Substance Abuse and the Functioning of Transition-Aged Youth with Psychiatric Disorders

Summary: Youth who had serious emotional disturbances or psychiatric disorders in childhood or adolescence generally have poor young adult functioning. Substance-related disorders increase dramatically from early adolescence to early adulthood in this population. The present study examined the relative contribution of substance-related and psychiatric disorders to decreased young adult role functioning by examining 15-25 year old subjects in the National Comorbidity Study (NCS) in which 8,098 respondents, ages 15-54, from a nationally representative sample of community households were interviewed. Findings indicate that substance-related disorders alone account for some but not other differences in functioning. Relationship to services will be discussed Paper presented on March 2, 2004. Proceedings published in 2005. Link to handout at http://rtckids.fmhi.usf.edu/rtcconference/handouts/default.cfm?appid=171204

Symptom severity of bipolar disorder during the menopausal transition

BACKGROUND: Little is known about the mood symptom experience of women with bipolar disorder during the menopausal transition (MT). Yet times of rapid hormonal decline, such as the postpartum, are associated with increased risk of severe mood episodes in bipolar disorder, and the MT is a time of increased risk for unipolar depression in women with or without a history of depression. METHODS: Enrollment included 56 women 40-60 years old diagnosed in the bipolar spectrum who were experiencing menopausal symptoms or were up to 5 years since their final menstrual period. Menopausal stages included early menopause, late menopause, or early postmenopause based on standardized criteria. Observational, prospective standardized mood symptom and reproductive hormone assessments were completed periodically. Concurrent menopausal symptoms as well as history of mood exacerbation during past reproductive events were assessed. RESULTS: Forty-four women were included in the main analysis. The average Montgomery-Asberg Depression Rating Scale (MADRS) score was 4.43 points higher in the late transition/early postmenopausal stage women (n = 29) compared to the early menopausal stage women (n = 15) (+/-SE 2.14; p = 0.039), corresponding to a roughly 10 % higher score (range 0-40) in the late/post stage across all study visits. Results were similar for the Young Mania Rating Scale (YMRS), where the average score was 2.54 points higher in the late/early postmenopausal stage women compared to the early menopausal stage women (+/-SE 1.15; p = 0.027), also roughly 10 % higher (range 0-26). Estradiol and follicle-stimulating hormone (FSH) absolute levels as well as between-visit change in levels were not notably associated with YMRS or MADRS during study observation. Total Greene Climacteric Symptom (menopausal symptom) score was significantly associated with MADRS but not YMRS. History of mood exacerbation premenstrually and/or postpartum was not significantly associated with YMRS or MADRS severity during the MT. CONCLUSIONS: These results support the theory that times of increased reproductive hormonal changes, such as the late MT and early postmenopause, here compared to early MT, are associated with greater mood symptom severity in bipolar spectrum women. Nonetheless, absolute or change in FSH and estradiol levels were not significantly associated with depression or mood elevation severity

The Family Networks Implementation Study

Family Networks is a comprehensive system transformation initiative to redesign and integrate traditional categorical services across Massachusetts into local systems of care for children, youth, and families served by the child welfare system. The Family Networks Implementation Study, a partnership between the Massachusetts Department of Social Services and the University of Massachusetts Medical School, is a two-year study of the process of implementing local systems of care that began in January 2007, and will continue through December 2008

Patterns of Psychotherapy Attendance in Emerging and Mature Adults

Approximately 760,000 emerging adults use outpatient psychotherapy in the U.S. each year (Olfson et al.,2002). Emerging adults are 1.6-7.9 times more likely to drop out of mental health treatment than fully mature adults (Edlund et al., 2002; Olfson et al., 2002). This Study compared temporal patterns of attendance and non attendance between emerging and mature adult

The Massachusetts Family Networks Implementation Study

Family Networks is a comprehensive systems transformation initiative to redesign and integrate traditional categorical services across the Commonwealth into local systems of care for children, youth, and families served by the child welfare system. The Family Networks Implementation Study, a partnership between the Massachusetts Department of Social Services (MA/DSS) and the University of Massachusetts Medical School, is a two-year study of the process of implementing local systems of care that began in January 2007, and will continue through December 2008. Findings from the Family Networks Implementation Study will inform MA/DSS strategic planning, system refinements, and the Family Networks outcomes evaluation. Continuous quality improvement strategies, drawn from study findings, will be relevant and useful to other Massachusetts EOHHS agencies with similar service delivery systems and agendas. Project activities and products will promote the Commonwealth’s participation in the national dialogue regarding systems transformation in child welfare, mental health, and juvenile justice

Trajectories of Offending from Childhood to Early Adulthood in Girls With and Without Mental Health System Involvement

Criminology literature is overwhelmingly based in studies of males, though studies of gender differences or of females are rapidly accumulating. Rates of psychiatric disorder are typically higher in females involved with justice systems compared to males. However, the juvenile or criminal justice involvement of girls in mental health systems, or with serious mental health conditions is greatly understudied. Identifying their arrest risk onset, peak, and offset provides practitioners information about when to intervene and with whom. The goal of the present study is to describe within-individual longitudinal arrest patterns from ages 8-24 in this population, and determine whether their arrest patterns differ from general offender females in ways that have practice implications. Methods: Using statewide administrative data from the Massachusetts Department of Mental Health (DMH) and Massachusetts’ juvenile and criminal courts, a database was constructed that contained juvenile and criminal arrest histories to age 25 for females born 1976-79. DMH females were adolescent service users (n=738), Non-DMH females had no DMH database records (n=34,436). Massachusetts Census 2000 provided the size of the general female population. Developmental trajectory modeling was used to group individuals’ patterns of offending over time (trajectories) into “clusters” of those whose trajectories are similar, and describe trajectories. Trajectory comparison methods minimized the greater Non-DMH cohort size. Results: DMH females were far more likely to be arrested by age 25 than Non-DMH females (46% vs. 22%) and to be arrested at multiple ages (28% vs. 7%). Analyses revealed eight justice system trajectories among those with multiple ages of arrest. Trajectories varied on level of involvement and timing of onset/offset/peaks. Non-DMH females comprised at least 93% of each trajectory cluster, though several clusters showed significant over- or under-representation of DMH females. Conclusions: Concern about justice system involvement of female youths in intensive MH services is justified. Among girls with multiple ages with arrest, differences in criminal careers between the mental health and non mental health system users was minimal. Implications of trajectory findings for timing and type of intervention will be presented

Family Members with Overlapping Mental Health Needs Require the Transformation of Systems and Services

Women and men with a lifetime prevalence of psychiatric disorder are at least as likely to be parents as are adults without psychiatric disorder. The majority of adults in all diagnostic categories are parents, including those meeting criteria for affective and anxiety disorders, PTSD, and non-affective psychosis. Children with Serious Emotional Disturbance (SED) receiving services in Systems of Care (SOCs) programs may have multiple family risk factors. Family-centered, strengths-based practices require a paradigm shift in the way administrators and providers view and intervene with children and adults. Presented at The Santa Fe Summit on Behavioral Health, the American College of Mental Health Administration, Santa Fe, New Mexico, March 2005