Latest News

Latest News





Do patients diagnosed with skin conditions have a higher risk of suicide?

Do patients diagnosed with skin conditions have a higher risk of suicide?

Do patients diagnosed with skin conditions have a higher risk of suicide?

Research suggests that patients diagnosed with skin conditions may have a higher risk of comorbid psychiatric conditions and suicide-related outcomes. To examine this theory in the US general population, Deepak Prabhakar, MD, MPH, led a study to examine the risk of suicide death in patients with dermatologic conditions using a retrospective case-control study conducted in 8 US health systems. A total of 2,674 individuals who died by suicide (cases) were matched with 267,400 general population control individuals. Overall, 619 cases and 54364 controls with skin conditions were analyzed.

After adjusting for age, sex, and any mental health or substance use condition, the authors did not find an association between death by suicide and any skin condition, and the study provides no evidence of increased risk of death by suicide in individuals with major skin disorders in the US general population.


Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System begins enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

Henry Ford Health System has begun enrollment as part of the All of Us Precision Medicine Initiative Cohort Program

A team of MHRN-affiliated health systems, including Henry Ford, Baylor Scott & White, and Essentia, recently received NIH funding to lead a five-member Healthcare Provider Organization research consortium to expand the geographic reach and diversity of enrollment and engagement in the NIH's All of Us Precision Medicine Initiative (PMI) Cohort Program.

The consortium, led by co-PIs Brian K. Ahmedani, PhD and Christine Johnson, PhD, is a landmark research effort with a goal to advance personalized health care by studying how individual differences in lifestyle, clinical history, environment and genetics influence a person's health, disease risk, and optimal prevention and treatment approaches.

More information on this program can be found on the following websites: the NIH reporter website and the program’s lead site, Henry Ford Health System


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MHRN Scientific Interest Group (SIG) on Perinatal Mental Health – new members welcome!

MHRN Scientific Interest Group (SIG) on Perinatal Mental Health – new members welcome!

A new MHRN Scientific Interest Group (SIG) has recently been formed to:

  • Promote a research agenda focused on perinatal mental health,
  • Facilitate collaboration among investigators,
  • Work on developing data infrastructure to support multisite perinatal mental health research projects,
  • Provide a forum for discussing research ideas and updating grant applications, projects, and papers.

SIG members meet regularly by phone and at an annual in-person meeting. New SIG members are always welcome! Contact Arne Beck, PhD, Director of Quality Improvement and Strategic Research, Kaiser Permanente, Colorado Region, or visit our website to learn more about taking part in this SIG.


MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

MHRN study examines proportion of suicide deaths that could be prevented by limiting firearm access for people with a mental health condition or history of suicidal behavior

Since firearms account for half of all suicide deaths in the United States, many assume that reducing access to firearms among at-risk patients will reduce suicide mortality, and attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior. To examine this theory, Jennifer M. Boggs,led an MHRN manuscript, as part of the Treatment Utilization Before Suicide study, to identify the proportion of suicide deaths that could potentially be prevented by limiting firearm access for people with a mental health condition or a history of suicidal behavior.

Using medical records and claims information, the team identified a group who had a history of any mental health or substance use condition, diagnosed at any medical or mental health visit in the year preceding death. They then identified a second group who had a history of previous suicide attempts (these were not mutually exclusive groups).
More people without a mental health or substance-use condition used firearms in their death than did people with those conditions (671 vs. 627). Also, more people without a previous suicide attempt used firearms in their death than did those with a previous attempt (1189 vs. 109). In fact, among people who died by suicide, only 4.1% had previously attempted suicide and used a firearm; 23.5% had a mental health or substance use condition and used a firearm.

Their findings indicate that, even if successful, current efforts to limit firearm access only for people with a mental health condition (including substance use disorders) or those who previously attempted suicide would prevent few suicide deaths by firearm. The authors suggest that prevention of firearm suicide should be expanded beyond the exclusive focus on patients with mental health conditions to include other persons at risk for suicide. Findings also highlight the importance of expanding attention beyond firearms—especially for persons with mental health or substance use conditions—to include other common means of suicide.


Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Funding received to evaluate the Zero Suicide Model across learning healthcare systems

Brian Ahmedani PhD and Greg Simon, MD, MPH lead a recently funded 5-year MHRN study to evaluate the Zero Suicide Model across learning healthcare systems. The study is based upon Henry Ford Health System’s Perfect Depression Care (PDC) Zero Suicide Initiative, which demonstrated a sustained decrease in the suicide rate of nearly 80% among behavioral health patients.

The 2012 National Strategy for Suicide Prevention promoted this initiative and its adoption of Zero Suicides as an aspirational goal of healthcare systems across the US. The Suicide Prevention Resource Center developed the resources and tools to prepare US health systems for local implementation of the National ZS Model (NZSM).

Funded by NIMH, the study aims to do the following:

  • Collaborate with health system leaders to develop electronic health record (HER) metrics to measure specific quality improvement targets and care processes tailored to local NZSM implementation.
  • Examine the fidelity of the specific NZSM care processes implemented in each system.
  • Investigate suicide attempt and mortality outcomes within and across NZSM system models.

Acknowledging that suicidal individuals often fall through multiple cracks in a fragmented healthcare system, the NZSM calls for a systematic, comprehensive approach across health service settings.  The NZSM approach involves local implementation of a series of evidence-based clinical interventions in four areas:

  • Identifying those at risk (IDENTIFY)
  • Initiating and maintaining engagement in care (ENGAGE)
  • Delivering effective treatments (TREAT)
  • Assuring appropriate care transitions (TRANSITION)

This project aims to fill a major research need by evaluating the separate and cumulative benefits of implementing specific components of the NZSM in large integrated healthcare systems within various service settings and patient populations.


Suicide Prevention Trial: Over 10,000 enrolled!

Suicide Prevention Trial: Over 10,000 enrolled!

Suicide Prevention Trial: Over 10,000 enrolled!

The Pragmatic Trial of Population-based Programs to Prevent Suicide Attempt, led by Greg Simon, MD, MPH has enrolled over 10,000 participants. Visit the MHRN website for more information on this project, which aims to conduct a large, pragmatic trial to examine two population-based programs to prevent suicide attempt.


Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

Development of a population-based risk calculator for suicidal behavior continues with newly awarded supplemental funding

In 2015 MHRN began a project to use population-based data from large health systems to develop evidence-based suicide attempt risk calculators for mental health and primary care clinicians. The models developed by the project were a substantial advance over existing risk prediction or risk stratification tools, however there were limitations. In 2017 NIMH awarded MHRN a supplement to extend this work, address some of these limitations, and do the following:

  • Expand and enhance the risk prediction dataset to: include larger numbers of observations with data regarding self-reported suicidal ideation (PHQ9 Item 9), include additional encounters and events following the transition from ICD9 to ICD10 diagnoses, and allow more detailed consideration of the timing of predictor events (diagnoses, encounters, prescription fills)
  • Expand sampling to include emergency department and inpatient encounters
  • Evaluate alternative modeling approaches, including classification- or tree-based approaches such as Classification and Regression Trees (CART), Mixed Effects Regression Trees (MERT), and Random Forest.
  • Rapidly disseminate all methods, tools and results to a wide range of stakeholders including health systems, researchers, and EHR vendors.

This research will make several significant and unique contributions to suicide prevention research, including:

  • An unprecedented sample size of patients, visits, and suicidal behavior outcomes
  • A population-based sample including mental health and primary care visits from seven health systems
  • Integration of electronic health records data (diagnoses, prescriptions) with systematically collected data regarding suicidal ideation
  • Inclusion of more diverse and detailed predictors than any previous research in this area

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Feedback-informed care: Mapping a new course for depression treatment

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?

Does item 9 of the Patient Health Questionnaire (PHQ9) predict risk for suicide attempts and deaths across age groups?

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

MHRN provides resources to examine treatment patterns associated with first episode psychosis

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, 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, 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?

Are changes in response to PHQ item #9 associated with subsequent risk of suicide attempts?

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

MHRN-affiliated project investigates how to implement an evidence-based program for firearm safety as a youth suicide prevention strategy in primary care

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 joins MHRN: Melissa Harry, PhD, MSW, from Essentia Health

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 new official site PI for MHRN at Kaiser Permanente Northern California

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.


Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

Four publications on the COMPASS Initiative: national initiative to disseminate and implement evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease

The COMPASS Initiative is a national effort to disseminate and implement an evidence-based collaborative care management model for patients with depression and poorly controlled diabetes and/or cardiovascular disease. Karen J. Coleman, PhD led a detailed description of the initiative in the August 2016 edition of General Hospital Psychiatry.It has been implemented in 18 medical groups and 172 clinics in 8 states. MHRN investigators associated with the COMPASS Initiative published four new publications on this ambitious initiative, covering a description of current conditions, an overview of the initiative, outcomes and key learnings. The goals of the initiative are to:

  1. Improve depression symptoms in 40% of patients.
  2. Improve diabetes and hypertension control rates by 20%.
  3. Increase provider satisfaction by 20%.
  4. Improve patient satisfaction with their care by 20%.
  5. Demonstrate cost savings.

 

The three other publications describe The impact of the COMPASS initiative, as well as a study to understand how care managers implemented COMPASS and if this implementation was related to health outcomes in their patients, and a study to describe primary care clinician’s self-reports of satisfaction, burnout and barriers associated with treating complex patients.


Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

Check out our online repository for MHRN diagnoses codes!

The Mental Health Research Network (MHRN) created an online repository for MHRN diagnoses codes on GitHub and posted various specifications and codes. Everything is downloadable and free to the public.


MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

MHRN Suicide Prevention Trial: new study site and 6,500 patients enrolled!

In September 2014, an MHRN-affiliated study began ground-breaking work on suicide prevention , with a goal to enroll 15,000 patients. We have now enrolled 6,500 participants and added a fourth data collection site: Kaiser Permanente Northwest.

This pragmatic trial of selective prevention should fill a major gap in current suicide prevention efforts, and the methods developed should dramatically accelerate future suicide prevention research. 


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New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

New HEDIS measures: MHRN partners with health systems to prepare for next generation of NCQA/HEDIS measures

NCQA has released preliminary specifications for a next generation of depression measures – focused on use of outcome measures (like the PHQ9) to assess quality and effectiveness of care.  MHRN investigators are partnering with our health systems to give feedback on measurement specifics, evaluate gaps in our current performance, and design appropriate quality improvement strategies.  Contact Leif Solberg (Leif.I.Solberg@HealthPartners.Com), Robert Penfold (penfold.r@ghc.org) or Greg Simon (simon.g@ghc.org) for more information.


Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

Now available via webcast: How to work with MHRN

A webcast on how to work with MHRN is available for anyone interested in partnering with us. The webcast is from a session at the 23rd NIMH Conference on Mental Health Services Research (MHSR), which brought together leading mental health services researchers, clinicians, mental health advocates, and federal and nonfederal partners. The conference highlighted opportunities for the next generation of high-impact research to drive mental health care improvement.