Publications by authors named "Robert A Rosenheck"

429 Publications

Associations of Current and Remitted Cannabis Use Disorder With Health-related Quality of Life and Employment Among US Adults.

J Addict Med 2021 Jun 17. Epub 2021 Jun 17.

Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT (TGR); Department of Psychiatry, School of Medicine, Yale University, New Haven, CT (TGR, RAR); VA New England Mental Illness, Research, Education and Clinical Center (MIRECC); VA Connecticut Healthcare System, West Haven, CT (TGR, RAR).

Background: The associations of current and remitted cannabis use disorder (CUD) with health-related quality of life (HRQOL) and employment have not been studied, and we aim to address these gaps.

Methods: The 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions III (NESARC III) surveyed a nationally representative sample of non-institutionalized civilian US adults (≥18 years) (n = 36,309 unweighted). Using DSM-5 criteria, adults with current CUD were compared with those with CUD in remission and no history of CUD on standard measures of the mental and physical component scores of HRQOL and of quality-adjusted life years (QALYs) along with employment in the past 12 months. Multivariable-adjusted regression analyses were used to adjust for and examine the role of covariates.

Results: Overall, 2.5% of the study sample, representing 6.0 million adults nationwide, met criteria for current CUD, and 3.7%, representing 8.8 million adults, met the criteria for CUD in remission. Adults with current or past CUD had lower mental HRQOL and QALYs, as compared to adults who never had CUD. However, these differences were no longer significant when adjusted for behavioral co-morbidities and personal histories. Current CUD was associated with lower odds of being employed (Adjusted odds ratio AOR = 0.76; 95% confidence intervals [CI], 0.60-0.96), but CUD in remission with a greater likelihood of employment (Adjusted odds ratio = 1.53; 95% CI, 1.23-1.91), both as compared to those never experiencing CUD.

Conclusions: Both current CUD and past CUD are adversely associated with HRQOL and current CUD with not being employed; Since CUD associations are not independent of comorbidities, treatment must take a wide-ranging approach.
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http://dx.doi.org/10.1097/ADM.0000000000000889DOI Listing
June 2021

Comparison of Black and white individuals who report diagnoses of schizophrenia in a national sample of US adults: Discrimination and service use.

Schizophr Res 2021 Jun 1. Epub 2021 Jun 1.

Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA.

Background: While there is increasing recognition of disparities in healthcare for Black Americans, there have been no comparisons in a nationally representative U.S. sample of Black and White adults with clinical diagnoses of schizophrenia.

Methods: Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III, we compared Black (n = 240, 36.2%) and White (n = 423, 63.8%) adults who report having been told by a physician that they have schizophrenia. Due to the large sample size, effect sizes (risk ratios and Cohen's d), rather than p-values, were used to identify the magnitude of differences in sociodemographic and clinical characteristics, including experiences of discrimination and service use. Multivariate analyses were used to identify independent factors.

Results: Black individuals with diagnoses of schizophrenia reported multiple sociodemographic disadvantages, including lower rates of employment, educational attainment, income, marriage, and social support, with little difference in incarceration, violent behavior, and quality of life. They reported much higher scores on a general lifetime discrimination scale (Cohen's d = 0.75) and subscales representing job discrimination (d = 0.85), health system discrimination (d = 0.70), and public race-based abuse (d = 0.55) along with higher rates of past year alcohol and drug use disorders, but lower rates of co-morbid psychiatric disorders. Multivariable-adjusted regression analyses highlighted the independent association of Black race with measures of discrimination and religious service attendance; less likelihood of receiving psychiatric treatment (p = 0.02) but no difference in substance use treatment.

Conclusion: Black adults with schizophrenia report numerous social disadvantages, especially discrimination, but religious service attendance may be an important social asset.
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http://dx.doi.org/10.1016/j.schres.2021.05.017DOI Listing
June 2021

Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China.

J ECT 2021 May 21. Epub 2021 May 21.

From the School of Public Health, University of Texas Health Science Center at Houston, Houston, TX US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL Department of Psychiatry, Yale University School of Medicine, New Haven Department of Psychology, University of Hartford, West Hartford, CT Guangzhou Mental Health Center, Guangzhou Medical University, Guangzhou, China McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.

Objective: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world.

Methods: We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale.

Results: Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions.

Conclusions: Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.
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http://dx.doi.org/10.1097/YCT.0000000000000775DOI Listing
May 2021

Cross-cultural Comparison of Perceptions and Knowledge About Electroconvulsive Therapy Among Adults Who Screened Positive for Depression in the United States, India, and China.

J ECT 2021 May 21. Epub 2021 May 21.

From the School of Public Health, University of Texas Health Science Center at Houston, Houston, TX US Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL Department of Psychiatry, Yale University School of Medicine, New Haven Department of Psychology, University of Hartford, West Hartford, CT Guangzhou Mental Health Center, Guangzhou Medical University, Guangzhou, China McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.

Objective: Despite the established efficacy of electroconvulsive therapy (ECT), negative perceptions and inaccurate knowledge about ECT in the United States and other countries persist. This study examined ECT perceptions and knowledge in the 3 most populous countries in the world.

Methods: We recruited participants who screened positive for depression on the Patient Health Questionnaire 9 (PHQ-9) in the United States (n = 1643), India (n = 1469), and China (n = 328) and compared responses on the ECT-Perception and Knowledge Scale.

Results: Although the US sample had significantly higher PHQ-9 scores than the India and China samples, the US sample was less likely to have been offered ECT or to have ever received ECT. Moreover, the US sample scored lower on the ECT Perception and Knowledge subscales than the other samples indicating more negative perceptions and inaccurate knowledge about ECT. Across samples, there were moderate fears about ECT being painful or causing brain damage, and misconceptions about ECT being outdated and adverse effects of induced seizures. Higher PHQ-9 scores were correlated with more negative perceptions.

Conclusions: Greater public education is needed about ECT, particularly in the United States. Misperceptions and lack of knowledge may hinder utilization of ECT in India, China, and the United States.
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http://dx.doi.org/10.1097/YCT.0000000000000775DOI Listing
May 2021

Who Uses Veterans Mental Health Services?: A National Observational Study of Male Veteran and Nonveteran Mental Health Service Users.

J Nerv Ment Dis 2021 May 14. Epub 2021 May 14.

Department of Psychiatry, Yale School of Medicine, New Haven New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut Hampton VA Medical Center, Hampton Departments of Physical Medicine & Rehabilitation and Psychiatry, Eastern Virginia Medical School, Norfolk, Virginia Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, Connecticut.

Abstract: Mental health (MH) research among veterans receiving services from the Veterans Health Administration (VHA) is extensive and growing and informs many clinical practice guidelines. We used nationally representative survey data to examine the generalizability of this extensive body of research by comparing sociodemographic and clinical characteristics of male veteran veterans health service (VHS) users (n = 491) with veteran non-VHS users (n = 840) and nonveteran (n = 6300) MH service users. VHS users were older, more often reported Black race, and less likely to have private or Medicaid insurance, but had similar prevalence of psychiatric or substance use disorder diagnoses but with a greater prevalence of posttraumatic stress disorder (PTSD). VHS users reported higher rates of medical diagnoses, pain interference, and poorer physical and MH status. These results suggest that VHA MH research may be reasonably generalizable to US mental health service users with caveats regarding age, PTSD diagnosis, pain, and racial distribution.
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http://dx.doi.org/10.1097/NMD.0000000000001369DOI Listing
May 2021

Long-term impact of the U.S. Armed forces Zero-Tolerance drug policy on female veterans.

J Addict Dis 2021 May 14:1-12. Epub 2021 May 14.

U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA.

Background: In 1980, the U.S. military instituted a zero-tolerance policy for illicit substance use that led to a reduction in such use during military services. Long-term post-military effects have not been studied.

Methods: National survey data from 2012-2013 were used to compared veteran versus non-veteran differences in sociodemographic, behavioral and substance use and psychiatric diagnoses among women by cohort (i.e., those younger than 52 who would have entered the military under the no tolerance policy, and those older than 52 who would have entered before this policy was implemented). Multivariate interaction analyses between cohorts and veteran status were used to identify significant changes in veteran-non-veteran differences between these age cohorts on during the decades following the implementation of the zero-tolerance policy.

Results: Significant interactions primarily involved substance use diagnoses which were less frequent among veterans than non-veterans in the younger group of women, in contrast to the older group in which veterans had greater rates of substance use than non-veterans. These patterns were less robust for alcohol than substance use disorders and were not significant for psychiatric disorders.

Conclusion: The zero-tolerance policy appears to have had a long-term effect resulting in less substance use disorder and, to some extent, less alcohol use disorder among veterans as compared to non-veterans who served in the military after the zero-tolerance policy was implemented.
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http://dx.doi.org/10.1080/10550887.2021.1922049DOI Listing
May 2021

Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration.

J Dual Diagn 2021 May 13:1-11. Epub 2021 May 13.

Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.

Objective: Opioid use disorder (OUD) is a significant problem among US veterans with increasing rates of OUD and overdose, and thus has substantial importance for service delivery within the Veterans Health Administration (VHA). Among individuals with OUD, several sex- specific differences have begun to emerge regarding co-occurring medical, psychiatric and pain-related diagnoses. The rates of such multimorbidities are likely to vary between men and women with OUD and may have important implications for treatment within the VHA but have not yet been studied. The present study utilized a data set that included all veterans receiving VHA health care during Fiscal Year (FY) 2012 (October 1, 2011 through September 30, 2012), who were diagnosed during the year with opioid dependence or abuse. VHA patients diagnosed with OUD nationwide in FY 2012 were compared by sex on proportions with OUD, and among those with OUD, on sociodemographic characteristics, medical, psychiatric and pain-related diagnoses, as well as on service use, and psychotropic and opioid agonist prescription fills. During FY 2012, 48,408 veterans were diagnosed with OUD, 5.77% of whom were women. Among those veterans with OUD, few sociodemographic differences were observed between sexes. Female veterans had a higher rate of psychiatric diagnoses, notably mood, anxiety and personality disorders, as well as higher rates of pain-related diagnoses, such as headaches and fibromyalgia, while male veterans were more likely to have concurrent, severe medical co-morbidities, including hepatic disease, HIV, cancers, peripheral vascular disease, diabetes and related complications, and renal disease. There were few differences in health service utilization, with women reporting greater receipt of prescriptions for anxiolytic/sedative/hypnotics, stimulants and lithium. Men and women did not differ in receipt of opioid agonist medications or mental health/substance use treatments. There are substantial sex-specific differences in patterns of multimorbidity among veterans with OUD, spanning medical, psychiatric and pain-related diagnoses. These results illustrate the need to view OUD as a multimorbid condition and design interventions to target such multimorbidities. The present study highlights the potential benefits of sex-specific treatment and prevention efforts among female veterans with OUD and related co-occurring disorders.
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http://dx.doi.org/10.1080/15504263.2021.1904162DOI Listing
May 2021

Insurance Status and Continuity for Young Adults With First-Episode Psychosis.

Psychiatr Serv 2021 May 11:appips201900571. Epub 2021 May 11.

Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck).

Objective: Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population.

Methods: Longitudinal data on insurance status and predictors of insurance status among adults with FEP were obtained from RAISE-ETP (Recovery After an Initial Schizophrenia Episode-Early Treatment Program) study participants with complete 1-year data (N=288). The frequencies of insurance status and transitions are presented. Bivariate comparisons were used to assess the impact of the comprehensive coordinated care intervention in RAISE-ETP on insurance changes. These data were compared with contemporaneous longitudinal data in the 2011 Medical Expenditures Panel Study.

Results: The RAISE-ETP experimental intervention did not significantly change insurance status. At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied.

Conclusions: Compared with a national sample, people with FEP were more likely to use public insurance but still had high persistence of 12-month uninsurance. That over half of the RAISE-ETP participants had a period of uninsurance suggests that more research is needed on whether these periods affect treatment continuity and medication adherence.
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http://dx.doi.org/10.1176/appi.ps.201900571DOI Listing
May 2021

Insurance Status and Continuity for Young Adults With First-Episode Psychosis.

Psychiatr Serv 2021 May 11:appips201900571. Epub 2021 May 11.

Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (Golberstein); Yale School of Public Health, Yale University, New Haven, Connecticut (Busch); Yale New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Sint); Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, and Mental Illness Research, Education and Clinical Center of New England, U.S. Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (Rosenheck).

Objective: Insurance status and continuity may affect access to and quality of care. The authors characterized patterns of and changes in insurance status over 1 year among people with first-episode psychosis (FEP), comparing insurance patterns with adults of similar age in the general population.

Methods: Longitudinal data on insurance status and predictors of insurance status among adults with FEP were obtained from RAISE-ETP (Recovery After an Initial Schizophrenia Episode-Early Treatment Program) study participants with complete 1-year data (N=288). The frequencies of insurance status and transitions are presented. Bivariate comparisons were used to assess the impact of the comprehensive coordinated care intervention in RAISE-ETP on insurance changes. These data were compared with contemporaneous longitudinal data in the 2011 Medical Expenditures Panel Study.

Results: The RAISE-ETP experimental intervention did not significantly change insurance status. At baseline, levels of uninsurance (47%) and public insurance (31%) were higher among RAISE-ETP participants than among a similar age group in the general public (29% and 13%, respectively). Insurance transitions were common among people with FEP, although 79% of those with public insurance at baseline also had public insurance at 1 year. Of studied RAISE-ETP participants, 60% had a period of uninsurance during the year studied.

Conclusions: Compared with a national sample, people with FEP were more likely to use public insurance but still had high persistence of 12-month uninsurance. That over half of the RAISE-ETP participants had a period of uninsurance suggests that more research is needed on whether these periods affect treatment continuity and medication adherence.
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http://dx.doi.org/10.1176/appi.ps.201900571DOI Listing
May 2021

Association of Adverse Family Experiences with School Engagement and Performance in US Adolescents: Do Behavioral Health Conditions Mediate the Relationship?

Psychiatr Q 2021 Mar 3. Epub 2021 Mar 3.

Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.

To examine the prevalence of adverse family experiences (AFEs), their association with poor school engagement and performance, and whether behavioral health conditions mediate the association among US adolescents. We conducted a cross-sectional analysis of data from adolescents aged 12-17 years from the 2016-2018 National Survey of Children's Health (n = 41,648 unweighted). We first estimated the prevalence of AFEs, investigated the association of AFEs with school engagement and performance, and whether behavioral health conditions mediate such relationships, using multivariable-adjusted Poisson regression models. A mediation analysis was used and covariates included socio-demographic characteristics and co-morbid medical conditions. A total of 52.9% of US adolescents (nationally representative of 12.9 million adolescents nationwide) reported experiencing at least one form of AFE, the most common of which included parental divorce/separation (33.1%), economic hardship (22.0%) and living with a person with substance misuse problems (11.5%). Adolescents with ≥4 AFEs had poorer outcomes in school engagement and performance (p < 0.001 each) when compared to those with no AFEs. Behavioral health conditions (e.g., anxiety, depression, and conduct problems) partially mediated these relationships (p < 0.01 each). The indirect effect of behavioral health conditions accounted for 20.4% of the total effect in the association between AFEs and school performance (p < 0.001). AFEs are common among US adolescents, and cumulative AFEs are associated with behavioral health conditions, which may in turn reduce school engagement and performance. While reducing AFEs is important in children and adolescents, addressing potentially resultant behavioral health conditions is equally important in improving school engagement and performance.
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http://dx.doi.org/10.1007/s11126-021-09900-3DOI Listing
March 2021

Correlates of Obtaining Employment among Veterans Receiving Treatment for Severe PTSD in Specialized Intensive Programs.

Psychiatr Q 2021 Jan 6. Epub 2021 Jan 6.

VA Connecticut Healthcare System, West Haven, CT, USA.

Severe Post-Traumatic Stress Disorder (PTSD) has been identified as a significant impediment to employment. However, little is known about correlates of employment recovery after a period of not working among veterans with severe PTSD treated in specialized intensive treatment programs. This study examines rates and correlates of transitioning from not being employed at admission to working four months after discharge using national Veterans Health Administration (VHA) program evaluation data on veterans engaged in specialized intensive PTSD treatment (N = 27,339). Results suggest that only 5.68% of the sample made the transition to employment while 10.6% lost employment, 8.9% worked both at admission and following discharge, and 74.9%, did not work either at admission or following discharge. Multinomial regression analysis found that compared to other groups, veterans who became employed were younger, less likely to receive service-connected disability payments, and experienced a significantly greater reduction in PTSD symptoms. Findings from this study highlight that this distinct population has very poor employment outcomes and deserves more attention, and that reducing PTSD symptoms can lead to improved employment outcomes. Efforts to integrate evidence-based vocational rehabilitation practice into residential PTSD treatment targeting PTSD symptoms is encouraged.
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http://dx.doi.org/10.1007/s11126-020-09864-wDOI Listing
January 2021

Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder.

J Psychiatr Res 2021 02 24;134:113-120. Epub 2020 Dec 24.

Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA.

Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.
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http://dx.doi.org/10.1016/j.jpsychires.2020.12.063DOI Listing
February 2021

Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder.

J Psychiatr Res 2021 02 24;134:113-120. Epub 2020 Dec 24.

Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; New England Mental Illness Research Education Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA.

Post-traumatic stress disorder (PTSD) is an often disabling mental disorder whose management typically focuses on reducing PTSD symptoms. Chronic pain and other comorbidities that commonly accompany PTSD symptoms may also be independently associated with disability. Using data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions, we examined the independent association of PTSD symptom severity, pain interference, non-PTSD psychiatric and substance use disorders (SUD), and medical illnesses with each of four domains of function: mental health-related quality of life and physical functioning assessed with the Mental Health Composite Score (MCS) and Physical Function Score (PFS) of the Short Form-12; perceived social support from the Interpersonal Support and Evaluation List-12 (ISEL-12); and self-reported past year employment. Among 1779 individuals representing 11 million U.S. adults who met the Diagnostic and Statistical Manual-5 (DSM-5) criteria for Past Year PTSD, the MCS (41.2; SD 12.5), PFS (44.8; SD 13.2) and ISEL-12 (33.6; SD 7.2) indicated substantial disability when compared to population norms, and only 63.6% were employed. Multiple regression showed the MCS had a modest negative association with PTSD symptoms, pain interference, psychiatric multimorbidity and medical comorbidity although not with SUD. PFS and employment had significant negative associations with pain interference and medical comorbidity. ISEL-12 had a weak negative association with PTSD symptoms and non-PTSD psychiatric comorbidity. Common comorbidities thus significantly influence disability associated with PTSD, often more strongly than PTSD symptoms. PTSD treatment may require integrative multimorbidity management beyond a focus on PTSD symptoms.
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http://dx.doi.org/10.1016/j.jpsychires.2020.12.063DOI Listing
February 2021

Impact of cannabis on non-medical opioid use and symptoms of posttraumatic stress disorder: a nationwide longitudinal VA study.

Am J Drug Alcohol Abuse 2020 11 9;46(6):812-822. Epub 2020 Oct 9.

Department of Psychiatry, Yale School of Medicine , New Haven, CT, USA.

Background: Multiple states have authorized cannabis as an opioid substitution agent and as a treatment for posttraumatic stress disorder (PTSD).

Objectives: This study sought to investigate the relationship between cannabis use, non-medical opioid use, and PTSD symptoms among U.S. veterans.

Methods: From 1992-2011, veterans admitted to specialized intensive PTSD treatment participated in a national evaluation with assessments at intake and four months after discharge. Participants with non-medical opioid use ≥ 7 days during the 30 days preceding admission were divided into two groups: those with cannabis use ≥ 7 days, and those without cannabis use. These two groups were compared on measures of substance use and PTSD symptoms at baseline and 4-months outpatient follow-up. We hypothesized that, at both assessments, the group with baseline cannabis use would show less non-medical opioid use and less severe PTSD symptoms.

Results: Of 1,413 veterans with current non-medical opioid use, 438 (30.3%) also used cannabis, and 985 (69.7%) did not. At baseline, veterans with concurrent non-medical opioid and cannabis use had slightly fewer days of non-medical opioid use ( < .005; d = -0.16), greater use of other substances ( < .0001) and more PTSD symptoms ( = .003; d = 0.16), compared to veterans who used non-medical opioids but not cannabis. At follow-up, substance use or PTSD symptoms did not significantly differ.

Conclusion: Cannabis use was not associated with a substantial reduction of non-medical opioid use, or either improvement or worsening of PTSD symptoms in this population. Hence, these data do not encourage cannabis use to treat either non-medical opioid use or PTSD.
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http://dx.doi.org/10.1080/00952990.2020.1818248DOI Listing
November 2020

Stages of major depressive disorder and behavioral multi-morbidities: Findings from nationally representative epidemiologic study.

J Affect Disord 2021 01 25;278:443-452. Epub 2020 Sep 25.

Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States of America; Mental Illness Research, Education and Clinical Center of New England, US Department of Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America.

Objective: To present a three stage-model of major depressive disorder (MDD) and evaluate differences in behavioral histories/experiences and multi-morbidities between stages.

Methods: We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a nationally representative cross-sectional survey of US adults (n = 36,309). Based on DSM-5 diagnostic criteria, we identified and compared three groups of adults with MDD histories: 1) new onset MDD (n = 509; 5.6%); 2) chronic MDD (n = 3,871; 46.1%); and 3) recovered from MDD (n = 3,673; 48.3%). Multivariable analyses tested independent group differences in behavioral histories/experiences and diagnostic multi-morbidities between 1) recovered MDD vs. new onset MDD; 2) chronic MDD vs. new onset MDD; and 3) recovered MDD vs. chronic MDD.

Results: Adults who have recovered from MDD as compared to those with chronic MDD were 2.5 times more likely to have recovered from two or more psychiatric disorders in addition to MDD (95% confidence intervals [CI]=1.76-3.61) and from alcohol use disorder (adjusted odds ratio [AOR]=1.28; 95% CI=1.08-1.52). They were also less likely than those with chronic MDD to have borderline personality disorder (p<0.001), pain (p<0.001), or medical co-morbidity (p = 0.003). Adults with new onset MDD were younger than other groups, and more likely than those who have recovered to have borderline personality disorder and concurrent psychiatric or substance use disorders (p<0.05 for all).

Conclusion: Behavioral histories/experiences and multi-morbidities differ significantly across stages of MDD. These concurrent problems may impede recovery and foster chronicity and should therefore be an integral focus of treatment.
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http://dx.doi.org/10.1016/j.jad.2020.09.081DOI Listing
January 2021

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs.

J Dual Diagn 2020 10 1;16(4):382-391. Epub 2020 Oct 1.

Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objectives: Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men.

Method: National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences.

Results: Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women ( = 0.33;  = .01) and men ( = 0.44,  < .0001) with no significant gender difference.

Conclusion: No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.
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http://dx.doi.org/10.1080/15504263.2020.1822569DOI Listing
October 2020

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs.

J Dual Diagn 2020 10 1;16(4):382-391. Epub 2020 Oct 1.

Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objectives: Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men.

Method: National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences.

Results: Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women ( = 0.33;  = .01) and men ( = 0.44,  < .0001) with no significant gender difference.

Conclusion: No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.
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http://dx.doi.org/10.1080/15504263.2020.1822569DOI Listing
October 2020

Opioid analgesic use and its sequelae: Opioid and other substance use disorders.

Early Interv Psychiatry 2020 Sep 15. Epub 2020 Sep 15.

Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.

Objectives: While use of opioids is a well-established risk factor for opioid use disorder (OUD), its association with lifetime use of other addictive substances and the emergence of other lifetime substance use disorders (SUDs) has not been studied.

Methods: We used data from 36 309 US adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III to identify those with lifetime opioid use (n = 4090; 11.3%). Of these individuals, we quantified use of other addictive substances; development of OUD and other SUDs; and whether use of opioids and development of OUD came before or after use of other substances and the emergence of other SUDs.

Results: Of the 11.3% of adults who reported any opioid use, 98.2% of such users reported use of other addictive substances. Of these opioid users, 18.1% met criteria for lifetime OUD but only 3.5% had OUD alone; 47.6% had SUDs other than OUD and 14.6% had OUD plus another SUD. In most instances, opioid use followed use of other substances and OUD followed development of other SUDs.

Conclusion: Opioid use is typically linked to use of multiple substances and while less than 20% developed OUD, more than half developed either OUD or another SUD. Opioid use and OUD most often followed other substance use and the emergence of other SUDs. Early intervention in OUD should consider potential complications of other present or past SUDs, and both prevention and treatment development efforts should focus on the multi-morbid dimensions of the current opioid epidemic.
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http://dx.doi.org/10.1111/eip.13043DOI Listing
September 2020

Longitudinal study of the housing and mental health outcomes of tenants appearing in eviction court.

Soc Psychiatry Psychiatr Epidemiol 2020 Sep 14. Epub 2020 Sep 14.

National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs Central Office, Tampa, FL, USA.

Purpose: Millions of people are evicted from rental properties in the U.S. annually, but little is known about them and their mental health. This study followed a cohort of eviction court participants over time and assessed their housing and mental health outcomes.

Methods: One hundred and twenty-one tenants were recruited from an eviction court in New Haven, Connecticut, and their housing, mental health, and psychosocial status were assessed at baseline, 1, 3, 6, and 9 months following their encounter with the court. Inverse probability weighting was used for missing data.

Results: At baseline, 42% of participants had appeared in eviction court before, 28% had experienced eviction, and 44% had been previously homeless. In addition, 39% screened positive for generalized anxiety disorder, 37% for posttraumatic stress disorder, 33% for major depressive disorder, and 17% reported suicidal ideation. At follow-up, participants experienced increased days of housing instability and homelessness over time with some persistent mental health symptoms. Less than one-quarter of participants received any mental health treatment during the 9-month follow-up period. About 54% of participants followed reported that they had to change their residence after their court appearance consistent with court records. Participants who had an eviction-related move experienced greater housing instability over time than participants who did not.

Conclusion: Together, these findings suggest that there is a sizable subgroup of adults who present to eviction court with persistent housing and mental health issues who do not receive adequate assistance in addressing these issues.
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http://dx.doi.org/10.1007/s00127-020-01953-2DOI Listing
September 2020

Why are black adults over-represented among individuals who have experienced lifetime homelessness? Oaxaca-Blinder decomposition analysis of homelessness among US male adults.

J Epidemiol Community Health 2021 Feb 12;75(2):161-170. Epub 2020 Sep 12.

Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.

Background: Non-Hispanic black adults experience homelessness at higher rates than non-Hispanic white adults in many studies. We aim to identify factors that could account for this disparity.

Methods: We used national survey data on non-Hispanic black and white men with complete data from the National Epidemiological Survey on Alcohol and Related Conditions Wave III. Using the Oaxaca-Blinder decomposition analysis, we examined race-based disparities in correlates of risk for lifetime homelessness.

Results: In our analysis, 905 of 11 708 (7.7%) respondents, representing 6 million adults nationwide, reported lifetime homelessness. Black adults were 1.41 times more likely to have been homeless than white adults (95% CI 1.14 to 1.73; p=0.002). Overall, 81.6% of race-based inequality in lifetime homelessness were explained by three main variables with black adults having: lower incomes, greater incarceration histories since age of 18 and a greater risk of traumatic events (p<0.01 for each). They also had more antisocial personality disorder, younger age and parental drug use (p<0.05 for each).

Conclusion: Although previous studies suggested that black homeless men have higher rates of drug abuse than white homeless men, our findings highlight the fact that black-white disparities in lifetime homeless risk are associated with socio-structural factors (eg, income and incarceration) and individual adverse events (eg, traumatic events), and not associated with psychiatric or substance use disorders.
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http://dx.doi.org/10.1136/jech-2020-214305DOI Listing
February 2021

Correlates of Concurrent Morbid Obesity and Tobacco Use Disorder Nationally in the Veterans Health Administration.

J Dual Diagn 2020 10 31;16(4):373-381. Epub 2020 Aug 31.

Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.

Objective: The aim of this study was to examine health, demographic, and service utilization characteristics of veterans with multimorbid tobacco use disorder (TUD) and morbid obesity compared to those with either condition alone. Health record data were extracted from the computerized patient record system of the Veterans Health Administration (VHA; October 1, 2011 to September 30, 2012). Bivariate and multivariate logistic regression models were used to compare veterans with both TUD and morbid obesity (body mass index [BMI] ≥ 40 kg/m) to veterans with each condition alone on a range of demographic, health, and service utilization outcome variables that also were extracted from the VHA administrative record. Veterans with both morbid obesity and TUD showed higher rates of medical and psychiatric comorbidity than did veterans with either condition alone. However, while veterans with TUD and morbid obesity showed higher rates of comorbid substance use disorders than veterans with morbid obesity alone, veterans with both conditions showed substantially lower rates of substance use disorders than those with TUD alone. Veterans with co-occurring morbid obesity and TUD appear to be at greater risk for medical disease and psychiatric conditions. The unexpected finding that veterans with TUD alone had more concurrent substance use disorders than veterans with both TUD and morbid obesity suggest the possibility that overeating may be a substitute for substance use in the context of TUD. The multimorbidity profile described here may suggest unique treatment needs for individuals with both TUD and morbid obesity. Highlights Medical multimorbidities predict additional health conditions and poorer outcomes. Obesity and tobacco use may share common underlying vulnerabilities. Veterans with both conditions showed higher rates of certain multimorbidities. Obesity may protect against substance use in tobacco users.
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http://dx.doi.org/10.1080/15504263.2020.1808749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717576PMC
October 2020

Social determinants of mental health care systems: intensive community based Care in the Veterans Health Administration.

BMC Public Health 2020 Aug 28;20(1):1311. Epub 2020 Aug 28.

Yale University Department of Psychiatry, 950 Campbell Ave, Building 35, West Haven, CT, 06516, USA.

Background: Since deinstitutionalization in the 1950s-1970s, public mental health care has changed its focus from asylums to general hospitals, outpatient clinics and specialized community-based programs addressing both clinical and social determinants of mental health. Analysis of the place of community-based programs within a comprehensive health system such as the Veterans Health Administration (VHA) may illuminate the role of social forces in shaping contemporary public mental health systems.

Methods: National VHA administrative data were used to compare veterans who exclusively received outpatient clinic care to those receiving four types of specialized community-based services, addressing: 1) functional disabilities from severe mental illness (SMI), 2) justice system involvement, 3) homelessness, and 4) vocational rehabilitation. Bivariate comparisons and multinomial logistic regression analyses compared groups on demographics, diagnoses, service use, and psychiatric prescription fills.

Results: An hierarchical classification of 1,386,487 Veterans who received specialty mental health services from VHA in Fiscal Year 2012, showed 1,134,977 (81.8%) were seen exclusively in outpatient clinics; 27,931 (2.0%) received intensive SMI-related services; 42,985 (3.1%) criminal justice services; 160,273 (11.6%) specialized homelessness services; and 20,921 (1.5%) vocational services. Compared to those seen only in clinics, veterans in the four community treatment groups were more likely to be black, diagnosed with HIV and hepatitis, had more numerous substance use diagnoses and made far more extensive use of mental health outpatient and inpatient care.

Conclusions: Almost one-fifth of VHA mental health patients receive community-based services prominently addressing major social determinants of health and multimorbid substance use disorders.
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http://dx.doi.org/10.1186/s12889-020-09402-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456068PMC
August 2020

Psychiatric Multimorbidity in a Specialized Program for Severely Mentally Ill Veterans.

Psychiatr Q 2021 Jun;92(2):489-499

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.

It has been suggested that psychiatric multimorbidity may better characterize severely impaired psychiatric patients than individual severe mental illness (SMI) diagnoses, and that these patients may be better served by centers offering integrated co-located, psychiatric and social services than in conventional clinics providing one-to-one care. We tested the hypothesis that multimorbidity is a critical characteristic of Veterans treated at a co-located multi-service Veteran's Health Administration (VHA) program originally established to treat Veterans living with SMI. Administrative data from the VA Connecticut Health Care System from fiscal year 2012 were used to compare veterans using diverse mental health and social services at the Errera Community Care Center (ECCC), an integrated "one-stop shop" for SMI veterans, and those seen exclusively at standard outpatient mental health clinics. Bivariate and multiple logistic regression analyses were used to compare groups on demographic characteristics, psychiatric and medical diagnoses, service utilization, and psychotropic medication fills. Results: Of the 11,092 veterans included in the study, 2281 (20.6%) had been treated at the ECCC and 8811 (79.4%) had not. Multivariable analysis highlighted the association of treatment in the ECCC and younger age, lower income, homelessness, and especially multimorbidity including both multiple substance use and multiple psychiatric diagnoses. Programs originally designed to address the diverse needs of patients living with SMI and homelessness may be usefully characterized as treating patients with psychiatric multimorbidity, a term of greater clinical relevance. Effectiveness research is needed to evaluate the one-stop shop approach to their treatment.
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http://dx.doi.org/10.1007/s11126-020-09826-2DOI Listing
June 2021

Increasing Emergency Department Visits for Mental Health Conditions in the United States.

J Clin Psychiatry 2020 07 28;81(5). Epub 2020 Jul 28.

School of Medicine, University of Connecticut, 263 Farmington Ave, Farmington, CT 06030.

Objective: The Affordable Care Act (ACA) of 2010 was fully implemented in 2014, expanding access to outpatient mental health services and potentially reducing reliance on emergency (ED) services. This study examined trends and correlates of ED visits for mental health conditions from 2007 to 2016, with attention to changes in ED use after 2014.

Methods: Nationally representative samples of ED visits in the United States were assessed using a repeated cross-sectional analysis of National Hospital Ambulatory Medical Care Survey data. This study used diagnoses associated with each ED visit to identify changes in proportions in mental health diagnostic categories (psychiatric diagnoses only, substance use-related diagnoses only, or both, based on ICD-9-CM or ICD-10-CM criteria). These trends were further examined by age, sex, race/ethnicity, and insurance status. The statistical significance of temporal patterns was evaluated with multivariate logistic regression analyses.

Results: Between 2007 and 2016, about 8.4 million (8.3%) of 100.9 million ED visits nationwide were for psychiatric or substance use-related diagnoses. Over the 10-year study period, the proportion of ED visits for mental health diagnoses increased from 6.6% to 10.9% (P < .001). Visits for alcohol and "other" substance use and psychiatric diagnoses classified as "other" accounted for an increasing portion of mental health-related ED visits during this time (P < .001). ED visits in which Medicaid was the primary source of insurance coverage showed the largest increase, nearly doubling from 27.2% in 2007-2008 to 42.8% in 2015-2016 (adjusted odds ratio for linear trends = 1.71; 95% CI, 1.36-2.15).

Conclusions: ED utilization for mental health conditions-and especially substance use conditions-significantly increased in the last decade. The increasing use of EDs by patients with mental health conditions may indicate suboptimal delivery of effective or acceptable outpatient mental health care, particularly for substance use-related conditions.
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http://dx.doi.org/10.4088/JCP.20m13241DOI Listing
July 2020

Prevalence of Treatment for Depression Among US Adults Who Screen Positive for Depression, 2007-2016.

JAMA Psychiatry 2020 Nov;77(11):1193-1195

Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.

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http://dx.doi.org/10.1001/jamapsychiatry.2020.1818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330829PMC
November 2020

Online video psychoeducation for electroconvulsive therapy in India: A randomized controlled trial.

Asia Pac Psychiatry 2020 May 29. Epub 2020 May 29.

U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA.

Despite its effectiveness, electroconvulsive therapy (ECT) has been widely but diminishingly used in India. The current study evaluated a video psychoeducation on ECT offered to adults in India who screened positive for depression. Participants were randomly assigned to receive either video or brochure psychoeducation. Both video and brochure psychoeducation significantly improved participants' perceptions, knowledge, and willingness to receive ECT with only a few significant differences between the two modalities. Together, these findings suggest that psychoeducation is effective. Video psychoeducation which can be inexpensive and widely distributed may represent an important way to encourage patients to consider ECT as an option.
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http://dx.doi.org/10.1111/appy.12395DOI Listing
May 2020

Do Sex Differences Among Adults With Opioid Use Disorder Reflect Sex-specific Vulnerabilities? A Study of Behavioral Health Comorbidities, Pain, and Quality of Life.

J Addict Med 2020 12;14(6):502-509

VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT (TGR, MKRP, MS, RAR); Department of Psychiatry, School of Medicine, Yale University, New Haven, CT (TGR, MKRP, MS, RAR); Department of Public Health Sciences, School of Medicine, University of Connecticut Health Care, Farmington, CT (TGR); Psychology Service, VA Connecticut Healthcare System, West Haven, CT (MKRP).

Objectives: Studies suggest that men and women have different vulnerabilities to a number of substance use disorders (SUDs). We examined whether differences between women and men with opioid use disorder (OUD) are significantly different from those without OUD for selected sociodemographic and health outcomes.

Methods: We used a cross-sectional survey design using data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III, which surveyed nationally representative samples of non-institutionalized adults (n = 36,309 unweighted). Past-year OUD and other behavioral co-morbidities were defined using DSM-5 criteria. In bivariate analyses, we investigated sex differences in socio-demographic factors, behavioral co-morbidities, pain, and health-related quality of life (HRQOL) between women and men with past-year OUD, and then those without past-year OUD. We further used logistic regression analyses to evaluate interactions between effect of sex and past-year OUD status on behavioral co-morbidities, pain, and HRQOL.

Results: When extrapolated, about 2.1 million US adults met diagnostic criteria for past-year OUD. Women with OUD had a higher likelihood of having several past-year psychiatric disorders, and a lower likelihood of having any past-year SUDs compared to male counterparts. However, similar relationships were observed among those without OUD and significant interaction effects were not found on behavioral co-morbidities, pain, and HRQOL, indicating that general sex differences are not specific to OUD.

Conclusions: Although sex differences are not specific to OUD, concurrent disorders are not uncommon among women, as well as men, with OUD. There is a need to treat concurrent behavioral health conditions from a multimorbidity perspective in the treatment of OUD in both sexes.
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http://dx.doi.org/10.1097/ADM.0000000000000662DOI Listing
December 2020

A single assessment with the Brief Adherence Rating Scale (BARS) discriminates responders to long-acting injectable antipsychotic treatment in patients with schizophrenia.

Schizophr Res 2020 06 5;220:92-97. Epub 2020 Apr 5.

Department of Psychiatry, University of Arizona and Southern Arizona VA Health Care System, Tucson, AZ 85723, USA.

Objective: To determine if a single baseline adherence assessment (Brief Adherence Rating Scale [BARS]) could identify patients who are likely to respond to long-acting injectable (LAI) antipsychotic treatment.

Method: The current secondary analysis included a sub-sample of adult outpatients (N = 176) with schizophrenia or schizoaffective disorder who participated in the "A Comparison of Long-Acting Injectable Medications for Schizophrenia (ACLAIMS)" trial and had a baseline BARS assessment and a baseline and month 3 Positive and Negative Syndrome Scale (PANSS) rating. The main outcome was LAI treatment response, defined as a ≥ 20% decrease (baseline to month 3) on the PANSS total score. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analysis was conducted to determine the optimal cutpoint of baseline BARS adherence in discriminating LAI treatment response at month 3. A logistic mixed model estimated the odds of response to LAI treatment at month 3 from the optimal baseline BARS cutpoint.

Results: The ROC analysis determined that the single baseline BARS rating (cutoff ≤66%), indicating low adherence, best discriminated patients likely to respond to LAI treatment (AUC = 0.603, SE = 0.046, 95% binomial exact CI = 0.527 to 0.676, p = 0.025), with 38% sensitivity and 85% specificity. The logistic mixed model analysis revealed that patients with ≤66% BARS adherence had 3.464 times the predicted odds (95% CI = 1.604 to 7.480, p = 0.001) of responding to LAI treatment than those who were >66% BARS adherent.

Conclusion: A single baseline BARS assessment discriminated response to LAI treatment suggesting it is a reasonable tool to identify candidates for LAI antipsychotic treatment.
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http://dx.doi.org/10.1016/j.schres.2020.03.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306424PMC
June 2020

Alcohol Use Disorder Among Adults Recovered From Substance Use Disorders.

Am J Addict 2020 07 26;29(4):331-339. Epub 2020 Mar 26.

Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut.

Background And Objectives: Alcohol use is often overlooked and underestimated among patients recovered from substance dependence. The prevalence and correlates of alcohol use disorder (AUD) among adults recovered from substance use disorders (SUDs) are estimated in this study.

Methods: A nationally representative cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions Wave-III was used in this study. Survey respondents, aged 18 or older, who recovered from SUDs, based on Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria (n = 2061 unweighted), were included. A total of three comparison groups were identified using DSM-5 criteria (1) current AUD, (2) former AUD, and (3) never had AUD. The prevalence of these groups was estimated; medical and psychiatric comorbidities and health-related quality of life were compared; and factors associated with having a current AUD when compared with those with former AUD and those who never had AUD were examined, controlling for other covariates.

Results: About 5.7% of US adults, nationally representative of 14.2 million, have been reported to have recovered from past SUDs. Of these, 28.9% met criteria for current AUD and 48.4% had former AUD. When compared with those who never had AUD, factors associated with having a current AUD included the following: living in urban areas (P = .019), having a bipolar 1 disorder (P < .001), and a history of lifetime incarceration (P = .004).

Discussion And Conclusion: Nearly one-third of adults recovered from SUDs had current AUD, and several behavioral factors were associated with having a current AUD when compared with those who never had AUD.

Scientific Significance: Our study highlights the substantial risk of AUD in adults who have successfully recovered from SUDs. (Am J Addict 2020;00:00-00).
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http://dx.doi.org/10.1111/ajad.13026DOI Listing
July 2020

A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States.

Psychiatr Serv 2020 06 10;71(6):562-569. Epub 2020 Mar 10.

National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs (VA), and the VA Connecticut Healthcare System, West Haven, Connecticut (Tsai, Rosenheck); Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Tsai, Rosenheck, Wilkinson); Department of Psychology, University of Hartford, West Hartford, Connecticut (Huang).

Objective: Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment.

Methods: This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation.

Results: Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT.

Conclusions: These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.
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http://dx.doi.org/10.1176/appi.ps.201900448DOI Listing
June 2020