Mental Health Condition – Page 6 – Mental Health Matters

What are the Risk factors of Hospitalisation for any Medical Condition among Patients with Prior Emergency Department Visits for Mental Health Conditions?

Published on 10/15/2020 by Andrew MarshallLeave a comment

Research Paper Title

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions.

Background

This longitudinal study identified risk factors for frequency of hospitalisation among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis.

Methods

Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalisation rates in the 12 months after a first ED visit in 2014-15 were categorised as no hospitalisations (0 times), moderate hospitalisations (1-2 times), and frequent hospitalisations (3+ times). Based on the Andersen Behavioural Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-2015, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalisation rate.

Results

Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalisations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalisations, while higher numbers (4+) of overall interventions in local community health service centres were a risk factor for frequent hospitalisations only. Patients with personality disorders, drug-related disorders, suicidal behaviours, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalised. Less urgent and non-urgent illness acuity prevented moderate hospitalisations only.

Conclusions

Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalisations as compared with non-hospitalised patients. Patients at risk for frequent hospitalisations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalisation.

Reference

Penzenstadler, L., Gentil, L., Grenier, G., Khazaal, Y. & Fleury, M-J. (2020) Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry. 20(1), pp.431. doi: 10.1186/s12888-020-02835-2.

Do Psychiatric Conditions Shift Over Time?

Published on 10/05/2020 by Andrew MarshallLeave a comment

Diagnoses for mental health conditions often morph into each other, suggesting that psychiatry’s reliance on specific diagnoses may be misguided.

A team led by Avshalom Caspi and Terrie Moffitt (2020) at Duke University, North Carolina, analysed data from the Dunedin Birth Cohort Study, which follows a nationally representative group of more
than 1,000 New Zealanders born in 1972 and 1973.

As the participants in the Dunedin Study have grown up, they have been assessed nine times to measure aspects of their health and behaviour, including their mental health. Caspi and Moffitt’s team found that by the age of 45, 86% of participants had met the criteria for at least one psychiatric diagnosis in one assessment. This did not mean that they had received a psychiatric diagnosis, but if they had seen a psychiatrist, they could have been given one.

A third of the cohort met the criteria for a psychiatric diagnosis before they reached the age of 15. Yet over time, people’s mental health usually shifted into a different category of psychiatric conditions.

This could suggest that an excessive focus on a current diagnosis is short-sighted and that therapy should not just address the presenting disorder, but must build fundamental skills for maintaining general mental health.

However, one must caution against ditching diagnostic categories as some disorders are linked to specific causes and respond better to certain treatments than others. It could do harm to ignore these distinctions, at least in some cases.

Reference

Caspi, A., Houts, R.M., Ambler, A., Danese, A., Elliott, M.L., Hariri, A., Harrington, H., Hogan, S., Poulton, R., Ramrakha, S., Rasmussen, L.J.H., Reuben, A., Richmond-Rakerd, L., Sugden, K., Wertz, J., Williams, B.S. & Moffitt, T.E. (2020) Longitudinal Assessment of Mental Health Disorders and Comorbidities Across 4 Decades Among Participants in the Dunedin Birth Cohort Study. JAMA Network Open. 3(4), pp.e203221. doi:10.1001/jamanetworkopen.2020.3221

Conditional Cash Transfers & Mental Health

Published on 09/30/2020 by Andrew MarshallLeave a comment

Research Paper Title

The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health.

Background

Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries.

Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects.

However, there is a gap in the literature on population-wide effects of cash transfers on mental health and if and how these vary by the severity of mental illness.

Methods

The researchers use the Malawian Longitudinal Study of Family and Health containing 790 adult participants in the Malawi Incentive Programme, a year-long randomized controlled trial.

They estimate average and distributional quantile treatment effects and we examine how these effects vary by gender, HIV status and usage of the cash transfer.

Results

They find that the cash transfer improves mental health on average by 0.1 of a standard deviation.

The effect varies strongly along the mental health distribution, with a positive effect for individuals with worst mental health of about four times the size of the average effect.

These improvements in mental health are associated with increases in consumption expenditures and expenditures related to economic productivity.

Conclusions

Their results show that CCTs can improve adult mental health for the poor living in low-income countries, particularly those with the worst mental health.

Reference

Ohrnberger, J., Fichera, E., Sutton, M. & Anselmi, L. (2020) The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health. Health Policy and Planning. doi: 10.1093/heapol/czaa079. Online ahead of print.

Risk Factors: Linking Hospitalisation, ED Visits & Mental Health Conditions

Published on 09/22/2020 by Andrew MarshallLeave a comment

Research Paper Title

Risk factors of hospitalisation for any medical condition among patients with prior emergency department visits for mental health conditions.

Background

Methods

Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalisation rates in the 12 months after a first ED visit in 2014-15 were categorised as:

No hospitalisations (0 times);
Moderate hospitalisations (1-2 times); and
Frequent hospitalisations (3+ times).

Based on the Andersen Behavioural Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-15, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalisation rate.

Results

Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalisations, while higher numbers (4+) of overall interventions in local community health service centres were a risk factor for frequent hospitalisations only.

Patients with personality disorders, drug-related disorders, suicidal behaviours, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalised. Less urgent and non-urgent illness acuity prevented moderate hospitalisations only.

Conclusions

Patients at risk for frequent hospitalisations were more vulnerable overall and had important biopsychosocial problems.

Improved primary care and integrated outpatient services may prevent post-ED hospitalisation.

Reference

On This Day … 01 September

Published on 09/01/2020 by Andrew Marshall1 Comment

Events

1939 – Adolf Hitler signs an order to begin the systematic euthanasia of mentally ill and disabled people.
2004 – Random Acts of Kindness Day (New Zealand).

Aktion T4

Aktion T4 was a postwar name for mass murder by involuntary euthanasia in Nazi Germany. The name T4 is an abbreviation of Tiergartenstraße 4, a street address of the Chancellery department set up in early 1940, in the Berlin borough of Tiergarten, which recruited and paid personnel associated with T4. Certain German physicians were authorised to select patients “deemed incurably sick, after most critical medical examination” and then administer to them a “mercy death” (Gnadentod). In October 1939, Adolf Hitler signed a “euthanasia note”, backdated to 01 September 1939, which authorised his physician Karl Brandt and Reichsleiter Philipp Bouhler to implement the programme.

The killings took place from September 1939 until the end of the war in 1945; from 275,000 to 300,000 people were killed in psychiatric hospitals in Germany and Austria, occupied Poland and the Protectorate of Bohemia and Moravia (now the Czech Republic). The number of victims was originally recorded as 70,273 but this number has been increased by the discovery of victims listed in the archives of the former East Germany. About half of those killed were taken from church-run asylums, often with the approval of the Protestant or Catholic authorities of the institutions.

The Holy See announced on 02 December 1940 that the policy was contrary to divine law and that “the direct killing of an innocent person because of mental or physical defects is not allowed” but the declaration was not upheld by some Catholic authorities in Germany. In the summer of 1941, protests were led in Germany by the Bishop of Münster, Clemens von Galen, whose intervention led to “the strongest, most explicit and most widespread protest movement against any policy since the beginning of the Third Reich”, according to Richard J. Evans.

Several reasons have been suggested for the killings, including eugenics, racial hygiene, and saving money. Physicians in German and Austrian asylums continued many of the practices of Aktion T4 until the defeat of Germany in 1945, in spite of its official cessation in August 1941. The informal continuation of the policy led to 93,521 “beds emptied” by the end of 1941. Technology developed under Aktion T4 was taken over by the medical division of the Reich Interior Ministry, particularly the use of lethal gas to kill large numbers of people, along with the personnel of Aktion T4, who participated in Operation Reinhard. The programme was authorised by Hitler but the killings have since come to be viewed as murders in Germany. The number of people killed was about 200,000 in Germany and Austria, with about 100,000 victims in other European countries.

And now something slightly more positive.

Random Acts of Kindness Day

Random Acts of Kindness Day is a day to celebrate and encourage random acts of kindness.

“It’s just a day to celebrate kindness and the whole pay it forward mentality”, said Tracy Van Kalsbeek, executive director of the Stratford Perth Community Foundation, in 2016, where the day is celebrated on 04 November 4.

It is celebrated on 01 September in New Zealand and on 17 February in the US.

Background

The Random Acts of Kindness Foundation (RAK) was founded in 1995 in the US.
It is a non-profit headquartered in Denver, Colorado.
Random Acts of Kindness (RAK) day began in 2004 in New Zealand.

What is a Random Act of Kindness

A random act of kindness is a nonpremeditated, inconsistent action designed to offer kindness towards the outside world.

Suggested Activities

Pay for the person behind you in the drive-thru.
Let someone go ahead of you in line.
Buy extra at the grocery store and donate it to a food pantry.
Buy flowers for someone (postal worker, grocery store clerk, bus driver, etc.).
Help someone change a flat tire.
Post anonymous sticky notes with validating or uplifting messages around for people to find.
Compliment a colleague on their work.
Send an encouraging text to someone.
Take muffins to work.
Let a car into the traffic ahead of you.
Wash someone else’s car.
Take a gift to new neighbors and introduce yourself.
Pay the bus fare for the passenger behind you.

Website

https://www.randomactsofkindness.org/

Does COVID-19 Fear, Mental Health, and Substance Misuse Conditions among University Social Work Students Ignore Nationality?

Published on 09/01/2020 by Andrew Marshall1 Comment

Research Paper Title

COVID-19 Fear, Mental Health, and Substance Misuse Conditions Among University Social Work Students in Israel and Russia.

Background

In December 2019, cases of pneumonia of unknown etiology but with acute respiratory distress syndrome (ARDS) and other serious complications were reported in Wuhan, Hubei Province, China. One month later, a novel coronavirus was identified by the Chinese Centre for Disease Control and Prevention (CDC) from the throat swab sample of a patient and was subsequently named “COVID-19” by the World Health Organisation (WHO) (Nanshan et al. 2020). At the end of June 2020, approximately 500,000 deaths worldwide have been linked to COVID-19 (Johns Hopkins University of Medicine 2020).

Following many cases reported by Chinese authorities, the WHO declared the new coronavirus pneumonia epidemic a public health emergency of international concern. Among the early virus characteristics reported were strong human-to-human transmission and fast transmission speed, mainly spread through respiratory droplets and contact (Nanshan et al. 2020). In response, Chinese authorities moved to a strategy of regional blockade aimed to stop the spread of the epidemic (Chen et al. 2020) as well as quarantine. “Quarantine” is one of the oldest and most effective tools of controlling communicable disease outbreaks. It means the restriction of movement among people presumed to have been exposed to a contagious disease but are not ill, either because they did not become infected or because they are still in the incubation period. The second tool that is widely used to prevent the spread of the pandemic is “social distancing.” It is designed to reduce interactions between people in a community where individuals may be infectious but have not yet been identified, and hence not yet isolated (Burdorf et al. 2020).

Once countries dealing with COVID-19 implemented quarantine and social distancing, the need for social workers and other health care professionals greatly increased due to mental health problems experienced by the general public. Studies have found that widespread outbreaks of infectious diseases, such as COVID-19, are associated with psychological distress and mental illness (Bao et al. 2020). Such conditions include stress, anxiety, depression, insomnia, anger, fear, stigma (Lin 2020; Pakpour and Griffiths 2020; Torales et al. 2020), and substance misuse (Baillie et al. 2010) on individual, family, community, and national levels (Harper et al. 2020; Kang et al. 2020). Older adults, especially with chronic health conditions, have been identified as extremely vulnerable to COVID-19. However, those dealing with the infection, such as medical and allied health personnel including those affiliated with social work, have received considerable attention for their “front line” efforts combating this disaster.

Israel and Russia pursue a similar policy to combat the COVID-19: strict quarantine or self-isolation, the abolition of all events with a large number of people, the closure of schools and universities, the cessation of aviation and railway travel and closed borders, the mandatory use of masks, etc. At the end of June 2020, there were 22,800 confirmed cases and 314 deaths in Israel and in Russia, 626,779 cases and 8958 deaths (JHUM 2020). Based on the dearth of information about student mental health during the COVID-19 pandemic (Grubic et al. 2020), The researchers hypothesized fear, mental health, and substance misuse among university students are similar regardless of nationality. For this purpose, social work students from Israel and Russia were studied.

Reference

Yehudai, M., Bendar, S., Gritsenko, V., Konstantinov, V., Reznik, A. & Isralowitz, R. (2020) COVID-19 Fear, Mental Health, and Substance Misuse Conditions Among University Social Work Students in Israel and Russia. International Journal of Mental Health Addiction. 1–8.
doi: 10.1007/s11469-020-00360-7 [Epub ahead of print].

On This Day … 15 July

Published on 07/15/2020 by Andrew Marshall1 Comment

1910 – In his book Clinical Psychiatry, Emil Kraepelin gives a name to Alzheimer’s disease, naming it after his colleague Alois Alzheimer.

Is Having a Mental Health Disorder Associated with Spending More on other Medical Conditions?

Published on 07/14/2020 by Andrew Marshall1 Comment

Research Paper Title

Association of Mental Health Disorders With Health Care Spending in the Medicare Population.

Background

The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown.

Therefore, the purpose of this study was to determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions.

Methods

This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilisation among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and post-traumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019.

Exposure: Diagnosis of an SMI or other common mental health disorder.

Main outcomes and measures: Risk-adjusted, standardised spending and health care utilisation. Multi-variable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical co-morbidities, using hospital referral region fixed effects.

Results

Of 4,358,975 Medicare beneficiaries, 987,379 (22.7%) had an SMI, 326,991 (7.5%) had another common mental health disorder, and 3,044,587 (69.8%) had no known mental illness.

Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001).

Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001).

Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders.

Among Medicare beneficiaries, $2,686,016,110 of $64,326,262,104 total Medicare spending (4.2%) went to mental health services and an additional $5,482,791,747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders.

Conclusions

In this study, having a mental health disorder was associated with spending substantially more on other medical conditions.

These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.

Reference

Figueroa, J.F., Phelan, J., Orav, E.J., Patel, V. & Jha, A.K. (2020) Association of Mental Health Disorders With Health Care Spending in the Medicare Population. JAMA Network Open. 3(3):e201210. doi: 10.1001/jamanetworkopen.2020.1210.

I Know This Much Is True (2020): S01E06

Published on 06/16/2020 by Andrew Marshall1 Comment

Introduction

I Know This Much Is True is an American television miniseries written and directed by Derek Cianfrance based on the 1998 novel of the same name by Wally Lamb.

Mark Ruffalo stars in two roles, identical twin brothers Dominick and Thomas Birdsey.

Outline

A lifetime of animosity between Dominick and Ray spills over in public at an inopportune time.

After an unexpected tragedy, Dominick seeks reconciliation with those he has hurt.

I Know This Much Is True Series

You can find a full index of I Know This Much Is True here.

Production & Filming Details

Narrator(s): Mark Ruffalo and Marcello Fonte.
Director(s): Derek Cianfrance.
Producer(s): Wally Lamb, Anya Epstein, Ben Browning, Glen Basner, Lynette Howell, Taylor, Gregg Fienberg, Mark Ruffalo, Derek Cianfrance, and Jeffrey T. Bernstein.
Writer(s): Derek Cianfrance and Anya Epstein.
Music: Harold Budd.
Cinematography: Jody Lee Lipes.
Editor(s): Ron Patane, Jim Helton, Malcolm Jamieson, Dean Palisch, and Nico Leunen.
Production: Willi Hill and FilmNation Entertainment.
Distributor(s): HBO.
Release Date: 14 June 2020.
Running Time: 59-80 minutes (per episode).
Country: US.
Language: English.