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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 706 Research Studies DisplayedMoise N, Paniagua-Avila A, Barbecho JM
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
This study used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. The goal is to optimize depression treatment in primary care clinics using the Transform DepCare shared decision-making and psychoeducation patient tool. The authors applied the Behaviour Change Wheel to their prior mixed methods to identify key sustainability behaviors and determinants of sustainability. The authors enlisted 22 national and local stakeholders to operationalize and adapt a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. They identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. They determined that a waiting room that delivered DepCare, the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key improvements would include expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).
AHRQ-funded; HS025198.
Citation: Moise N, Paniagua-Avila A, Barbecho JM .
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
Implement Sci Commun 2023 Jan 25; 4(1):10. doi: 10.1186/s43058-022-00383-2..
Keywords: Depression, Primary Care, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Thompson KA, Hedlund EL, Sun Q
Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic.
The purpose of this study was to assess changes in and predictors of Eating Disorder (ED) symptoms, ED concerns related to the COVID-19 pandemic, and anxiety symptoms within the first 12 months of the COVID-19 pandemic among individuals with self-reported EDs in the United States, Sweden, and the Netherlands. The researchers administered an online survey to participants, evaluating ED symptoms, general anxiety symptoms, pandemic-related ED worries about accessing food, lack of structure and social support, being in a triggering environment, and costs of food and treatment. The study found that 3 patterns were evident: 1) a curvilinear progression with the greatest level of symptoms at baseline, declining through November 2020, and then increasing through the remainder of the year; 2) a linear declining progression; and 3) a stable progression with no variations. The researchers reported that concerns about COVID-19 infection, lockdown, worries about lack of structure and social support, and worries about accessing food aligned with their recovery meal plan predicted increases in ED symptoms.
AHRQ-funded.
Citation: Thompson KA, Hedlund EL, Sun Q .
Course and predictors of eating disorder symptoms, anxiety symptoms, and pandemic-related eating disorder concerns among adults with eating disorders during the first year of the COVID-19 pandemic.
Int J Eat Disord 2023 Jan; 56(1):151-68. doi: 10.1002/eat.23870..
Keywords: COVID-19, Behavioral Health, Anxiety
Safon CB, Estela MG, Rosenberg J
Implementation of a novel pediatric behavioral health integration initiative.
The purpose of this concurrent, qualitative-dominant mixed methods empirical study was to explore healthcare professionals' perceptions of the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). The researchers utilized semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year process and surveys administered at three time points. Qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. The researchers round five emergent themes aligning with RC domains. The results of the survey showed that healthcare professionals reported both greater behavioral healthcare integration into clinic practice and greater clinic readiness to address behavioral health needs. The researchers concluded that effective pediatric BHI and care delivery at CHCs may depend on solid professional relationships and communication.
AHRQ-funded; HS022242.
Citation: Safon CB, Estela MG, Rosenberg J .
Implementation of a novel pediatric behavioral health integration initiative.
J Behav Health Serv Res 2023 Jan;50(1):1-17. doi: 10.1007/s11414-022-09803-6..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Primary Care, Patient-Centered Healthcare, Community-Based Practice
Goodsmith N, Cohen AN, Pedersen ER
Predictors of functioning and recovery among men and women veterans with schizophrenia.
This study examined predictors of functioning and recovery among men and women veterans with schizophrenia in treatment at Veterans Affairs medical centers using participant surveys at baseline and one year later. The cohort included 734 men and 67 women at baseline and 604 men and 58 women one year later. They were surveyed on quality of life and functioning. Men and women did not differ significantly in baseline social support, psychiatric symptoms, or recovery. Being female predicted higher occupational functioning, while social functioning in men was inversely related to baseline symptom severity. Marriage predicted higher quality of life for women, but not for men.
AHRQ-funded; HS026407.
Citation: Goodsmith N, Cohen AN, Pedersen ER .
Predictors of functioning and recovery among men and women veterans with schizophrenia.
Community Ment Health J 2023 Jan; 59(1):110-21. doi: 10.1007/s10597-022-00979-x..
Keywords: Behavioral Health, Sex Factors
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
AHRQ-funded; HS027389.
Citation: Toseef MU, Durfee J, Podewils LJ .
Total cost of care associated with opioid use disorder treatment.
Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
McQuillan J, Andersen JA, Berdahl TA
AHRQ Author: Berdahl TA
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
The objective of this study was to examine associations between changes in Rheumatoid Arthritis symptoms and depressive symptoms and to test if these associations differed by education, or gender, or race/ethnicity. Data was taken from the National Rheumatoid Arthritis Study, 1988-98. The results indicated that people with Rheumatoid Arthritis experienced increases in depressive symptoms as well as pain, functional disability, and household work disability over the study period. There was no difference noted in the rate of change in depressive symptoms by education, gender, nor race/ethnicity, but the association of functional disability with depressive symptoms was stronger for men than women. The researchers concluded that it is important to monitor and treat both mental and physical health symptoms, and that future research should focus on the collection of data that reflects the educational, gender, and racial/ethnic diversity of people with Rheumatoid Arthritis.
AHRQ-authored.
Citation: McQuillan J, Andersen JA, Berdahl TA .
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
Arthritis Care Res 2022 Dec;74(12):2050-58. doi: 10.1002/acr.24730..
Keywords: Arthritis, Depression, Behavioral Health, Racial and Ethnic Minorities, Sex Factors, Chronic Conditions
Stransky ML, Fuchu P, Prendergast K
Beyond housing for health: using flexible funds to improve maternal and child health.
The purpose of this article is to describe the Upstreaming Housing for Health’s (UHfH) use of a flexible fund. The UHfH was a pilot program developed and implemented to improve housing stability and decrease health inequities among people with high-risk pregnancies and their babies. The flexible fund is a cash transfer policy that served 50 families from 2019 to 2020 and addressed housing stability and material needs that encouraged family stability within the context of their housing. The researchers found that 76% of the families accessed flexible funds for items such as rental assistance, cribs, and breast pumps, with average financial support of $1343 (standard deviation = $625). The researchers advise that cash transfer policies such as the flexible fund have been shown to positively impact family health and well-being around the world.
AHRQ-funded; HS022242.
Citation: Stransky ML, Fuchu P, Prendergast K .
Beyond housing for health: using flexible funds to improve maternal and child health.
J Urban Health 2022 Dec;99(6):1027-32. doi: 10.1007/s11524-022-00686-8..
Keywords: Children/Adolescents, Behavioral Health, Social Determinants of Health, Outcomes
Leyenaar JK, Tolpadi A, Parast L
Collaborative to increase lethal means counseling for caregivers of youth with suicidality.
The authors implemented an eight-hospital quality improvement collaborative with the goals of an absolute increase in hospitals' mean rate of caregiver lethal means counseling (LMC) and evaluating the effectiveness of the collaborative on LMC. The collaborative used a structured process of alternating learning sessions and action periods to improve LMC; electronic medical record documentation of LMC were evaluated during three phases: precollaborative, active collaborative, and postcollaborative. Findings showed that LMC increased during the collaborative but did not exceed expected trends. The authors concluded that interventions developed by the participating hospitals may be beneficial to improve LMC for caregivers of hospitalized youth with suicidality.
AHRQ-funded; HS025291.
Citation: Leyenaar JK, Tolpadi A, Parast L .
Collaborative to increase lethal means counseling for caregivers of youth with suicidality.
Pediatrics 2022 Dec 1;150(6):e2021055271. doi: 10.1542/peds.2021-055271..
Keywords: Children/Adolescents, Caregiving, Behavioral Health
Borgatti AC, Crockett KB, Jacob AE
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
The objective of this study was to evaluate changes in stress and loneliness among participants with obesity who were engaged in weight loss self-management in the US during COVID-19, and to identify risk factors that may increase psychosocial distress during this period. Participants completed an online survey about social, economic and health behavior changes during COVID-19 and their relationship to changes in perceived stress and loneliness. Results indicated that stress and loneliness increased two months into the COVID-19 pandemic-related shutdown. Factors associated with increased stress and/or loneliness included higher body mass index, social distancing, alcohol intake, and working from home. The authors concluded that ongoing attention to psychosocial well-being among individuals with obesity remains imperative both during the ongoing pandemic and afterwards.
AHRQ-funded; HS013852.
Citation: Borgatti AC, Crockett KB, Jacob AE .
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
Psychol Health 2022 Dec; 37(12):1547-64. doi: 10.1080/08870446.2022.2038790..
Keywords: COVID-19, Obesity, Stress, Social Stigma, Behavioral Health
Richards JE, Yarborough BJH, Holden E
Implementation of suicide risk estimation analytics to support mental health care for quality improvement.
The purpose of this mixed-methods quality improvement study was to examine and describe the use of estimation analytics to enhance existing suicide prevention practices during routine mental health specialty engagements. The study found that during the 3.5 month observation period there were 4,789 patient engagements by 1939 patients. This included 161 engagements newly identified by suicide risk estimation analytics. The researchers reported that the engagement-based risk identifications did not consistently trigger additional suicide risk assessment as intended. During newly identified engagements: 57 patients reported frequent suicidal ideation and, as per preexisting workflow, 54 completed a Columbia-Suicide Severity Rating Scale (C-SSRS); 75 patients reported no or infrequent suicidal ideation, but only 10 completed a C-SSRS, per new workflow; 29 patients did not answer the Patient Health Questionnaire-9 (PHQ-9), and only 1 patient completed a C-SSRS, per new workflow. The providers interviewed (n = 8) reported important implementation concerns, including 1) lack of follow-up, 2) electronic health record- (EHR-) related inefficiencies, and 3) reliability and accuracy of the trigger. The patients interviewed (n = 20) repeated concerns about reliability and accuracy of estimation analytics. In addition, providers described concerns about access to care and potential liability associated with known suicide risk. Patients repeated the provider concerns about access and reported fears about identification of suicide risk resulting in coercive care. The researchers conclude that this unique quality improvement study underscores important implications for health care organizations considering implementation of estimation analytics to support engagement-based identification of suicide risk.
AHRQ-funded; HS026369.
Citation: Richards JE, Yarborough BJH, Holden E .
Implementation of suicide risk estimation analytics to support mental health care for quality improvement.
JAMA Netw Open 2022 Dec;5(12):e2247195. doi: 10.1001/jamanetworkopen.2022.47195..
Keywords: Behavioral Health, Quality Improvement, Quality of Care
Carlile N, Fuller TE, Benneyan JC
Lessons learned in implementing a chronic opioid therapy management system.
This article describes a research collaborative of health service researchers, systems engineers, and clinicians that sought to improve processes for safer chronic opioid therapy management in an academic primary care center. The authors present implementation results and lessons learned along with an intervention toolkit that others may consider using within their organization. They designed, tested, and implemented two key safe opioid use process metrics-percent for patients with recent opioid treatment agreements and urine drug tests. Focus groups were conducted after the conclusion of the implementation. They found a general lack of knowledge regarding resources available to patients and prescribers in the primary care clinic. In addition, 69% of clinicians reported largely “inheriting” (rather than initiating) their chronic opioid therapy patients. They also tracked 68 patients over a 4-year period and found although process measures improved, full adherence was not achieved for the entire population. Barriers identified included team structure, the evolving opioid environment, and surveillance challenges, along with disruptions resulting from the 2019 novel coronavirus.
AHRQ-funded; HS024453.
Citation: Carlile N, Fuller TE, Benneyan JC .
Lessons learned in implementing a chronic opioid therapy management system.
J Patient Saf 2022 Dec 1;18(8):e1142-e49. doi: 10.1097/pts.0000000000001039..
Keywords: Opioids, Medication, Pain, Chronic Conditions, Substance Abuse, Behavioral Health, Practice Patterns
Acolin J, Hajat A, Nurius PS
Playgrounds are for children: investigating developmentally-specific “green space” and child mental health.
This article investigated the association between parks with playgrounds and young children’s mental health. The authors found that children who lived near parks with playgrounds had better mental health than those near parks with no playground. They concluded that while their results are not statistically significant, it may be worthwhile to examine developmentally specific features in “green space” and their effects.
AHRQ-funded; HS013853.
Citation: Acolin J, Hajat A, Nurius PS .
Playgrounds are for children: investigating developmentally-specific “green space” and child mental health.
SSM Mental Health 2022 Dec; 2:100087..
Keywords: Children/Adolescents, Behavioral Health
Ortiz D, Perkins AJ, Fuchita M
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
The purpose of this retrospective post-hoc analysis study was to evaluate variations in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Data from the Trauma Medical Home, a multicenter randomized controlled trial was used for analysis. The study found that almost 50% of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9, and 41% of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at the baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) were more likely to have experienced at least mild depression at the time of hospital discharge after traumatic injury.
AHRQ-funded; HS026390.
Citation: Ortiz D, Perkins AJ, Fuchita M .
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
Ann Surg Open 2022 Dec; 3(4):e217. doi: 10.1097/as9.0000000000000217..
Keywords: Elderly, Anxiety, Depression, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Injuries and Wounds
Richmond J, Adams LB, Annis IE
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
The purpose of this cross-sectional survey study was to assess factors related with African American parents seeking care for their child within 30 days after identifying the child’s behavioral or emotional need and with postponing care for 1 year or more. The researchers surveyed 289 African American parents who were raising a child with emotional or developmental challenges to explore relationships between parent activation, medical mistrust, and care-seeking barriers with two outcomes: rapidly seeking care (within 30 days after identifying a child’s need) and deferring care seeking. The study found that approximately 22% of parents rapidly sought care, and 49% deferred care for 1 year or more. Parents were more likely to rapidly seek care if they had higher parent activation scores; lived with other adults with mental health challenges; or, contrary to the authors' hypothesis, mistrusted doctors. Parents were less likely to rapidly seek care if the challenge did not initially bother them much or if their health insurance would not cover the service. Parents were more likely to defer care if they feared involuntary hospitalization for their child or if their health insurance would not cover the service. Parents were less likely to defer care if they had at least some college education or lived with other adults with mental health challenges. The researchers concluded that when developing programs that support African American families, professionals should be advised about facilitators and barriers to mental health care seeking.
AHRQ-funded; HS026122.
Citation: Richmond J, Adams LB, Annis IE .
Rapid and deferred help seeking among African American parents of children with emotional and behavioral difficulties.
Psychiatr Serv 2022 Dec;73(12):1359-66. doi: 10.1176/appi.ps.202100553..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Behavioral Health, Healthcare Utilization
Klawetter S, Cetin N, Ilea P
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
The purpose of this qualitative study was to examine the mental health needs of parents of infants in a neonatal intensive care unit (NICU), and the challenges and solutions to meeting those needs. Through interviews with 15 parents and staff at a level IV NICU in the United States, the study found: the relationship between staff and parents filter protect from trauma and distress; information needs and mental health needs change over time, a lack of continuity of care affects response to mental health concerns, and NICU plays a critical role in addressing the mental health of parents. The researchers concluded that mental health support should be integrated into and customized to the entire NICU trajectory, with emphasis on parents living in rural locations and non-English-speaking parents.
AHRQ-funded; HS026370.
Citation: Klawetter S, Cetin N, Ilea P .
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
J Perinatol 2022 Nov;42(11):1496-503. doi: 10.1038/s41372-022-01426-1..
Keywords: Caregiving, Newborns/Infants, Critical Care, Intensive Care Unit (ICU), Behavioral Health
Fletcher EH, Kalofonos I
Adaptation of a Hearing Voices group facilitation training for VA stakeholders.
The purpose of this study was to describe an adaptation of a Hearing Voices (HV) group facilitation training at the Veterans Administration hospital of Greater Los Angeles (VAGLA) and to explore training modifications, trainee perceptions and application and intervention outcomes. Researchers conducted surveys of trainees (n = 18) and collected field notes throughout the 24-hour online training. The study found that the training had high acceptability and appropriateness and high feasibility in implementation.
AHRQ-funded; HS026407.
Citation: Fletcher EH, Kalofonos I .
Adaptation of a Hearing Voices group facilitation training for VA stakeholders.
Community Ment Health J 2022 Nov;58(8):1592-604. doi: 10.1007/s10597-022-00975-1..
Keywords: Behavioral Health, Training
Grove LR, Rao N, Domino ME
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
This study’s goal was to inform efforts to increase prescriptions of medications for opioid use disorder (MOUD) among Medicaid beneficiaries. A retrospective study of North Carolina licensed physicians, physician assistants, and nurse practitioners was conducted to estimate Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and to estimate the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Outcomes looked for were indicators of any Medicaid professional claims and Medicaid claims data for buprenorphine and naltrexone. Licensure data from 2018 was merged with 2019 US Drug Enforcement Administration to identify clinicians who used the DEA waiver required to prescribe buprenorphine (n = 1714). Services by waivered clinicians to Medicare beneficiaries ranged from 67% of behavioral health clinicians to 82.9% of specialist physicians. Prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians.
AHRQ-funded; HS000032.
Citation: Grove LR, Rao N, Domino ME .
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
Addiction 2022 Nov;117(11):2855-63. doi: 10.1111/add.15854..
Keywords: Opioids, Substance Abuse, Behavioral Health, Vulnerable Populations, Medication, Access to Care, Medicaid
Gibbons RD, Hur K, Lavigne JE
Association between folic acid prescription fills and suicide attempts and intentional self-harm among privately insured US adults.
This paper describes a large-scale pharmacoepidemiologic study of folic acid prescription fills to determine if there is a decreased risk of suicide attempt. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for 866,586 patients with private health insurance who filled a folic acid prescription from 2012 to 2017. In the cohort 81.3% were female, and 10.42% were 60 years and older. Overall, there were 261 suicidal events during covered by a folic acid prescription for a rate of 4.73 per 100,000 person-months, compared with 895 suicidal events during months without folic acid for a rate of 10.61 per 100,000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56, with similar results for the modal dosage of 1 mg of folic acid per day and women of childbearing age. The same association with the negative control cyanocobalamin found no association with suicide attempt.
AHRQ-funded; HS016973.
Citation: Gibbons RD, Hur K, Lavigne JE .
Association between folic acid prescription fills and suicide attempts and intentional self-harm among privately insured US adults.
JAMA Psychiatry 2022 Nov;79(11):118-1123. doi: 10.1001/jamapsychiatry.2022.2990..
Keywords: Medication, Behavioral Health, Adverse Drug Events (ADE), Adverse Events
Benson NM, Yang Z, Weiss M
Identifying diagnoses of schizophrenia spectrum disorder in large data sets.
The objective of this study was to determine which index diagnoses of schizophrenia spectrum disorder were new diagnoses. Researchers used to the Massachusetts All-Payer Claims Database to identify patients with a schizophrenia spectrum disorder diagnosis in 2016, then reviewed patient care histories to identify previous diagnoses. Their findings show that, of the 7,217 patients aged 15–35 with a diagnosis of schizophrenia spectrum disorder, more than 67 percent had at least 48 months of historical diagnosis data. They conclude that the examination of multiple years of patient history is critical to the identification of new schizophrenia spectrum disorder diagnoses.
AHRQ-funded; HS024725.
Citation: Benson NM, Yang Z, Weiss M .
Identifying diagnoses of schizophrenia spectrum disorder in large data sets.
Psychiatr Serv 2022 Nov;73(11):1210-16. doi: 10.1176/appi.ps.202100696..
Keywords: Behavioral Health
Valentine KD, Lipstein EA, Vo H
Pediatric caregiver version of the Shared Decision Making Process Scale: validity and reliability for ADHD treatment decisions.
This study’s goal was to examine the validity and reliability of a scale for a shared decision making (SDM) Process scale in attention-deficit/hyperactivity disorder (ADHD) treatment decisions. This cross-sectional survey included 498 caregivers of children aged 5-13 diagnosed with ADHD who had made a decision about ADHD medication in the last 2 years. Surveys included the adapted SDM Process scale, decisional conflict, decision regret, and decision involvement. The scale was found to be acceptable and reliable. Scores demonstrated convergent validity, as they were higher for those without decisional conflict than those with decisional conflict and higher for caregivers who stated they made the decision with the provider than those who made the decision themselves. Higher scores were related to less regret, though the magnitude of the relationship was small.
AHRQ-funded; HS025718.
Citation: Valentine KD, Lipstein EA, Vo H .
Pediatric caregiver version of the Shared Decision Making Process Scale: validity and reliability for ADHD treatment decisions.
Acad Pediatr 2022 Nov-Dec;22(8):1503-09. doi: 10.1016/j.acap.2022.07.014..
Keywords: Children/Adolescents, Behavioral Health, Shared Decision Making, Patient-Centered Healthcare
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Mackie TI, Schaefer AJ, Palatucci JS
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
The purpose of this sequential multi-method study was to propose a classification for the procedural elements of informed consent policies based upon existing child welfare policies and then explored whether formal state policies across the United States authorized these elements. The researchers conducted interviews with 58 key informants primarily from state child welfare agencies to identify a classification of procedural elements for informed consent of psychotropic medications. A legislative review of the 50 states and D.C. was then conducted to characterize whether formal policies endorsed each procedural element. Key informants reported five procedural elements in policy, and 23 states endorsed relevant legislation. Only two states specified all five procedural elements, and the content of any procedural elements varied considerably across policies.
AHRQ-funded; HS02198501; HS026001
Citation: Mackie TI, Schaefer AJ, Palatucci JS .
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
Adm Policy Ment Health 2022 Nov;49(6):986-1003. doi: 10.1007/s10488-022-01212-3..
Keywords: Children/Adolescents, Vulnerable Populations, Medication, Behavioral Health, Policy
Hoopes AJ, Brandzel SD, Luce C
What do adolescents and their parents need from mental health integration in primary care? A qualitative exploration of design insights.
The purpose of this study was to 1) explore the challenges of primary care-based mental health and substance use screening and care for adolescents and 2) identify program design solutions. The researchers conducted interviews and focus groups with adolescents receiving care at Kaiser Permanente Washington in 2020, and separate interviews with the parents of the participants. The study found five overarching design principle themes emerged from the 41 interviews and 10 focus groups: 1) Engagement, 2) Privacy, 3) Communication, 4) Choice, and 5) Ease.
Citation: Hoopes AJ, Brandzel SD, Luce C .
What do adolescents and their parents need from mental health integration in primary care? A qualitative exploration of design insights.
J Pediatr Health Care 2022 Nov-Dec; 36(6):570-81. doi: 10.1016/j.pedhc.2022.06.006..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Behavioral Health, Primary Care