Initiating Telephone Follow Up After Hospital Discharge From an Inpatient Psychiatric Setting to Reduce Recidivism.

The purpose of the current evidence-based practice (EBP) project was to reduce recidivism in patients with depression after acute psychiatric hospital discharge through implementation of telephone follow up. Eight patients (intervention group) were called within 72 hours of discharge to reinforce discharge instructions and administer the Patient Health Questionnaire-9 (PHQ-9). The results were compared to 16 patients (control group) who were discharged during the same timeframe 1 year prior. The findings from the control group revealed one (6.25%) patient was readmitted and three (18.75%) patients visited the emergency department (ED) within 30 days of discharge. No one in the intervention group was readmitted or visited the ED within 30 days post discharge. Statistically significant differences were not detected in discharge telephone call status (received or did not receive) and readmissions (p = 1.000) and ED visits (p = 0.526). For six patients in the intervention group, the mean PHQ-9 score was 3.3, which was within a depression severity of none to minimal. This quality improvement project helped address patient lack of knowledge related to discharge instructions after being discharged from the hospital to home. [Journal of Psychosocial Nursing and Mental Health Services, 58(5), 25-31.].

Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014.

PURPOSE: To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS: Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS: There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS: There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.

Racial/ethnic differences in mental health treatment among a national sample of pregnant women with mental health and/or substance use disorders in the United States.

OBJECTIVE: To examine racial/ethnic differences in the receipt of mental health treatment among pregnant women with mental health (i.e., depression and serious psychological distress) and/or substance use disorders. METHOD: Secondary analysis of data from the National Survey on Drug Use and Health was conducted. The sample consisted of 1232 pregnant women with mental health/substance use disorders. RESULTS: Black/African American (Adjusted Odds Ratio [AOR]: 0.36, 95% Confidence Interval [CI]: 0.17-0.75), other non-Hispanic (AOR: 0.24, 95% CI: 0.11-0.52), and Hispanic (AOR: 0.42, 95% CI: 0.22-0.81) pregnant women had significantly lower odds of mental health treatment receipt compared to Whites, even when controlling for age, education, marital status, number of children, employment status, income, health insurance, county urbanicity, self-rated health status, type of mental health condition, and time. There were no racial/ethnic differences by mental health and/or substance use disorders. Among pregnant women who perceived unmet mental health treatment need (N = 299), a greater proportion of White compared to Non-White pregnant women perceived cost as an obstacle to access treatment (62.1% vs. 35.6%, p = .001); however, the two groups did not differ in other perceived barriers to mental health treatment (i.e., opposition to treatment, stigma, time/transportation limitation, and not knowing where to go). CONCLUSIONS: Strategies are needed to increase access to mental health treatment among racial/ethnic minority women who are pregnant and have mental health/substance use disorders. Further studies are required to understand racial/ethnic differences in the perceived barriers to mental health treatment.

A novel text message-based motivational interviewing intervention for college students who smoke cigarettes.

INTRODUCTION: Tobacco use disorder is critical among people aged 16 to 25 years. College campuses are prime locations for smoking cessation interventions for young adults. The vast majority of the smoking research with college students has been epidemiological in nature. This study examined a novel motivational interviewing intervention designed for college students, and explored predictors of smoking behavior change. METHODS: A quasi-experimental one group pretest-posttest design with repeated measures was used to evaluate a novel text message-based brief motivational interviewing intervention. The data were collected from undergraduate students (N=33) who smoked cigarettes in Fall 2015. RESULTS: Students' level of autonomy and relatedness needs satisfaction, autonomous motivation, and smoking cessation self-efficacy increased (p < 0.05), and their rate of daily smoking declined (p <0 .05) over time. However, competence need satisfaction, readiness to quit smoking and severity of nicotine addiction remained unchanged. Smoking cessation self-efficacy was the strongest predictor of smoking behavior change in college students. CONCLUSIONS: This study adds to the knowledge on smoking behavior among college students. Preliminary evidence indicates that text message-based motivational interviewing and smoking cessation self-efficacy may help guide successful smoking behavior interventions for college students.

Predictors of well-being among college students.

OBJECTIVES: Identification of health-related risk behaviors associated with well-being in college students is essential to guide the development of health promotion strategies for this population. The purposes were to evaluate well-being among undergraduate students and to identify health-related risk behaviors that predict well-being in this population. METHODS: A cross-sectional Web-based survey of undergraduate students was conducted at a metropolitan university in the Southeast United States. A total of 568 students responded (response rate 14.2%). Data were collected on health-related risk behaviors using the National College Health Assessment II. RESULTS: Controlling demographic characteristics, the best predictive model included physical activity, current tobacco user, depression, ever received mental health services, and sleep quality, which was the strongest predictor (ß = .45, p < .001). This model explained 35% of the variance in well-being. CONCLUSIONS: Interventions that promote sleep quality among college students may be most beneficial in improving well-being.

The relationships of coping, negative thinking, life satisfaction, social support, and selected demographics with anxiety of young adult college students.

PROBLEM: Understanding young adults' anxiety requires applying a multidimensional approach to assess the psychosocial, behavioral, and cognitive aspects of this phenomenon. METHODS: A hypothesized model of the relationships among coping style, thinking style, life satisfaction, social support, and selected demographics and anxiety among college students was tested using path analysis. A total of 257 undergraduate students aged 18-24 years completed an online survey. The independent variables were measured using the Multidimensional Scale of Perceived Social Support, the Brief Students' Multidimensional Life Satisfaction Scale, the Brief COPE Inventory, the Positive Automatic Thoughts Questionnaire, and the Cognition Checklist-Anxiety. The outcome, anxiety, was measured using the Anxiety subscale of the 21-item Depression Anxiety and Stress Scale. FINDINGS: Only negative thinking and maladaptive coping had a direct relationship with anxiety. Negative thinking was the strongest predictor of both maladaptive coping and anxiety. CONCLUSION: These findings suggest that helping undergraduates manage their anxiety by reducing their negative thinking is critical. Designing and testing interventions to decrease negative thinking in college students is recommended for future research.

Advanced practice psychiatric nurses' outcomes of care: a pilot study.

This pilot study evaluated the effectiveness of the Advanced Practice Psychiatric Nurse (APPN) in improving clinical outcomes of depressed clients and measured their clients' level of satisfaction with APPN care. A longitudinal study design using repeated measures was conducted to evaluate clinical outcomes and satisfaction with care of depressed clients treated by APPNs. The findings suggest that APPNs are highly effective in treating clients with depression and that clients are very satisfied with the care they receive from APPNs.

Smoke-free policy and alcohol use among undergraduate college students.

OBJECTIVES: The purpose of this study was to assess attitudes and behaviors related to smoke-free policy among undergraduate student alcohol drinkers on a campus in a community with smoke-free bars. DESIGN AND SAMPLE: This was a secondary data analysis of a study in which participants completed mailed surveys assessing demographic characteristics, attitudes and behaviors related to alcohol and tobacco use and smoke-free policy (n = 337). Opinion and behavior items were summarized descriptively; associations were examined using Kruskal Wallis tests and chi-square tests of association. Logistic regression tested for predictors of importance of smoke-free policy. RESULTS: Respondents were predominantly female and Caucasian; mean age 20.3 years. One fourth were current smokers. Seventy-nine percent said the community smoke-free law had no effect on frequency of visiting bars. Eighty-seven percent said smoke-free policy in campus buildings was "somewhat" or "very important." Predictors of perceived importance of smoke-free policy included gender and smoking status. CONCLUSIONS: Most smokers in this sample did not experience a change in their motivation to quit smoking or in number of cigarettes smoked daily. Implementation of a community smoke-free law did not reduce the likelihood of visiting bars. Women and nonsmokers were more likely to rate smoke-free campus policy as very important.

The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles.

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates' depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18-24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students' Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.

Prevention approaches in child mental health disorders.

If the health of children is to be improved, systems of care for youth must organize and collaborate around an emphasis toward promotion of health and prevention of mental illness. This approach demands an understanding of the complex interplay of genes, environment, risk, and protective factors that influence the manifestation of behavior problems. The focus of this article is prevention efforts aimed at processes thought to be involved in the development of mental illnesses. A particular emphasis is on prevention strategies that reduce risk prior to the onset of an identifiable mental disorder. Included are interventions appropriate to nurses who deal with children in schools, pediatric primary care, and specialty mental health care.

Smoke-free laws and smoking and drinking among college students.

Little is known about the impact of smoke-free legislation on smoking and drinking alcohol among college students. The purpose was to examine whether strength and duration of municipal smoke-free laws are associated with cigarette and alcohol use among college students. Full-time undergraduates from two Southeastern universities participated in mailed (Site A) or electronic (Site B) surveys assessing tobacco and alcohol use and other risk behaviors pre and post comprehensive municipal smoke-free laws (Site A, N = 1,366. Site B, N = 1,404). The first cohort at each site participated prior to a municipal smoke-free law in the community. The second survey was conducted post-law (Site A, 3.5 years, Site B, 8 months). Past 30-day cigarette and alcohol use and other demographic and personal characteristics were assessed. At Site A, controlling for demographic differences and current alcohol use, the odds of being a current smoker were 32% lower post-law (28% pre-law vs. 19% post-law; odds ratio = 0.68, P = 0.02). At Site B, with demographics and drinking status in the model, the decrease in smoking rate from pre- to post-law was not significant. At both sites, controlling for demographics and current smoking status, change in the likelihood of drinking was not significant. Comprehensive smoke-free laws in the surrounding community may reduce smoking rates among college students who live, work and recreate there, particularly after the laws are well-established. While alcohol prevalence is very high among college students, enacting smoke-free legislation was not associated with alcohol use.

Strategies used by advanced practice psychiatric nurses in treating adults with depression.

PURPOSE: Strategies used by psychiatric advanced practice registered nurses (APRNs) in treating clients with depression are described to explore their effectiveness. DESIGN AND METHODS: Ten APRNs participated in semistructured individual interviews for this qualitative descriptive study. The use of either a symptom severity scale or symptom reduction checklist was used to measure the effectiveness of the strategies used. FINDINGS: APRNs identified a biopsychosocial approach as the primary component of their treatment of clients with depression. Other strategies identified include psychopharmacology, cognitive-behavioral therapy, and partnering with the client. PRACTICE IMPLICATIONS: Treatment of depression can be enhanced with the incorporation of the biopsychosocial strategies along with standard treatment modalities.

Relationship of work hours with selected health behaviors and academic progress among a college student cohort.

UNLABELLED: Approximately 57% of college students work while attending school. Health risks related to working while in college have not been widely studied. OBJECTIVE: The authors' purpose in this study was to determine associations between hours worked, binge drinking, sleep habits, and academic performance among a college student cohort. PARTICIPANTS AND METHODS: The authors randomly selected a sample of 1,700 undergraduates from a southeastern US university and mailed to them a survey requesting a variety of self-reported health behaviors and hours worked. A total of 903 completed questionnaires were received, indicating a response rate of 57.3%. RESULTS: Binge drinking, less sleep, and lower academic performance were significantly associated with working 20 or more hours per week. Those variables were not associated with working fewer than 20 hours per week. CONCLUSIONS: Although administrators and others in higher education are aware of the impact of economics on a school's ability to operate, they may not be aware of the impact on students' health.

Social influences on cigarette initiation among college students.

OBJECTIVES: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. METHODS: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). RESULTS: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. CONCLUSIONS: Strategies that focus on reducing alcohol and tobacco use need to be tested.

College students' perspective on smoking cessation: "If the message doesn't speak to me, I don't hear it".

The purpose of this study was to document the smoking cessation experiences of three groups of 18-24-year-old college students and explore their ideas for cessation. Focus group interviews were conducted with former smokers (n = 7), smokers struggling to quit (n = 7), and smokers with no desire to quit (n = 5). Participants indicated a need for smoking cessation programs that would help the students understand the immediate physiological impact of smoking, addictive nature of nicotine, and benefits of using nicotine replacement therapy. They believed emotional and cognitive strategies for coping with cravings and environmental cues to smoking should be included in smoking cessation programs. Students indicated that cost and convenience were important considerations for smoking cessation programs. They stated that the media messages were for teens and older adults and did not relate to them as college students or young adults.