Mathilde M. Husky

Computerized ambulatory monitoring in psychiatry: a multi-site collaborative study of acceptability, compliance, and reactivity

Computerized ambulatory monitoring overcomes a number of methodological and conceptual challenges to studying mental disorders, however concerns persist regarding the feasibility of this approach with severe psychiatric samples and the potential of intensive monitoring to influence data quality. This multi‐site investigation evaluates these issues in four independent samples. Patients with schizophrenia (n = 56), substance dependence (n = 85), anxiety disorders (n = 45), and a non‐clinical sample (n = 280) were contacted to participate in investigations using computerized ambulatory monitoring. Micro‐computers were used to administer electronic interviews several times per day for a one‐week period. Ninety‐five percent of contacted individuals agreed to participate in the study, and minimum compliance was achieved by 96% of these participants. Seventy‐eight percent of all programmed assessments were completed overall, and only 1% of micro‐computers were not returned to investigators. There was no evidence that missing data or response time increased over the duration of the study, suggesting that fatigue effects were negligible. The majority of variables investigated did not change in frequency as a function of study duration, however some evidence was found that socially sensitive behaviors changed in a manner consistent with reactivity. Copyright

Mental Health Screening and Follow-up Care in Public High Schools

OBJECTIVE Despite increased interest in screening adolescents for mental health problems and suicide risk, little is known regarding the extent to which youth are identified and connected with appropriate services. METHOD Between 2005 and 2009, a total of 4,509 ninth-grade students were offered screening. We reviewed the records of the 2,488 students who were screened. Students identified as being at risk were provided with a referral. Data were collected on screening results, mental health referrals, and completion of recommended treatment over approximately 90 days. RESULTS Among students screened, 19.6% were identified as being at risk, 73.6% of whom were not currently receiving any treatment. Students referred for school services tended to be less severely ill than those referred for community services, with lower rates of suicidal ideation, prior suicide attempts, and self-injury. Among at-risk students not currently in treatment, 76.3% of students referred received at least one mental health visit during the follow-up period. Overall, 74.0% of students were referred to school and 57.3% to community services. A great majority of school referrals (80.2%) successfully accessed services, although a smaller proportion of community services referrals successfully accessed treatment (41.9%). CONCLUSIONS Systematic voluntary school-based mental health screening and referral offers a feasible means of identifying and connecting high-risk adolescents to school- and community-based mental health services, although linkages to community-based services may require considerable coordination.

Identifying Adolescents at Risk through Voluntary School-Based Mental Health Screening.

This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66-70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52-8.73) or community-based services (AOR: 20.02 95%CI 2.66-150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.

Social environments and daily life occurrence of psychotic symptoms: An experience sampling test in a non-clinical population

Abstract.Background:If impairment in social cognition is an important feature of psychosis, characteristics of the social environment may influence the occurrence of psychotic symptoms. The aim of this study was to explore in a non-clinical population whether specific social environments modify the expression of psychotic symptoms in daily life.Methods:The Experience Sampling Method was used to collect information on characteristics of the social company and of the daily life psychotic experiences of a sample of 79 students. The level of psychotic symptoms was measured using the Mini International Neuropsychiatric Interview (MINI).Results:Subjects with MINI psychosis criteria were at increased risk of experiencing unusual perceptions in the presence of non-familiar individuals, and at lower risk of experiencing strange impressions in the presence of family members or friends. Dynamic changes in the social company rather than the social company per se drive variation of psychotic experiences in daily life.Conclusion:The data suggest that the earliest stages of expression of psychosis vulnerability are driven by subtle person-environment interactions in the stream of daily life.

Feasibility and validity of ecological momentary assessment in the investigation of suicide risk

Ecological Momentary Assessment has been used to investigate a wide range of behaviors and psychiatric conditions. Previous investigations have consistently obtained promising results with high acceptance and compliance rates, and with only minor reactive effects for specific variables. Despite the promise of this methodology for the study of severe psychiatric populations, little is known about its feasibility in samples at risk for suicide. In the present study, four samples at varying risk for suicide completed an Ecological Momentary Assessment study by responding to five electronic assessments per day over a one-week period. Samples included healthy controls (n=13), affective controls (n=21), past suicide attempters (n=20), and recent suicide attempters (n=42). The results demonstrate satisfactory participation rates and high compliance with daily life repeated assessments across all groups. Importantly, negative thoughts or suicidal ideation were not reactive to the duration of the study, indicating that the repeated assessment of such cognitions in daily life have little or no effect on their frequency. The findings provide support for the use of Ecological Momentary Assessment in the study of suicidal ideation and suggest that mobile technologies represent new opportunities for the assessment of high-risk cognitive states experienced by patients in daily life.

Computerized ambulatory monitoring in mood disorders: Feasibility, compliance, and reactivity

Patients with depression (n=20) or bipolar disorder (n=21) completed computerized ambulatory monitoring for three consecutive days. Results indicate satisfactory rates of acceptance and compliance, with no salient fatigue effects. However, some evidence for reactive effects was found. The findings provide support for this approach in the study of mood disorders.

Risk behaviors, suicidal ideation and suicide attempts in a nationally representative French sample.

BACKGROUND Data from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women. METHODS Data were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15-85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used. RESULTS Overall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women. LIMITATIONS Cross-sectional survey. CONCLUSION The findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior.

A Daily Life Comparison of Sociotropy-Autonomy and Hopelessness Theories of Depression

The hopelessness theory and Beck’s cognitive theory of depression were compared, controlling for other factors associated with mood change and stress reactivity. Using a high-risk design, 179 individuals were selected based on cognitive vulnerabilities and substance use frequency. Assessments of mood, daily events, and specific attributions were acquired using the Experience Sampling Method. Strong support was found for attributional style and sociotropy as indirect determinants of depressed mood, as well as for the notions of causal mediation and vulnerability specificity. Hopelessness theory explained a slightly larger portion of variance in depressed mood overall. The personality diatheses described by either theory were largely independent of each other and their mechanisms of action were not influenced by depression history or substance use.

Gender differences in the associations of gambling activities and suicidal behaviors with problem gambling in a nationally representative French sample

INTRODUCTION The objectives of the present study are to describe gender differences in factors associated with moderate risk and problem gambling. METHOD Data were extracted from the 2010 Health Barometer, a large survey on a representative sample of the general population aged 15-85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview system was used. RESULTS The findings indicate that men are three times more likely to experience problems with gambling. Men and women have different patterns of gambling activities. Men were more involved with Rapido, internet gambling, sports and racetrack betting, poker, and casino tables, whereas women gambled more often on scratch games. Both men and women engaging in immediate reward games were significantly more likely to experience difficulties with gambling. This association, however, was stronger in women. Furthermore, suicidal ideation and behaviors were more likely to be associated with gambling problems in women as compared to men. CONCLUSIONS The study underscores the importance of considering gender-related differences in the study of gambling behaviors.

Mobile technologies in the early detection of cognitive decline.

The identification of biological and pathophysiological processes implicated in different forms of dementia is itself dependent on reliable descriptions of cognitive performance and capacities. However, traditional instruments are often unable to detect subtle declines in cognitive functions due to natural variation at the time of testing. Mobile technologies permit the repeated assessment of cognitive functions and may thereby provide more reliable descriptions of early cognitive difficulties that are inaccessible to clinic or hospital-based instruments. This assessment strategy is also able to characterize in real-time the dynamic associations between cognitive performance and specific daily life behaviors or activities. In a cohort of elderly rural residents, 60 individuals were administered neuropsychological and neuroimaging exams as well as a one-week period of electronic ambulatory monitoring of behavior, semantic memory performance, and daily life experiences. Whereas imaging markers were unrelated to traditional neuropsychological test scores, they were significantly associated with mobile assessments of semantic memory performance. Moreover, certain daily life activities such as reading or completing crossword puzzles were associated with increases in semantic memory performance over the subsequent hours of the same day. The revolution in mobile technologies provides unprecedented opportunities to overcome the barriers of time and context that characterize traditional hospital and clinical-based assessments. The combination of both novel and traditional methods should provide the best opportunity for identifying the earliest risk factors and biomarkers for Alzheimers disease and other forms of dementia.