Reduction In Mental Health Research Articles

Does social capital and a healthier lifestyle increase mental health resilience to disability acquisition? Group-based discrete trajectory mixture models of pre-post longitudinal data

Poor mental health is strongly associated with disability acquisition. Social capital and healthier lifestyles pre-disability onset may help promote mental health resilience (i.e. a state of seemingly being unaffected by the event), or the capacity to ‘bounce back’, post-acquisition. This paper used a novel methodology (discrete trajectory mixture models) to examine discrete trajectories in mental health before and after disability acquisition in the Household Income Labour Dynamics in Australia (HILDA) survey. Group membership in association with pre-onset social capital and healthy lifestyles were then examined using multinomial logistic regressions. Four discrete trajectory groups were identified in 2904 Australians reporting onset of ongoing disability, with about 28.4% demonstrating mental health resilience. Three other groups were identified, each demonstrating increasingly severe reductions in mental health. No clear ‘bounce back’ group was observed. Group membership was associated with participants who felt they had ‘no-help from others’ prior to disability acquisition. Pre-disability acquisition measures of social capital and unhealthy behaviours moderated the association between disability acquisition and mental health trajectories. Social capital was protective only for the respondents who had poorer mental health before disability onset and had less resilience after onset, and long working hours and less resilience were positively associated. Public policies that help to enhance levels of social capital and reduce unhealthy behaviours at a population level may help to promote mental health resilience to adversities such as the acquisition of disability.

Underemployment, overemployment and deterioration of mental health: the role of job rewards.

Working more (overemployment) or less (underemployment) than preferred has been associated with poor mental health in cross-sectional studies, but longitudinal evidence is scarce. We investigate whether under- and overemployment is associated with 2-year changes of mental health and whether associations vary by job rewards (i.e. high earnings, job security, promotion prospects and occupational prestige). We used two waves of the German Socio-Economic Panel (GSOEP), with information on mental health collected in 2006 and 2008. Workers in paid employment (3266 men and 3139 women) who did not change jobs between 2006 and 2008, aged 20-60years were selected. Under- and overemployment was assessed using the discrepancy between the actual and preferred working hours. Mental health was assessed using the Mental Component Summary (MCS) score, a subscale from the Short Form 12 Health Survey. Questions on rewards at work were added and divided into tertiles. Conditional change models were estimated to predict change in MCS. Findings indicate that overemployment and low reward at work (for men and women) were linked to a reduction in mental health. Underemployment was not related to a reduction in mental health. Albeit associations between under-/overemployment and mental health slightly differed across levels of reward, interactions did not reach statistical significance. Our findings demonstrate that overemployment was related to negative mental health change, and that this relationship held true both for people with high and with low reward at work.

Psychiatric Rehabilitation Outcomes Among Hispanics with Co-Occurring Serious Mental Illness and Substance Use Disorders: A Systematic Review

Purpose: To conduct a systematic literature review relating to psychiatric rehabilitation (PsyR) outcomes of Hispanics with co-occurring serious mental illness (SMI) and substance use disorder (SUD) and to identify the most appropriate evidenced-based practices (EBPs) to facilitate treatment strategies for this population. Method: The following electronic databases were used to search multiple keywords and keyword combinations: MEDLINE/PubMed, SpringerLink, and Education Resources Information Center (ERIC). The initial search resulted in a total of 911 articles. Next, 906 articles from the initial search were excluded because they did not meet inclusion criteria for the following reasons: duplicates (n = 50), not relating to PsyR outcomes (n = 718) or to co-occurring SMI and SUD (n = 53), and not including Hispanics (n = 85). Five articles were retained for this study. Results: The included studies were classified by intervention into three categories: Integrated Mental Health and Substance Abuse Treatments (3), Motivational Interviewing (1), and Psychosocial Resources (1). Outcomes included reduction in mental health and PTSD symptoms, increased abstinence, decrease in substance use and psychiatric hospitalizations, improved self-efficacy for recovery, and better quality of life (QOL). Conclusion: This review identified several successful PsyR outcomes for Hispanics with co-occurring SMI and SUD; however, it also highlighted the limited availability of extant literature focused on EBPs for Hispanics with co-occurring SMI and SUD. As the Hispanic population increases, their specific needs should be addressed.

Nausea in Children With Functional Abdominal Pain Predicts Poor Health Outcomes in Young Adulthood.

Nausea is common among children with functional abdominal pain (FAP). We evaluated the relation of nausea to short- and long-term morbidity in pediatric patients with FAP. We performed a prospective study of 871 children with FAP (age, 8-17 y) seen in a pediatric gastroenterology practice; follow-up data were collected from 392 of the patients at 8.7 ± 3.3 years later. Participants were defined as having significant nausea if they reported nausea "a lot" or "a whole lot" within the past 2 weeks. Validated questionnaires assessed abdominal pain, gastrointestinal and somatic symptoms, and depression. Baseline measures, anxiety, and the Rome III criteria were assessed in the follow-up evaluation. At baseline, 44.8% of the patients reported significant nausea. Those with nausea reported worse abdominal pain, gastrointestinal symptoms, somatic symptoms, and depression than those without nausea (P < .001 for all). When the children had reached young adulthood, those with nausea in childhood continued to have more severe gastrointestinal (P < .001) and somatic symptoms (P= .003) than patients without nausea in childhood, as well as higher levels of anxiety (P= .02) and depression (P= .02). In the follow-up evaluation, somatic symptoms, depression, and anxiety remained significant after controlling for baseline abdominal pain severity. Pediatric patients with FAP and nausea have more severe short- and long-term gastrointestinal and somatic symptoms than patients with FAP without nausea, as well as reductions in mental health and daily function. Pediatric patients with FAP and nausea therefore need intensive treatment and follow-up evaluation.

ECOLOGICAL STRESS AND QUALITY OF LIFE AMONG ADOLESCENTS LIVING IN RISK CONDITIONS OF TECNOHENIC-ECOLOGICAL THREATS

В статье поднимается проблема негативного влияния условий проживания с риском техногенно-экологической угрозы на качество жизни населения. Цель исследования заключается в изучении связи экологического стресса и качества жизни населения юношеского возраста, проживающего в зоне металлургического производства Кузбасса. Методы : опросник субъективного качества жизни Р. Элиота, адаптированная под задачи исследования методика незаконченных предложений для выявления и раскрытия содержания экологического стресса; опросник выявления экологической установки «Экологический аттитюд» (Калмыков А.А.) с введенной шкалой переживания экологической угрозы. Полученные результаты позволили определить уровень качества жизни, наиболее стресснапряженные и удовлетворяющие сферы жизни, интенсивность экологического стресса населения юношеского возраста, проживающего в зоне металлургического производства . Экологический стресс может проявляться в виде переживания экологической угрозы, угрозысобственного здоровья, снижения работоспособности и возможностей самореализации, негативного отношения к металлургическому производству в настоящее время и для своего будущего, формирования миграционной готовности. П оказаны негативное влияние экологического стресса на субъективную оценку качества жизни и необходимость ранней диагностики и профилактики снижения психологического здоровья. Определены основные направления информационного-просветительской работы с населением в возрасте юности с целью профилактики негативного влияния техногенно-экологической угрозы.

Housing tenure and affordability and mental health following disability acquisition in adulthood

Acquiring a disability in adulthood is associated with a reduction in mental health and access to secure and affordable housing is associated with better mental health. We hypothesised that the association between acquisition of disability and mental health is modified by housing tenure and affordability. We used twelve annual waves of data (2001–2012) (1913 participants, 13,037 observations) from the Household, Income and Labour Dynamics in Australia survey. Eligible participants reported at least two consecutive waves of disability preceded by two consecutive waves without disability. Effect measure modification, on the additive scale, was tested in three fixed-effects linear regression models (which remove time-invariant confounding) which included a cross-product term between disability and prior housing circumstances: housing tenure by disability; housing affordability by disability and, in a sub-sample (896 participants 5913 observations) with housing costs, tenure/affordability by disability. The outcome was the continuous mental component summary (MCS) of SF-36. Models adjusted for time-varying confounders. There was statistical evidence that prior housing modified the effect of disability acquisition on mental health. Our findings suggested that those in affordable housing had a −1.7 point deterioration in MCS (95% CI -2.1, -1.3) following disability acquisition and those in unaffordable housing had a −4.2 point reduction (95% CI -5.2, -1.4). Among people with housing costs, the largest declines in MCS were for people with unaffordable mortgages (−5.3, 95% CI −8.8, −1.9) and private renters in unaffordable housing (−4.0, 95% CI −6.3, −1.6), compared to a −1.4 reduction (95% CI −2.1, −0.7) for mortgagors in affordable housing. In sum, we used causally-robust fixed-effects regression and showed that deterioration in mental health following disability acquisition is modified by prior housing circumstance with the largest negative associations found for those in unaffordable housing. Future research should test whether providing secure, affordable housing when people acquire a disability prevents deterioration in mental health.

Mental Health Following Acquisition of Disability in Adulthood--The Impact of Wealth.

BackgroundAcquisition of a disability in adulthood has been associated with a reduction in mental health. We tested the hypothesis that low wealth prior to disability acquisition is associated with a greater deterioration in mental health than for people with high wealth.MethodsWe assess whether level of wealth prior to disability acquisition modifies this association using 12 waves of data (2001–2012) from the Household, Income and Labour Dynamics in Australia survey–a population-based cohort study of working-age Australians. Eligible participants reported at least two consecutive waves of disability preceded by at least two consecutive waves without disability (1977 participants, 13,518 observations). Fixed-effects linear regression was conducted with a product term between wealth prior to disability (in tertiles) and disability acquisition with the mental health component score of the SF–36 as the outcome.ResultsIn models adjusted for time-varying confounders, there was evidence of negative effect measure modification by prior wealth of the association between disability acquisition and mental health (interaction term for lowest wealth tertile: -2.2 points, 95% CI -3.1 points, -1.2, p<0.001); low wealth was associated with a greater decline in mental health following disability acquisition (-3.3 points, 95% CI -4.0, -2.5) than high wealth (-1.1 points, 95% CI -1.7, -0.5).ConclusionThe findings suggest that low wealth prior to disability acquisition in adulthood results in a greater deterioration in mental health than among those with high wealth.

The Health Consequences of Adverse Labor Market Events: Evidence from Panel Data

This study investigates the associations between self‐assessed adverse labor market events (experiencing problems with coworkers, employment changes, financial strain) and health. Longitudinal data are obtained from the National Epidemiological Survey of Alcohol and Related Conditions. Our findings suggest problems with coworkers, employment changes, and financial strain are associated, respectively, with a 3.1 percent (3.3 percent), 0.9 percent (0.2 percent), and 4.5 percent (5.1 percent) reduction in mental health among men (women). Associations are smaller in magnitude and less significant for physical health.

Cost-benefit analysis of a preventive intervention for divorced families: reduction in mental health and justice system service use costs 15 years later.

This cost-benefit analysis compared the costs of implementing the New Beginnings Program (NBP), a preventive intervention for divorced families to monetary benefits saved in mental healthcare service use and criminal justice system costs. NBP was delivered when the offspring were 9-12 years old. Benefits were assessed 15 years later when the offspring were young adults (ages 24-27). This study estimated the costs of delivering two versions of NBP, a single-component parenting-after-divorce program (Mother Program, MP) and a two-component parenting-after-divorce and child-coping program (Mother-Plus-Child Program, MPCP), to costs of a literature control (LC). Long-term monetary benefits were determined from actual expenditures from past-year mental healthcare service use for mothers and their young adult (YA) offspring and criminal justice system involvement for YAs. Data were gathered from 202 YAs and 194 mothers (75.4 % of families randomly assigned to condition). The benefits, as assessed in the 15th year after program completion, were $1630/family (discounted benefits $1077/family). These 1-year benefits, based on conservative assumptions, more than paid for the cost of MP and covered the majority of the cost of MPCP. Because the effects of MP versus MPCP on mental health and substance use problems have not been significantly different at short-term or long-term follow-up assessments, program managers would likely choose the lower-cost option. Given that this evaluation only calculated economic benefit at year 15 and not the previous 14 (nor future years), these findings suggest that, from a societal perspective, NBP more than pays for itself in future benefits.

Employment status and mental health among persons with and without a disability: evidence from an Australian cohort study

BackgroundUnemployment and economic inactivity are associated with worse mental health in the general population, but there is limited understanding of whether these relationships are different for those persons with mental...

Solitary Time and Mental Health in the Netherlands

Whereas prior research focused on the beneficial effects of time spent with others, this study investigated the association between solitary time and mental health by hypothesizing about the possible detriments as well as benefits. Additionally, we studied whether the association between solitary time and mental health was nonlinear and moderated by gender and life stage. We hypothesized that whereas solitary time limits individuals’ access to social resources and support (decreasing mental health), it also helps individuals to recharge (enhancing mental health). We used the Dutch Time Use Survey from 2006 (N = 1,487). Results of Tobit models indicated that more solitary time in leisure (but not household labor) was associated with a reduction in mental health. For men, we did find a negative association between alone time in household labor and mental health. There was no evidence for a curvilinear relationship between time alone and mental health, nor did life course stage appeared to moderate this association.

The effect of leaving employment on mental health: testing ‘adaptation’ versus ‘sensitisation’ in a cohort of working-age Australians

ObjectivesTo investigate the ‘adaptation’ versus ‘sensitisation’ hypotheses in relation to mental health and labour market transitions out of employment to determine whether mental health stabilised (adaptation) or worsened (sensitisation) as...

Social disadvantage and individual vulnerability: A longitudinal investigation of welfare receipt and mental health in Australia

To examine longitudinal associations between mental health and welfare receipt among working-age Australians. We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity to receive welfare payments. Random effect models tested the effects of income support transitions. Socio-demographic and financial variables explained the association between mental health and income support for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents. The poor mental health of welfare recipients may limit their opportunities to gain work and participate in community life. In part, this seems to reflect their adverse social and personal circumstances. However, there remains evidence of a direct link between welfare receipt and poor mental health that could be due to factors such as welfare stigma or other adverse life events coinciding with welfare receipt for those receiving unemployment or disability payments. Understanding these factors is critical to inform the next stage of welfare reform.

Child maltreatment as predictors of suicidal ideas and attempts in a general female population

Child maltreatment has been investigated as a suicide risk for decades. The aim of this study was to evaluate the prevalence of women from the general population with suicidal ideas or attempts and add to the actual literature a larger perspective of different types of maltreatment in regards to experiences such as neglect, psychological, physical or sexual abuse, and its association to risk factor for suicide ideas and attempts. Data were collected during a telephone survey held between March and April, 2009 among a sample of 1,001 female adult respondents from the province of Quebec (Canada). Questions were selected to investigate childhood maltreatment as a risk factor for probable depression, and actual post-traumatic stress disorders, and suicidal behaviours in the course of their lives. Regression analysis indicates a positive association between sexual abuse and suicidal ideations, as well as a positive association between sexual abuse, psychological abuse, probable depression and suicide attempts. Respondents, who attempted suicide, were two to three times more likely to have experienced the presence of sexual or psychological abuse in the past and four times more likely to have been screened for a probable depression. Interventions that target the early reduction of sexual or psychological abuse, may translate into ulterior reduction in mental health and suicidal behaviours. Key words: Suicide attempt, suicidal ideas, child maltreatment, neglect, abuse.

Love and addiction: an uneasy marriage? A response to "The devil is in the differences"

We would like to thank Hostetler and Ryabinin for their insightful commentary on our review. We welcome their perspective and believe that it is wholly complementary to our own. In our manuscript, we focused primarily on highlighting the parallels between social attachments and drug addiction. Nonetheless, we agree that examining both the remarkable similarities and detailed differences between these processes is essential for rapid progress in understanding the biology of social relationships and for the development of new treatment strategies for addiction. While we agree with most of Hostetler and Ryabinin’s points, there is one issue that deserves a comment. Hostetler and Ryabinin point out that social attachments (which we termed “partner addictions”) are evolutionarily adaptive and generally promote healthy social functioning. Contrarily, in drug addiction, there is no social partner, and subsequently all of the social, societal, and evolutionary benefits are subtracted; while detriments to mental and physical health are observed. However, these differences in mental health outcome may not be related to fundamental differences in neuro-chemistry underlying bonding or addiction, but rather may derive, in whole or part, from the beneficial aspects of being in a social relationship. Another possibility is that criminalization, social stigma, and side-effects due to excessive exposure to an exogenous substance lead to detriments in mental and physical health as seen in drug addiction. With partner addictions, the resulting behaviors are widely accepted and strongly encouraged, and their performance often results in social prestige; if these behaviors resulted in a similar social stigma, perhaps we would also see reductions in mental health. In fact, homosexual populations, whose social attachments are sometimes treated in exactly this manner by society, are at a substantially higher risk for depression, anxiety disorders, and suicide (Fergusson et al. 1999; Herrell et al. 1999; Sandfort et al. 2001; King et al. 2008; Chakraborty et al. 2011). Finally, high-functioning addicts may meet the criteria for drug dependence despite experiencing no distressing feelings or negative consequences (Kuhar 2012). Therefore, the observation that social attachment and drug addiction have different mental and physical health outcomes is not necessarily evidence of a difference in the underlying neuro-chemical pathways. Finally, we wholeheartedly agree that understanding the bidirectional interactions of the neural mechanisms of social relationship and addiction is an exciting new direction of research that may have important implications for the prevention and treatment of substance abuse. While we obviously failed to raise this and other issues mentioned by Hostetler and Ryabinin in our original review, we are delighted that our review has already initiated dialog between social neuroscientists and addiction researchers through this commentary, and we hope that this dialog leads to a lasting union and exciting new discoveries for both fields.

Return to pre-injury health status and function 12 months after hospitalisation for sport and active recreation related orthopaedic injury

BackgroundHospitalised sport and active recreation injuries can have serious long-term consequences. Despite this, few studies have examined the long-term outcomes of these injuries. The purpose of this study was to...

Impact of crisis resolution and home treatment services on user experience and admission to psychiatric hospital

Aims and methodCrisis resolution and home treatment (CRHT) teams began operating in Edinburgh in late 2008. We ascertained service users' and carers' experiences of CRHT using a standardised questionnaire. We also assessed the impact of CRHT on psychiatric admissions and readmissions by analysing routinely collected data from November 2003 to November 2009.ResultsThere was a 24% decrease in acute psychiatric admissions in the year after CRHT began operating, whereas the previous 5 years saw an 8% reduction in the admission rate. The mean duration of in-patient stay fell by 6.5 days (22% decrease) in the 12 months following CRHT introduction, alongside a 4% decrease in readmissions and a 17% reduction in Mental Health Act 1983 admissions. Although the mean response rate was low (29%), 93% of patients reported clinical improvement during CRHT care, 27% of patients felt totally recovered at discharge from CRHT, 90% of patients felt safe during CRHT treatment, and 94% of carers said their friend or relative got better with CRHT input.Clinical implicationsCrisis resolution and home treatment service in Edinburgh had a positive impact during the first 12 months in terms of reduced admissions, reduced duration of in-patient stay and reduced use of the Mental Health Act. The service can catalyse a more efficient use of in-patient care. Service users and carers report high rates of improvement and satisfaction with CRHT.

Association Between Prior Authorization for Medications and Health Service Use by Medicaid Patients With Bipolar Disorder

Objective: This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods: A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prepolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results: Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental disorders and use of medications and health services. The policy was associated with increased medication discontinuation among attenders and nonattenders, reductions in mental health visits after discontinuation among attenders (−.64 per patient per month; p<.05), and increases in emergency room visits after discontinuation among nonattenders (.16 per patient per month; p<.05). During the eight-month policy period, the policy had no detectable impact on hospitalization risk. Conclusions: The prior-authorization policy was associated with increased medication discontinuation and subsequent changes in health service use. Although small, these unintended effects raise concerns about quality of care for a group of vulnerable patients. Long-term consequences of prior-authorization policies on patient outcomes warrant further investigation. (Psychiatric Services 62:186–193, 2011)

Association Between Prior Authorization for Medications and Health Service Use by Medicaid Patients With Bipolar Disorder

This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month policy (July 2003-February 2004), and a comparison group of 1,014 was identified from the prepolicy period (July 2002-February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental disorders and use of medications and health services. The policy was associated with increased medication discontinuation among attenders and nonattenders, reductions in mental health visits after discontinuation among attenders (-.64 per patient per month; p<.05), and increases in emergency room visits after discontinuation among nonattenders (.16 per patient per month; p<.05). During the eight-month policy period, the policy had no detectable impact on hospitalization risk. The prior-authorization policy was associated with increased medication discontinuation and subsequent changes in health service use. Although small, these unintended effects raise concerns about quality of care for a group of vulnerable patients. Long-term consequences of prior-authorization policies on patient outcomes warrant further investigation.

Medicaid Prescription Cost Containment and Schizophrenia

In 2002, the Mississippi Division of Medicaid enacted several policies to curb prescription spending including increasing prescription copayments from $1 to $3 per brand, a cap of 7 prescriptions per month, a 34-day supply limitation, and a 5% reduction in dispensing fees. The objectives of this study were to examine the influence of these policies on (1) compliance to antipsychotic medications and (2) mental health care utilization and payments among patients with schizophrenia. This study used a 12-month pretest and 12-month posttest longitudinal design to compare the effect of these policies among patients with schizophrenia in Minnesota and Indiana, who had less restrictive cost-containment using administrative claims data. Generalized estimating equations were used to run difference in difference models to compare medication compliance (proportion of days covered) and health care utilization in Mississippi to the control states. After policy adoption, patients in Mississippi were 4.87% less compliant with antipsychotic treatments and experienced 20.5% more 90 day antipsychotic treatment gaps than patients in the control states. Although these policies did not affect inpatient or emergency department care among patients with schizophrenia, there was a 3.7% reduction in outpatient mental health visits and a 4.2% reduction in mental health care payments. Despite the potential for savings, policy makers should consider carefully the potential adverse consequences that may arise from implementing aggressive cost-containment policies among patient with severe mental illness.