Biomedical subjects

Haiyi Xie

Publications and source records attributed to Haiyi Xie.

At least 19 recordsLinked to original sources

PubMed2006

Addiction treatment services and co-occurring disorders: Prevalence estimates, treatment practices, and barriers.

As the model for treating co-occurring disorders in addiction treatment settings becomes articulated, service systems need data on prevalence, current practice, and barriers to the implementation of evidence-based practices. A self-report survey was administered to 453 addiction treatment providers (43 agency directors, 110 clinical supervisors, and 300 clinicians) from a single state system of care. Data on prevalence estimates, treatment practices, and barriers to implementing services for co-occurring disorders were obtained. The three groups estimated that several co-occurring disorders were extremely common: mood disorders (40%-42%), anxiety disorders (24%-27%), posttraumatic stress disorder (24%-27%), severe mental illnesses (16%-21%), antisocial personality disorder (18%-20%), and borderline personality disorder (17%-18%). Practice patterns for patients with these co-occurring disorders differed widely, from referral to mental health programs to provision of integrated treatment. Common barriers to providing services to persons with co-occurring disorders were lack of psychiatric personnel and resources. Comprehensive surveys of an addiction treatment service system can rapidly and economically produce estimates of prevalence, current practices, and barriers to evidence-based practices. This objective information is critical for systems intending to enhance services to persons with co-occurring disorders.

Administrative Personnel↗

PubMed2006

Enhancing validity in co-occurring disorders treatment research.

Despite the high prevalence of co-occurring mental health and substance-use disorders, there has been a relative lack of treatment research with this population, and the existing research often has limited validity. This article explores some of the barriers to the conduct of research on promising interventions for substance-abuse treatment for people with co-occurring disorders, using the concepts of external and ecological validity to make recommendations for future investigation. The central recommendation is to move rapidly from efficacy studies to more credible and valid effectiveness studies, in order to facilitate the adoption of evidence-based interventions in routine practice settings.

Comorbidity↗

PubMed2006

Clozapine use and relapses of substance use disorder among patients with co-occurring schizophrenia and substance use disorders.

BACKGROUND: Previous correlational research with schizophrenic patients has suggested that the second-generation antipsychotic medication clozapine helps to induce remissions of substance use disorder in patients with co-occurring psychosis and substance abuse. This research, however, could be biased by selection factors. Studying patients who are currently in substance abuse remission could control for level of motivation to stop using substances and other methodological confounds. METHODS: To test whether clozapine was associated with prevention of substance abuse relapses, we examined patients with schizophrenia or schizoaffective disorder who were in their first 6-month remission of substance use disorder during a prospective 10-year follow-up study. All patients received yearly multimodal assessments of substance use. Antipsychotic medications were prescribed by community doctors as part of usual clinical care. RESULTS: Patients using clozapine at the first 6-month period of substance abuse remission (n = 25) were much less likely to relapse over the next year compared with those on other antipsychotic medications (n = 70): 8.0% vs 40.0%, chi(2) = 8.73 (df = 1), P = .003. Although medication assignment was not randomized, several potential confounders were similar between the groups. CONCLUSION: Clozapine should be considered for the treatment of patients with schizophrenia and co-occurring substance use disorder to prevent relapses to substance abuse.

Adult↗

PubMed2006

Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders.

The long-term courses of people with schizophrenia and of those with substance use disorder have been studied separately and extensively. The long-term course of clients with co-occurring schizophrenic and substance use disorders has, however, not been examined. This article reports 10-year outcomes for 130 clients with co-occurring schizophrenic and substance use disorders in the New Hampshire Dual Diagnosis Study. In addition, we report on 6 "recovery outcomes," identified by dual diagnosis clients, as examples of positive coping behaviors. Longitudinal data were modeled using generalized estimating equation (GEE) methods. Participants improved steadily over 10 years in the outcome domains of symptoms, substance abuse, institutionalization, functional status, and quality of life. Further, at the 10-year follow-up, substantial proportions were above cutoffs selected by dual diagnosis clients as indicators of recovery: 62.7% were controlling symptoms of schizophrenia; 62.5% were actively attaining remissions from substance abuse; 56.8% were in independent living situations; 41.4% were competitively employed; 48.9% had regular social contacts with non-substance abusers; and 58.3% expressed overall life satisfaction. These 6 outcomes were only weakly interrelated over time, suggesting that recovery, as defined by clients, is a multidimensional concept. Overall, the 10-year findings on recovery outcomes provide a hopeful long-term perspective for dual diagnosis clients.

Adult↗

PubMed2006

Are there distinctive trajectory groups in substance abuse remission over 10 years? An application of the group-based modeling approach.

This paper introduces to mental health services and evaluation researchers a method for analyzing longitudinal data: a group-based modeling approach for applied research. We present the basic formulations of the model and illustrate its application by analyzing the 10-year longitudinal data on substance abuse remission from the New Hampshire Dual Disorders Study. The basic features of the approach are: identifying latent groups with distinctive trajectories, estimating the proportion of the population in each group, linking individual-level covariates to group membership, assigning individuals to different groups, and creating group profiles based on posterior probabilities. We also discuss cautions and the controversies surrounding this approach. The major findings include four groups with distinct trajectories of remission from substance abuse.

Female↗

PubMed2006

What predicts supported employment program outcomes?

Numerous state systems and local mental health and vocational rehabilitation programs are currently attempting to implement supported employment. This cross-sectional survey of 26 mental health agencies, partnering with federal-state vocational rehabilitation, identified differences in access to supported employment services and rates of competitive employment (efficiency) as well as predictors of access and efficiency. Access varied from 2 to 100% and was related to the percentage of supported employment specialists per consumers with serious mental illness served by the mental health agency (funding). Efficiency varied from 7 to 75% and was related to implementation of the critical components of evidence-based supported employment and to the local unemployment rate. To help mental health clients achieve their employment goals, state systems and local programs should address consolidation of resources in supported employment and the quality of implementation of supported employment.

Adolescent↗

PubMed2006

Effect of benefits counseling services on employment outcomes for people with psychiatric disabilities.

OBJECTIVE: This study examined the impact of specialized benefits counseling services on levels of competitive employment for people with psychiatric disabilities receiving Social Security Administration (SSA) disability benefits in Vermont. METHODS: Beneficiaries who had a psychiatric disability and who received specialized benefits counseling (N = 364) were compared with matched contemporaneous and historical control participants over four years, two years before and two years after the initiation of the intervention. Study participants were consumers of vocational rehabilitation services, and the outcome measure was quarterly earnings from state unemployment insurance program records. Benefits counseling included general education regarding SSA disability programs, the various work incentives available under those programs, and other federal and state public benefits; individualized research and counseling regarding enrollees' current benefits packages; assistance in managing benefits through the transition to employment; and provision of information to supporting professionals. RESULTS: Participants who received specialized benefits counseling achieved significantly greater improvements in earnings. The benefits counseling group increased its adjusted average earnings by 1,256 dollars per year in comparison with the two control groups. CONCLUSIONS: Specialized benefits counseling appears to be an important employment support for Social Security Administration disability beneficiaries who have psychiatric disabilities.

Adolescent↗

PubMed2006

Generalisability of the individual placement and support model of supported employment: results of a Canadian randomised controlled trial.

BACKGROUND: Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment. AIMS: To determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting. METHOD: A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n = 75) or traditional vocational services (n = 75). RESULTS: Over the 12 months of followup, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P < 0.001). They averaged 126 h of competitive work, v. 72 in the control group (P < 0.001). CONCLUSIONS: Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.

Adult↗

PubMed2005

Three-year recovery outcomes for long-term patients with co-occurring schizophrenic and substance use disorders.

Little is known about the expected treatment outcomes of patients with co-occurring schizophrenic and substance use disorders. This paper reports 3-year outcomes for 152 patients with schizophrenia or schizoaffective disorder and substance use disorders, all of whom received integrated dual disorders treatments in the New Hampshire Dual Diagnosis Study. Outcomes are defined as positive coping behaviors identified by consumers as indicators of recovery. Participants improved steadily in terms of controlling symptoms of schizophrenia, actively attaining remissions from substance abuse, increasing competitive employment, increasing social contacts with non-substance abusers, and improving life satisfaction. Though successful in reducing hospitalization and homelessness, they did not increase time in independent living situations. Outcomes were only weakly interrelated, suggesting that recovery is a multidimensional concept. Neither psychotic diagnosis (schizophrenia vs. schizoaffective disorder) nor substance abuse diagnosis (alcohol vs. other drug disorder vs. both) was related to outcomes. However, these patients with co-occurring schizophrenic and substance use disorders did significantly less well than patients with co-occurring bipolar and substance use disorders in terms of hospitalization, independent living, and quality of life. Overall, the findings provide a hopeful long-term perspective for dual diagnosis patients.

Adaptation, Psychological↗

PubMed2005

Improving mental health assessment and service planning practices for older adults: a controlled comparison study.

This study evaluated the effectiveness of a guided assessment and service planning intervention in improving the clinical practices of non-physician community mental health providers caring for older persons. Thirteen agencies, 44 clinicians, and 100 consumers (age 60 and older) were assigned to the intervention or a comparison group receiving usual care. Baseline interviews of clinicians and chart reviews found that clinicians' routine evaluation and service planning practices showed inattention to key domains such as substance abuse (over 33% of clinicians), suicide risk and dangerous behaviors (over 40%), and caregiver burden and risk of neglect or abuse (over 75%). At 1-year follow-up, the intervention was associated with increased rates of routine assessments of major symptom, functioning, and support domains. There was also significant improvement in the specificity of treatment planning within the intervention condition. Implications for quality improvement are discussed.

Aged↗

PubMed2005

The effects of clozapine and risperidone on spatial working memory in schizophrenia.

OBJECTIVE: The purpose of this investigation was to evaluate the effects of clozapine and risperidone on spatial working memory in patients with schizophrenia. METHOD: Spatial working memory performance was evaluated at baseline and after 17 and 29 weeks in 97 patients with schizophrenia participating in a multisite trial. RESULTS: Compared with baseline performance while receiving conventional antipsychotic medication, risperidone improved, and clozapine worsened, spatial working memory performance. CONCLUSIONS: The differential effects of these medications on spatial working memory may be due to the anticholinergic effects of clozapine and prefrontal dopamine-enhancing effects of risperidone.

Adult↗

PubMed2005

The effectiveness of skills training for improving outcomes in supported employment.

OBJECTIVE: This study evaluated whether a supplementary skills training program improved work outcomes for clients enrolled in supported employment programs. METHODS: Thirty-five recently employed clients with severe mental illness who were receiving supported employment services at a free-standing agency were randomly assigned to participate in either the workplace fundamentals program, a skills training program designed to make work more "successful and satisfying," or treatment as usual. Knowledge of workplace fundamentals (for example, identifying workplace stressors, problem solving, and improving job performance) was assessed at baseline and at nine months; employment outcomes and use of additional vocational services were tracked for 18 months. RESULTS: Clients in the workplace fundamentals group (N=17) improved more in knowledge of workplace fundamentals than those in the control group (N=18) at the nine-month follow-up, but the two groups did not differ in the number of hours or days worked, salary earned, or receipt of additional vocational services over the 18-month period. In general, clients in this study had higher educational levels and better employment outcomes than clients in most previous studies of supported employment, making it difficult to detect possible effects of the skills training intervention on work. CONCLUSIONS: Supplementary skills training did not improve work outcomes for clients who were receiving supported employment.

Adult↗

PubMed2005

Substance abuse relapse in a ten-year prospective follow-up of clients with mental and substance use disorders.

OBJECTIVES: This study addressed the rate and predictors of substance abuse relapse among clients with severe mental illness who had attained full remission from substance abuse. METHODS: In a ten-year prospective follow-up study of clients with co-occurring severe mental and substance use disorders, 169 clients who had attained full remission, defined according to DSM-III-R as at least six months without evidence of abuse or dependence, were identified. The Kaplan-Meier survival curve was developed to show the pattern of relapse, and a discrete-time survival analysis was used to identify predictors of relapse. RESULTS: Approximately one-third of clients who were in full remission relapsed in the first year, and two-thirds relapsed over the full follow-up period. Predictors of relapse included male sex, less than a high school education, living independently, and lack of continued substance abuse treatment. CONCLUSIONS: After attaining full remission, clients with severe mental disorders continue to be at risk of substance abuse relapse for many years. Relapse prevention efforts should concentrate on helping clients to continue with substance abuse treatment as well as on developing housing programs that promote recovery.

Adult↗

PubMed2004

Three-year outcomes of long-term patients with co-occurring bipolar and substance use disorders.

Little is known about the long-term outcomes of patients in the public mental health system who are disabled by co-occurring bipolar and substance use disorders. This article reports on the 3-year course of 51 patients with co-occurring bipolar and substance use disorders in the New Hampshire Dual Diagnosis Study. Participants received integrated dual disorders treatments in the state mental health system and were independently assessed with standardized measures at baseline and every 6 months for 3 years. Though psychiatric symptoms improved only modestly, participants improved steadily in terms of remission from substance abuse (61% in full remission at 3 years); they also achieved greater independent living (average 239 days in third year), competitive employment (49% in third year), regular social contacts with nonsubstance abusers (46% at 3 years), and quality of life (56% satisfied with life at 3 years). Different domains of outcome were only weakly related to each other. Long-term, disabled patients with co-occurring bipolar and substance use disorders have potential for remission from substance abuse and substantial improvements in functioning and quality of life.

Activities of Daily Living↗

PubMed2004

A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system.

Addiction research is challenged to disseminate evidence-based practices into routine clinical settings. The successful adoption of innovation must consider issues of fit, such as the characteristics, readiness, and attitudes of clinicians in the community. We constructed a survey to assess clinical practices and readiness to adopt certain evidence-based practices in addiction treatment programs. The instrument was administered to directors (n = 21) and clinicians (n = 89) from 24 public addiction treatment programs in New Hampshire (USA). Clinicians are more motivated to adopt some evidence-based practices (twelve-step facilitation, cognitive behavioral therapy, motivational interviewing, relapse prevention therapy) than others (contingency management, behavioral couples therapy, pharmacotherapies). Translational strategies for treatment development and research dissemination are discussed.

Adult↗

PubMed2004

Posttraumatic stress disorder, supported employment, and outcomes in people with severe mental illness.

OBJECTIVE: To evaluate whether posttraumatic stress disorder (PTSD) is related to outcomes in persons with severe mental illness (SMI) participating in a study of vocational rehabilitation programs. BACKGROUND: PTSD is a common comorbid disorder in people with SMI, but it is unknown whether PTSD interferes with the ability to benefit from rehabilitation programs such as supported employment. METHODS: The relationships between PTSD and symptoms, health, quality of life, and work outcomes was examined in 176 clients with SMI participating in a 2-year randomized controlled trial of three vocational rehabilitation programs: supported employment based on the Individual Placement and Support model, a psychosocial rehabilitation program based on transitional employment, and standard services. RESULTS: The overall rate of current PTSD in the sample was 16 percent. Compared with clients without PTSD, clients with PTSD had more severe psychiatric symptoms, worse reported health, lower self-esteem, and lower subjective quality of life. Clients with PTSD who participated in the Individual Placement and Support model (the most effective vocational model of the three studied) also had worse employment outcomes over the 2-year study period than clients without PTSD, with lower rates of competitive work, fewer hours worked, and fewer wages earned. Employment outcomes did not differ between clients with PTSD versus without PTSD in the other two vocational rehabilitation approaches. CONCLUSION: The findings suggest that PTSD may contribute to worse work outcomes in clients participating in supported employment programs. Effective treatment of these clients with PTSD may improve their ability to benefit from supported employment.

Adult↗

PubMed2004

A method for analyzing longitudinal outcomes with many zeros.

Health care utilization and cost data have challenged analysts because they are often correlated over time, highly skewed, and clumped at 0. Traditional approaches do not address all these problems, and evaluators of mental health and substance abuse interventions often grapple with the problem of how to analyze these data in a way that accurately represents program impact. Recently, the traditional 2-part model has been extended to mixed-effects mixed-distribution model with correlated random effects to deal simultaneously with excess zeros, skewness, and correlated observations. We introduce and demonstrate this new method to mental health services researchers and evaluators by analyzing the data from a study of assertive community treatment (ACT). The response variable is the number of days of hospitalization, collected every 6 months over 3 years. The explanatory variable is group: ACT vs. standard case management. Diagnosis (schizophrenia vs. bipolar disorder), time, and the baseline values of hospital days are covariates. Results indicate that clients in the ACT group have a higher probability of hospital admission, but tend to have shorter lengths of stay. The mixed-distribution model provides greater specification of a model to fit these data and leads to more refined interpretation of the results.

Adult↗

PubMed2004

A randomized controlled trial of integrated versus parallel housing services for homeless adults with severe mental illness.

This study compared two contemporary approaches to linking housing and mental health services. In the integrated housing program, case management and housing services were provided by teams within a single agency and were closely coordinated. In the parallel housing condition, case management services were provided by mobile assertive community treatment teams and housing by routine community-based landlords. Adults with severe mental illness who were at high risk for homelessness (n = 121; 72.7% schizophrenia spectrum) were assigned randomly to integrated or parallel housing services and followed for 18 months. Integrated housing services led to more days of stable housing and greater life satisfaction than parallel housing services, especially for male participants. Integrated housing services were also associated with greater reductions in psychiatric symptoms. Closer integration between clinical and housing services, and greater use of supervised living settings, led to more time in stable housing for participants in the integrated housing services condition and was associated with greater gains in several outcome domains.

Adult↗