Literature Collection

INTRODUCTION: The aim is to elucidate approaches to care for comorbid chronic pain and PTSD (CP + PTSD) in the Veterans Administration (VA). These conditions are co-magnifying and highly comorbid but traditionally treated in separate clinical settings. MATERIALS AND METHODS: This multimethod analysis examined care for CP + PTSD via administrative data analyses and qualitative interviews of VA-served veterans. RESULTS: All participants with diagnoses of CP + PTSD in 2021 were identified using VA administrative data (N = 456,544). Visits during the following year (2022) coded for chronic pain, PTSD, or both were analyzed. Qualitative interview participants (N = 22) were recruited, screened, consented, and enrolled in 2023. Administrative findings demonstrated that clinical settings differed where CP and PTSD were treated. For PTSD, 90.7% of visits occurred in the mental health service line, whereas for CP, visits occurred across a range of settings outside mental health (e.g., primary care, rehabilitative services, and surgical services). A small percentage of visits (4.8%) were coded for both CP + PTSD, indicating possible combined care. In qualitative interviews, participants acknowledged that CP and PTSD symptoms may impact one another but noted that the health care they received for these 2 conditions was typically siloed. Participants also identified barriers that would need to be addressed before a fully integrated coordinated care model could be implemented. CONCLUSIONS: Veterans reported interest in coordinated treatment for CP + PTSD; however, the provision of CP + PTSD care provided across different service lines may pose challenges to optimizing care coordination.

BACKGROUND: Substance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder. METHODS: The study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively. RESULTS: Of the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1-28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3-32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p = 0.022). CONCLUSIONS: Opioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia. TRIAL REGISTRATION: Our study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.

Hypertension is a significant risk factor for cardiovascular diseases, while anxiety and depression are highly prevalent mental health disorders that may influence the development and management of hypertension. The bidirectional associations between these conditions remain understudied, particularly among adults in the United States. Understanding the interplay of mental health and hypertension is critical for improving clinical and public health interventions. This systematic review aims to examine the prevalence and bidirectional associations between anxiety, depression, and hypertension among US adults; identify clinical, behavioral, and sociodemographic factors influencing comorbidity; and explore implications for hypertension management. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across multiple databases, including PsycINFO, Scopus, PubMed, Web of Science, ScienceDirect, and Google Scholar, covering literature from 2015 to 2024. Eligible studies included cross-sectional, cohort, and case-control designs focusing on US adults (≥18 years) and examining the association between anxiety, depression, and hypertension. Data extraction covered study characteristics, diagnostic criteria, statistical findings, and relevant confounders. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. Eight studies met the inclusion criteria, comprising six cross-sectional and two cohort studies. Anxiety and depression were significantly associated with increased hypertension risk, with stronger effects observed among low-income populations, women, and minority groups. Cohort studies indicated that depression contributed to hypertension incidence via inflammatory and autonomic dysfunction pathways, while cross-sectional studies highlighted that hypertension itself exacerbated psychological distress, leading to a cyclical comorbid relationship. The review also found that individuals with comorbid anxiety or depression had poorer hypertension control and lower adherence to antihypertensive treatment. The findings underscore the need for integrated care approaches that address both mental health and hypertension, particularly in vulnerable populations. Routine mental health screenings should be incorporated into hypertension management strategies to improve adherence and outcomes. Future longitudinal research should explore causal mechanisms and assess intervention effectiveness in mitigating the adverse effects of comorbidity.

BACKGROUND: Opioid use disorder (OUD) is a public health crisis and is challenging to treat. Previous research has shown correlations between OUD, abuse/trauma, and chronic pain. AIMS: The purpose of this study was to investigate history of lifetime sexual, physical, and/or emotional abuse among participants in a medication-assisted treatment (MAT) program for OUD, and to investigate associations between abuse history and chronic pain. METHODS: This is a secondary analysis of intake data from a 2-year, nonexperimental cohort treatment program of patients with OUD in rural Colorado. De-identified data were provided by 476 adult MAT patients using the Adult Addiction Severity Index (ASI-6). The ASI-6 includes three yes/no questions about history of abuse (emotional, physical, and sexual), with separate scoring for "past 30 days" and "lifetime" abuse. RESULTS: Lifetime history among MAT program for OUD patients was 23% for sexual abuse, 43% for physical abuse, and 58% for emotional abuse. History of physical abuse was significantly associated with having a chronic pain diagnosis, χ(2) = 4.49, p = .03, and also with higher reported pain levels, t(460) = 2.71, p = .007. CONCLUSION: Lifetime history of physical abuse was associated with OUD and chronic pain, yet standard pain assessments do not assess these factors. In health care settings, the implementation of standardized trauma-informed screening tools, prompt recognition of abuse/trauma history, and adjunct psychological interventions may reduce stigma, reduce opioid use escalation, and help patients overcome OUD.

BACKGROUND: Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems. METHODS: Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework. RESULTS: The seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation. CONCLUSIONS: We propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation. TRIAL REGISTRATION: Not applicable.