(August 27, 2019) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about serious mental illness and summarizes recently published research reports or developments.
DATAPOINT of the Month
- More than one-third of college students have been diagnosed with a psychiatric condition.
Based on a ten-year analysis of college student mental health, 35.5% of U.S. college students have been diagnosed with a mental disorder at some point in their lifetime. For the purposes of the study, a mental disorder is defined by a wide range of diagnoses, including depression, anxiety, bipolar disorder, neurodevelopmental disorders, substance use disorders, and psychosis. The statistic represents the highest lifetime prevalence rate for this population since at least 2007. As current students head back to school, education professionals, families, and students alike should be mindful of the growing psychiatric need on college campuses and the importance of timely treatment; particularly for serious mental illness, when early intervention is critical to long-term recovery.
RESEARCH of the Month
- Resource utilization based on location of first schizophrenia diagnosis.
The location at which young adults are first diagnosed with schizophrenia may impact the amount and type of resources they use in the year following that diagnosis, according to an analysis of administrative claims data recently published in Schizophrenia Bulletin. Overall, 80% of young adults utilized outpatient services and just 36% filled prescriptions for antipsychotic medications in the post-diagnosis period.
The researchers also found notable differences in service utilization based on where the first diagnosis occurred. Among the findings, young adults diagnosed in an inpatient setting were most likely to fill an antipsychotic prescription in the following year, and those diagnosed in a hospital-based or community-based outpatient setting were most likely to receive outpatient mental health services. Young adults diagnosed at an emergency department were most likely to require inpatient care within the year following their diagnosis.
The study’s authors conclude by noting “widespread missed opportunities” for care coordination among hospital and community treatment providers, and that efforts should be made to improve these relationships and better facilitate effective treatment for young adults diagnosed with schizophrenia before relapse occurs.
Gilmer, T. P., et al. (2019). Service use following first-episode schizophrenia among commercially insured youth. Schizophrenia Bulletin.
- Lung cancer risk perception and clinician assistance with smoking cessation among adults with schizophrenia.
Individuals with schizophrenia die from smoking-related diseases such as lung cancer at double the rate of the general population. Despite this troubling reality, research suggests that most individuals with schizophrenia (between 60% and 80%) still currently smoke. In a study recently published in Psychiatric Services, researchers surveyed individuals with schizophrenia being treated at a community mental health clinic to gauge their smoking habits and personal perception of cancer risk, as well as any assistance received from primary care providers and psychiatrists to help them quit smoking.
The results aligned with prior research on schizophrenia and tobacco use, with nearly 80% of participants identifying themselves as current or former smokers. And based on factors such as age and an average smoking history of more than 30 packs per year, 34% of older participants were eligible for lung cancer screening. For younger participants, 78% of current smokers would be eligible if they continued to smoke as they age. However, more than half of current and former smokers said they “rarely or never” worry about getting lung cancer and that their risk for developing the disease is “very to somewhat low.” Older adults were particularly unlikely to worry about developing lung cancer. Participants also indicated that assistance with smoking cessation from primary care providers and clinic psychiatrists, either through medication or referral to counseling, was relatively uncommon. The study authors suggest a number of strategies to address lung cancer risk among this population, including reassessing the ideal age for initial screening and better coordination between primary care providers and psychiatrists in helping current smokers quit.
Irwin, K. E.,et al. (2019). Lung cancer screening eligibility, risk perceptions, and clinician delivery of tobacco cessation among patients with schizophrenia. Psychiatric Services.
- Brief Jail Mental Health Screen across multiple jail bookings.
The Brief Jail Mental Health Screen (BJMHS) is a survey used by county jails to identify individuals with serious mental illness who require further evaluation by a mental health professional and may need treatment. The survey asks questions related to current psychiatric symptoms, current use of psychiatric medication, and prior hospitalization. Jail staff can also refer individuals for evaluation at their own discretion “for any other reason.” Citing a lack of research on the reliability of BJMHS results over time, researchers investigated whether the same individual could have differing results across repeated jail bookings and discussed the implication of the findings for future use of the tool.
The researchers analyzed data from a large, urban jail, which were comprised of BJMHS results for more than 12,500 detainees with at least two bookings over 3.5 years. The analysis indicates that individual results do change over time, with chances of a positive screen increasing across bookings. The authors note that this increase was driven mostly by jail staff use of the discretionary referral option, which indicates a significant influence of staff judgments on the fate of individual screen results. In contrast, the likelihood of screening positive specifically on indicators of prior hospitalization and current symptoms decreased across bookings. Unstable responses may not necessary reflect clinical changes among jail populations, say the study authors, but a number of reporting problems such as incorrect histories provided by detainees, fear, apathy, or fatigue about repeatedly disclosing mental health information, or administration errors. The authors stress the importance of high-quality, reliable tools to identify individuals with serious mental illness in jails, and advocate for further research to ensure surveys like the BJMHS and their administration by jail staff are meaningful and accurate over time.
Zottola, S. A., et al. (2019). Results of the Brief Jail Mental Health Screen across repeated jail bookings. Psychiatric Services.
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center
Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
