A simulation–optimization framework for post-disaster allocation of mental health resources

Extreme events, such as natural or human-caused disasters, cause mental health stress in affected communities. While the severity of these outcomes varies based on socioeconomic standing, age group, and degree of exposure, disaster planners can mitigate potential stress-induced mental health outcomes by assessing the capacity and scalability of early, intermediate, and long-term treatment interventions by social workers and psychologists. However, local and state authorities are typically underfunded, understaffed, and have ongoing health and social service obligations that constrain mitigation and response activities. In this research, a resource assignment framework is developed as a coupled-state transition and linear optimization model that assists planners in optimally allocating constrained resources and satisfying mental health recovery priorities post-disaster. The resource assignment framework integrates the impact of a simulated disaster on mental health, mental health provider capacities, and the Center for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) to identify vulnerable populations needing additional assistance post-disaster. In this study, we optimally distribute mental health clinicians to treat the affected population based upon rule sets that simulate decision-maker priorities, such as economic and social vulnerability criteria. Finally, the resource assignment framework maps the mental health recovery of the disaster-affected populations over time, providing agencies a means to prepare for and respond to future disasters given existing resource constraints. These capabilities hold the potential to support decision-makers in minimizing long-term mental health impacts of disasters on communities through improved preparation and response activities.

Psychiatric Health Problems and Health Seeking Behavior of Men Who Have Sex with Men (MSM) in Agra city, Uttar Pradesh

Introduction: Researches had shown that Men who have sex with men (MSM) have higher chances of having psychiatric disorder as compared to heterosexual men. Ongoing homophobia, stigma and discrimination have negative effects on mental health of MSM. Many MSM do not seek care from mental health provider because of fear of discrimination Objectives: This study was carried out to assess psychiatric health problem among MSM and also assess their health seeking behavior. Method: The Snowball sampling technique was used. First participants were recruited through a non-profit peer group. Further participants were subsequently referred by participants from their peer circles. Data obtained from total 52 MSM using pretested questionnaire and General health questionnaire (GHQ-28) was analyzed using MS Excel. Results: Two-fifth (40.38%) of MSM had self-reported psychiatric health problem. While on GHQ, 57.69% of MSM were found to have psychiatric health problem with GHQ score of ≥24. MSM who were completely homosexual and who were victims/doer of violence with sex partners had significantly higher chances of having psychiatric health problem.57.15% MSM sought treatment for their psychiatric problem from an Allopathic doctor. Rest of them either went for a self treatment (28.57%) or not taken any treatment (14.28%). 75% MSM reportedly sought treatment from private health facility. Better facility, cost effectiveness, someone known recommended were most commonly cited reason for preferring a mental health provider. Conclusion: High prevalence of psychiatric health problems was found among MSM who engage in higher-risk sexual behavior. MSM require access to mental health screening services.

The stigma of digital amputation: a survey of amputees with analysis of risk factors

The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36–64) was similar to the mean value of the normal population. Younger age, a worker’s compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation. Level of evidence: III

A comparison of oncologist versus mental health provider attitudes towards standardized and tailored patient-reported outcomes

Background Patient-reported outcomes (PROs) can be used to monitor patients during treatment. Healthcare provider preferences for individualized vs. standardized PROs have been understudied. Methods This study surveyed oncology and mental health providers to compare attitudes towards individualized and standardized PROs. We have developed a method for individualizing PROs, called precision PROs, and the survey specifically assessed preferences for this method. We compared attitudes and preferences by provider type and by whether respondents were current or never users of PROs. Results Oncology providers expressed more positive attitudes for standardized PROs in treatment planning compared to mental health providers (F(1,440) = 5.978, p = 0.015). The interaction between provider type (oncology vs. mental health) and type of PRO (individualized vs. standardized) was not significant for the attitudes about the clinical utility of PROs (p = 0.709). When directly asked about the precision PRO approach, oncologists were less likely to prefer standardized items (OR = 0.478, p = 0.001) or have no preference (OR = 0.445, p = 0.007) to the precision PRO approach when compared to mental health providers. Qualitative analyses suggested standardized PROs may be simpler or easier to understand whereas individualized PROs better capture patient variability and the unique aspects of each patient’s condition. Some mental health providers expressed reticence about letting patients choose how to tailor PROs. Never users of PROs reported more positive attitudes towards individualized measures than standardized measures whereas current users of PROs did not have a difference in attitudes (p = 0.010). User status was mostly unrelated to preferences. Conclusion Results suggest that healthcare provider preference for individualized PROs may differ by medical specialty. How PROs are tailored may need to differ by discipline. This is particularly important given that previous research showing a preference for individualized PROs over standardized was conducted with psychotherapists. Further research on patient preferences for individualized and standardized PROs is warranted as is research on the clinical utility of individualized PROs such as the precision PRO approach.

Psychometric Validation of a Combined Assessment for Anxiety and Depression in Primary Care in Mozambique (CAD-MZ)

This study sought to validate a combined assessment for major depression and generalized anxiety, administered by health providers in a primary care setting in Mozambique. Patients attending a primary care visit ( N = 502) were enrolled in the study and completed the Patient Health Questionniare–9, the Generalized Anxiety Disorder–7, and six items identified in a global systematic qualitative review of depression that were not captured in existing measures (e.g., social isolation, “thinking too much,” and “heart problems”). A separate trained mental health provider conducted the Mini International Neuropsychiatric Interview 5.0, adapted for Mozambique, to establish clinical diagnoses. Item response theory, factor analysis, and receiver operating characteristics were all used to identify the best screening items. Eight items were identified for the final screener: four items from the Patient Health Questionniare–9, two from the Generalized Anxiety Disorder–7, and two from the global depression literature. A cut-score of 7 was found to consistently increase the diagnostic likelihood of having a particular disorder. Overall, findings indicate good clinical utility of the screener in primary care in Mozambique.

Acceptability and Feasibility of a Computerized Cognitive Behavioral Therapy Intervention for Depression among Veterans (Preprint)

BACKGROUND Computerized cognitive behavioral therapies (cCBT) have been developed to deliver efficient, evidence-informed treatment for depression and other mental health conditions. One of the most empirically supported cCBTs for depression is Beating the Blues (BtB), which is often administered with the support of a care provider or peer. This increases the complexity and cost of the intervention. OBJECTIVE Researchers at a Veterans Affairs Medical Center (VAMC) aimed to test the acceptability and feasibility stand-alone cCBT for depression among US military Veterans. METHODS Among United States (US) military Veterans experiencing current mild to moderate depressive symptoms, a before-after trial was implemented to examine the acceptability of BtB delivered without additional peer or other mental health provider support. Feasibility of the study design for use in a future efficacy trial was also evaluated. RESULTS Forty-nine Veterans completed pre-intervention assessments and received access to BtB. Twenty-nine participants completed all post-intervention assessments. Thresholds for acceptability of the intervention were met. While pre-determined feasibility criterion regarding eligibility, use of BtB, and post-assessment completion were not met, results were comparable with other cCBT studies. CONCLUSIONS This study is the first among US military Veterans to demonstrate support for implementation of a cCBT for depression without the assistance of a mental health professional or a peer support specialist; thereby suggesting that a stand-alone computer-aided intervention may be viable. Further research is warranted. CLINICALTRIAL N/A

Mental health Project ECHO Autism: Increasing access to community mental health services for autistic individuals

Despite the high prevalence of co-occurring autism spectrum disorders and mental health condition(s), there exist substantial barriers to mental health treatment for autistic individuals. These barriers are exacerbated by a lack of mental health provider training and self-efficacy in providing adapted services to autistic individuals. One method which has been effective in mitigating similar service gaps is the Extension for Community Healthcare Outcomes (Project ECHO) Autism model, a tele-mentoring platform that connects primary care physicians to autism spectrum disorder experts to improve physicians’ knowledge, self-efficacy, and practice. This study developed and implemented a pilot mental health version of Project ECHO Autism designed to increase mental health provider knowledge, self-efficacy, and problem-solving. Community mental health providers ( N = 51) participated in the 6-month Project ECHO Autism including mental health–focused didactics and provider case presentations. Analysis of pre- and post-measures revealed improvements in all domains, including significant increases in provider knowledge of autism spectrum disorders, self-efficacy, and problem-solving. Participants additionally reported high satisfaction with their experience. Taken together, preliminary results indicate that Project ECHO Autism may be a feasible, accessible, and effective method for increasing mental health provider competence and ultimately increasing access to services for autistic individuals who have co-occurring mental health diagnoses. Lay abstract Although many autistic individuals have additional mental health conditions, most have a hard time getting services from mental health providers. One reason why these services can be hard to access is that many mental health providers do not feel confident in their ability to provide services to autistic individuals. To share autism expertise with local community providers and boost their confidence in working with autistic individuals, we created a mental health version of the Extension for Community Healthcare Outcomes (Project ECHO) Autism virtual teleconsultation program. In this pilot study, we recruited 51 community mental health providers to participate in Project ECHO Autism. During each biweekly session, providers received information from autism experts about how to tailor mental health interventions (e.g. attention-deficit hyperactivity disorder or anxiety interventions) for use with autistic individuals. They also had the opportunity to ask questions and get advice on their current cases. At the end of the 6-month study, mental health providers showed improvements in their confidence, in their knowledge of autism, and in their problem-solving skills. Nearly half (45%) of these providers participated from rural counties, suggesting that the Project ECHO Autism teleconsultation model was able to reach mental health providers who might not have been able to get training otherwise. This study supports the feasibility of using Project ECHO Autism to share autism knowledge with mental health providers, consequently expanding mental health service options for autistic individuals with co-occurring mental health conditions.