Lisa Townsend

Integrating Thematic, Grounded Theory and Narrative Analysis: A Case Study of Adolescent Psychotropic Treatment

In this article, we integrate thematic, grounded theory and narrative analytic techniques. We apply methods from each to the same qualitative data to illustrate how they provide different interpretive scopes on medication meaning making. Findings from each are concatenated to produce an integrated conceptual framework for understanding adolescent experience of psychiatric medication. We conclude that thematic, grounded theory, and narrative methods, when integrated, produce a multidimensional understanding of medication experience.

Adolescent Experience of Psychotropic Treatment

Despite growing concern over the treatment of adolescents with psychiatric medications, little research has examined youth understandings and interpretations of mental illness and psychotropic treatment. This article reports the exploratory findings of semi-structured and open-ended interviews carried out with 20 adolescents diagnosed with one or more psychiatric disorders, and who were currently prescribed psychiatric medications. Grounded theory coding procedures were used to identify themes related to adolescent subjective experience with psychiatric medications. The categories identified are interpreted as different points of view through which adolescents understand and take action upon their illness concerns; their need for medication treatment; their perceptions of how medications work; their responses to parental and other influences upon medication treatment; and, their everyday management activities.

A systematic review of validated methods for identifying depression using administrative data

review. Each abstract was reviewed independently by the first and second authors (L.T. and J.W.) to determine whether the full-text article should be reviewed. The following abstract exclusion criteria were applied: (i) The abstract did not mention depression or dysthymia; (ii) the study did not use an administrative database (eligible sources included insurance claims databases and other secondary databases that identify health outcomes using billing codes); and (iii) the data source was not from the USA or Canada. Exclusion criteria were documented sequentially (i.e., if one exclusion criterion was met, then the other criteria were not documented). If the reviewers disagreed on whether the full text should be reviewed, then it was selected for review. Interrater agreement on whether to include or exclude an abstract was calculated using Cohen’s kappa. Full-text review. Full-text articles were reviewed independently by the first and second authors (L.T. and J.W.), with the goal of identifying validation studies. The full-text review included examination of articles’ reference sections as an additional means of capturing relevant citations. Citations from the references were selected for full-text review if they were cited as a source for a depression algorithm or were otherwise deemed likely to be relevant. Full-text studies were excluded from the final evidence table if they met one or more of the following criteria: (i) The article contained a poorly described or difficult to operationalize depression algorithm defined by the absence of Diagnostic and Statistical Manual of Mental Disorder (DSM) depression diagnosis codes (296.2, 296.3, 300.4, or 311) or the International Classification of Diseases (ICD) diagnosis codes for depression (296.2, 296.3, 300.4, 311, 298.0, or 309.1), and (ii) the article provided no validation measure of depression or did not report validity statistics. Full-text review exclusion criteria were applied sequentially. If there was disagreement on whether a study should be included, the two reviewers (L.T. and J.W.) attempted to reach consensus on inclusion by discussion. If they could not agree, an additional investigator (M.O.) was consulted to make the final decision. All studies that survived the exclusion screen were included in the final evidence table. A single investigator abstracted each study for the table. A second investigator confirmed the accuracy of the abstracted data. A clinician or topic expert was consulted to review the results of the evidence table and to evaluate how the findings compared with the findings of diagnostic methods used in clinical practice. This assessment helped to determine whether the algorithms excluded any depression diagnosis codes commonly used in clinical practice and the appropriateness of the validation measures in relation to clinical diagnostic criteria.

A systematic review of validated methods for identifying suicide or suicidal ideation using administrative or claims data

As part of the Mini‐Sentinel pilot program, under contract with the Food and Drug Administration, an effort has been made to evaluate the validity of algorithms useful for identifying health outcomes of interest, including suicide and suicide attempt.

Family conflict moderates response to pharmacological intervention in pediatric bipolar disorder.

OBJECTIVE Family conflict affects the expression of psychopathology in youth. This study investigated whether family conflict moderates response to medication in youth with bipolar disorder. METHODS Youth ages 5-17 years diagnosed with bipolar I or II disorder were recruited from a trial of combination therapy with divalproex and lithium. Mania and depression were assessed at baseline and after 8 weeks of treatment using the Young Mania Rating Scale (YMRS) and the Childrens Depression Rating Scale-Revised (CDRS-R). Parents completed the Family Assessment Device (FAD). Ordinary least-squares regression evaluated whether family conflict contributed to YMRS/CDRS-R outcomes controlling for severity of baseline mood. RESULTS In 55 youths, the model examining family conflict and CDRS-R outcomes showed that family conflict variables accounted for 10% of the variance in CDRS-R scores after 8 weeks of treatment. The final model was statistically significant. The FAD Problem Solving subscale was the only uniquely significant predictor of CDRS-R scores after 8 weeks of treatment. Family conflict did not predict YMRS outcomes. CONCLUSION There is a significant relationship between family problem solving and depressive symptoms that persist despite pharmacotherapy. Although depression severity was mild at baseline, it persisted despite pharmacological treatment in youths whose families endorsed higher levels of conflict.

Strategies to predict, measure, and improve psychosocial treatment adherence.

AbstractNonadherence to psychosocial and behavioral treatment is a significant public health problem that presents a barrier to recovery and effective treatment. An estimated 20% to 70% of individuals who initiate psychosocial mental health services discontinue treatment prior to clinicians’ recommendations. Empirically supported, evidence-based, stand-alone or adjunctive psychosocial interventions treat an increasingly wide range of mental health conditions. A core assumption of most, if not all, interventions is that clients will fully and actively engage in the treatment protocol. Adherence to psychosocial treatment has received much less scientific attention, however, than adherence to medical treatment. Drawing extensively from existing research, this comprehensive review conceptualizes several types of psychosocial and behavioral treatment adherence, examines predictors of adherence to psychosocial treatment, summarizes measures of adherence, and describes existing interventions to enhance psychosocial treatment adherence.

THE CONCEPTUAL ADEQUACY OF THE DRUG ATTITUDE INVENTORY FOR MEASURING YOUTH ATTITUDES TOWARD PSYCHOTROPIC MEDICATIONS: A MIXED METHODS EVALUATION

Adolescents are routinely treated with psychiatric medications; however, little is known about their attitudes toward pharmacological intervention. The authors used a concurrent triangulation, mixed methods design to assess whether the Drug Attitude Inventory (DAI), developed for adults, is suitable for measuring adolescent attitudes toward psychiatric medications. Factor analytic techniques and qualitative data were used to investigate whether the instrument provides comprehensive measurement of medication-related constructs in adolescents. Findings suggest that the DAI contributes to knowledge of youth attitudes toward psychotropic treatment; however, limitations were uncovered by the mixed methods approach. This study enhances the measurement and mixed methods literature by showing how qualitative and quantitative techniques served as parallel data reduction strategies for examining an instrument’s utility with a new population.

Are Health Beliefs Related to Adherence Among Adolescents with Mood Disorders

This study explored the illness perceptions, attitudes towards mental health services and adherence behaviors among a group of adolescents in treatment for mood disorders in an urban city in the United States. Seventy adolescents completed a battery of questionnaires assessing demographics (e.g., gender, family income), perceptions of illness (e.g., consequences, treatment control) and overall attitudes towards mental health services. Adolescents and their parents also reported on the youth’s adherence to both psychotropic medication and mental health appointments. Simultaneous logistic regression analyses revealed that attitudes and family income made a significant and unique contribution in explaining adolescents’ adherence behaviors. Interventions that help adolescents become aware of their attitudes toward mental health services and provide information on dimensions of mood disorders, such as the chronic nature of depression and the effectiveness of treatment, may impact adherence behavior. Also, among a group of families with access to services, yearly family income remained a significant barrier to attending appointments all of the time. Policy implications are discussed.

How Effective are Interventions to Enhance Adherence to Psychiatric Medications? Practice Implications for Social Workers Working With Adults Diagnosed With Severe Mental Illness

This study integrates eight systematic reviews of adherence enhancement interventions to develop practice guidelines for social workers who work with adults who do not adhere to prescribed psychiatric medications. Findings indicate that existing investigations are disparate in their adherence definitions, methodologies employed, and sampling strategies, rendering it difficult to construct overall guidelines for social work practice. However, themes associated consistently with increased adherence are collaboration between clients and providers regarding medication decisions, consistent follow-up care, and a comprehensive network of professionals and caregivers who support clients in their use of medication to facilitate stabilization of mental health symptoms.

Modifying the risk of atypical antipsychotics in the treatment of juvenile-onset schizophrenia

Importance to the field: This review summarizes the evidence for use of typical and atypical antipsychotic medications for the treatment of juvenile-onset schizophrenia. We highlight the risks and benefits of antipsychotic agents for youth with this disorder, paying special attention to weight gain and metabolic effects, an area of specific concern within child and adolescent psychiatry. Areas covered in this review: We describe the seriousness of juvenile-onset schizophrenia and its impact on long-term functioning, noting that pharmacological treatment remains the standard of care for this disorder. We focus on weight gain and metabolic effects associated with atypical agents and review strategies to modify risks associated with these agents. What the reader will gain: We summarize strategies for attenuating the risk of weight gain for youth on atypical antipsychotics, including what is known about nutritional counseling and exercise programs as well as pharmacotherapy with adjunctive weight loss agents. Take-home message: Given the negative consequences associated with untreated schizophrenia, it appears that the most effective way to improve the risk:benefit ratio in the treatment of adolescents with schizophrenia is to reduce the risks associated with pharmacological treatment.