Meta-Analysis of the Treatment of Posttraumatic Stress Disorder in Adults With Comorbid Severe Mental Illness.

Objective: To evaluate the efficacy of psychosocial treatments for posttraumatic stress disorder (PTSD) among individuals with a comorbid severe mental illness (SMI; ie, schizophrenia, bipolar disorder, major depressive disorder).Data Sources: PubMed, PsycINFO, CINAHL, and Cochrane Library were searched from January 1998 to March 2020 using keywords related to PTSD, treatment, and severe mental illness.Study Selection: All clinical trials for PTSD psychotherapy among individuals with SMI were included. From 38 potentially eligible studies, a total of 14 clinical trials across 684 individuals with comorbid SMI and PTSD were identified and included in the analysis.Data Extraction: Data on demographic, SMI diagnosis, symptom severity, sample attrition, and treatment protocol received were extracted. Effect size calculations and subsequent meta-analyses were conducted using the Meta-Analysis Package for R (metafor) version 2.1-0 in R (3.6.0).Results: PTSD treatments had a large effect on PTSD outcomes among individuals with SMI, with patients experiencing a standard deviation reduction in PTSD symptomatology pre- to post-treatment (g = -1.009, P < .001, k = 34). Prolonged exposure (g = -1.464; P < .001; SE = 0.276; k = 5), eye movement desensitization and reprocessing (g = -1.351; P < .001; SE = 0.276; k = 5), and brief treatment program (g = -1.009; P < .001; SE = 0.284; k = 5) had the largest effects on PTSD symptoms.Conclusions: Although underrepresented in the PTSD literature, PTSD psychotherapies are effective for individuals with SMI. Treatments with an exposure-based component may have greater efficacy in this clinical population.

Brief Psychosocial Intervention to Address Poststroke Depression May Also Benefit Fatigue and Sleep-Wake Disturbance.

PURPOSE: This study aimed to determine if brief psychosocial/behavioral therapy directed to reduce poststroke depression would decrease fatigue and improve sleep-wake disturbance. DESIGN: A preplanned secondary data analysis from a completed clinical trial was conducted. METHODS: One hundred participants received usual care, in-person intervention, or telephone intervention. Depression, fatigue, and sleep-wake disturbance were measured at entry, 8 weeks, 21 weeks, and 12 months following the intervention. FINDINGS: Fatigue (within: p = .042, between: p = .394), sleep disturbance (within: p = .024, between: p = .102), and wake disturbance (within: p = .004, between: p = .508) decreased over the 12 months in the intervention groups, but not in the control group. This difference was clinically meaningful for wake disturbance and approached the clinically important difference for fatigue. CONCLUSIONS/CLINICAL RELEVANCE: Reduction in wake disturbance was consistent with clinically meaningful difference standards for patient-reported outcomes, warranting further research in larger samples.

Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: A systematic review.

AIMS: This systematic review aimed to evaluate randomized controlled trials (RCTs) to examine the effect of maternal and infant sleep intervention during women's pregnancy for the purpose of preventing perinatal depression. METHOD: A systematic search (from inception to January 28, 2019) for RCTs using five electronic databases-the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, PsycINFO, and Ichushi Web (Japan Medical Abstracts Society)-was conducted. Twelve investigators independently conducted initial screenings based on title and abstract, and then, two researchers performed full-text reviews one by one. A meta-analysis would be conducted if at least three studies were found. However, only two articles that met inclusion criteria, and narrative data synthesis was conducted for these two articles. The study protocol has been registered at PROSPERO (CRD42019119999). RESULT: A total of 13 654 studies were initially searched. After removing duplicates, 10 547 studies were screened, and finally, two studies met the inclusion criteria. In both studies, the intervention was a one-time face-to-face session during pregnancy to deliver the behavioral knowledge and skills for optimizing sleep hygiene for both infant and mother. Effectiveness of the intervention in improving maternal mood was not significant in one study. In the other, there was a significant difference in maternal mood between the intervention and control group. No mood comparison was made between baseline and postintervention. CONCLUSION: This study found limited evidence to support the effectiveness of sleep intervention for all pregnant women, which means "universal intervention," to protect maternal mental health. Further well-designed RCTs are needed to confirm these findings.

Promotion, prevention and treatment interventions for mental health in low- and middle-income countries through a task-shifting approach.

Recently, mental health and ill health have been reframed to be seen as a continuum from health to ill health, through the stages of being asymptomatic 'at risk', to experiencing 'mental distress', 'sub-syndromal symptoms' and finally 'mental disorders'. This new conceptualisation emphasised the importance of mental health promotion and prevention interventions, aimed at reducing the likelihood of future disorders with the general population or with people who are identified as being at risk of a disorder. This concept generated discussion on the distinction between prevention and treatment interventions, especially for those mental health conditions which lie between psychological distress and a formal psychiatric diagnosis. The present editorial aims to clarify the definition of promotion, prevention and treatment interventions delivered through a task-shifting approach according to a global mental health perspective.

Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. OBJECTIVE: To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. METHODS: Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. RESULTS: In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. CONCLUSIONS: STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.

An observational study of system-level changes to improve the recording of very brief advice for smoking cessation in an inpatient mental health setting.

BACKGROUND: Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient's smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). METHODS: We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012-September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free policy; C) enhancements to the patient electronic healthcare record (EHCR) which included C1) a temporary form to record the financial incentivisation of ASK and ACT (OFFER) C2) amendments to how VBA was recorded in the EHCR and C3) the integration of a new electronic national referral system in the EHCR. The recording of ASK, ADVISE, ACT (OFFER/CONSENT) were extracted using a de-identified psychiatric case register. RESULTS: There were 8976 admissions of 5434 unique individuals during the study period. Following A) financial incentive, the odds of recording ASK increased (OR: 1.56, 95%CI: 1.24-1.95). Following B) comprehensive smoke-free policy, the odds of recording ADVICE increased (OR: 3.36, 95%CI: 1.39-8.13). Following C1) temporary recording form, the odds of recording ASK (OR:1.99, 95%CI:1.59-2.48) and recording ACT (OFFER) increased (OR: 4.22, 95%CI: 2.51-7.12). Following C3) electronic referral system, the odds of recording ASK (OR:1.79, 95%CI: 1.31-2.43) and ACT (OFFER; OR: 1.09, 95%CI: 0.59-1.99) increased. There was no change in recording VBA outcomes following C2) amendments to VBA recording. CONCLUSIONS: Financial incentives and the recording of incentivised outcomes, the comprehensive smoke-free policy, and the electronic referral system, were associated with increases in recording individual VBA elements, but other changes to the EHCR were not. System-level changes may facilitate staff recording of VBA provision in mental health settings.

Brief behavioral activation intervention for depressive symptoms: Patient satisfaction, acceptability, engagement, and treatment response.

Depressive symptoms are the most common reason for referral to integrated behavioral health providers in primary care. Although evidence-based brief psychotherapies for depression in primary care exist, treatment duration is a significant barrier to implementation. In this open trial, we examined the patient experience of receiving a brief behavioral activation intervention designed for use in primary care (BA-PC), which comprised 2 30-min appointments and 2 boosters spaced 2-3 weeks apart across 12 weeks, and its impact on depression symptoms. Participants were 22 patients recruited from primary care who reported at least moderate depressive symptoms (score ≥ 10 on the Patient Health Questionnaire-9 [PHQ-9]). Patient experiences were examined through assessing patient engagement, satisfaction, acceptability, and treatment response. Fidelity of intervention delivery in delivering the BA-PC within a 12-week period was also assessed. Participants reported a high level of satisfaction with and acceptability of the BA-PC intervention, materials, and format. Within-subject t tests revealed a significant reduction in depressive symptoms from baseline at the 12-week assessment, based on PHQ-9 total score, t(21) = 3.80, p = .001. Evidence of fidelity included 81% of patients completing the 2 BA-PC appointments, average appointment lengths of approximately 30 min, and high content fidelity within each appointment. These preliminary findings suggest that overall experience of a brief BA-PC intervention was positive, with high patient satisfaction, patient acceptability, and treatment fidelity as well as positive patient treatment response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A hospital-based treatment of suicide attempt patients with problematic alcohol use: Rationale and treatment development.

OBJECTIVE: Problematic alcohol use (PAU) is a potent risk factor for suicidal behavior yet individuals with PAU presenting to hospital with suicidal risk may receive less intensive hospital-based treatment than suicidal patients without PAU. Developing efficacious interventions for at-risk patients with PAU that may be delivered in hospital is critical, particularly for those hospitalized following a suicide attempt, a group at marked risk. METHOD: The authors identified the Attempted Suicide Short Intervention Program (ASSIP) for adaption for hospitalized suicide attempt patients with PAU because of its flexibility, brevity, and evidence of efficacy to reduce risk for suicide reattempt. After consulting with the developers of ASSIP, clinical research experts in the treatment of suicidal risk and PAU, and treatment providers of hospitalized suicide attempt patients, the authors made modifications to ASSIP to tailor it to hospitalized suicide attempt patients with PAU. Results and conclusion Our modifications to ASSIP include highlighting links between PAU and the timing of the attempt; integrating such links into the narrative story of the attempt, the written case formulation, and the homework task; and identifying concrete strategies to address PAU-related risk in the prevention plan. These modifications are the focus of an ongoing treatment development study.

Impact of brief intervention and art therapy for alcohol users / Impacto de la intervención breve y de la arteterapia en usuarios de alcohol / Impacto da intervenção breve e arteterapia para usuários de álcool

ABSTRACT Objective: To identify the impact of brief intervention paired with art therapy in patients who use alcohol. Method: This study presents intra-group design, with 11 alcoholics in the city of Tamarana-PR, Brazil, between 2015 and 2016. A test to identify the alcohol consumption level was used at the beginning/end of the actions. Cohen's effect size and paired t-test were used to identify the impact of the actions on the reduction of alcohol intake. Results: Six participants ceased alcohol consumption, four showed high level of consumption and one presented average consumption. The paired t-test result suggested statistically significant difference between the initial and final scores, as well as 0.76 effect size. Conclusion: The brief intervention associated with the art therapy resulted in significant impact in reducing alcohol consumption. Investing in the continuous training of primary health care professionals is crucial to consolidate the improvements achieved.

RESUMEN Objetivo: Evaluar el impacto de la intervención breve junto con la arteterapia en usuarios que consumen alcohol. Método: Diseño intragrupo, siendo realizado entre 2015 y 2016, con la participación de 11 alcohólicos de la ciudad de Tamarana (PR, Brasil). Se realizó una prueba para identificar el nivel de consumo de alcohol antes y después de las acciones, y se calcularon el tamaño del efecto de Cohen y la prueba t pareada para evaluar el impacto de las acciones en la reducción del consumo de alcohol. Resultados: Seis dejaron de consumir alcohol, cuatro presentaron un alto consumo y uno presentó un consumo mediano. El resultado de la prueba t pareada reveló una diferencia estadísticamente significativa entre los puntajes inicial y final, así como en el tamaño del efecto con un 0,76. Conclusión: La intervención breve asociada a la arteterapia tuvo un gran impacto en la disminuición del consumo de alcohol. Es fundamental invertir en la educación continuada de los profesionales de la atención primaria de salud para consolidar las mejoras obtenidas.

RESUMO Objetivo: Identificar o impacto da intervenção breve em conjunto com a arteterapia em usuários que consomem álcool. Método: Delineamento intragrupo, com 11 alcoolistas na cidade de Tamarana-PR, entre 2015 e 2016. Foi utilizado um teste para identificação do nível de consumo de álcool ao início/término das ações e calculada a medida de efeito de Cohen e teste t pareado, para identificar o impacto das ações na redução do consumo de álcool. Resultados: Houve seis cessares do consumo de álcool, quatro apresentaram nível elevado de consumo e um apresentou consumo mediano. O resultado do teste t pareado sugeriu diferença estatisticamente significativa entre os escores iniciais e finais, assim como a medida de efeito de 0,76. Conclusão: A intervenção breve associada à arteterapia resultaram em grande impacto para a redução do consumo de álcool. É fundamental investir na educação continuada dos profissionais da atenção primária em saúde para consolidar as melhorias obtidas.

Brief interventions for cannabis use in emerging adults: A systematic review, meta-analysis, and evidence map.

PURPOSE: This systematic review summarizes and critically appraises the existing literature on brief interventions (BIs) for cannabis use among emerging adults. METHODS: Eligible BIs were operationalized as 1-2 sessions focused exclusively on cannabis use for samples with mean ages between 15 and 30. Outcomes related to cannabis use, other substance use, mental health, help-seeking, or functional status were included. Two independent reviewers screened a total of 3638 records, identifying 244 studies for full-text screening. In total, 32 BIs in 26 primary studies with 6318 participants were included. RESULTS: Participants were typically not seeking treatment and using cannabis at least once a month. Most interventions were motivational, single sessions, and delivered in person. Few discussed concurrent psychiatric conditions. Pooling results at 1-3 months post-intervention, BIs compared to passive control slightly reduced symptoms of cannabis use disorder (SMD -0.14 [95% CI -0.26 to -0.01]) and increased the odds of abstinence (OR 1.73 [95% CI 1.13-2.66]). Other outcome results often favored BIs but were not significant. Results of studies comparing types of BIs (k = 8) or BIs to longer interventions (k = 1) are discussed narratively. Quality assessment suggested low to very low-quality evidence. CONCLUSIONS: This review indicates that BIs targeting non-treatment seeking emerging adults result in significant reductions in symptoms of cannabis use disorder and an increased likelihood of cannabis abstinence, however evidence is of low quality.

Impact of brief intervention and art therapy for alcohol users.

OBJECTIVE: To identify the impact of brief intervention paired with art therapy in patients who use alcohol. METHOD: This study presents intra-group design, with 11 alcoholics in the city of Tamarana-PR, Brazil, between 2015 and 2016. A test to identify the alcohol consumption level was used at the beginning/end of the actions. Cohen's effect size and paired t-test were used to identify the impact of the actions on the reduction of alcohol intake. RESULTS: Six participants ceased alcohol consumption, four showed high level of consumption and one presented average consumption. The paired t-test result suggested statistically significant difference between the initial and final scores, as well as 0.76 effect size. CONCLUSION: The brief intervention associated with the art therapy resulted in significant impact in reducing alcohol consumption. Investing in the continuous training of primary health care professionals is crucial to consolidate the improvements achieved.

Sustained Reduction in Health Care Service Usage after Adjunctive Treatment of Intensive Short-Term Dynamic Psychotherapy in Patients with Bipolar Disorder.

The aim of this study was to evaluate changes in long-term health care costs and symptom severity after adjunctive intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with bipolar disorder undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 4.6 one-hour sessions of ISTDP to 29 patients with bipolar disorders. Health care service costs were compiled for a one-year period prior to the start of ISTDP along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Hospital cost reductions were significant for the one-year post-treatment period relative to baseline year, and all cost reductions were sustained for the follow-up period of four post-treatment years. Self-reported psychiatric symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and cost-effective in select patients with bipolar disorders, and that gains may be sustained in long-term followup. Future research directions are discussed.

[Relevance and experience of surveillance and brief contact intervention systems in preventing reattempts of suicide among children and adolescents]. / Pertinence et expérience des dispositifs de veille et de recontact dans la prévention suicidaire auprès des enfants et des adolescents.

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

[Impacts of a brief contact intervention in suicide prevention on medical care consumptions]. / Impacts d'un système de veille en prévention du suicide sur les consommations de soins.

INTRODUCTION: Suicide prevention is a major objective in public health. The development of alternative approaches to the prevention of suicide, such as monitoring systems, is growing quickly. The results are encouraging, but the analysis of the effectiveness remains complex. The objective of this study is to evaluate the medico-economic impact of the ALGOS brief contact intervention (BCI) on the consumption of medical care. METHOD: ALGOS is a prospective, comparative, multicentre, single-blind, randomized, controlled trial, which compared two groups after a suicide attempt (SA). The ALGOS algorithm assigned each BCI to the subgroup of participants. The medico-economic impact of each intervention was evaluated at 6 and 13 months after inclusion. RESULTS: In all, 987 patients were included. There was no significant difference between the two groups at 6 months and at 13 months after SA in the total number of patients who had been hospitalized in psychiatry or other care services. However, the average number of rheumatology visits was significantly higher in the control group (P=0.01) at 13 months. The total number of rheumatologist and physiotherapist visits was significantly higher in the control group at 6 and 13 months. CONCLUSION: Our results suggest that the use of a BCI after SA does not lead to increased consumption of medical care.

Predictors of treatment initiation for alcohol use disorders in primary care.

BACKGROUND: We identified predictors of receiving treatment (brief therapy [BT] and/or extended-release injectable naltrexone [XR-NTX]) for the treatment of alcohol use disorders (AUDs) in primary care. We also examined the relationship between receiving BT and XR-NTX. METHODS: Secondary data analysis of SUMMIT, a randomized controlled trial of collaborative care. Participants were 290 individuals with AUDs who reported no past 30-day opioid use and who were receiving primary care at a multi-site Federally Qualified Health Center. Bivariate and multivariate analyses examined predictors of BT and/or XR-NTX. RESULTS: Thirty-two percent (N = 93) received either BT or XR-NTX, 28% (N = 82) received BT and 13% (N = 37) received XR-NTX; 9% (N = 26) received both BT and XR-NTX. Older age, white race, talking with a professional about alcohol use and having more negative consequences all predicted receipt of evidence-based treatment; being homeless was a negative predictor. The predictors of receiving BT included not being homeless and previously talking with a professional; the predictors of receiving XR-NTX included older age, white race and experiencing more negative consequences. In 80% of those who received both BT and XR-NTX, receipt of BT preceded XR-NTX. CONCLUSIONS: Patient factors were important predictors of receiving primary-care based AUD treatment and differed by type of treatment received. Receiving BT was associated with subsequent use of XR-NTX and may be associated with a longer duration of XR-NTX treatment. Providers should consider these findings when considering ways to increase primary-care based AUD treatment.

Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department.

Importance: Suicidal behavior is a major public health problem in the United States. The suicide rate has steadily increased over the past 2 decades; middle-aged men and military veterans are at particularly high risk. There is a dearth of empirically supported brief intervention strategies to address this problem in health care settings generally and particularly in emergency departments (EDs), where many suicidal patients present for care. Objective: To determine whether the Safety Planning Intervention (SPI), administered in EDs with follow-up contact for suicidal patients, was associated with reduced suicidal behavior and improved outpatient treatment engagement in the 6 months following discharge, an established high-risk period. Design, Setting, and Participants: Cohort comparison design with 6-month follow-up at 9 EDs (5 intervention sites and 4 control sites) in Veterans Health Administration hospital EDs. Patients were eligible for the study if they were 18 years or older, had an ED visit for a suicide-related concern, had inpatient hospitalization not clinically indicated, and were able to read English. Data were collected between 2010 and 2015; data were analyzed between 2016 and 2018. Interventions: The intervention combines SPI and telephone follow-up. The SPI was defined as a brief clinical intervention that combined evidence-based strategies to reduce suicidal behavior through a prioritized list of coping skills and strategies. In telephone follow-up, patients were contacted at least 2 times to monitor suicide risk, review and revise the SPI, and support treatment engagement. Main Outcomes and Measures: Suicidal behavior and behavioral health outpatient services extracted from medical records for 6 months following ED discharge. Results: Of the 1640 total patients, 1186 were in the intervention group and 454 were in the comparison group. Patients in the intervention group had a mean (SD) age of 47.15 (14.89) years and 88.5% were men (n = 1050); patients in the comparison group had a mean (SD) age of 49.38 (14.47) years and 88.1% were men (n = 400). Patients in the SPI+ condition were less likely to engage in suicidal behavior (n = 36 of 1186; 3.03%) than those receiving usual care (n = 24 of 454; 5.29%) during the 6-month follow-up period. The SPI+ was associated with 45% fewer suicidal behaviors, approximately halving the odds of suicidal behavior over 6 months (odds ratio, 0.56; 95% CI, 0.33-0.95, P = .03). Intervention patients had more than double the odds of attending at least 1 outpatient mental health visit (odds ratio, 2.06; 95% CI, 1.57-2.71; P < .001). Conclusions and Relevance: This large-scale cohort comparison study found that SPI+ was associated with a reduction in suicidal behavior and increased treatment engagement among suicidal patients following ED discharge and may be a valuable clinical tool in health care settings.

Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder?

BACKGROUND: Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS: The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS: The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (ß = 0.43, p < 0.001) and 90 days (ß = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION: The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE: Prospective randomized controlled trial, level II.

Influence of a targeted performance measure for brief intervention on gender differences in receipt of brief intervention among patients with unhealthy alcohol use in the Veterans Health Administration.

AIMS: Women are less likely than men to receive brief intervention (BI) for unhealthy alcohol use. In 2007, the U.S. Veterans Health Administration (VA) used a national performance measure to implement BI. Although AUDIT-C scores ≥3 for women and ≥4 for men optimize sensitivity and specificity for identifying unhealthy alcohol use, VA's performance measure required BI only among a targeted subgroup defined by a non-gender-specific score threshold (AUDIT-C ≥5). This may have influenced gender differences in receipt of BI among those optimally eligible for BI. Therefore, we evaluate differences in proportions of women and men offered BI before and after BI implementation. METHODS: National secondary chart review data (7/06-6/10) identified all outpatients with unhealthy alcohol use for whom BI would be indicated (AUDIT-C ≥3 women, ≥4 men). Logistic regression, including a time-by-gender interaction, estimated the prevalence and 95% confidence interval (CI) of BI for women and men pre- and post-implementation. FINDINGS: Among patients optimally eligible for BI (n=51,272, 8206 women and 43,066 men), the prevalence of BI increased more steeply for men than women after implementation (interaction p-value <0.0001). Pre-implementation rates of BI were 21% (95% CI, 18-24) for women and 26% (95% CI, 24-29) for men, and post-implementation rates were 32% (95% CI, 30-34) for women and 47% (95% CI, 45-49) for men. CONCLUSIONS: Healthcare systems implementing BI with performance measures may wish to consider that specifying a single alcohol screening threshold for men and women may increase gender differences in receipt of BI among patients likely to benefit.

The Intensity of Brief Interventions in Patients with Acute Alcoholic Pancreatitis Should be Increased, Especially in Young Patients with Heavy Alcohol Consumption.

AIMS: After the first acute alcoholic pancreatitis (AAP), active repeated brief interventions (BIs) have been shown to protect against recurrent acute pancreatitis (RAP). However, in daily hospital practice the treatment of alcohol problems varies. Our aim was to study BIs performed in the clinic during AAP and whether this prevents from future RAP episodes. METHODS: Data on all patients discharged between 10/2010 and 10/2012 with acute pancreatitis as the primary diagnosis were obtained from the hospital database. Patients with the first attack of AAP were included in the study. Documented BIs during hospitalization for AAP and RAP and the development of RAP and chronic pancreatitis during median (range) follow-up of 4.2 (0.2-6.1) years were analyzed. Patients were also contacted with a mailed questionnaire. RESULTS: A total of 74 patients with first AAP during the study period were included. Of these, 32% developed RAP during follow-up. Of the patients, 72% received a documented BI during initial hospitalization, with no difference between patients who later did or did not develop RAP (71 vs. 72%; ns). Younger age (OR = 0.96, 95% CI = 0.92-1.00) and higher AUDIT points (P = 0.044; OR = 5.6; 95% CI = 1.02-30.9 for ≥20 AUDIT points) were associated with RAP. AUDIT test had 70% sensitivity and 71% specificity at a cut-off value of 20 points for predicting RAP. CONCLUSIONS: Only 72% of the patients received a documented BI during the initial hospitalization for AAP. The in-hospital BI as such did not prevent the development of RAP. Young patients with AUDIT points ≥20 are especially at high risk for developing RAP and should be included in a more intense follow-up care program to maximize prevention. SHORT SUMMARY: During hospitalization for acute alcoholic pancreatitis (AAP), one third of the patients did not receive brief interventions (BIs). The in-hospital BI by itself was not sufficient enough to prevent disease recurrence in follow-up of 4 years. Young age and higher AUDIT-points were significant risk factors for recurrent attacks of AAP.

Attitudes, perceptions and practice of alcohol and drug screening, brief intervention and referral to treatment: a case study of New York State primary care physicians and non-physician providers.

OBJECTIVES: Screening, Brief Intervention, and Referral to Treatment (SBIRT) has been endorsed by the United States Preventive Services Task Force as an evidence-based strategy to address risky alcohol use among adults in primary care. Nevertheless, very few healthcare professionals report using SBIRT in their practice. The purpose of this study was to explore attitudes regarding addressing substance use; perceptions of effectiveness, role responsibility, and self-efficacy; and current SBIRT practice among primary care physicians, nurse practitioners, and physician assistants to identify factors which may impact routine delivery of SBIRT in primary care. STUDY DESIGN: A cross-sectional design was used to meet study objectives. Responses of physicians and non-physician providers (nurse practitioners and physician assistants) were compared. METHODS: Primary care members of three New York State physician, nurse practitioner, and physician assistant professional organizations were surveyed between October 2013 and November 2013. RESULTS: Barely half of participants (57%) reported screening their patients for substance use, and less than half provided brief intervention (46%) or referral to treatment (47%). Using a standardized tool to screen patients for risky substance use and assessing readiness to change were practised least frequently. Compared to physicians, nurse practitioners and physician assistants felt less responsible for addressing substance use (P = 0.019), felt less comfortable discussing substance use (P = 0.004), had more negative attitudes toward addressing substance use (P = 0.015), and were less likely to conduct brief intervention (52% vs 32%; P < 0.0005) and referral to treatment (50% vs 70%; P = 0.001). CONCLUSIONS: This study identifies important attitudinal and perceptual differences between physicians and non-physician providers which may be targeted by education and training and underscores an opportunity for using non-physician providers to conduct SBIRT.