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Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care. [ABSTRACT FROM AUTHOR]

Objective: Continuation of antidepressant treatment for depression beyond the first months helps to consolidate treatment response and to reduce the risk of early relapse. The authors sought to characterize the rate and pattern of antidepressant discontinuation among adults initiating antidepressant treatment for depression. Method: Data were drawn from the household component of the Medical Expenditure Panel Survey for 1996-2001. Analysis was limited to data for adults age 18 years and older (N=829) who initiated antidepressant treatment for depression and who 1) discontinued treatment during the first 30 days of treatment, 2) completed the first 30 days of treatment and then discontinued treatment during the following 60 days, or 3) continued treatment for more than 90 days after treatment initiation. Results: A majority of the patients discontinued antidepressant therapy during the first 30 days (42.4%). Only 27.6% of the patients continued antidepressant therapy for more than 90 days. Antidepressant discontinuation during the first 30 days of treatment was significantly more common among Hispanics (53.8%) than non-Hispanics (41.3%); patients with fewer than 12 years of education (50.8%), compared with those with 12 or more years (39.3%); and patients with low family incomes (50.2%), compared with those with medium or high family incomes (38.6%). Patients were significantly more likely to continue anti-depressant treatment beyond 30 days if they received psychotherapy (68.0% versus 43.7%), completed 12 or more years of education (64.8% versus 52.0%), or had private health insurance (60.1% versus 50.8%). Among those who continued antidepressants beyond 30 days, antidepressant continuity during the subsequent 60 days was significantly associated with fair or poor pretreatment self-rated mental health and physical health, treatment with a selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor, and psychotherapy. Conclusions: Early discontinuation of antidepressant therapy is widespread in the community treatment of depression, especially among socioeconomically disadvantaged patients. Provision of psychotherapy and selection of an appropriate antidepressant medication may reduce the risk of discontinuation during the first 3 months of antidepressant treatment for depression. [ABSTRACT FROM AUTHOR]

Compares trends in outpatient treatment of depressive disorders in the United States in 1987 and 1997. Design, setting, and participants; Main outcome measures; Results; Conclusion there was in increase in outpatient treatment with psychotropic medications, but fewer outpatient visits and less use of psychotherapy; Indication that these changes coincided with the introduction of better-tolerated antidepressants, the expansion of third-party payment, and the development of rapid diagnostic procedures.

Attempts to determine the extent and pattern of blood serum monitoring of mood stabilizers in Medicaid patients with bipolar disorder. Demographic and service use characteristics; Likelihood of therapeutic drug monitoring and case management services; Likelihood that lithium users will receive the recommended serum level test.

Background: In addition to symptoms, DSM-IV criteria for major depression require clinical significance, operationalized via reports of receipt of care or interference in functioning. The authors examined whether this confounding of symptoms with receipt of care and/or impairment affected racial differences in rates of major depression in the community. Method: Analysis of data from the 1999 National Health Interview Survey for a nationally representative community sample of 30,801 adults administered the depression module of the Composite International Diagnostic Interview-Short Form. Results: There were no differences between African American subjects and white/other subjects when diagnosis was based solely on symptoms. Symptomatic African American individuals were less likely to endorse either receipt of care or interference in functioning, so that the clinical significance criterion served to reduce their rates of DSM-IV diagnosis. Conclusions: The clinical significance criterion underestimates of the rate of depression for African American individuals relative to white/other subjects, which may in turn underestimate their need for services. [ABSTRACT FROM AUTHOR]

Objective Multiple barriers to quality health care may affect the outcomes of postacute treatment for individuals with serious mental illness (SMI). This study examined rehospitalization for medical and surgical inpatients with and without a comorbid diagnosis of SMI which included psychotic disorders, bipolar disorder and major depression. Methods We examined hospital discharge records for medical and surgical inpatients from a large urban health system. Descriptive statistics and logistic regression models compared 7-, 30-, 60-, 90- and 180-day rehospitalization among medical and surgical inpatients with SMI ( n = 3221) and without an SMI diagnosis ( n = 70,858). Results Within 6 months following discharge, hospitalized medical patients without an SMI diagnosis (34.3%) and with an SMI diagnosis (43.4%) were rehospitalized ( P < .001), while surgical patients without an SMI diagnosis (20.3%) and with an SMI diagnosis (30.0%) were rehospitalized ( P < .001). Odds of rehospitalization among medical patients were 1.5 to 2.4 times higher for those with an SMI diagnosis compared to those without an SMI diagnosis ( P < .001). Conclusions Medical patients with a comorbid psychotic or major mood disorder diagnosis have an increased likelihood of a medical rehospitalization as compared to those without a comorbid SMI diagnosis. These findings support prior literature and suggest the importance of identifying targeted interventions aimed at lowering the likelihood of rehospitalization among inpatients with a comorbid SMI diagnosis. [ABSTRACT FROM AUTHOR]

Objective: This pilot study examined the effect of structural family therapy (SFT) on children’s impairment and depressive symptomatology and mothers’ depressive symptomatology and anxiety for 31 families served by a community mental health clinic. Method: A one group predesign/postdesign, with a baseline and two follow-up time points, was used. Results: A series of repeated measures analyses of variance showed significant improvement for mothers’ depression, F(2, 36) = 6.93, p = .003, η2 = .278, and anxiety, F(2, 34) = 6.44, p = .004, η2 = .275. Mothers’ ratings of their children’s impairment significantly improved, F(2, 42) = 6.27, p = .005, η2 = .270, though children’s self-rated impairment and depressive symptomatology did not change. Results were confirmed using random regression analyses. Conclusion: SFT has promise for simultaneously addressing mothers’ and children’s needs in community mental health settings. However, structural barriers impacting feasibility were identified and discussed. [ABSTRACT FROM PUBLISHER]

Objective: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. Method: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a di- agnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring in- patient treatment. Overall population- based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, in- patient costs, method of injury, and associated mental disorder diagnoses. Results: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were in- creases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%), There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and non-mental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. Conclusions: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders. [ABSTRACT FROM AUTHOR]

: BackgroundClinical trials indicate that electroconvulsive therapy (ECT) is the most effective treatment for major depression, but its effectiveness in community settings has not been examined.: MethodsIn a prospective, naturalistic study involving 347 patients at seven hospitals, clinical outcomes immediately after ECT and over a 24-week follow-up period were examined in relation to patient characteristics and treatment variables.: ResultsThe sites differed markedly in patient features and ECT administration but did not differ in clinical outcomes. In contrast to the 70%–90% remission rates expected with ECT, remission rates, depending on criteria, were 30.3%–46.7%. Longer episode duration, comorbid personality disorder, and schizoaffective disorder were associated with poorer outcome. Among remitters, the relapse rate during follow-up was 64.3%. Relapse was more frequent in patients with psychotic depression or comorbid Axis I or Axis II disorders. Only 23.4% of ECT nonremitters had sustained remission during follow-up.: ConclusionsThe remission rate with ECT in community settings is substantially less than that in clinical trials. Providers frequently end the ECT course with the view that patients have benefited fully, yet formal assessment shows significant residual symptoms. Patients who do not remit with ECT have a poor prognosis; this underscores the need to achieve maximal improvement with this modality. [Copyright &y& Elsevier]

Previous studies of adults have shown protective associations between clinical recognition of a mental disorder in the emergency department and short-term risk of repeat self-harm. Similar studies of young self-harm patients are lacking. We conducted a retrospective longitudinal cohort analysis of national Medicaid claims data in patients aged 10-19 years with self-harm who were discharged from emergency departments to the community (N = 2,703). Emergency department mental disorder recognition was not associated with a significant change in repeat self-harm visits during the 30-day follow-up period. Future studies should assess whether other aspects of emergency care influence short-term risk of repeat self-harm. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are prevalent in youth and associated with later depressive disorders. A recent model posits three distinct anxiety-depression pathways. Pathway 1 represents youth with a diathesis to anxiety that increases risk for depressive disorders; Pathway 2 describes youth with a shared anxiety-depression diathesis; and Pathway 3 consists of youth with a diathesis for depression who develop anxiety as a consequence of depression impairment. This is the first partial test of this model following cognitive-behavioral treatment (CBT) for child anxiety.Method: The present study included individuals (N = 66; M age = 27.23 years, SD = 3.54) treated with CBT for childhood anxiety disorders 7-19 years (M = 16.24; SD = 3.56) earlier. Information regarding anxiety (i.e., social phobia (SoP), separation anxiety disorder (SAD), generalized anxiety disorder (GAD)) and mood disorders (i.e., major depressive disorder (MDD) and dysthymic disorders) was obtained at pretreatment, posttreatment, and one or more follow-up intervals via interviews and self-reports.Results: Evidence of pathways from SoP, SAD, and GAD to later depressive disorders was not observed. Treatment responders evidenced reduced GAD and SoP over time, although SoP was observed to have a more chronic and enduring pattern.Conclusions: Evidence for typically observed pathways from childhood anxiety disorders was not observed. Future research should prospectively examine if CBT treatment response disrupts commonly observed pathways. [ABSTRACT FROM AUTHOR]

Background: Falling duration of psychiatric inpatient stays over the past 2 decades and recent recommendations to tighten federal regulation of electroconvulsive therapy (ECT) devices have focused attention on trends in ECT use, but current national data have been unavailable. Methods: We calculated the annual number of inpatient stays involving ECT and proportion of general hospitals conducting the procedure at least once in the calendar year with a national sample of discharges from 1993 to 2009. We estimated adjusted probabilities that inpatients with severe recurrent major depression (n = 465,646) were treated in a hospital that conducts ECT and, if so, received the procedure. Results: The annual number of stays involving ECT fell from 12.6 to 7.2/100,000 adult US residents, driven by dramatic declines among elderly persons, whereas the percentage of hospitals conducting ECT decreased from 14.8% to 10.6%. The percentage of stays for severe recurrent major depression in hospitals that conducted ECT fell from 70.5% to 44.7%, whereas receipt of ECT where conducted declined from 12.9% to 10.5%. For depressed inpatients, the adjusted probability that the treating hospital conducts ECT fell 34%, whereas probability of receiving ECT was unchanged for patients treated in facilities that conducted the procedure. Adjusted declines were greatest for elderly persons. Throughout the period inpatients from poorer neighborhoods or who were publicly insured or uninsured were less likely to receive care from hospitals conducting ECT. Conclusions: Electroconvulsive therapy use for severely depressed inpatients has fallen markedly, driven exclusively by a decline in the probability that their hospital conducts ECT. [ABSTRACT FROM AUTHOR]