Literature Collection

AIM: To determine the association between types of mental illness, levels of social disadvantage and metabolic risk factors (obesity, tobacco smoking, high blood pressure and high cholesterol) and to investigate whether mental health care plans modify metabolic risk. METHODS: Two cohorts (2016-2023) of all primary care patients in Western Sydney with active mental illness or never having a mental illness (reference cohort) were compared on metabolic risk and change in metabolic risk during the period of the care plan (12 months) using random effects regression. Also, the social gradient of metabolic risk in patients with active mental illness was determined. Analyses were adjusted for age, sex and social disadvantage. RESULTS: There were 29,592 patients with active mental illness and 962,416 never having mental illness. Care plan utilisation ranged from 35% to 51%, with the lowest utilisation for Schizophrenia (33%). Daily tobacco smoking rates were elevated for all mental illness types. Care plans were associated with a reduction in daily tobacco smoking rates (0.7 odds ratio; 95% confidence interval: 0.6-0.99). Patients with schizophrenia had excess body mass index (+5.6 body mass index; 95% confidence interval: 2.1-9.1). Care plans reduced the excess body mass index (-6.6 body mass index; 95% confidence interval: -17.7 to +4.5)). Obesity and daily tobacco smoking followed a social gradient in patients with mental illness, but cholesterol and blood pressure did not. High blood pressure and high cholesterol was not elevated compared to the reference group in all types of mental illness. CONCLUSION: Metabolic risk was particularly elevated in tobacco smoking rates for patients with any active mental illness and for obesity in patients with schizophrenia. Care plans were associated with a reduction in much of this risk.

The rising prevalence of mental health conditions and substance use disorders (MH/SUD) underscores the important role of health centers (HCs) in caring for low-income and uninsured MH/SUD patients. This study used the 2014 Health Center Patient Survey and 2014 Uniform Data System to determine the independent association between delivery of MH/SUD integration and related interventions to patients that reported a MH/SUD condition (n=2714) with the number of HC visits, emergency department (ED) visits, and hospitalizations last year. Results showed that health education was associated with fewer predicted ED visits (1.8 vs. 2.3) and lower likelihood of hospitalizations (16% vs. 24%) among MH patients. Medical enabling services was associated with lower rates of ED visits (0.3 vs.1.9) and hospitalizations (< 1% vs. 13%) among SUD patients. The results indicate the utility of integration and related intervention services in primary care settings to improve service use and reduce ED and hospitalization among MH/SUD patients.

BACKGROUND: Depression and anxiety in the perinatal period affect many women and have multiple negative impacts on the mother and baby. The Integrated Infant Mental Health approach embeds a Behavioral Health Consultant (IMH-BHC) who has specialized training in Infant Mental Health into OB/GYN clinics. This manuscript reports a quasi-experimental comparison of two groups of women through pregnancy and the first year postpartum, receiving integrated IMH care versus standard OB care. We hypothesized integrated IMH care patients would show less anxiety and depression across pregnancy and postpartum than comparison patients. METHODS: Using a quasi-experimental design, we compared integrated IMH care patients with standard OB care patients to evaluate the primary outcomes of depression and anxiety symptoms from pregnancy through 12 months postpartum across ten obstetric clinics (seven treatment clinics and three comparison clinics) between 2018 and 2021. Data collection included questionnaires in-person, then over the phone during the COVID-19 pandemic. Regression analysis, using fixed effects models to accommodate differences between clinics, compared changes in number of symptoms over time between treatment and comparison groups. Logistic regression was used for comparing number of participants above clinical cutoffs for anxiety and depression symptoms in late pregnancy and at 12-months postpartum. Piecewise linear modeling was used to examine trajectories of symptoms of anxiety and depression. RESULTS: During pregnancy, depression scores for the intervention group (n = 90) remained constant whereas depression in the comparison group (n = 68) increased across the later stage of pregnancy. The slope of change for depression scores across the postpartum year was not significantly different in the two groups. Anxiety symptom trajectories did not differ significantly by group membership during pregnancy or in the postpartum period. The intervention group was less likely to be married, to own their homes, or to have completed schooling beyond high school. More participants in the intervention group identified as Black or non-White. Propensity score weighting achieved equivalence in demographics between intervention and comparison groups. CONCLUSIONS: Our findings suggest possible benefits of the integrated IMH model for maternal wellness, most notably for depression symptoms during late pregnancy in a sample of women with high comorbid risk. Supporting at-risk dyads through programs like integrated IMH care represents a much-needed intervention that may make a meaningful difference in the lives of families.

INTRODUCTION: Measurement-based care (MBC) uses standardized measurement to systematically monitor treatment response over time. Although MBC is underutilized in mental health settings, primary care-mental health integration (PC-MHI) settings are expected to provide MBC. This article describes a quality improvement (QI) process to increase Patient Health Questionnaire-9 (PHQ9) utilization within a PC-MHI setting. AIMS: Pre-intervention, rates of baseline and follow-up PHQ9 administration for veterans with a depressive disorder were 76% and 35%, respectively. This article describes a QI process to increase PHQ9 utilization rates within a PC-MHI setting, with the goal to improve provider PHQ9 utilization rates at baseline and within 4-week follow-up to 90%. METHOD: An educational intervention and weekly motivational enhancement sessions were implemented in 2017. Chart review data compared PHQ9 utilization rates from fall 2016 and 2017. RESULTS: Following intervention, provider PHQ9 utilization rates increased to 98% and 88% at baseline and follow-up. CONCLUSIONS: These findings demonstrate that a brief education-based intervention can increase clinician use of MBC within a PC-MHI setting. Meaningful use of MBC to inform treatment was not evaluated in this QI project and is an area for future investigation.