Selection from the latest research impacting C-L Psychiatry
Climate Change: The Scale of Emotional and Psychological Effects upon Children
Research: Climate Anxiety in Children and Young People and their Beliefs about Government Responses to Climate Change: A Global Survey
Authors: Caroline Hickman, et al.
Abstract/Extract: Mary Burke, MD, has chosen this research as one of three reports for a new section on climate change in this quarter’s Annotations, prepared by the ACLP Guidelines & Evidence-Based Medicine Subcommittee.
This is the first large, global study of young people’s psychological response to climate change. The researchers surveyed 10,000 children and young people, aged 16-25, in 10 countries (Australia, Brazil, Finland, France, India, Nigeria, Philippines, Portugal, the UK, and the US—1,000 participants per country).
“Across multiple geographic and economic demographics, young people report feeling high levels of distress, and betrayal by their governments for failing to act,” says Dr. Burke. “Climate anxiety is a practical, non-pathological response to reality. However, the pervasive experience of anxiety about the future can exacerbate other anxieties or increase vulnerability to mental illnesses.”
Young people in India and the Philippines reported the highest levels of distress—74% in both countries reported that their worry impacted functioning, and 35% and 49% respectively reported they were extremely worried. Young people in the US reported the least distress, with only 26% reporting impact on function, and 19% reporting extreme distress.
The authors build on smaller-scale studies they have done previously. They do not specifically address mental illness per se but, rather, negative feelings that correspond to feeling betrayed by those in power. Their closing comments are: “As a research team, we were disturbed by the scale of emotional and psychological effects of climate change upon the children of the world, and the number who reported feeling hopeless and frightened about the future of humanity.”
Importance: Mental health clinicians who treat young people should be aware of the increasingly pervasive and intense pessimism about the future in these generations.
Availability: ACLP’s Annotations this quarter is here.
Peer Recovery Specialists and Telehealth Work Well Together
Research: Virtual Engagement with Peer Recovery Specialists for Patients with Substance Use Disorders Hospitalized during the COVID-19 Pandemic: A Case Report
Authors: Kate Fruitman, BS, et al.
Abstract/Extract: Growing appreciation for the role of recovered individuals—those who share experiential knowledge on the struggle of addiction and recovery—in connecting patients to substance use disorder (SUD) treatment is acknowledged in this case report.
Peer Recovery Specialists (PRS) services are designed to link patients with SUD with peers trained in the provision of emotional and informational support. These programs have been successfully implemented across a variety of health care settings, including acute environments such as the emergency departments. Peers have been shown to reduce substance use and increase treatment retention among patients with PRS exposure.
Teleconference-based health care delivery has been shown to be effective in the treatment of a variety of SUDs, including Alcohol Use Disorder (AUD), opioid use disorder, and nicotine use disorder.
But “despite mounting evidence for both the utilization of PRS services and telehealth platforms in the treatment of patients with SUD, there is a paucity of literature exploring the adaptation of peer intervention resources to virtual encounters during the COVID-19 pandemic,” say the authors.
So, they present a novel case report documenting the virtual engagement of a PRS with a patient with AUD and the subsequent successful connection to long-term telemedicine-based SUD treatment.
Importance: In a spring 2020 survey of mental health providers in the US, most expressed positive experiences with telepsychiatry; the majority reported that they would want to continue to use telehealth platforms for at least 25% of their caseload. In a survey of peers in the US, more than half reported that changes in their job as a result of the pandemic were largely positive, with many citing the benefits of integrating virtual support services.
Virtual peer programs may therefore represent a low-resource strategy by which patients can engage with a PRS on a mutually convenient platform.
Availability: Pre-publication in the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP)
Causes of Death for Patients who Receive Specialty Emergency Psychiatric Services
Research: More than Suicide: Mortality after Emergency Psychiatric Care and Implications for Practice
Authors: Scott Simpson, MD, FACLP, et al.
Abstract/Extract: Emergency department (ED) patients with behavioral health presentations, particularly suicidal ideation, are at increased risk of death by suicide, medical illness, trauma, or overdose. Causes of death for patients who receive specialty emergency psychiatric services remain undescribed. So, the authors set out to describe the incidence and cause of death after care in a psychiatric emergency service (PES).
Mortality data were obtained for all adult patients treated in a safety net ED from April 2016 to June 2020. Causes of death were categorized as medical, external (accidents, overdoses, and homicide), or suicide and compared between PES patients and ED patients who were not treated in the PES.
The authors analyzed 164,422 encounters including 6,063 PES visits. Mortality in the 30 days after discharge was 0.3% among PES patients and 0.6% among medical ED patients. At both 30 and 365 days, PES patients were more likely to die by suicide than were medical ED patients, and ED patients were more likely to die by medical causes.
The authors concluded that most patients who die after receiving emergency psychiatric care die by medical and external causes such as accidents, overdose, and homicide. Patients who are older and have opioid or stimulant use disorders are at higher risk of non-suicide mortality. “We propose interventions to re-imagine emergency psychiatric care and address non-suicide mortality among psychiatric patients treated in emergency and crisis settings,” say the authors.
Importance: More than 10% of the over 130 million ED visits a year in the US involve a mental health diagnosis. This high volume reflects EDs’ accessibility and role as safety net providers for underserved communities and for patients with acute mental health symptoms such as suicide risk and agitation.
Mental health clinicians provide care in a variety of forms in emergency and crisis settings. One care model includes dedicated psychiatric emergency service (PES) for treating the highest acuity patients. Units such as a PES provide high-quality emergency psychiatric care that decreases the need for psychiatric hospitalization, shortens boarding times, and reduces future ED utilization.
A better understanding of the causes and risks of death among emergency psychiatric patients is necessary for improving treatment in this care setting.
Availability: Pre-publication in the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP)
Impact of Positive and Negative Psychological Factors Occurring Together
Research: The Association of Efficacy, Optimism, Uncertainty and Health Anxiety with Inflammatory Bowel Disease Activity
Authors: James Stone, et al.
Abstract/Extract: Both positive and negative psychological attributes have been shown to influence disease outcomes in many chronic health conditions. Here the authors aimed to evaluate the association between self-efficacy, optimism, health anxiety, and intolerance of uncertainty and disease activity in inflammatory bowel disease (IBD).
The study illustrates the need for further research on how psychological variables relate to disease activity, and whether targeting psychological therapies to challenge anxiety and facilitate psychological resilience would translate into better outcomes.
Importance: Self-efficacy and optimism are considered positive or potentially protective psychological attributes as they are strength-based aspects of functioning, while anxiety about disease and health and difficulty coping with uncertainty are categorized as negative attributes.
Self-efficacy, which relates to patients’ belief they can successfully manage a situation, has been shown to have positive associations in chronic disease, including improving mobility in post-stroke patients, glycemic control in diabetic patients, physical functioning in cancer patients—and it is associated with improved patient reported outcomes in IBD patients.
In a cardiac population, optimism has been associated with improved cardiac health and decreased levels of inflammatory markers, while pessimism was associated with increased levels of inflammation.
Most IBD literature to date has focussed on negative psychological functioning including stress, inability to cope, psychological distress, pessimism, and anxiety—and only modest attention has been given to single domains of positive functioning (e.g., self-efficacy).
While positive psychological attributes, such as self-efficacy and optimism, have been associated with improved patient-reported health outcomes in IBD patients, the association of both positive and negative psychological functioning with multiple measures of disease activity has not previously been examined together in a single IBD sample.
Availability: Pre-publication in the Journal of Psychosomatic Research
How to Avoid Emergency Department Return Visits
Research: Emergency Department Patient Navigator Program in Reducing ED Return Visits and Improving Outpatient Follow-up Adherence
Authors: Lynn Jiang MD, et al.
Abstract/Extract: An estimated 56% of emergency department (ED) visits are avoidable. One motivation for return visits is patients' perception of poor access to timely outpatient care. Efforts to facilitate access may help reduce preventable ED visits.
So the authors analyzed whether an ED patient navigator (PN) program improved adherence with outpatient appointments and reduced ED return visits.
They retrospectively analyzed patients evaluated and discharged from two EDs from October 2016 to December 2019. Using propensity score matching, an intervention case group was matched against two control groups—similar patients to the case group who presented either:
- Pre-PN intervention or
- Post-PN intervention and did not receive intervention.
There was a total of 14,295 patients in each group.
PN intervention decreased both acute and subacute ED return visits. Navigated patients also had outpatient appointment adherence rates of 74-80% compared to the estimated national average of 25-56%.
Importance: By facilitating access to post-ED care, PNs may reduce avoidable ED utilization and improve outpatient follow-up adherence.
Availability: Pre-publication in The American Journal of Emergency Medicine
