Paul J. Barreira

Nonsuicidal Self-injury in a College Population: General Trends and Sex Differences

Abstract Objective: To describe basic nonsuicidal self-injury (NSSI) characteristics and to explore sex differences. Methods: A random sample from 8 universities were invited to participate in a Web-based survey in 2006–2007; 38.9% (n = 14,372) participated. Analysis assessed sex differences in NSSI prevalence, practices, severity, perceived dependency, and help-seeking; adjusted odds ratios for NSSI characteristics were calculated by sex status. Results: Lifetime NSSI prevalence rates averaged 15.3%. Females were more likely than males to self-injure because they were upset (adjusted odds ratio [AOR] = 1.6; 95% confidence interval [CI] = 1.3–2.1) or in hopes that someone would notice them (AOR = 1.6, 95% CI = 1.1–2.7). Males were 1.6 times (95% CI = 1.2–2.2) more likely to report anger and 4.0 times (95% CI = 2.3–6.8) more likely to report intoxication as an initiating factor. Sexual orientation predicted NSSI, particularly for women (Wald F = 8.81, p ≤ .000). Only 8.9% of the NSSI sample reported disclosing NSSI to a mental health professional. Conclusions: NSSI is common in college populations but varies significantly by sex and sexual orientation. NSSI disclosure is low among both sexes.

Comparison of metoprolol and propranolol in the treatment of akathisia

Metoprolol was compared to propranolol in the treatment of neuroleptic-induced akathisia by means of an on-drug/off-drug crossover study. Both beta-blockers were effective, but the usefulness of metoprolol was limited by side effects due to the high dose of this medication required to produce a therapeutic effect. The mechanism of action of beta-blockers in the treatment of akathisia is discussed in light of the different pharmacologic properties of metoprolol and propranolol. The study results suggest that these agents are effective in reducing akathisia through a central mechanism of action requiring beta-2 blockade.

Work Interest as a Predictor of Competitive Employment: Policy Implications for Psychiatric Rehabilitation

Consumers with serious mental illness (N=166) enrolling in two community-based mental health programs, a vocational Program of Assertive Community Treatment and a clubhouse certified by the International Center for Clubhouse Development (ICCD), were asked about their interest in work. About one third of the new enrollees expressed no interest in working. Equivalent supported employment services were then offered to all participants in each program. Stated interest in work and receipt of vocational services were statistically significant predictors of whether a person would work and how long it would take to get a job. Two thirds of those interested in work and half of those with no initial interest obtained a competitive job if they received at least one hour of vocational service. Once employed, these two groups held comparable jobs for the same length of time. These findings demonstrate the importance of making vocational services continuously available to all people with serious mental illness, and the viability of integrating these services into routine mental health care.

Linking substance abuse and serious mental illness service delivery systems: initiating a statewide collaborative.

In the past, persons with serious mental illness and substance abuse often found themselves in parallel systems of care that inadequately addressed their needs. Recent advances have seen the development of an integrated approach to care for these disorders in both the public and private sectors. While some state departments of mental health have developed integrated systems of care for public sector patients, no department appears to have developed such a system for both public and private clients, and there appears to be no published journal report of a model to induce cooperation by all stakeholders. This article outlines a two-step approach by the Massachusetts Department of Mental Health to foster stakeholder cooperation in designing an integrated system of care for both public and private clients with co-occurring disorders.

When Parents with Severe Mental Illness Lose Contact with Their Children: Are Psychiatric Symptoms or Substance Use to Blame

This study compared parental psychiatric symptom severity, and the absence or presence of severe substance abuse, as predictors of contact with minor children for a representative sample of adults with diagnoses of serious mental illness (N = 45). Child contact and psychiatric symptom severity were measured during regularly scheduled 6-month research interviews over a total 30-month period following each participants entry into the project. Severe substance abuse was documented as present or absent for the 6-month interval preceding each interview. Results revealed that incidence of severe substance abuse was repeatedly associated with less frequent parent-child contact, even after controlling for psychiatric symptoms, diagnosis, gender, age, ethnicity, and socioeconomic status. Neither psychiatric diagnosis nor symptom severity predicted frequency of child contact when substance abuse was taken into account. Mental health agencies offering parenting classes for adults with serious mental illness should incorporate substance use interventions to reduce loss of child custody and strengthen parent-child relationships.

When Programs Benefit Some People More than Others: Tests of Differential Service Effectiveness

Practitioners need to know for whom evidence-based services are most or least effective, but few services research studies provide this information. Using data from a randomized controlled comparison of supported employment findings for two multi-service psychiatric rehabilitation programs, we illustrate and compare procedures for measuring program-by-client characteristic interactions depicting differential program effectiveness, and then illustrate how a significant program-by-client interaction can explain overall program differences in service effectiveness. Interaction analyses based on cluster analysis-identified sample subgroups appear to provide statistically powerful and meaningful hypothesis tests that can aid in the interpretation of main effect findings and help to refine program theory.

Insurance status and length of stay for involuntarily hospitalized patients

General and private psychiatric hospitals are becoming increasingly common as sites for involuntary hospitalization. Unlike the public facilities that these settings are supplanting, these hospitals must pay strict attention to issues associated with reimbursement, insurance status, and managed care. This article examines the effects of insurance status on length of stay for involuntarily hospitalized patients in general and private hospitals in Massachusetts. Using a two-stage sampling procedure, data on episodes of involuntary hospitalization were gathered and assessed using multiple regression. The primary effect was found between patients with Medicare, who had the longest stays, and individuals who were uninsured, who had the shortest. The data raise concerns that warrant closer scrutiny on the part of administrators and clinicians.

Development of tolerance to the therapeutic effect of amantadine on akathisia.

Four patients with akathisia as a result of neuroleptic administration were treated with aman-tadine. Although substantial improvement occurred initially, all four patients developed tolerance to this therapeutic effect within 1 week. An increase in dosage also had only a transient effect. The rapid development of tolerance significantly limits the usefulness of amantadine in the treatment of akathisia. One patient who suffered from akathisia and drug-induced parkinsonism experienced significant attenuation of both movement disorders in response to treatment with amantadine. Although she became tolerant to the effect of amantadine on her akathisia within the first week of treatment, her parkinsonism did not recur. The possibility that these two neuroleptic-induced ex-trapyramidal syndromes are pharmacologically separable is discussed.

PARENTAL DEATH IN THE LIVES OF PEOPLE WITH SERIOUS MENTAL ILLNESS

Nearly a fourth (22%) of the participants within a research sample of 148 individuals with serious mental illness reported the death of a loved one as a significant loss, and two thirds of these deaths involved the loss of one or both parents. The key determinant of the severity and duration of grief in response to the death of a parent was whether or not there were extenuating circumstances that complicated the death event, such as co-residence with the deceased at the time of death or a lack of regular social contact with anyone other than the deceased. In all instances of severe or prolonged grief, there was no preparation for the parental death, either through preparatory counseling or practical plans for funeral arrangements, financial repercussions, life-style changes, or residential relocation. Mental health agencies serving people with serious mental illness should being to incorporate financial and emotional preparation for parental deaths and bereavement counseling as essential services.

Preference in random assignment: implications for the interpretation of randomized trials

Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often assignment preference might have complicated the interpretation of findings. Condition descriptions, and greater early attrition from services-as-usual comparison conditions, suggest that many study enrollees favored assignment to new rapid-job-placement supported employment, but no study took this possibility into account. Reviews of trials in other service fields are needed to determine whether this design problem is widespread.