[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.
Cadernos de saúde pública. 06/2014; 30(6):1195-206.
[Show abstract][Hide abstract] ABSTRACT: The Affordable Care Act (ACA) creates incentives to coordinate primary care, mental health (MH) care, and addiction services. Integration of clinical HIV and MH services has been shown to improve quality of life and physical and MH of people living with HIV/AIDS. However, few studies have investigated the practice of service integration systematically. We examined the practice patterns of 515 direct service providers in New York State who received training about HIV MH between May 2010 and July 2012. We sought to identify provider and treatment setting characteristics associated with an integrated spectrum of care. Using factor analysis and linear modeling, we found that patterns of service integration varied by type of health-care setting, service setting location, providers' HIV caseload, and the discipline of the provider describing the direct services. Understanding the existing capacities of clinicians providing care in a variety of settings throughout New York will help to guide staffing and linkage to enhance HIV MH service integration as significant shifts in the organization of health care occur.
[Show abstract][Hide abstract] ABSTRACT: Objective
To assess correlates of hepatitis B among adults with mental illness under care in Brazil.
Cross-sectional national multicenter study of 2,206 patients with mental illnesses randomly selected from 26 public mental health services. Sociodemographic and behavioral data were obtained from face-to-face interviews and psychiatric diagnoses from medical charts. Serology testing was conducted and prevalence rate ratios were estimated by log-binomial regression.
The weighted prevalence of current HBV infection (HBsAg +) and previous HBV exposure (anti-HBc +) were 2.0% (95%CI: 1.5%-2.7%) and 17.1% (95%CI: 16.0%-19.0%), respectively. Correlates of HBsAg + included male gender, younger age (18–29 y.o.), unstable place of residence, intellectual disability, main psychiatric diagnosis of dementia, presence of other medical comorbitidy, use of alcohol/drugs during sex, more than one sexual partner, and use of cocaine. Correlates of anti-HBc + included male gender, older age (≥ 30 y.o.), black skin color, lower education, unstable place of residence, currently hospitalized, intellectual disability, history of any STD or syphilis, poor HIV knowledge, history of imprisonment and sexual violence.
Hepatitis B is an important comorbidity among psychiatric patients in Brazil. Screening for HBV, effective prevention and intervention strategies, including universal HBV immunization, should be routine practices in these mental health services.
General hospital psychiatry 01/2014; · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: People living with mental illness are at increased risk for HIV. There are scarce data on correlates and prevalence of HIV infection, and none with a nationally representative sample. We report on correlates of HIV infection from a cross-sectional national sample of adults receiving care in 26 publicly funded mental health treatment settings throughout Brazil. Weighted prevalence rate ratios were obtained using multiple log-binomial regression modeling. History of homelessness, ever having an STD, early age of first sexual intercourse before 18 years old, having suffered sexual violence, previous HIV testing, self-perception of high risk of HIV infection and not knowing one's risk were statistically associated with HIV infection. Our study found an elevated HIV seroprevalence and correlates of infection were not found to include psychiatric diagnoses or hospitalizations but instead reflected marginalized living circumstances and HIV testing history. These adverse life circumstances (history of homelessness, having suffered sexual violence, reporting a sexually transmitted disease, and early sexual debut) may not be unique to people living with mental illness but nonetheless the mental health care system can serve as an important point of entry for HIV prevention in this population.
[Show abstract][Hide abstract] ABSTRACT: People who inject drugs are more likely to be HIV positive and to have a mental disorder than the general population. We explore how the detection and treatment of mental illness among people who are injecting drugs are essential to primary and secondary prevention of HIV infection in this population. Aside from opioid addiction, few studies have been conducted on the links between mental disorders and injection-drug use. However, independent of the injection-drug use literature, a growing number of studies demonstrate that untreated mental illness, especially depression and alcohol/substance use disorders, is associated with HIV-related risk behaviors, acquiring HIV infection, failure to access HIV care and treatment, failure to adhere to HIV care and treatment, and increased morbidity and mortality from HIV-related diseases and comorbidities. In our review of both the published literature and gray literature we found a dearth of information on models for providing care for both opioid addiction and other mental illnesses regardless of HIV status, particularly in low- and middle-income countries. We therefore make recommendations on how to address the mental health needs of HIV-positive people who inject drugs, which include the provision of opioid substitution therapy and integrated mental health, substance abuse, and HIV services.
Advances in preventive medicine. 01/2013; 2013:690386.
[Show abstract][Hide abstract] ABSTRACT: We conducted the first study to examine rates of sexual activity, sexual risk behaviors, sexual protective behaviors, injection drug use (IDU), needle sharing, and knowledge about HIV/AIDS among outpatients with severe mental illness (SMI) in Rio de Janeiro, Brazil. Using a measure with demonstrated reliability, we found that 42% of 98 patients engaged in vaginal or anal sex within the past three months. Comorbid substance use disorder was significantly associated with sexual activity. Only 22% of sexually active patients used condoms consistently, despite having better HIV knowledge than those who were sexually abstinent. Overall, 45% of patients reported not engaging in any HIV protective behaviors. There were no reports of drug injection. Adults with SMI in Brazil are in need of efficacious HIV prevention programs and policies that can sustain these programs within mental health treatment settings.
World psychiatry: official journal of the World Psychiatric Association (WPA) 11/2008; 7(3):166-72. · 8.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This chapter provides a comprehensive discussion of clinical evaluation and treatment planning. It describes the use of present and past psychological, biological, social, and environmental data for the purpose of establishing a comprehensive picture of a patient's strengths and problems, including psychiatric diagnoses. The chapter also describes risk assessment and the development of treatment plans. Clinical evaluation and treatment planning are the essential beginning of every course of psychiatric treatment and, when carried out successfully, integrate a multimodal approach to understanding mental illness and providing clinical care.
[Show abstract][Hide abstract] ABSTRACT: Following the terrorist attacks of September 11, 2001, New York's Muslim communities turned to their mosques for help, but were noticeably hesitant to avail themselves of services offered by the broader community. Research has shown that few mental health professionals are familiar with the Arabic language and Islamic values. Moreover, little is known about Islamic counseling and psychotherapy, or the techniques applied by providers in the mosques to help the Islamic community cope with stressful events. This study is intended to examine the role of imams in Muslim mental health promotion and the worshippers’ attitudes toward mental health services and resources prior to 9/11 and post-9/11. A cross-sectional survey of 22 imams and 102 worshippers from 22 mosques in New York City was conducted. Our results show that, even though the majority of the 22 imams had no formal training in Western psychotherapy intervention, they nonetheless played a major role in the promotion of mental health in the wake of this national disaster. Imams, we have learned, use a multifaceted model of unstructured psychotherapy intervention based on Islamic directives and teachings. Our study finds that guidance for mental health issues among New York City's Muslim community was sought most often from imams before and after 9/11. Results of the study may help to bridge the gap between Islamic intervention and modern, Westernized psychotherapy paradigms.
Journal of Muslim Mental Health 01/2008; 3(2):155-176.
[Show abstract][Hide abstract] ABSTRACT: As in other countries worldwide, adults with severe mental illness in Brazil have elevated rates of HIV infection relative
to the general population. However, no HIV prevention interventions have been tested for efficacy with psychiatric patients
in Brazil. We conducted participatory research with local providers, community leaders, patient advocates, and patients using
an intervention adaptation process designed to balance fidelity to efficacious interventions developed elsewhere with fit
to a new context and culture. Our process for adapting these interventions comprised four steps: (1) optimizing fidelity;
(2) optimizing fit; (3) balancing fidelity and fit; and (4) pilot testing and refining the intervention. This paper describes
how these steps were carried out to produce a Brazilian HIV prevention intervention for people with severe mental illness.
Our process may serve as a model for adapting existing efficacious interventions to new groups and cultures, whether at a
local, national, or international level.
AIDS and Behavior 10/2007; 11(6):872-883. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We conducted a randomised clinical trial to test the efficacy of an enhanced version of an intervention previously shown to reduce HIV sexual risk behaviours among men with severe mental illness. One-hundred-and-forty-nine subjects aged 18-59 years were randomly assigned to the experimental or control conditions. Sexual risk behaviours were assessed every three months for 12-months. The primary analysis compared experimental and control groups with respect to sexual risk behaviours with casual partners as measured by the Vaginal Episodes Equivalent (VEE) score. Additional analyses included comparison of VEE scores of those men sexually active in the three months prior to baseline and the proportion of condom-protected sexual acts with casual partners. There were no significant differences in sexual risk behaviours with casual partners between experimental and control subjects. Additional analyses demonstrated a trend toward sexual risk reduction at six months post-intervention (p=0.06) but not at 12 months. These results may reflect a lack of efficacy or a true reduction in risk that the trial was underpowered to detect at the 0.05-level. If there was a true reduction in risk, it was not maintained after the initial six months.
AIDS Care 06/2007; 19(5):579-88. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mental health is an essential component of worldwide efforts to contain the spread of HIV infection and to treat those who are already infected or affected by the virus. This paper describes the integration of mental health approaches into primary and secondary prevention strategies for vulnerable populations, the identification and management of psychiatric conditions that increase the risk for becoming infected with HIV, and the diagnosis and treatment of the neuropsychiatric manifestations of HIV infection.
World psychiatry: official journal of the World Psychiatric Association (WPA) 11/2005; 4(3):135-41. · 8.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients with schizophrenia are at significantly increased risk for infection with human immunodeficiency virus (HIV), hepatitis C virus, or both. Several factors underlie this increased risk, including substance abuse and high-risk sexual behavior. Although being sexually active tends to be less common among patients with schizophrenia than among nonpsychotic individuals, patients with schizophrenia who are sexually active are more likely than nonpsychotic individuals to engage in high-risk behavior. Many patients with schizophrenia have inadequate knowledge about the risks of HIV, but delivering factual information is not likely, by itself, to bring about behavioral changes that reduce the risk of exposure and transmission. Comorbidity of schizophrenia and life-threatening viral illnesses incurs a worse prognosis for both conditions. Nevertheless, effective pharmacotherapy exists, and antipsychotics and highly active antiretroviral treatments for HIV can be used together successfully. The clinical challenge is to encourage adherence to treatment and to coordinate the clinical services needed to address the diverse psychiatric and medical problems that coexist in this population.
The Journal of Clinical Psychiatry 02/2005; 66 Suppl 6:27-33. · 5.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients.
Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management.
Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly.
Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals.
American Journal of Public Health 01/2003; 92(12):1931-40. · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Profound loss in childhood as a precipitant for symptoms of posttraumatic stress disorder has been a largely neglected subject. There is now some literature to suggest that severe loss and the absence of care may be as predictive of psychological distress in children as events that are more frequently studied, such as exposure to natural disasters and physical or sexual abuse. This paper combines the author's personal experience as an orphaned child who was placed in foster care with a discussion of this emerging literature to examine the relationship between childhood loss and trauma symptoms. An awareness of the traumatic nature of severe losses in childhood could help caregivers and mental health professionals deal more effectively with such children.
[Show abstract][Hide abstract] ABSTRACT: Rates of HIV infection, STDs, and sexual and drug-use risk behaviors are high among people with severe mental illness. Clinicians often are in the best position to connect psychiatric patients to the particular HIV-related services they need. These may include prevention interventions, risk assessment, antibody test counseling, and medical care. This review article describes the AIDS epidemic and its underpinnings in this population in an effort to help clinicians to recognize when their patients are at risk for acquiring or transmitting the virus and to intervene appropriately and effectively with an array of relevant services. The importance of training to enhance clinicians' skills and comfort in delivering these services is emphasized. The lives and well-being of psychiatric patients are threatened by the AIDS epidemic, and there is much clinicians can do to minimize the devastating impact of HIV and AIDS on clients in hospitals, clinics, and other psychiatric treatment settings.
[Show abstract][Hide abstract] ABSTRACT: To clarify the relative contributions of psychiatric and alcohol or other drug (AOD) use disorders on sexual risk for HIV infection among people with severe mental illness, we interviewed 195 psychiatric patients. In the prior 6 months the 100 (51%) sexually active patients had a mean of 3.9 sex partners and 27.5 sex episodes; 49% had known high-risk sex partners; 34% used AOD during sex; 28% traded sex; and 59% never used condoms. The likelihood of being sexually active decreased with age and cognitive symptoms, increased with excited symptoms, and was more than twice as high for African-American patients as others. The likelihood of trading sex increased with cognitive symptoms. The likelihood of having a sexually transmitted disease history (reported by 32% of all patients) increased with depressed/anxious symptoms, a lifetime AOD use diagnosis (obtained for 57% of patients), and was more than twice as high for African-American patients as others. HIV prevention interventions that address specific psychiatric conditions and developmental and cultural issues of psychiatric patients should be developed and tested.
AIDS and Behavior 08/2001; 5(3):233-240. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload.
The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs.
Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found.
Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.
Journal of Substance Abuse 02/2001; 13(1-2):127-35.
[Show abstract][Hide abstract] ABSTRACT: New information about the life cycle of HIV, new HIV-specific laboratory tests, and newer antiretroviral medications have transformed the management of HIV illness. Knowledge about these changes will help mental health providers better understand the latest medical issues affecting their HIV-infected patients, which will assist them in providing better care.
New Directions for Mental Health Services 02/2000;
[Show abstract][Hide abstract] ABSTRACT: Since the advent of highly active antiretroviral therapy, the issue of strict adherence has become increasingly important. This chapter examines how the mental health provider can employ a multimodal approach to promoting patient adherence, which increases the chances of success.
New Directions for Mental Health Services 02/2000;