populations that were older, on Medicaid/Medicare, had disability benefits, or had difficulty walking due to a health condition. Findings suggest that PEH who received disability benefits were significantly less likely to visit social and community establishments and services as frequently post-decentralization. Additional findings suggest that the shelter furthest away from downtown Salt Lake City post-decentralization had a disproportionate number of PEH who did not frequently visit social and community establishments and services. Future shelter relocation models should consider these patterns and potential accessibility issues to ensure PEH needs are being adequately supported.

Recovering the Vocational Self?: Service User Accounts of Barriers to Work and School and the Role of Early Psychosis Services in Supporting Career Development.

Vocational recovery is frequently identified as a primary goal of specialized early intervention in psychosis services (EIS). However, few studies have investigated the multi-level impacts of psychosis and its social sequelae on emerging vocational identities and mechanisms by which EIS may contribute to longer-term career development. The goal of this study was to deepen our understanding of the experiences of young adults with early psychosis during and following discharge from EIS as they relate to vocational derailment, identity and career development. We conducted in-depth interviews with 25 former EIS recipients and five family members (N = 30). Interviews were analyzed using modified grounded theory, with an orientation to generating a rich, theory informed understanding young people's experiences. Approximately half of the participants in our sample were not in employment, education, or training (NEET) and had applied for or were receiving disability benefits (SSI/SSDI). Among those participants who were working, the majority reported short-term, low-wage work. Thematic findings elucidate factors underlying the erosion of vocational identity, as well as ways in which both participant-reported vocational service characteristics and socioeconomic background shape different pathways to college, work and/or disability benefits both during and following discharge from EIS. Findings underscore the need for additional research on vocational identity among youth and young adults with early psychosis and the development and evaluation of interventions designed to support career development, address social and structural barriers to education and training, and foster long-term socioeconomic mobility.

Patients Response to Interventional Care for Chronic Pain Study (PRICS): A Cross-Sectional Survey of Community-Based Pain Clinics in Ontario, Canada.

Non-image guided injection treatments ("nerve blocks") are commonly provided in community pain clinics in Ontario for chronic non-cancer pain (CNCP) but remain controversial. We explored patients' perspectives of nerve blocks for CNCP. We administered a 33-item cross-sectional survey to patients living with CNCP pain attending four community-based pain clinics in Ontario, Canada. The survey captured demographic information and asked about patient experiences with nerve blocks. Among 616 patients that were approached, 562 (91%) provided a completed survey. The mean age of respondents was 53 (SD 12), 71% were female, and the majority (57%) reported living with CNCP for more than a decade. Fifty-eight percent had been receiving nerve blocks for their pain for >3 years, 51% on a weekly frequency. Since receiving nerve blocks, patients self-reported a median improvement in pain intensity of 2.5 points (95% CI -2.5 to -3.0) on an 11-point numeric rating scaleand 66% reported stopping or reducing prescription medications, including opioids. The majority who were not retired (62%) were receiving disability benefits and were unable to work in any capacity. When asked what impact cessation of nerve blocks would have, most employed patients (52%) reported they would be unable to work, and the majority indicated their ability to function across multiple domains would decrease. Our respondents who received nerve blocks for CNCP attribute important pain relief and functional improvement to this intervention.Randomized trials and clinical practice guidelines are urgently needed to optimize the evidence-based use of nerve blocks for CNCP.

An empirical staging model for schizophrenia using machine learning

IntroductionOne of the great challenges still to be achieved in schizophrenia is the development of a staging model that reflects the progression of the disorder. The previous models suggested have been developed from a theoretical point of view and do not include objective variables such as biomarkers, physical comorbidities, or self-reported subjective variables (Martinez-Cao et al. Transl Psychiatry 2022; 12(1) 1-11).ObjectivesDevelop a multidimensional staging model for schizophrenia based on empirical data.MethodsNaturalistic, cross-sectional study. Sample: 212 stable patients with Schizophrenia (F20). Assessments: ad hoc questionnaire (demographic and clinical information); psychopathology: PANSS, CDS, OSQ, CGI-S; functioning: PSP; cognition: MATRICS; laboratory tests: C-Reactive Protein (CRP), IL-1RA, IL-6, Platelets/Lymphocytes (PLR), Neutrophils/Lymphocytes (NLR), and Monocytes/Lymphocytes (MLR) ratios. Statistical analysis: Variables selection was performed with an ad hoc algorithm developed for this research. The referred algorithm makes use of genetic algorithms (GA) to select those variables that show the best performance for the patients classification according to their global CGI-S. The objective function of the GA maximizes the individuals correct classification of a support vector machines (SVM) model that employs as input variables those given by the GA (Díez-Díaz et al. Mathematics 2021; 9(6) 654). Models performance was assessed with the help of 3-fold cross-validation and these process was repeated 10,000 times for each one of the models assessed.ResultsMean age(SD): 39.5(13.54); men: 63.5%; secondary education: 59.50%. Most patients in our sample had never been married (74.10%), and more than a third received disability benefits due to schizophrenia (37.70%). The mean length of the disease was 11.98(12.02) years. The best SVM model included the following variables: 1)Clinical: number of hospitalizations, positive, negative, depressive symptoms and general psychopathology; 2)Cognition: speed of processing, visual learning and social cognition; 3)Functioning: PSP total score; 4)Biomarkers: PLR, NLR and MLR. This model was executed again 100,000 times applying again 3-fold cross-validation. In 95% of the algorithm executions more than a 53.52% of the patients were classfied in the right CGI-S category. On average the right classification was of 61.93%. About specificity and sensitivity the average values obtained were of 0.85 and 0.64 respectively.ConclusionsOur staging model is a robust method that appropriately distributes patients according to the severity of the disorder. Highlights the importance of clinical, functional and cognitive factors to classify patients. Finally, the inflammatory parameters PLR, NLR and MLR have also emerged as potential biomarkers for staging schizophrenia.Disclosure of InterestNone Declared

A Framework for Evaluating the Adequacy of Disability Benefit Programs and its Application to the U.S. Social Security Disability Programs

Abstract The degree to which disability benefit programs provide an adequate standard of living to those with work-limiting disabilities has long been overlooked in social policy research. This paper presents a framework for assessing disability-related decommodification and then applies that framework to an analysis of the Social Security Disability (SSD) programs in the United States. The paper draws on survey data from the Health and Retirement Study linked to administrative records from the Social Security Administration, and further compares the U.S. estimates to those from 27 other countries. The results indicate that more than 50 percent of older adults of working-age with work-disabilities in the U.S. do not receive SSD benefits, though rates of benefit receipt are higher than the average across other high-income countries. Those that receive SSD benefits, moreover, experience greater difficulty achieving an adequate standard of living, as measured by an index of financial security, than those with similar characteristics in the U.S. who do not receive disability benefits. The paper thus provides a framework for future policy research on benefit adequacy, while evaluating the availability and generosity of disability benefits in the U.S.

Factors associated with material deprivation in persons with multiple sclerosis in Switzerland: Cross-sectional data from the Swiss Multiple Sclerosis Registry.

Multiple sclerosis (MS) impacts education, future career pathways and working capability and therefore may negatively impact the financial situation of persons with MS (pwMS) in Switzerland. We therefore investigated the financial situation and its influencing sociodemographic and disease-specific factors of pwMS compared to the general Swiss population with focus on material deprivation (MD). Data on the financial situation of pwMS were collected via a specific questionnaire added to the regular, semi-annual follow-up assessments of the Swiss Multiple Sclerosis Registry. Questions were taken in an unmodified format from the standardized "Statistics on Income and Living Conditions" (SILC) questionnaire 2019 of the Federal Statistical Office of Switzerland which evaluates the financial situation of the general Swiss population, enabling a direct comparison of pwMS with the general Swiss population. PwMS were 1.5 times more frequently affected by MD than the general Swiss population (6.3% of pwMS versus 4.2% of the general Swiss population) which was confirmed in a multivariable logistic regression analysis of pooled SILC and Swiss Multiple Sclerosis Registry (SMSR) data. High symptom burden, having only mandatory schooling, well as having a pending disability insurance application (as opposed to no application or receiving benefits) were associated with a higher odds of MD whereas higher education, older age, having a Swiss citizenship, living with a spouse or a partner or being currently employed were independently associated with a lower odds of MD. MS has a negative impact on the financial situation and is associated with MD. PwMS with a high symptom burden at the transition from work force to receiving disability benefits appeared to be vulnerable for MD. Higher education, older age, having a Swiss citizenship, living with a spouse or a partner or being currently employed were independently associated with a lower odds of MD.

Education and employment status among adults with Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome in Norway, a questionnaire based study.

To describe education level and employment status among adults with Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome, and explore factors related to work participation. Cross-sectional postal survey in 2018. Individuals with molecularly verified diagnosis were recruited through a National Resource Centre for Rare Disorders. A study specific questionnaire included topics on disease burden and validated instruments regarding education level, employment, pain, fatigue, psychological distress, and satisfaction with life. Fifty persons (56% women) aged 18-67 years, participated. Almost 60% reported education level ≤13 years. Two thirds (66%) received disability benefits, 21 (42%) had full-time disability pension. The median age at ending work was 41 years. Full-time employed and students were younger (p = 0.014), less fatigued (p = 0.035), had less sleep problems (p = 0.028) and higher satisfaction with life (p<0.001) than those who received disability pension. A third (32%) were currently or used to be in sedentary work, and 68% currently had or used to be in practical work requiring much standing and walking (23%), much walking and lifting (34%) or heavy manual work (11%). There is a potential that more adults with these diagnoses can sustain employment for more years. Health and social service follow-up routines and future studies should include details on employment perspectives to reveal those at risk of poor employment and to identify modifiable factors for work participation.

Occupational health patients' parallel use of primary- and secondary-care services and linkage to work disability: A follow-up study in Finland.

This study aimed to investigate occupational health (OH) primary-care patients' use of other health-care services and whether parallel use affects their likelihood to have sickness absences (SA) or disability pensions (DP). Primary-care services in Finland are provided through three parallel health-care sectors, all available to the working population: public, private and OH sectors. Patients may also be referred to secondary care. This follow-up study combines real-world medical record data containing SA data from a nationwide OH provider with health-care attendance data from public and private primary-care sectors and public secondary care, sociodemographic data and DP decisions. Patients between 18 and 68 years of age who used OH primary care at least once during the study years 2014-2016 were included. The total study population comprised 59,650 patients. Odds ratios were used to analyse association between parallel service use and SA or DP. Females and patients with a lower educational level were more likely to use services in other health-care sectors in addition to OH than others. Those patients who used any other health-care sector in addition to OH primary care had an increased likelihood of having long SA or receiving DP. OH primary-care patients using the services of several health-care sectors in parallel have an increased likelihood of receiving disability benefits - either SA or DP. There is need for care coordination to ensure adequate measures for work-ability support.

How do academic and career services affect employment, education, and disability benefit receipt in the transition to adulthood for youth with disabilities who have aged out of foster care?

ABSTRACT The transition to adulthood is an important process with implications for inequality. Both those with disabilities and those who age of out of foster care are vulnerable during this transition. This project examines the intersection of these groups, exploring employment, education, and disability benefit receipt, the supports these youth receive, and how these supports may mitigate risk in this transition. Findings suggest that those with emotional or mental disabilities face employment risks in the transition to adulthood, and that services may mitigate some of this risk and present unique benefits for youth with disabilities. For example, the odds of employment are greater and the odds of receiving disability benefits are lower among those who receive academic supports (=1.3, =0.7), post-secondary supports (=1.3, =0.8), education financial assistance (=1.3, =0.7), and career services (=1.3, =0.7). These services should be prioritized for funding, especially education financial assistance as a lower proportion of youth with disabilities receive than their non-disabled peers.

Long-term results after isolated iliac wing fractures

IntroductionIsolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of life in patients with this injury, the primary aim of this study was to evaluate the long-term functional results, and secondly to evaluate the patients’ clinical function and fracture healing. Patients and MethodsAll patients treated in Oslo University Hospital, Ullevaal (OUH-U), the Norwegian National Pelvic Service, in the time period 2006–2016 were included. Nine of 13 eligible patients (69%) were evaluated by the Patient Reported Outcome Measures (PROM); EQ-5D-3L and Majeed Score. For the secondary outcomes, the patients were clinically examined for Range of Motion (ROM) in the hips, pain, muscular function and nerve deficiencies. Finally, the patients underwent X-rays (AP-view and iliac and obturator oblique views). ResultsAll patients were injured in high-energy trauma with severe associated injuries. Five patients were operated and four received conservative treatment. At the time of follow-up (median seven years after injury), the mean EQ-5D VAS was 84, and the mean Majeed score was 87. Two out of nine reported moderate level of pain, three reported mild pain, and the rest reported no pain. Six patients were still working, two were retired, and the last one was receiving disability benefit of other reasons than the iliac fracture. One patient had difference in range of external rotation of >10° between the hips, while the rest had no differences in ROM. The follow-up X-rays showed healed fractures in all the patients. ConclusionPatients with isolated iliac wing fractures seem to have a good general state of health, scoring high on the PROMs, with minor and insignificant clinical sequela. This original finding is in accordance with the general assumption amongst pelvic surgeons that the injury is a benign one.

Has the share of the working life expectancy that is spent receiving a partial or full disability pension changed in Finland over the period 2005–2018? A longitudinal register-based study

ObjectivesThe share of the overall working careers that is spent receiving disability benefits is unclear. We examined trends in full-time equivalent working life expectancy (FTE-WLE) among those with and without...

Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures

ObjectiveWe explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). MethodsWe undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. ResultsModerator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group.Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a “logical” treatment (MCS).Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. ConclusionPatient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.

Characteristics of Persons Seeking Care for Moderate to Severe Pain Due to Chronic Low Back Pain and Osteoarthritis: A Cross-Sectional Study.

PurposeTo assess the associations between pain severity or physical (pQoL) and mental (mQoL) health-related quality of life and disability status or health-care utilization among persons living with moderate/severe pain due to chronic low back pain (CLBP) or osteoarthritis (OA), who received treatments in Quebec’s tertiary care pain centers.Materials and MethodsThis retrospective study was carried out using the Quebec Pain Registry (Canada) from 2008 to 2014 and contains data on persons referred to tertiary pain management clinics. Participants were selected if they were diagnosed with CLBP (N = 2663) or OA (N = 139) of more than 3 months duration and of pain intensity ≥5 on the Numeric Rating Scale (0–10) and completed baseline questionnaires.ResultsLess than 5% of persons were hospitalized in the 6 months before their first visit at the pain clinic, and 11.9% and 18.9% of persons with OA and CLBP, respectively, had a pain-related emergency room (ER) visit. Less than 1/5 and more than 1/4 of persons with OA and CLBP were receiving disability benefits, respectively. Persons with CLBP who had visited the ER, those on disability and those receiving disability benefits, reported higher levels of pain severity, interference, and lower levels of mQoL (and pQoL for those on disability or receiving benefits) compared to those who did not consult the ER, those not on disability or not receiving disability benefits, respectively (all p < 0.05). For OA, disability status was the only variable associated with pain interference and QoL (all p < 0.05).ConclusionPain severity, pain interference and mQoL were associated with health-care utilization and disability status in persons with CLBP. These results were globally not found among persons with OA, which might be due to smaller sample size or unique characteristics of this population.

Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy.

BackgroundAlthough cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments.PurposeThe aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy.MethodsThis was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes.ResultsThe ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC = 0.04) was not warranted. Group percentage of participants receiving disability benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes.ConclusionGiven the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and countertherapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.

Suicide after contact with a national digital mental health service

BackgroundThe safety of mental health care provided remotely via the internet, in particular, the probability of suicide after contact, is not known. MethodAn observational cohort study of patients registered with the MindSpot Clinic an Australian national digital mental health service (DMHS), linked to the National Death Index. Measures included demographic information, the nature of contact, duration between last contact and death, scores on measures of psychological distress (K-10), depression (PHQ-9) and anxiety (GAD-7), and responses to questions about suicidal thoughts or plans for patients who died by suicide within two years of last contact with the service. ResultsSixty-four (0.11%) of 59,033 patients registered with the MindSpot Clinic between 1 January 2013 and 31 December 2016 died from suicide within two years of last contact. The mean time between last contact and death was 344 days. Fourteen patients died within 90 days of last contact, and 4 of 285 who were urgently referred for crisis service intervention at the time of contact or soon afterwards died within 2 years. Suicidal thoughts (OR: 2.59), a suicide plan (OR: 10.8), and a score of “3” to item 9 of the PHQ9 (OR: 16.4) were significantly associated with subsequent suicide. Patients who died by suicide were more likely to be male (OR: 3.2), middle-aged (35–45; OR: 2.3), separated or divorced (OR: 3.1), unemployed (OR: 3.1) or receiving disability benefits (OR: 5.1). Enrolling in an online treatment course was associated with reduced risk (OR: 0.38). ConclusionsAlthough DMHS provide services to patients with severe symptoms of depression, only a small proportion died by suicide, and only a small number of those referred for urgent care, which suggests that the safety protocols of the clinic are relatively effective.