Distinct and shared contributions of diagnosis and symptom domains to cognitive performance in severe mental illness in the Paisa population: a case-control study.

BACKGROUND: Severe mental illness diagnoses have overlapping symptomatology and shared genetic risk, motivating cross-diagnostic investigations of disease-relevant quantitative measures. We analysed relationships between neurocognitive performance, symptom domains, and diagnoses in a large sample of people with severe mental illness not ascertained for a specific diagnosis (cases), and people without mental illness (controls) from a single, homogeneous population. METHODS: In this case-control study, cases with severe mental illness were ascertained through electronic medical records at Clínica San Juan de Dios de Manizales (Manizales, Caldas, Colombia) and the Hospital Universitario San Vicente Fundación (Medellín, Antioquía, Colombia). Participants were assessed for speed and accuracy using the Penn Computerized Neurocognitive Battery (CNB). Cases had structured interview-based diagnoses of schizophrenia, bipolar 1, bipolar 2, or major depressive disorder. Linear mixed models, using CNB tests as repeated measures, modelled neurocognition as a function of diagnosis, sex, and all interactions. Follow-up analyses in cases included symptom factor scores obtained from exploratory factor analysis of symptom data as main effects. FINDINGS: Between Oct 1, 2017, and Nov 1, 2019, 2406 participants (1689 cases [schizophrenia n=160; bipolar 1 disorder n=519; bipolar 2 disorder n=204; and major depressive disorder n=806] and 717 controls; mean age 39 years (SD 14); and 1533 female) were assessed. Participants with bipolar 1 disorder and schizophrenia had similar impairments in accuracy and speed across cognitive domains. Participants with bipolar 2 disorder and major depressive disorder performed similarly to controls, with subtle deficits in executive and social cognition. A three-factor model (psychosis, mania, and depression) best represented symptom data. Controlling for diagnosis, premorbid IQ, and disease severity, high lifetime psychosis scores were associated with reduced accuracy and speed across cognitive domains, whereas high depression scores were associated with increased social cognition accuracy. INTERPRETATION: Cross-diagnostic investigations showed that neurocognitive function in severe mental illness is characterised by two distinct profiles (bipolar 1 disorder and schizophrenia, and bipolar 2 disorder and major depressive disorder), and is associated with specific symptom domains. These results suggest the utility of this design for elucidating severe mental illness causes and trajectories. FUNDING: US National Institute of Mental Health.

Assessing the Equivalence of Paper, Mobile Phone, and Tablet Survey Responses at a Community Mental Health Center Using Equivalent Halves of a 'Gold-Standard' Depression Item Bank.

BACKGROUND: The computerized administration of self-report psychiatric diagnostic and outcomes assessments has risen in popularity. If results are similar enough across different administration modalities, then new administration technologies can be used interchangeably and the choice of technology can be based on other factors, such as convenience in the study design. An assessment based on item response theory (IRT), such as the Patient-Reported Outcomes Measurement Information System (PROMIS) depression item bank, offers new possibilities for assessing the effect of technology choice upon results. OBJECTIVE: To create equivalent halves of the PROMIS depression item bank and to use these halves to compare survey responses and user satisfaction among administration modalities-paper, mobile phone, or tablet-with a community mental health care population. METHODS: The 28 PROMIS depression items were divided into 2 halves based on content and simulations with an established PROMIS response data set. A total of 129 participants were recruited from an outpatient public sector mental health clinic based in Memphis. All participants took both nonoverlapping halves of the PROMIS IRT-based depression items (Part A and Part B): once using paper and pencil, and once using either a mobile phone or tablet. An 8-cell randomization was done on technology used, order of technologies used, and order of PROMIS Parts A and B. Both Parts A and B were administered as fixed-length assessments and both were scored using published PROMIS IRT parameters and algorithms. RESULTS: All 129 participants received either Part A or B via paper assessment. Participants were also administered the opposite assessment, 63 using a mobile phone and 66 using a tablet. There was no significant difference in item response scores for Part A versus B. All 3 of the technologies yielded essentially identical assessment results and equivalent satisfaction levels. CONCLUSIONS: Our findings show that the PROMIS depression assessment can be divided into 2 equivalent halves, with the potential to simplify future experimental methodologies. Among community mental health care recipients, the PROMIS items function similarly whether administered via paper, tablet, or mobile phone. User satisfaction across modalities was also similar. Because paper, tablet, and mobile phone administrations yielded similar results, the choice of technology should be based on factors such as convenience and can even be changed during a study without adversely affecting the comparability of results.

Validation of the NetSCID: an automated web-based adaptive version of the SCID.

The present study developed and validated a configurable, adaptive, web-based version of the Structured Clinical Interview for DSM, the NetSCID. The validation included 24 clinicians who administered the SCID and 230 participants who completed the paper SCID and/or the NetSCID. Data-entry errors, branching errors, and clinician satisfaction were quantified. Relative to the paper SCID, the NetSCID resulted in far fewer data-entry and branching errors. Clinicians 'preferred' using the NetSCID and found that the NetSCID was easier to administer.

Development of the Perinatal Depression Inventory (PDI)-14 using item response theory: a comparison of the BDI-II, EPDS, PDI, and PHQ-9.

The objective of this study is to develop a simple, brief, self-report perinatal depression inventory that accurately measures severity in a number of populations. Our team developed 159 Likert-scale perinatal depression items using simple sentences with a fifth-grade reading level. Based on iterative cognitive interviewing (CI), an expert panel improved and winnowed the item pool based on pre-determined criteria. The resulting 67 items were administered to a sample of 628 pregnant and 251 postpartum women with different levels of depression at private and public sector obstetrics clinics, together with the Beck Depression Inventory (BDI-II), Edinburg Postpartum Depression Scale (EPDS), and the Patient Health Questionnaire (PHQ-9), as well as Module A of the Structured Clinical Interview for DSM-IV Diagnoses (SCID). Responses were evaluated using Item Response Theory (IRT). The Perinatal Depression Inventory (PDI)-14 items are highly informative regarding depression severity and function similarly and informatively across pregnant/postpartum, white/non-white, and private-clinic/public-clinic populations. PDI-14 scores correlate well with the PHQ-9, EPDS, and BDI-II, but the PDI-14 provides a more precise measure of severity using far fewer words. The PDI-14 is a brief depression assessment that excels at accurately measuring depression severity across a wide range of severity and perinatal populations.

Psychometric characteristics of the Teen Addiction Severity Index-Two (T-ASI-2).

The Teen Addiction Severity Index-Two (T-ASI-2) was developed as an extension of the T-ASI to assess the severity of substance abuse and related problems among adolescents (N = 371) 12-19 years of age. The T-ASI-2 consists of 18 domains that assess current use of alcohol, tobacco, marijuana, and other drugs, as well as mental health service utilization, treatment satisfaction, school difficulties, social functioning with family members and peers, substance use by family members and peers, depression, anxiety, attention deficit, hyperactivity, defiant and risky behaviors, and readiness for change. Results show that all domains have adequate to excellent internal consistency (.54 to .88, median .80). New domains assessing psychological factors strongly correlated with gold standard assessments in the respective areas. The T-ASI-2 was designed to be a user friendly, cost-effective, viable assessment of substance use behavior and related factors.

Adolescent substance use assessment in a primary care setting.

Health initiatives suggest that adolescent substance use assessment may be beneficial as part of primary care to screen for early problematic behaviors. To examine the accuracy of such reporting, we compared the anonymous and confidential self-reports of 180 adolescents in a primary care setting. Matching samples to control for demographic variables, we found that adolescents were more likely to report marijuana use and substance use behaviors, such as selling drugs, when reporting anonymously vs. reporting confidentially. These results challenge the accuracy of confidential self-reports within this setting, and suggest further research is needed.

Monitoring patient improvement and treatment outcomes in managed behavioral health.

This study examined the use of outcome reports sent to clinicians by a managed behavioral healthcare organization to monitor patient progress and its relation to treatment outcome. Results showed that clinicians who reported using outcome information had patients who also reported greater improvement at 6 months from baseline. Improvement per session was greatest among patients whose clinicians reported reading the outcome report and using outcome measures in their clinical practice. Using baseline and ongoing measures to assess patient improvement can provide clinicians with feedback during treatment, which may lead to better clinical outcomes and enable quality management systems in managed care to flag high-risk cases and identify failure of adequate improvement.

The acceptability and effectiveness of patient-reported assessments and feedback in a managed behavioral healthcare setting.

OBJECTIVE: To determine whether providing clinicians with the results of a patient-reported mental health assessment would have a significant impact on patients' mental health outcomes. STUDY DESIGN: The study used a portion of the SCL-90 (Symptom Checklist-90) to track the perceived mental health of 1374 patients in a managed behavioral healthcare system over 6 weeks. METHODS: Participants were randomized into a feedback group whose clinicians received clinical feedback reports at intake and at 6 weeks, and a control group whose clinicians received no report. RESULTS: Patients in the feedback group achieved statistically significant improvement in clinical status relative to controls. CONCLUSIONS: Overall, the study suggests that patient-reported mental health assessments have the potential both to become acceptable to clinicians and to improve the effectiveness of clinical care.

Reliability and acceptability of automated telephone surveys among Spanish- and English-speaking mental health services recipients.

Interactive Voice Response (IVR), an automated system that administers surveys over the phone, is a potentially important technology for mental health services research. Although a number of studies have compared IVR to live interviews, few have looked at IVR in comparison to pencil-and-paper survey administration. Further, few studies have included subjects from those populations most likely to benefit from IVR technology, namely patients with lower education levels and non-English-speaking patients. This randomized clinical study, conducted at a community health center serving low-income English- and Spanish-speaking populations, assessed the reliability of an IVR-administered Brief Symptom Inventory (BSI) relative to a paper-and-pencil version. The study was adequately powered. Results showed that patients gave similar responses to the IVR and paper-and-pencil surveys; in addition, patients were generally equally satisfied with both experiences. We conclude that, while more large-scale research is needed, IVR can be a useful survey administration tool.

Conversion and validation of the Teen-Addiction Severity Index (T-ASI) for Internet and automated-telephone self-report administration.

This study converted the Teen-Addiction Severity Index (T-ASI) into self-report formats using Internet (Net) and interactive voice response (IVR) automated-telephone technologies. Reliability and convergent validity were assessed among 95 inpatient adolescent participants. Current functioning scores obtained by clinician interview correlated well with self-report Net (mean r=.74, SD=.14) and IVR (mean r=.72, SD=.16). Lifetime history items obtained by clinicians were consistent with self-report Net (mean r=.60, SD=.32; mean kappa=.67, SD=.24) and IVR formats (mean r=.60, SD=.30; mean kappa=.64, SD=.26). Participants rated "ease of use" as being high for both Net and IVR formats. These findings suggest that automated T-ASI administration is a valid and potentially less expensive alternative to clinician-administered T-ASI interviews.

Validation of the Addiction Severity Index (ASI) for internet and automated telephone self-report administration.

This study assesses the convergent validity of Internet (Net) and interactive voice response (IVR) automated telephone self-report versions of the Addiction Severity Index (ASI) relative to the established, clinician-administered (CA) ASI. Eighty-eight subjects were recruited from an addiction treatment program to complete three ASI assessments. The mean correlation between composite scores obtained by Net and IVR and those obtained via clinician interview was.91 (range.81-.95). For History items, the mean correlation was.77 (range.14-1.00) and the mean kappa coefficient was.75 (range.46-1.00). The results demonstrated the validity of these self-report Net and IVR versions of the ASI. Self-report Net and IVR were rated as "very satisfactory" or "extremely satisfactory" by a majority of respondents for ease of use. Automation can reduce the labor costs associated with ASI administration and may facilitate longitudinal tracking of subjects from home.

Characteristics of suicide attempts in a large urban jail system with an established suicide prevention program.

OBJECTIVE: The King County Department of Adult and Juvenile Detention in Washington State, like many jail systems across the nation, implemented a suicide prevention program in response to high suicide rates. A review committee was formed to prospectively study the patterns of suicide attempts that occurred in the system after the program was implemented and to make recommendations for improvements. METHODS: All first suicide attempts per jail booking over a 33-month period in two of the department's jails were studied. For each attempt, characteristics of the individual and of the attempt were abstracted by trained staff. RESULTS: A total of 132 first suicide attempts were made by 124 individual inmates during the study period. The prevalence of mental illness among inmates who attempted suicide was 77 percent, compared with 15 percent in the general jail population. Seventy-five percent of the inmates who attempted suicide had received a mental health evaluation from jail personnel before the attempt. Suicide attempts that were made in observation units for suicidal inmates (42 percent of all attempts), particularly those made in group observation units, necessitated fewer visits to an emergency department than those that occurred in general areas of the jail. CONCLUSIONS: On the basis of these findings, the jails implemented interventions such as more suicide screening and treatment for inmates who have active substance abuse, greater consensus building in decisions about housing, and structural changes such as greater use of group-housing units and the use of barriers to prevent the inmates from jumping from balconies.