Substance Use Disorder and Violence Among People with Severe Mental Illness in the United States.

In studying substance use disorder (SUD) and violence in severe mental illness (SMI), researchers account for presence of SUD or addictions to specific substances. However these studies fail to comprehensively capture solitary drug use versus specific combinations in a single exhaustive variable with more nuance (e.g., opioids only, alcohol only, both alcohol and opioids only, and so on). Using logistic regression to predict past-year violence, this study compared conventional SUD measurement (Model I: presence versus absence of SUD or specific SUDS) to a newer and more holistic approach (Model II: a single exhaustive variable with both solitary addictions [e.g., opioids only] and specific combinations of addictions [e.g., both opioids and alcohol only]) among 10,551 people with SMI in the National Survey of Drug Use and Health (20,015 - 2019). After adjusting for a wide variety of factors in Model II, people with (1) alcohol use disorders only were 2.24 times more likely to be violent (CI = 1.46-3.45, p <.001); (2) opioid use disorders only were 3.45 times more likely (CI-1.48-8.05, p,>01); (3) both alcohol and cocaine use disorders or cocaine only were 5.85 times more likely (CI = 2.63-13.05, p <.001); and (4) both alcohol and opioid use disorders only were 4.28 times more likely (CI = 1.34-13.71, p <.05). These more nuanced findings in Model II differed substantially from those using conventional SUD assessment in Model I, and the newer and more holistic approach can better reflect the complexity of addiction in relation to violence in SMI. Therefore studies, practices, and policies that address SUD and violence in SMI could be beneficially revisited with this greater comprehensiveness and detail.

Correlates of Opioid Use Disorders among People with Severe Mental Illness in the United States.

BACKGROUND/OBJECTIVES: The number of Americans with opioid use disorders (OUDs: prescription painkillers or heroin) has increased dramatically, yet little is known about OUD among people with severe mental illness (SMI). METHODS: Using the National Survey on Drug Use and Health (N = 502,467), logistic regression was used to: (1) identify factors associated with past-year OUD among people with SMI; and (2) examine associations between OUD and adverse outcomes (e.g., suicide attempt). RESULTS: After controlling for a number of factors, correlates of OUD among people with SMI included male gender, younger age, marital status (never been married), use of certain drugs before age 18 (especially marijuana), and ease of obtaining certain drugs. People with prescription painkiller use disorder (only) were 7.43 times more likely (CI = 4.55-12.14, p < .001) than people without substance use disorder to have criminal justice system involvement, while those with: (1) heroin use disorder (only) were 18.78 times more likely (CI = 9.22-38.24, p < .001); (2) both prescription painkiller and heroin use disorder (only) were 25.83 times more likely (CI = 14.06-47.47, p < .001); and (3) all other substance use disorders were 5.15 times more likely (CI = 3.95-6.72, p < .001). People with prescription painkiller use disorder (only) were 2.40 times more likely (CI = 1.72-3.35, p < .001) to attempt suicide than those without substance use disorder, and those with all other substance use disorders (i.e., apart from OUD) were 79% more likely (OR = 1.79, CI = 1.45-220, p < .001). Conclusions/Importance: My findings on OUD and OUD outcomes can help identify and understand individuals with SMI who could benefit from OUD prevention and intervention efforts.

Willingness to Ask Tor Help Among Persons with Severe Mental illness: Call for Research.

There are times when people with severe mental illness (SMI) must be willing to ask for help (e.g., with managing symptoms). But what makes one person ask for help and another decide to go it alone? We used logistic regression to assess willingness to request assistance among 150 people with SMI. Hispanics were more likely (OR 8.51, CI 2.05-35.36, p < .01) than Caucasians to be willing to ask for help, and people with the highest incomes (relative to the lowest) were more likely (OR 7.23, CI 1.76-29.97, p > .01). Individuals with the most social support (relative to the least) were more likely (OR 12.36, CI 3.01-50.85, p < .001) to be willing to request assistance, and people who were willing to ask for help were more likely (OR 2.07, CI 1.01-4.26, p < .05) than less willing individuals to report being happy. More research is needed in order to better understand predisposition to seek aid, and interventions are needed that promote it.

Loneliness Among Persons With Severe Mental Illness.

Although studies show that loneliness increases risk of illness and hastens death, it is poorly understood among persons with severe mental illness (SMI). Using data on 150 people with SMI, we used logistic regression to predict (1) loneliness from sociodemographic and clinical characteristics, and (2) psychiatric hospitalization from presence of loneliness. We also examined mediating effects. Study participants who were most willing to ask for help were 70% less likely (odds ratio [OR], 0.30; confidence interval [CI], 0.09-0.99; p < 0.05) to be lonely than those who were least willing, and participants with high levels of internalized stigma were 9.25 times as likely (CI, 9.25; OR, 2.29-37.32; p < 0.01) as other participants to be lonely. Participants who were most lonely were 2.69 times (CI, 1.03-7.04, p < 0.05) as likely to be placed in psychiatric hospitals as those who were less lonely. Loneliness mediates the association between internalized stigma and psychiatric hospitalization (OR, 1.30; CI, 1.04-1.73). Findings can be used to help prevent inpatient stay.

Wanna grab some dinner? Social relations between helping professionals and members of community mental health or other human service organizations.

PURPOSE: Could practitioners and members (consumers) of mental health or other organizations interact socially by regularly going out for drinks or dinner together, for example? The American Psychological Association explicitly states for example, "your psychologist shouldn't also be your friend." However such social interactions have occurred for decades in certain clubhouse-modeled community mental healthcare, and maybe research and a more balanced perspective is warranted. DESIGN/METHOD: We interviewed six clubhouse staff that interact socially with members and held three focus groups with 20 members. RESULTS/CONCLUSIONS: In relation to what we call a social interaction policy, we herein highlight: (a) four policy dimensions (e.g. activity types; relationship closeness); (b) a spectrum of policy challenges (e.g., dealing with romantic overture; feelings of exclusion or hurt and effects on mental health; symptom flare-up while out socializing; financial constraints of members such as dinner costs on limited incomes); and (c) a wide variety of policy benefits such as: (a) learning opportunities for members who can process with staff the ups and downs of social relationships; (b) social skill and network development; (c) enhanced assessment across different times/settings; (d) addressing stigma among staff who must grapple with internal resistance to spend free time with members; (e) enrichment of staff social life; (f) reducing internalized stigma among members when staff value them more holistically; and (g) empowerment of members when staff freely (and optionally) offer a valuable resource (spare time). We offer suggestions for certain types of agencies that may wish to implement social interaction policies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Substance abuse and hospitalization for mood disorder among Medicaid beneficiaries.

OBJECTIVES: We compared the influence of substance abuse with that of other comorbidities (e.g., anxiety, HIV) among people with mood disorder (N=129,524) to explore risk factors for psychiatric hospitalization and early readmission within 3 months of discharge. METHODS: After linking Medicaid claims data in 5 states (California, Florida, New Jersey, New York, and Texas) to community-level information, we used logistic and Cox regression to examine hospitalization risk factors. RESULTS: Twenty-four percent of beneficiaries with mood disorder were hospitalized. Of these, 24% were rehospitalized after discharge. Those with comorbid substance abuse accounted for 36% of all baseline hospitalizations and half of all readmissions. CONCLUSIONS: Results highlight the need for increased and sustained funding for the treatment of comorbid substance abuse and mood disorder, and for enhanced partnership between mental health and substance abuse professionals.

Risk of criminal justice system involvement among people with co-occurring severe mental illness and substance use disorder.

While there are documented risk factors for criminal justice system involvement (CJSI) among persons with severe mental illness, little is known about risk for CJSI among people with co-occurring severe mental illness and substance use disorders. Using logistic regression, we identified sociodemographic and clinical risk factors that most increase risk of CJSI among people with co-occurring disorders (N = 10,855: National Survey of Drug use and Health, 2006-2014), and examined whether co-occurring disorders increase CJSI risk and risk of violent offenses in relation to severe mental illness alone versus substance use disorder alone. Seventeen percent of people with co-occurring disorders in our study were arrested and booked for breaking the law in the past year. At heightened risk were males, Blacks (relative to Whites), younger people, people with less education, divorced or separated individuals (relative to married), the unemployed, persons in the largest households (6 or more people, relative to one person), people in substance abuse treatment, and persons with certain drug use disorders (e.g., both alcohol and marijuana, relative to alcohol only). At reduced risk were Asians (relative to Whites), people with the highest incomes, and people with marijuana use disorders (relative to alcohol). In relation to people without severe mental illness or substance use disorder, those with co-occurring disorders were 7.47 times as likely (CI = 6.56-8.51, p < .001) to be arrested and booked for breaking the law in the last 12 months, while those with severe mental illness (only) were 1.84 times as likely (CI = 1.64-2.08, p < .001) and those with substance use disorder (only) were 5.32 times as likely (CI = 4.86-5.83, p < .001). After using our findings to identify people who are at greatest risk for CJSI, preventative interventions could be offered.

Incarceration rates of persons with first-admission psychosis.

OBJECTIVE: This prospective study examined jail stay in a cohort of persons with schizophrenia and other psychotic disorders who experienced their first hospital admission and who were participating in the Suffolk County Mental Health Project. Demographic and clinical risk factors for jail placement were investigated over a four-year period after hospital discharge. METHODS: The sample included 538 first-admission respondents diagnosed as meeting DSM-IV criteria for having schizophrenia, psychotic mood disorder, or other psychotic disorders. Initial interviews occurred in the hospital; face-to-face follow-ups occurred at the six-, 24-, and 48-month points, and telephone contact was maintained every three to six months. Multivariate logistic regression analysis was used to examine the demographic and clinical risk factors. RESULTS: Forty-seven respondents (9%) were incarcerated over the follow-up period. Among them, 20 were incarcerated multiple times. The prevalence, incidence, reasons for incarceration, and time served did not vary significantly by diagnosis. The most significant predictors of jail stay and time to incarceration during the follow-up were being male or black and having been incarcerated before admission. Predictive effects of other risk factors (for example, symptom severity or substance abuse) were smaller or statistically insignificant. CONCLUSIONS: The results suggest a need for mental health care professionals to routinely evaluate, document, and collaboratively address incarceration history, especially when working with black males, in an effort to avert future incarceration.

Promoting consumer empowerment through entrepreneurship: a proposal.

In order to promote life control, this proposal suggests strategies to help people who use community mental health services to access small loans or "microcredit" for entrepreneurship in self-help groups.

Ethnicity and life quality of recently discharged inpatients with schizophrenia.

Three months after inpatient discharge, quality of life was examined in 259 individuals with schizophrenia. As in findings by Lehman, Rachuba, and Postrado (1995), Black participants reported a higher quality than Whites after controlling for gender, degree of psychopathology, functioning level, substance abuse, and baseline life quality. Implications are discussed.

Delinquency, depression, and substance use disorder among child welfare-involved adolescent females.

Although adolescents with delinquency are known to have higher-than-average rates of depression or substance use disorder (SUD), research on the topic is inconsistent. It remains unclear weather depression or SUD leads to delinquency, whether delinquency leads to depression or SUD, or whether there is bi-directionality. Utilizing the National Survey of Child and Adolescent Well-Being (Wave I: 2008-2009; Wave II: 18 months later: N=5872), we used logistic regression to predict depression from delinquency (and vice versa), and SUD from delinquency (and vice versa). After inclusion of control variables, we found that females with minor theft in Wave I were more than 4 times as likely (adjusted odds ratio [aOR]=4.34; 95% CI: 1.10-17.16) as females without minor theft to be depressed in Wave II, and those with public disorder in Wave I were almost 3 times as likely (aOR=2.74; 95% CI: 1.03-7.30) as those without public disorder to have SUD in Wave II. Overall delinquency also predicted depression or SUD, and SUD predicted delinquency. Practitioners could address risk for depression or SUD among child welfare-involved adolescent females by focusing on overall delinquency or on specific types of delinquency (minor theft for depression and public disorder for SUD) and by offering interventions (e.g., cognitive-behavioral psychotherapy) that have been shown to be effective in preventing depression or SUD. In addition, with respect to our finding that SUD predicts delinquency among adolescent females, practitioners can help prevent delinquency by offering interventions (e.g., intensive outpatient treatments) that have well documented effectiveness in addressing SUD.

Call for research: detecting early vulnerability for psychiatric hospitalization.

This study delineated the extent to which a broad set of risk factors in youth, a period well suited to primary prevention strategies, influences the likelihood and timing of first lifetime psychiatric hospitalizations. Logistic regression was used to delineate early risk factors for psychiatric hospitalization among Americans in a nationally representative survey (NCS-R, Part II, 2001-2003: N = 5,692). Results suggest that inpatient stay is more common and happens at earlier ages among Americans who report growing up with versus without: (1) depressed parents or caregivers, (2) family members who victimized them, or (3) one of three child mental illnesses (conduct, oppositional defiant, or separation anxiety disorder). In order to prevent inpatient stay, findings call for longitudinal research on early vulnerability for psychiatric hospitalization among families with: (1) depressed parents of children or adolescents, (2) violence against children, and (3) children that have externalizing or separation anxiety disorders.

Risk of inpatient stay for mental illness among individuals with substance use disorders.

OBJECTIVE: Whereas most studies of inpatient stay for mental illness examine whether substance use is present, this study identified types or combinations of abused substances that most increased hospitalization risk. METHODS: Logistic regression of data from the 2007 National Survey of Drug Use and Health (N=37,654) was used to predict past-year hospitalization of individuals with DSM-IV substance use disorders. RESULTS: Even after the inclusion of control variables, adults with four types of substance abuse or dependence were more likely to be hospitalized than adults without substance abuse or dependence. High-risk disorders included abuse of or dependence on opioid analgesics (odds ratio [OR]=6.85, p<.001), cocaine (OR=2.65, p<.05), alcohol and cocaine (OR=2.58, p<.05), and alcohol and marijuana (OR=3.10, p<.01). CONCLUSIONS: Researchers examining inpatient stays may find it beneficial to look at abuse of specific substances or combinations of substances, and efforts to prevent inpatient stays could target people with high-risk substance use disorders.

Serious mental illness and risk of new HIV/AIDS diagnoses: an analysis of Medicaid beneficiaries in eight states.

OBJECTIVE: A longitudinal analysis was used to explore the relationship between diagnosis of serious mental illness and subsequent new diagnoses of HIV. METHODS: Logistic regression was used to predict HIV/AIDS diagnoses in 2002­2004 among Medicaid beneficiaries in eight states (N=6,417,676) who were without HIV in 2001. Results for beneficiaries with and without serious mental illness, a substance use disorder, and psychiatric comorbidities in 2001 were compared. RESULTS: After controlling for substance abuse or dependence and other factors, the analyses indicated that the odds of new HIV/AIDS diagnoses among beneficiaries with or without serious mental illness did not differ significantly. Compared with beneficiaries without a substance use disorder or serious mental illness, individuals with a substance use disorder but without serious mental illness were 3.1 times (OR=3.13, p<.001) more likely, and those with both substance abuse or dependence and serious mental illness were 2.1 times (OR=2.09, p<.001) more likely, to receive a new HIV diagnosis in 2002­2004. However, people with serious mental illness but without a substance use disorder in 2001 were 23% less likely (OR=.77, p<.001) than people without serious mental illness or a substance use disorder in 2001 to receive a new HIV diagnosis. CONCLUSIONS: After substance abuse or dependence was controlled for longitudinally, little independent association between serious mental illness and the risk of new HIV diagnoses was found. HIV-prevention services for low-income individuals should be delivered to all persons with serious mental illness, but especially those with comorbid substance use disorders.

Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992--2002; length of stay and expenditures by facility type.

We summarize Medicare utilization and payment for inpatient treatment of non-dementia psychiatric illnesses (NDPI) among the elderly during 1992 and 2002. From 1992 to 2002, overall mean Medicare expenditures per elderly NDPI inpatient stay declined by $2,254 (in 2002 dollars) and covered days by 2.8. However, these changes are complicated by expanded use of skilled nursing facilities and hospital psychiatric units, and decreased use of long-stay hospitals and general hospital beds. This suggests that inpatient treatment for NDPI is shifting into less expensive settings which may reflect cost-cutting strategies, preferences for less restrictive settings, and outpatient treatment advances.

Hospitalization for psychiatric illness among community-dwelling elderly persons in 1992 and 2002.

OBJECTIVE: The authors evaluated the evolution of inpatient care for psychiatric illness in 1992 and 2002 for senior community-dwelling Medicare beneficiaries. METHODS: National Medicare Provider Analysis and Review files for 1992 and 2002 were analyzed. RESULTS: From 1992 to 2002, rates of inpatient hospital use for treatment of psychiatric illness declined 28%, from 429 to 311 stays per 100,000 eligible beneficiaries, mostly because of reduced hospitalization for depression, and next, for substance use disorder. Inpatient care patterns for patients with schizophrenia and bipolar disorder changed little. Although stays were shorter in 2002 in general, rehospitalization rates remained the same in 2002 as they were in 1992. CONCLUSION: Trends in hospitalizations differed by diagnoses, which may be representative of general changes in treatment philosophy during the 1990s.