RESUMEN
Behavioral health crisis care (BHCC) is a care delivery model for individuals experiencing acute distress related to a mental health or substance use disorder. We examined market factors associated with comprehensive BHCC availability using 2022 data on mental health treatment facilities (n = 9385) obtained from the Substance Abuse and Mental Health Services Administration. We aggregated facility-level data by county (n = 3142) and merged with county-level market factors. Logistic regression models were used to examine the adjusted associations between market factors and BHCC availability. We found that 468 (14.9%) counties had at least one mental health treatment facility offering comprehensive BHCC services. Specifically, counties with more mental health providers (Adjusted Odds Ratio = 2.26, Confidence Interval = 1.32-3.86) and metropolitan counties (AOR = 3.26, CI = 1.95-5.43) had higher odds of having a comprehensive BHCC facility. Our findings highlight the importance of developing the mental health workforce to increase BHCC availability and a need to address disparities in rural counties.
Asunto(s)
Accesibilidad a los Servicios de Salud , Trastornos Mentales , Servicios de Salud Mental , Humanos , Estados Unidos , Servicios de Salud Mental/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Trastornos Relacionados con Sustancias/epidemiología , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , United States Substance Abuse and Mental Health Services AdministrationRESUMEN
BACKGROUND: Hurricane Harvey was the second costliest storm to impact the U.S. More research is needed to understand the mental health consequences of these extreme events in children and adolescents extending beyond the acute recovery period. METHODS: Daily anonymized Crisis Text Line (CTL) conversations were used to understand patterns in crisis responses for youth one year before and after Harvey's landfall. A quasi-experimental difference-in-differences analysis compared changes in texts for stress/anxiety, depression, thoughts of suicide, and self-harm following Harvey between exposed and unexposed youth in Texas. RESULTS: CTL users with Texas-based area codes (N = 23,016) were compriesd largely of youth who self-identified as female (78.1 %), 14-17 year old (50.4 %), white (38.9 %), and LGBTQ+ (51.2 %). We observed parallel increases in crisis texts for depression and thoughts of suicide in most months following Harvey among exposed and unexposed youth. However, non-impacted youth had significantly larger increases in texts for depression up to three months post-Harvey and thoughts of suicide one year after Harvey compared to directly impacted communities. LIMITATIONS: Sample size was restricted to texters who completed the post-conversation demographics survey, who may fundamentally differ from those who declined to respond. Harvey exposure was determined using texter area code and county-level disaster declarations, limiting our ability to guarantee individual-level exposure. CONCLUSIONS: Texas youth traditionally considered unexposed experienced nearly identical increases in concerns of depression and thoughts of suicide to those directly exposed. Findings suggest spillover effects (e.g., economic concerns, media exposure) may contribute to statewide impacts on youth mental health after natural disasters.
Asunto(s)
Tormentas Ciclónicas , Depresión , Desastres , Humanos , Adolescente , Texas/epidemiología , Femenino , Masculino , Depresión/epidemiología , Depresión/psicología , Ideación Suicida , Estrés Psicológico/psicología , Estrés Psicológico/epidemiología , Ansiedad/epidemiología , Ansiedad/psicología , Niño , Envío de Mensajes de Texto/estadística & datos numéricos , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricosRESUMEN
Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care.
Asunto(s)
Trastornos Mentales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Trastornos Mentales/epidemiología , Trastornos Mentales/diagnóstico , Estados Unidos/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/diagnóstico , Anciano , Adulto Joven , Veteranos/estadística & datos numéricos , Trastornos Somatomorfos/epidemiología , Trastornos Somatomorfos/diagnóstico , Líneas Directas/estadística & datos numéricos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricosRESUMEN
INTRODUCTION: This study identifies changes in Veterans Crisis Line (VCL) contact volume following the 988 National Suicide Prevention Hotline rollout, and examines changes in contact volume for self-identified Veterans. METHODS: VCL's Medora database was analyzed from July 2018 to June 2023, fitting linear interrupted time series models to forecast trends after the July 2022 rollout of the 988 Suicide Prevention Hotline. Data analysis was performed from 2023 to 2024. RESULTS: After the 988 rollout, average monthly VCL contact volume increased by 5,388 contacts (8.2%). The number of contacts self-identifying as Veterans increased by 2,739 (6.2%), while the percentage of self-identifying Veteran contacts who could be linked to VHA records declined by 3.8%. CONCLUSIONS: The 988 rollout was associated with increased VCL contact volume and broad changes in the profile of users. This underscores the importance of crisis services in adapting to dynamic user needs and highlights the potential of national suicide prevention initiatives to reach diverse populations.
Asunto(s)
Líneas Directas , Prevención del Suicidio , United States Department of Veterans Affairs , Veteranos , Humanos , Veteranos/estadística & datos numéricos , Veteranos/psicología , Líneas Directas/estadística & datos numéricos , Estados Unidos/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Análisis de Series de Tiempo Interrumpido , Suicidio/estadística & datos numéricos , Suicidio/tendenciasRESUMEN
OBJECTIVE: Crisis services are undergoing an unprecedented expansion in the United States, but research is lacking on crisis system design. This study describes how individuals flow through a well-established crisis system and examines factors associated with reutilization of such services. METHODS: This cross-sectional study used Medicaid claims to construct episodes describing the flow of individuals through mobile crisis, specialized crisis facility, emergency department, and inpatient services. Claims data were merged with electronic health record (EHR) data for the subset of individuals receiving care at a crisis response center. A generalized estimating equation was used to calculate adjusted odds ratios for demographic, clinical, and operational factors associated with reutilization of services within 30 days of an episode's end point. RESULTS: Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset (N=9,202 episodes) with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. CONCLUSIONS: Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.
Asunto(s)
Intervención en la Crisis (Psiquiatría) , Medicaid , Humanos , Masculino , Estudios Transversales , Femenino , Estados Unidos , Adulto , Medicaid/estadística & datos numéricos , Persona de Mediana Edad , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Adulto Joven , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adolescente , Trastornos Mentales/terapia , Servicios de Urgencia Psiquiátrica/estadística & datos numéricos , Registros Electrónicos de Salud/estadística & datos numéricos , Unidades Móviles de Salud/estadística & datos numéricosRESUMEN
OBJECTIVES: Crisis pregnancy centers (CPCs) are nonprofit antiabortion organizations that claim provision of pregnancy resources. With the Reproduction Freedom, Accountability, Comprehensive Care, and Transparency Act repealed, CPCs are no longer mandated to share information on state-funded family planning and abortion services. As patients increasingly seek healthcare guidance online, we evaluated crowd-sourced reviews of CPCs using the social networking site Yelp. METHODS: CPCs were identified with the CPC Map, a geo-based location resource. Of California's 145 CPCs, 84% had Yelp pages, and 619 reviews (2010-2019) were extracted. Thematic codes were individually applied to 220 excerpts and then analyzed in detail using thematic analysis to capture emergent themes related to motivations for and experiences of CPCs. To ensure thematic saturation, we applied a natural language-processing technique called the meaning extraction method to computationally derive themes of discussion from all of the extracted posts. RESULTS: Motivations to seek care from CPCs included pregnancy confirmation, gaps in healthcare coverage, parenting and emotional support, and abortion care. A review of experiences reveal that CPC faith-based practice garnered both positive- and negative-based experiences. Reviewers also articulated inaccurate medical information, lack of transparency, and reduced options at CPCs. CONCLUSIONS: This is the first study to analyze California CPCs using a social media platform. Pregnant patients turn to social media to share experiences about pregnancy resources, to find healthcare providers, and to increase transparency of services. This content provides valuable insight into the concerns of pregnant patients and offers an intimate view of California CPCs at a time when no federal regulations are in place.
Asunto(s)
Aborto Inducido/psicología , Intervención en la Crisis (Psiquiatría)/normas , Acontecimientos que Cambian la Vida , Satisfacción del Paciente/estadística & datos numéricos , Aborto Inducido/métodos , Adolescente , Adulto , California , Intervención en la Crisis (Psiquiatría)/métodos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Colaboración de las Masas/métodos , Colaboración de las Masas/estadística & datos numéricos , Femenino , Humanos , Internet , Motivación , EmbarazoAsunto(s)
Codificación Clínica/métodos , Intervención en la Crisis (Psiquiatría) , Intento de Suicidio , Intervención en la Crisis (Psiquiatría)/métodos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Inglaterra/epidemiología , Humanos , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/normas , Mejoramiento de la Calidad , Ideación Suicida , Intento de Suicidio/prevención & control , Intento de Suicidio/psicología , Intento de Suicidio/estadística & datos numéricosRESUMEN
BACKGROUND: Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors. METHODS: This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017. RESULTS: We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions. CONCLUSIONS: These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.
Asunto(s)
Alcoholismo/terapia , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Behavioral economic theory predicts that low access to environmental reward is a risk factor for alcohol use disorder (AUD). The Substance-Free Activity Session (SFAS) is a behavioral economic supplement to standard brief alcohol interventions that attempts to increase environmental reward and may therefore have beneficial effects, particularly for individuals with low levels of environmental reward. METHODS: Participants were 393 college students who reported at least 2 heavy-drinking episodes in the past month. Participants were randomly assigned to 1 of 3 conditions following a baseline assessment: a standard alcohol-focused brief motivational intervention plus relaxation training session (BMI + RT), BMI plus Substance-Free Activity Session (BMI + SFAS), or an assessment-only control condition (AO). In a secondary analysis of the data from this study, we used person-centered statistical techniques to describe trajectories of alcohol severity and environmental reward over a 16-month follow-up and examined whether environmental reward levels moderated the effectiveness of the interventions. RESULTS: Piecewise growth mixture modeling identified 2 trajectories of reward availability: low increasing (LR; n = 120) and high stable (HR; n = 273). Depressive symptoms, cannabis use, sensation seeking, and low life satisfaction were associated with a greater probability of classification in the LR trajectory. Alcohol severity was greater in the LR trajectory than the HR trajectory. For students in the LR trajectory, at 1, 6, and 12 months, BMI + SFAS led to greater increases in reward availability and reduced levels of alcohol severity compared with the BMI + RT and AO conditions and at 16 months compared with AO. CONCLUSIONS: Young adults with low levels of environmental reward are at heightened risk for greater alcohol severity and may show greater benefit from brief alcohol interventions that focus on increasing substance-free reward than individuals who are not deficient in reward availability.
Asunto(s)
Consumo de Alcohol en la Universidad/psicología , Alcoholismo/psicología , Alcoholismo/terapia , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Recompensa , Índice de Severidad de la Enfermedad , Adolescente , Trastornos Relacionados con Alcohol/epidemiología , Alcoholismo/epidemiología , Depresión/epidemiología , Etnicidad , Femenino , Humanos , Masculino , Abuso de Marihuana , Motivación , Adulto JovenRESUMEN
Pediatrician Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices vary widely, though little is known about the correlates of SBIRT implementation. Using data from a national sample of US pediatricians who treat adolescents (n = 250), we characterized self-reported utilization rates of SBIRT among US pediatricians and identified provider- and practice-level characteristics and barriers associated with SBIRT utilization. All participants completed an electronic survey querying the demographics, practice patterns, and perceived barriers related to SBIRT practices. Our results showed that 88% of respondents reported screening for substance use annually, but only 26% used structured/validated screening instruments. Furthermore, 40% of respondents provided evidence-based brief interventions, and only 11% implemented all core SBIRT practices. Common barriers (eg, confidentiality and insufficient time) and unique provider- and setting-specific barriers to implementation were identified. These findings indicate that although most pediatricians deliver some SBIRT components in their practice, few implement the full SBIRT model, and barriers persist.
Asunto(s)
Intervención en la Crisis (Psiquiatría)/métodos , Tamizaje Masivo/métodos , Pediatras/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapia , Adolescente , Conducta del Adolescente , Confidencialidad , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Humanos , Trastornos Relacionados con Sustancias/prevención & control , Tiempo , Estados UnidosRESUMEN
OBJECTIVES: The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN: We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING: An urban safety-net hospital ICU. PATIENTS: All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS: Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.
Asunto(s)
COVID-19/terapia , Intervención en la Crisis (Psiquiatría)/normas , Asignación de Recursos/métodos , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Intervención en la Crisis (Psiquiatría)/métodos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Massachusetts , Persona de Mediana Edad , Asignación de Recursos/estadística & datos numéricos , Estudios Retrospectivos , Proveedores de Redes de Seguridad/organización & administración , Proveedores de Redes de Seguridad/estadística & datos numéricos , Nivel de Atención/normas , Nivel de Atención/estadística & datos numéricos , Población Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD. METHODS: Using 2015-2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity. RESULTS: Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6-8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7-82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9-70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0-12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6-5.6%) who were referred to treatment, and 5.8% (95% CI 5.4-6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity. CONCLUSIONS: Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings-particularly primary care settings-represent a prime opportunity to implement AUD treatment to improve outcomes in this high-risk population.
Asunto(s)
Alcoholismo/epidemiología , Alcoholismo/terapia , Adolescente , Adulto , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Prevalencia , Derivación y Consulta , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Between March and May 2020, the Spanish Ministry of Health and the Spanish Psychological Association created the Psychological First Care Service (Servicio de Primera Ayuda Psicológica-SPAP), a national helpline designed to provide early psychological intervention to those people affected by COVID-19. This service attended more than 15,000 calls and carried out more than 11,000 interventions and 9,500 follow-ups with the general population, healthcare and other essential professionals and the patients and relatives of the sick or deceased. Results show that the majority of calls (45.7%) came from the Autonomous Community of Madrid, that women significantly used this service in a higher proportion than men (73.5%) and that the commonest age range among users was 40-59. 75.9% of consultations were related to psychological problems linked to anxiety and depressive symptoms. However, grief symptoms also stood out among the patients or relatives of the sick and deceased and, to a lesser extent, stress symptoms were prevalent in the group of professionals. These data show the usefulness of this early psychological care service and the need for similar resources to be implemented in coordination with or within the National Health System.
Entre marzo y mayo de 2020, el Ministerio de Sanidad y el Consejo General de la Psicología de España, pusieron en marcha el Servicio de Primera Ayuda Psicológica (SPAP), un servicio telefónico para toda España, diseñado para proveer atención psicológica temprana a las personas afectadas por la COVID-19. En el tiempo en que el servicio estuvo disponible, se gestionaron 15.170 llamadas, que condujeron a realizar 11.417 intervenciones psicológicas con personal sanitario y otros intervinientes, con enfermos y familiares de enfermos o fallecidos, y población general. Los resultados muestran que la mayoría de llamadas (45,7%) provenían de la Comunidad Autónoma de Madrid, que hubo significativamente más mujeres que utilizaron el servicio (73,5%) y que el rango de edad más común entre los usuarios era el de 40-59 años. El 75,9% de las consultas tuvo que ver con problemas psicológicos relacionados con sintomatología ansiosa y depresiva, aunque también destacaba la sintomatología de duelo entre los enfermos o familiares de enfermos y fallecidos y, en menor medida, la sintomatología de estrés en el grupo de intervinientes. Estos datos muestran la necesidad de este servicio de atención psicológica temprana y sugieren que recursos como este deberían implementarse de manera integrada en el Sistema Nacional de Salud.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/psicología , Intervención en la Crisis (Psiquiatría)/métodos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Neumonía Viral/psicología , Telemedicina/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/terapia , COVID-19 , Niño , Infecciones por Coronavirus/terapia , Intervención en la Crisis (Psiquiatría)/organización & administración , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Depresión/epidemiología , Depresión/etiología , Depresión/terapia , Femenino , Pesar , Humanos , Masculino , Servicios de Salud Mental/organización & administración , Persona de Mediana Edad , Programas Nacionales de Salud , Pandemias , Neumonía Viral/terapia , Prevalencia , SARS-CoV-2 , España/epidemiología , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Teléfono , Adulto JovenRESUMEN
BACKGROUND: Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. METHOD: Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. RESULTS: Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. CONCLUSIONS: Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/terapia , Servicios de Salud Mental/estadística & datos numéricos , Adulto , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Quebec , Encuestas y Cuestionarios , Adulto JovenAsunto(s)
COVID-19/epidemiología , COVID-19/prevención & control , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Medicina Basada en la Evidencia/normas , COVID-19/diagnóstico , COVID-19/virología , Toma de Decisiones , Humanos , Administración en Salud Pública/métodos , Administración en Salud Pública/estadística & datos numéricos , Política Pública/legislación & jurisprudencia , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificaciónRESUMEN
The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work-related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co-workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self-identity. Work-related critical incident stress has implications for nurses, the discipline, and the health care system.
Asunto(s)
Intervención en la Crisis (Psiquiatría)/métodos , Estrés Laboral/complicaciones , Alberta , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Enfermería de Cuidados Críticos/normas , Hermenéutica , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/normas , Estrés Laboral/psicología , Estrés Laboral/terapia , Investigación Cualitativa , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIMS: Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). DESIGN: Multi-center cross-sectional study. SETTING AND PARTICIPANTS: Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. MEASUREMENTS: We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. FINDINGS: A total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians. CONCLUSIONS: In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.
Asunto(s)
Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Adulto , Estudios Transversales , Atención a la Salud , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Fumadores/estadística & datos numéricos , España , Encuestas y Cuestionarios , Tabaquismo/terapiaRESUMEN
OBJECTIVE: Despite the interest in technology-enhanced preventive interventions for suicidality, there is minimal peer-reviewed research on conversations of text message hotlines. In this large-scale study, the authors explored distinct classes of users of the Crisis Text Line who reported suicidality. Classes were based on texters' presenting psychosocial issues and were explored across frequency of hotline use and conversation number. METHODS: Data included 153,514 conversations from 122,909 individuals collected by the Crisis Text Line (2013-2017). Analyses were restricted to conversations from users who mentioned current or previous suicidality and excluded texters who discussed a third party. The authors used latent class analysis to identify distinct classes of texters on the basis of crisis counselor-assigned issue tags and across subgroups reflecting whether the conversation was the first or last contact with the hotline and frequency of use (one-time, two-time, or ≥3-time texters). RESULTS: Three classes emerged in all subsamples. The largest class, "lower distress," had the lowest prevalence of all issues. The second largest class, "anxious distress," had the highest prevalence of anxiety or stress and elevated depression. The smallest class, "relational distress," had the highest prevalence of depression and self-harm and higher probability of endorsing relational indicators. CONCLUSIONS: Psychological and relational issues mostly distinguished the three classes. Despite differing frequency of hotline usage, most texters who reported suicidal ideation and behaviors endorsed similar issues, and these issues did not seem to vary across conversations. Yet there appeared to be distinct subgroups of texters with different presenting issues, which may inform how crisis counselors tailor strategies for both low- and high-volume texters.
Asunto(s)
Ansiedad/epidemiología , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Depresión/epidemiología , Líneas Directas/estadística & datos numéricos , Relaciones Interpersonales , Estrés Psicológico/epidemiología , Ideación Suicida , Envío de Mensajes de Texto/estadística & datos numéricos , Adulto , Humanos , Análisis de Clases Latentes , Distrés PsicológicoRESUMEN
OBJECTIVE: The most common crisis intervention used with German rescue workers is Critical Incident Stress Management (CISM). Results regarding its effectiveness are inconsistent. A negative reinforcement of avoidance, due to premature termination of strong emotions during the Critical Incident Stress Debriefing (CISD), may explain this. The effectiveness of the CISD after terror attacks in Germany has not yet been investigated. METHODS: All emergency responders deployed at the terror attack on Breitscheidplatz in Berlin were invited to take part in the study; 37 of the N = 55 participants had voluntarily participated in CISD; 18 had not. RESULTS: Participants with CISD showed lower quality of life in psychological health and higher depressive symptomatology. Of these, females had lower quality of life in social relationships, whereas males showed more posttraumatic stress symptoms. Emergency responders from non-governmental organizations had higher phobic anxiety. Emergency medical technicians showed more somatic and depressive symptoms. CONCLUSION: There is no conclusive explanation for why rescue workers with CISD score worse on certain measures. It is possible that CISD has a harmful influence due to negative reinforcement, or that there was a selection effect. Further research differentiating occupational group, sex, and type of event is necessary.
Asunto(s)
Intervención en la Crisis (Psiquiatría)/normas , Socorristas/psicología , Terrorismo/psicología , Adulto , Berlin , Intervención en la Crisis (Psiquiatría)/métodos , Intervención en la Crisis (Psiquiatría)/estadística & datos numéricos , Socorristas/estadística & datos numéricos , Femenino , Humanos , Masculino , Servicios de Salud Mental/normas , Servicios de Salud Mental/estadística & datos numéricos , Psicometría/instrumentación , Psicometría/métodos , Trabajo de Rescate/métodos , Encuestas y CuestionariosRESUMEN
BACKGROUND AND AIMS: Alcohol screening, brief intervention (BI) and referral to treatment is often considered stepped care, such that BI with referral links patients to treatment. A meta-analysis of randomized trials found no evidence that BI increases treatment for alcohol use disorder (AUD). This study aimed to determine whether BI is associated with receipt of treatment for AUD among patients receiving BI as part of routine care. DESIGN: Regression analysis. SETTING: US Veterans Health Administration (VA), in which BI is supported by performance measurement and electronic clinical reminders. PARTICIPANTS: VA outpatients with positive Alcohol Use Disorders Identification Test Consumption screens (≥ 5) (n = 830,825) documented nationally from 1 October 2009 to 30 May 2013. MEASUREMENTS: Regression models estimated the prevalence of receiving VA specialty addictions treatment within 0-365 days for patients with documented BI (advice to reduce/abstain within 0-14 days) compared to those without. Models clustered on patient and adjusted for demographics and mental health and substance use conditions were fit among all patients and stratified across documented past-year AUD diagnosis. Multiple secondary analyses assessed robustness of findings, including assessing repeated BI as a predictor. FINDINGS: Among 830,825 VA outpatients with unhealthy alcohol use (1,172,606 positive screens), documented BI was associated with lower likelihood of receiving VA specialty addictions treatment [adjusted incidence rate ratio (aIRR) = 0.84, 95% confidence interval (CI) = 0.83-0.84]. Associations were similar for those with and without AUD (aIRR = 0.83, 95% CI = 0.82-0.84 and aIRR = 0.86, 95% CI = 0.83-0.88, respectively) and in most secondary analyses. However, among patients without AUD, documentation of more than one BI was associated with greater likelihood of treatment relative to no BI (aIRR = 1.75, 95% CI = 1.68-1.83). CONCLUSIONS: In a national sample of US Veterans Health Administration patients with unhealthy alcohol use, documented brief intervention for alcohol use was associated with lower likelihood of receiving specialty addictions treatment regardless of alcohol use disorder diagnosis.