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Objective: This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics., Methods: 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled., Results: Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services., Conclusions: Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement., (© Copyright 2020 Physicians Postgraduate Press, Inc.)

Objective: To develop a comprehensive etiologic model of DSM-5 prescription opioid use disorder (POUD) based on Kendler and colleagues' development model for major depressive disorder., Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). Risk factors were divided into 4 developmental tiers (childhood/early adolescence, late adolescence, adulthood, past year). Hierarchical logistic regression models were used to examine the independent contribution of each risk factor. Separate models were built to predict 12-month nonmedical use of prescription opioids and risk of POUD among those with 12-month nonmedical use., Results: After adjustment for other risk factors, the odds of past 12-month nonmedical use of prescription opioids were increased by history of trauma, social deviance, and use of drugs other than opioids in adulthood and by past-year pain, alcohol use disorder (AUD), tobacco use disorder, any Axis I disorder other than SUD, and number of stressful events. History of POUD in adulthood and pain, AUD, tobacco use disorder, and any Axis I disorder other than substance use disorders (SUD) in the past year increased the odds of 12-month POUD. History of SUD other than POUD in adulthood was associated with lower odds of POUD. For both outcomes, the effect of earlier development tiers was mediated by more proximal ones., Conclusions: A modification of Kendler and colleagues' model for major depressive disorder provides a useful foundation for a comprehensive developmental model of nonmedical opioid use and opioid use disorder., (© Copyright 2019 Physicians Postgraduate Press, Inc.)

Objective: This study analyzed past 12-month disorder-specific mental health treatment patterns of common DSM-5 disorders in the United States., Methods: Nationally representative face-to-face household survey data from structured diagnostic interviews of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) (n = 36,309) were used to estimate percentages of respondents with 12-month DSM-5 mood, anxiety, and substance use disorders who received disorder-specific treatment during the 12 months before the interview., Results: The percentage receiving treatment was highest for mood disorders (37.8%; 95% CI, 36.1%-39.6%), followed by anxiety disorders (24.1%; 95% CI, 22.6%-25.6%), and lowest for substance use disorders (18.8%; 95% CI, 17.8%-19.8%). Among anxiety disorders, panic disorder (47.9%; 95% CI, 43.9%-52.0%) had the highest treatment rate, and among substance use disorders, tobacco use disorder (20.3%; 95% CI, 19.0%-21.7%) had the highest treatment rate. Adults with mood and anxiety disorders (53.1%; 95% CI, 49.7%-56.4%) were more likely than those with only mood (32.0%; 95% CI, 29.5%-34.6%) or only anxiety (13.2%; 95% CI, 11.6%-15.0%) disorders to receive any mental health treatment. Lack of insurance coverage was associated with significantly lower odds of treatment for all disorders except specific phobia (0.55; 95% CI, 0.30-1.03), drug use disorders other than tobacco (0.80; 95% CI, 0.47-1.36), and alcohol use disorder (1.52; 95% CI, 1.12-2.07)., Conclusions: Most adults with common mental disorders in the United States were not treated for their disorders, and treatment rates varied considerably across disorders and sociodemographic groups, with particularly low rates of treatment for substance use disorders. Policy and clinical interventions are needed to promote greater access to treatment of adults with common substance use, anxiety, and mood disorders., (© Copyright 2019 Physicians Postgraduate Press, Inc.)

Objective: Multiple factors have an impact on the risk of attempting suicide in depressed individuals. The elevated number of contributing factors and their frequent co-occurrence suggest the need to combine them in integrative models to develop more effective suicide prevention strategies. This report presents a comprehensive model of the 3-year risk of suicide attempt in individuals with major depressive episode (MDE) using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 1, 2001-2002; Wave 2, 2004-2005)., Methods: Structural equation modeling was used to simultaneously examine effects of 4 broad groups of clinical factors previously identified as potential predictors of suicide attempts: (1) severity of depressive illness, (2) severity of psychiatric and other physical comorbidity, (3) sociodemographic characteristics, and (4) treatment-seeking behavior., Results: About 3.5% of the 2,587 participants with a DSM-IV diagnosis of MDE attempted suicide during the 3-year follow-up period. Several factors predicted attempted suicide independently of each other: the absence of treatment-seeking behavior for MDE, the severity of the depressive illness (ie, recurrent thoughts of death, prior suicide attempts, and severity of the general depressive symptom dimension representing the joint effect of most depressive symptoms), and the severity of comorbidities (ie, severity of the general psychopathology factor representing the mechanisms shared across all comorbid psychiatric disorders and lower mental health-related quality of life). No sociodemographic characteristics independently contributed to this risk., Conclusions: This model may help identify high-risk individuals with MDE and inform future research on risk of suicide., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

Background: It is unclear whether the higher prevalence of posttraumatic stress disorder (PTSD) in women than in men is due to sex differences in the prevalence of the exposure to traumatic events or to differences in vulnerability to traumatic events among those exposed to them., Methods: We applied mediation and moderated mediation models to a large nationally representative sample of US adults (N = 34,653) drawn from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions., Results: A model that assumed that the effect of 19 traumatic events was the same across sexes and examined whether sex differences in the prevalence of DSM-IV PTSD were due exclusively to sex differences in exposure to traumatic events predicted similar prevalence of PTSD among men and women (indirect effect standardized β = 0.04, P = .61), contrary to empirical findings. By contrast, a model that allowed the effect of 19 traumatic events on risk of PTSD to vary by gender, while taking into account sex differences in the prevalence of exposure, indicated that, for 13 of the traumatic events, the effect was significantly greater in women than in men (range of standardized β coefficients = 0.02-0.12, P < .05). The total indirect and direct effects of sex on PTSD in this model were, respectively, β = 0.42 (P < .01) and β = -0.03 (P = .76), indicating that all of the effect of sex on PTSD was explained by this moderated mediation model., Conclusions: The higher prevalence of PTSD among women appears to be due mainly to their greater vulnerability to the effects of traumatic events., (© Copyright 2018 Physicians Postgraduate Press, Inc.)

Objective: To estimate how results would have varied if a substance abuse clinical trial had been conducted with nationally representative adults with substance use and with representative adults receiving substance use treatment., Methods: Results were analyzed from a multisite clinical trial comparing the effectiveness of the Therapeutic Education System to treatment as usual for outpatient addiction treatment (n = 507). Patients were recruited between June 2010 and August 2011. Abstinence was the primary outcome. The general population sample and general population-treated samples were derived from Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093). Propensity scores provided a standardized measure of the difference between clinical trial participants and the 2 NESARC samples. The clinical trial was reanalyzed by reweighting the sample with propensity scores derived from the 2 samples to obtain generalizable estimates of treatment effects., Results: Before the clinical trial sample was reweighted, the odds ratio (OR) of response to Therapeutic Education System versus treatment as usual in the trial was 1.62 (95% CI, 1.12-2.35). After the sample was reweighted to be representative of the 2 NESARC groups, ORs were 1.33 (95% CI, 0.34-5.26) for the representative sample with any substance use and 1.64 (95% CI, 0.82-3.27) for the representative treated sample., Conclusions: Applying propensity score weighting to clinical trial results provides a method for estimating the population generalizability of clinical trial findings that relies on effect moderators observed in the study sample and population. Broader confidence intervals in the reweighted samples do not necessarily indicate lack of efficacy of the Therapeutic Education System but rather greater uncertainty concerning effectiveness in general population samples., (© Copyright 2017 Physicians Postgraduate Press, Inc.)

Objective: Although neuroimaging studies have an important role in psychiatric nosology and treatment development, little is known about the representativeness of participants in neuroimaging research. We estimated the effects of commonly used study eligibility criteria on the representativeness of neuroimaging research participants in relation to the general population with the psychiatric disorders of interest., Methods: Common eligibility criteria were applied from 112 published neuroimaging studies of DSM-IV nicotine dependence (13 studies), alcohol dependence (12 studies), drug use disorders (13 studies), major depressive disorder (MDD) (37 studies), and posttraumatic stress disorder (PTSD) (36 studies) to representative US samples with these conditions from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (n = 43,093). The analyses were repeated with NESARC respondents with the disorders and substantial psychosocial impairment., Results: Most NESARC respondents with nicotine dependence (64.1%), alcohol dependence (57.7%), drug use disorders (86.6%), and PTSD (66.9%), though not with MDD (18.2%), would have been excluded by eligibility criteria used in at least half of the relevant neuroimaging studies. Across the diagnostic groups, comorbid psychiatric and general medical conditions resulted in the largest percentages of exclusions. Corresponding analyses limited to respondents with substantial impairment excluded larger percentages with nicotine dependence (77.6%), alcohol dependence (75.8%), drug use disorders (93.5%), and PTSD (76.8%), though not MDD (18.3%)., Conclusions: Neuroimaging studies tend to recruit highly selected samples with the psychiatric disorders of interest that markedly underrepresent individuals with common comorbid conditions. Larger studies with less restrictive eligibility criteria may promote translation of advances in neuroimaging research to populations commonly encountered in clinical practice., (© Copyright 2016 Physicians Postgraduate Press, Inc.)

Background: Previous research suggests that various types of childhood maltreatment frequently co-occur and confer risk for attempting suicide. However, it is unknown whether the effect of childhood maltreatment on this risk occurs through diverse, specific mechanisms or through a generalized liability, independently of psychopathology. Although these competing explanations have different implications for intervention, they have never been evaluated empirically., Method: Structural equation modeling was used to examine the effect of different types of childhood maltreatment (ie, sexual abuse, physical and emotional abuse and neglect) on suicide attempt risk, and on age at first suicide attempt and repeated suicide attempts among attempters. Analyses controlled for demographic characteristics and DSM-IV Axis I and Axis II disorders. Data were drawn from a nationally representative survey of US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (N = 34,653)., Results: Childhood maltreatment was associated with an increased risk for attempting suicide and an earlier age at first suicide attempt among attempters, independently of psychopathology (P < .005). These associations operated mainly through the latent variable representing effects shared by the different types of childhood maltreatment, although sexual abuse had an additional, direct effect on the risk of suicide attempt. Childhood maltreatment types were not significantly associated with a history of multiple suicide attempts (all P values > .05)., Conclusions: The association between childhood maltreatment and suicide attempt operates mainly through a single broad liability, suggesting that the mechanisms underlying this dimension should be considered as an important therapeutic target for suicide prevention., (© Copyright 2015 Physicians Postgraduate Press, Inc.)

Objective: To determine whether patient expectancy plays a role in observed placebo and nocebo effects in 2 clinical trials., Method: Data were reanalyzed from 2 fluoxetine-discontinuation studies conducted from March 1990 to September 1992 and from May 1997 to December 2002. The 673 outpatients included were aged 18-65 years with DSM-III-R major depressive disorder (MDD), responded to 12-week duration open treatment, and were randomized to continued fluoxetine or placebo for an additional year. Participants in 1 of the included studies received a fixed dose of fluoxetine 20 mg daily, while the second study utilized flexible fluoxetine doses up to 60 mg daily. Mixed effects longitudinal models determined whether the possible randomization to placebo at 12 weeks resulted in significant depressive symptom worsening across treatments. Correlations were computed between early symptom change (weeks 1-3 of open treatment) and postrandomization symptom change (weeks 13-16 following randomization)., Results: Participants continuing to receive fluoxetine and those switched to placebo had significantly higher mean Hamilton Depression Rating Scale (HDRS) scores immediately postrandomization compared to the final weeks of open treatment (P < .001 for both fluoxetine- and placebo-treated patients). In both studies, early HDRS change was significantly correlated with postrandomization HDRS change for patients receiving fluoxetine (r = -0.46, P < .001) as well as placebo (r = -0.48, P < .001)., Conclusions: The possibility of receiving placebo following 12 weeks of open fluoxetine was associated with significant symptom worsening in 2 large fluoxetine discontinuation studies. Worsening depression scores following randomization were significantly associated with the degree of improvement participants experienced during weeks 1-3 of open treatment. These results suggest that treatment changes influence patients' expectations of improvement, which, in turn, affect their depressive symptoms., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

Objective: Acculturation is the process by which immigrants acquire the culture of the dominant society. Little is known about the relationship between acculturation and suicidal ideation and attempts among US Hispanics. Our aim was to examine the impact of 5 acculturation measures (age at migration, time in the United States, social network composition, language, race/ethnic orientation) on suicidal ideation and attempts in the largest available nationally representative sample of US Hispanics., Method: Study participants were US Hispanics (N = 6,359) from Wave 2 of the 2004-2005 National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653). We used linear χ(2) tests and logistic regression models to analyze the association between acculturation and risk of suicidal ideation and attempts., Results: Factors associated with a linear increase in lifetime risk for suicidal ideation and attempts were (1) younger age at migration (linear χ(2)(1) = 57.15; P < .0001), (2) longer time in the United States (linear χ(2)(1)= 36.09; P < .0001), (3) higher degree of English-language orientation (linear χ(2)(1) = 74.08; P <.0001), (4) lower Hispanic composition of social network (linear χ(2)(1) = 36.34; P < .0001), and (5) lower Hispanic racial/ethnic identification (linear χ(2)(1) = 47.77; P <.0001). Higher levels of perceived discrimination were associated with higher lifetime risk for suicidal ideation (β = 0.051; P < .001) and attempts (β = 0.020; P = .003)., Conclusions: There was a linear association between multiple dimensions of acculturation and lifetime suicidal ideation and attempts. Discrimination was also associated with lifetime risk for suicidal ideation and attempts. Our results highlight protective aspects of the traditional Hispanic culture, such as high social support, coping strategies, and moral objections to suicide, which are modifiable factors and potential targets for public health interventions aimed at decreasing suicide risk. Culturally sensitive mental health resources need to be made more available to decrease discrimination and stigma., (© Copyright 2014 Physicians Postgraduate Press, Inc.)