Is the Association between Mental Disorders & Cardiovascular Disease Spurious or Real?

Research Paper Title

PsyCoLaus: mental disorders and cardiovascular diseases: spurious association?

Background

Cardio-vascular diseases (CVD), their well established risk factors (CVRF) and mental disorders are common and co-occur more frequently than would be expected by chance.

However, the mechanisms underlying this association are still poorly understood.

The main study questions of PsyCoLaus, the psychiatric arm of CoLaus, are:

  • Do mental disorders increase vulnerability to CVRF and CVD?
  • Do CVRF and CVD promote the development of mental disorders?
  • Do CVRF/ CVD and mental disorders share common pathogenetic processes?

The longitudinal project adds a comprehensive psychiatric evaluation to the CoLaus investigation.

A better understanding of the psychological, physiological and behavioural links underlying CVD/ CVRF and mental disorders will result in the development of more specific and efficient strategies of prevention and treatment for both psychiatric and CVD/CVRF, two major elements of burden of disease.

Reference

Preisig, M., Waeber, G., Mooser, V. & Vollenweider, P. (2020) PsyCoLaus: mental disorders and cardiovascular diseases: spurious association? Revue Medicale Suisse. 7(315), pp.2127-2129.

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

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.

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

Research Paper Title

Risk factors of hospitalisation 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 2014-15, 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

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 specialised 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.

Alzheimer’s Disease: Carers and their Mental Health

Research Paper Title

Predictors of mental health problems in formal and informal caregivers of patients with Alzheimer’s disease.

Background

Caring for a person with Alzheimer’s disease (AD) is associated with significant mental burden e.g., depression and anxiety, and difficulties with social, familial, and professional functioning. To date, few studies have examined variables which would allow for a comprehensive and detailed study of the relationship between personal resources and caregiver health status, with a majority of studies focusing on factors that contribute to increased caregiver’s burden. Moreover, the available evidence fails to address differences in the functioning of formal and informal carers. Paying proper attention to the problems of nursing home staff can help identify important risk factors. Therefore, this study compared mental health problems in informal and formal caregivers and examined the relationship between mental resources and mental health problems in both groups of caregivers.

Methods

This cross-sectional study examined 100 formal (n = 50) and informal (n = 50) caregivers of AD patients. Personal resources were measured with the Social Support Questionnaire (SSQ), the Generalised Self-Efficacy Scale (GSES), and the Sense of Coherence Questionnaire (SCQ), while mental health was assessed with the Depression Assessment Questionnaire (DAQ) and the General Health Questionnaire (GHQ). Multivariate stepwise regression was performed separately for both investigated groups.

Results

There were no significant differences between informal and formal caregivers in terms of psychological variables, i.e., sense of coherence, social support, self-efficacy, or mental health problems. In contrast, there were different significant predictors of mental health problems in both groups. Comprehensibility (SCQ) was a significant predictor of mental health problems measured by DAQ and self-efficacy (GSES) was a significant predictor of mental health problems measured by GHQ in informal caregivers. For formal caregivers, emotional support (SSQ) and comprehensibility (SCQ) were significant predictors of mental health problems measured by DAQ, while tangible support (SSQ) and meaningfulness (SCQ) were significant predictors of mental health problems measured by GHQ.

Conclusions

Personal resources are significant predictors of mental health outcomes in caregivers of AD patients. Preventive actions should therefore include assessment of factors affecting caregivers’ mental health in order to provide them with necessary care and create appropriate support groups.

Reference

Soltys, A. & Tyburski, E. (2020) Predictors of mental health problems in formal and informal caregivers of patients with Alzheimer’s disease. BMC Psychiatry. 20(1), pp.435. doi: 10.1186/s12888-020-02822-7.

Developing a Behavioural Health Readiness & Suicide Risk Reduction Review for Military Personnel

Research Paper Title

Development of the US Army’s Suicide Prevention Leadership Tool: The Behavioural Health Readiness and Suicide Risk Reduction Review (R4).

Background

Although numerous efforts have aimed to reduce suicides in the US Army, completion rates have remained elevated.

Army leaders play an important role in supporting soldiers at risk of suicide, but existing suicide-prevention tools tailored to leaders are limited and not empirically validated.

The purpose of this article is to describe the process used to develop the Behavioral Health Readiness and Suicide Risk Reduction Review (R4) tools for Army leaders that are currently undergoing empirical validation with two US Army divisions.

Methods

Consistent with a Secretary of the Army directive, approximately 76 interviews and focus groups were conducted with Army leaders and subject matter experts (SMEs) to obtain feedback regarding existing practices for suicide risk management, leader tools, and institutional considerations.

In addition, reviews of the empirical literature regarding predictors of suicide and best practices for the development of practice guidelines were conducted. Qualitative feedback, empirical predictors of suicide, and design considerations were integrated to develop the R4 tools.

A second series of 11 interviews and focus groups with Army leaders and SMEs was also conducted to validate the design and obtain feedback regarding the R4 tools.

Results

Leaders described preferences for:

  • Tool processes (e.g. incorporating engaged leadership, including multiple risk identification methods);
  • Formatting (e.g. one page);
  • Organisation (e.g. low-intermediate-high risk scoring system);
  • Content (e.g. excluding other considerations related to vehicle safety, including readiness implications); and
  • Implementation (e.g. accounting for leadership judgement, tailoring process to specific leadership echelons, consideration of institutional barriers).

Evidence-based predictors of suicide risk and practice guideline considerations (e.g. design) were integrated with leadership feedback to develop the R4 tools that were tailored to specific leadership echelons.

Leaders provided positive feedback regarding the R4 tools and described the importance of accounting for potential institutional barriers to implementation. This feedback was addressed by including recommendations regarding the implementation of standardized support meetings between different echelons of leadership.

Conclusions

The R4 development process entailed the simultaneous integration of leadership feedback with evidence-based predictors of suicide risk and design considerations.

Thus, the development of these tools builds upon previous Army leadership tools by specifically tailoring elements of those tools to accommodate leader preferences, accounting for potential implementation barriers (e.g. institutional factors), and empirically evaluating the implementation of those tools.

Future studies should consider utilising a similar process to develop empirically based resources that are more likely to be incorporated into the routine practice of leaders supporting soldiers at risk of suicide, very often located at the company level and below.

Reference

Curley, J.M., Penix, E.A., Srinivasan, J., Sarmiento, D.S., McFarling, L.H., Newman, J.B. & Wheeler, L.A. (2020) Development of the U.S. Army’s Suicide Prevention Leadership Tool: The Behavioral Health Readiness and Suicide Risk Reduction Review (R4). Military Medicine. 185(5-6), pp.e668-e677. doi: 10.1093/milmed/usz380.

Suicide Screening and Prevention

Reseach Paper Title

Suicide Screening and Prevention.

Background

Suicide is a major public health problem not only in the United States (US) but in many western nations as well.

In the US, it is the 10th leading cause of death, accounting for nearly 44,000 deaths each year. Suicide is also the seventh leading cause of years of potential loss of life, surpassing liver disease, diabetes, and HIV.

Each year, nearly half a million individuals present to the emergency departments in the US following attempted suicide.

Data indicate that nearly 1 out of every 7 young adults admits to having some type of suicidal ideation at some point in their lives and at least 5% have made a suicide attempt.

Suicide has repercussions way beyond the affected individual. It costs the US healthcare system over $70 billion, and untold billions of dollars are lost by the families who are affected, in terms of loss of earning.

Suicides are at an all-time high and affect both genders. Men are nearly 3.5 times more likely than women to commit suicide, and on average 123 people kill themselves every day.

The World Health Organisation (WHO) has predicted that in the next 2 years, depression will be the leading cause of disability globally. Depression is not only a North American phenomenon but is now being diagnosed in almost every nation. The annual prevalence of major depressive disorders in North America is 4.5%, but this is a gross underestimate because many individuals do not seek medical help. Depression is a serious medical disorder and associated with a high risk of suicide. Data reveals that more than 90% of individuals with a major depressive disorder do see a healthcare provider within the first 12 months of the episode and at least 45% of suicide victims have had some contact with a primary health care provider within the 4 weeks of suicide.

This indicates that if their healthcare providers are more vigilant and alert, suicide could be prevented in these individuals. These grim statistics have led to a National Strategy for Suicide Prevention in the US.

Considering that many individuals who commit suicide have a mental health disorder and have visited their primary caregiver, the focus now is on health care providers to become aware of the factors that increase the risk of suicide and to refer these individuals to mental health professionals for some type of intervention.

The current United States Preventive Services Task Force (USPSTF) recommendations are that primary caregivers should screen adolescents and adults for depression only when there are appropriate systems in place to ensure adequate diagnosis, treatment, and follow-up.

Aetiology

Many factors have been identified in individuals who commit suicides or have attempted suicide. These factors include the following:

  • Advanced age.
  • Availability of a firearm.
  • Chronic illness.
  • A family history of suicides.
  • Financial difficulties.
  • Negative life experiences.
  • Loss of job.
  • Marital status divorced.
  • Medications.
  • Mental illnesses such as depression, anxiety, post-traumatic stress disorder (PTSD).
  • Pain that is continuous.
  • A physical illness that has led to disability.
  • Race: white.
  • Gender: Male.
  • Social media.
  • Stress.
  • A sense of no purpose in life.

Other Risk Factors for Suicide

Over the years, several other factors have been identified that increases the risk of suicide and they include:

  • Major childhood adverse events, for example, sexual abuse.
  • Discriminated for being gay, lesbian, transgender or bisexual.
  • Having access to lethal means.
  • A long history of being bullied.
  • Chronic sleep problems.

In Males and Older Individuals

  • Loss of job or unemployment.
  • Low income.
  • Neurosis.
  • Social isolation.
  • Spousal loss, bereavement.
  • Affective disease.
  • Functional impairment.
  • Physical illness.

Military Personnel

  • Traumatic brain injury.
  • PTSD.
  • Other mental health issues.

The most important thing to understand is that having just one risk factor has very limited predictive value. Millions of Americans have one of these factors at any one point in time, but very few attempt suicide and even fewer die as a result. One has to look at the entire clinical picture to increase the predictive values of these risk factors.

Function

Which type of mental health disorder is associated with an increased risk of suicide?

Accumulated data reveal that many types of mental health disorders have been associated with an increased risk of suicide and they include the following:

  • Major depression.
  • Schizophrenia.
  • Substance abuse.
  • Alcoholism.
  • Post-traumatic stress disorder.
  • Bipolar disorder.
  • Personality disorders.
  • Emotional stress.
  • Medications and Suicides.

You can read further @ https://www.ncbi.nlm.nih.gov/books/NBK531453/.

Reference

O’Rourke, M.C., Jamil, R.T. & Siddiqui, W. (2020) Suicide Screening and Prevention. Treasure Islan, Florida: StatPearls Publishing.

Is Type 2 Diabetes an Independent Risk Factor for Alzheimer Patients with Depression?

Research Paper Title

Analysis of Risk Factors for Depression in Alzheimer’s Disease Patients.

Background

Depression, which affects about 52% of Alzheimer’s disease (AD) patients, can worsen cognitive impairment and increase mortality and suicide rates.

The researchers hope to provide clinical evidence for the prevention and treatment of depression in AD patients by investigating related risk factors of depression in AD patients.

Methods

158 AD inpatients of the Department of Neurology, Daping Hospital from September 2017 to March 2019 were enrolled. General information, laboratory tests, cognitive and emotional function assessments of the inpatients were collected.

Logistic regression was used to analyse the risk factors of depression in AD patients, and the relationship between 17 Hamilton depression scale scores and HbA1c levels in AD patients was further analysed.

Results

The prevalence of age, gender, hypertension, hyperlipidemia, Type 2 diabetes mellitus (T2DM), and white matter lesions (WML) in the AD with depression group was significantly different from without depression group.

Hypertension, T2DM, and WML are independent risk factors for depression in AD patients.

The depression scores of AD patients with HbA1c>6.5% were significantly higher than AD patients with HbA1c ≤ 6.5%, and there were significant difference in depression scale scores between using anti-diabetes drugs group and not using anti-diabetes drugs group whose HbA1c level is >6.5%, while no difference in depression scores between using anti-diabetes drugs group and not using anti-diabetes drugs group whose HbA1c level is ≤6.5%.

Conclusions

T2DM is an independent risk factor for AD patients with depression.

Increased HbA1c levels aggravate depression in AD patients, and controlling HbA1c levels and anti-diabetes drugs can reduce the severity of depression in AD patients.

Reference

Yang, H., Hong, W., Chen, L., Tao, Y., Peng, Z. & Zhou, H. (2020) Analysis of Risk Factors for Depression in Alzheimer’s Disease Patients. The International Journal of Neuroscience. 1-6. doi: 10.1080/00207454.2020.1730369. Online ahead of print.

A Leader Suicide Risk Assessment Tool for Mitigating Risk Factors

Research Paper Title

Development of a Leader Tool for Assessing and Mitigating Suicide Risk Factors.

Background

Despite efforts in prevention, suicide rates in the US military remain unchanged. This article describes the development of a tool for leaders to identify and mitigate suicide risk factors.

Methods

A seven-item measure, the Leader Suicide Risk Assessment Tool (LSRAT), was constructed to allow leaders to assess and mitigate suicide drivers. During a 6-month pilot, unit leaders completed the LSRAT for 161 at-risk soldiers. The LSRAT data were compared to clinical data from a subset of these soldiers.

Results

The LSRAT showed good test-retest reliability. The LSRAT scores showed significant correlations with both clinical and screening measures of suicidality. Command actions mitigated or partially mitigated 89% of risk factors identified on the LSRAT.

Conclusions

This study provides initial psychometric data on a tool that prescribes concrete responses to mitigate risk. The LSRAT may be a valid and feasible tool to assist front-line commanders in identifying potential area’s risk mitigation. Synchronisation efforts between commanders, clinicians, and support services are crucial to ensure effective intervention to prevent suicide behaviour.

Reference

Hoyt, T., Repke, D., Barry, D., Baisley, M., Jervis, S., Black, R., McCreight, S., Prendergast, D., Brinton, C. & Amin, R. (2020) Development of a Leader Tool for Assessing and Mitigating Suicide Risk Factors. Military Medicine. 185(Suppl 1), pp.334-341. doi: 10.1093/milmed/usz194.

Are Soldiers-in-training Likely to Seek Help when Experiencing a Problem?

Research Paper Title

Identifying Risk and Resilience Factors Associated With the Likelihood of Seeking Mental Health Care Among U.S. Army Soldiers-in-Training

Background

The Department of Defence aims to maintain mission readiness of its service members. Therefore, it is important to understand factors associated with treatment seeking in order to identify areas of prevention and intervention early in a soldier’s career that can promote positive functioning and increase their likelihood of seeking mental health care when necessary.

Methods

Using a theory of planned behaviour lens, this study identified potential barriers (risk) and facilitators (resilience) to treatment seeking among 24,717 soldiers-in-training who participated in the New Soldiers Study component of the “Army Study to Assess Risk and Resilience in Servicemembers” (Army STARRS). Hierarchal linear regression modelling and independent samples t-tests were used to examine associations between demographics and study variables, intersections of risk and resilience, and to explore differences in the likelihood of seeking help based on mental health diagnoses.

Results

A four-stage hierarchical linear regression was conducted, using likelihood of help-seeking as the dependent variable, to identify the most salient factors related to help-seeking. “Step one” of the analysis revealed soldiers-in-training who identified as female, Hispanic or Other ethnicity, and married, divorced, or separated reported a greater likelihood of seeking help. “Step two” of the analysis indicated soldiers-in-training with a history of sexual trauma, experience of impaired parenting, and clinical levels of mental health symptomatology (anxiety, depression, PTSD) reported a greater likelihood of seeking help.

Inversely, soldiers-in-training with a history of emotional trauma and parental absence/separation reported a lower likelihood of seeking help. “Step three” of the analysis demonstrated soldiers-in-training with a prior history of seeking help and larger social networks had a greater likelihood of seeking help. “Step four” of the analysis revealed several interactive effects between risk and resilience factors.

Specifically, soldiers-in-training who reported greater depressive symptomatology in combination with prior history of treatment seeking reported a greater likelihood of help seeking, whereas soldiers-in-training who reported prior sexual trauma and PTSD in combination with large social networks reported a lower likelihood of seeking help. Finally, a greater percentage of soldiers-in-training with clinical levels of anxiety, depression, and PTSD indicated they would likely seek help in comparison to soldiers-in-training without clinical symptoms.

Conclusions

Findings suggest few soldiers-in-training are likely to seek help when experiencing a problem. General efforts to encourage help-seeking when needed are warranted with particular focus on subsets of soldiers-in-training (e.g., men, those with a history of some adverse childhood experiences).

Strengths of this study include the examination of a large sample of soldiers-in-training to identify possible leverage points for early intervention or prevention prior to entering stressful military operating environments.

Limitations of this study include the examination of only one military branch and exclusion of soldiers not “in-training.”

Future studies could consider replicating the current study using a sample of military personnel longitudinally to track behavioral trends as well as looking at military populations outside of basic combat training.

Reference

Duncan, J.M., Reed-Fitzke, K., Ferraro, A.J., Wojciak, A.S., Smith, K.M. & Sanchez, K. (2020) Identifying Risk and Resilience Factors Associated With the Likelihood of Seeking Mental Health Care Among U.S. Army Soldiers-in-Training. Military Medicine. doi: 10.1093/milmed/usz483. Online ahead of print.