Depression, anxiety, and patterns of mental health care among men with prostate cancer on androgen deprivation therapy (ADT).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12100-12100
Author(s):  
Phoebe A. Tsao ◽  
Ryan Ross ◽  
Amy S. B. Bohnert ◽  
Bhramar Mukherjee ◽  
Megan Veresh Caram
Keyword(s):  
Mental Health ◽  
Prostate Cancer ◽  
Health Care ◽  
Mental Health Care ◽  
Reuptake Inhibitor ◽  
Increased Risk ◽  
Norepinephrine Reuptake Inhibitor ◽  
Mental Health Treatments ◽  
New Diagnosis ◽  
Insured Patients

12100 Background: ADT is associated with an increased risk of depression and anxiety, raising the concern that a substantial portion of men with prostate cancer need mental health care. We sought to investigate the development of depression or anxiety and subsequent patterns of mental health care in men with prostate cancer on ADT. Methods: Clinformatics DataMart, a claims database of commercially insured patients, was used to identify men with prostate cancer who received ADT between 2001-2015 and had continuous enrollment for 1 year before and 2 years after starting ADT. We determined the rate of incident diagnoses of depression or anxiety and the incident use of mental health treatments - psychotherapy and psychiatric medications (≥ 5 day supply) - after the start of ADT. Results: Among 37,388 men in the final analytic cohort, 11.3% (n=4239, 95% confidence interval (CI) 11.0-11.6%) received new diagnoses of depression or anxiety: 5.8% depression (95% CI, 5.5-6.0%), 3.7% anxiety (95% CI 3.5-3.9%), and 1.8% both (95% CI, 1.7-1.9%). Those who received a diagnosis of depression or anxiety were more likely to be white (68% v. 64%, p<0.01); no differences were noted in age, education, or household income. Among those with a new diagnosis of depression or anxiety, 0.07% received psychotherapy (95% CI, 0.02-0.23%), 34.9% a selective serotonin reuptake inhibitor (95% CI, 33.5-36.4%), 11.6% a serotonin norepinephrine reuptake inhibitor (95% CI, 10.7-12.6%), and 19.9% a benzodiazepine (95% CI, 18.7-21.1%). Conclusions: Among men with prostate cancer receiving ADT, more than 1 in 10 received a new diagnosis of depression or anxiety. Of those, 1 in 5 were introduced to a benzodiazepine, a drug class with risks of dependence, cognitive impairment, falls, and fractures, whereas receipt of psychotherapy was rare. Further investigation into how to improve the mental health care of men on ADT is needed. [Table: see text]

Mental health care utilization among veterans with castration-resistant prostate cancer receiving abiraterone or enzalutamide.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18680-e18680
Author(s):  
Phoebe A. Tsao ◽  
Jennifer A. Burns ◽  
Shami Entenman ◽  
Kyle Kumbier ◽  
Jordan Sparks ◽  
...  
Keyword(s):  
Mental Health ◽  
Prostate Cancer ◽  
Health Care ◽  
Mental Health Care ◽  
Health Administration ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Castration Resistant ◽  
Diagnostic Characteristics ◽  
Comorbidity Burden

e18680 Background: Abiraterone and enzalutamide are oral therapies widely used to treat men with castration-resistant prostate cancer (CRPC). Recent data have suggested potentially worsened quality of life and depression with use of enzalutamide compared to abiraterone. Because Veterans are at a higher risk for mental health conditions, we sought to compare mental health service utilization in Veterans with CRPC receiving enzalutamide to those receiving abiraterone. Methods: The Veterans Health Administration Corporate Data Warehouse was used to identify men with CRPC who received abiraterone or enzalutamide for ≥ 30 days as first-line treatment between 2010-2017. We compared the rate of mental health visits per 100 patient-months for men on abiraterone versus enzalutamide using an exact rate ratio test, assuming Poisson counts. Results: Among 2902 male Veterans, 68.6% (n=1992) received abiraterone and 31.4% (n=910) enzalutamide as first-line therapy. Men who received enzalutamide were older (76 vs 74, p<0.01) and had a higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥ 2 in 28.7% vs 21.6%, p<0.01); no differences were noted in race or prevalence of preexisting documented mental health diagnoses. Median time on drug was 8 months for both medications. There was no difference in the rate of mental health visits per 100 patients-months on enzalutamide versus abiraterone (6.6 v. 6.7, p=0.66). However, within patient sub-groups, men who were age 75 or older, not married, or without notable comorbidities had lower rates of mental health visits with enzalutamide compared to abiraterone; whereas those who were younger than 75, married, had higher comorbidities, or a preexisting mental health diagnosis had higher rates of mental health visits with enzalutamide (Table). Conclusions: Among Veterans with CRPC who received a novel antiandrogen therapy first-line, there was no difference in engagement in mental health care between those who received abiraterone versus enzalutamide. Sub-group analysis revealed significant differences between patients on the two medications in demographic and diagnostic characteristics associated with number of visits, suggesting that vulnerability for mental health symptoms may vary by medication type. Further work in understanding the long-term impact of novel antiandrogens on mental health is needed.[Table: see text]

scholarly journals Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris

2020 ◽  
Vol 17 (24) ◽  
pp. 9397
Author(s):  
Andrea Tortelli ◽  
Florence Perquier ◽  
Maria Melchior ◽  
François Lair ◽  
Fabien Encatassamy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Asylum Seekers ◽  
Service Use ◽  
Pathways To Care ◽  
Treatment Level ◽  
Stable Housing ◽  
Increased Risk ◽  
Provision Of Care

Background: Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed. Methods: In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers. Results: We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02–1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38–0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum. Conclusions: Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.

The helps toolkit - a tool to promote the physical health of residents in psychiatric facilities across Europe

2011 ◽  
Vol 26 (S2) ◽  
pp. 587-587
Author(s):  
P. Weiser ◽  
T. Becker ◽  
R. Kilian
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Physical Health ◽  
Health Care Facilities ◽  
Medical Care System ◽  
Increased Risk ◽  
Co Morbidity ◽  
Wide Range ◽  
Care Facilities

IntroductionPeople with a mental disorder are at increased risk for physical illness and therefore their risk of premature death is raised. An unhealthy lifestyle, living conditions, medication side-effects and a lack of physical health monitoring are regarded as the main causes of high somatic morbidity. But up to now only little research has addressed the physical co-morbidity in mentally ill. At present, there are no specific policies to improve the health status of residents in mental health care facilities.Objectives / methodsAgainst this background a multi-disciplinary network of experts from 15 European countries was set up. Working together with researchers, stakeholders, professionals, networks, practitioners, and relevant organizations, the HELPS network developed a “physical health promotion toolkit” for routine application in a wide range of mental health care facilities across Europe. The HELPS toolkit intends to empower patients and staff to identify the most relevant risk factors in their specific context and subsequently select the most appropriate action out of a range of defined health promoting interventions. In doing so, the toolkit takes into account the heterogeneity of mental disorders, the high number of somatic problems, aspects of lifestyle, environment, medical care system, personal goals of patients and their motivation for health behavior.Results / conclusionsThe poster presents the HELPS toolkit. It illustrates the individual components of the tool and the processes of its implementation and evaluation. First results of the pilot study concerning the feasibility of the toolkit will be presented and discussed.

scholarly journals Pathways to Care

2019 ◽  
pp. 439-466
Author(s):  
Ramin Mojtabai ◽  
Sarah Murray ◽  
William W. Eaton
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Treatment ◽  
Insurance Coverage ◽  
Theoretical Models ◽  
Health Insurance Coverage ◽  
Treatment Seeking ◽  
Pathways To Care ◽  
Mental Health Treatments

This chapter discusses the gap between the need for mental health care and the actual receipt of such care, and the barriers that contribute to this gap. These barriers include attitudes such as stigma, negative attitudes about the benefits of mental health treatments, and lack of perceived need for care. Another set of barriers is related to the structure of services such as scarcity of providers, geographical distance, and inadequate health insurance coverage of mental health services. The chapter describes theoretical models used to understand the process of treatment-seeking and examples of initiatives that have been used to overcome barriers to care. Among these initiatives, public campaigns aimed at increasing awareness and recognition of mental disorders and at reducing stigma, and legislative initiatives aimed at increasing insurance coverage for mental health care have received public attention. Future initiatives to improve access to services and reduce the treatment gap would benefit from a better understanding of the process of treatment-seeking and barriers to mental health treatment.

Depression Fotonovela

2016 ◽  
Author(s):  
Leopoldo J. Cabassa
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Disparities ◽  
The United States ◽  
Cultural Elements ◽  
Limited Health Literacy ◽  
Latino Community ◽  
Limited Health ◽  
Mental Health Treatments

Latinos in the United States face serious mental health care disparities. A combination of person-level barriers, such as low levels of acculturation, stigma, negative attitudes towards mental health treatments, and limited health literacy, contribute to these inequities in mental health care. In this chapter, we review the literature on how person-level barriers impact mental health care disparities in the Latino community. We describe how a depression fotonovela, “Secret Feelings”, that integrates cultural elements from the Latino community and uses an entertainment-education approach can help address these barriers. We also discuss the practice and research implications of using “Secret Feelings” to improve mental health care in the Latino community.

Prenatal Psychological Distress and Access to Mental Health Care in the ELFE Cohort

2015 ◽  
Vol 30 (2) ◽  
pp. 322-328 ◽  
Author(s):  
M. Bales ◽  
E. Pambrun ◽  
M. Melchior ◽  
N.M.-C. Glangeaud-Freudenthal ◽  
M.-A. Charles ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Psychological Distress ◽  
Mental Health Care ◽  
Unwanted Pregnancy ◽  
Psychological Status ◽  
Mental Health Specialist ◽  
Increased Risk ◽  
Health Specialist ◽  
Prenatal Distress

AbstractBackground:Pregnant women are vulnerable to the deleterious impact of environmental stressors. The aims were to identify the environmental and pregnancy characteristics independently associated with prenatal psychological distress and access to mental health care.Methods:We used data from the French cohort Étude Longitudinale Française depuis l’Enfance (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. Information about prenatal psychological status and access to mental health care was collected during the maternity stay. Maternal/pregnancy characteristics independently associated with psychological distress and access to mental health care were explored using multivariate analyses.Results:Of the 15,143 mothers included, 12.6% reported prenatal psychological distress. Prenatal distress was more frequent in women with very low economical status, alcohol/tobacco use, unplanned/unwanted pregnancy, late pregnancy declaration, multiparity and complicated pregnancy (high number of prenatal visits, prenatal diagnosis examination, obstetrical complications). Of the women reporting prenatal distress, 25% had a prenatal consultation with a mental health specialist and 11% used psychotropic drugs during pregnancy. Decreased likelihood to consult a mental health specialist was found in young women, with intermediate educational level and born abroad.Limitations:Causal inferences should be made cautiously as the questionnaire did not collect information on the temporal sequence between psychological distress and associated characteristics.Conclusions:Women with social and obstetrical vulnerabilities are at increased risk of poor mental health during pregnancy. Improving mental health care access during pregnancy is a public health priority.

scholarly journals Exploring the factors associated with non-urgent emergency department utilisation for mental health care

2019 ◽  
Vol 24 (8) ◽  
pp. 663-674 ◽  
Author(s):  
Fabrice I Mowbray ◽  
Abeer E Omar ◽  
Kathyrn Pfaff ◽  
Maher M El-Masri
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Department ◽  
Mental Health Care ◽  
Secondary Data ◽  
Time Of Day ◽  
Emergency Department Visits ◽  
Local Health ◽  
Emergency Department Use ◽  
Increased Risk

Background Emergency department visits for mental health care are on the rise across North America. Patients with mental illness are at an increased risk for frequent and non-urgent emergency department visitation. Aims The purpose of this study was to examine the independent predictors of non-urgent emergency department use for mental health care. Methods A secondary data analysis was conducted with archived data provided by the Erie St. Clair Local Health Integration Network in Ontario. Results A total of 13,114 mental health-related emergency department visits were analysed using logistic regression with generalised estimating equations modelling. The findings suggest the following characteristics are predictive of non-urgent emergency department use for mental health care: age, season, time of day, access to primary health care, mode of arrival, hospital type, referral source and patient diagnosis. Conclusions The findings of this study can be utilised to assist clinicians and policy makers in identifying and managing patients using the emergency department for non-urgent mental health care.

scholarly journals An evaluation of a veterinary-specific mental health service

2020 ◽  
Vol 70 (3) ◽  
pp. 169-175 ◽  
Author(s):  
A McKenzie ◽  
R Allister ◽  
D Humphrey ◽  
K Moore ◽  
K Greenberg ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Case Management ◽  
Mental Health Care ◽  
Qualitative Interviews ◽  
Service Users ◽  
Management Service ◽  
Case Management Service ◽  
Increased Risk ◽  
Mental Health Difficulties

Abstract Background Veterinary professionals are at increased risk of suicide and mental health difficulties compared to the general population. Vetlife Health Support (VHS) is a mental health case management service for veterinarians with mental health difficulties. Aims To evaluate the VHS case management service from the service user’s perspective. Methods Service users (n = 98) completed questionnaires assessing their experience with VHS and current mental health status using the Kessler-6 Scale. A sub-sample was interviewed and the data qualitatively analysed (n = 14). Results The results show that 97% (n = 95) reported a positive experience with VHS and 98% (n = 96) reported VHS staff respected and listened to them. Participants reported significant improvements in relationships with others after VHS (P &lt; 0.001) and were significantly more likely to be in receipt of formal mental health care after VHS than before (P &lt; 0.01). The main emergent themes from the qualitative interviews were (i) positive communication between clinician and service users, (ii) veterinary-specific mental health services were regarded as important to understanding service users’ circumstances, (iii) knowing someone is supporting them positively impacted wellbeing and (iv) confusion with discharge status. Conclusions Most participants reported positive experiences with VHS. Quantitatively, data showed that participants reported significant improvements in relationships and access to formal mental health care after contact with VHS. Interviews with service users revealed that they felt speaking to a mental health professional with veterinary-specific knowledge was beneficial for their wellbeing. Further evaluation assessing whether VHS leads to a measurable impact on psychological wellbeing is recommended.

A Tribute to the Late William J. Curran

1996 ◽  
Vol 24 (3) ◽  
pp. 274-275
Author(s):  
O. Lawrence ◽  
J.D. Gostin
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
United Nations ◽  
Mental Health Care ◽  
Harvard University ◽  
Legal Medicine ◽  
General Assembly ◽  
International Institute ◽  
University Professor

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

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