Predictors of Mental Health Need and Treatment in Safety Net Primary Care

Many mental health (MH) needs go unidentified in primary care, and certain patients appear to be at higher risk of needs going unidentified and subsequently untreated. Little is known about patterns of detection and treatment in clinics with integrated mental health services. The purpose of this study was to characterize the prevalence of MH needs and evaluate patient characteristics as predictors of both the presence of a MH need and type of MH services received. Subjects were patients receiving care at two safety net primary care clinics with integrated mental health services (N=816; 52.7% Latinx, 15.9% African American), and were classified as either having received integrated MH services in the previous year or as not. Sociodemographic and medical information was extracted from all medical records, and patients who had not received integrated MH services completed a MH needs assessment. The prevalences for depression, suicidal ideation, anxiety and PTSD were within expected ranges. Surprisingly, patient characteristics did not predict the presence of a MH need, though several characteristics predicted the type of MH treatment received. Patients were less likely to receive integrated MH services if they were older (χ2(1) = 7.36, p= .007), Hispanic/Latinx (χ2(1) = 7.97, p= .005), and/or partnered (χ2(1) = 20.65, p= .000). This study suggests that biases in detection of MH needs in integrated primary care may be less pronounced than in non-integrated primary care. However, longstanding disparities in MH treatment may persevere in this newer model of primary care

Community Input on an Enhanced Care Planning Tool Addressing Health Behaviors, Mental Health Needs, and Social Risks

Background: Many patients with multiple chronic conditions (MCC) have social risks, mental health needs, and/or unhealthy behaviors. These interfere with their ability to manage their MCC. A care planning tool was created to help address these needs; this study solicited feedback from stakeholder groups and incorporated it into improving the tool. Methods: Instrument: The Enhanced Care Planning (ECP) tool screens patients for social risks, mental health needs, and unhealthy behaviors. They are shown where their responses revealed risk, then select 1-2 to improve upon. Next, patients set personal goals and select strategies to support them. Patients are supported by the clinical care team and a community health worker to connect them to community resources. Procedures: Four stakeholder groups provided feedback on the ECP tool: community members, community service professionals (CSPs), researchers, and patients. A community review board of community members reviewed the ECP process. Researchers and CSPs then reviewed ECP content. Feedback was incorporated into revisions of the ECP content and process, then patients provided final feedback. Results: All stakeholder groups provided unique feedback. Community members desired visuals, the ability to individualize and receive support throughout the process. Researchers and CSPs recommended removing jargon. While researchers were interested in specific evidence-based strategies, CSPs suggested strategies with anecdotal support. Patients expressed positive overall impressions of the tool, interest in using it, and increased awareness of domains that influence their health. Conclusion: Feedback from all groups significantly altered the ECP tool’s design, and is likely to improve its usability and impact.https://scholarscompass.vcu.edu/gradposters/1109/thumbnail.jp

Behavioral Health Integration in Primary Care

Behavioral Health Integration in Primary Care Casey Zapata, Depts. of Psychology and English, Demetrius Carter, & MaryKate Crawford, and Samantha Mladen, Emily Donovan, Amber Fox, & Kristen O’Loughlin, Dept. of Psychology Graduate Students, with Dr. Bruce Rybarczyk, Dept. of Psychology Background/Aims: Due to limited access to mental health care, many patients present to primary care with mental health concerns, such as depression and anxiety. Integrated primary care (IPC), an emerging practice model that integrates behavioral health providers with medical providers in primary care, has been demonstrated to improve patient outcomes. This project aims to characterize patients being seen in safety-net IPC, both demographically and clinically. Methods: The data were collected across three safety-net clinics in the Richmond area. The sample consisted of 96 adult patients: 68 female (71%), 24 male (25%), 1 non binary (1%), and 3 not collected (3%); 54 African-American (56%), 29 White (30%), 1 Asian (1%), 1 Other (1%), and 11 not collected (12%). Measures included a patient-completed checklist of patients’ behavioral health concerns, the PHQ-9 for depression, the GAD-7 for anxiety, and clinician-completed chart review for demographic factors. Results: Of the 72 patients who completed the GAD-7, patients reported 13 (18%) severe symptoms of anxiety, 11 (15%) moderate symptoms, 15 (21%) mild symptoms, and 33 (46%) subclinical symptoms. For the 37 patients who completed the PHQ-9, patients reported 7 (19%) severe depressive symptoms, 10 (27%) moderately severe symptoms, 12 (32%) moderate symptoms, 6 (16%) mild symptoms, and 2 (5%) subclinical symptoms. The six most commonly patient-reported problems were stress (n= 73), anxiety (n= 70), depression (n= 65), sleep (n = 55), grief (n = 53), and irritability (n= 53). When asked to rank their top three concerning problems, the five concerns most commonly ranked as top problems were: : (1) anxiety (n = 29), (2) stress (n = 28), (3) depression (n = 27), (4) sleep (n=16), and (5) weight (n=15). Further, 56 (58%) participants reported both depression and anxiety as among their top three concerns. Discussion: Anxiety and depression were reported by the majority of patients, with 33% experiencing at least moderate anxiety and 78% experiencing at least moderate depression. Additionally, anxiety and depression were cited as the third most commonly reported concerns, respectively, as well as ranked within the top three most concerning problems for most participants. Stress, anxiety, depression, and sleep were included in both the most commonly reported problems and the most common top three concerns of participants, suggesting that these concerns are both pervasive and troublesome for participants. Over time, this project will prioritize increasing sample size and tracking longitudinal trends. The continued study of safety-net IPC may allow for increasing access to behavioral health, identifying common behavioral health concerns in primary care, and meeting unmet patient needs.https://scholarscompass.vcu.edu/uresposters/1340/thumbnail.jp

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Examining Psychosocial Factors of Chronic Disease Control to Improve Outcomes for Patients with Multiple Chronic Conditions

Psychosocial needs are associated with worse health outcomes for patients with multiple chronic conditions (MCC). The Biopsychosocial Model provides a framework for conceptualizing the influence that psychosocial factors have on the management of disease. To date, research has primarily focused on examining the relation between psychosocial factors and chronic disease onset. Therefore, the temporal relation between psychosocial factors and disease management remains poorly understood. The current study aimed to 1) describe patients’ psychosocial needs and their prioritization, 2) examine reciprocal relations between anxious symptoms, depressive symptoms, social needs, and MCC management, and 3) qualitatively explore patient definitions of health in the context of MCC. Data came from the Enhanced Care Planning (ECP) study, a randomized controlled trial of primary care patients with MCC; all participants were included (n = 175). Patients had an average of 1.01 psychosocial needs (SD = 1.44), 27.0% of patients endorsed a mental health need and 33.3% endorsed having a social need, though very few patients prioritized either type of need. Four cross-lagged regression models were run with three waves of data. When anxious symptoms and MCC management were examined alone, better MCC management predicted greater future anxious symptoms. When all psychosocial variables were examined together, anxious symptoms predicted better future MCC management. No support was found for a relation between depressive symptoms or total social needs with chronic disease management. Finally, when defining health, patients identified four states which were of particular interest to them: health condition management, pain management, mental wellness, and social connectedness. They described health as an active and complex interaction between several stable factors (i.e., healthcare, social context, and physical environment) and a range of dynamic psychosocial factors. Collectively, these findings highlight the relevance of psychosocial factors to patients’ everyday lives and perceived ability to be healthy. Further research is necessary to examine a broader scope of health-related needs among patients with MCC, assess the nuanced relation between anxiety levels and chronic disease management, and to elucidate how psychosocial factors differentially relate to various metrics of health

Potential Impacts of Bison Wallows on a Restored Tallgrass Prairie Community

When bison (Bos bison) repeatedly roll on the ground, they denude vegetation and create wallows (semi-permanent bare areas) that alter the native prairie plant community. Responses to these wallow-related disturbances are not as well documented in restored prairies. From 1 June to 1 September 2010 and from 3 June to 6 August 2011, we examined potential responses at Neal Smith National Wildlife Refuge, a restored prairie with resident bison. We hypothesized that plants and beetles would vary along a disturbance gradient. Our predictions were: (1) near wallows, plants with weedy lifestyles would have highest cover and biomass compared to plants with nonweedy lifestyles, (2) in control areas (i.e., nonwallows), weedy compared to nonweedy plant cover and biomass would not change over distance (measured from nonwallow locations with similar dimensions as their paired wallows), and (3) ground beetle abundance would increase further from wallows, but not change across distance at nonwallows. Results were varied. Indices of weedy to nonweedy plant cover and weedy to nonweedy biomass were highest adjacent to wallows, with no distance effect at nonwallows. Beetle abundance was affected by location but not distance, with more beetles trapped at nonwallows than wallows. Additionally, of the five common beetle genera, three were unequally distributed between wallows and nonwallows. Both plants and insects varied across wallows and nonwallows, but their responses along disturbance gradients likely occur at different scales

Potential Impacts of Bison Wallows on a Restored Tallgrass Prairie Community

When bison (Bos bison) repeatedly roll on the ground, they denude vegetation and create wallows (semi-permanent bare areas) that alter the native prairie plant community. Responses to these wallow-related disturbances are not as well documented in restored prairies. From 1 June to 1 September 2010 and from 3 June to 6 August 2011, we examined potential responses at Neal Smith National Wildlife Refuge, a restored prairie with resident bison. We hypothesized that plants and beetles would vary along a disturbance gradient. Our predictions were: (1) near wallows, plants with weedy lifestyles would have highest cover and biomass compared to plants with nonweedy lifestyles, (2) in control areas (i.e., nonwallows), weedy compared to nonweedy plant cover and biomass would not change over distance (measured from nonwallow locations with similar dimensions as their paired wallows), and (3) ground beetle abundance would increase further from wallows, but not change across distance at nonwallows. Results were varied. Indices of weedy to nonweedy plant cover and weedy to nonweedy biomass were highest adjacent to wallows, with no distance effect at nonwallows. Beetle abundance was affected by location but not distance, with more beetles trapped at nonwallows than wallows. Additionally, of the five common beetle genera, three were unequally distributed between wallows and nonwallows. Both plants and insects varied across wallows and nonwallows, but their responses along disturbance gradients likely occur at different scales