Typology of Currently or Formerly Homeless Individuals Based on Their Use of Health and Social Services

Community Mental Health Journal - This study identified profiles among 455 currently or formerly homeless individuals in Quebec (Canada), based on health and social service use. Using latent class...     

The social and economic impact of the Montreal Longitudinal and Experimental Study

Background

The effectiveness of early prevention programmes and their viability as a public policy option have increasingly caught the attention of scholars and policymakers. Given the implementation costs of such programmes, it is important to assess whether they achieved anticipated objectives and whether they made efficient use of taxpayer money.

Aim

To discuss the social and economic impact of a 2-year randomised intervention aimed to improve social skills and self-control (i.e., non-cognitive skills) among disruptive boys from low-income neighbourhoods in Montreal.

Method

We review findings from published studies documenting the impact of the intervention at different stages of the life course, as well as its cost-effectiveness and cost-benefit.

Results

The intervention improved behavioural indicators throughout adolescence and eventually led to greater high school graduation rates, reduced crime, and better labour market outcomes in adulthood. Importantly, the prevention programme generated considerable returns to taxpayer investments.

Conclusion

Findings from the Montreal Longitudinal Experimental Study have been well-received and have contributed to an early prevention ‘awakening’ in Quebec and elsewhere.

     

A Typology of UK Slot Machine Gamblers: A Longitudinal Observational and Interview Study

Slot machine gambling is a popular leisure activity worldwide yet there has been very little research into different types of slot machine gamblers. Earlier typologies of slot machine gamblers have only concentrated on adolescents in arcade environments. This study presents a new typology of slot machine players based on over 1000 h of participant and non-participant observation, and informal interviews with slot machine players in a range of UK gambling environments. Three key behavioural variables were systematically and consistently observed during the field research. These were (a) ability (i.e., how proficient the person was at gambling on a slot machine), (b) control (i.e., how controlled the person was in their playing of slot machines), and (c) time spent gambling (i.e., frequency of visits and duration gambling session). These three behavioural variables were then used to develop a new typology of slot machine gamblers. Overall six types of UK slot gambler were observed based on the three behavioural variables. These were: The Dedicated Professional, The Dedicated Impulsivist, The Dedicated Amateur, The Part-time Professional, The Part-time Impulsivist and The Casual Amateur. The implications for problem gambling and treatment of these different sub-types are also assessed.     

A Comparison of Treatment Outcomes for Individuals with Substance Use Disorder Alone and Individuals with Probable Dual Diagnosis

The co-occurrence of substance use and mental health problems, often referred to as dual diagnosis (DD), is increasingly recognised as commonplace within substance abuse treatment programs. Two-hundred and thirty-four individuals from 9 Australian Salvation Army drug and alcohol rehabilitation programs completed a 3-month post-discharge telephone follow-up. Using a cut-off score from the Psychiatric Subscale of the Addiction Severity Index (5^th ed.), 66.7% were classified as likely to have DD and 33.3% as substance use disorder only (SUD). Both groups reported comparable and decreased substance use levels at follow-up, yet DD individuals perceived less improvement in substance use problems. Comparable improvements were reported in the areas of: symptom distress and recovery from symptoms. This was despite greater scope for improvement in individuals with DD. Duration of treatment and access to post treatment services were also assessed. Understanding factors effecting treatment outcomes is imperative for the implementation of effective, evidence based treatment programs.     

Cognitive Behavioral Intervention for Individuals with Severe Mental Illness Who Have a Substance Misuse Problem

Abstract

There have been considerable advances in the use of psychological treatments for individuals with psychosis in the last 20 years or so. This paper describes an ongoing study in which these treatment approaches are being modified and combined for use with a particularly challenging client group–those with a diagnosis of schizophrenia who have a comorbid drug or alcohol problem. Prevalence rates for such individuals with “dual diagnosis” are high, with surveys indicating that from 20%-60% of clients with schizophrenia may have a substance use problem. More importantly, there is evidence that clinical outcomes are worse for this group and that persons in treatment present many difficulties for services, for example, frequent hospital admissions, violence, engagement problems, and noncompliance. Although there are accounts and evaluations of integrated treatment strategies in the U.S. (Drake et al., 1989; 1991), there is little published work from the UK demonstrating an integration of treatments targeted at both the mental health and substance use problems.     

An Ethnographic Study of the Longitudinal Course of Substance Abuse Among People with Severe Mental Illness

A two-year ethnography conducted among 16 dually diagnosed clients yielded two longitudinal findings. First, four positive quality of life factors were strongly correlated with clients' efforts to cease using addictive substances: (1) regular engagement in an enjoyable activity; (2) decent, stable housing; (3) a loving relationship with someone sober who accepts the person's mental illness; and (4) a positive, valued relationship with a mental health professional. Second, the study revealed that five negative background factors in participants' childhood homes were predictive of long-term continuation of substance use: (1) substance abuse in childhood home, (2) childhood household in dire poverty, (3) non-functional household members, (4) reporting of abuse imputed to care-givers, and (5) serious mental illness in household. The implications of these findings for treatment are discussed.     

Migraine headaches are not associated with a unique depressive symptom profile: results from the Baltimore Epidemiologic Catchment Area Study

OBJECTIVE: There is a well-established link between migraine headaches and depression. However, it is unclear whether individuals with migraine experience a unique profile of depressive symptoms in comparison to individuals without migraine. METHODS: This question was addressed using data from the Baltimore cohort of the Epidemiologic Catchment Area Study. The cross-sectional association between migraine headaches and each depressive symptom was calculated using logistic regression, and symptom profiles among those with migraine headaches (n=249) and those without (n=1480) were compared using generalized estimating equations. RESULTS: Migraine headaches were associated with increased odds of reporting seven of nine depressive symptom groups by a factor of roughly 2. However, when the symptom profiles were compared, individuals with migraine headaches did not differ in their profile of symptoms. CONCLUSION: These results suggest that individuals with migraine headaches are more likely to report depressive symptoms but do not display a unique profile of symptoms.     

Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders

This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen’s model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.     

One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites

One-month prevalence results were determined from 18,571 persons interviewed in the first-wave community samples of all five sites that constituted the National Institute of Mental Health Epidemiologic Catchment Area Program. US population estimates, based on combined site data, were that 15.4% of the population 18 years of age and over fulfilled criteria for at least one alcohol, drug abuse, or other mental disorder during the period one month before interview. Higher prevalence rates of most mental disorders were found among younger people (less than age 45 years), with the exception of severe cognitive impairments. Men had higher rates of substance abuse and antisocial personality, whereas women had higher rates of affective, anxiety, and somatization disorders. When restricted to the diagnostic categories covered in international studies based on the Present State Examination, results fell within the range reported for European and Australian studies.     

Jewish Americans and mental health: results of the NIMH Epidemiologic Catchment Area Study

Summary Data from the Epidemiologic Catchment Area Study showed that the overall lifetime rate of psychiatric disorder among Jews did not differ from the rate among non-Jews. However, there was a significant difference between Jewish and non-Jewish samples when comparing the distribution of specific psychiatric disorders. Compared with Catholics and Protestants, Jews had significantly higher rates of major depression and dysthymia, but lower rates of alcohol abuse. Jews were more likely than Catholics or Protestants to seek treatment with mental health specialists and general practitioners. These differences remained statistically significant after adjusting for sex, age, race and socioeconomic status.     

Exploring the Psychometric Properties of the Spiritual Well-Being Scale Among Individuals with Substance Use Disorders

Although spirituality seems to be an important protective factor in the treatment of addiction, a serious limitation within the current literature involves a lack of research examining the psychometric properties of scales that measure spirituality among individuals struggling with substance use disorders (SUDs). The purpose of this study was to investigate the psychometric properties of the Spiritual Well-Being Scale (SWB) among a sample of 305 individuals recruited from a residential substance abuse treatment center. Exploratory factor analyses supported the scale’s original structure. Validity and reliability tests suggested the SWB could be useful in assessing spiritual well-being among individuals with SUDs.     

药物依赖者人格特征的研究

本文通过对近年来国内外在药物依赖者及其人格特征之间关系的研究成果进行了综述。结果表明，药物依赖者在形成药物依赖前具有一定的潜在人格缺陷；而在药物依赖形成的过程中，人格成长出现病态发展倾向，并在人格缺陷基础上进一步发展、强化为病态人格；在药物依赖戒断后，人的记忆模式发生了改变，导致戒断后的药物渴求行为和焦虑情绪的表现等。     

Differences in Symptom Severity and Independent Living Skills Between Re-hospitalized and Not Re-hospitalized Individuals with Schizophrenia: A Longitudinal Study

This study determined if schizophrenia symptom severity and independent living skills at discharge, or while residing in the community, predicted re-hospitalization for discharged patients with schizophrenia. A total of 60 patients were discharged from a state psychiatric hospital and had completed assessments at discharge, 6 months, and 1 year post discharge. There were 12 patients who were re-hospitalized. There were no differences between the re-hospitalized and not re-hospitalized groups based on third-party ratings of schizophrenia symptom severity and independent living skills. However, the patients’ self-report and third party ratings of deteriorating general mental health symptoms 6 months after discharge predicted re-hospitalization.     

Low Risk of Development of Substance Dependence for Barbiturates and Clobazam Prescribed as Antiepileptic Drugs: Results from a Questionnaire Study

There is no systematical research about the topic of dependence on antiepileptic drugs (AED) for patients with epilepsy, despite the fact that barbiturates and benzodiazepines comprise a potential risk of dependence. We hypothesize that there is no psychological substance dependence for patients with epilepsy, possibly because of their outcome expectations. The aim of the study was to examine these patients in terms of substance dependence. One hundred inpatients at the Lake Constance Epilepsy Center were asked about their experiences with AED in terms of dependence in a structured interview. We registered general statements about dependence of AED, markers for substance dependence, and outcome expectations. About 50% of the patients reported withdrawal symptoms and the development of tolerance, but less than 10% noticed loss of control and craving. Withdrawal symptoms and development of tolerance were significantly lower in a group of patients without barbiturates or clobazam versus patients with barbiturates or/and clobazam. There was no significant difference between these two groups in psychological criteria of dependence, that is, loss of control and craving. Outcome expectations of AED were clearly related to the efficacy against seizures, and only to a small amount to psychotropic effects. The study demonstrates that physiological variables of dependence are present more in patients with epilepsy with a permanent intake of barbiturates or clobazam, but psychological variables of dependence are rarely present in epileptic patients, with or without an intake of barbiturates and clobazam. These results confirm our hypothesis that substance dependence is not a major problem in benzodiazepines and barbiturates in patients with epilepsy. Outcome expectations seem to be related mainly to the anticonvulsant and not the psychotropic effect. This might be the reason for the absence of dependence.     

Prevalence and Course of Symptom-Defined PTSD in Individuals Directly or Indirectly Exposed to Terror: A Longitudinal Study

Objective: It is well established that direct exposure to terrorism can result in posttraumatic stress disorder (PTSD). However, individuals indirectly exposed to terrorism may also develop symptoms of PTSD. This study examined the prevalence and course of symptom-defined PTSD in employees who were present and not present at the site of a workplace terror attack. Methods: Survey data from ministerial employees were collected 10, 22, and 34 months after the 2011 bombing in the government district of Oslo. A total of 3,520 employees were initially invited to the study. Response rates of eligible participants were 56% (N = 1,974) at T1, 55% (N = 1,780) at T2, and 54% (N = 1,578) at T3. PTSD was measured using the Post-traumatic Stress Disorder Checklist—Specific (PCL-S). Symptom-defined PTSD was specified as meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), B, C, and D criteria. Results: Our findings showed a low and declining prevalence of symptom-defined PTSD in employees indirectly exposed to a workplace terror attack (4%, 3%, and 2% at the three respective times). In employees present at the site of the explosion, PTSD was six- to eightfold more prevalent (24%, 17%, and 17%). Conclusions: Individuals indirectly exposed to terrorism may develop long-lasting posttraumatic stress reactions fulfilling PTSD symptom criteria. Due to the large number of individuals that may be indirectly exposed to terrorism, even a low risk of PTSD may result in high numbers of individuals with substantial posttraumatic stress. Our findings have implications for the planning and implementation of health care services beyond those directly exposed after large-scale terror events.