ABSTRACT
This dissertation consists of two studies. Study one examined child-level predictors of mental health care service utilization among youth with bipolar spectrum disorders who were overweight/obese. Study two examined the differences in medication adherence and barriers to medication adherence among youth with bipolar spectrum disorders who were overweight/obese before and since the COVID-19 pandemic. Youth in this study were enrolled in Metformin for Overweight & OBese ChILdren and Adolescents with BIpolar Spectrum Disorders Treated with Second-Generation AntipsYchotics (MOBILITY), a prospective, large, pragmatic, randomized trial to study the impact of metformin and simple healthy lifestyle intervention (LIFE) vs. LIFE alone on patient-centered outcomes of body weight, second-generation antipsychotics (SGA) adherence, psychiatric symptom burden (e.g. mood/anxiety), and quality of life.Study One Introduction: The primary aim of this study was to examine variables, such as symptom severity and insurance status, related to continuity of care (follow-up visits, hospitalization) for youth with bipolar spectrum disorders who are overweight/obese. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY participants enrolled from November 5, 2015 through December 1, 2018 in the Midwest Region (N = 610) were included in analyses. Results: Participants enrolled from an inpatient hospital setting had fewer follow-up visits than those enrolled from an outpatient setting. Patients enrolled on an inpatient vs. outpatient setting were analyzed separately. Among patients enrolled from an outpatient setting, having public health insurance was associated with having higher numbers of psychiatric followup visits. Outpatients with lower CGI-S scores (less severe) at baseline had more follow-up visits. Higher CGI-S scores were associated with increased number of hospitalizations for those enrolled in outpatient settings. Outpatients with higher CGI-S scores and more follow-up visits had fewer hospitalizations than those with fewer follow-up visits. For participants enrolled on an inpatient setting, younger age was associated with higher number of hospitalizations. Conclusions: This study documented differences in continuity of care among the MOBILITY sample. Future studies are needed to determine if additional patient-level variables contribute to gaps in continuity of care so interventions can be targeted to those most vulnerable.Study Two The primary purpose of this study was to examine differences in SGA medication adherence among youth with bipolar spectrum disorders who were overweight/obese, before and iv since the COVID-19 pandemic. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY patient/caregiver dyads (N = 376) who completed tablet assessments for the Month 6 MOBILITY visit between March 1, 2019 and April 30, 2021 were included in analyses. Results: Before COVID-19, patients reported they missed 8.8% of prescribed doses/week, while caregivers reported patients missed 8.05% doses/week. Since COVID-19, patients reported missing 11.95% doses/week, and caregivers reported patients missed 4.63% doses/week. There were no significant differences in medication adherence rates before and since COVID-19 among patients or caregivers. The most frequently reported barrier to medication adherence among patients and caregivers in both time frames was forgetting to take medications. According to patients, caregiver assistance in taking medication may improve mediation adherence. Discussion: Patient and caregiver report of adherence rates since COVID19 differed, but reports of rates by both groups were similar before the pandemic. Future studies are needed to determine if adherence rates changed over time during the pandemic and to determine patient- and caregiver-acknowledged factors that facilitate adherence to medication regimens. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
This dissertation consists of two studies. Study one examined child-level predictors of mental health care service utilization among youth with bipolar spectrum disorders who were overweight/obese. Study two examined the differences in medication adherence and barriers to medication adherence among youth with bipolar spectrum disorders who were overweight/obese before and since the COVID-19 pandemic. Youth in this study were enrolled in Metformin for Overweight & OBese ChILdren and Adolescents with BIpolar Spectrum Disorders Treated with Second-Generation AntipsYchotics (MOBILITY), a prospective, large, pragmatic, randomized trial to study the impact of metformin and simple healthy lifestyle intervention (LIFE) vs. LIFE alone on patient-centered outcomes of body weight, second-generation antipsychotics (SGA) adherence, psychiatric symptom burden (e.g. mood/anxiety), and quality of life.Study One Introduction: The primary aim of this study was to examine variables, such as symptom severity and insurance status, related to continuity of care (follow-up visits, hospitalization) for youth with bipolar spectrum disorders who are overweight/obese. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY participants enrolled from November 5, 2015 through December 1, 2018 in the Midwest Region (N = 610) were included in analyses. Results: Participants enrolled from an inpatient hospital setting had fewer follow-up visits than those enrolled from an outpatient setting. Patients enrolled on an inpatient vs. outpatient setting were analyzed separately. Among patients enrolled from an outpatient setting, having public health insurance was associated with having higher numbers of psychiatric followup visits. Outpatients with lower CGI-S scores (less severe) at baseline had more follow-up visits. Higher CGI-S scores were associated with increased number of hospitalizations for those enrolled in outpatient settings. Outpatients with higher CGI-S scores and more follow-up visits had fewer hospitalizations than those with fewer follow-up visits. For participants enrolled on an inpatient setting, younger age was associated with higher number of hospitalizations. Conclusions: This study documented differences in continuity of care among the MOBILITY sample. Future studies are needed to determine if additional patient-level variables contribute to gaps in continuity of care so interventions can be targeted to those most vulnerable.Study Two The primary purpose of this study was to examine differences in SGA medication adherence among youth with bipolar spectrum disorders who were overweight/obese, before and iv since the COVID-19 pandemic. Methods: A secondary data analysis of data collected in MOBILITY was performed. All MOBILITY patient/caregiver dyads (N = 376) who completed tablet assessments for the Month 6 MOBILITY visit between March 1, 2019 and April 30, 2021 were included in analyses. Results: Before COVID-19, patients reported they missed 8.8% of prescribed doses/week, while caregivers reported patients missed 8.05% doses/week. Since COVID-19, patients reported missing 11.95% doses/week, and caregivers reported patients missed 4.63% doses/week. There were no significant differences in medication adherence rates before and since COVID-19 among patients or caregivers. The most frequently reported barrier to medication adherence among patients and caregivers in both time frames was forgetting to take medications. According to patients, caregiver assistance in taking medication may improve mediation adherence. Discussion: Patient and caregiver report of adherence rates since COVID19 differed, but reports of rates by both groups were similar before the pandemic. Future studies are needed to determine if adherence rates changed over time during the pandemic and to determine patient- and caregiver-acknowledged factors that facilitate adherence to medication regimens. (PsycInfo Database Record (c) 2022 APA, all rights reserved)