Vol 8-2 Research Article

Tele-Psychiatry to address Severe Persistent Mental Illness in Rural Communities: An Economic and Break-Even Analysis

Sarah C. Haynes1,2*, James P. Marcin1,2, Peter Yellowlees3, Stephanie Yang1, Jeffrey S. Hoch4,5

1Department of Pediatrics, University of California Davis, Sacramento, California, USA

2Center for Health and Technology, University of California Davis, Sacramento, California, USA

3Department of Psychiatry, University of California Davis, Sacramento, California, USA

4Department of Public Health Sciences, University of California Davis, Sacramento, California, USA

5Center for Healthcare Policy and Research, University of California Davis, Sacramento, California, USA

Background: People living in rural communities experience significant barriers accessing mental health care, including a shortage of psychiatrists and other behavioral health specialists. Telemedicine has the ability to improve access for these populations by allowing psychiatrists in urban settings to treat rural patients over video. However, start-up costs may hinder implementation of new tele-psychiatry programs.

Materials and Methods: We created a model to estimate the point at which tele-psychiatry would financially break even based on estimates of improved access to outpatient care for people with schizophrenia and bipolar disorder. We demonstrate how our model can be used with an example of a tele-psychiatry program serving five rural Indian Health Services clinics in California.

Results: When reimbursement for psychiatric services provided over telemedicine is relatively low compared to reimbursement for hospitalization visits, changes in the ratio of hospitalizations to telemedicine visits have very little impact on required hospitalization improvement.

Conclusions: Tele-psychiatry programs are likely to break even within the first three years when providing psychiatry services to a rural community with a scarcity of mental health services. Our findings are important because they indicate that the cost of improving access to tele-psychiatry services is likely low compared to the potential cost savings associated with reduced hospitalizations for people with severe persistent mental illness.

DOI: 10.29245/2578-2959/2024/2.1313 View / Download Pdf
Vol 8-2 Review Article

Barriers and Solutions to Comprehensive Care for Mental Health Patients in Hospital Emergency Departments

Elizabeth Levin1*, Husam Aburub2

1Department of Psychology, Laurentian University, Sudbury, Ontario, Canada

2Health Sciences North, Sudbury, Ontario, Canada

Hospital emergency departments in Ontario, have become a common place for patients with mental health problems to seek treatment. Studies report healthcare providers have limited knowledge and competency to provide optimal care for patients with mental health problems. As a result, these patients are at risk of poor hospital experiences and treatment outcomes. In addition, emergency staff report considering patients with mental health problems lower priority to other patients. This paper reviews the existing literature and examines the challenges surrounding patients with mental health problems seeking treatment in emergency rooms and how it leads to sub-optimal care. Strategies are then shared to overcome these challenges by changing emergency department experiences for mental health patients seeking treatment.

DOI: 10.29245/2578-2959/2024/2.1302 View / Download Pdf
Vol 8-2 Research Article

Effects of Interpersonal Psychotherapy on Postpartum Depression among Females at Tertiary Care Hospital Lahore

Sehrish Arshad1*, Muhammad Afzal2, Hajra Sarwar3

1Doctors Hospital College of Nursing and Allied Health Sciences, Lahore, Pakistan

2Director Academics Faculty of Allied Health Sciences, University of Lahore, Pakistan

3University of Lahore, Pakistan

Introduction: Postpartum depression (PPD) is a major public health issue among females after giving birth to the baby, characterized by low mood, feeling of guilt and suicide. When left untreated, it has the potential for a profound negative impact on mothers, children and families. The efficacy of interpersonal psychotherapy (IPT) in addressing depression has been well-documented. However, the impact of IPT on PPD remains inadequately substantiated, particularly within the context of Pakistan, where data pertaining to its effectiveness remains limited.

Objective: The aim of study was to assess the level of depression in postpartum females and evaluate the effects of IPT on PPD among females at tertiary care hospital Lahore.

Methods: A Randomized controlled trial (RCT) was conducted at the Services Hospital Lahore from September 2021 to the same month in 2023. Subjects (n=110) were screened using the hamilton depression rating scale (HDRS) and divided equally in intervention group and control group to get eight sessions of individual based IPT versus routine care. Data was analyzed using SPSS version 21, intergroup comparison was done by Mann Whitney U test for intra group comparison Wilcoxon Signed Rank test was used, with 95% Confidence Interval (CI) and 5% level of significance. Significance of result showed with p value <0.05.

Results: Prevalence of PPD among female was observed 82%. Upon receiving IPT, females exhibited a statistically significant reduction (p<0.001) in scores indicative of mild depression, from 48 (87.3%) to 5(9.1%), as well as for moderate depression, from 7(12.7%) to 1(1.8%). Furthermore, following the IPT sessions, marked improvements were noted within the intervention group across various domains including depressed mood p<0.001, CI (0.000, 0.027), feelings of guilt p<0.001, CI (0.000, 0.027), early night insomnia p<0.008, CI (0.000, 0.043), impaired work and activities p<0.05, CI (0.072, 0.200), and insight p<0.001, CI (0.000, 0.027). Conversely, the control group did not exhibit any significant alterations in these parameters.

Conclusion: The results indicate a concerning prevalence rate of PPD among the study sample with many cases remaining undiagnosed and untreated. More positively, the study demonstrates the potential of IPT as an effective method to mitigate mild to moderate PPD. This research suggests the incorporation of IPT into therapeutic models could result in timely, potentially preventive interventions and lessen the occurrence of severe complications.

DOI: 10.29245/2578-2959/2024/2.1301 View / Download Pdf
Vol 8-2 Original Article

Sex Differences in the Relationship Between Nucleus Accumbens Volume and Youth Tobacco or Marijuana Use Following Stressful Life Events

Shervin Assari1,2,3*, Payam Sheikhattari4,5,6

1Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

2Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

3Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

4Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA

5The Prevention Sciences Research Center, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

6Department of Public and Allied Health Sciences, School of Community Health and Policy, Morgan State University, Baltimore, MD, USA

Background: Exposure to stressful life events (SLEs) can upset balance and affect the healthy brain development of children and youths. These events may influence substance use by altering brain reward systems, especially the nucleus accumbens (NAc), which plays a key role in motivated behaviors and reward processing. The interaction between sensitization to SLEs, depression, and substance use might vary between male and female youths, potentially due to differences in how each sex responds to SLEs.

Aims: This study aims to examine the effect of sex on the relationship between SLEs, Nucleus Accumbens activity, and substance use in a nationwide sample of young individuals.

Methods: We utilized data from the Adolescent Brain Cognitive Development study (ABCD), a longitudinal study of pre-adolescents aged 9–10 years, comprising 11,795 participants tracked over 36 months. Structured interviews measuring SLEs were conducted using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Initial linear regression analyses explored if SLEs could predict volumes of the right and left NAc. Subsequently, Cox regression models were used to investigate how SLEs and NAc volume might predict the initiation of tobacco and marijuana use, with the analysis stratified by sex to address potential sex differences.

Results: Our findings reveal that SLEs significantly predicted marijuana use in males but not in females, and tobacco use was influenced by SLEs in both sexes. A higher number of SLEs was linked with decreased left NAc volume in males, a trend not seen in females. The right NAc volume did not predict substance use in either sex. However, volumes of both the right and left NAc were significant predictors of future tobacco use, with varying relationships across sexes. In females, an inverse relationship was observed between both NAc volumes and the risk of tobacco use. In contrast, a positive correlation existed between the left NAc volume and tobacco and marijuana use in males, with no such relationship for females.

Conclusion: This study underscores that the associations between SLEs, NAc volume, and subsequent substance use are influenced by a nuanced interplay of sex, brain hemisphere, and substance type.

DOI: 10.29245/2578-2959/2024/2.1305 View / Download Pdf