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1.
Adm Policy Ment Health ; 51(1): 134-143, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37962714

RESUMEN

The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.


Asunto(s)
Servicios de Salud Mental , Salud Mental , Humanos , Estados Unidos , Empleo , Consejo , Personal de Salud/psicología
2.
Psychiatr Serv ; 74(10): 1027-1036, 2023 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-36987709

RESUMEN

OBJECTIVE: Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness. METHODS: Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models. RESULTS: Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high. CONCLUSIONS: Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care.


Asunto(s)
Trastornos Mentales , Servicios de Salud Mental , Humanos , Adulto , Pacientes no Asegurados , Salud Mental , Autocuidado , Trastornos Mentales/terapia
3.
Psychosom Med ; 85(4): 341-350, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-36961349

RESUMEN

OBJECTIVE: Sexual and physical abuse are highly prevalent among women living with HIV (WLWH) and are risk factors for the development of mental health and substance use disorders (MHDs, SUDs), and cognitive and medical comorbidities. We examined empirically derived patterns of trauma, MHD, and SUD, and associations with later cognitive and health outcomes. METHODS: A total of 1027 WLWH (average age = 48.6 years) in the Women's Interagency HIV Study completed the World Mental Health Composite International Diagnostic Interview from 2010 to 2013 to identify MHDs, SUDs, and age at onset of sexual and physical abuse. Then, cognitive impairment, cardiovascular/metabolic conditions, and HIV disease outcomes were assessed for up to 8.8 years. Latent class analysis identified patterns of co-occurring trauma, MHDs, and/or SUDs. Generalized estimating equations determined associations between these patterns and midlife cognitive and medical outcomes. RESULTS: Six distinct profiles emerged: no/negligible sexual/physical trauma, MHD, or SUD (39%); preadolescent/adolescent sexual trauma with anxiety and SUD (22%); SUD only (16%); MHD + SUD only (12%); early childhood sexual/physical trauma only (6%); and early childhood sexual/physical trauma with later MHD + SUD (4%). Profiles including early childhood trauma had the largest number of midlife conditions (i.e., cognitive, cardiovascular, HIV-related). Preadolescent/adolescent sexual trauma with anxiety and SUD predicted both global and domain-specific cognitive declines. Only SUD without trauma predicted lower CD4, whereas childhood trauma with MHD + SUD predicted increased CD8. CONCLUSIONS: WLWH have complex multisystem profiles of abuse, MHD, and/or SUD that predict midlife cognitive, metabolic/cardiovascular, and HIV outcomes. Understanding the interplay between these factors over time can identify risks and personalize preventative and treatment interventions.


Asunto(s)
Infecciones por VIH , Trastornos Relacionados con Sustancias , Preescolar , Adolescente , Humanos , Femenino , Niño , Persona de Mediana Edad , Longevidad , Trastornos Relacionados con Sustancias/epidemiología , Morbilidad , Comorbilidad , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones
5.
AIDS ; 37(2): 259-269, 2023 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-36541638

RESUMEN

OBJECTIVE: To describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHDs). DESIGN: Observational study of participants in the North American AIDS Cohort Collaboration on Research and Design. METHODS: PWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008 to 2018 based on International Classification of Diseases code mapping. Mental health (MH) multimorbidity was defined as having two or more MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥1 visit/year) and viral suppression (HIV RNA ≤200 copies/ml) by presence vs. absence of each MHD between 2016 and 2018. RESULTS: Among 122 896 PWH, 67 643 (55.1%) were diagnosed with one or more MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008 and 2018, whereas bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016 to 2018 (N = 64 684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR = 0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR = 0.99 [0.99-1.00]) compared with PWH without MHD. CONCLUSION: The prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.


Asunto(s)
Infecciones por VIH , Trastornos Mentales , Humanos , Salud Mental , Prevalencia , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Trastornos Mentales/epidemiología , Trastornos de Ansiedad/epidemiología , Continuidad de la Atención al Paciente
6.
Psychiatr Serv ; 74(5): 463-471, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-36377367

RESUMEN

OBJECTIVE: The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS: Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS: Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS: NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.


Asunto(s)
Ejercicio Físico , Estilo de Vida , Humanos , Pérdida de Peso
7.
Psychiatr Serv ; 74(5): 480-487, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-36254454

RESUMEN

OBJECTIVE: The authors sought to determine whether staff at a peer-run agency could deliver supported employment services with high fidelity to the individual placement and support (IPS) model and whether employment outcomes of peer-delivered IPS plus work-specific health promotion were superior to usual supported employment services. METHODS: Two teams from a vocational program of a large peer-run agency were studied from July 2015 to July 2017. One team received training and supervision in delivering IPS plus employment-focused physical wellness support and mentoring. The other team continued providing usual supported employment services. Study data included vocational outcomes from 348 clients served by the two teams (IPS, N=184; comparison condition, N=164) and the results of IPS fidelity reviews of the IPS team at study baseline, midpoint, and end. The authors modeled the primary outcome of competitive employment with random-effects logistic regression and adjusted propensity scores for age, gender, race, ethnicity, education, and months of service receipt. RESULTS: Following training, the IPS team demonstrated acceptable and increasing fidelity to the IPS model, achieving "good fidelity" by the end of the 25-month observation period. Among IPS recipients, 43% achieved competitive employment versus 21% of comparison recipients (p<0.001). Multivariable analysis indicated that IPS recipients were significantly more likely to achieve competitive employment than individuals in the comparison group (OR=4.06, p<0.001). CONCLUSIONS: Providing training in IPS along with health promotion to the behavioral health peer workforce may help address the severe shortage of IPS services and enhance the competitive employment outcomes of people served by peer-run programs.


Asunto(s)
Empleos Subvencionados , Trastornos Mentales , Humanos , Rehabilitación Vocacional/métodos , Trastornos Mentales/terapia , Salud Mental , Promoción de la Salud
8.
Psychiatr Serv ; 73(11): 1239-1247, 2022 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-35734863

RESUMEN

OBJECTIVE: A 3-year study explores employment outcomes of certified peer specialists (CPSs). Analyses reported here identified relationships between demographic, clinical, work history, and geographic characteristics and employment status and current employment in peer services jobs versus other jobs. METHODS: The study recruited adults who recently became a CPS, regardless of current employment status, in four states. Online survey data were collected from March to October 2020 and included demographic information, health status and diagnoses, mental health service use, motivations for becoming certified, employment history, and job characteristics, including job satisfaction. Descriptive statistics and logistic regression models were used to compare groups. RESULTS: Of 681 respondents, 591 provided data on current employment and were included. Participants who received Social Security Disability Insurance or Supplemental Security Income, veterans, those who used outpatient counseling or therapy, and those who did not disclose their mental health status in the workplace were less likely to report current employment. Lack of disclosure and higher local unemployment rates contributed to a lower likelihood of working in peer services jobs, whereas individuals reporting depressive disorders were more likely to hold such jobs. Compared with those in other jobs, those in peer services jobs reported longer job tenure, and a larger proportion received employee benefits. Job satisfaction was significantly higher among those with peer services jobs. CONCLUSIONS: Workers with a CPS credential had higher employment rates, compared with adults with psychiatric disabilities, and the quality of peer specialist jobs was equal to or higher than the quality of other jobs held by study participants.


Asunto(s)
Empleo , Servicios de Salud Mental , Adulto , Humanos , Desempleo/psicología , Grupo Paritario , Certificación
9.
J Gerontol B Psychol Sci Soc Sci ; 77(1): 39-49, 2022 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33945614

RESUMEN

OBJECTIVES: Connections to the gay community may elicit negative self-appraisals among men who have sex with men (MSM), which may be exacerbated for people with HIV (PWH). Fitness engagement may mediate self-appraisals by maintaining or improving appearance and health. We hypothesized that gay community connections would be positively related to negative self-appraisal and explored whether this association would be mediated by fitness engagement and moderated by HIV status. METHOD: Data were obtained from the Multicenter AIDS Cohort Healthy Aging study (N = 1,026; PWH n = 525; people without HIV [PWOH] n = 501). Structural equation modeling (SEM) examined associations between gay community connections, negative self-appraisal (body image dissatisfaction, self-perception of aging), and fitness engagement (physical activity, motivation to be fit). Multiple-group SEM tested the moderating effects of HIV serostatus. RESULTS: The SEM fit the data well (root mean square error of approximation = 0.056; 90% CI: 0.046, 0.066). Connection to the gay community was inversely related to negative self-appraisals and positively related to fitness engagement. Fitness engagement mediated the association between community connections and negative self-appraisal and was inversely related to negative self-appraisals. Among PWH, the association between community connections and self-appraisal was weaker and the effect of fitness engagement on negative self-appraisal was stronger compared to PWOH. DISCUSSION: Connection to the gay community may be a source of resilience for aging MSM by lessening negative self-appraisals and promoting strategies that address body image dissatisfaction and self-perceptions of aging. Interventions facilitating connections to the gay community may support healthy aging in this population.


Asunto(s)
Envejecimiento/psicología , Ejercicio Físico/psicología , Homosexualidad Masculina/psicología , Autoimagen , Minorías Sexuales y de Género/psicología , Identificación Social , Apoyo Social , Anciano , Insatisfacción Corporal/psicología , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Aptitud Física/fisiología , Resiliencia Psicológica
10.
Psychiatr Rehabil J ; 45(1): 11-17, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34672640

RESUMEN

OBJECTIVE: Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. METHOD: Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April-May 2020. Multivariable analysis examined the effects of sleep and dietary changes, COVID-19 exposure, anxiety (Generalized Anxiety Disorder-2), and depressive symptoms (Patient Health Questionnaire-2) on employment status and job changes. Respondents' open-ended descriptions of pandemic-related changes in employment were analyzed using the constant comparative method. RESULTS: Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work's positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study to suggest the important role that work played for people with preexisting behavioral health disorders during the pandemic, with both positive and negative influences, and important implications for services and supports. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Asunto(s)
Trastornos de Ansiedad , COVID-19 , Depresión , Empleo , Pandemias , Adulto , Trastornos de Ansiedad/epidemiología , COVID-19/psicología , Depresión/epidemiología , Humanos
11.
Psychiatr Serv ; 72(8): 912-919, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33887953

RESUMEN

OBJECTIVE: Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education. METHODS: This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight preimplementation study quarters, controlling for clinic site and preimplementation secular trends. RESULTS: Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%. CONCLUSIONS: Significant improvement in medical outcomes was found among patients of a behavioral health home who had comorbid diabetes and mental illness after introduction of a multicomponent care coordination intervention, regardless of which clinic they attended.


Asunto(s)
Diabetes Mellitus Tipo 2 , Trastornos Mentales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/análisis , Humanos , Programas Controlados de Atención en Salud , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Sistema de Registros
12.
Transl Behav Med ; 11(5): 1162-1171, 2021 05 25.
Artículo en Inglés | MEDLINE | ID: mdl-33739399

RESUMEN

People with behavioral health disorders may be particularly vulnerable to the impact of the COVID-19 pandemic, yet little is known about how they are faring. A mixed-methods, anonymous needs assessment was conducted to understand changes in the lives of adults with mental health and substance use disorders since the pandemic onset. A cross-sectional, online survey was completed by 272 adults in April and May 2020, recruited from statewide networks of community programs in New Jersey and New York. Measures included the Patient Health Questionnaire-2 and the Generalized Anxiety Disorder-2 to screen for depressive and anxiety disorders. Also assessed was the pandemic's impact on sleep and dietary patterns, exposure to COVID-19 infection, and access to health care and medications. Finally, respondents were asked to describe in their own words any changes in their lives since the pandemic began. Over one-third (35.1%) screened positive for generalized anxiety disorder and over one-quarter (29.6%) screened positive for major depressive disorder. The majority reported pandemic-related changes in eating and sleeping patterns and exposure to COVID-19 infection. Multivariable logistic regression analysis found that many changes attributed to the pandemic were positively and significantly associated with screening positive for anxiety and depressive disorders. Qualitative analysis confirmed these findings and identified participants' resilience stemming from social support, emotion management, and self-care. These results can inform the design of services that assist this population to bolster self-management skills and reestablish daily habits to improve their lives during and following the pandemic.


Asunto(s)
Trastornos de Ansiedad/psicología , COVID-19/psicología , Trastorno Depresivo Mayor/psicología , Salud Mental , Adulto , Estudios Transversales , Conducta Alimentaria , Humanos , New Jersey/epidemiología , New York/epidemiología , Pandemias , Sueño
13.
Gen Hosp Psychiatry ; 70: 10-17, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33639449

RESUMEN

OBJECTIVE: Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood. METHODS: Using the Truven Health Analytics MarketScan® Medicaid Multi-State Database, we studied 43,817 Medicaid beneficiaries, age 18-64, following discharge from medical hospitalizations in 2011. Logistic regression models compared all-cause, 30-day readmissions among those with SMI, OMH, and no psychiatric diagnosis, and examined associations of 30-day outpatient service use with 30-day readmissions. RESULTS: Thirty-day readmission rates were 15.9% (SMI), 13.8% (OMH), and 11.7% (no mental illness). In multivariable analysis, compared to patients without mental illness, odds of readmission were greater for those with SMI (aOR = 1.43, 95%CI:1.32-1.51) and OMH (aOR = 1.21, 95%CI:1.12-1.30), and lower among those using outpatient mental health services (aOR = 0.50, 95%CI: 0.44-0.56). CONCLUSION: The adult Medicaid population disproportionately includes patients with SMI and OMH disorders, both of which were found to be associated with 30-day hospital readmissions. Receiving outpatient mental health services after hospital discharge may be protective against readmission following medical hospitalizations, suggesting the need for further research on these topics.


Asunto(s)
Trastornos Mentales , Readmisión del Paciente , Adolescente , Adulto , Cuidados Posteriores , Atención Ambulatoria , Atención a la Salud , Hospitalización , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Salud Mental , Persona de Mediana Edad , Pacientes Ambulatorios , Alta del Paciente , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
15.
Psychiatr Serv ; 71(10): 1039-1046, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32838676

RESUMEN

OBJECTIVE: Adults with serious mental illness have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with comorbid illnesses, especially when instructors are certified peer specialists. This study assessed the longitudinal effectiveness of a peer-delivered health promotion program. METHODS: Community mental health program clients in Georgia and Illinois with serious mental illness and health impairments were randomly assigned to receive either Whole Health Action Management (WHAM), a medical illness self-management program led by peer specialists, or care as usual, resulting in a sample of N=139 (WHAM N=68, control N=71). Assessments were conducted at study baseline and at 3 and 6 months. Generalized estimating equations were used to examine change over time in the primary outcome of patient activation and secondary outcomes of general health, hope, and employment. RESULTS: Longitudinal analysis indicated that compared with control participants, WHAM participants demonstrated significantly greater improvement over time in patient activation for health care. Intervention participants also demonstrated greater improvement in their self-assessed general health, overall hopefulness, and paid employment. Reactions to the WHAM program were positive, with 97% reporting being very or somewhat satisfied, and almost two-thirds (63%) reporting that their health was better than before they joined the program. CONCLUSIONS: The WHAM program improved patient activation, perceived general medical health, hopefulness, and likelihood of paid employment among people with serious mental illness and co-occurring medical conditions. Results suggest that peer-delivered health self-management education is effective and well received by participants.


Asunto(s)
Trastornos Mentales , Adulto , Estudios Transversales , Georgia , Promoción de la Salud , Humanos , Illinois , Trastornos Mentales/terapia , Multimorbilidad
16.
Psychiatry Res ; 291: 113168, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32619823

RESUMEN

While evidence suggests that adults with serious mental illness have an elevated rate of 30-day readmissions after medical hospitalizations, most studies are of patients who are privately insured or Medicare beneficiaries, and little is known about the differential experiences of people with schizophrenia, bipolar disorder, and major depression. We used the Truven Health Analytics MarketScan® Medicaid Multi-State Database to study 43,817 Medicaid enrollees from 11 states, age 18-64, who were discharged from medical hospitalizations in 2011. Our outcome was unplanned all-cause readmissions within 30 days of discharge. In a multivariable analysis, compared to those with no SMI, people with schizophrenia had the highest odds of 30-day readmission (aOR: 1.46, 95% CI: 1.33-1.59), followed by those with bipolar disorder (aOR: 1.25, 95% CI: 1.14-1.38), and those with major depressive disorder (aOR: 1.18, 95% CI: 1.06-1.30). Readmissions also were more likely among those with substance use disorders, males, those with Medicaid eligibility due to disability, patients with longer index hospitalizations, and those with 2 or more medical co-morbidities. This is the first large-scale study to demonstrate the elevated risk of hospital readmission among low-income, working-age adults with schizophrenia. Given their greater psychological, social, and economic vulnerability, our findings can be used to design transition interventions and service delivery systems that address their complex needs.


Asunto(s)
Trastorno Bipolar/epidemiología , Trastorno Depresivo Mayor/epidemiología , Medicaid/tendencias , Readmisión del Paciente/tendencias , Esquizofrenia/epidemiología , Adulto , Anciano , Trastorno Bipolar/economía , Trastorno Bipolar/terapia , Comorbilidad , Bases de Datos Factuales/tendencias , Trastorno Depresivo Mayor/economía , Trastorno Depresivo Mayor/terapia , Femenino , Hospitalización/tendencias , Humanos , Masculino , Medicaid/economía , Persona de Mediana Edad , Esquizofrenia/economía , Esquizofrenia/terapia , Trastornos Relacionados con Sustancias/economía , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Estados Unidos/epidemiología
17.
Psychiatr Serv ; 70(3): 191-201, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30630401

RESUMEN

OBJECTIVE: Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. METHODS: Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixed-effects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models. RESULTS: Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups. CONCLUSIONS: The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.


Asunto(s)
Trastornos Mentales/rehabilitación , Servicios de Salud Mental/economía , Servicios de Salud Mental/normas , Autocuidado/métodos , Adulto , Costos y Análisis de Costo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Satisfacción Personal , Calidad de Vida
18.
AIDS Behav ; 22(10): 3141-3154, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29460130

RESUMEN

We used the World Health Organization's Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women's race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Infecciones por VIH/epidemiología , Trastornos del Humor/epidemiología , Asunción de Riesgos , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Trastornos de Ansiedad/diagnóstico , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Trastornos del Humor/diagnóstico , Prevalencia , Conducta Sexual , Estados Unidos/epidemiología
19.
Psychol Assess ; 30(1): 97-105, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28230409

RESUMEN

The prevalence of depression among women living with HIV/AIDS is elevated, compared with women in the general population and men diagnosed with HIV/AIDS. Although symptoms of HIV may overlap with somatic symptoms of depression, little research has explored how well screening tools accurately assess depression rather than symptoms of HIV/AIDS among women. The present study examined the utility of a widely used tool for assessing depression symptoms among women living with HIV/AIDS. Data are from the Women's Interagency HIV Study (WIHS), a multisite, longitudinal cohort study of women living with HIV/AIDS (n = 1,329) and seronegative women (n = 541) matched on key risk factors for HIV/AIDS. Confirmatory factor analysis-based measurement invariance tests of the Center for Epidemiologic Studies Depression Scale (CES-D) were conducted to determine whether women with HIV and those without HIV responded to the scale similarly. Results supported measurement invariance of CES-D scores. Findings suggest that the CES-D can be used to assess for burden of depression symptoms among women diagnosed with HIV/AIDS. (PsycINFO Database Record


Asunto(s)
Depresión/diagnóstico , Trastorno Depresivo/diagnóstico , Infecciones por VIH/psicología , Escalas de Valoración Psiquiátrica/normas , Adulto , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Reproducibilidad de los Resultados , Riesgo
20.
Psychiatr Rehabil J ; 40(4): 343, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29265859

RESUMEN

As the authors complete the 2017 publication cycle of Psychiatric Rehabilitation Journal and their term as editors draws to a close, they take the opportunity to welcome the new leadership of PRJ, to thank the many people who have contributed to its success, and to reflect on the importance of the journal's focus and scope to the field. They are pleased to welcome Dr. Sandra ("Sandy") Resnick as the new editor of PRJ, who will begin her incoming term by accepting new manuscripts starting January 1, 2018. In her role as Editor, Dr. Resnick hopes to further increase PRJ's accessibility to both practitioners and policymakers, while maintaining the high-quality of original research submissions that have led to widely cited articles in the field. (PsycINFO Database Record


Asunto(s)
Publicaciones Periódicas como Asunto , Rehabilitación Psiquiátrica , Edición/normas , Políticas Editoriales , Humanos , Mejoramiento de la Calidad
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