Strategies and foundations for scientific discovery in longitudinal studies of bipolar disorder.

Bipolar disorder (BD) is a complex and dynamic condition with a typical onset in late adolescence or early adulthood followed by an episodic course with intervening periods of subthreshold symptoms or euthymia. It is complicated by the accumulation of comorbid medical and psychiatric disorders. The etiology of BD remains unknown and no reliable biological markers have yet been identified. This is likely due to lack of comprehensive ontological framework and, most importantly, the fact that most studies have been based on small nonrepresentative clinical samples with cross-sectional designs. We propose to establish large, global longitudinal cohorts of BD studied consistently in a multidimensional and multidisciplinary manner to determine etiology and help improve treatment. Herein we propose collection of a broad range of data that reflect the heterogenic phenotypic manifestations of BD that include dimensional and categorical measures of mood, neurocognitive, personality, behavior, sleep and circadian, life-story, and outcomes domains. In combination with genetic and biological information such an approach promotes the integrating and harmonizing of data within and across current ontology systems while supporting a paradigm shift that will facilitate discovery and become the basis for novel hypotheses.

The post COVID-19 healthcare landscape and the use of long-acting injectable antipsychotics for individuals with schizophrenia and bipolar I disorder: the importance of an integrated collaborative-care approach.

BACKGROUND: Long-acting injectable antipsychotics (LAIs) are an essential maintenance treatment option for individuals with schizophrenia or bipolar I disorder (BP-I). This report summarizes a roundtable discussion on the impact of COVID-19 on the mental healthcare landscape and use of LAIs for individuals with schizophrenia or BP-I. METHODS: Ten experts and stakeholders from diverse fields of healthcare participated in a roundtable discussion on the impact of the COVID-19 pandemic, treatment challenges, and gaps in healthcare for individuals with schizophrenia or BP-I, informed by a literature search. RESULTS: Individuals with schizophrenia or BP-I are at increased risk of COVID-19 infection and increased risk of mortality after COVID-19 diagnosis. LAI prescriptions decreased early on in the pandemic, driven by a decrease in face-to-face consultations. Mental healthcare services are adapting with increased use of telehealth and home-based treatment. Clinical workflows to provide consistent, in-person LAI services include screening for COVID-19 exposure and infection, minimizing contact, and ensuring mask-wearing by individuals and staff. The importance of continued in-person visits for LAIs needs to be discussed so that staff can share that information with patients, their caregivers, and families. A fully integrated, collaborative-care model is the most important aspect of care for individuals with schizophrenia or BP-I during and after the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic has highlighted the importance of a fully integrated collaborative-care model to ensure regular, routine healthcare contact and access to prescribed treatments and services for individuals with schizophrenia and BP-I.

Qualitative Study of NAMI Homefront Family Support Program.

The National Alliance on Mental Illness's Homefront program is a 6-week peer-taught program for family members of veterans and active duty soldiers. Homefront is associated with increased empowerment, coping, and knowledge, but little is known about member experiences. This study used telephone interviews to identify program components that are helpful or need improvement, and to compare the online and in-person program formats. Seventeen participants (7 online) and 17 instructors (3 online) were interviewed and qualitative data analysis suggested that the most helpful components were group discussion, lessons on veteran-specific issues, and coping skills workshops. Some suggested expanding Homefront to 8 or 10 weeks. The online program was convenient for those unable to attend otherwise, but participants cited some dissatisfaction with the discussion format. Instructors described teaching the program as rewarding and noted learning from the curriculum. Understanding the experiences of participants may inform the development of future psychoeducation programs.

Effect of Contact-Based Education on Medical Student Barriers to Treating Severe Mental Illness: a Non-randomized, Controlled Trial.

OBJECTIVE: Emerging evidence suggests that contact-based education-learning via structured social interactions designed around intergroup contact theory-could be an important educational adjunct in improving attitudes, beliefs, and behaviors of medical students toward patients with severe mental illness (SMI). However, existing literature in the area lacks structured curriculum, control group designs, or longitudinal analyses. The authors conducted a longitudinal, non-randomized, controlled trial of the National Alliance on Mental Illness (NAMI) Provider Education Program-a 15-h contact-based adjunctive curriculum-on the attitudes, beliefs, and behavior of third-year medical students (MS3) at a single institution. METHODS: Two-hundred and thirty-one students were invited to participate. Forty-one students elected to complete the curriculum and eighty served as the control group (response rate = 52%). Participants in both conditions completed questionnaires assessing aspects of caring for patients with SMI at pre-test, 1-week post-curriculum, and at 3-month follow-up. RESULTS: Results indicated that participants in the curriculum reported improved attitudes, beliefs, and behavior in working with SMI as compared with their cohort-matched peers. The majority of these outcomes were maintained at 3-months post-intervention, with effect sizes in the medium to large range. The largest improvement was in behavioral responses to a vignette describing an acute psychiatric emergency. CONCLUSIONS: The present study provides evidence that a contact-based curriculum leads to improvements in the attitudes, beliefs, and behaviors of MS3 students when offered as an adjunctive program following their first year of clinical rotations.

Impact of Treating Depression on Associated Comorbidities: A Systematic Literature Review.

Objective: To identify and summarize data that describe the impact of effectively treating major depressive disorder (MDD) on the severity or risk of serious comorbidities.Data Sources: MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and several congresses were searched. Searches included terms related to MDD, randomized controlled trials (RCTs), and physical comorbidities and were restricted to English-language publications. Searches were conducted in November 2019 for the previous 2 years for conference proceedings; no date restriction was applied to the database searches.Study Selection: Included studies were RCTs or meta-analyses that assessed depression therapies. Studies were required to report a statistically significant improvement in depression scores as well as the concurrent impact on comorbidities. A total of 1,997 articles were initially identified for screening.Data Extraction: Two investigators extracted data and assessed study quality.Results: A total of 30 studies, including 24 RCTs (N = 6,333) and 6 meta/pooled analyses of RCTs, were included. Findings in several comorbidity categories were mixed; for example, in half (4 of 8) of the identified studies in people with cardiovascular disease and depression, individuals who received treatment leading to reduced depressive symptoms compared with a control arm also had a significantly decreased incidence of cardiovascular events or significantly improved cardiac disease symptom/severity scores compared with controls. Significant improvements in comorbid disease severity observed alongside improvements in depressive symptoms were also noted in studies of comorbid Parkinson's disease, multiple sclerosis, chronic pain and fibromyalgia, and chronic obstructive pulmonary disease.Conclusions: Effective treatment of MDD may lead to a reduction in the severity of certain serious comorbidities. These results highlight the importance of appropriate and timely treatment of MDD.

Impact of Major Depressive Disorder on Comorbidities: A Systematic Literature Review.

Objective: To summarize the breadth of data exploring the relationship between major depressive disorder (MDD) and both the incidence and the disease course of a range of comorbidities.Data Sources: The authors searched MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and several prespecified congresses. Searches included terms related to MDD and several comorbidity categories, restricted to those published in the English language from 2005 onward.Study Selection: Eligibility criteria included observational studies within North America and Europe that examined the covariate-adjusted impact of MDD on the risk and/or severity of comorbidities. A total of 6,811 articles were initially identified for screening.Data Extraction: Two investigators extracted data and assessed study quality.Results: In total, 199 articles were included. Depression was significantly (P < .05) associated with an increased incidence of dementia and Alzheimer's disease as well as cognitive decline in individuals with existing disease; increased incidence and worsening of cardiovascular disease/events (although mixed results were found for stroke); worsening of metabolic syndrome; increased incidence of diabetes, particularly among men, and worsening of existing diabetes; increased incidence of obesity, particularly among women; increased incidence and worsening of certain autoimmune diseases; increased incidence and severity of HIV/AIDS; and increased incidence of drug abuse and severity of both alcohol and drug abuse.Conclusions: The presence of MDD was identified as a risk factor for both the development and the worsening of a range of comorbidities. These results highlight the importance of addressing depression early in its course and the need for integrating mental and general health care.

Needs and Experiences of Users of Digital Navigation Tools for Mental Health Treatment and Supportive Services: Survey Study.

BACKGROUND: Despite a recent proliferation in web-based and digital resources that are designed to assist users in finding appropriate mental health treatment and supportive services, it can be overwhelming, confusing, and difficult for an individual or family member to access and use an appropriate navigation tool. As digital resources are increasingly sought after, there is an urgent need for a clearer understanding of digital navigation tools in order to help link individuals with the tool that is best suited to their needs. OBJECTIVE: The objective of this study was to determine the needs of individuals seeking mental health treatment and supportive services and to quantify their experiences and satisfaction with available digital navigation tools. METHODS: A survey was offered via an email newsletter and social media posting throughout the extended membership of the National Alliance on Mental Illness, which includes both individuals with a mental health condition and their family members and support networks. A 13-item anonymous survey, which consisted of multiple-choice and open response options, was developed to measure participants' past use of and experiences with web-based, mobile, and phone-based navigation tools. The survey was available from April 9 through May 21, 2020. RESULTS: A total of 478 respondents completed the survey; the majority of respondents were female (397/478, 83.1%) and aged ≥35 years (411/478, 86%). Younger respondents were more likely to report seeking mental health services for themselves, while older respondents were more likely to be searching for such services on behalf of a family member. The majority of respondents seeking such services on behalf of a family member (113/194, 58.2%) required a combination of mental health treatment and supportive services. Furthermore, two-thirds of respondents (322/478, 67.4%) used a navigation tool to find treatment or services. The majority of respondents who provided feedback about their experiences with navigation tools (224/280, 80%) reported difficulties, with data availability and accuracy being the most commonly reported issues. CONCLUSIONS: The survey results suggest that issues with data availability and accuracy in available navigation tools remain a major barrier for locating timely and appropriate mental health treatment and supportive services within the population of individuals seeking such services. Particularly for individuals seeking care on behalf of a family member, improving the accuracy of and users' experiences with navigation tools could have a major impact on effectively connecting people to treatment and support services.

Supporting the Mental Health Workforce During and After COVID-19.

The COVID-19 pandemic has catalyzed structural changes in the public mental health sector, including a shift to telehealth and telesupervision, financial strain for community mental health organizations and clinicians, and risk of burnout among clinicians and staff. This Open Forum considers how technical assistance organizations have supported community mental health providers in adapting to these changes. Moving forward, knowledge gained through this work can help to build the body of practice-based evidence to inform future technical assistance activities in a postpandemic world.

Effectiveness of the NAMI Homefront Program for Military and Veteran Families: In-Person and Online Benefits.

OBJECTIVE: This study aimed to evaluate the effectiveness of Homefront, a six-session, peer-taught family education program by the National Alliance on Mental Illness (NAMI), delivered in person or online, for families or support persons of military service members or of veterans with mental illness. METHODS: Program participants completed online surveys at baseline, at the end of the program (postprogram), and at 3-month follow-up, which measured subjective empowerment, burden, coping, psychological distress, family functioning, experience of caregiving, and knowledge of mental illness. A mixed-effects model examined change over time. RESULTS: A total of 119 individuals (in person, N=63 [53%]; online, N=56 [47%]) enrolled. Participants showed statistically significant improvement on all dimensions between baseline, postprogram, and follow-up, except for subjective burden, which improved between baseline and follow-up. Results for in-person and online formats did not differ. CONCLUSIONS: The six-session NAMI Homefront program was associated with benefits for military and veteran family members and support persons.