Effectiveness of a Web-Based Tailored Intervention (E-health4Uth) and Consultation to Promote Adolescents’ Health: Randomized Controlled Trial

Background

To promote well-being and health behaviors among adolescents, 2 interventions were implemented at 12 secondary schools. Adolescents in the E-health4Uth group received Web-based tailored messages focused on their health behaviors and well-being. Adolescents in the E-health4Uth and consultation group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems.

Objective

This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being (ie, mental health status and health-related quality of life) and health behaviors (ie, alcohol and drug use, smoking, safe sex).

Methods

A cluster randomized controlled trial was conducted among third- and fourth-year secondary school students (mean age 15.9, SD 0.69). School classes (clusters) were randomly assigned to (1) E-health4Uth group, (2) E-health4Uth and consultation group, or (3) control group (ie, care as usual). Adolescents completed a questionnaire at baseline and at 4-month follow-up assessing alcohol consumption, smoking, drug use, condom use, mental health via the Strengths and Difficulties Questionnaire (SDQ) and the Youth Self Report (YSR; only measured at follow-up), and health-related quality of life. Multilevel logistic, ordinal, and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up. Subsequently, it was explored whether demographics moderated the effects.

Results

Data from 1256 adolescents were analyzed. Compared to the control intervention, the E-health4Uth intervention, as a standalone intervention, showed minor positive results in health-related quality of life (B=2.79, 95% CI 0.72-4.87) and condom use during intercourse among adolescents of Dutch ethnicity (OR 3.59, 95% CI 1.71-7.55) not replicated in the E-health4Uth and consultation group. The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents (SDQ: B=−0.60, 95% CI −1.17 to −0.04), but a negative effect on drug use among boys (OR 0.36, 95% CI 0.13-0.96). In the subgroup of adolescents who were at risk of mental health problems at baseline (and referred for a consultation with the nurse), the E-health4Uth and consultation group showed minor to moderate positive results in mental health status (SDQ: B=−1.79, 95% CI −3.35 to −0.22; YSR: B=−9.11, 95% CI −17.52 to −0.71) and health-related quality of life (B=7.81, 95% CI 2.41-13.21) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline.

Conclusions

Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems. Future research is needed to further evaluate the effects of the consultation as a standalone intervention, and the dual approach of further tailored eHealth messages and a consultation.

Trial Registration

Nederlands Trial Register: NTR 3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6PmgrPOuv).     

Primary group size, social support, gender and future mental health status in a prospective study of people living in private households throughout Great Britain

BACKGROUND: Structural characteristics of social networks such as primary group size have received less attention than measures of perceived social support. Previous research suggests that associations between social network size and later common mental disorder status may differ according to sex and initial mental state. METHOD: Adults participating in the 2000 British National Household Survey of psychiatric morbidity were randomly selected for follow-up 18 months later. The revised Clinical Interview Schedule (CIS-R) and the Interview Measure of Social Relations (IMSR) were administered at baseline and follow-up. Primary group size was defined as the total number of close relatives and friends. A four-level scale of common mental disorder was modelled with ordinal logistic regression, based on weighted data (n=2413). FINDINGS: After adjusting for confounders, a primary group size of three or less at time 1 predicted worse mental health at time 2. This effect was greatest in men who were initially non-cases at baseline (averaged odds 4.5) and in women who were initially cases at baseline (average odds 2.9). Primary group size at time 2 was significantly predicted by level of common mental disorder at time 1 in women but not in men. Thus, confounding by baseline disorder does not explain risk of developing poor mental health in socially isolated men. CONCLUSION: This study replicates the strong effects of primary group size on future mental health that emerge when men and women are studied separately and when subjects are categorized according to baseline mental health status.     

Workload implications of community psychiatric nurse employment by a general practice: a pilot study.

This study examines the impact of the employment of a community psychiatric nurse (CPN), dedicated to the care of patients with chronic mental illness, on general practice workload. Although the consultation rate with general practitioners for mental health reasons was significantly lower after CPN intervention, no differences were found in the total consultation rate.     

The evaluation and treatment of adolescent overdoses in an adolescent medical service

Aspects of the mental health care provided in an adolescent medical setting are examined. Over a six-month period, 38 patients were admitted to an inpatient adolescent medical unit because of drug ingestion. Following evaluation by the adolescent medical team, psychiatric consultations were requested in 47 percent of the cases. Most patients were referred for follow-up “counseling” in an adolescent clinic. In comparing the “consult” and “non-consult” groups, data are given on the demographics, diagnoses, reasons for the consultation request, lengths of hospital admission, follow-up dispositions, and compliances. Illustrations are given of the counseling process in the adolescent clinic. Patients in both groups had substantial psychosocial problems. Many patients received conduct-disorder diagnoses with varying degrees of subjective distress. It was generally the degree of depression, as assessed by the pediatrician, that determined whether a psychiatric consultation was requested. The acceptance of follow-up recommendations was approximately 50 to 60 percent in both groups.     

Patient satisfaction with telemedicine consultation in primary care: comparison of ratings of medical and mental health applications.

OBJECTIVE: To assess the viability of telemedicine as a vehicle for offering mental health consultations to primary-care patients. METHODS: Satisfaction ratings from 34 mental health encounters were compared with ratings from a convenience sample of 59 non-mental health encounters on four aspects of satisfaction: self-reported ability to speak freely; probability of further use of telemedicine; perceived experience of telemedicine personnel; and relative preference for a telemedicine visit compared with a face-to-face visit. The study was conducted in the context of the Telemedicine Program at the University of California, Davis. RESULTS: No significant differences in satisfaction were found between mental health and non-mental health encounter groups for any of the four aspects of satisfaction. CONCLUSIONS: Ratings from patients receiving mental health consultation using telemedicine yielded levels of satisfaction similar to those found in telemedicine consultations in non-mental health medical areas. The results support telemedicine as a means to extend mental health consultation to rural primary-care patients.     

Computer-assisted psychological intervention: A review and commentary

This paper reviews the 25-year history of computer-assisted psychological intervention, with particular emphasis on the current status of the computer in psychotherapy. The computer is playing an increasingly important role in personality and behavioral assessment, diagnostic interviewing and history taking, health education, mental health consultation, and clinical training. In these areas, the reliability, validity, and utility of the computer compares very favorably with that of the clinician. Evaluations of the use of the computer with psychiatric patients conclude that even those who are quite disturbed interact very successfully with computers, including many patients who are unable to interact with mental health personnel. Computer-assisted psychotherapy programs have been most successfully implemented in the areas of cognitive and behavioral psychotherapy. In the case of psychodynamic psychotherapy, computer programs appear to be limited by our failure to make fully explicit the rules governing therapist behavior and by the continuing inability of computers to comprehend natural language.     

Longitudinal study of resilience and mental health in Marines leaving military service

BackgroundDespite a growing emphasis on psychological outcomes following military combat, few longitudinal studies have examined the combined role of risk and protective factors in the mental health of combat-exposed military personnel. This study characterizes the impact of resilience scale scores and combat exposure on mental health outcomes among Marines after separating from military service, along with intra-individual changes in mental health status.MethodsData were collected from longitudinal surveys of 475 active duty Marines attending a random sample of mandatory Transition Assistance Program workshops before leaving the military and responding to follow-up mail or web surveys an average of 6 months after returning to civilian life.ResultsResults revealed distinct risk and protective factors for those meeting screening criteria for mental health problems (depression, anxiety, and PTSD) and functional impairment at follow-up. Primary risk factors included experiencing higher levels of pre-separation combat exposure; post-separation stress across multiple life domains; and experiencing multiple areas of pain post-separation. Protective factors include having higher scores on pre-separation resilience and perceived social support at follow-up indices. We also identified a number of factors associated with change in mental health status from baseline to follow-up.LimitationsGenerality is limited by a lower than expected follow-up response rate and an exclusively Marine sample.ConclusionThe role of resilience appeared to have a greater impact on functional impairment than on mental health symptoms per se. Findings provide important input for enhancing training programs and services intended to promote adjustment from military to civilian life. Additional emphasis on social support and coping with stress-related issues are needed in support of combat veterans.     

Patterns of General Practitioner consultation for mental illness by young people in rural areas. A cross-sectional study

The prevalence of psychiatric morbidity appears to be lower in rural than urban areas. Using the Fourth National GP Morbidity Survey (1991-1992) we have compared patterns of GP consultation for mental illness by young people living in rural and urban areas to investigate whether patterns of morbidity are reflected in GP help-seeking. We investigated whether urban-rural differences were due to differences in the socio-economic characteristics of residents. The crude rate ratio for consultation for mental disorder in rural compared to urban males was 0.55 (95% Cl 0.47 to 0.65) and for females was 0.78 (0.71 to 0.86). After controlling for socioeconomic differences between rural and urban areas, consultation rates for mental illness were 30% (95% Cl 19% to 41%) lower in males and 16 per cent (8% to 24%) lower in females in rural compared to urban areas. These findings are in line with population surveys indicating that levels of mental illness are lower in rural compared to urban areas. Part of the difference economic characteristics of people living in these areas. Further studies are needed to investigate possible area effects on the prevalence of mental illness. reflects differences in the socio-     

Facilitating psychiatric patient follow-up: a study of transfer attrition

Tested the hypothesis that two brief pre-discharge interventions would improve transfer success for psychiatric inpatients discharged to an outpatient community aftercare program. Seventy-four inpatients viewed one of three videotapes designed to: (1) provide programmatic information about follow-up clinics; (2) shape accurate expectations for outpatient therapy; or (3) provide non-specific emphasis to the importance of aftercare. A baseline group also was employed. As hypothesized, posttest questionnaires showed that experimental Ss had significantly more knowledge of the follow-up program and greater congruence of therapy expectations. A generalized behavioral effect also occurred; the two experimental groups had a higher rate of transfer success (82%) than the controls (59%). No differences in therapy persistence were observed. These findings suggest that mental health centers might improve transfer success by providing inpatients with detailed information about community aftercare programs.     

构建高校学生心理健康教育411模式的实践与探索

目的通过对大学生心理健康教育411模式的探索,总结和构建出一个比较完善的高等学校学生心理健康教育与心理辅导工作的组织体系与运行机制。方法对每一级组织的设立与人员配备,成员的培训与要求,工作的范围与职能,机制的运行与组织协调等进行比较详细地论述。结论构建高校学生心理健康教育411模式,是开展大学生心理健康教育与心理辅导工作的有效途径。     

Gastroenterologists' perceptions of need and availability of psychiatric services for patients with hepatitis C

The authors examined gastroenterologists' perceptions of psychiatric comorbidity in hepatitis C, access to, and use of psychiatric services. An eight-item survey was mailed to gastroenterologists, with a total of 75 participating. Fifty-eight (77.3%) agreed with the statement "My patients with hepatitis C have significant rates of psychiatric and substance-abuse comorbidity." Less than half (41%) agreed or strongly agreed that "My patients with hepatitis C have adequate access to psychiatric consultation." However, only eight (11%) referred to a mental health provider. Gastroenterologists are aware of the need for psychiatric services for their hepatitis C patients, but few refer for it, and access may be limited.     

Mental health consultation for a clinical law training program

Interaction between mental health professionals and the legal system has been essentially unproductive. Psychologists have traditionally been limited to two basic roles: (1) expert witnesses and (2) therapists for offenders. This paper describes a mental health consultation program which attempted to develop an innovative and productive relationship between psychologists and the legal system. The goal of the consultation was to increase the ability of law students to be more sensitive and responsive to their clients' complex psychological-social problems. The consultation focused on enhancing the skills of law professors to teach basic interviewing techniques and to integrate these techniques into a model for legal counseling which is more responsive to the clients' total needs. Significant differences between legal and psychological counseling are described, and areas for future consultation by community psychologists are identified.     

Relationship Between Allergic Rhinitis and Mental Health in the General Korean Adult Population

Purpose

This study was conducted to evaluate the association between AR and mental health status in the general Korean adult population and to investigate the relative burden of AR on mental health using the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification.

Methods

A cross-sectional study was performed by using data from 11,154 individuals, 19 years old or older in the Korean National Health and Nutrition Examination Survey 2011-2012. Univariate analysis was conducted in the healthy AR groups with weighted prevalence of demographic characteristics, socioeconomic status, and comorbid diseases. Subanalysis that classified AR severity according to the ARIA classification was carried out to evaluate the relationship of AR severity with mental health. The odds ratios (ORs) for each component representing mental health status were estimated by multiple logistic regression analysis with confounder adjustment.

Results

Univariate analysis with the chi-square test after adjustment for age, sex, body mass index, smoking status, alcohol use status, and exercise status, components representing mental health status showed a linear relationship with the severity of AR according to the ARIA classification. Stress, depressive mood, suicidal thoughts, and psychological consultation factors were correlated with AR after adjustment for demographic characteristics and socioeconomic status. Even after adjustment for comorbid allergic diseases, the correlation remained significant with stress, depressive mood, and psychological consultation factors (OR [95% CI]; 1.227 [1.042, 1.445], 1.368 [1.095, 1.71], 1.804 [1.096, 2.969], respectively).

Conclusions

Patients with AR appear to be at higher risk of mental disorders in the general Korean adult population. Moreover, persistent or severe AR was correlated with poor mental health. Therefore, better control of AR may be conducive to better mental health, and more attention should be paid to the psychological status of AR patients.     

Psychiatric aspects of patients with HIV infection in the general hospital

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.     

A Digital Feedback System to Support Implementation of Measurement-Based Care by School-Based Mental Health Clinicians

Evidence supports the utility of measurement-based care (MBC) to improve youth mental health outcomes, but clinicians rarely engage in MBC practices. Digital measurement feedback systems (MFS) may reflect a feasible strategy to support MBC adoption and sustainment. This pilot study was initiated to evaluate the impact of a MFS and brief consultation supports to facilitate MBC uptake and sustainment among mental health clinicians in the education sector, the most common mental health service delivery setting for youth. Following an initial training in MBC, 14 clinicians were randomized to either a digital MFS and brief consultation supports or control. Baseline ratings of MBC attitudes, skill, and use were collected. In addition, daily assessment ratings tracked 2 core MBC practices (i.e., assessment tool administration, provision of feedback) over a 6-month follow-up period. Clinicians in the MFS condition demonstrated rapid increases in both MBC practices, whereas the control group did not significantly change. For clinicians in the MFS group, consultation effects were significant for feedback and approached significance for administration. Over the follow-up period, average decreases in the current study were moderate with only 1 of the 2 outcome variables (administration) decreasing significantly. Inspection of individual clinician trajectories revealed substantial within-group trend variation. MFS may represent an effective MBC implementation strategy beyond initial training, although individual clinician response is variable. Identifying feasible and impactful implementation strategies is critical given the ability of MBC to support precision health care.     

A follow-up study of psychiatric consultations in the general hospital: What happens to patients after discharge?

BACKGROUND: An appropriate follow-up is considered essential in the consultation-liaison psychiatry setting, but it is often neglected. This study evaluated the effectiveness of the psychiatric consultation process in the general hospital, by investigating what occurred to patients 3-5 months after discharge. METHODS: We used a three-part questionnaire: (1) the results of the consultation process; (2) a telephone interview with patients, and (3) a telephone interview with the patients' primary care physician, to whom the patients were referred after discharge from hospital. We contacted all consecutive, unselected patients referred to psychiatric consultation from January to July 1999. Complete data were available for 119 patients from an initial group of 318. RESULTS: The consultation process was well accepted by patients and useful to general hospital physicians to complete the final diagnosis of the patient when discharged from hospital. In most cases (78.9%), the psychiatric letter was attached to the discharge letter. The second part of the questionnaire indicated that most patients were satisfied with the consultation process. They thought it helped focus their problems and 60% asserted that they felt better after following their psychiatrists' instructions or therapy. The primary care physicians agreed with the diagnostic results of the psychiatric consultation, mainly followed the psychiatrists' advice, and generally expressed positive comments about the consultation-liaison service. CONCLUSIONS: Compliance of hospital physicians, patients, and primary care physicians was good. Follow-up studies on outcome of psychiatric consultations are few and further analysis is strongly recommended.     

Stigmatizing attributions about mental illness

Work and housing opportunities of persons with psychosis, substance abuse disorder, and other mental illnesses are significantly hampered by societal stigma. Earlier research by Weiner and colleagues (1988) examined stigmatizing attitudes associated with general health disabilities in terms of attributions about the controllability and stability of these disabilities. The relevance of this model for describing attributions about four psychiatric disorders is examined in this study. One hundred and fifty two adults rated four psychiatric groups (cocaine addiction, depression, psychosis, and mental retardation) and two physical health groups (cancer and AIDS) on six items corresponding with controllability and stability attributions. Findings from a factor analysis supported the distinction between controllability and stability factors. Results also suggested that mental health disabilities were rated more negatively on these factors than physical disabilities. Participants clearly discriminated among mental health disabilities, with cocaine addiction rated most negative in terms of controllability and mental retardation rated most negative in terms of stability. Attribution analyses provide useful information for changing the community's reactions to persons with mental illness. © 2000 John Wiley & Sons, Inc.     

Improving psychiatric consultation to nonpsychiatrist physicians

Nonpsychiatrist physicians were surveyed regarding problems that they had experienced when seeking a psychiatric consultation or treatment referral. They gave three main reasons for not referring more patients to psychiatrists: a belief that other mental health professionals could do as well at less cost, that psychiatrists were less available to discuss patients, and that greater stigma was attached to seeing a psychiatrist than seeing other mental health professionals. Psychiatrists might improve their consultation and referral networks by addressing the misperceptions of their nonpsychiatrist physician colleagues.