Journal of Behavioral Health Services & Research最新文献

Firefighters are public safety personnel who act as first responders to protect people and property from fire dangers. Although firefighters frequently face severe incidents in their profession, there has been limited attention given to the childhood traumas they may have experienced and the long-term psychological impact of these early traumatic experiences within this professional group. This study aims to examine the correlation between childhood traumas and dissociative experiences, as well as suicidal ideas, among firefighters. The study was conducted on firefighters employed by the Hatay Metropolitan Municipality Fire Department. Between January and June 2024, the study recruited 210 firefighters from the Fire Department. Childhood traumas, dissociative experiences, and suicidal ideas were evaluated with validated psychometric instruments. The 4th model of the Hayes was utilized to examine the mediating role of suicidal ideas on the relationship between childhood traumas and dissociative experiences. Additionally, independent samples t-test and coefficient of determination were utilized. The firefighters who scored higher on the CTQ cut-off score showed greater levels of dissociative experiences and suicidal ideas compared to the lower-scoring group. The r² values emphasized significant correlations between childhood traumas, dissociative experiences, and suicidal ideas. Dissociative experiences partially mediate the relationship between childhood traumas and suicidal desire. The establishment of specific mental health services is essential to mitigate the psychological effects of both occupational and previous traumas that firefighters have encountered. The long-term consequences of traumatic experiences should be the primary focus when developing mental health interventions for firefighters.

Telehealth is increasingly a standard and routine clinical option, indicating a changing outlook for SUD treatment from in-person to the more convenient option of telehealth. As populations across geographies increasingly prefer telehealth, more research is warranted that focuses on how where a person lives is associated with telehealth availability. The authors used the Mental Health and Addiction Treatment Tracking Repository (MATTR 2024) to identify telehealth availability among all known licensed SUD treatment facilities in the USA (N = 10,492 facilities). The authors merged external geocoded data to MATTR to characterize the communities and spaces immediately surrounding each facility, including social vulnerability indices (census tract), population demographics (county), and state-level telehealth policies. Multilevel multivariable logistic regression was used to model telehealth availability. Roughly 4 out of 5 treatment facilities (81%) offered telehealth. At the census tract level, for every additional point on the racial/ethnic minority status vulnerability scale, the odds of a facility offering telehealth decreased by 4% (aOR = 0.96, 95% CI = 0.93-0.99, p = 0.02). Compared to states with substantial legal barriers about starting telehealth by any mode, facilities in states with stronger, innovation-ready laws had higher odds of offering telehealth (aOR = 1.47, 95% CI = 1.13-1.92, p < 0.01). Similarly, facilities in states that minimize barriers to allowing nurses to practice and use telehealth independently had higher odds of offering telehealth (aOR = 1.42, 95% CI = 1.09-1.84, p < 0.01). State-level health policies impact access to SUD care in a multitude of ways, and new policies that promote telehealth by minimizing barriers to service delivery will benefit people in need of SUD treatment.

Despite recommendations, screening for unhealthy alcohol use occurs infrequently in US ambulatory care. One barrier to screening often cited by physicians is misalignment of incentives, but it is unclear which financial arrangements contribute to or alleviate this misalignment. This analysis investigates how determinants of income-both patient care revenue and physician remuneration-encourage or discourage guideline-concordant alcohol screening. Cross-sectional data from the US National Ambulatory Medical Care Survey 2015, 2016, 2018, and 2019 are pooled. Covariate-adjusted logistic regression is used to estimate associations between alcohol screening during visits and variables capturing methods of patient care revenue generation and of physician remuneration. Methods of revenue generation include receipt of revenue from capitation and Medicaid. Methods of physician remuneration include payment by share of practice billings, consideration of productivity and patient satisfaction in determining compensation, and practice ownership. Of 10,607 visits under study, fewer than 3% included screening. In the adjusted model, visits to physicians who received > 25% of patient revenue from capitated payments had higher odds of including screening (adjusted odds ratio (aOR) = 5.94; 95% confidence interval (CI) = 2.33, 15.13) compared with visits to physicians who received less from capitation, as did visits to physicians for whom patient satisfaction surveys impacted compensation (aOR = 3.56; 95% CI = 1.51, 8.37). Payment methods that reward value (e.g., capitation) and patient-centered outcomes (e.g., patient satisfaction), rather than productivity, may promote alcohol screening in US ambulatory care. However, the low rates of screening observed suggest transitioning towards such methods will not be sufficient to achieve optimal screening rates.

The meaning of (in)voluntary in the context of psychiatric, behavioral, and mental health services in the United States lacks shared understanding despite widespread use, such as in "involuntary treatment," "involuntary hospitalization," and "voluntary patient." A pre-registered scoping review was conducted to describe how U.S.-based healthcare professionals explicitly define (in)voluntary when referring to psychiatric, behavioral, and mental health concepts. Nine databases and nine organization/government websites were searched. Eligibility criteria included English availability, U.S.-based healthcare author(s), and an explicit definition of (in)voluntary. Extracted data included study characteristics and (in)voluntary term(s) with definitions. Open coding was used for the (in)voluntary-associated definition. Meaning categories were created by grouping codes. A total of 29,313 citations were screened for a final 162 sources, containing 203 definitions. Evidence sources (years 1966-2023) were most frequently research articles (33%), review articles (24%), and books (20%) with authorship including persons with an M.D./D.O. (70%) and/or Ph.D. (51%). The most common definition words were order, coercion, against/opposed to a patient's will/wishes, consent, force, and adhere. Meaning categories were external pressure, civil rights, individual agency, competence and capacity, and ethics. Involuntary definitions more commonly characterized the patient as actively against an intervention (23%), rather than without active agreement (11%). Some definitions included a legal (62%) and/or ethical dimension (33%). Two-thirds of sources used at least one additional (in)voluntary term in the publication without defining it. Because there exists a range of competing definitions for the term (in)voluntary, authors who use this descriptor clearly are recommended to explain their meaning.

Viral suppression is essential for individuals living with HIV, as it is linked to improved clinical outcomes and long-term health. Research has documented age and racial disparities in HIV viral suppression. Men who have sex with men (MSM) are particularly affected by HIV infections, especially in the Southern United States. Studies indicate that substance use among people with HIV in the U.S. presents significant barriers to engaging in HIV care. This study investigated the relationships between age, race, MSM status, and viral suppression among men living with HIV (MLWH), who participated in the Helping HAND program at an academic medical center in a Southern state. The analysis included 746 male participants, primarily Black/African American. The results showed that increases in age were positively associated with a greater likelihood of viral suppression, even after adjusting for harmful or hazardous drinking, problematic substance use, race, and MSM status. Younger MSM participants were less likely to achieve viral suppression than older MSM participants. In this male only sample, neither race nor MSM status was found to be related to viral suppression. Additionally, harmful or hazardous drinking and problematic substance use did not moderate the associations between age, race, or MSM and viral suppression. These findings highlight disparities in viral suppression across different age groups among men living with HIV. The results emphasize the need for targeted outreach initiatives specifically designed for younger age cohorts living with HIV, including MSM.

HIV infection has been known to cause or exacerbate psychiatric symptoms. In individuals with HIV, mania may present as part of a bipolar disorder or as a distinct condition referred to as Mania Associated with Advanced HIV Disease (previously known as AIDS mania). We present a case of a 57-year-old patient with new onset symptoms of bipolar disorder in the setting of HIV infection. The patient was admitted for treatment of mania and found to have an HIV infection, but with a CD4 + count that was still above the threshold of AIDS. Eventually, the patient's mood stabilized on a regimen of valproic acid 1500 mg twice daily and olanzapine 10 mg once daily. He developed infectious symptoms and was found to have cryptococcal pneumonia. He was started on fluconazole, but then subsequently left the hospital against medical advice.

To address high-cost inpatient utilization for those with severe and persistent mental illness, stakeholders from a County Department of Human Services, a Behavioral Health Managed Care Organization, and mental health providers created a value-based payment (VBP) model to shift funding from inpatient mental health treatment (IPMH) to intensive, evidence-based, community-based mental health treatment, Assertive Community Treatment (ACT). Using a retrospective observational study, individuals who received ACT from providers participating in the VBP (N = 2) were compared to individuals who received ACT from providers (N = 17) not supported through a VBP. Results show decreasing average ACT and IPMH expenditures as well as shorter lengths of stay over time for providers under a VBP compared to those not in a VBP. Access to care was not impacted. These results, including implications for behavioral health, are discussed in the context of quality of care.

Delta-8 THC is a psychoactive cannabinoid typically synthesized from hemp, with similar intoxicating effects as delta-9 THC. Surging public interest alongside the lack of federal regulation of delta-8 THC has led to an unclear legal landscape and increasing safety concerns. Educating young adults about the dangers of delta-8 THC is imperative. The current study investigated the effects of a brief educational video about delta-8 THC for college students. First, to help develop the intervention, an exploratory online survey was administered (N = 291) to gather information about perceptions of delta-8 THC and motivations for use. Mixed-methods analysis indicated that many students perceive delta-8 THC to have weaker (less intense, shorter-lasting) effects while being beneficial for mental and physical health. A strong motive for consumption was to enhance positive feelings, while conformity was a significantly weaker motive. These results informed the development of an educational video for students to highlight the risks of delta-8 THC and improve decision-making. Participants (N = 120) were randomly assigned to watch either a brief educational video about delta-8 THC or an unrelated control video about attending college. Results found that the educational video increased knowledge about delta-8 THC across all students, and lowered intentions to use delta-8 THC specifically for students who reported prior but not recent use of the substance. Perceived benefits, perceived costs, and attitudes towards legislation were not affected. Overall, results demonstrate support for the format of a brief stand-alone video intervention to increase knowledge and reduce behavioral intentions regarding delta-8 THC.