RESUMO
Persons with mental illnesses use tobacco at significantly higher and heavier rates than the general population, and suffer greater tobacco- related morbidity and mortality. However, there are few existing tobacco cessation interventions for these individuals. This study examined two tobacco cessation interventions, a telephonic quitline intervention (counseling and nicotine replacement therapy) and a community-based group counseling intervention with adults currently receiving community mental health services. At 6-month follow-up, both groups demonstrated significantly reduced tobacco use, but participants who received both quitline services and the group counseling intervention were significantly more likely to have a 50% tobacco use reduction. Across groups, the overall intent-to-treat cessation rate was 7%. Tobacco dependence, depression symptoms, and psychotic symptoms decreased significantly for all treatment groups, while health and mental health functioning increased. Findings suggest that common community tobacco cessation services are effective for this population.
Assuntos
Redes Comunitárias , Promoção da Saúde/métodos , Transtornos Mentais/complicações , Abandono do Hábito de Fumar , Tabagismo/complicações , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Tabagismo/terapia , Estados Unidos , Adulto JovemRESUMO
OBJECTIVES: Forty-one percent (41%) of persons in the U.S. who reported having recent mental illnesses also smoke cigarettes. Tobacco use among this population is associated with up to 25 less years of life and excess medical comorbidity compared to the general population. While research demonstrates that tobacco interventions can be effective for persons with mental illnesses, they are not commonly utilized in clinical practice. The current study explored how to adapt evidence-based tobacco cessation interventions to meet the unique physiological, psychological, and social challenges facing persons with mental illnesses. METHODS: Ten focus groups were conducted utilizing a semi-structured discussion; 5 for adult mental health consumers (n = 62) and 5 with mental health clinicians and administrators (n = 22). Content analysis was used to organize themes into categories. RESULTS: Five thematic categories were found: (1) Barriers to treatment, (2) Resources and infrastructure, (3) Negative influences on smoking behavior, (4) Knowledge deficits, and (5) Treatment needs. CONCLUSIONS: These findings are instructive in developing appropriate tobacco cessation services for this population. Specifically, these data have been incorporated into a mental health provider toolkit for smoking cessation and have informed the development of a tobacco cessation intervention study.
Assuntos
Transtornos Mentais/complicações , Serviços de Saúde Mental , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Adolescente , Adulto , Estudos de Coortes , Colorado , Grupos Focais , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Transtornos Mentais/psicologia , Avaliação das Necessidades , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto/métodos , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas/métodos , Qualidade de Vida , Abandono do Hábito de Fumar/psicologia , Tabagismo/complicações , Tabagismo/psicologia , Adulto JovemRESUMO
OBJECTIVE: This study used statewide administrative data sets to estimate the prevalence of tobacco use among persons with mental illnesses who were accessing public-sector mental health care in Colorado and to determine the relationships between tobacco use and primary diagnosis and alcohol and drug use. METHODS: This study utilized the Colorado Client Assessment Record to examine predictors of tobacco use among 111,984 persons with mental illnesses who were receiving services in the public mental health system. RESULTS: Thirty-nine percent of the sample (N=43,508) used tobacco. Multiple logistic regression analysis found that schizophrenia, schizoaffective disorder, and bipolar disorder (p<.001 for all), and depression or dysthymia (p<.01) were associated with greater tobacco use than other diagnoses. Significant differences in tobacco use existed across gender, age group, race or ethnicity, and substance use categories. CONCLUSIONS: Findings suggest that an administrative database is a low-burden means of identifying persons at high risk of tobacco use to inform resource allocation.
Assuntos
Transtornos Mentais/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Idoso , Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Colorado , Comorbidade , Estudos Transversais , Bases de Dados Factuais , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Transtornos Psicóticos/epidemiologia , Setor Público , Risco , Esquizofrenia/epidemiologia , Estatística como Assunto , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
CONTEXT: The US FDA has issued an advisory warning of a possible link between antidepressant treatment for paediatric patients with major depressive disorder (MDD) and an increased risk of suicidal behaviour. A large database of paid health insurance claims for adolescents with MDD provided the opportunity to examine this possible relationship. OBJECTIVE: To examine the potential empirical link between antidepressant treatment and suicide attempts among adolescents aged 12-18 years using a community sample of managed care enrollees across the US. DESIGN: A retrospective longitudinal cohort using paid insurance claims for all healthcare and prescription fills for adolescents who were newly diagnosed with MDD and had at least 6 months of follow-up data. A multivariate Cox proportional hazards regression analysis was used to test the hypothesis that antidepressant use increased the risk of suicide attempt, adjusting for propensity for allocation to each treatment group and for demographic and clinical characteristics. SETTING: Managed care plans including both commercial and Medicaid plans in the east, midwest, south and western regions of the US from January 1997 to March 2003. PARTICIPANTS: All adolescent insurance members aged 12-18 years at first diagnosis of MDD. MAIN OUTCOME MEASURES: Suicide attempts as indicated by medical utilisation with International Classification of Diseases (9th edition) [ICD-9] or 10th edition (ICD-10) codes in any healthcare setting or by any covered provider. RESULTS: 24 119 adolescents met inclusion criteria (63% female). Crude suicide attempt rates ranged from 0.0-2.3% by index treatment group. Treatment with SSRIs (hazard ratio) [HR] = 1.59; CI 0.89, 2.82), other antidepressants (HR = 1.03; CI 0.43, 2.44), or multiple antidepressants (HR = 1.43; CI 0.70, 2.89) after index MDD diagnosis resulted in no statistically increased risk of suicide attempt. Treatment with antidepressant medication for at least 180 days (6 months) reduced the likelihood of suicide attempt compared with antidepressant treatment for <55 days (8 weeks) [HR = 0.34; CI 0.21, 0.55]. Other variables that were independently associated with greater risk of suicide attempts included female gender, severity of illness indicators, younger age at time of MDD diagnosis, and living in the midwest or west. CONCLUSIONS: Antidepressant medication use had no statistically significant effect on the likelihood of suicide attempt in a large cohort of adolescents across the US after propensity adjustment for treatment allocation and controlling for other factors. The relationship between suicidal behaviour and antidepressant medication use is complex and requires further investigation.
Assuntos
Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Fatores Etários , Antidepressivos/classificação , Antidepressivos/uso terapêutico , Criança , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Estudos Longitudinais , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estados UnidosRESUMO
Colorado Access, a nonprofit health plan, collaborated with the Center for Health Care Strategies and the State of Colorado Department of Health Care Policy Financing, to develop, implement, and evaluate a care management services pilot program focused on improving the quality of care and decreasing the cost of care for the highest cost, highest need Medicaid recipients. Colorado Access' preliminary internal evaluation demonstrated decreases in hospitalizations and emergency department utilization and increases in primary care ambulatory visits and member satisfaction. Qualitative analyses informed program implementation. Implementation lessons learned are discussed.
Assuntos
Prestação Integrada de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde , Medicaid , Avaliação de Resultados em Cuidados de Saúde , Adulto , Colorado , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos , Avaliação de Resultados em Cuidados de Saúde/métodos , Satisfação do Paciente , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estados UnidosRESUMO
The prevalence of tobacco use among persons with mental illnesses is 2 to 3 times that of the general population, and these individuals suffer significant related health disparities. Many people with mental illnesses contact tobacco quitlines for cessation assistance. With free telephone counseling and in some cases nicotine replacement therapy, quitlines offer a potentially effective resource for this population. However, quitlines are still trying to determine how best to meet these callers' unique needs. The authors discuss emerging practices regarding quitline services for persons with mental illnesses, as well as expert opinion for enhancing work with these individuals.
RESUMO
OBJECTIVE: The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is designed to evaluate the longitudinal outcome of patients with bipolar disorder. The STEP-BD disease-management model is built on evidence-based practices and a collaborative care approach designed to maximize specific and nonspecific treatment mechanisms. This prospective study examined the longitudinal relationships between patients' satisfaction with care, levels of hope, and life functioning in the first 1000 patients to enter STEP-BD. METHODS: The study used scores from the Care Satisfaction Questionnaire, Beck Hopelessness Scale, Range of Impaired Functioning Tool, Young Mania Rating Scale, and Montgomery-Asberg Depression Rating Scale at 5 time points during a 1-year interval. Analyses tested mediational pathways between care satisfaction, hope, and life functioning, depression, and mania using mixed-effects (random and fixed) regression models. RESULTS: Increases in care satisfaction were associated with decreased hopelessness (P < .01) but not related to symptoms of depression or mania. Similarly, decreased hopelessness was associated with better life functioning (P < .01) but not related to symptoms of depression or mania. Depression was independently associated with poorer life functioning (P < .0001). CONCLUSIONS: This study provided support for the hypothesized mediational pathway between care satisfaction, hopelessness, and life functioning. Findings suggest that providing care that maximizes patient hope may be important. By so doing, patients might overcome the learned helplessness/hopelessness that often accompanies a cyclical illness and build a realistic illness-management strategy.