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See past highlights of MHRN activity in our Winter Newsletter

 

 

 

 

The Latest from MHRN

Feedback-informed care: Mapping a new course for depression treatment
With support from the Garfield Memorial Fund, MHRN researchers at KP Colorado and KP Washington are working with health system leaders to harness the power of big data to help customize and improve care for depression.

 

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?
Rebecca Rossom, MD, MS, led a study that was recently published in the Journal of Affective Disorders. The team examined PHQ9s completed by adult outpatients treated for mental health conditions in 2010-2012 at four Mental Health Research Network-affiliated healthcare systems. The goal was to examine suicidal ideation and attempts/deaths in order to determine whether item 9 of the Patient Health Questionnaire (PHQ9) predicted risk for suicide attempts and deaths across age groups.They found that those with nearly daily suicidal ideation (compared to those without) were:

·        5-to-8 times more likely to attempt suicide and 3-to-11 times more likely to die by suicide within 30 days, and
·        2-to-4 times more likely to attempt suicide and 2-to-6 times more likely to die by suicide within 365 days.

The study team also found that, for those with any level of suicidal ideation, the increased risk of suicide attempts and deaths persisted over two years. The absolute risk of suicide attempts generally declined with age, while the absolute risk of suicide death generally increased with age. However, the relationship between reported suicidal ideation and suicide attempts and deaths was similar across age groups. They concluded that suicidal ideation reported on the PHQ9 is a robust predictor of suicide attempts and death, regardless of age, and that healthcare systems should address both the immediate and sustained risk of suicide for patients of all ages.

 

MHRN provides resources to examine treatment patterns associated with first episode psychosis
Todd P. Gilmer, PhD, at the University of California, San Diego, is using MHRN resources to conduct a study, which will describe treatment for first-episode psychosis in a large commercially insured population using data from the OptumLabs Data Warehouse (OLDW). “Dr. Simon and his team have been very generous,” Dr. Gilmer said, “sharing both their research design and their programming code.  I am excited to be able to contribute to their important work examining first-episode psychosis by applying their methods to a national dataset.”

The proposed research will build on work that was initiated in four MHRN sites to identify individuals experiencing a first episode of psychosis and to describe their treatment patterns using administrative databases. The main goals for this project are 1) To identify individuals receiving treatment for first diagnosis of psychotic disorder, 2) To describe health care treatment patterns prior to first diagnosis of psychotic disorder, 3) To describe health care treatment patterns after first diagnosis of psychotic disorder, and 4) To estimate costs associated with specific patterns of treatment before and after first diagnosis of psychotic disorder. Although the proposed analysis are largely descriptive, we hypothesize that we will be able to identify treatment patterns (e.g. more intensive outpatient therapy and using of low-dose antipsychotic medication) that are associated with improved outcomes following the first diagnosis of psychotic disorder, such as lower rates of inpatient admissions and emergency room visits.  This work has the potential significantly inform and advance ongoing national efforts aimed at the prevention and early intervention of psychosis, leading to improved life trajectories for patients and potentially immediate and long-term cost savings to health plans.

 

Christine Lu, PhD, MSc, selected to present abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy
Christine Lu, PhD, MSc, was selected to present her MHRN-related abstract at the Thirteenth Workshop on Costs and Assessment in Psychiatry: Mental Health Policy and Economics, in Venice, Italy. Her presentation, "Near Real-Time Surveillance for Consequences of Health Policies Using Sequential Analysis,” reports their follow-up study using the maxSPRT methods to examine the association between suicidality and FDA antidepressant warnings.

 

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?
Although clinicians are expected to routinely assess and address suicide risk, there is little guidance regarding the significance of visit-to-visit changes in suicidal ideation.

Since healthcare systems increasingly use PHQ9 in both primary care and specialty mental health clinics in patients reporting frequent thoughts of death or self-harm, questions have arisen:  Does an apparent decrease in suicidal ideation (i.e. decreasing score on PHQ9 item 9) actually imply a decrease in risk of subsequent suicidal behavior?  Does the apparent onset of suicidal ideation imply an increase in risk compared to pre-existing or “chronic” suicidal ideation?

A study led by Greg Simon, MD, MPH suggests that current suicidal ideation is a powerful indicator of near-term risk, independent of past reports of suicidal ideation.  Individuals who reported thoughts of death or self-harm at a prior visit remained at moderately increased risk even if they reported no such thoughts at the current visit. While the apparent onset of suicidal thoughts did predict significant risk, risk was actually highest for patients reporting sustained or repeated thoughts of death or self-harm.

 

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care
Rinad Beidas, PhD, at the University of Pennsylvania, is leading an MHRN-related project investigating how to implement an evidence-based program for firearm safety as a suicide prevention strategy for youth in primary care. The long-term goal of this two-year NIMH-funded project is to reduce death by suicide by increasing the use of evidence-based strategies in pediatric primary care while also promoting multi-level implementation strategies informed by a systematic and rigorous development approach. Currently the team is analyzing data collected from approximately 140 participating primary doctors at participating sites, Henry Ford Health System and Baylor Scott & White Health. Dr. Beidas recently presented preliminary results at the Society for Prevention Research Conference in DCIn 2018, the investigators plan to submit an R01 application to conduct a hybrid trial that will evaluate both the effectiveness of the adapted Safety Check in pediatric primary care as well as the implementation strategies used to implement it.

 

New investigator joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health
New investigator, Melissa Harry, PhD, MSW, from Essentia Health, has joined the Mental Health Research Network (MHRN). Dr. Harry received her PhD in 2016 from the Boston College School of Social Work. She previously worked in child and adolescent mental health as a licensed social worker. Her doctoral research centered around experiences and outcomes with self-directed budgets for purchasing home and community-based long-term care services and supports for people with disabilities. She also studies the cross-cultural measurement invariance of mental health scales with a focus on indigenous cultures and is interested in intervention research, program evaluation, and secondary data analysis with complex data sets.

 

Stacy Sterling, DrPH, MSW is new official site PI for MHRN at Kaiser Permanente Northern California
Stacy Sterling, DrPH, MSW is the new official site PI for MHRN at Kaiser Permanente Northern California (KPNC), replacing Enid Hunkeler, MA who retired in the fall of 2016. Dr. Sterling is with the Drug and Alcohol Research Team (DART) and the Behavioral Health Research Initiative at the Kaiser Permanente Northern California Division of Research. She received her doctoral training at the University of North Carolina, Gillings School of Global Public Health, and Master’s degrees in Public Health and Social Welfare at the University of California, Berkeley. Her research interests include developing and studying systems for implementing evidence-based, integrated behavioral health services into primary care, adolescent behavioral health prevention and early intervention, and mental health and alcohol and drug treatment outcomes and access.  She is the Principal Investigator of a Conrad N. Hilton Foundation-funded study to develop predictive models for adolescent substance use problem development, the Kaiser P.I. of a Hilton Foundation-funded trial of extended screening, brief intervention and referral to treatment (SBIRT) for adolescent behavioral health problems in pediatric primary care, the Kaiser P.I. of an NIH/NIAAA adolescent SBIRT trial in pediatric primary care and of an NIH/NIAAA survey of Pediatrician attitudes toward and practices of adolescent behavioral health risk screening and intervention; and of Robert Wood Johnson Foundation and Center for Substance Abuse Treatment-funded studies of adolescents in drug and alcohol treatment in Kaiser. She has overseen the implementation of region-wide alcohol SBIRT in KPNC adult primary care.