A growing body of research has emerged to characterize differences in posttraumatic stress disorder (PTSD) symptom presentations in individuals from diverse racial and ethnic groups. However, less ...research has examined if these observed differences can be attributed to bias within PTSD assessments. Knowledge about potential bias in PTSD assessment is essential for interpreting group differences. If PTSD assessments do not perform similarly across diverse demographic groups, then observed differences may be artificial products of inaccurate measurement, new assessments could be required for individuals from different demographic groups, and we would be unable to accurately detect PTSD treatment effects in patients from diverse groups.
We evaluated PTSD assessment bias through tests of measurement invariance for the semistructured, clinician-administered AUDADIS-5 diagnostic assessment of participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III. Participants included those who reported having experienced at least one potentially traumatic event in their lifetime (
= 23,936). Measurement invariance was assessed for participants who identified from several demographic groups (Asian, Native Hawaiian, or Pacific Islander; Hispanic; American Indian/Alaskan Native; and Black) compared to participants who identified as White (non-Hispanic).
Overall, PTSD assessment was largely invariant across groups, while small amounts of measurement invariance were detected that can inform future research and clinical adaptations.
This work validates prior research that relies on a common conceptualization of PTSD, and it provides several paths for future improvement in research and clinical practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Length of stay (LOS) and boarding in the emergency department (ED) for psychiatric patients have been the subject of concern, given the problems with crowding and excessive wait times in EDs. This ...investigation examined correlates of LOS and boarding in Florida EDs for patients presenting with psychiatric complaints from 2010 to 2013.
Utilizing the Florida ED discharge database, the authors examined the association of LOS and boarding with hospital and encounter factors for adult patients presenting with a primary psychiatric diagnosis (N=597,541).
The mean LOS was 7.77 hours. Anxiety disorders were the most frequent psychiatric complaint and were associated with the lowest mean LOS compared with other diagnoses (p<.05). Patient encounters resulting in a presentation of intentional self-harm and suicidality or schizophrenia were associated with significantly longer stays compared with other psychiatric diagnoses. Commercial insurance was associated with the shortest average LOS. African Americans, Hispanics, and patients age 45 and older were associated with a longer average LOS. Smaller hospital size, for-profit ownership, and rural designation were associated with a shorter average LOS. Teaching status was not associated with LOS. Furthermore, 73% of encounters resulting in transfers qualified as episodes of boarding (a stay of more than six or more hours in the ED).
Extended LOS was endemic for psychiatric patients in Florida EDs.
Abstract Objective The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive–compulsive symptoms. Treatment determinations ...are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive–compulsive symptom severity. Method Nine hundred fifty-four adult patients with obsessive–compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions–Severity scale (CGI-Severity). Results Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R2 = .48). Y-BOCS scores of 0–13 corresponded with ‘mild symptoms’ (CGI-Severity = 0–2), 14–25 with ‘moderate symptoms’ (CGI-Severity = 3), 26–34 with ‘moderate-severe symptoms’ (CGI-Severity = 4) and 35–40 with ‘severe symptoms’ (CGI-Severity = 5–6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive–compulsive symptoms than males ( d = .34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. Conclusions These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
The objective of the study was to examine the optimal Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS) percent reduction and raw cutoffs for predicting cognitive-behavioral treatment (CBT) ...response among children and adolescents with obsessive–compulsive disorder (OCD). The sample consisted of children and adolescents with OCD (
N
= 241) participating in the first step of the Nordic long-term OCD treatment study and receiving 14 weekly sessions of CBT in the form of exposure and response prevention. Evaluations were conducted pre- and post-treatment, included the CY-BOCS, Clinical Global Impressions—severity/improvement. The results showed that the most efficient CY-BOCS cutoffs were 35 % reduction for treatment response, 55 % reduction for remission, and a post-treatment CY-BOCS raw total score of 11 for treatment remission. Overall, our results diverge from previous research on pediatric OCD with more conservative cutoffs (higher cutoff reduction for response and remission, and lower raw score for remission). Further research on optimal cutoffs is needed.
•Both pharmacotherapy and CBT were found to be cost-effective.•Both systematic review and simulation supported study conclusions.•Limits to prior work reduced the precision of specific ...cost-effectiveness estimates.•More information is needed to support comparisons between interventions.•These results can aid treatment dissemination via third-party payers.
While multiple treatments for pediatric anxiety and obsessive compulsive disorder (OCD) are efficacious, little is known about their cost-effectiveness. In response, we sought to provide relevant information through systematic review and cost-effectiveness simulation.
We evaluated the cost-effectiveness of treatment for pediatric anxiety and OCD in two ways. First, we conducted a systematic review following PRISMA guidelines. Second, we evaluated cost-effectiveness for antidepressant medication, cognitive behavioral therapy, and their combination via a simulation that integrated information from the Truven MarketScan database and the NIMH National Database for Clinical Trials Related to Mental Illness.
Both systematic review and simulation found antidepressant medication and cognitive behavioral therapy to be cost-effective for pediatric anxiety and OCD. Antidepressant medication was the least costly approach, and cognitive behavioral therapy provided additional cost-effectiveness, especially for OCD.
During systematic review, relatively few articles provided information about both costs and effectiveness. While there was a notable margin of error to support multiple interventions as cost-effective, limited prior research decreased precision of point estimates and comparisons between interventions.
Both antidepressant medication and cognitive behavioral therapy were found to be cost-effective for pediatric anxiety and OCD. Results supported investment from third party payers, who serve as critical gatekeepers that can increase treatment dissemination. However, more precise information would better inform the exact amount of investment needed, especially with regard to selection decisions between active interventions. Cost-effectiveness research would benefit from systematic collection of data on treatment costs and quality of life in future clinical trials.
Ego‐depletion refers to the purported decrease in performance on a task requiring self‐control after engaging in a previous task involving self‐control, with self‐control proposed to be a limited ...resource. Despite many published studies consistent with this hypothesis, recurrent null findings within our laboratory and indications of publication bias have called into question the validity of the depletion effect. This project used three depletion protocols involved three different depleting initial tasks followed by three different self‐control tasks as dependent measures (total n = 840). For each method, effect sizes were not significantly different from zero When data were aggregated across the three different methods and examined meta‐analytically, the pooled effect size was not significantly different from zero (for all priors evaluated, Hedges’ g = 0.10 with 95% credibility interval of −0.05, 0.24) and Bayes factors reflected strong support for the null hypothesis (Bayes factor > 25 for all priors evaluated).
While there is great enthusiasm about new data sharing initiatives in mental health research, some concerns have recently been expressed that reflect tension between those who generate data and those ...who engage in secondary data analysis. While many aspects of data sharing have been considered, some of this tension has not been fully addressed. If this tension continues to go unresolved, enthusiasm for data sharing initiatives may be hindered. The author suggests solutions to these issues after carefully considering respective stakeholder interests (including those of patients, researchers, and funding agencies).
Background
Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges—aversive physical sensations that precede tics and are temporarily ...relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance—difficulty tolerating premonitory urges—predicted tic severity and tic-related impairment among adults with TS.
Methods
Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance—comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model.
Results
Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment.
Conclusion
This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
Length of stay (LOS) and boarding for pediatric psychiatric patients presenting in the emergency department (ED) have been understudied, despite evidence that children with psychiatric disorders ...experience longer LOS relative to those without. This investigation examined correlates of LOS and boarding among youth with psychiatric disorders presenting to the ED in a large, statewide database.
Using the 2010 to 2013 Florida ED discharge database, generalized linear mixed models were used to examine for associations between LOS and patient and hospital characteristics among pediatric patients (<18 years) who presented with a primary psychiatric diagnosis (N = 44,328).
Patients had an overall mean ± SD ED LOS of 5.96 ± 8.64 hours. Depending on the definition used (ie, 12 or 6 hours), between 23% and 58% of transferred patients were boarded. Patient characteristics associated with a longer LOS included female sex, being 15 to 17 years old, Hispanic ethnicity, having Medicaid or VA/TriCare insurance, having impulse control problems, having mood or psychotic disorders, and exhibiting self-harm behaviors. Patient transfer, large hospital size, and rural designation were associated with longer LOS. Teaching hospital status and profit status were not significantly associated with LOS.
These data suggest that LOS for pediatric psychiatry patients in the ED varies significantly by psychiatric presentation, patient disposition, and hospital factors. Such findings have implications for quality of care, patient safety, and health outcomes.
Despite extensive use of the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997), the lack of normative data impedes interpretation of individual CYBOCS scores. ...Consequently, psychometrics on CYBOCS severity scores from 815 treatment-seeking youth with obsessive-compulsive disorder (OCD) are presented, across age and sex, so that normative comparisons of obsessive, compulsive, and combined obsessive-compulsive severity could be calculated. Our findings suggest no evidence for marked age or sex differences. Further, obsessive-compulsive symptom severity scores (measured via the CYBOCS) appear consistent with global OCD syndrome severity (measured via the Clinician Global Impression-Severity scale CGI-S; Guy, 1976; r = .58). This study contributes the 1st empirically based guidelines for interpreting obsessive-compulsive symptom severity scores. After a diagnosis of OCD is determined, the CYBOCS can be used to determine severity of illness (however, categories of severity proposed by this article should not be used in the screening of OCD symptoms). Findings can facilitate clinicians' and investigators' ability to draw comparisons across obsessive-compulsive severity scores.
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