Antidepressant and mental health care utilization in pregnant women with depression and/or anxiety: an interrupted time-series analysis

Objectives To assess mental health care utilization patterns during and after pregnancy in women with depression and/or anxiety in Norway according to antidepressant fill trajectories in pregnancy. Method We conducted a registry-linkage cohort study of pregnancies within women having outpatient visit for depression and/or anxiety and antidepressant fills in the six months prior to pregnancy identified from four national registries of Norway (2009-2018). Number of consultations for depression/anxiety per 100 pregnancies as proxy of mental health care utilization were modelled using interrupted time-series analysis with first month into pregnancy and first month after delivery as interruption points. We investigated the time window including six months prior to pregnancy, eight months into pregnancy and one year postpartum. Antidepressant fill trajectories in the corresponding time window were identified using longitudinal k-means trajectory modelling. Results The cohort included 8,460 pregnancies within 8,062 women with depression/anxiety. We observed reduced mental health care utilization when pregnant women entered the course of pregnancy (negative slopes during pregnancy for all psychiatric specialists and psychologists). The declines were observed for all antidepressant fill trajectories (i.e., discontinuers and continuers) except interrupters (i.e., discontinued then resumed treatment). We found increased mental health care utilization in the postpartum year, notably in interrupters (positive slopes in consultation rates with specialists of outpatient clinics and public-contracted psychiatrists).. Conclusions Pregnancy was associated with reduced mental health care utilization regardless of whether antidepressant treatment was maintained during pregnancy or not. Increases in mental health care utilization were observed in the postpartum year, especially in interrupters.

Utilization of Inpatient Mental Health Care in the Rhineland During the COVID-19 Pandemic

Background: During the Coronavirus-19 (COVID-19) pandemic, considerable changes occurred in the utilization of mental health care.Objectives: We conducted an analysis of the changes of inpatient and day patient mental health care utilization in an association of psychiatric hospitals during the COVID-19 pandemic.Materials and Methods: We used the statistics database of the association of nine psychiatric hospitals of the Rhineland Regional Council (Landschaftsverband Rheinland, LVR). We compared the case numbers of spring 2019 and spring 2020 and analyzed alterations in the diagnostic spectrum. Finally, we analyzed the age, gender, and diagnoses of patients tested positive for COVID-19.Results: A total of 25,612 inpatient psychiatric hospital admissions were assessed. Case rates decreased by 25% during the COVID-19 pandemic. Changes varied between diagnostic groups, and there were even increases in case numbers for certain diagnoses. Women and patients of higher ages were overrepresented among psychiatric inpatients with COVID-19.Conclusions: The COVID-19 pandemic resulted in considerable reductions in the total number of mental health-care admissions and in changes in the diagnostic spectrum. The results may be explainable by deferrals of elective hospital admissions during the acute phase of the pandemic and by destabilizing effects of the pandemic and social distancing on people with mental disorders.

Course and Predictors of Posttraumatic Stress Disorder in the Canadian Armed Forces: A Nationally Representative, 16-Year Follow-up Study: Cours et prédicteurs du trouble de stress post-traumatique dans les Forces armées canadiennes: une étude de suivi de 16 ans nationalement représentative

Objective: This study examined baseline risk and protective predictors and interim correlates of the persistence/recurrence, remission, and onset of posttraumatic stress disorder (PTSD) in a 16-year prospective, nationally representative sample of Canadian Forces members and veterans. Methods: The 2018 Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey is a prospective study of 2,941 regular force service members and veterans who participated in the 2002 Canadian Community Health Survey on Mental Health and Wellbeing: Canadian Forces Supplement ( n = 5,155; ages 15 to 64 years; response rate 68%). PTSD diagnoses in 2002 and 2018 were used to create 4 groups: (1) no lifetime, (2) remitted, (3) new onset, and (4) persistent/recurrent PTSD. Multinomial regressions were conducted to identify predictors of PTSD courses. Results: Female sex, being a junior noncommissioned member (vs. officer), and land (vs. air) operations in 2002 were associated with all PTSD courses relative to no lifetime PTSD (relative risk ratio [RRR] range: 1.28 to 3.65). After adjusting for sociodemographic variables, baseline predictors of all PTSD courses included lifetime mental disorder, history of mental health care utilization, all trauma type categories (deployment-associated, sexual, “other”), and the number of lifetime traumatic events (RRR range: 1.14 to 8.95). New (“since 2002”) traumas, transitioning to veteran status, and alcohol dependence were mostly associated with the new onset and persistent/recurrent PTSD courses (RRR range: 1.79 to 4.31), while mental health care utilization and greater avoidance coping were associated with all PTSD courses (RRR range: 1.10 to 17.87). Protective factors for several PTSD courses at one or both time points included social support, social network size, and problem-focused coping (RRR range: 0.71 to 0.98). Conclusions: This is the first population-based survey to examine the longitudinal course of PTSD in Canadian Forces members. Prevention and intervention programs focused on bolstering social support and active coping strategies as possible protective factors/correlates may help mitigate the development and persistence of PTSD.

Mindfulness, sleep, and post-traumatic stress in long-haul truck drivers

BACKGROUND: The high stress culture and demands associated with long-haul truck driving place truckers at risk for mental health and sleep disorders, and thereby, increased risk for accidents, injuries, and fatality. Hours-of-service regulations have proven insufficient as a stand-alone intervention to protect the welfare of long-haul truckers, impacting those working in the industry and those sharing our nation’s roads. Interventions to increase mindfulness have been used across occupational and personal domains to improve sleep quality, mental health, awareness of the environment, and reaction time. OBJECTIVE: The purpose of this study was to examine the relationships between sleep, mental health, health care utilization, and mindfulness in long-haul truck drivers in the United States. METHODS: Participants (N = 140) were recruited to complete a web-based survey. Descriptive statistics, bivariate analysis, and regression analysis were used to examine variables of interest. RESULTS: Post-traumatic Stress Disorder (PTSD) symptomology and daytime sleepiness predicted mental health care utilization in the past year. Mindfulness was inversely correlated with PTSD symptomology, however in the full regression model, mindfulness failed to predict mental health care utilization. CONCLUSIONS: Occupational health professionals should utilize mindfulness screenings as an adjunctive component to traditional mental health screenings and refer drivers for advanced care as appropriate.