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Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care. 急性精神病护理患者暴力风险评估中的系统和人际偏见。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-19 DOI: 10.1176/appi.ps.20240108
Christoffer Dharma, Susan J Bondy, Laura Sikstrom, Peter S Muirhead, Juveria Zaheer, Marta M Maslej

Objective: The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients.

Methods: The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent).

Results: In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40).

Conclusions: Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.

目的:急性精神病护理中住院患者暴力风险的评估和管理是引入潜在偏见的挑战。本研究旨在检查基于健康的社会决定因素(SDoH)(例如,种族、民族、性别或急性护理的入院方式)的不公平,这些不公平可能导致对精神病患者的不公平评估。方法:作者分析了加拿大一家大型精神病院12,650次住院(2016-2022年)的7,424名急症护理患者的电子健康记录。SDoH计算了工作人员高风险评估(感知风险)、暴力事件(实际风险)和潜在偏倚风险评估(特别是当患者被评估为高风险但未发生暴力行为时)的风险比(rr)。结果:在单变量分析中,被评估为高危但没有暴力倾向的患者男性多于女性,黑人、土著或中东人多于白人。当所有变量相互调整rr时,性别和种族-民族的关联减弱或不再具有统计学意义。与潜在偏见风险的关联仍然显著,包括大多数精神病诊断(与抑郁或焦虑症相比),支持性或不稳定的住房(与拥有住房相比),以及警察的入院(与自我入院相比;Rr =2.14, 95% ci =1.92-2.40)。结论:系统因素,如警察和住房状况,以及患有严重精神疾病是观察到的少数民族患者风险评估不公平的主要驱动因素。解决这些系统因素可能是改善急性精神病护理的关键。
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引用次数: 0
My Personal Journey to Wholeness Through Peer Wellness. 我通过同伴健康走向完整的个人旅程。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-19 DOI: 10.1176/appi.ps.20240490
Constandina Savvenas
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引用次数: 0
Effect of Rurality on Type of Clinicians Delivering Psychotherapy and Prescribing Antidepressants to Veterans. 乡村性对退伍军人心理治疗及抗抑郁药物处方临床医生类型的影响
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-12 DOI: 10.1176/appi.ps.20240186
Luke Rozema, Sarah L Cornelius, Brian Shiner, Bradley Vince Watts, Matthew Vincenti

Objective: Mental health care is delivered by teams that include social workers, psychologists, nonphysician prescribing clinicians (NPPCs), and physicians. The objective of this study was to determine whether patient rurality has an effect on the types of U.S. Department of Veterans Affairs (VA) clinicians delivering psychotherapy and prescribing antidepressants to veterans.

Methods: Patients (N=3,537,595) receiving VA mental health services between 2013 and 2022 were stratified by rural, micropolitan, and metropolitan residence. A generalized estimating equation with a negative binomial distribution was used to estimate rates of psychotherapy delivered by social workers or psychologists and antidepressant prescribing rates by NPPCs or physicians. Rate ratios (RRs) comparing rural with metropolitan patients were calculated for each fiscal year.

Results: Total psychotherapy visit rates were similar for rural, micropolitan, and metropolitan veterans, but women received psychotherapy from psychologists at higher rates than men and combat veterans received psychotherapy from psychologists at higher rates than noncombat veterans. Rural patients received psychotherapy from social workers more often (RR=1.24-1.30) and from psychologists less often (RR=0.80-0.88) than metropolitan patients. Rural patients were given prescriptions for antidepressants by NPPCs more often (RR=1.28-1.36) and by physicians less often (RR=0.87-0.92) than metropolitan patients.

Conclusions: Rural veterans with mental health conditions receive more of their psychotherapy and antidepressant prescriptions from clinicians with master's- versus doctoral-level training. Future work should assess how rural-urban differences in mental health care delivery affect patient satisfaction, cost, and clinical outcomes.

目的:精神卫生保健由包括社会工作者、心理学家、非医师处方临床医生(NPPCs)和医生在内的团队提供。本研究的目的是确定患者的乡村性是否对美国退伍军人事务部(VA)临床医生的类型有影响,这些临床医生为退伍军人提供心理治疗和开抗抑郁药。方法:2013年至2022年期间接受VA精神卫生服务的患者(N=3,537,595)按农村,小城市和大都市居住分层。使用负二项分布的广义估计方程来估计社会工作者或心理学家提供的心理治疗率和NPPCs或医生开具的抗抑郁药处方率。计算了每个财政年度农村与城市患者的比率(rr)。结果:农村、小城市和大城市退伍军人的心理治疗总访问率相似,但女性接受心理治疗的比例高于男性,战斗退伍军人接受心理治疗的比例高于非战斗退伍军人。农村患者接受社会工作者心理治疗的频率高于城市患者(RR=1.24 ~ 1.30),而接受心理医生心理治疗的频率低于城市患者(RR=0.80 ~ 0.88)。农村患者由NPPCs开具抗抑郁药处方的频率高于城市患者(RR=1.28 ~ 1.36),由医生开具抗抑郁药处方的频率低于城市患者(RR=0.87 ~ 0.92)。结论:具有心理健康问题的农村退伍军人从具有硕士水平培训的临床医生那里获得的心理治疗和抗抑郁药物处方多于从具有博士水平培训的临床医生那里获得的。未来的工作应该评估城乡在精神卫生保健服务方面的差异如何影响患者满意度、成本和临床结果。
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引用次数: 0
Youth Emergency Department and Inpatient Psychiatric Recidivism After Treatment in a Community-Based Crisis Program. 青少年急诊科和住院病人精神病再犯治疗后的社区危机计划。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-12 DOI: 10.1176/appi.ps.20230445
Rebecca Marshall, Amanda Ribbers, Ilana Freeman, Sophia Nguyen, Julie Magers, Lydia Maitland, David Sheridan

Objective: In emergency departments (EDs) nationwide, increasing numbers of youths in psychiatric crisis are "boarding," or awaiting psychiatric care in a nonpsychiatric setting. Community stabilization programs may reduce the prevalence of boarding while supporting behavioral health. This study aimed to evaluate ED and inpatient (IP) psychiatric recidivism of youths receiving Crisis and Transition Services (CATS), a community-based program providing in-home behavioral health crisis services.

Methods: This retrospective matched cohort study used 2012-2020 medical claims data and linked program-collected data to compare CATS participants with nonparticipants (2018-2020). In total, 533 youths receiving CATS were matched to a control group (N=1,066) on initial ED visit date, reason for visit, age, and sex. Outcomes included time until first insurance claim for psychiatric or suicide attempt recidivism to an ED, IP admission, or both. Cox proportional hazard models were used to estimate the association between the outcomes of interest and CATS participation or nonparticipation up to 1 year following hospital (ED or IP) discharge.

Results: CATS participation was significantly associated with reduced psychiatric recidivism to an ED, IP, or both, compared with nonparticipation, with significantly lower IP return admissions for suicide attempt.

Conclusions: Some boarding youths may be safely discharged to intensive community-based behavioral health crisis programs. Although return visits to EDs for suicide attempt did not differ between groups, youths in CATS had significantly lower hazards of IP admissions for suicide attempt. Comparable programs may reduce boarding without adding risk. Future studies should examine which individuals would benefit most from community-based treatment as well as key program components associated with outcomes.

目的:在全国的急诊科,越来越多的青少年在精神危机中“寄宿”,或在非精神病学环境中等待精神病学治疗。社区稳定项目可以在支持行为健康的同时减少寄宿的流行。本研究旨在评估接受危机与过渡服务(CATS)的青少年的ED和住院精神疾病再犯。CATS是一个以社区为基础的家庭行为健康危机服务项目。方法:本回顾性匹配队列研究使用2012-2020年医疗索赔数据和相关项目收集的数据,比较CATS参与者和非参与者(2018-2020年)。总共有533名接受CATS治疗的青少年与对照组(N= 1066)进行了首次ED就诊日期、就诊原因、年龄和性别的匹配。结果包括第一次因精神疾病或自杀未遂再犯的保险索赔到急诊科,IP入院或两者兼而有之的时间。使用Cox比例风险模型来估计住院(ED或IP)出院后1年内参与或不参与CATS的结果与感兴趣的结果之间的关联。结果:与不参加CATS相比,参加CATS与减少ED、IP或两者的精神再犯显著相关,与自杀未遂的IP返回入院显著降低相关。结论:一些寄宿青少年可以安全出院,参加社区行为健康危机强化计划。虽然因自杀未遂而回访急诊室的人数在两组之间没有差异,但CATS的青少年因自杀未遂而入院的风险显著降低。类似的项目可以在不增加风险的情况下减少登机。未来的研究应该检查哪些个体将从社区治疗中获益最多,以及与结果相关的关键项目组成部分。
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引用次数: 0
How Chronic Illness Forged My Path to Healing Others. 慢性疾病如何锻造了我治愈他人的道路。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-06 DOI: 10.1176/appi.ps.20240513
Sue Ram
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引用次数: 0
Testing the Impact of a Law Enforcement-Operated Co-responder Program for Youths: A Quasi-Experimental Approach. 测试由执法部门操作的青少年共同应对计划的影响:准实验方法。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-06-28 DOI: 10.1176/appi.ps.20240003
Kristina K Childs, Richard L Elligson, Caitlin M Brady

Objective: The authors examined whether use of a co-responder program reduced the likelihood of an involuntary commitment examination as the disposition of a police encounter with youths experiencing a mental health crisis and 1 year after the initial incident.

Methods: Using a quasi-experimental design, the authors compared 206 incidents that involved the co-response program with 327 incidents that did not involve the program. Propensity score matching was used to balance groups on demographic and incident characteristics. The dependent variables included the disposition of the incident (deescalation or involuntary commitment examination), whether the youths experienced a later involuntary commitment examination within 1 year of the initial intervention, and time to the subsequent examination. Propensity score-weighted binary logistic regression and time-to-event analysis were used.

Results: The co-responder program was associated with a significantly lower likelihood of police officer-initiated involuntary commitment examinations and a lower likelihood of an involuntary commitment examination within 1 year. Eighty percent of the incidents that resulted in a co-response involving a police officer and a mental health professional were deescalated, allowing the youth to remain in the community with a safety plan, whereas 17% of incidents with a police-only response ended with crisis deescalation.

Conclusions: These findings provide further support for the implementation of co-responder options that are available to police officers during encounters with children and adolescents experiencing a mental health crisis.

目的:作者研究了在遭遇精神健康危机的青少年报警后 1 年,使用共同应对计划是否会降低非自愿入院检查的可能性:作者采用准实验设计,比较了 206 起涉及共同应对计划的事件和 327 起未涉及该计划的事件。采用倾向得分匹配法来平衡各组的人口统计学特征和事件特征。因变量包括事件的处置(降级或非自愿入院检查)、在最初干预后的一年内青少年是否经历了后来的非自愿入院检查,以及到后来检查的时间。研究采用了倾向得分加权二元逻辑回归和时间到事件分析:结果:共同应答者计划与警官发起的非自愿入院检查的可能性明显降低以及在 1 年内进行非自愿入院检查的可能性降低有关。在由警察和心理健康专业人员共同应对的事件中,80%的事件得到了缓解,使青少年能够通过安全计划留在社区中,而在仅由警察应对的事件中,17%的事件以危机缓解告终:这些研究结果进一步支持了在警察与遭遇心理健康危机的儿童和青少年接触时,实施共同应对方案。
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引用次数: 0
Therapist-Driven Telephone Call Outreach to Improve Depression Remission in a Federally Qualified Health Center. 以治疗师为主导的电话推广活动,改善联邦合格医疗中心的抑郁症缓解情况。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-07-03 DOI: 10.1176/appi.ps.20230527
Shannon Kinnan, Ricki Lieu, Alexander Hall, Jenny Xiao, Makenzie Maroney, Naomi Schmalz

The authors examined the feasibility and impact of a therapist-driven outreach program on depression outcomes in a primary care clinic. Patients with a diagnosis of depression but missing a 1-year follow-up Patient Health Questionnaire-9 (PHQ-9) screening were rescreened via telephone. Eligible patients (N=241) were contacted, and implementation rates and outcomes, along with feasibility, were assessed. Of the patients contacted, 47% indicated a depression response (reduction in PHQ-9 score of ≥50%), and 33% met remission criteria (PHQ-9 score <5). PHQ-9 scores decreased by approximately 7 points (p<0.001). This project may have helped to improve depression symptoms and remission rates for patients of the clinic and to facilitate patient reengagement with treatment.

作者研究了由治疗师驱动的外展项目对初级保健诊所抑郁症治疗效果的可行性和影响。通过电话对确诊为抑郁症但未接受 1 年随访的患者进行了患者健康问卷-9(PHQ-9)筛查。对符合条件的患者(241 人)进行了联系,并对实施率、结果和可行性进行了评估。在联系过的患者中,47% 的人表示有抑郁反应(PHQ-9 评分下降≥50%),33% 的人符合缓解标准(PHQ-9 评分≥50%)。
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引用次数: 0
Social and Emotional Learning Interventions for Preadolescents and Adolescents: Assessing the Evidence Base. 针对青少年的社会和情感学习干预措施:评估证据基础。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-08-09 DOI: 10.1176/appi.ps.20240040
John A Cosgrove, Neha Rao, Preethy George, Tabitha Hoey, Jeffrey Taylor, Tina Marshall, Sushmita Shoma Ghose, Nikhil A Patel

Objective: The social and emotional learning (SEL) framework is widely recognized as being effective for developing social and emotional competencies among students of all ages. However, the evidence for specific intervention models with older student populations is less established. The objective of this systematic review was to rate the evidence supporting the effectiveness of SEL interventions aimed at improving mental health outcomes among preadolescents and adolescents.

Methods: A search of major databases, gray literature, and evidence base registries was conducted to identify studies published from 2008 to 2022 that assessed the effects of SEL interventions on mental health outcomes among students ages 10-19 years. The authors rated the evidence for SEL interventions as high, moderate, or low based on established rating criteria.

Results: In total, 25 articles reporting on 17 original research studies were reviewed. Sixteen intervention models were assessed, with 11 resulting in improved mental health symptoms; however, no intervention was evaluated in a large enough number of studies to surpass a low evidence rating. Some studies reported cost benefits and high effectiveness of an intervention with students from diverse racial-ethnic or low socioeconomic backgrounds.

Conclusions: SEL interventions can improve mental health outcomes among preadolescents and adolescents. Additional research is needed to strengthen the evidence base for specific intervention models.

目的:社会和情感学习(SEL)框架被广泛认为能有效培养各年龄段学生的社会和情感能力。然而,针对高年级学生群体的特定干预模式的证据却不那么成熟。本系统性综述的目的是对旨在改善学龄前儿童和青少年心理健康结果的 SEL 干预措施的有效性证据进行评估:方法:对主要数据库、灰色文献和证据基础登记处进行了检索,以确定 2008 年至 2022 年间发表的评估 SEL 干预措施对 10-19 岁学生心理健康结果影响的研究。作者根据既定的评级标准,将 SEL 干预措施的证据评级为高、中或低:结果:共审查了 25 篇文章,报告了 17 项原创研究。对 16 种干预模式进行了评估,其中 11 种干预模式的心理健康症状得到了改善;但是,没有任何一种干预模式在足够多的研究中得到评估,因此被评为低证据等级。一些研究报告称,对来自不同种族或低社会经济背景的学生进行干预具有成本效益和较高的有效性:结论:SEL 干预措施可以改善学龄前儿童和青少年的心理健康结果。需要进行更多的研究来加强特定干预模式的证据基础。
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引用次数: 0
The Power of Hope: Growing Up in the Forensic System. 希望的力量:在法医系统中成长》(The Power of Hope: Growing Up in the Forensic System)。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-10-29 DOI: 10.1176/appi.ps.20240363
Grant J Everett
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引用次数: 0
Randomized Trial of the Effectiveness of Videoconferencing-Based Versus Message-Based Psychotherapy on Depression. 基于视频会议的心理疗法与基于信息的心理疗法对抑郁症疗效的随机试验。
IF 3.3 3区 医学 Q1 HEALTH POLICY & SERVICES Pub Date : 2024-12-01 Epub Date: 2024-07-19 DOI: 10.1176/appi.ps.20230176
Patricia A Areán, Michael D Pullmann, Isabell R Griffith Fillipo, Jerilyn Wu, Brittany A Mosser, Shiyu Chen, Patrick J Heagerty, Thomas D Hull

Objective: The authors compared the engagement, clinical outcomes, and adverse events of text or voice message-based psychotherapy (MBP) versus videoconferencing-based psychotherapy (VCP) among adults with depression.

Methods: The study used a sequential multiple-assignment randomized trial design with data drawn from phase 1 of a two-phase small business innovation research study. In total, 215 adults (ages ≥18 years) with depression received care from Talkspace, a digital mental health care company. Participants were initially randomly assigned to receive either asynchronous MBP or weekly VCP. All therapists provided evidence-based treatments such as cognitive-behavioral therapy. After 6 weeks of treatment, participants whose condition did not show a response on the Patient Health Questionnaire-9 or was rated as having not improved on the Clinical Global Impressions scale were randomly reassigned to receive either weekly VCP plus MBP or monthly VCP plus MBP. Longitudinal mixed-effects models with piecewise linear time trends applied to multiple imputed data sets were used to address missingness of data.

Results: Participants who were initially assigned to the MBP condition engaged with their therapists over more weeks than did participants in the VCP condition (7.8 weeks for MBP vs. 4.9 weeks for VCP; p<0.001). No meaningful differences were observed between the two groups in rates of change by 6 or 12 weeks for depression, anxiety, disability, or global ratings of improvement. Neither treatment resulted in any adverse events.

Conclusions: MBP appears to be a viable alternative to VCP for treating adults with depression.

目的作者比较了基于短信或语音信息的心理疗法(MBP)与基于视频会议的心理疗法(VCP)在成人抑郁症患者中的参与度、临床疗效和不良事件:该研究采用了连续多次分配随机试验设计,数据来自一项分两个阶段进行的小型企业创新研究的第一阶段。共有 215 名成年人(年龄≥18 岁)抑郁症患者接受了数字心理健康护理公司 Talkspace 的护理。参与者最初被随机分配接受异步 MBP 或每周 VCP 治疗。所有治疗师都提供认知行为疗法等循证治疗。经过 6 周的治疗后,如果参与者的病情在患者健康问卷-9 中没有显示出反应,或者在临床总体印象量表中被评为没有改善,那么他们将被随机重新分配接受每周 VCP 加 MBP 或每月 VCP 加 MBP 的治疗。采用纵向混合效应模型,将片断线性时间趋势应用于多个估算数据集,以解决数据缺失问题:结果:与 VCP 条件下的参与者相比,最初被分配到 MBP 条件下的参与者与治疗师接触的周数更多(MBP 为 7.8 周,VCP 为 4.9 周;p 结论:MBP 似乎是一种可行的治疗方法:在治疗成人抑郁症方面,MBP 似乎是 VCP 的可行替代方案。
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引用次数: 0
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Psychiatric services
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