Helen Anne Sweeney

The De-adoption of Innovative Mental Health Practices (IMHP): Why Organizations Choose not to Sustain an IMHP

The de-adoption or discontinuance of innovative mental health practices (IMHPs) was investigated among twelve mental health providers in Ohio. Researchers used mixed methodology to investigate factors that led the organizations to de-adopt the IMHPs. Findings suggest at least five indicators that an organization is likely to discontinue an IMHP (e.g., lack of financial resources and problems related to attracting and retaining qualified staff). Adopting agencies, state and local mental health authorities, and external technical assistance groups may be able to use this information to assist organizations in continuing with the implementation process.

Widening Rural-Urban Disparities in Youth Suicides, United States, 1996-2010

IMPORTANCE Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities. OBJECTIVE To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum. DESIGN, SETTING, AND PARTICIPANTS Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years. MAIN OUTCOMES AND MEASURES Rates of suicide per 100,000 persons. RESULTS Across the study period, 66,595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100,000, respectively) and females (4.40 and 2.39 per 100,000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females). CONCLUSIONS AND RELEVANCE Suicide rates for adolescents and young adults are higher in rural than in urban communities regardless of the method used, and rural-urban disparities appear to be increasing over time. Further research should carefully explore the mechanisms whereby rural residence might increase suicide risk in youth and consider suicide-prevention efforts specific to rural settings.

A Naturalistic Study of MST Dissemination in 13 Ohio Communities

The diffusion of evidence-based practices (EBPs) to child-serving human service organizations often occurs within the context of a comprehensive system-of-care in which a coordinated network of service providers collaborate to meet the needs of children and adolescents with serious behavioral and emotional disturbances. To the extent that inter-organizational networks influence the choices of organizational decision makers, it is necessary to understand interactions among participating organizations within the system when studying diffusion processes associated with EBP adoption and implementation. The present study analyzes decision making about the adoption and implementation of an EBP within the ecological context of system-of-care collaboration. Findings suggest that several factors impact the adoption decision, including system-of-care infrastructure planning and development activities before the decision process, the perception of adequate start-up and ongoing implementation resources among key players in the system-of-care, the range of motivations to participate in collaborative decision making, and the presence of entrepreneurial leadership.

Benzodiazepine use and risk of mortality among patients with schizophrenia: a retrospective longitudinal study.

OBJECTIVE This study examined the association between benzodiazepine use alone or in combination with antipsychotics and risk of mortality in patients with schizophrenia. METHODS A retrospective longitudinal analysis was performed using Medicaid claims data merged with death certificate data for 18,953 patients (aged 18-58 years) with ICD-9-diagnosed schizophrenia followed from July 1, 2006, to December 31, 2013. Cox proportional hazard analyses were used to estimate the risk of all-cause mortality associated with benzodiazepine use; adjustment was made for a wide array of fixed and time-varying confounders, including demographics, psychiatric and medical comorbidities, and other psychotropic medications. RESULTS Of the 18,953 patients diagnosed with schizophrenia, 13,741 (72.5%) were not prescribed a benzodiazepine, 3,476 (18.3%) were prescribed benzodiazepines in the absence of antipsychotic medication, and 1,736 (9.2%) were prescribed benzodiazepines in combination with antipsychotics. Controlling for a wide array of demographic and clinical variables, the hazard of mortality was 208% higher for patients prescribed benzodiazepines without an antipsychotic (HR = 3.08; 95% CI, 2.63-3.61; P < .001) and 48% higher for patients prescribed benzodiazepines in combination with antipsychotics (HR = 1.48; 95% CI, 1.15-1.91; P = .002). Benzodiazepine-prescribed patients were at greater risk of death by suicide and accidental poisoning as well as from natural causes. CONCLUSIONS Benzodiazepine use is associated with increased mortality risk in patients with schizophrenia after adjusting for a wide range of potential confounders. Given unproven efficacy, physicians should exercise caution in prescribing benzodiazepines to schizophrenic patients.

Analyzing excess mortality from cancer among individuals with mental illness

The objective was to compare patterns of site‐specific cancer mortality in a population of individuals with and without mental illness.

The Impact of the Great Recession on Community-Based Mental Health Organizations: An Analysis of Top Managers’ Perceptions of the Economic Downturn’s Effects and Adaptive Strategies Used to Manage the Consequences in Ohio

The Great Recession of 2007–2009 adversely affected the financial stability of the community-based mental health infrastructure in Ohio. This paper presents survey results of the type of adaptive strategies used by Ohio community-based mental health organizations to manage the consequences of the economic downturn. Results were aggregated into geographical classifications of rural, mid-sized urban, and urban. Across all groups, respondents perceived, to varying degrees, that the Great Recession posed a threat to their organization’s survival. Urban organizations were more likely to implement adaptive strategies to expand operations while rural and midsized urban organizations implemented strategies to enhance internal efficiencies.

Factors Associated With Timely Follow-Up Care After Psychiatric Hospitalization for Youths With Mood Disorders

OBJECTIVES This study identified patient-, hospital-, and community-level factors associated with timely follow-up care following psychiatric hospitalization for children and adolescents with mood disorders. METHODS The patients were 7,826 youths (ages six to 17) admitted to psychiatric hospitals with a primary diagnosis of mood disorder (July 2009-November 2010). Outcome variables were defined as one or more mental health visits within seven days and 30 days of psychiatric hospitalization. Predictor variables included patient-, hospital-, and community-level factors obtained from Medicaid claim files from four states (California, Florida, Maryland, and Ohio), the American Hospital Association annual survey, and the Area Resource File. Multilevel modeling was used to assess the association between patient-, hospital-, and community-level factors and receipt of follow-up care. RESULTS Following discharge, an outpatient mental health visit was obtained by 48.9% of children and adolescents within seven days and by 69.2% of children and adolescents within 30 days. Positive predictors of follow-up at both seven and 30 days included prior outpatient mental health care, foster care, psychiatric comorbidity, care in teaching hospitals and psychiatric hospitals, and residence in counties with more child and adolescent psychiatrists. Negative predictors included older age, black race, care in hospitals with higher levels of Medicaid penetration, and substance use disorders. CONCLUSIONS One in three youths did not receive mental health follow-up in the 30 days after psychiatric hospitalization. Linkage to follow-up care appears to be complex and multidetermined. Study findings underscored the need for quality improvement interventions targeting vulnerable populations and promoting successful transitions from inpatient to outpatient care.

Mapping suicide mortality in Ohio: A spatial epidemiological analysis of suicide clusters and area level correlates

Previous studies have investigated spatial patterning and associations of area characteristics with suicide rates in Western and Asian countries, but few have been conducted in the United States. This ecological study aims to identify high-risk clusters of suicide in Ohio and assess area level correlates of these clusters. We estimated spatially smoothed standardized mortality ratios (SMR) using Bayesian conditional autoregressive models (CAR) for the period 2004 to 2013. Spatial and spatio-temporal scan statistics were used to detect high-risk clusters of suicide at the census tract level (N=2952). Logistic regression models were used to examine the association between area level correlates and suicide clusters. Nine statistically significant (p<0.05) high-risk spatial clusters and two space-time clusters were identified. We also identified several significant spatial clusters by method of suicide. The risk of suicide was up to 2.1 times higher in high-risk clusters than in areas outside of the clusters (relative risks ranged from 1.22 to 2.14 (p<0.01)). In the multivariate model, factors strongly associated with area suicide rates were socio-economic deprivation and lower provider densities. Efforts to reduce poverty and improve access to health and mental health medical services on the community level represent potentially important suicide prevention strategies.

A Comparison of Benefit Limits in Mental Health.

Abstract This study provides insight to policy makers and stakeholders on how three types of benefits limits on Medicaid-covered mental health services might affect access for consumers diagnosed with severe mental illness. The study used a retrospective cohort design with data for Medicaid-covered, community-based mental health services provided in Ohio during fiscal year 2010. Log-binomial regression was used for the analysis. Results indicate that limits compared have significant, varying consequences based on Medicaid coverage and diagnoses. When constraining Medicaid costs, policy makers should consider how limits will disrupt care and include clinicians in discussions prior to implementation.