A Retrospective Analysis of Early 20th Century Asylum Records of Patients with Dementia Praecox.

Mental illness definitions and classifications are to a certain extent intrinsically tied to social factors. To empirically examine the impact of sociodemographic factors on patients institutionalized with dementia praecox in the early 20th century, we examined records from Dorothea Dix Hospital (DDH), an asylum in Southeastern United States. Data was extracted from digitally archived handwritten admission ledgers and general casebooks. Of those institutionalized at DDH between 1896-1917, 190 patients were diagnosed with dementia praecox. Clinical characteristics of patients are described using descriptive text analysis. We used regression models to examine the influence of sociodemographic factors on length of stay and release condition from the asylum. Race was not recorded for any patient and presumed White since DDH was not racially integrated until 1960s. Women had a significantly increased odds (OR = 3.8, p = 0.016) of dying in the facility than getting discharged; being single significantly increased the odds of dying in the facility (OR = 6.8, p = 0.002). Marital status predicted length of stay-being single increased the length of stay (b = 5.97, t (159) = 2.43, p = 0.016) adjusting for the effects of gender, age, and education. We report the impact of gender and marital status on patient release condition and length of stay in an asylum in the early 20th century. Results from the historical data we empirically examined are relevant today as women continue to experience disparities in mental health care. Family support was crucial to better outcomes then, as it is today.

Perceptions of ACT Team Members on the Implementation of Physical Health Services: A Qualitative Study.

BACKGROUND: Adults with severe mental illnesses have mortality rates 2.5 to 3 times higher than the general population, largely due to medical illnesses. Those with the most profound mental illnesses are served by assertive community treatment (ACT) teams that provide intensive mental health care; however, there are no clearly established models to integrate physical health treatment into ACT and this is a critical gap in the literature. AIMS: To describe perceptions of ACT team members regarding services provided for their clients to treat physical health, how those services can be improved, and what implementation strategies would likely be needed to promote uptake and sustainability of those services on ACT teams. METHOD: Qualitative interviews were conducted via Zoom using a semistructured interview guide with 19 employees from three ACT teams in a southeastern state. Interview transcripts were analyzed, using manifest content analysis, a form of qualitative analysis, to identify key themes in the interview transcripts. RESULTS: ACT team members described limited physical health services for their clients. They reported (1) system-level barriers to improving physical health care, such as inadequate tools and training; and (2) patient-level barriers, such as limited awareness of physical care needs. ACT team members reported the need for additional medical staff and strengthened relationships with primary care providers. They also recommended changes in policy, education, and quality monitoring to implement new physical health care services. CONCLUSIONS: Findings suggest intervention components and implementation strategies for improving physical health care of ACT consumers.

Disorder agnostic network structure of psychopathology symptoms in youth.

BACKGROUND: Youth mental health disorders are strong predictors of adult mental health disorders. Early identification of mental health disorders in youth is important as it could aid early intervention and prevention. In a disorder agnostic manner, we aimed to identify influential psychopathology symptoms that could impact mental health in youth. METHODS: This study sampled 6063 participants from the Philadelphia Neurodevelopmental Cohort and comprised of youth of ages 12-21 years. A mixed graphical model was used to estimate the network structure of 115 symptoms corresponding to 16 psychopathology domains. Importance of individual symptoms in the network were assessed using node influence measures such as strength centrality and predictability. RESULTS: The generated network had stronger associations between symptoms within a psychopathological domain; overall had no negative associations. A conduct disorder symptom eliciting threatening others and a depression symptom - persistent sadness or depressed mood - had the greatest strength centralities (ß = 2.85). Fear of traveling in a car and compulsively going in and out a door had the largest predictability (classification accuracy = 0.99). Conduct disorder, depression, and obsessive compulsive disorder symptoms generally had the largest strength centralities. Suicidal thoughts had the largest bridge strength centrality (ß = 2.85). Subgroup networks revealed that network structure differed by socioeconomic status (low versus high, p = 0.04) and network connectivity patterns differed by sex (p = 0.01), but not for age or race. CONCLUSIONS: Psychopathology symptom networks offer insights that could be leveraged for early identification, intervention, and possibly prevention of mental health disorders.