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We used the World Health Organization's Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women's race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV.

ObjectiveThe risk of clinically significant depressive symptoms increases during perimenopause. With highly active antiretroviral treatment (HAART), more human immunodeficiency virus (HIV)-infected women survive to transition through menopause. In a cross-sectional analysis, we evaluated the association of menopausal stage and vasomotor symptoms with depressive symptoms in an ethnically diverse cohort of women with a high prevalence of HIV.MethodsParticipants included 835 HIV-infected women and 335 HIV-uninfected controls from the Women's Interagency HIV Study (63% African American). The Center for Epidemiologic Studies Depression Scale was used to screen for elevated depressive symptoms. Menopausal stages were defined according to standard definitions. Logistic regression analysis was used to identify predictors of elevated depressive symptoms.ResultsCompared with premenopausal women, early perimenopausal women (OR [odds ratio], 1.74; 95% CI, 1.17-2.60), but not late perimenopausal or postmenopausal women, were more likely to show elevated depressive symptoms in adjusted analyses. The odds were similar in HIV-infected and HIV-uninfected women. Persistent vasomotor symptoms also predicted elevated depressive symptoms in HIV-infected and HIV-uninfected women (OR, 1.45; 95% CI, 1.02-2.06). In HIV-infected women, menopausal stage interacted with antiretroviral use (P = 0.02); the likelihood of elevated depressive symptoms in early perimenopause compared with premenopause was especially high in HAART-untreated women (OR, 3.87; 95% CI, 1.57-9.55).ConclusionsIn HIV-infected and HIV-uninfected women, the odds of elevated depressive symptoms were significantly higher during early perimenopause. Elevated depressive symptoms were associated with nonadherence to HAART, underscoring the importance of screening and treating depressive symptoms in HIV-infected women who have experienced a change in the regularity of their menstrual cycles.

The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the employment experiences of people with preexisting behavioral health conditions during the coronavirus disease of 2019 (COVID-19) pandemic, despite the recognized importance of work for this group. Method: Two hundred and seventy two adults with behavioral health conditions, recruited through statewide mental health networks in NJ and NY, completed an online survey in April–May 2020. Multivariable analysis examined the effects of sleep and dietary changes, COVID-19 exposure, anxiety (Generalized Anxiety Disorder-2), and depressive symptoms (Patient Health Questionnaire-2) on employment status and job changes. Respondents' open-ended descriptions of pandemic-related changes in employment were analyzed using the constant comparative method. Results: Two-thirds (65%) were employed, only 4% became unemployed, and 29% reported changes in their jobs as a result of the pandemic. In logistic regression analysis controlling for age, race, education and gender, workers were more likely than nonworkers to report altered eating and sleeping habits, but not greater anxiety or depression. However, those whose jobs changed were more likely to report COVID-19 exposure, altered sleep patterns, clinically significant anxiety symptoms, and both anxiety and depressive symptoms compared to those whose jobs had not changed. Qualitative analysis revealed work's positive impact (pride in job performance, using new skills, feeling safer working from home) and its negative effects (lifestyle disruption, worry about job security, isolation from coworkers). Conclusions and Implications for Practice: This is the first study to suggest the important role that work played for people with preexisting behavioral health disorders during the pandemic, with both positive and negative influences, and important implications for services and supports. Impact and Implications: Study findings point to the important role work plays in the lives of employees with preexisting behavioral health conditions during the pandemic, with implications for designing services and supports. This includes the need for mental health peer and professional support, including evidence-based supported employment services, vocationally oriented peer support, health and wellness education, and infection precaution assurance. Also needed is help balancing work, family, and caregiving to reduce employee stress and enhance job satisfaction. [ABSTRACT FROM AUTHOR]

Objective: Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education.Methods: This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight preimplementation study quarters, controlling for clinic site and preimplementation secular trends.Results: Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%.Conclusions: Significant improvement in medical outcomes was found among patients of a behavioral health home who had comorbid diabetes and mental illness after introduction of a multicomponent care coordination intervention, regardless of which clinic they attended. [ABSTRACT FROM AUTHOR]

Prior research has not addressed whether both serious mental illness (SMI) and other mental health (OMH) disorders affect the likelihood of 30-day readmissions after medical hospitalizations, or whether post-discharge use of outpatient medical, mental health, and pharmacy services is associated with readmission likelihood. Using the Truven Health Analytics MarketScan® Medicaid Multi-State Database, we studied 43,817 Medicaid beneficiaries, age 18–64, following discharge from medical hospitalizations in 2011. Logistic regression models compared all-cause, 30-day readmissions among those with SMI, OMH, and no psychiatric diagnosis, and examined associations of 30-day outpatient service use with 30-day readmissions. Thirty-day readmission rates were 15.9% (SMI), 13.8% (OMH), and 11.7% (no mental illness). In multivariable analysis, compared to patients without mental illness, odds of readmission were greater for those with SMI (aOR = 1.43, 95%CI:1.32–1.51) and OMH (aOR = 1.21, 95%CI:1.12–1.30), and lower among those using outpatient mental health services (aOR = 0.50, 95%CI: 0.44–0.56). The adult Medicaid population disproportionately includes patients with SMI and OMH disorders, both of which were found to be associated with 30-day hospital readmissions. Receiving outpatient mental health services after hospital discharge may be protective against readmission following medical hospitalizations, suggesting the need for further research on these topics. [ABSTRACT FROM AUTHOR]

Objective: Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness.Methods: Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixed-effects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models.Results: Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups.Conclusions: The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual. [ABSTRACT FROM AUTHOR]

Date Presented 04/20/2023 The purpose of this randomized controlled trial (RCT) was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) Intervention in improving competency and behaviors related to weight management for individuals with psychiatric disabilities. The intervention group improved more than the control group on healthy lifestyle behaviors and perceived competence. Participants at only some of the sites had significant weight loss, suggesting a supportive setting is important when providing the intervention. Primary Author and Speaker: Catana Brown Contributing Authors: Judith A. Cook, Jessica A. Jonikas, Pamela J. Steigman, Jane K. Burke-Miller [ABSTRACT FROM AUTHOR]

Objective: Recovery from mental illness is influenced by one's social location along multiple dimensions of identity, such as race, class, gender, age, and ability, and by how these social locations are expressed through structural and institutional barriers. This project was developed using an intersectional policy analysis framework designed to promote equity across identity locations--called the multistrand method--to examine the potential use of self-directed care financing approaches in the Canadian mental health system. Method: A panel of 16 diverse stakeholders came together 4 times at structured 6-hr meetings to examine the evidence for self-directed care and explore its application in the Canadian context. Telephone interviews with evidence panel members were conducted to assess their perceptions of the group process and outcomes. Results: Our analysis revealed ways that intersecting strand locations might differentially influence the degree of choice and recovery experienced by self-directed care participants. Individualized resource allocation, draining financial resources from ethnically specific services, unevenness in acceptance of the recovery orientation, and paucity of service options in different geographical regions were identified as contexts in which self-directed care policies could promote inequity. However, greater peer involvement in the model's implementation, use of indigenous community supports, purchase of material goods by economically disenfranchised persons, and access to services from ethnically diverse clinicians in the private sector were identified as equity-promoting model features. Conclusion and Implications for Practice: By couching their analysis at the level of unique socially-situated perspectives, the group developed detailed policy recommendations and insights into both the potential and limitations of self-directed care. The knowledge gained from our project can be used to develop uniquely Canadian self-directed care models tailored to promote recovery through empowerment and self-determination across intersecting identity strand locations. [ABSTRACT FROM AUTHOR]

Objective:As part of a study of health status among 457 adults with diagnostically heterogeneous serious mental illnesses served by the public mental health system in four U.S. states, we assessed predictors of current cigarette smoking.Methods:We examined bivariate relationships between smoking status and risks for drug and alcohol use disorders, residential setting, parental status, and employment. Finally, we used multivariable logistic regression to predict current smoking, controlling for significant confounds.Results:Of the total sample, 44% of participants reported that they currently smoked and most (62%) were moderately to severely nicotine-dependent. Those at high risk for drug use disorders were more than three times as likely and those at high risk for alcohol use disorders were more than twice as likely to smoke, compared to their counterparts with little or no drug or alcohol use disorder risk. Controlling for all other model variables including drug and alcohol disorder risk, current smokers were less likely to be parents and more likely to reside in supervised settings than nonsmokers. Younger people and those without a college degree were more likely to smoke, controlling for all other model variables.Conclusions:Given the high degree of comorbidity of smoking, alcohol disorders, and drug use disorders, the authors highlight the need for integrated interventions that address these issues simultaneously. [ABSTRACT FROM AUTHOR]

Objective: This study examines the long-term effects of evidence-based supported employment services on three vocational outcomes: labor force participation, earnings, and attainment of Social Security Administration (SSA) nonbeneficiary status through suspension or termination of disability cash payments due to work (NSTW).Method: Data from 449 individuals with psychiatric disabilities who participated in a multisite controlled trial of supported employment were matched to SSA data over a 13-year period (2000-2012) following supported employment services. Long-term outcomes were analyzed using random effects regression models comparing participants in the experimental and control conditions on measures of employment, earnings, and attainment of NSTW. The authors adjusted for time, age, race/ethnicity, gender, education, schizophrenia diagnosis, substance abuse history, and geographic region.Results: Overall outcomes were modest across the 13-year follow-up, with 32.9% of participants having any earned income and 13.1% ever attaining NSTW. Supported employment recipients were almost three times as likely as control subjects to be employed over 13 years (odds ratio=2.89). Although earnings were low, supported employment participants had significantly higher earnings per month than control subjects over time (parameter estimate=$23.82) and were more likely than control subjects to attain NSTW (odds ratio=12.99). The supported employment effect diminished and was completely attenuated over time.Conclusions: The study's findings indicate a small but significant vocational advantage accruing to recipients of evidence-based supported employment in the decade following service delivery, adding to the evidence on the durability of supported employment effects. Results can inform policies designed to help workers enhance economic security and reduce dependence on Social Security disability benefits. [ABSTRACT FROM AUTHOR]

The prevalence of obesity and its associations with gender, clinical factors, and medical co-morbidities were examined among 457 adults attending public mental health programs in 4 U.S. states. BMI was measured directly and other information was gathered by interview. Over half (59 %, n = 270) were obese including 18 % (n = 83) who were morbidly obese. In hierarchical ordinary least squares regression analysis controlling for demographic, psychiatric, medical, smoking, and health insurance statuses, women were significantly more likely to be obese than men. Obesity also was more likely among those who were younger and not high school graduates, those with diabetes or hypertension, and those who did not smoke tobacco. Interaction effects were found between gender and diabetes, hypertension, tobacco smoking, education, race, and age. The high prevalence of obesity among women, coupled with interactions between gender and other factors, suggest that targeted approaches are needed to promote optimal physical health in this population. [ABSTRACT FROM AUTHOR]

Motivational interventions help people with mental illness try to quit smoking, but few studies have evaluated factors associated with this groups' cessation with community treatment. We examined predictors of abstinence after a brief motivational intervention among smokers with severe mental illness. Education, stage of change post intervention, and use of cessation treatment predicted any 1-week period of self-reported abstinence over 6 months (29 %). Cessation treatment mediated the relationship between stage of change and abstinence. Because treatment was the key modifiable predictor of abstinence, future research should establish strategies that improve motivation for, access to, and retention in cessation treatment. Clinical Trials Identifier NCT01412866 [ABSTRACT FROM AUTHOR]

Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care. [ABSTRACT FROM AUTHOR]

Background This study examined the prevalence and treatment of 17 co-occurring physical health conditions among adults with serious mental health disorders, and factors associated with prevalence of the 5 most common medical co-morbidities. Methods Data were collected from 457 adults attending publicly funded mental health programs who participated in community health screenings held in 4 U.S. states. Face-to-face interviews included standardized items from the National Health Interview Survey and the National Health and Nutrition Examination Survey. Ordinary least squares regression analysis examined associations between prevalence of the 5 most common co-morbid conditions and respondents' demographic, clinical, attitudinal, and health insurance statuses. Results Compared to the U.S. population, prevalence was significantly higher for 14 out of 17 medical conditions assessed. The 5 most common were hyperlipidemia (45%), hypertension (44%), asthma (28%), arthritis (22%), and diabetes (21%). Controlling for age, study site, and Medicaid status, racial/ethnic minorities were almost twice as likely as Caucasians to be diagnosed with hypertension and diabetes; women were almost twice as likely as men to be diagnosed with diabetes; and people with schizophrenia were around half as likely as those with other disorders to be diagnosed with hypertension and arthritis. Age was positively related to all conditions except asthma. Treatment prevalence was below 70% for approximately half of ongoing conditions. Conclusions These results suggest a high level of medical vulnerability and need for coordination of health and mental health services in this population. Associations with age, minority status, and gender point to the need for targeted health care strategies. [ABSTRACT FROM AUTHOR]

Objective: This study examined the prevalence and correlates of co-occurring obesity and diabetes among community mental health program members.Methods: Medical screenings of 457 adults with serious mental illnesses were conducted by researchers and peer wellness specialists in four U.S. states. Body mass index was measured directly. Diabetes was assessed via glycosylated hemoglobin and interview self-report. Multivariable logistic regression analysis examined associations with known predictors.Results: In the sample, 59% were obese, 25% had diabetes, and 19% had both conditions. When gender, diagnosis, and site were controlled, co-occurring diabetes and obesity was almost three times as likely among African Americans (OR=2.93) as among participants from other racial groups and half as likely among smokers as among nonsmokers (OR=.58). Older persons and those with poorer self-rated physical health also were more likely to have these co-occurring conditions.Conclusions: Results support the need for culturally competent treatment and for smoking cessation options with sensitivity to the potential for weight gain. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to test the efficacy of a peer-led, mental illness education intervention called Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES). Method: Subjects were recruited from outpatient community mental health settings in eight Tennessee communities. Using a single-blind, randomized controlled trial design, 428 individuals with serious mental illness (SMI) were interviewed at baseline and assigned to BRIDGES or to a services as usual wait list control condition. Two-and-one-half hour classes were taught once a week for 8weeks by peers who were certified BRIDGES instructors. Subjects were followed-up at immediate post-intervention and 6-months later. The primary outcome was self-perceived recovery, measured by the Recovery Assessment Scale (RAS). A secondary outcome was hopefulness as assessed by the State Hope Scale (SHS). An exploratory hypothesis examined the impact of depressive symptoms on both recovery outcomes. Results: Eighty six percent of participants were followed up. On average, participants attended five sessions. Intent-to-treat analysis using mixed-effects random regression found that, compared to controls, intervention participants reported: 1) significantly greater improvement in total RAS scores as well as subscales measuring personal confidence and tolerable symptoms; and 2) significantly greater improvement in hopefulness as assessed by the agency subscale of the SHS. While study subjects with high levels of depressive symptoms had significantly poorer outcomes, outcomes were superior for BRIDGES participants regardless of depressive symptoms. Conclusions: Peer-led mental illness education improves participants'' self-perceived recovery and hopefulness over time, even controlling for severity of depressive symptoms. [Copyright &y& Elsevier]

This article summarizes the published results of the Employment Intervention Demonstration Program (EIDP), a federally-funded, multi-site study examining the effectiveness of supported employment programs for 1273 unemployed individuals with psychiatric disabilities in the U.S. Findings confirm the effectiveness of supported employment across different models, program locations, and participant populations. The study's results are discussed in the context of public policies designed to encourage return to work for those with a severe mental illness. [ABSTRACT FROM AUTHOR]

Effects of co-occurring disorders on work outcomes were explored among individuals with severe mental illness who were participating in a multisite randomized study of supported employment. At seven sites, 1,273 people were randomly assigned to an experimental supported employment program or a control condition and followed for 2 years. Multivariate regression analysis examined work outcomes including earnings, hours worked, and competitive employment, as well as whether psychiatric disability was disclosed to coworkers and supervisors. Individuals with any comorbidity had lower earnings and were less likely to work competitively. Those with physical comorbidities had lower earnings, worked fewer hours, and were less likely to work competitively. Disclosure was more likely among those with both cognitive and physical comorbidities, as well as those with learning disabilities. Competitive employment was less likely among those with intellectual disability, visual impairment, and human immunodeficiency virus/acquired immunodeficiency syndrome. The experimental condition was positively related to all outcomes except disclosure. The results suggest that, with some exceptions, comorbidities affect employment outcomes, requiring tailored services and supports to promote vocational success. [ABSTRACT FROM AUTHOR]

The article focuses on importance of psychiatric rehabilitation services during and after the COVID-19 pandemic. Topics include the National Institute on Disability, Independent Living, and Rehabilitation Research a federal agency that supports rigorous applied research, the translation service delivery models that improve outcomes for people living, and funding for the social model of disability has directed attention to environmental factors that affect people with serious mental illnesses.

The purpose of this study was to explore the effects of local unemployment rates on evidence-based supported employment (SE) programs tailored for people with psychiatric disabilities. Participants (n=1,273) from 7 states in the US were randomly assigned to experimental SE or services as usual/comparison conditions and followed for 24 months. Mixed-effects random regression analysis found that both local unemployment rate and study condition were significant predictors of competitive employment and working 40 or more hours per month. An interaction between study condition and unemployment rate was found, in which participants in areas with low unemployment receiving best practice SE had consistently better outcomes than all others. However, even in areas with high unemployment, those who received evidence-based SE had outcomes superior to those in the control condition. This confirms the influence of local labor market forces on individuals with psychiatric disabilities participating in vocational rehabilitation programs. It also suggests that those who are attempting to return to work in areas with weak local economies are likely to fare especially poorly if they are not receiving high quality SE interventions. Thus, use of evidence-based SE can help to ameliorate the effects of high unemployment on work outcomes. [ABSTRACT FROM AUTHOR]

The article describes the nature of barriers to paid work and economic security for people with disabling mental disorders by reviewing research from the fields of disability, economics, health care and labor studies in the U.S. Current policy initiatives in health care, mental health and disability are also discussed.

The article discusses the study on determining the efficacy of the family-led education intervention for family members of adults with mental illness. A total of 462 family members of adults with mental illness participated in the Journey of Hope intervention in Louisiana. The result of the study showed that family-led educational interventions are effective in improving participants' psychological well-being and their relationship with their ill relatives.

The article calculates the amount of payments to employment service providers for persons with mental illness enrolled in the Ticket to Work Program in the U.S. This article concludes that the payment systems of the program do not reflect the reality of rehabilitation for individuals with severe mental illness. It is recommended to take into account the outcomes of return-to-work services for this population.

Examines the effects of job development and job support among other services on acquisition and retention of competitive employment. Association of job support with more months in the first competitive job but not total hours of worked; Absence of evidence for the causal role of job support in analyses that tested the effects of job support after the job support was provided; Significance of the causal role of job support.

Context National probability surveys indicate that most individuals with schizophrenia and other severe mental illnesses are not employed. This multisite study tested the effectiveness of supported employment (SE) models combining clinical and vocational rehabilitation services to establish competitive employment. Methods We randomly assigned 1273 outpatients with severe mental illness from 7 states in the United States to an experimental SE program or to a comparison or a services-as-usual condition, with follow-up for 24 months. Participants were interviewed semiannually, paid employment was tracked weekly, and vocational and clinical services were measured monthly. Mixed-effects random regression analysis was used to predict the likelihood of competitive employment, working 40 or more hours in a given month, and monthly earnings. Results Cumulative results during 24 months show that experimental group participants (359/648 [55%]) were more likely than those in the comparison programs (210/625 [34%]) to achieve competitive employment (χ2 = 61.17; P<.001). Similarly, patients in experimental group programs (330/648 [51%]) were more likely than those in comparison programs (245/625 [39%]) to work 40 or more hours in a given month (χ2 = 17.66; P<.001). Finally, participants in experimental group programs had significantly higher monthly earnings than those in the comparison programs (mean, $122/mo [n=639] vs $99/mo [n=622]); t1259 = -2.04; P<.05). In the multivariate longitudinal analysis, experimental condition subjects were more likely than comparison group subjects to be competitively employed, work 40 or more hours in a given month, and have higher earnings, despite controlling for demographic, clinical, work history, disability beneficiary status, and study site confounders. Moreover, the advantage of experimental over comparison group participants increased during the 24-month study period. Conclusion The SE models tailored by integrating clinical and vocational services were more effective than services as usual or unenhanced services. [ABSTRACT FROM AUTHOR]

Reliability of well-known instruments was examined in 202 people with severe mental illness participating in a multisite vocational study. We examined interrater reliability of the Positive and Negative Syndrome Scale (PANSS) and the internal consistency and test-retest reliability of the PANSS, the Rosenberg Self-Esteem Scale, the Medical Outcomes Study Short Form-36 (SF-36), and the Quality of Life Interview. Most scales had good levels of reliability, with intraclass correlation coefficients (ICCs) and coefficient alphas above .70. However, the SF-36 scales were generally less stable over time, particularly Social Functioning (ICC = .55). Test-retest reliability was lower among less educated respondents and among ethnic minorities. We recommend close monitoring of psychometric issues in future multisite studies. [ABSTRACT FROM AUTHOR]

Reports on the outcomes of 424 families who participated in the Journey of Hope (JOH), an intervention program to help families of persons with mental illness. Increase in the knowledge of the causes and treatment of mental illness; Improvement in the understanding of the mental health service system and morale.

Discusses the impact of severe mental illness on parent and adult child relationships. Influence of family demographic characteristics; Parental caregiving burden; Effect of perceived caregiving burden; Implications for intervention; Predictors of positive parent/adult child relationships; Limitations of the study.

Focuses on the important challenges in providing high-quality community-based services for persons with severe mental illness in Illinois. Use of the service delivery model of assertive community treatment by mental health providers; Evaluation of the didactic educational component; Safety tips for delivering mental health services.

Examines the support group experiences of minority and white families of persons with mental illness. Demographic characteristics of minority and Caucasian subjects; Measurement of the support group participation of the subjects; Results of the study suggesting that ethnic minority family develop more friendships with other group members and are more satisfied with the group itself than Caucasian groups are.

The article reports on the natural vocational supports for persons with severe mental illness particularly the Tresholds supported employment program. Robert Wood Johnson Foundation gave a three-year grant to Thresholds, a psychosocial rehabilitation agency in Chicago to add supported employment services to its programming for persons with psychiatric disabilities.

The article discusses various reports published within a special section in the issue including one by Pickett and Diehl on a peer-education program, one on the financial aspects of recovery from psychiatric disability by Burke-Miller and Swarbrick and one by Cook and Copeland on recovery self-management strategies.

Trauma can affect anyone's life. However, some people are more likely than others to have experienced trauma in their lives and are more sensitive to its effects. In particular, people with a serious mental illness tend to have been exposed to high levels of trauma, both before and after the onset of their mental illness, and not surprisingly they have higher rates of PTSD than in the general population. Just as there is a need to educate the general public about PTSD and its treatment, mental health professionals and service users would benefit from learning similar information and understanding that there is realistic hope for developing a worthwhile and rewarding life after recovery from trauma and PTSD. [ABSTRACT FROM AUTHOR]

The author reflects on the use of collaborative partnership models in healthcare in providing medical care for people with psychiatric disabilities. It states that people with significant mental illnesses die on average 25 years sooner than the general population with the majority of those deaths due to preventable, treatable medical conditions. It talks about the lack of affordable medical care and on discrimination from medical care providers toward people with psychiatric disabilities.

The purpose of this research was to use Web-based survey methodology to examine the use of information technology (IT) by people with psychiatric disabilities, as well as its association with self-determination in their lives. Survey respondents were recruited via notices posted on mental health listserves and Web sites as well as through newsletters and emails. A total of 911 respondents completed the survey. Respondents reported diverse uses of the Internet, in some cases exceeding usage reported by the general population. A positive association was identified between frequency of Internet use and self-assessed degree of self-determination. In multivariate analyses controlling for demographic variables (including income and education) and impairment indicators (including hospitalization history), those with higher self-determination were significantly less likely to hold negative attitudes about Internet use. Many respondents reported using IT to advocate for themselves, as well as to organize others in groups that can advocate for each other. [ABSTRACT FROM AUTHOR]

The authors examined changes in caregiving satisfaction and information needs among 462 relatives of individuals with mental illness who participated in a study of a family-led education course, the Journey of Hope (JOH). Participants were randomly assigned to receive JOH or to a control group waiting list and followed for 9 months. General linear model repeated measures analysis of variance found that, compared with the control group, the intervention group showed significant improvement in caregiving satisfaction and information needs following course completion and maintained these gains for another 6 months. Education and support from other family members in the form of a structured course is effective in meeting the caregiving needs of relatives of persons with mental illness. [ABSTRACT FROM AUTHOR]

This review addresses the needs and experiences of young adult women, aged 16 to 21, who have a diagnosis of serious emotional disturbance (SED) or mental illness. Given the large numbers of young women with SED, evidence that they are underserved, and the continuity of many disorders from adolescence to adulthood, an integrative review in this area can enhance our ability to better address these young women's needs. [ABSTRACT FROM AUTHOR]

Abstract: Health concerns are common reasons for wanting to quit smoking among smokers with mental illnesses. Motivational interventions have used feedback from a carbon monoxide monitor to increase awareness of health concerns, but this device is not commonly available. Whether brief motivational interventions can be effective without this feedback is unknown. Using a randomized controlled trial, this study tested the effect of carbon monoxide feedback within a brief, multi-component, computerized motivational intervention among 124 smokers with schizophrenia or mood disorders. The main outcome was initiating cessation treatment over two months. Although participants in the carbon monoxide group increased their knowledge about the carbon monoxide, (χ2 =6.97, df=1, p=.008), the main and secondary outcomes did not differ significantly between groups. Overall, 32% of participants initiated treatment. This study suggests that a computerized motivational decision support system can lead users to initiate cessation treatment, and that carbon monoxide feedback is not a necessary component. [Copyright &y& Elsevier]

Objective: Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 160 participants in the Building Recovery of Individual Dreams and Goals (BRIDGES) education program. BRIDGES is a peer-led 8-week course taught by trained instructors who publicly disclose the fact that they are in recovery from mental illness. Method: Structured interviews assessing recovery outcomes were conducted with participants in the month prior to their receipt of BRIDGES, and immediately after receipt of the intervention. Paired t-tests were conducted to examine changes in psychiatric symptoms, hopefulness, social support, self-advocacy, empowerment, adaptive coping, and recovery pre-receipt and post-receipt of BRIDGES. Results: Post-receipt of BRIDGES, participants reported significantly fewer psychiatric symptoms, decreased use of maladaptive coping behaviors, and increased feelings of hopefulness, self-advocacy, empowerment, and recovery. Conclusions: These promising early results from our ongoing study of BRIDGES suggest that peer-led education interventions are a valuable resource. Additional research is needed to better understand the effectiveness of these interventions, including potential long-term post-program participation benefits. [ABSTRACT FROM AUTHOR]

Topic: Studies indicate that asset development programs such as Individual Development Accounts (IDAs) can enhance the economic security of low-income populations; however, only a handful of asset development programs have been implemented specifically to serve people with psychiatric disabilities, and larger programs have not collected disability-specific information. Purpose: The purpose of this article is to increase our knowledge about the use of IDAs to enhance selfdetermination and recovery for people with psychiatric disabilities. Sources used: Background information about IDAs is presented followed by case studies of two IDA programs that serve people with psychiatric disabilities. Conclusions: The use of IDA programs in enhancing self-determination among people with psychiatric disabilities is discussed, along with barriers and future directions. [ABSTRACT FROM AUTHOR]

As mental health recovery gains traction, many people have put forward varying definitions. Few attempts have been made to create a dimensional analysis of the recovery literature that assesses the growing consensus about what recovery is or what its definition should entail. This paper incorporates an ecological framework to take the individual's life context into account while emphasizing both the reestablishment of one's mental health (i.e., first order change) and the mitigation of the oppressive nature of barriers imposed by the greater community (i.e., second order change) so that people may experience social integration and community inclusion. [ABSTRACT FROM AUTHOR]