Can Health Services Defeat Epidemiology?

8 August 2017 01:52 PM   •   Greg Simon   •   0 comments

Can health services defeat epidemiology? This question is not inspired by the School of Public Health summer softball league. Instead it’s inspired by a conversation with my colleague Ed Boudreaux about screening for suicidal ideation as a tool for preventing suicide attempts and suicide deaths.

Social Determinants of Health: What's in a Name?

11 July 2017 08:56 AM   •   Greg Simon   •   7 comments

I have a beef with the name “Social Determinants of Health”. I absolutely agree with putting the word “social” right up front. It’s a fact that zip code often has a greater effect on health than genetic code. And the effects of social and environmental factors - such as trauma, loss, and deprivation - are especially relevant to mental health. It’s the specific word “determinants” that I’d want to change.

Who decides what a word means?

5 June 2017 10:41 AM   •   Greg Simon   •   0 comments

Our collaboration with MHRN health systems to improve depression care has emphasized the systematic use of standard outcome measures - like the PHQ9 depression scale. Front-line clinicians and health system managers often ask whether those standard questionnaires can accurately measure depression or predict suicidal behavior across diverse patient populations.

Coordinated Care for First-Episode Psychosis and the End of Gadgets

5 June 2017 09:46 AM   •   Greg Simon   •   0 comments

As MHRN investigators, we often hear from academic researchers hoping to study new psychotherapies or eHealth interventions in our healthcare systems.

Reducing Science Friction

7 December 2016 12:58 PM   •   Greg Simon   •   3 comments

At our recent MHRN investigator meeting, we were discussing the challenges of evaluating mobile health tools in real-world healthcare systems.

Should Suicide Prevention Be Adjusted for Race and Ethnicity?

10 October 2016 08:52 AM   •   Greg Simon   •   1 comment

Our MHRN Suicide Prevention Outreach Trial offers outreach and support interventions based on patients’ response to item 9 of the PHQ9 depression questionnaire. We reach out to patients who reported thoughts of death or self-harm “more than half the days” or “nearly every day” at a recent visit. This threshold for outreach is based on our previous research showing that those patients reporting frequent suicidal thoughts have an approximately 2.5% risk of suicide attempt over the following year. Now, several of our MHRN health systems are using the same threshold (a score of 2 or 3 on item 9 of the PHQ9) to identify patients needing additional assessment and follow-up.

Zero Suicide: Aspirations and Accountability

29 July 2016 12:25 PM   •   Greg Simon   •   1 comment

My colleague Ursula Whiteside and I have an ongoing discussion (or maybe even debate) about “Zero Suicide”, the name of the comprehensive program developed by the National Action Alliance for Suicide Prevention. “Zero Suicide” is a bold, aspirational name. My reservation is not about the aspiration, but about the accountability.

Stepping Back from the Nuclear Option

24 June 2016 02:58 PM   •   Greg Simon   •   1 comment

One of our new MHRN research projects, led by Rob Penfold at Group Health, will implement and evaluate a program to curb over-prescribing of antipsychotic medication to children and teens. The program focuses on youth prescribed antipsychotics for non-psychotic disorders – especially attention deficit disorder, oppositional defiant disorder, conduct disorder, and depression.


24 May 2016 12:24 PM   •   Greg Simon   •   2 comments

Can persistent outreach reduce the risk of suicide attempt in people who report frequent thoughts of death or self-harm? Our MHRN Suicide Prevention Outreach Trial is testing the effectiveness of persistent outreach programs, using decision support software built into the electronic health record.

The Precision Medicine Intitiative and "The Journal of Job"

11 May 2016 01:37 PM   •   Greg Simon   •   12 comments

It seems half of the papers in mental health research describe the co-occurrence of misery; so much so that there could be a new journal devoted to this scientific genre "The Journal of Job". But that's devoid of hope. Perhaps the NIH Precision Medicine Initiative (PMI) offers some hope.