Predictors of psychiatric hospitalization, predisposing, enabling and need, of adults with co-occurring mental and substance disorders were compared to predictors for adults with a mental illness ...only. Research participants were 1,613 users of crisis intervention services. Findings using Cox regression show that dually-diag-nosed individuals were more likely to be hospitalized. Enabling and need factors were important predictors for both groups. Disruptive behavior was a predictor for dually-diagnosed clients but not for clients with mental illness only. Findings suggest that outpatient mental health services are less well equipped to address a psychiatric crisis when it was accompanied by substance use issues.
Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data ...from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.
Objective: To examine the impact of community-based mobile crisis services on postcrisis community-based mental health service use and user characteristics related to likelihood of postcrisis service ...use. Method: Differences in use of postcrisis mental health services and timing between a community-based intervention cohort and a matched hospital-based cohort were assessed using a Cox proportional hazards model. Results: A mobile crisis intervention consumer was 17% more likely to receive community-based mental health services within 90 days after the crisis event. Controlling for prior service use, mobile crisis intervention consumers with no prior mental health service use were 48% more likely to receive community-based mental health services within 90 days after the crisis event than a consumer from the hospital-based intervention cohort. Consumers more likely to use postcrisis services were African American, homeless, experiencing acute problems, previous mental health service users, and severely mentally disabled. Conclusions: Implications for social work practice are discussed.
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