Erin L. Kelly

Factor Structure and Diagnostic Validity of the Beck Depression Inventory-II With Adult Clinical Inpatients: Comparison to a Gold-Standard Diagnostic Interview

Little is known about the psychometric properties and clinical utility of the Beck Depression Inventory-II (BDI-II) among adult clinical inpatients, a group at high risk for major depressive disorder (MDD). Data from 1,904 adult inpatients were analyzed using confirmatory factor analysis (CFA), Cronbachs alpha, and Pearsons correlations. Receiver operating characteristic (ROC) analyses evaluating MDD diagnostic performance were conducted with a subsample (n = 467) using a structured diagnostic interview for reference. CFA of 3 previous 2-factor oblique solutions, observed in adolescent and older adult inpatient clinical samples, and 3 corresponding bifactor solutions indicated that BDI-II common item variance was overwhelmingly accounted for by 1 general factor specified to all items, with minor additional variance contributed by 2 specific factors. Analyses revealed high internal consistency (Cronbachs α = .93) and significant (p < .01) intercorrelations between the BDI-II total scale and Behavior and Symptom Identification Scale-24s Depression/Functioning (r = .79) and Overall (r = .82) subscales. ROC analyses generated low area under the curve (.695; 95% confidence interval [.637, .752]) and cutoff scores with poor sensitivity/specificity balance. BDI-II use as a screening instrument for overall depressive symptomology was supported, but MDD diagnostic performance was suboptimal. Clinicians are advised to use the BDI-II to gauge severity of depression and measure clinical changes to depressive symptomology over time but to be mindful of the limitations of the BDI-II as a diagnostic tool for adult inpatients.

A Systematic Review of Self-Management Health Care Models for Individuals With Serious Mental Illnesses

OBJECTIVE The general medical health of individuals with serious mental illnesses is compromised relative to those without serious mental illnesses. To address this health disparity, numerous integrated care strategies are being employed from the system level to the level of individual patients. However, self-management of health care, a strategy considered an integral aspect of typical care, has been infrequently included in interventions for this population. Despite reservations about the capacity of those with serious mental illnesses to self-manage health care, a subset of new interventions focused on general medical health in this population has tested whether models including self-management strategies have empirical support. To understand whether these models are supported, the authors reviewed the evidence for self-management models. METHODS This systematic review examined collaborative and integrated care models that include self-management components for individuals with serious mental illnesses. RESULTS Across the 14 studies identified in this review, promising evidence was found that individuals with serious mental health issues can collaborate with health professionals or be trained to self-manage their health and health care. The evidence supports the use of mental health peers or professional staff to implement health care interventions. However, the substantial heterogeneity in study design, types of training, and examined outcomes limited conclusions about the comparative effectiveness of existing studies. CONCLUSIONS This review found preliminary support that self-management interventions targeting the general medical health of those with serious mental illnesses are efficacious, but future work is needed to determine what elements of training or skills lead to the most salient changes.

Integrating behavioral healthcare for individuals with serious mental illness: A randomized controlled trial of a peer health navigator intervention

OBJECTIVE Individuals with serious mental illness also have high rates of comorbid physical health issues. To address those issues, this population needs interventions that improve self-management of health and healthcare. METHODS In order to improve the health and healthcare of individuals with serious mental illnesses, 151 consumers with serious mental illness were randomized to receive either usual mental healthcare plus the Bridge intervention (n=76) or usual mental healthcare while on a 6month waitlist (n=75). The waitlist group received the intervention after the waitlist period. RESULTS Change score comparisons (difference of differences) of the treatment vs the waitlist groups revealed that the treated group showed significantly greater improvement in access and use of primary care health services, higher quality of the consumer-physician relationship, decreased preference for emergency, urgent care, or avoiding health services and increased preference for primary care clinics, improved detection of chronic health conditions, reductions in pain, and increased confidence in consumer self-management of healthcare. CONCLUSIONS Peer providers using a manualized intervention can be an important part of the efforts to address the general medical care of individuals with serious mental illnesses.

Mental Health Screening in Juvenile Justice Settings: Evaluating the Utility of the Massachusetts Youth Screening Instrument, Version 2:

Allocating limited mental health resources is a challenge for juvenile justice facilities. We evaluated the clinical utility of the Massachusetts Youth Screening Instrument, Version 2 (MAYSI-2)—an instrument designed to aid in this process—in three subsamples of justice-involved youth (ages 14-17): detained girls (n = 69), detained boys (n = 130), and incarcerated boys (n = 373). For perspective, we compared its performance (in the incarcerated subsample) to that of the Youth Self-Report (YSR), a more widely-used screen. The MAYSI-2 subscales were moderately useful for detecting relevant diagnoses, and differences were observed across samples. However, as a general mental health screen, the MAYSI-2 performed well (and comparably to the YSR), correctly classifying 66% to 75% of youth. When used to differentiate youth with any and without any disorder, both instruments were effective. Given the MAYSI-2’s practical advantages over the YSR (lower cost, easier administration), it may be a better option for juvenile facilities.

PBRN Findings: Integrated Care for Individuals With Serious Mental Illnesses

TOTHEEDITOR: In our column in this issue (1), we discuss the formation of a practice-based research network (PBRN) by mental health providers and how a card study was used to generate R3 rapid-learning research designs (2). Here, we briefly report the findings of that initial study, which focused on integrated general medical andmental health care services directed by mental health providers. We chose this topic because most service-level intervention strategies targeting this health disparity for individuals with serious mental illnesses have focused on how general medical providers can direct and improve health care for this population. Mental health providers can also effectively lead these efforts, but more research is needed on integrated services that are organized or provided by mental health agencies (3). A brief cross-sectional survey about integrated services received through their mental health agencies was completedwith 237 individuals with serious mental illness. Each of the PBRN agencies had been offering integrated services for 18 months at the time of the survey (1). The nine-item card study asked participants to rate changes in several domains since they began receiving integrated services. The servicemodels differed at each agency, ranging from use of specially trained service integrators, who help consumers use the resources of both formal provider networks (mental health and health care providers) and nontraditional provider networks (community-defined healers); an integrated mobile health team; a collaborative outpatient clinic; and peer health navigators (4,5). Each agency delivered integrated services to a small subset of consumers (ranging from 110–250). During one month, staff members from each agency invited consumers with serious mental illnesses to participate in the survey. Surveys took about ten minutes to complete, and participants did not receive any compensation. Fifty-eight percent (N5138) identified as male with a mean6SD age of 47.4611.5 years. The sample was diverse: 27% (N563) Caucasian, 22% (N552) Hispanic, 21% (N549) African American, 16% (N538) Armenian, and 10% (N525) other; and 4% (N510) had missing data. Respondents experienced statistically significant reductions in their use of emergency services, more use of primary care services, increased access to care, better general medical health, fewer general medical symptoms, improved mental health, increased ability to meet mental health treatment goals, healthier lifestyles, and high satisfaction with services. [A table in an online supplement to this letter presents these and other results.] We also found that older participants had a weaker response to integrated services: they experienced less mental health improvement, less ability to meet treatment goals, and unchanged emergency room use. Few differences were noted across agencies, which could reflect responses to the various forms of integrated care. These are findings that can be immediately moved into practice. The results suggest that mental health agencies can effectively launch PBRNs to capture important data about the impact of their services. Although this study was not methodologically rigorous, it allowed the nascent PBRN to coalesce around a significant question that interested and had an impact on many of the stakeholders (consumers, staff, community partners, and funders). As PBRNsmature they are capable of mounting rigorous studies with significant funding, and in mental health care they can bridge practice and research and blend evidence-based practice with practice-based evidence in ways that are novel and compelling. PBRNs are underdeveloped in mental health services, but that can change.

Provider and consumer perspectives of community mental health services: Implications for consumer-driven care.

Public mental health services in the community are broad and continue to expand to address the multiple issues faced by those with serious mental illnesses. However, few studies examine and contrast how helpful consumers and providers find the spectrum of services. The present study examines the services at community mental health service clinics (CMHCs) from the perspectives of providers and consumers. There were 351 consumers and 147 providers from 15 CMHCs who rated and ranked the helpfulness of 24 types of common services. All of the agencies were participating in a Practice-Based Research Network (PBRN). Social support was the highest rated service by both types of respondents, and the creation of a welcoming environment was the highest ranked service by both. There were also areas of disagreement. Consumers identified traditional mental health services (individual therapy and medication services) as being most helpful to them whereas providers selected longer-term services that promote self-reliance (e.g., securing housing, and promoting self-sufficiency) as the most helpful. Understanding how consumers and providers perceive the range of CMHC services provided in usual care is important to develop new targets for intervention. A welcoming milieu and providing social support appear important to both, but significant differences exist between these groups regarding other aspects of services. This holds implications for the design and implementation of consumer-driven services. (PsycINFO Database Record

Using Electronic Health Records to Enhance a Peer Health Navigator Intervention: A Randomized Pilot Test for Individuals with Serious Mental Illness and Housing Instability

Individuals with serious mental illnesses have high rates of comorbid physical health issues and have numerous barriers to addressing their health and health care needs. The present pilot study tested the feasibility of a modified form of the “Bridge” peer-health navigator intervention delivered in a usual care setting by agency personnel. The modifications concerned the use of an electronic personal health record with individuals experiencing with housing instability. Twenty participants were randomized to receive the intervention immediately or after 6 months. Health navigator contacts and use of personal health records were associated with improvements in health care and self-management. This pilot study demonstrated promising evidence for the feasibility of adding personal health record use to a peer-led intervention.

Sources of Social Support After Patient Assault as Related to Staff Well-Being

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care.

The Recovery-Oriented Care Collaborative: A Practice-Based Research Network to Improve Care for People With Serious Mental Illnesses

Practice-based research networks (PBRNs) create continuous collaborations among academic researchers and practitioners. Most PBRNs have operated in primary care, and less than 5% of federally registered PBRNs include mental health practitioners. In 2012 the first PBRN in the nation focused on individuals with serious mental illnesses-the Recovery-Oriented Care Collaborative-was established in Los Angeles. This column describes the development of this innovative PBRN through four phases: building an infrastructure, developing a research study, executing the study, and consolidating the PBRN. Key lessons learned are also described, such as the importance of actively engaging direct service providers and clients.