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IntroductionThe Crisis Intervention Team (CIT) training was developed to educate police officers regarding the complexity of mental health (MHI) issues, and better prepare them for crisis encounters with persons with mental illness (PwMI).ObjectivesTo determine if CIT training improves police officers’ knowledge, attitude, and stigma about mental health issues.MethodsA systematic review followed the PRISMA protocol and was conducted on the PubMed database (Figure 1). Search strings were “crisis intervention team training,” “crisis intervention team,” “CIT,” “effectiveness,” and “police.” Inclusion eligibility required primary studies using surveys that measured the CIT training outcomes (i.e., knowledge, attitude, and stigma). Literature/narrative reviews or opinions were excluded.ResultsThe comprehensive meta-analysis software version 3.0 was utilized during analysis. Randomized odds ratios using a 95% confidence interval (CI) were obtained. Officers’ scores for knowledge, attitude, and stigma about MHI were taken before and after the survey. The Control group consisted of officers without CIT training. The CIT trained officers displayed an improvement in knowledge (OR 2.35, CI: 1.51– 3.67), attitude (OR 2.55, CI: 1.36–4.78), and stigma (OR 3.11, CI: 1.88–5.17). The results were statistically significant, with a p-value of less than 0.001 (Figure 2).ConclusionsCIT trained police officers displayed a significant improvement in their knowledge, attitude, and reduced stigma towards PwMI. Although our study displays CIT training’s positive effects, previous studies reported a nullified effect of CIT in reducing arrests and the use of force during police officers encounters with PwMI. Future researchers must explore this gap, mainly focusing on gender and race bias.

IntroductionInsomnia is strongly associated with Major depressive disorders (MDD). There is strong evidence that it is one of the risk factor for suicide. Studies have shown the relationship of suicidal behavior in MDD patients with insomnia. However, it has not been evaluated in a large inpatient sample.ObjectivesTo evaluate suicidality in MDD patients with insomnia compared to those without insomnia.MethodsFrom the National Inpatient Sample (NIS 2006-2015) database using ICD-9 code, we obtained patients with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+S). We compared it with MDD patients without insomnia disorders (MDD-S) by performing a 1:2 match for primary diagnosis code in the unweighted dataset. Suicidal ideation/attempt data were compared between the groups by multivariate logistic regression analysis.ResultsAfter the diagnostic code matching, 139061 patients were included in the MDD+S group and 276496 patients in the MDD- S group. MDD+S patients were older (47 years vs 45 years, p < 0.001) compared to the MDD-S group. Prevalence of Suicidal ideation/attempt was 56.0% in the MDD+S group and 42.0% in the MDD-S group (p < 0.001). After adjusting for age, sex, and race, MDD+S was associated with 1.8 times higher odds of suicidal behavior compared to the MDD-S group. (Odds ratio: 1.79, 95% confidence interval 1.68-1.91, p < 0.001).ConclusionsInsomnia in MDD patients is significantly associated with the risk of suicide. It is important to be watchful for insomnia in MDD patients.DisclosureNo significant relationships.

IntroductionGlobally, depression affects millions of individuals. A third of depression patients meet the criteria for treatment-resistant depression (TRD). The N-methyl-D-aspartate receptor antagonist, ketamine, improved depressive symptoms in a span of 24-hours. Recently, the FDA approved esketamine, an enantiomer of ketamine for TRD.ObjectivesTo determine the effectiveness of ketamine and esketamine in TRD, and observe their role in suicidality.MethodsIndividual systematic searches were conducted on the PubMed database following the PRISMA protocol (Figure 1). Inclusion criteria included randomized clinical trials (RCT). Search strings were (i) “ketamine” OR “esketamine” AND “treatment-resistant depression” (ii) “ketamine” OR “esketamine” AND “suicide.” Eleven studies were included for depression and five studies for suicidality (Table 1). Comparison analysis for suicide appeared trivial because of only one inclusion eligible esketamine RCT. This review was submitted for registration at PROSPERO. Randomized odds ratios, 95% confidence interval (CI), and heterogeneity were obtained.ResultsThe comprehensive meta-analysis, version 3.0, was used for analysis. Ketamine improved TRD symptoms and reduced suicidality by a nine-fold and three-fold odds, respectively (OR 9.01, CI 4.89–16.6, pConclusionsFindings must be cautiously interpreted as the primary endpoint differed. The primary endpoint was set at 24-hours and 28-days for ketamine and esketamine, respectively. Esketamine’s effectiveness over 28 days appears promising for TRD. Current aim should consist of structured guidance for clinicians in esketamine administration.

IntroductionRecently, several studies have shown both positive and negative impacts of social media on mental health. However, little is known regarding the reasons for the negative impact of social media on mental health.ObjectivesTo evaluate the role of social media on mental health.MethodsWe reviewed the documentary ‘The Social Dilemma’ released on Netflix in September 2020, which explored the role of social media in our life. The documentary discussed the behind the scene development of the social media world.ResultsThe central message from the documentary is that all the social media applications we use are capable of hijacking the thought process of your brain and are consciously designed by the artificial intelligence technology in a way that one spends more time on them. It collects users’ data such as topics they like, follow, search, subscribe, shop, and several others. Based on this data it feeds you the information according to your taste and next time you log in on the website, you spend more time on it. This causes positive reinforcement, the more time you spend on a particular topic, the more you will be presented which results in addictive behavior.ConclusionsIt is known that social media addiction is prevalent, and it affects brain like drug and alcohol addiction. This documentary provided technological insight into this type of behavior. Though social media has its pros, it has numerous cons despite being used for right intentions. Better regulatory measures are needed to prevent psychological disorders related to social media usage.DisclosureNo significant relationships.

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing major depressive disorder(MDD).BackgroundWhile post-AF MDD has been extensively studied, contemporary studies including temporal trends on impact of pre-AF MDD on AF and post-AF outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AF and MDD as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3,887,827 AF hospital admissions from 2002 to 2012 of which 6.78% had MDD. Proportion of hospitalizations with MDD increased from 4.93% to 14.19% (P-trend < 0.001). Utilization of atrial cardioversion was lower in patients with MDD (34.37% vs. 40.52%, P < 0.001). In-hospital mortality was significantly lower in patients with MDD (aOR0.749; 95% CI 0.664–0.846; P < 0.001) but discharge to specialty care was higher (aOR 1.695; 95%CI 1.650–1.741; P < 0.001). In addition, median length of hospitalization (2.5 vs. 2.13 days; P < 0.001) and median cost of hospitalization (28,246 vs. 22,663; P < 0.001) was higher in hospitalizations with MDD.ConclusionsOur study displayed an increasing proportion of patients with MDD admitted due to AF in the last decade with lower mortality but higher morbidity post-AF. In addition, there was significantly less utilization of atrial cardioversion in this population along with higher median length and cost of hospitalization. There is a need to explore the reasons behind this disparity in outcomes and atrial cardioversion utilization in order to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveTo determine trends and impact on outcomes of atrial fibrillation (AF) in patients with pre-existing psychosis.BackgroundWhile post-AF psychosis has been extensively studied, contemporary studies including temporal trends on the impact of pre-AF psychosis on AF and post-AF outcomes are largely lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from the healthcare cost and utilization project (HCUP) from year's 2002–2012. We identified AF and psychosis as primary and secondary diagnosis respectively using validated international classification of diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes, and used Cochrane–Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 3.887.827AF hospital admissions from 2002–2012 of which 1.76% had psychosis. Proportion of hospitalizations with psychosis increased from 5.23% to 14.28% (P trend < 0.001). Utilization of atrial-cardioversion was lower in patients with psychosis (0.76%v vs. 5.79%, P < 0.001). In-hospital mortality was higher in patients with Psychosis (aOR 1.206; 95%CI 1.003–1.449; P < 0.001) and discharge to specialty care was significantly higher (aOR 4.173; 95%CI 3.934–4.427; P < 0.001). The median length of hospitalization (3.13 vs. 2.14 days; P < 0.001) and median cost of hospitalization (16.457 vs. 13.172; P < 0.001) was also higher in hospitalizations with psychosis.ConclusionsOur study displayed an increasing proportion of patients with Psychosis admitted due to AF with higher mortality and extremely higher morbidity post-AF, and significantly less utilization of atrial-cardioversion. There is a need to explore reasons behind this disparity to improve post-AF outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesSchizoaffective disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 4,66,800 patients were analyzed; 50.90% were female and 49.10% male (P < 0.0001); 61.15% were white, 25.97% black and 12.88% of other race (P < 0.0001). Rate of hospitalization increased from 13,035.05/million to 26,703.21/million from 1998–2011. Overall mortality was 0.50% and mean cost of hospitalization was 20,995.19$. The in-hospital mortality increased from 0.46% to 0.50% (P < 0.0001) and mean cost of hospitalization increased from 11,504.94$ to 31,460.67$. Total spending on SD related admissions increased from $1.2 billion/year to $6.6 billion/year.ConclusionsWhile mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $1.2 billion/year to $6.6 billion/year which leads to an estimated $5.4 billion/year additional burden to US health care system. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesAnorexia Nervosa (AN) is an important cause of morbidity and mortality in hospitalized patients. While AN has been extensively studied in the past, the contemporary data for impact of AN on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes for AN. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.Results28,150 patients were analyzed. 93.94% were female and 6.06% were male (P < 0.0001). 88.67% were white, 2.93% were black and 8.4% were of other race (P < 0.0001). Rate of hospitalization decreased from 1530/million to 1349.5/million from 1998-2011. Overall mortality was 0.78% and mean cost of hospitalization was 25,829.82$. The in-hospital mortality reduced from 0.95% to 0.44% (P < 0.0001) and mean cost of hospitalization increased from 11,956.55$ to 39,831.51$. Total yearly spending on AN related admissions increased from $145.33 million/year to $420.61 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $145.33 million/year to $420.61 million/year, which leads to an estimated $275.28 million additional burden to the US health care system. In the era of cost conscious care, preventing AN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for AN related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesSchizophreniform disorder (SD) is an important cause of morbidity and mortality in hospitalized patients. While SD has been extensively studied in the past, the contemporary data for impact of SD on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 8645 patients were analyzed; 36.21% were female and 63.79% were male (P < 0.0001); 49.04% were white, 39.06% black and 19.9% of other race (P < 0.0001). Rate of hospitalization decreased from 599.22/million to 394.47/million from 1998–2011. Overall mortality was 0.23% and mean cost of hospitalization was 17930.23. The in-hospital mortality reduced from 0.21% to 0.15% (P < 0.0001) and mean cost of hospitalization increased from 9662.88$ to 27,749.68$ from 1998–2011. Total spending on SD related admissions have increased from $47.59 million/year to $853.83 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $47.59 million/year to $853.83 million/year, which leads to an estimated $806.24 million/year additional burden to US health care system from 1998 to 2011. In the era of cost conscious care, preventing SD related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for SD related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesSchizophrenia is an important cause of morbidity and mortality in hospitalized patients. While schizophrenia has been extensively studied in the past, the contemporary data for impact of schizophrenia on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 443,659 patients were analyzed; 38.78% were female and 61.22% were male (P < 0.0001); 48.19% were white, 35.30% black and 16.51% of other race (P < 0.0001). Rate of hospitalization increased from 56,768.47/million to 79,44466/million from 1998–2011. Overall mortality was 0.70% and mean cost of hospitalization was 23,568.47$. The in-hospital mortality decreased from 0.75% to 0.73% (P < 0.0001) and mean cost of hospitalization increased from 12,775.64$ to 36,768.58$. Total spending on schizophrenia related admissions have increased from $1.75 billion/year $6.23 billion/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $1.75 billion/year to $6.23 billion/year which leads to an estimated $4.48 billion/year additional burden to US health care system. In the era of cost conscious care, preventing schizophrenia related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for schizophrenia related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesBipolar I most recent episode-manic (BP-I-M) is an important cause of morbidity and mortality in hospitalized patients. While BP-I-M has been extensively studied in the past, the contemporary data for impact of BP-I-M on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 10,875 patients were analyzed; 57.13% were female and 42.87% were male (P < 0.0001); 74.78% were white, 14.51% black and 10.71% of other race (P < 0.0001). Rate of hospitalization increased from 528.71/million to 588.76/million from 1998–2011. Overall mortality was 0.42% and mean cost of hospitalization was 22,215.77$. The in-hospital mortality increased from 0.37% to 0.82% (P < 0.0001) and mean cost of hospitalization increased from 10,580.54$ to 40,737.65$. Total spending on BP-I-M related admissions have increased from $44.24 million/year to $187.00 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $44.24 million/year to $187.00 million/year, which leads to an estimated $ 142.76 million/year additional burden to US health care system from. In the era of cost conscious care, preventing BP-I-M related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BP-I-M related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesBipolar I (B-I) is an important cause of morbidity and mortality in hospitalized patients. While B-I has been extensively studied in the past, the contemporary data for impact of B-I on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 1,80,681 were analyzed; 56.29% were female and 43.71% were male (P < 0.0001); 70.63% were white, 17.14% black and 12.23% of other race (P < 0.0001). Rate of hospitalization increased from 7469.65/million to 9375.27/million from 1998–2011. Overall mortality was 0.12% and mean cost of hospitalization was 19,821.50$. The in-hospital mortality increased from 0.13% to 0.16% (P < 0.0001) and mean cost of hospitalization increased from 12,091.31$ to 29,292.97$. Total yearly spending on B-I related admissions increased from $0.72 million/year to $2.16 billion/year.ConclusionsWhile mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $0.72 million/year to $2.16 billion/year, which leads to an estimated $1.46 billion/year additional burden to US health care system. In the era of cost conscious care, preventing B-I related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for B-I related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectivesBipolar unspecified (BP-U) is an important cause of morbidity and mortality in hospitalized patients. While BP-U has been extensively studied in the past, the contemporary data for impact of BP-U on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.ResultsA total of 711,147 patients were analyzed; 61.33% were female and 38.67% were male (P < 0.0001); 77.63% were white, 13.17% black and 9.2% of other race (P < 0.0001). Rate of hospitalization increased from 2,310.28/million to 74,908.88/million from 1998–2011. Overall mortality was 0.81% and mean cost of hospitalization was $25,152.02. The in-hospital mortality reduced from 1.24% to 0.97% (P < 0.0001) and mean cost of hospitalization increased from 11,308.05$ to 32,211.67$. Total yearly spending on BP-U related admissions have increased from $207 million/year to $19.15 billion/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $0.21 billion/year $19.15 billion/year, which leads to an estimated $18.94 billion/year additional burden to US health care system. In the era of cost conscious care, preventing BP-U related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BP-U related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveTo determine trends and impact on outcomes of acute myocardial infarction (AMI) in patients with pre-existing psychosis.BackgroundWhile post-AMI psychosis has been extensively studied, contemporary studies including temporal trends on impact of pre-AMI Psychosis on AMI and post-AMI outcomes are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project(HCUP) from 2002 to 2012. We identified AMI and psychosis as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and Cochrane-Armitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.77% had psychosis. Proportion of hospitalizations with psychosis increased from 6.94% to 11.85% (P-trend < 0.001). Utilization of percutaneous coronary intervention (PCI) was lower in patients with psychosis (29.98% vs. 40.36%, P < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with psychosis (8.01% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with psychosis (aOR 0.677; 95% CI 0.630–0.727; P < 0.001) but discharge to specialty care higher (aOR 1.870; 95%CI 1.786–1.958; P < 0.001). In addition, median length of hospitalization (3.77 vs. 2.90 days; P < 0.001) was higher in hospitalizations with psychosis.ConclusionsOur study displayed increasing proportion of patients with psychosis admitted due to AMI in last decade with lower mortality but higher morbidity post-infarction, and significantly less utilization of PCI and CABG. There was also increased length of stay patients with MDD. There is need to explore reasons behind this disparity in outcomes and PCI and CABG utilization to improve post-AMI outcomes in this vulnerable population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveTo determine temporal trends, invasive treatment utilization and impact on outcomes of pre-infarction drug abuse (DA) on acute myocardial infarction (AMI) in adults.BackgroundDA is important risk factor for AMI. However, temporal trends in drug abuse on AMI hospitalization outcomes in adults are lacking.MethodsWe used Nationwide Inpatient Sample (NIS) from Healthcare Cost and Utilization Project (HCUP) from 2002 to 2012. We identified AMI and DA as primary and secondary diagnosis respectively using validated International Classification of Diseases, 9th Revision, and Clinical Modification (ICD9CM) codes, and used the CochraneArmitage trend test and multivariate regression to generate adjusted odds ratios (aOR).ResultsWe analyzed total of 7,174,274 AMI hospital admissions from 2002 to 2012 of which 1.67% had DA. Proportion of hospitalizations with DA increased from 5.63% to 12.08% (P trend < 0.001). Utilization of coronary artery bypass grafting (CABG) was lower in patients with DA (7.83% vs. 9.18%, P < 0.001). In-hospital mortality was significantly lower in patients with DA (aOR 0.811; 95% CI 0.693–0.735; P < 0.001) but discharge to specialty care was higher (aOR 1.076; 95% CI 1.025–1.128; P < 0.001). The median cost of hospitalization (40,834 vs. 37,253; P < 0.001) was higher in hospitalizations with DA.ConclusionsWe demonstrate an increasing proportion of adults admitted with AMI have DA over the decade. However, DA has paradoxical association with mortality in adults. DA is associated with lower CABG utilization and higher discharge to specialty care, with a higher mean cost of hospitalization. The reasons for the paradoxical association of DA with mortality and worse morbidity outcomes need to be explored in greater detail.Disclosure of interestThe authors have not supplied their declaration of competing interest.