810 Routine Psychosocial Screening and Follow-up of Adult Burn Patients in an Outpatient Clinic

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S243-S244
Author(s):  
Alaina Tiani ◽  
Desiree N Williford ◽  
Carrie B Jackson ◽  
Kristine Durkin ◽  
Ariana Langholz ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Burn Injury ◽  
Psychological Services ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
Burn Survivors ◽  
Clinically Significant ◽  
At Home

Abstract Introduction Sustaining a burn injury is associated with increased risk of mental health issues, and common among these are depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. Unfortunately, less than half of these adult burn survivors receive services related to their mental health concerns. Moreover, few studies have examined the routine implementation of a psychosocial screener in an outpatient burn clinic setting, and there is a paucity of research which examines how to proceed when patients endorse symptomology. The aim of the current study is to report on outcomes of a routine psychosocial screener in a sample of adult burn survivors and patient response to brief psychological consultation at initial screen and 1-month follow-up. Methods A psychosocial screener was developed and implemented (October 2016-August 2019) in an outpatient burn clinic to identify patients who endorse clinically significant psychosocial distress. Comprised of very brief, validated scales (and their clinical cut-off scores), the screener assessed for safety at home, suicidal risk, depression, anxiety, and substance use. Adult burn survivors completed the questionnaire at their first outpatient appointment. Patients who endorsed safety concerns at home and/or suicidal ideation/risk were immediately evaluated by a physician or psychology staff. Those who endorsed significant distress, but no suicidal or safety risk, were contacted by psychology staff within one week of the screener date. Those who did not indicate significant clinically significant distress did not require further action. Results Of the 393 patients who completed the screener, 102 individuals (26%) indicated clinically significant mental/behavioral distress. Psychology staff were able to reach 80 patients (78%) for initial brief consultation (i.e., within one week). Of those contacted, 14 (18%) indicated that they were already receiving psychological services, 25 (31%) reported they were not interested in a psychological referral, 20 (25%) accepted a new referral for psychological services, and 19 (24%) endorsed minimal or decreased symptoms. In February 2019, we began to conduct 1-month follow-up. A total of 19 individuals were eligible (had positive screens) and 8 (42%) were reached. Of those reached, 2 (25%) accepted a new psychological referral, 2 (25%) indicated no interest in a referral, and 3 (37%) reported minimal/no psychological symptoms. Conclusions Implementing a psychosocial screener is a feasible way to screen for distress in outpatients. Applicability of Research to Practice A 1-month follow-up contact helps staff to understand whether referrals are utilized or how symptoms may change over time and yields another opportunity to provide referrals to those previously uninterested.

scholarly journals Canadian Adolescents’ Mental Health and Substance Use during the COVID-19 Pandemic: Associations with COVID-19 Stressors

2020 ◽  
Author(s):  
Stephanie Craig ◽  
Megan E. Ames ◽  
Bianca C. Bondi ◽  
Debra Pepler
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Online Survey ◽  
Mental Health Problems ◽  
Family Stress ◽  
Health Impact ◽  
Health Problems ◽  
Post Traumatic Stress ◽  
Positive Coping ◽  
At Home

Objective: There have been significant concerns regarding the mental health impact of coronavirus disease 2019 (COVID-19), due to isolation, anxiety around the pandemic, and increased conflict in the home. The purpose of this study was to examine the rates of mental health problems and substance use, and to assess which COVID-19 related stressors were predictors of mental health and substance use in a large Canadian sample of adolescents, with comparisons across genders. Method: Participants (N = 809, Mage = 15.67, SD = 1.37) identified as a girl (56.2%), boy (38.7%), or trans/non-binary individual (TNBI; 5.1%) and were recruited via social media to complete an online survey. Results: A high proportion of adolescents met clinical cut-offs for depression (51%), anxiety (39%), and post-traumatic stress disorder (45%). Other mental health problems ranged from 9%-20%. Adolescents were mainly concerned with the health of family members and vulnerable populations, as well as the increased family stress at home during COVID-19. Rates of substance use were higher than expected, with over 50% of youth engaging in some form of substance use in the past 90 days, and almost 20% engaging in substance use at least once a week. TNBI and girls reported higher rates of mental health problems compared to boys. Family stress due to confinement and violence at home predicted higher rates of mental health, but not substance use problems. Conclusions: Increased rates of mental health problems and substance use necessitate targeted supports that encourage positive coping amidst the additional stresses of COVID-19.

scholarly journals Exploring the impact of COVID-19 and restrictions to daily living as a result of social distancing within veterans with pre-existing mental health difficulties

2020 ◽  
pp. bmjmilitary-2020-001622 ◽  
Author(s):  
Dominic Murphy ◽  
C Williamson ◽  
J Baumann ◽  
W Busuttil ◽  
N T Fear
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
Mental Health Difficulties ◽  
Post Traumatic ◽  
The Impact

IntroductionData are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic.MethodsData were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions—Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity.ResultsIt was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties.ConclusionsOur findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.

scholarly journals Mental health and resilience among Eritrean refugees at arrival and one-year post-registration in Switzerland: a cohort study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Afona Chernet ◽  
Nicole Probst-Hensch ◽  
Véronique Sydow ◽  
Daniel H. Paris ◽  
Niklaus D. Labhardt
Keyword(s):  
Mental Health ◽  
Asylum Seekers ◽  
Assessment Tools ◽  
Migration Route ◽  
Post Traumatic Stress ◽  
Hazardous Alcohol Use ◽  
Hazardous Alcohol ◽  
One Year ◽  
The One

Abstract Objective Eritrea is the most frequent country of origin among asylum seekers in Switzerland. On their journey through the desert and across the Mediterranean Sea, Eritrea refugees are often exposed to traumatizing experiences. The aim of this study is to assess the mental health status and resilience of Eritrean migrants in Switzerland upon arrival and one-year post-arrival, using standardized mental health screening and resilience assessment tools. Results At baseline, 107 refugees (11.2% female, median age 25) were interviewed: 52 (48.6%) screened positive for Post-Traumatic Stress Disorder (score ≥ 30), 10.3% for anxiety (≥ 10) and 15.0% for depression (≥ 10); 17.8% scored as risk/hazardous drinkers (≥ 8). The majority (94.4%) had a high resilience score (≥ 65). For one-year follow-up, 48 asylum seekers could be reached. In interviews 18 (38%) of these reported imprisonment in a transit country and 28 (58%) that they had witnessed the death of a close person along the migration route. At the one year assessment, rates of risky/hazardous alcohol use remained unchanged, rates of positive PTSD screening tended to be lower (50.0% (24/48) at baseline vs 25.0% (12/48) at follow-up), as were rates of positive screening for anxiety (8.3% vs 4.2%) and depression (14.6 vs 6.3%).

scholarly journals An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

2021 ◽  
Vol 11 (3) ◽  
pp. 178
Author(s):  
Noah R. Delapaz ◽  
William K. Hor ◽  
Michael Gilbert ◽  
Andrew D. La ◽  
Feiran Liang ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Previous History ◽  
Current Treatment ◽  
Careful Consideration ◽  
P Value ◽  
Post Traumatic Stress ◽  
Increased Risk ◽  
History Of ◽  
Almost All

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

scholarly journals Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045356
Author(s):  
Nick A Francis ◽  
Beth Stuart ◽  
Matthew Knight ◽  
Rama Vancheeswaran ◽  
Charles Oliver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Hospital Setting ◽  
Health Problems ◽  
Clinical Deterioration ◽  
Care Services ◽  
Increased Risk ◽  
Remote Assessment ◽  
History Of

ObjectiveIdentify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.DesignReal-world prospective observational study.SettingVH remote assessment service in West Hertfordshire NHS Trust, UK.ParticipantsPatients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.Main outcome measureDeath or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.Results900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).ConclusionsThese predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.

scholarly journals Impact of the Healing in Harmony program on women's mental health in a rural area in South Kivu province, Democratic Republic of Congo

2021 ◽  
Vol 8 ◽  
Author(s):  
Justin Cikuru ◽  
Ali Bitenga ◽  
Juvenal Bazilashe Mukungu Balegamire ◽  
Prince Mujumbe Salama ◽  
Michelle M. Hood ◽  
...  
Keyword(s):  
Mental Health ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Women’S Mental Health ◽  
Post Traumatic Stress ◽  
Republic Of Congo ◽  
Women's Mental Health ◽  
Relative Risks ◽  
Post Test

Abstract Background To assess whether Healing in Harmony (HiH), a form of music therapy, improved women's mental health following conflict-related trauma and sexual violence in the Democratic Republic of Congo. Methods This study used a step-wedged design and included 167 women, who completed up to two pre-tests, a post-test, and up to two follow-up interviews at 3 and 6 months after completing the program. The Hopkins Symptoms Checklist was used to measure anxiety and depression. The Harvard Trauma Questionnaire was used to measure post-traumatic stress disorder (PTSD). Generalized estimating equations with unstructured covariance were used to estimate mean change in mental health scores and relative risks (RRs) for screening positive. Results Prior to starting the HiH program, 73.9, 84.2, and 68.5% screened positive with median scores being 2.20, 2.70, and 2.06 for depression, anxiety, and PTSD, respectively. The RR for screening positive declined significantly (RR = 0.49 for depression, 0.61 for anxiety, and 0.54 for PTSD) and mean scores declined significantly by −0.54, −0.67, and −0.53 points, respectively, from the pre- to the post-test, declines that were sustained at the 3-month and 6-month follow-up interviews. Conclusion The HiH program was associated with significant improvement in women's mental health that was sustained up to 6 months post completion of the program despite instability in the region and evidence of continued experience of conflict-related trauma during the study. These data support the value of providing psychological care in the context of ongoing humanitarian crises.

Standard EMDR Protocol for Alcohol and Substance Dependence Comorbid With Posttraumatic Stress Disorder: Four Cases With 12-Month Follow-Up

2016 ◽  
Vol 10 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Claire Kullack ◽  
Jonathan Laugharne
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Substance Use ◽  
Alcohol Dependence ◽  
Posttraumatic Stress ◽  
Substance Use Disorders ◽  
Substance Dependence ◽  
Stress Disorder ◽  
Case Series ◽  
Post Traumatic Stress

This report begins with a summary of the literature regarding the theoretical models behind the comorbid relationship between posttraumatic stress disorder and substance use disorders and the various modified addiction protocols formulated to assist in treating these disorders. This case series outlines the effect that the standard eye movement desensitization and reprocessing (EMDR) protocol had on alcohol and substance dependence for 4 patients who attended our Post Traumatic Stress Clinic in Fremantle, Western Australia, primarily for treatment for posttraumatic stress disorder. Patients were assessed for substance use disorders using the Mini International Neuropsychiatric Interview Plus prior to, immediately after, and 12 months after completing EMDR therapy. Results indicate that the standard EMDR protocol was successful in reducing alcohol and substance use. Prior to treatment, 3 patients met criteria for alcohol dependence and 1 met criteria for substance dependence. At 12-month follow-up, 3 out of 4 clients did not meet the diagnostic criteria for current alcohol dependence or current substance dependence. The implications of these findings are discussed with reference to theories of comorbid posttraumatic stress disorder and substance use disorder and the modified EMDR protocols developed for patients with substance dependence.

Postpartum Depression Risk following Prenatal Diagnosis of Major Fetal Structural Anomalies

2021 ◽  
Author(s):  
Christina L. Herrera ◽  
John J. Byrne ◽  
David B. Nelson ◽  
Rachel C. Schell ◽  
Jodi S. Dashe
Keyword(s):  
Mental Health ◽  
Prenatal Diagnosis ◽  
Postpartum Depression ◽  
Depressive Disorder ◽  
Structural Anomaly ◽  
Depression Risk ◽  
Organ Systems ◽  
Increased Risk ◽  
Structural Anomalies

Objectives Our primary objective was to evaluate how prenatal diagnosis of a major fetal structural anomaly and resulting pregnancy outcome affected postpartum depression risk, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Secondary objectives were to review the rate of mental health follow-up and subsequent diagnosis of postpartum depression in screen-positive women. Study Design Singleton pregnancies with prenatal diagnosis of one or more major fetal structural anomalies were ascertained from prospectively maintained databases that included perinatal outcomes and subsequent EPDS responses from January 2010 to May 2018. EPDS scores of 13 or higher were considered positive and prompted referral for mental health follow-up, which was verified by medical record review. Statistical analyses were performed using Student's t-test, χ2, and odds ratios (ORs) with p < 0.05 considered significant. Results A total of 1,306 women had a prenatal diagnosis of one or more major fetal structural anomalies, 896 (68%) also had a postpartum EPDS screening, and 82 (9.2%) screened positive. Positive EPDS screening was more common with anomalies of multiple organ systems (16.5 vs 7.8%, p = 0.002) and aneuploidy (17.1 vs 9.3%, p = 0.02). Pregnancies complicated by fetal death, neonatal death, and termination for anomaly were significantly more likely to screen positive than those with neonatal survival to discharge (OR, 3.1 [95% confidence interval [CI], 1.6–6.2], 3.0 [95% CI, 1.5–5.8], and 4.4 [95% CI, 2.1–8.9], respectively, p ≤ 0.002). Of the 35 (43%) screen-positive women who attended follow-up appointments with mental health providers, 18 (51%) were diagnosed with a depressive disorder, accounting overall for 22% of those with a positive EPDS screen. Conclusion Among women with a prenatal diagnosis of a major fetal structural anomaly, those experiencing a perinatal loss or pregnancy termination have an increased risk of positive EPDS screen result compared with who have a neonate surviving to discharge. A depressive disorder was diagnosed postpartum in 22% of these women with a positive EPDS screen. Our findings highlight the mental health needs in this vulnerable population. Key Points

scholarly journals Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada—A Systematic Review and Meta-Analysis

2018 ◽  
Vol 7 (12) ◽  
pp. 543 ◽  
Author(s):  
Sarvenaz Esmaeelzadeh ◽  
John Moraros ◽  
Lilian Thorpe ◽  
Yelena Bird
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Substance Use ◽  
Young Adults ◽  
Meta Analysis ◽  
Mental Health Disorders ◽  
Adolescents And Young Adults ◽  
Health Disorders ◽  
The U.S

Background: The purpose of this systematic review was to examine the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada. Methods: The following databases were used: Medline, PubMed, Embase, PsycINFO, and Cochrane Library. Meta-analysis used odds ratios as the pooled measure of effect. Results: A total of 3656 studies were screened and 36 were selected. Pooled results showed a positive association between depression and use of alcohol (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.24–1.83), cannabis (OR = 1.29, 95% CI: 1.10–1.51), and tobacco (OR = 1.65, 95% CI: 1.43–1.92). Significant associations were also found between anxiety and use of alcohol (OR = 1.54, 95% CI: 1.19–2.00), cannabis (OR = 1.36, 95% CI: 1.02–1.81), and tobacco (OR = 2.21, 95% CI: 1.54–3.17). A bidirectional relationship was observed with tobacco use at baseline leading to depression at follow-up (OR = 1.87, CI = 1.23–2.85) and depression at baseline leading to tobacco use at follow-up (OR = 1.22, CI = 1.09–1.37). A unidirectional relationship was also observed with cannabis use leading to depression (OR = 1.33, CI = 1.19–1.49). Conclusion: This study offers insights into the association and directionality between mental health disorders and substance use among adolescents and young adults. Our findings can help guide key stakeholders in making recommendations for interventions, policy and programming.

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