Receiving Disability Benefits Research Articles

Between health, morality and pragmatics: common mental disorders and decision-making for disability benefits in the Norwegian welfare state

Across Europe, the number of young adults with common mental disorders receiving disability benefits is on the rise. The suggested reasons for this increase reflect different ideological perspectives. However, no available research has investigated how different ideological perspectives may influence the decision-making process for granting disability benefits. By analysing 12 qualitative interviews with the professional groups involved in the Norwegian decision-making process, we delimited different interpretative repertoires about common mental disorders and assessed the consequences of framing disability benefits within these specific repertoires. We employed a discursive psychological framework and described three interpretative repertoires: medical, moral, and pragmatic. Young applicants for disability benefits appeared in these repertoires in different subject positions as ill, lazy, or pitiable, but ill for practical reasons. We further identified an ideological dilemma caused by the ambivalent character of common mental disorders as a legitimate reason for allocating disability benefits. Points of interest Norwegian case managers and general practitioners apply different perspectives when making decisions regarding disability benefits due to common mental health problems. The different perspectives create dilemmas for case managers and general practitioners and concerns the applicants need for a medical diagnosis. A medical diagnosis is only partly able to capture the underlying reasons for the granting of disability benefits.

Exploring the Impact of Fatigue in Progressive Multiple Sclerosis: A Mixed-Methods Analysis

BackgroundPatient-focused literature on fatigue in progressive forms of multiple sclerosis (MS) is sparse. This study aimed to explore progressive MS patients’ experiences of fatigue. MethodsAdult patients in the United States with primary progressive MS (n=21) and secondary progressive MS (n=23), recruited from research panels, completed the following PRO measures: Patient Global Impression of Severity (Fatigue) (PGI-F); Fatigue Scale of Motor and Cognitive Functions (FSMC); Modified Fatigue Impact Scale (MFIS); Patient Health Questionnaire, two-item version (PHQ-2); and Patient Determined Disease Steps (PDDS). Patients subsequently participated in a 45-minute semistructured telephone interview and were asked to describe their MS symptoms and to comment on how MS affected their day-to-day lives. More detailed questions followed on the nature of their fatigue, including symptoms, impacts, frequency, and bothersomeness. ResultsPatients’ mean age was 52.5 years, mean time since diagnosis was 14.7 years, and 81.8% were female. 79.5% of patients were unemployed and/or receiving disability benefits. Of all spontaneously reported MS symptoms, fatigue was the most common (n=38, 86.4%), followed by ambulation problems (n=31, 70.5%) and muscle weakness (n=25, 56.8%). Patients used the words “tired,” “exhausted,” “wiped out,” and having “little or no energy” to describe their fatigue. More patients rated fatigue as their “most troubling symptom” (n=17, 38.6%) compared with other MS-related symptoms. Half of patients reported feeling constantly fatigued, and more than 90% reported experiencing fatigue at least daily. The top three most frequently reported negative impacts of fatigue were social functioning, emotional well-being, and cognitive functioning (all >80%). Patients described themselves as “homebodies,” as fatigue limited their social interactions with friends and family and impacted the types of activities they could participate in. Patients attributed their inability to think clearly or focus for long periods of time to their fatigue. Patients also reported experiencing depression and anxiety because of their fatigue, which would often have further negative effects on their relationships with friends and family. On the fatigue PRO measures, mean (standard deviation) scores were 75.2 (14.7) on the FSMC and 55.0 (15.2) on the MFIS. Most participants scored in the “high” fatigue category on the FSMC (84.1%) and above the clinically significant fatigue threshold (86.4%). MFIS and FSMC total scores correlated with PGI-F (polyserial correlations r=0.74 and r=0.62, both p<0.01) and PHQ-2 (r=0.56 and r=0.57, both p<0.01), but not with PDDS (r=0.09 and r=0.02, both p>0.05). ConclusionsFatigue is a common, troublesome, and disabling symptom which has a profound impact on patients’ daily lives, as evidenced by qualitative analyses and high scores on established fatigue measures observed in this sample. These findings provide insights into the burden of fatigue and can inform its measurement in both clinical and research settings. Treatments that improve the symptoms of fatigue or prevent exacerbations are needed for patients with progressive MS.

Association of Disability Benefits and/or Litigation With Time to Return to Work After Tibia Shaft Fracture Fixation.

We explored the association of compensation status with return to work (RTW) after tibial fracture. Eligible patients were adults with tibial shaft fractures enrolled in the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures. We explored the association between disability benefits and/or litigation and RTW using multivariable discrete interval hazard analysis, adjusting for sex, age, country of residence, smoking status, body mass index, polytrauma, fracture severity, fracture gap, pain severity, and physical functioning. Of 330 eligible patients, 111 (34%) had not returned to full-time work 1-year after surgery. In our adjusted model, receipt of disability benefits and/or involvement in litigation was associated with delayed RTW (HR = 0.71, 95% CI 0.52-0.96). Tibial shaft fracture patients receiving disability benefits and/or involved in litigation are less likely to RTW.

Health and Social Care Diversity Among Individuals with Longstanding Physical and Psychological Health Problems: Pooled Repeated Cross Sectional Analyses

This paper examines differences in health-and-social care utilisation for individuals with physical and/or mental health problems. Logistic regression models are used to determine disparity in the percentage of General Household/Lifestyle Survey participants with physical compared to mental health problems receiving disability benefits or health care services between 2000 and 2011. Our findings of a relative underutilisation of secondary health care combined with a relative overutilization of out-of-work benefits by individuals with mental health problems is novel to the field of rehabilitative health care. These results provide evidence for the previously suspected disparity in health care utilisation of individuals with mental health problems and indicate problems in labour force integration. The findings support the political call for a ‘parity of esteem’, which, in Britain, was enshrined in the Health and Social Care Act of 2012.

Employed Vocational Rehabilitation Applicants with Visual Disabilities: Factors Associated with Timely Service Delivery

Introduction: Employed applicants for vocational rehabilitation need timely services to improve the likelihood of their successful job retention or career advancement. Little research exists that examines timeliness of services among employed applicants, particularly for applicants with visual disabilities. This study investigated time from vocational rehabilitation application to a signed Individualized Plan for Emplolyment (IPE) for employed applicants with visual disabilities. Method: The sample of 5,096 competitively employed vocational rehabilitation applicants from the FY2015 RSA-911 report was combined with survey responses from 51 vocational rehabilitation agencies about services to persons with visual disabilities. Multilevel modeling was used to examine effects of state-level and individual-level characteristics and cross-level interactions on the length of waiting time from vocational rehabilitation application to signed IPE. Results: The time from application to IPE was shorter for employed applicants with visual disabilities who received services from separate vocational rehabilitation agencies compared to that of combined vocational rehabilitation agencies. Employed vocational rehabilitation applicants with visual disabilities waited longer if they were younger, non-White, or received disability benefits. Official job-retention policies in state vocational rehabilitation agencies appeared to reduce the delay of IPE implementation for persons with secondary disabilities, for applicants who received disability benefits, and for persons who worked more hours per week. Discussion: Additional research to determine how vocational rehabilitation can provide services to employed persons as soon as possible after application is indicated, particularly for persons applying to combined agencies. Implications for practitioners: Vocational rehabilitation providers should explore ways to expedite service delivery, particularly for persons who are younger, non-White, or receiving disability benefits. Implementing official vocational rehabilitation policies for addressing job-retention and career-advancement cases may be one avenue to expedite services to some employed applicants.

Financial burden and quality of life among thyroid cancer survivors

BackgroundSurvivors of cancer in the United States are often financially encumbered by expenses and lost wages from cancer treatment. The majority of patients with thyroid cancer are diagnosed before age 65, when they are not eligible for Medicare. We hypothesized that financial distress would be common among thyroid cancer survivors and would be associated with poor health-related quality of life. MethodsA financial distress questionnaire and Patient-Reported Outcomes Measurement Information System (29-item) were completed online by 1,743 adult thyroid cancer survivors living in the United States. Multivariable modeling was used to identify variables which independently predicted poor health-related quality of life. The magnitude of predicted change was estimated by β coefficients and 95% confidence intervals. A β ≥3 was considered clinically significant; α was set at 0.01. ResultsFinancial difficulties were reported by 43% of thyroid cancer survivors and were associated with worse anxiety (β = 5.07; P < .01) and depression (β = 5.47; P < .01). Living in poverty was associated with worse anxiety (β = 4.14; P < .01) and depression (β = 4.35; P < .01). Lost productivity at work was associated with worse fatigue (β = 5.99; P < .01) and social functioning (β = –4.07; P < .01). Inability to change jobs was associated with worse fatigue (β = 3.08; P < .01), pain interference (β = 3.56; P < .01), and social functioning (β = –3.09; P < .01). Receiving disability benefits was associated with worse pain interference (β = 3.93; P < .01). Impaired ability to obtain a job was associated with worse social functioning (β = –3.02; P < .01). Reported unemployment rate was 12.3%. ConclusionFinancial distress and negative financial events were common among thyroid cancer survivors and were associated with poorer health-related quality of life across 5 Patient-Reported Outcomes Measurement Information System health domains.

Adverse Childhood Experiences, Other Psychosocial Sources of Adversity, and Quality of Life in Vulnerable Primary Care Patients.

Adults who had adverse childhood experiences (ACEs) have increased risk of negative health outcomes. Despite the prevalence of ACEs, literature is scarce on quality of life (QOL) and ACEs in disadvantaged primary care populations. To examine the prevalence of ACEs and association with chronic health problems and QOL in disadvantaged primary care patients in Oklahoma. During a primary care visit, adults completed a questionnaire measuring demographics, ACEs, current health status and well-being, sources of support and adversity, and QOL. A physician investigator reviewed participants' health records, recording the incidence of 32 diagnoses commonly associated with chronic health problems. The survey was completed by 354 patients. Forty-three percent received disability benefits and 71% were unemployed. More than 37% reported 4 or more ACEs, and 35.5% had 0 or 1 ACE.The amount of health problems ranged from 0 to 11 and increased with the number of reported ACEs. The mean number of health problems for each ACE level was as follows: ACEs 0 to 1 had 3.01 problems (95% confidence interval = 2.96-3.88), ACEs 2 to 3 had 3.42 problems (95% confidence interval = 2.96-3.88), and ACEs 4 and above had 4.18 problems (95% confidence interval = 3.72-4.64). ACEs were significantly related to QOL. This disadvantaged primary care population had high numbers of ACEs. ACEs correlated with increasing numbers of health problems and worse QOL. Enhanced awareness and action are needed to reduce health disparities and improve outcomes in similar populations.

Poor mental health and uptake of disability benefits

Background with rationale Disability related social security benefits were introduced to help off-set the additional costs incurred by people with disability and to help them better integrate into society. However, there are concerns that not everyone with a disability is receiving the benefits to which they are entitled.&#x0D; Aim To undertake a record-linkage study to compare levels of benefit uptake Disability Living Allowance (DLA) according to disability type and severity as reported in the Northern Ireland 2011 Census.&#x0D; Data/methods The linked data sources were the 2011 census records and all DLA records for calendar year 2011. The main comparison was of DLA receipt amongst those reporting chronic mobility difficulties (MD) and those with chronic poor mental health (PMH) (both yes/no) with the addition of limitation of daily activities (none, a little, a lot), which was used as a proxy for severity and DLA eligibility.&#x0D; Results Most people with disability had multiple disabilities but here the analysis is primarily amongst people with solitary conditions to avoid potential confounding. Approximately 20,000 people in the population reported either only MD or only PMH, though 68% of MD had their daily activities limited a lot compared to 55% of those with PMH. Overall, 71.8% of people with MD and daily activities limited a lot were on DLA compared to only 57.5% of similarly affected people with PMH the relative odds ratio being (OR 0.53 95%CI 0.50, 0.56).&#x0D; Conclusion It appears that people with poor mental health are less likely to receive disability benefits compared to those with mobility problems. This may be because they are less able to prove their eligibility for these benefits under the current assessment processes.

Occupational diseases in self-employed workers in France

Abstract Background In France, self- employed workers receive disability benefits, but are outside of the specific legislation protecting employees from occupational accident and diseases. Physicians are generally not aware of this shortcoming and ask for occupational diseases benefits, as they do for salaried employees. The health fund of independent workers (HFIW ), dismiss the application, which is uphold by law, but can be a threat to the patient, if it shutters hope for other available benefits. Our aim was to see if the request for occupational diseases was related to significant disability in self-employed workers, and if such a disability could be handled by available benefits from HFIW. This survey could be instructive for countries without occupational diseases frame for self-employed workers. Methods A prospective study was conducted on self-employed claimants applying for occupational disease, from June 2015 to September 2017, with an 18 month period follow-up, in the Ile- de- France region. A questionnaire was sent to the claimant and the data were completed through a phone call or appointment. The main outcome was the number of claimants qualifying for disability benefit available at the HFIW. Results 148 claimants were identified and 141 (95%) matched with the occupational diseases legal setting. The causative agents were close to those observed in employed workers: musculoskeletal, asbestosis. Disability allowance, complete or partial, could be provided by the HFIW because his criteria were met in 38 claimants(27%);benefits for asbestosis exposure were possible through a specialized body in 16 claimants(11%). Conclusions The occupational disease request from self-employed workers matched with medical conditions granted by the HFIW, or external social bodies. This screening should be routinely implemented by nurses or any insurance officer. Key messages Self-employed workers are outside of the specific legislation protecting employees from occupational accident and diseases but 27% of them may apply for other disability benefits. The occupational disease request from self-employed workers dismiss an application but match with available disability benefits from the Independent health fund and should be routinely screened.

What Is the Role of a Specialist Assessment Clinic for FND? Lessons From Three National Referral Centers

A growing interest in functional neurological disorders (FND) has led to the development of specialized clinics. This study aimed to better understand the structure and role of such clinics. Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for FND in general. Data were for 492 consecutive patients referred over a 9- to 15-month period: 100 from the United Kingdom clinic, 302 from the Swiss clinic, and 90 from the Canadian clinic. Data included symptom subtype and duration, comorbid pain and fatigue, disability, and treatment recommendations. The mean age of the 492 patients was 44 years, and most (73%) were female. Most had a prolonged motor FND (mean symptom duration of 6 years); 35% were not working because of ill health, 26% received disability benefits, and up to 38% required a care giver for personal care. In the Swiss cohort, 39% were given a diagnosis of another somatic symptom disorder rather than an FND diagnosis. Pain was common in the United Kingdom (79%) and Canada (56%), as was fatigue (48% and 47%, respectively). Most patients (61%) were offered physiotherapy; referral to neuropsychiatry or psychology differed across centers (32%-100%). FND specialty clinics have an important role in ensuring correct diagnosis and appropriate treatment. Most patients with motor FND require specialized neurophysiotherapy. Patients readily accepted an integrated neuropsychiatric approach. Close collaboration between FND clinics and acute neurology facilities might improve early detection of FND and could improve outcomes.

The Labor Market Consequences of Receiving Disability Benefits during Childhood

I estimate the labor market effects of gaining eligibility for Supplemental Security Income (SSI) disability benefits during childhood. A Supreme Court decision eased the criteria to be considered disabled, disproportionately affecting child applicants with mental disorders. For individuals with mental disorders, each additional year of exposure to eased standards during childhood increased their SSI receipt by 0.3 years. The additional benefit receipt reduced cumulative labor market earnings through age 30 by $1,600 for each additional year of exposure for those with mental disorders. Importantly, this does not address the full range of outcomes that may be affected by receiving benefits.

Healthcare utilization of breast cancer patients following telephone-based consultations of oncology nurse navigator via telemedical care.

ObjectivesTo characterize breast cancer patients who received telephone-based consultations of oncology nurse navigator via telemedical care (TMC patients) and analyze their healthcare utilization (HCU) one year before and after receiving this service.MethodsA retrospective study among Maccabi Healthcare Services enrollees that were newly diagnosed during 2016 (n = 1035). HCU, demographic characteristics and comorbidities were obtained from computerized database. Multivariable ordered logit model was specified for the determinants of HCU by quarters. Independent variables included: annual number of telephone-based consultations, gap between diagnosis and first consultation, age, socio-economic status, eligibility for disability and income security benefits, and comorbidities.ResultsTwenty-two percent of our cohort were TMC patients. Compared to others, these patients were younger and had a lower prevalence of hypertension. A higher proportion of these patients received disability benefits, and a lower proportion received income security benefits. The total average annual HCU of TMC patients (n = 107) before first consultation was $8857 and increased to $44130 in the first year following it (p<0.001), predominantly due to a significant increase in outpatient visits ($20380 vs. $3502, p<0.001) and medication costs ($19339 vs. $1758, p<0.001). The multivariable model revealed that each additional telephone-based consultation decreased the likelihood to be in the lowest quarter of the HCU distribution by 1.1 percentage points (p = 0.015), and increased the likelihood to be in the upper quarter of the HCU distribution by 1.1 percentage points (p = 0.016).ConclusionsThere was a significant increase in outpatient care and medications usage following first consultation. Moreover, a more intense use of this service was associated with elevated HCU. This result may stem from the proactive nature of the telemedical care.

PND36 LONGITUDINAL COMPARISON IN EMPLOYMENT BETWEEN MULTIPLE SCLEROSIS PATIENTS VERSUS CONTROLS

A key burden for MS patients is employment loss. This 24-month prospective cohort study investigated whether MS patients differ in self-reported employment compared to healthy controls (HC). We followed relapsing-remitting MS patients between 18 and 60 taking natalizumab (NTZ) for at least 2 years at study start for 24 months along with age- and sex-matched HC. Employment outcomes were collected at baseline and 24 months. Key outcome analyzed was self-reported employment status (full-time vs not full-time). Other outcomes included: cutting back on work and disability benefits. Demographic and disease history were also collected. Relative risk regression, with generalized estimating equations was used to calculate risk ratios (RR) for group x time, controlling for age, education and gender. Symmetry tests for participants with data at both time points assessed change in employment status over time. A total of 111 patients (48MS and 63HC) met study inclusion criteria. Mean age was 45.11MS and 45.27HC years (p=0.92). Mean disease duration was 12.52MS (+/-5.67) years. At baseline, 40.4%MS were not currently fully employed vs 20.6%HC (p=.02), and at 24 months, 43.2%MS vs 21.0%HC (p=.01). Adjusted estimates showed that MS patients were approximately twice as likely to report not being fully employed as HC, at baseline (RR: 1.95, p=.023), and at 24 months (RR: 2.07, p=.014). Employment status was consistent within group over 24 months for both MS (p=.66) and HC (p=.98). Paired analysis, with 43MS, found employment status was unchanged over 2 years for 83.7%MS. Among the employed, at baseline, 28.2%MS cut back at work vs 0%HC (p<.001) and at 24 months, 27.3%MS vs 1.82%HC (p=.0005). At baseline, 21.3%MS received disability benefits vs 0%HC (p=.001) and at 24 months, 22.7%MS vs 1.64%HC (p=.0006). This study provides early longitudinal data on the self-reported employment differences between MS patients and HC.

Examining the relevance of employment integration policies on disability benefit receipt: a multilevel analysis of older working age adults in 16 countries

Purpose: Nearly all advanced economic countries have adopted employment integration policies to improve the labor market outcomes of workers with disabilities and to reduce enrollment on disability benefits. To date, research has yet to investigate whether the adoption of integration policies is associated with a reduced likelihood of an older working age adult receiving disability benefits.Materials and methods: This study, drawing on data of older working-age adults from the Survey of Health Ageing and Retirement in Europe, the English Longitudinal Study of Ageing, and the Health and Retirement Study, applies multilevel logistic regression to investigate the relationship between country-level integration policies and the likelihood of disability benefit receipt in 16 OECD countries.Results: No clear association was identified between the adoption of major integration policies (comprehensiveness of vocational rehabilitation systems, employer obligation policies, work-incentive rules, benefit suspension options, and early intervention efforts) and an individual’s likelihood of receiving disability benefits. The minimum level of disability required to receive benefits was, however, identified as a significant country-level factor.Conclusions: The findings of this study may prove useful for policy makers who must weigh the costs and benefits of expanding integration measures targeted at those nearing the state pension age.Implications for RehabilitationMany countries have adopted integration policies to improve employment outcomes of adults with work-disabilities.No clear association is identified between the adoption of integration policies and a reduced likelihood of receiving disability benefits among older adults in 16 countries.The strictness of the definition of disability used to determine eligibility is identified as a significant country-level predictor.Policy makers should carefully weigh the costs and benefits of expanding integration measures targeted at those nearing the state pension age.

Assessing Social Connectedness Among Persons with Schizophrenia: Psychometric Evaluation of the Perceived Social Connectedness Scale.

The purpose of this study was a psychometric evaluation of the 4-item perceived social connectedness (PSC) scale. The study analyzed secondary data from a project that assessed physical, behavioral, and social health characteristics of adults with serious mental illness receiving integrated services at community mental health centers (CMHs). The current sample comprised those diagnosed with schizophrenia attending these CMHs (N = 146). Most participants were African-American males who receive disability benefits with Medicaid as health insurance. The sample self-reported low-to-moderate levels of social connectedness, daily functioning, and symptom severity. Factor analysis of the PSC scale revealed one dimension, accounting for 66% of total variance, with strong item loadings. Reliability coefficients indicated sufficient scale internal consistency. Construct validity was suggested via the PSC scale's directional, significant convergence with daily functioning and symptom severity. Implications include the application of the PSC scale for this socioeconomically disadvantaged population that customarily lacks meaningful social networks.

In or out of work: A preliminary investigation of mental health, trait anxiety and metacognitive beliefs as predictors of work status

BackgroundCommon mental disorders are associated with significant economic, social, and personal costs that are primarily incurred through loss of work status. Psychological interventions based on cognitive‐behavioural therapy have been implemented to enhance return to work (RTW), but have not proved sufficiently successful. According to the metacognitive model of psychological disorders, metacognitive beliefs are the key factors underlying self‐regulation and could therefore potentially be important for work status. The aim of the current study was therefore to investigate whether metacognitive beliefs could have predictive utility for work status.MethodIn a cross‐sectional design, 427 working age individuals reporting to be working (n = 292) or receiving disability benefits (n = 135) participated in the study.ResultsWe found that metacognitive beliefs about the need for mental control were significant as predictors of work status over and above the presence of a diagnosed mental disorder and levels of trait anxiety.ConclusionsThese findings imply that metacognitive beliefs have predictive utility for work status even when controlling for mental health status, and that metacognitive beliefs might therefore be addressed in treatment to enhance RTW and with the aim of reducing long‐term sick leave.

Living With, and Caring for, Congenital Heart Disease in Australia: Insights From the Congenital Heart Alliance of Australia and New Zealand Online Survey

There is a paucity of data describing the day-to-day experiences of adult Australians personally living with or caring for a child born with congenital heart disease (CHD). Such data would be of great practical importance to inform health care initiatives to improve outcomes. 588 men (38.3 ± 11.9 years) and women (39.6 ± 12.6 years, 78% of respondent patients) living with CHD and 1,091 adult carers (93% mothers) of children with CHD (median age 7.3 [IQR 3.5-13.3 years], 54% male), representing all Australian states and territories, responded to a comprehensive online survey designed and hosted by the Congenital Heart Alliance of Australia and New Zealand. Data on demographic factors, the nature of underlying CHD, interactions with health care services, psychological wellbeing and wider impacts of CHD were collected. Most respondents were able to identify the type of CHD they (29% with a simple lesion such atrial septal defect, 17% tetralogy of Fallot) or their child had (21% with a simple lesion, 15% tetralogy of Fallot), whilst 90% cases of CHD had undergone cardiac surgery. Patients with CHD were mostly employed (70%) or studying (8.8%), whilst 9.1% were receiving disability benefits. In terms of transition care, 52% of adult patients had been referred by a paediatric to adult cardiologist with 84% still actively managed by a specialist. Overall, 31% of patients with CHD sought emergency care and required >10 days sick leave in the past 12 months. Moreover, 71% and 55% of patients, respectively, reported recent feelings of anxiety/worry or depressive thoughts related to their CHD (61% sought professional assistance). Consistent with high levels of disruption to daily living, 59% of carer respondents (24%>10 days) had taken carer's leave in the past 12 months. These contemporary, self-reported, Australian data reveal the burden of living and caring for CHD from an adult's perspective. Survey respondents highlighted the potential disconnect between paediatric and adult CHD services and suggest an important, unmet need for dedicated health services/community care to cost-effectively manage high levels of health care utilisation coupled with associated psychological distress.

Obstetric brachial plexus injuries (OBPIs): health-related quality of life in affected adults and parents

BackgroundObstetric brachial plexus injuries (OBPIs) are rare but can have significant implications for those affected, their caregivers and the health system. Symptoms can range from restricted movement to complete paralysis of the arm. We investigated health-related quality of life in adults with OBPIs and parents of children with permanent OBPIs, compared these with population norms, and investigated whether certain socio-demographic or clinical factors were associated with the quality of life in these cohorts.MethodsA cross-sectional study examined 50 affected adults and 78 parents. Participants completed EQ-5D-5 L and characteristics questionnaires. EQ-5D-5 L responses were mapped onto an EQ-5D-3 L value set to generate utility scores. Mean utility scores were compared with English population norms. Univariable and multivariable linear regression models were conducted to assess for associations between participant characteristics and the utility scores.ResultsThe overall mean utility scores for affected adults and parents were 0.56 (SD 0.28) and 0.80 (SD 0.19) respectively. Affected adults (95% CI (− 0.38, − 0.22), p < 0.001) and parents of children with permanent OBPIs (95% CI (− 0.10, − 0.02), p = 0.007) had lower mean utility scores, and therefore quality of life, compared to English population norms. For affected adults, previous OBPI surgery (95% CI (0.01, 0.25), p = 0.040), employment in non-manual work (95% CI (0.06, 0.30), p = 0.005) and having a partner (95% CI (0.04, 0.25), p = 0.009) appeared to be positively associated with the utility score. Affected adults receiving disability benefits related to OBPIs appeared to have worse utility scores than those not receiving any disability benefits (95% CI (− 0.31, − 0.06), p = 0.005). For parents, employment was associated with better utility scores (95% CI (0.02, 0.20), p = 0.024) but the presence of one or more medical condition appeared to be associated with worse utility scores (95% CI (− 0.16, − 0.04), p = 0.001).ConclusionsAdults with OBPIs and parents of children with permanent OBPIs reported worse utility scores, and therefore quality of life, compared to the English general population. We also identified certain characteristics as possible factors to consider when dealing with utility scores in these cohorts. The utility scores in this study can be used in future economic evaluations related to OBPIs.

Supporting Employment for Young Adults Living with Mental Health Conditions

Having a job as a youth or young adult is a predictor of long-term work success. Having a job has also been related to improved self-esteem, self-efficacy, and life satisfaction. However, there is a significant gap in work experience for many young adults living with mental health conditions. This tip sheet has information on 1) why work is especially important for young adults; 2) the impact of receiving disability benefits rather than employment early in life; 3) how to cultivate motivation toward employment goals; 4) ways to promote work experiences; 5) tips on helping young adults with mental health conditions get a job; 6) and resources to learn more. A Portuguese translation of this publication is available for download.

Predictors of Dropout From a 20-Week Dialectical Behavior Therapy Skills Group for Suicidal Behaviors and Borderline Personality Disorder.

Treatment dropout among individuals with borderline personality disorder (BPD) is associated with negative psychosocial outcomes. Identifying predictors of dropout among this population is critical to understanding how to improve treatment retention. The present study extends the current literature by examining both static and dynamic predictors of dropout. Chronically suicidal outpatients diagnosed with BPD (N = 42) were randomly assigned to a 20-week dialectical behavior therapy (DBT) skills training group. Static and dynamic predictors were assessed at baseline, 5, 10, 15, 20 weeks, and 3 months post-intervention. A post-hoc two-stage logistic regression analysis was conducted to predict dropout propensity. Receiving disability benefits at baseline and decreases in mindfulness were associated with significantly increased probability of dropout. Clinicians working with chronically self-harming outpatients diagnosed with BPD would benefit from prioritizing clinical interventions that enhance mindfulness in order to decrease dropout propensity.