Depression and Anxiety in Long-Term Care Residents During the COVID-19 Pandemic: The Influence of Telehealth Availability, Cognitive Status, and Trauma History.

OBJECTIVES: The present study investigates the impact of disrupted mental health services during the COVID-19 pandemic on depression and anxiety symptoms in long-term care (LTC) residents. METHODS: The study examined clinical data from 5,645 residents who received at least two psychological services in a long-term care (LTC) or assisted living (AL) setting between March 2019 and March 2021. A series of multiple regressions were run to explore the effects of the COVID-19 shutdown on depression and anxiety symptoms while examining the effects of COVID-19-related facility closure and facility telehealth capabilities. Follow-up regression analyses explored the impact of cognitive impairment and positive trauma history on depression and anxiety symptoms. RESULTS: Post-COVID levels of anxiety and depression were higher for residents with higher levels of pre-COVID anxiety and depression. The interaction between facility closure and availability of telehealth services and trauma history predicted self-report anxiety symptoms. Clinician-observed anxiety symptoms were predicted by cognitive impairment. Residents with a history of trauma had an increase in self-reported anxiety symptoms. CONCLUSIONS: Telehealth appeared to mitigate anxiety during the pandemic for residents with higher pre-COVID anxiety. CLINICAL IMPLICATIONS: For those individuals with severe anxiety, results suggest the importance of ensuring that mental health services are available to mitigate symptoms via telehealth when infection control disrupts the usual delivery of treatment.

Psychologists in Long-Term Care (PLTC) Guidelines for Psychological and Behavioral Health Services in Long-Term Care Settings.

To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.

Workplace response of companies exposed to the 9/11 World Trade Center attack: a focus-group study.

The terrorist attacks of 11 September 2001 (9/11) left workplaces in pressing need of a mental health response capability. Unaddressed emotional sequelae may be devastating to the productivity and economic stability of a company's workforce. In the second year after the attacks, 85 employees of five highly affected agencies participated in 12 focus groups to discuss workplace mental health issues. Managers felt ill prepared to manage the magnitude and the intensity of employees' emotional responses. Rapid return to work, provision of workplace mental health services, and peer support were viewed as contributory to emotional recovery. Formal mental health services provided were perceived as insufficient. Drawing on their post-9/11 workplace experience, members of these groups identified practical measures that they found helpful in promoting healing outside of professional mental health services. These measures, consistent with many principles of psychological first aid, may be applied by workplace leaders who are not mental health professionals.

Effects of the COVID-19 Pandemic on Anxiety Symptoms in Long-Term Care Residents: A Multilevel Growth Curve Analysis.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted the mental health functioning of older adults residing in long-term care (LTC) settings. This study examines the impact of the lockdown on anxiety symptoms over time in LTC residents. DESIGN: Secondary data analysis was conducted on clinical data obtained with permission from a large behavioral health company that provides behavioral health services in long-term care (LTC) and assisted living (AL) facilities. SETTING AND PARTICIPANTS: Data were obtained from 1149 adults (mean age 72.37, 70% female) in LTC and AL facilities across the United States who were receiving psychological services 1 year prior, and 1 year after, the COVID-19 pandemic lockdown. METHODS: Changes in anxiety (measured using a clinician rating scale) over time before and after the pandemic were assessed using latent growth curve modeling with psychiatric diagnosis, psychiatric medication, and demographic factors included as covariates. RESULTS: Anxiety severity decreased over time before and after the onset of the COVID-19 pandemic. Although pandemic-level factors such as facility closure and telehealth availability did not affect anxiety over time, individual treatment factors such as obsessive compulsive disorder diagnosis, initial anxiety severity, bipolar disorder diagnosis, and prescriptions for anxiolytic and antipsychotic medications affected the trajectory of anxiety during the pandemic. CONCLUSIONS AND IMPLICATIONS: These results demonstrate that individual covariates such as diagnosis, symptom severity, and medication use impacted the trajectory of anxiety symptoms before and during the COVID-19 pandemic more strongly than pandemic-related circumstances (facility closure, telehealth availability). The impact of the COVID-19 pandemic may be better observed through treatment-relevant variables, rather than pure symptom severity. In preparation for future pandemics or other large-scale disasters potentially impacting service delivery, facilities should continue to prioritize continuity of care or a timely resumption of services attending to individual treatment factors.

Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study.

OBJECTIVE: To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI). DESIGN: Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data. SETTING: SCI centers in the Veterans Health Administration. PARTICIPANTS: Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual-interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual-observational site [TAU-OS]). INTERVENTIONS: The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness. MAIN OUTCOME MEASURES: The primary study outcome measurement was competitive employment in the community. RESULTS: Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment. CONCLUSIONS: To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.

Sleep Challenges and Interventions in Children With Visual Impairment.

PURPOSE: To examine sleep patterns in a large and heterogeneous group of children with visual impairment. METHODS: A cross-sectional survey of parents of children with visual impairment was offered via the National Federation of the Blind and the National Organization for Albinism and Hypopigmentation. RESULTS: Complete survey results were available for 72 participants, aged 1 to 16 years. Parents of 52 (72%) children reported that their child had cycles of good sleep and bad sleep, and 50 (69%) reported that their child's sleep patterns caused significant stress for them or their family. Scores on the Childhood Sleep Habits Questionnaire (CSHQ) increased (> 41) in 64 (89%) children, indicating a likely clinically significant sleep problem. When compared to normative data from children aged 4 to 10 years, children in the current sample scored higher (more sleep problems) on all eight subscales on the CSHQ. The presence of comorbid developmental delay was most strongly associated with sleep problems. Supplemental melatonin and improving daytime and nighttime schedules or routines were reported as the most helpful for sleep. Many families reported a need for further information regarding melatonin use as a supplement. CONCLUSIONS: A high proportion of children with visual impairment experience clinically meaningful sleep problems, regardless of degree of light perception or visual acuity. There is a strong need for increased awareness and screening for sleep problems in this population. Potential treatment modalities, including supplemental melatonin, should be discussed with families. [J Pediatr Ophthalmol & Strabismus. 2022;59(2):77-86.].

Measuring use and cost of care for patients with mood disorders: the utilization and cost inventory.

BACKGROUND: Researchers conducting cost-outcome studies must account for all materially relevant care that subjects receive from their care providers. However, access to provider records is often limited. This article describes and tests the Utilization and Cost Inventory (UAC-I), a structured patient interview designed to measure costs of care when access to provider records is limited. METHODS: UAC-I was tested on 212 consenting adult veterans with mood disorder attending a VA medical center. Counts (inpatient days and outpatient encounters) and costs (dollars) computed from survey responses were compared with estimates from medical records and an alternative structured questionnaire. RESULTS: The agreement between inpatient costs computed from provider records and from UAC-I responses, assessed using the intraclass correlation coefficient (ICC), was 0.66, 95% confidence interval (CI), 0.30-0.84; the bias was -3.7%, 95% CI, -48 to 41. The ICC for the service data (inpatient days) was 0.97, 95% CI, 0.95-0.99; the bias was <1%, 95% CI, -14 to 15. The ICC for outpatient costs computed from provider records and from UAC-I responses was 0.53 95% CI, 0.38-0.65; the bias was <1%, 95% CI, -27 to 27. The ICC for outpatient encounters was 0.74, 95% CI, 0.65-0.80; the bias was <1%, 95% CI, -16 to 18. CONCLUSIONS: These results indicate that it may be feasible for cost-outcome studies to compare patient groups for inpatient and outpatient costs computed from patient self-reports.

Review of critical factors related to employment after spinal cord injury: implications for research and vocational services.

BACKGROUND/OBJECTIVE: Employment rates after spinal cord injury (SCI) vary widely because of discrepancies in studies' definition of employment and time of measurement. The objective of this study was to provide a comprehensive summary of the literature on employment rates, predictors of employment, and the benefits and barriers involved. METHODS: A search using the terms spinal cord injury and employment in the databases PubMed, PsycINFO, and MEDLINE. The search included a review of published manuscripts from 1978 through 2008. RESULTS: A total of 579 articles were found and reviewed to determine the presence of reported employment rates. Of these, 60 articles were found to include a report of employment rates for individuals with SCI. Results indicated that, in studies that examined paid employment, the average rate of any employment after SCI was approximately 35%. CONCLUSIONS: Characteristics associated with employment after SCI include demographic variables, injury-related factors, employment history, psychosocial issues, and disability benefit status. It is recommended that researchers studying employment after SCI use common outcome measures such as competitive employment rates, duration of employment, and job tenure. Empirical evidence is lacking in regard to the most effective methods of vocational rehabilitation among this population. Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment. Controlled studies are needed to test this assumption.

Military sexual trauma: a review of prevalence and associated health consequences in veterans.

This article reviews the literature documenting the prevalence of military sexual trauma (MST) and its associated mental and physical health consequences. Existing research indicates that prevalence rates of MST vary depending on method of assessment, definition of MST used, and type of sample. Risk factors for MST have been identified as including age, enlisted rank, negative home life, and previous assault history. MST has been associated with increased screening rates of depression and alcohol abuse, in addition to significantly increased odds of meeting criteria for post-traumatic stress disorder. In addition, MST has been associated with reporting increased number of current physical symptoms, impaired health status, and more chronic health problems in veterans. Available research on health care utilization and MST is also discussed. Researchers are encouraged to utilize standardized definitions of MST, employ standardized assessment methodology, and utilize more male veterans in future research. Policy and practice implications are discussed.

A data accounting system for clinical investigators.

Clinical investigators often preprocess, process, and analyze their data without benefit of formally organized research centers to oversee data management. This article outlines a practical three-file structure to help guide these investigators track and document their data through processing and analyses. The proposed process can be implemented without additional training or specialized software. Thus, it is particularly well suited for research projects with small budgets or limited access to viable research/data coordinating centers.

Mental health, quality of life, and health functioning in women veterans: differential outcomes associated with military and civilian sexual assault.

The present study examined psychiatric, physical, and quality-of-life functioning in a sample of 270 women veterans receiving outpatient treatment at a Veterans Affairs medical center. Participants were interviewed regarding their civilian (CSA) and military sexual assault (MSA) histories, and data regarding quality of life and health outcomes were obtained through structured interviews and questionnaires. Women veterans with CSA histories reported significantly poorer physical, psychiatric, and quality-of-life functioning compared to those without a history of sexual assault. Furthermore, women veterans with an MSA history demonstrated additional negative consequences above and beyond the effects of CSA. The study sample was comparable to a national random sample of women veterans who access care in the Veterans Affairs healthcare system, increasing the generalizibility of the results.

Sexual assault in women veterans: an examination of PTSD risk, health care utilization, and cost of care.

OBJECTIVE: This study examines the differential impact of military, civilian adult, and childhood sexual assault on the likelihood of developing posttraumatic stress disorder (PTSD). It also examines the relationship of military sexual assault (MSA) to service utilization and health care costs among women who access services through Veterans Affairs (VA). METHODS: A convenience sample of 270 veteran women receiving medical and/or mental health treatment at the VA North Texas Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS) and categorized into a sexual assault group using the Interview of Sexual Experiences (ISE). A chart review was also conducted to determine the frequency of diagnoses among the women. Data regarding health care utilization was obtained from self-report using the Utilization and Cost Patient Questionnaire (UAC-PQ) and VA administrative records. RESULTS: Compared with those without a history of sexual assault, women veterans were 9 times more likely to have PTSD if they had a history of MSA, 7 times more likely if they had childhood sexual assault (CSA) histories, and 5 times more likely if they had civilian sexual assault histories. An investigation of medical charts revealed that PTSD is diagnosed more often for women with a history of MSA than CSA. CSA was associated with a significant increase in health care utilization and cost for services, but there was no related increase in use or cost associated with MSA. CONCLUSION: Women veterans have differential rates of PTSD due to sexual assault, with higher rates found among those assaulted while on active duty. Although women with MSA are more likely to have PTSD, results suggest that they are receiving fewer health care services.

The business of healing: focus group discussions of readjustment to the post-9/11 work environment among employees of affected agencies.

OBJECTIVE: Understanding postdisaster workplace adjustment may help guide interventions for postdisaster emotional functioning and recovery. METHODS: One to two years after the September 11, 2001, terrorist attacks, 12 focus groups were conducted with 85 employees of companies directly affected by the 9/11 attacks on New York City, to discuss mental health issues surrounding return to the workplace after the disaster. RESULTS: Risk communication, tension between workplace productivity and employees' emotional needs, and postdisaster work space were topics discussed in the focus groups. Employees identified many effective responses by their companies after 9/11 relating to these areas of concern as well as gaps in response. CONCLUSIONS: Recommended risk communication procedures were applied but not systematically. Little direction was available for balancing workplace productivity and employees' emotional needs or for strategic management of postdisaster workspace, suggesting areas for future disaster workplace research.