Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study.

PURPOSE: Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system. METHOD: Using secondary data from the 2015-2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs. RESULTS: The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU (OR = 0.73, 95% CI [0.60, 0.90]). CONCLUSIONS: MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.

Association of functional disability and treatment modalities with perceived effectiveness of treatment among adults with depression: a cross-sectional study.

BACKGROUND: Approximately 17.3 million US adults had at least one major depressive episode (MDE) in 2017. Of those, about two-thirds received mental health services from health professionals. Persons with disabilities (PWD) have higher risks of depression and may face more challenges in seeking treatment. OBJECTIVE: Examined whether the presence of disabilities affected the perceived effectiveness of treatment for people with MDE who received outpatient mental health care. METHODS: We obtained MDE status, functional disability, modality of treatment (i.e., medication only, counseling only, medication plus counseling), self-reported effectiveness of treatment, and covariates from a nationally representative sample of US adults aged ≥18 years in the 2015-2019 National Survey on Drug Use and Health. We used multivariable logistic regression models with recommended survey weighting to examine associations between disability and perceived effectiveness of treatment. RESULTS: The study population comprised 9992 respondents, representing 9.53 million US adults who had MDE and received outpatient mental health care in the past year. Overall, 58.9% had at least one functional limitation. A higher proportion of PWDs received medication plus counseling treatment compared to persons without disabilities (79.2% vs. 67.9%, P < .001). PWDs were significantly less likely to rate treatment as effective (OR = 0.77; 95% CI: 0.66-0.91). Odds ratios decreased as the number of limitations increased, and this association was moderated by treatment modality. CONCLUSION: PWDs have poorer perceived outcomes of outpatient mental health care for depression, especially for treatment modalities involving counseling. These findings call for focused attention to depression treatment efforts for PWD that accommodate their needs.

Association of functional disability with mental health services use and perceived unmet needs for mental health care among adults with serious mental illness.

BACKGROUND: Approximately 13.1 million U.S. adults experienced serious mental illness (SMI) in 2019. Persons with disability (PWD) have higher risks of SMI. Ensuring adequate access to mental health (MH) services for PWD is imperative to ameliorate this burden. METHODS: Using the 2015-2019 National Survey on Drug Use and Health, we obtained study variables for U.S. adults with SMI in the past year and used multivariable logistic regression models to examine the association of disability with MH services and perceived unmet needs. RESULTS: The sample comprised 12,532 respondents, representing 11,143,650 U.S. adults with SMI. Overall, PWD had higher proportions of using prescription medications (64.7% vs. 46.2%), outpatient treatment (48.4% vs. 36.5%) and inpatient treatment (8.6% vs. 4.7%) compared to persons without disability; however, the prevalence of perceived unmet MH service needs was also higher (46.3% vs. 39.4%) among PWD. Multivariable logistic regression models showed presence of any disability, cognitive and ≥2 limitations were significantly associated with MH services use (all p<0.01). However, PWD were significantly more likely to report perceived unmet MH service needs (p<0.01 for any disability as well as cognitive, complex activity, and ≥2 limitations). LIMITATIONS: Due to data limitations, disability status and SMI may be misclassified for some respondents, and the results may not be generalized to all individuals with SMI. CONCLUSION: While PWD were more likely to use MH services, they also had higher odds of unmet MH needs. These results call for more effective and tailored mental health services for PWD.

Evaluating Dependence Criteria for Caffeine.

Background: Although caffeine is the most widely used mood-altering drug in the world, few studies have operationalized and characterized Diagnostic and Statistical Manual IV (DSM-IV) substance dependence criteria applied to caffeine. Methods: As a part of a nosological study of substance use disorders funded by the National Institute on Drug Abuse, we assessed caffeine use and dependence symptoms among high school and college students, drug treatment patients, and pain clinic patients who reported caffeine use in the last 7 days and also reported use of alcohol, nicotine, or illicit drugs within the past year (n=167). Results: Thirty-five percent met the criteria for dependence when all seven of the adopted DSM dependence criteria were used. Rates of endorsement of several of the most applicable diagnostic criteria were as follows: 26% withdrawal, 23% desire to cut down or control use, and 44% continued use despite harm. In addition, 34% endorsed craving, 26% said they needed caffeine to function, and 10% indicated that they talked to a physician or counselor about problems experienced with caffeine. There was a trend towards increased caffeine dependence among those dependent on nicotine or alcohol. Within a subgroup that had used caffeine, alcohol, and nicotine in the past year, 28% fulfilled criteria for caffeine dependence compared to 50% for alcohol and 80% for nicotine. Conclusion: The present study adds to a growing literature suggesting the reliability, validity, and clinical utility of the caffeine dependence diagnosis. Recognition of caffeine dependence in the DSM-V may be clinically useful.

Enrolling, Retaining, and Benefiting Out-of-Treatment Drug Users in Intervention Research.

LONGITUDINAL RESEARCH ON street-recruited out-of-treatment drug users involves ethical issues concerning enrollment and retention of participants, remuneration and benefits. In contrast to practices of excluding such high-risk populations from research and assuming that they would not comply with a protocol requiring repeated measures over a 12-month period, this report presents examples from 15 years of community-based studies that have enrolled drug-using participants and achieved a 96% retention rate. We also examine ethical issues connected with cash remuneration, and describe methods to elucidate the kinds of benefits that are most meaningful to this population. Findings suggest that the research community must reconsider the ethics of blanket exclusions of such high-risk subjects, and make evidence-based decisions about recruitment, retention, remuneration, and benefits.

Quality of care: expanding the social work dialogue.

For social work practitioners to engage fully in efforts designed to improve the quality of social services, they need to understand what is meant by quality of care, grapple with its complexity, and know how to identify and leverage the key factors most likely to influence it. This article introduces a conceptual model that articulates numerous influences on the quality of social services. It details the macrosystem, consumer, advocacy, organizational, and practitioner influences on technically proficient and sensitively delivered social services that affect consumer outcomes in desired ways. The model can be used to assess targets for quality improvement intervention in social services practice settings.