Robert A Rosenheck

Yale-New Haven Hospital, New Haven, Connecticut, United States

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Publications (356)1324.34 Total impact

  • Dolores Vojvoda, Elina Stefanovics, Robert A Rosenheck
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    ABSTRACT: Recent military conflicts have generated significantly more demand for treatment of posttraumatic stress disorder (PTSD) as well as concerns about the adverse effects of stigma associated with specialty mental health care. This study examined the extent to which veterans diagnosed as having PTSD received treatment exclusively in primary care settings.
    Psychiatric services (Washington, D.C.) 07/2014; · 2.81 Impact Factor
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    ABSTRACT: The authors surveyed attitudes towards mental illness among Nigerian medical personnel at three different levels of training and experience: medical students who had not completed their psychiatry rotation, medical students who had competed their psychiatry rotation, and graduate physicians.
    06/2014;
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    ABSTRACT: Long-acting injectable antipsychotics are used to reduce medication nonadherence and relapse in schizophrenia-spectrum disorders. The relative effectiveness of long-acting injectable versions of second-generation and older antipsychotics has not been assessed.
    JAMA The Journal of the American Medical Association 05/2014; 311(19):1978-87. · 29.98 Impact Factor
  • Ellen L. Edens, Jack Tsai, Robert A. Rosenheck
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    ABSTRACT: Background Recent research suggests low-demand housing (ie, not contingent upon abstinence) is effective in helping people exit homelessness, even among recent active substance users. Whether active users of illicit drugs and stimulants have worse housing outcomes than primary alcohol users, however, is unknown.MethodsA total of 149 participants in a multisite supportive housing program who reported high levels of active substance use at program entry were classified as either (1) predominantly “Alcohol Use” (>10 of 30 days alcohol, but not >10 days of drug use) or (2) “Illicit Drug Use” (>10 of 30 days any single illicit drug use with or without alcohol use). Sub-analysis of the “Illicit Drug Use” group compared participants reporting high levels of “Stimulant Use” (>10 days cocaine, crack, or methamphetamine use) to those with high levels of “Non-stimulant Use” (>10 days marijuana or other non-stimulant drug use). Group differences in housing outcomes were examined with mixed model multivariate regression.ResultsDuring 24-month follow-up, days housed increased dramatically for both the “Alcohol Use” and the “Illicit Drug Use” groups without significant differences. Sub-analysis of illicit drug users showed stimulant use was associated with fewer days housed (p = .01) and more days homeless (p = .02) over time.Conclusions Among illicit drug users, stimulant users have somewhat less successful housing outcomes than other active drug and alcohol users, though both groups maintained substantial housing improvements in low-demand housing. (Am J Addict 2014;23:243–248)†
    American Journal on Addictions 05/2014; 23(3). · 1.74 Impact Factor
  • Eric D A Hermes, Rani Hoff, Robert A Rosenheck
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    ABSTRACT: OBJECTIVE Correlates of the sharp increase in Vietnam era veterans diagnosed as having posttraumatic stress disorder (PTSD) in the Veterans Health Administration (VHA) were examined. METHODS Analyses compared receipt of a PTSD diagnosis and service-connected disability compensation in 2004-2006 and 2007-2009. RESULTS Among Vietnam era veterans, the percentage with a PTSD diagnosis in 2007-2009 was 22.2% higher than the percentage with PTSD in 2004-2006; the percentage without PTSD was 6.2% higher than in 2004-2006. Of those with PTSD in 2007-2009, 22.6% were previous VHA service users newly diagnosed ("conversions"); only 12.8% were entirely new to VHA ("recents"). Rates of disability compensation among recents and conversions were almost two and three times higher, respectively, than among those without PTSD. CONCLUSIONS The increase in Vietnam era veterans with PTSD is associated with more frequent "conversion" to PTSD among previous VHA users and receipt of disability compensation.
    Psychiatric services (Washington, D.C.) 04/2014; · 2.81 Impact Factor
  • Jack Tsai, Robert A Rosenheck, Vincent Kane
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    ABSTRACT: As more women serve in the U.S. military, the proportion of females among homeless veterans is increasing. The current study compares the individual characteristics and 1-year outcomes of homeless female and male veterans in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program nationally. Administrative data on 43,853 veterans (10.69% females; 89.31% males) referred to HUD-VASH were analyzed for gender differences at baseline and over a 1-year period. Homeless female veterans were younger, had shorter homeless and incarceration histories, and were less likely to have substance use disorders than men. However, despite being less likely to report combat exposure, female veterans were more likely to have posttraumatic stress disorder. Homeless female veterans were also much more likely to have dependent children with them and to plan to live with family members in supported housing. Once admitted to HUD-VASH, there were no gender differences in attrition or main housing outcomes. Case managers were faster to admit female veterans to the program, reported better working alliances, and provided more services related to employment and income than male veterans. These findings suggest homeless female veterans may have certain strengths, including being younger, less involved in the criminal justice system, and more adept at relating to professional and natural supports; but special attention to noncombat trauma and family-oriented services may be needed. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychological Services 04/2014; · 1.08 Impact Factor
  • Jack Tsai, Anne Klee, Robert A Rosenheck, Laurie Harkness
    Psychiatric services (Washington, D.C.) 04/2014; 65(4):564-5. · 2.81 Impact Factor
  • Meaghan Leddy, Elina Stefanovics, Robert Rosenheck
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    ABSTRACT: Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.
    The Journal of Rehabilitation Research and Development 04/2014; 51(1):161-75. · 1.78 Impact Factor
  • Jack Tsai, Elina Stefanovics, Robert A Rosenheck
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    ABSTRACT: Objective: To examine the frequency and predictors of group attendance in a new group-intensive peer support (GIPS) model of case management for the Veterans Affairs supported housing program. Methods: Administrative data and group attendance records from 1 GIPS program were analyzed using bivariate and regression analyses. Results: Of 295 clients, 42% attended at least 1 group and attended an average of 3 groups per month. There were no significant differences in any demographic, psychosocial, or clinical characteristics at baseline between group attenders and nongroup attenders. However, among group attenders, those who entered the program with more days homeless in the past month and more mental health symptoms attended groups more frequently. Conclusions and Implications for Practice: These results provide support for group-based models of care in supported housing and suggest those with more extensive housing and mental health problems may be more receptive to attending groups. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 03/2014; · 0.75 Impact Factor
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    ABSTRACT: This study assessed beliefs about mental disorders and changes in those beliefs following an educational intervention for a convenience sample of Nigerian medical and nursing students. A 43-item questionnaire was used to assess perceptions regarding mental disorders and attitudes toward people with mental illness before and after a 4-day educational intervention. Factor analysis identified four domains: (1) socializing with people with mental illness, (2) belief in witchcraft or curses as causes of mental illness, (3) favorable attitudes toward normalization of the lives of people with mental illness, and (4) biopsychosocial approaches to mental illness. The greatest changes were in attitudes favoring normalization of the lives of people with mental illness (p = 0.0002), socializing with the mentally ill (p = 0.01), and biopsychosocial perspectives on mental illness (p = 0.01). Brief educational interventions may alter some stigmatizing negative attitudes toward mental illness in healthcare trainees in low- and middle-income countries.
    Academic Psychiatry 03/2014; · 0.81 Impact Factor
  • Yanling Zhou, Robert A Rosenheck, Hongbo He
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    ABSTRACT: Economic reform in China 30 years ago virtually eliminated all public health insurance. In the last 10 years, diverse government insurance programs have been implemented, now covering 95% of the population, primarily for inpatient care. While the development of health care in China is an incomplete work in progress and highly variable, it is unclear whether the depth of insurance coverage affects the accessibility, length of stay (LOS) of inpatient mental health services or not.
    The Journal of Mental Health Policy and Economics 03/2014; 17(1):25-32. · 0.97 Impact Factor
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    ABSTRACT: There is considerable public and professional concern about the mental health status of veterans deployed to Iraq and Afghanistan as well as how to engage and retain symptomatic veterans in treatment. This study examined demographic, psychiatric, and psychosocial determinants of prospective initiation and retention in mental health services among symptomatic Iraq/Afghanistan veterans. One hundred thirty-seven symptomatic veterans who were referred to mental health screening completed a survey at the time of their first mental health visit. Associations between survey variables and subsequent Veterans Affairs service utilization were evaluated. The most consistent determinants of mental health service initiation and retention were severity of posttraumatic stress disorder (PTSD) and depressive symptoms. Notably, whereas PTSD-related re-experiencing symptoms were independently associated with initiation of mental health treatment, PTSD-related numbing symptoms were independently associated with retention in treatment. Stigma, barriers to care, and beliefs about mental health treatment were not associated with either mental health initiation or retention.
    The Journal of nervous and mental disease 02/2014; 202(2):97-104. · 1.77 Impact Factor
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    ABSTRACT: This column describes the planning and development of The Equilibrium Program (TEP) for multiply traumatized and neglected children and adolescents with mental and general medical problems in São Paulo, Brazil. The program is a partnership between university faculty, various service providers, the courts, and the city government. In the first step, child psychiatry faculty from the University of São Paulo visited central-city areas and group shelters to talk to street youths to better understand their needs. A nearby community sports center building was chosen to be a center where youths could access services and engage in recreational activities and where the work of family integration could be facilitated. A multidisciplinary team conducts an in-depth assessment and creates an intervention plan, overseen by a case manager. Challenges to implementing such programs are discussed.
    Psychiatric services (Washington, D.C.) 02/2014; 65(2):138-40. · 2.81 Impact Factor
  • Elina A Stefanovics, John H Krystal, Robert A Rosenheck
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    ABSTRACT: To describe and compare the structure and relative severity of symptoms in clinical trial patients diagnosed with Post Traumatic Stress Disorder (PTSD) or schizophrenia using the Positive and Negative Syndrome Scale (PANSS), developed originally to evaluate symptoms of schizophrenia. This secondary data analysis used baseline PANSS symptom ratings (n=267) from a six-month multicenter randomized placebo-controlled trial of adjunctive risperidone in patients with chronic military-related PTSD. First, using a split-half design, Exploratory Factor Analysis (EFA) was employed to identify independent factors which were then compared to published factor structures for schizophrenia. Next, Confirmatory Factor Analysis (CFA) was applied to the second half of the sample to compare the results of the EFA and published factor structures. Finally, T-tests were used to compare the severity of factor scores between the PTSD sample and the baseline PANSS ratings from the Clinical Antipsychotic Trial for Intervention Effectiveness (CATIE) schizophrenia sample (n=1460). EFA suggested five factors similar to those identified in a summary of 29 schizophrenia studies by Wallwork (Schizophrenia Research, 137:246-250). CFA showed that the five factor Wallwork model fit the data better than the EFA, although both had relatively high goodness of fit. T-tests showed that the PTSD sample had more severe symptoms on the Depressive factor, and the schizophrenia sample on the Positive, Negative, and Disorganized factors, with no significant difference on the Excited factor. Veterans with PTSD had similar symptom structure to patients with schizophrenia on the PANSS, but were less symptomatic on psychosis-related factors and more symptomatic on depression. Dimensional symptom factors can be virtually the same across diagnoses.
    Comprehensive psychiatry 01/2014; · 2.08 Impact Factor
  • Jack Tsai, Robert Rosenheck
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    ABSTRACT: Objectives. We examined the number and clinical needs of uninsured veterans, including those who will be eligible for the Medicaid expansion and health insurance exchanges in 2014. Methods. We analyzed weighted data for 8710 veterans from the 2010 National Survey of Veterans, classifying it by veterans' age, income, household size, and insurance status. Results. Of 22 million veterans, about 7%, or more than 1.5 million, were uninsured and will need to obtain coverage by enrolling in US Department of Veterans Affairs (VA) care or the Medicaid expansion or by participating in the health insurance exchanges. Of those uninsured, 55%, or more than 800 000, are likely eligible for the Medicaid expansion if states implement it. Compared with veterans with any health coverage, those who were uninsured were younger and more likely to be single, Black, and low income and to have been deployed to Iraq and Afghanistan. Conclusions. The Patient Protection and Affordable Care Act is likely to have a considerable impact on uninsured veterans, which may have implications for the VA, the Medicaid expansion, and the health insurance exchanges. (Am J Public Health. Published online ahead of print January 16, 2014: e1-e6. doi:10.2105/AJPH.2013.301791).
    American Journal of Public Health 01/2014; · 3.93 Impact Factor
  • Eric D.A. Hermes, Robert A. Rosenheck
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    ABSTRACT: Objective There is little information on diagnostic rates or treatment correlates of insomnia in real-world practice. Study objectives were to identify the 1-year prevalence, psychotropic pharmacotherapy, and clinical correlates of diagnosed insomnia, nationally in the Veterans Health Administration (VHA). Method The study utilized national administrative data on all individuals receiving VHA care in 2010. Receipt of insomnia in addition to comorbid diagnoses were identified using relevant ICD-9 diagnostic codes. The adjusted mean number of psychotropic prescription fills and comorbid conditions associated with insomnia were identified using bivariate and multivariable regression models. Results Of the 5,531,379 individuals receiving VHA care in 2010, 190,378 (3.4%) received an insomnia diagnosis. Controlling for clinical characteristics, the presence of an insomnia diagnosis was associated with an average of four additional psychotropic prescription fills over the year. Among demographic characteristics, deployment to recent conflicts in Iraq/Afghanistan (Adjusted Odds Ratio [AOR]=1.62) displayed the strongest independent association, while age, unexpectedly, did not display any association with insomnia. Among diagnostic variables, anxiety disorders other than posttraumatic stress (AOR=2.12) and depressive disorders other than major depression (AOR=2.05) displayed the strongest independent associations with insomnia. Conclusion The diagnosis of insomnia is associated with the filling of more psychotropic prescriptions, net of the presence of psychiatric comorbidity in national VHA administrative data, and the prevalence of diagnosed insomnia is lower than that found in systematic surveys of the general population, a potential impediment to optimal treatment.
    Sleep Medicine 01/2014; · 3.49 Impact Factor
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    ABSTRACT: Stigma towards people with mental illness is believed to be widespread in low and middle income countries.
    International Journal of Mental Health Systems 01/2014; 8:26. · 1.06 Impact Factor
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    ABSTRACT: The Social Security Administration (SSA) provides financial support to adults disabled by psychiatric conditions to provide for their basic needs. For beneficiaries identified as incapable of managing their funds, representative payee assignment is mandated. However, studies indicate that the current SSA method of determining capability leads to idiosyncratic payee assignment, with a tendency to under-identify beneficiaries needing payees. Over two phases with data from 78 mental health clinicians treating 134 patient-beneficiaries, we describe the development of a new assessment, the Clinician Assessment of Financial Incapability (CAFI). Item generation, subscale construction, and preliminary assessments of validity are described. We also describe the simultaneous development of a criterion measure of capability, a comprehensive review of all data. Experts identified four subscales mapping to four criteria of incapability; factor analysis provided support for this item structure. Close to one-half of patients were determined to be incapable by review of all data. CAFI and SSA methods correctly classified 73% of cases, but errors with CAFI were more evenly distributed between false negatives and false positives. The implications of classification error are considered, and advantages of CAFI over the SSA method are enumerated. Plans for future instrument revision are briefly described.
    Psychiatry Research 01/2014; · 2.46 Impact Factor
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    ABSTRACT: Thirty-eight U.S. Department of Veterans Affairs’s (VA) residential treatment programs for posttraumatic stress disorder took part in a formative evaluation of their programmatic services, including perceptions of effective treatment. From July 2008 through March 2011, face-to-face qualitative interviews were conducted with over 250 VA residential staff. A wide variety of perceived effective treatment elements were noted. The most frequently mentioned elements were evidence-based treatments, frequency and intensity of milieu, staff cohesion, varied programming, and individualized treatment. Implications for VA managers and policy-makers as well as non-VA health care systems and health care providers are discussed. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
    Traumatology: An International Journal. 01/2014; 20(1):43.
  • Jack Tsai, Wesley J Kasprow, Vincent Kane, Robert A Rosenheck
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    ABSTRACT: Street outreach is one of the most direct methods of engaging homeless individuals, but the characteristics of those most likely to be engaged this way is not well-understood. Data from the Department of Veterans Affairs (VA) Homeless Operations Management and Evaluation System showed that of the 70,778 literally homeless veterans engaged in VA homeless services in 2011-2012, 12% were through street outreach while the majority was through provider referrals (41%) and self-referrals (28%). Veterans engaged through street outreach had more extensive histories of recent homelessness, were more likely to be chronically homeless, and were more likely to be referred and admitted to the VA's supported housing program than other veterans. These findings suggest street outreach is an especially important approach to engaging chronic street homeless veterans in services and linking them to permanent supported housing.
    Journal of Health Care for the Poor and Underserved 01/2014; 25(2):694-704. · 1.10 Impact Factor

Publication Stats

8k Citations
1,324.34 Total Impact Points

Institutions

  • 2004–2014
    • Yale-New Haven Hospital
      • Department of Laboratory Medicine
      New Haven, Connecticut, United States
    • Hospital Nuestra Señora del Rosario
      Madrid, Madrid, Spain
  • 2000–2014
    • Yale University
      • Department of Psychiatry
      New Haven, Connecticut, United States
  • 2013
    • Robert Wood Johnson Foundation
      Princeton, New Jersey, United States
  • 2012
    • Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
      • Departamento de Psiquiatria
      São Paulo, Estado de Sao Paulo, Brazil
  • 2005–2012
    • VHA National Center for Organization Development (NCOD)
      Cincinnati, Ohio, United States
    • West Haven University
      West Haven, Connecticut, United States
  • 2003–2012
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2011
    • Hospital of the University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
    • The University of Calgary
      • Department of Psychiatry
      Calgary, Alberta, Canada
    • University of São Paulo
      • Institute of Psychiatry
      San Paulo, São Paulo, Brazil
    • University of South Florida
      Tampa, Florida, United States
  • 2010–2011
    • University of Massachusetts Boston
      • Gerontology Institute
      Boston, MA, United States
  • 2008–2011
    • The Ohio State University
      • College of Social Work
      Columbus, OH, United States
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, CA, United States
    • Medical University of South Carolina
      Charleston, South Carolina, United States
    • University of California, Los Angeles
      • Department of Psychiatry and Biobehavioural Sciences
      Los Angeles, CA, United States
  • 2005–2011
    • Columbia University
      • • Department of Psychiatry
      • • Department of Economics
      New York City, New York, United States
  • 2009
    • Penn State Hershey Medical Center and Penn State College of Medicine
      • Public Health Sciences
      Hershey, Pennsylvania, United States
  • 2006–2008
    • University of Iowa
      Iowa City, Iowa, United States
    • University of North Carolina at Chapel Hill
      • • Department of Medicine
      • • Department of Psychiatry
      Chapel Hill, NC, United States
    • State University of New York Downstate Medical Center
      • Department of Psychiatry and Behavioral Sciences
      Brooklyn, NY, United States
  • 2005–2008
    • Duke University Medical Center
      • Department of Psychiatry and Behavioral Science
      Durham, NC, United States
    • Brown University
      Providence, Rhode Island, United States
  • 2002–2008
    • University of Illinois at Chicago
      • Department of Psychiatry (Chicago)
      Chicago, Illinois, United States
    • University of Toronto
      • Institute of Health Policy, Management and Evaluation
      Toronto, Ontario, Canada
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, MD, United States
  • 2007
    • Emory University
      Atlanta, Georgia, United States
  • 2006–2007
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2004–2006
    • University of Southern California
      • Marshall School of Business
      Los Angeles, California, United States
  • 2004–2005
    • University of Wisconsin–Madison
      Madison, Wisconsin, United States
  • 2001
    • National Institute of Mental Health (NIMH)
      Maryland, United States
    • Boston College, USA
      Boston, Massachusetts, United States