Ramin Mojtabai

Tulane University | TU · Department of Psychiatry

Objectives Heterogeneity of treatment effect (HTE) is a concern in substance use disorder (SUD) treatments but has not been rigorously examined. This exploratory study applied a causal forest approach to examine HTE in psychosocial SUD treatments, considering multiple covariates simultaneously. Methods Data from 12 randomized controlled trials of...

Objective: Up to 2 million college students in the United States have been diagnosed as having attention-deficit hyperactivity disorder (ADHD), a condition associated with negative academic, social, and psychiatric outcomes. The authors investigated the online availability and content of policies governing ADHD services at college clinics. Method...

Importance Medical debt is common in the US and may hinder timely access to care for mental disorders. Objective To estimate the prevalence of medical debt among US adults with depression and anxiety and its association with delayed and forgone mental health care. Design, Setting, and Participants Cross-sectional, nationally representative survey...

Aims The aim of this study was to measure trajectories of craving for methamphetamine during the course of pharmacotherapy trials for methamphetamine use disorder. Design, setting and participants Craving trajectories were identified using Group‐Based Trajectory Modeling. The association of craving trajectories with drug use trajectories was exami...

Background Alcohol use has profound public health impact on women; however, modifiable factors that may influence alcohol use progression/recovery, including health service utilization, are understudied in women. Objective To investigate the association between mental health (MH) and substance use (SU) treatment with alcohol use progression and re...

Purpose Suicidal thoughts and behaviors (STB) have been increasing among US college students. Accurate measurement of STB is key to understanding trends and guiding suicide prevention efforts. We aimed to compare the prevalence estimates of STB among college students from two campus-based surveys (the National College Health Assessment [NCHA] and t...

Purpose This study examined time trends in significant child and adolescent psychological symptoms and explored the association of frequent and problematic social media use with these symptoms. Methods Time trends in psychological symptoms were assessed using data from five waves of the international survey of Health Behavior in School-aged Childr...

Objective: The National Survey on Drug Use and Health (NSDUH), as the primary source of epidemiological substance use data in the US, could illuminate trends in fentanyl use behaviors contributing to the opioid overdose crisis. We hypothesized that the trend in NSDUH prevalence of lifetime fentanyl injection would match the direction and magnitude...

Purpose Household economic adversity during adolescence is hypothesized to be a risk factor for poor mental health later in life. To test this hypothesis, we conducted a quasi-experimental analysis of an economic shock, the Great Recession of 2007–2009. We tested if going through adolescence during the Great Recession was associated with increased...

Background and aims Total abstinence has historically been the goal of treatment for substance use disorders; however, there is a growing recognition of the health benefits associated with reduced use as a harm reduction measure in stimulant use disorders treatment. We aimed to assess the validity of reduced stimulant use as an outcome measure in r...

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the assoc...

Objective: The authors aimed to assess differences in appointment completion rates between telepsychiatry and in-person outpatient psychiatric care for patients with depression in an academic health system. Methods: Electronic health records of encounters for patients (ages ≥10) with a depression diagnosis and at least one scheduled outpatient p...

Purpose The aim of this literature review is to examine evidence of time trends and birth cohort effects in depressive disorders and symptoms among US adolescents in peer-reviewed articles from January 2004 to April 2022. Methods We conducted an integrative systematic literature review. Three reviewers participated at different stages of article r...

Backgrounds Meta-analyses can be a powerful tool but need to calibrate potential unrepresentativeness of the included trials to a target population. Estimating target population average treatment effects (TATE) in meta-analyses is important to understand how treatments perform in well-defined target populations. This study estimated TATE of paliper...

Objective: To assess whether prevalence of treatment for ADHD varies by location of mental healthcare among US college students aged 18 to 25 with professionally diagnosed ADHD. Method: Our analysis uses cross-sectional data from the National College Health Assessment (NCHA) and evaluated the relationship between types of care received and locat...

Objective: An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. Methods: Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participat...

Objective: To determine whether use of medications with potential depressive symptom side effects is associated with a higher level of depressive symptoms in adults with antidepressant-treated major depressive disorder (MDD). Methods: The study was based on the 2013-2014, 2015-2016, and 2017-2018 National Health and Nutrition Examination Survey (NH...

Background: Children from lower socioeconomic status (SES) households are at greater risk for mental illnesses. Socioeconomic status has different dimensions: Objective SES, subjective SES, and contextual SES. Evidence suggests that subjective SES partially mediates the impact of objective SES on mental health. However, these hypotheses have not be...

Purpose: This study examined time trends in significant child and adolescent internalizing symptoms and explored the association of excessive and problematic social media use with these symptoms. Methods: Time trends in internalizing symptoms were assessed using data from five waves of the international survey of Health Behavior in School-aged Chil...

Objective: Clozapine is the most efficacious antipsychotic medication, but it is underutilized and its mechanism of action is still poorly understood. One aspect of its unique efficacy that requires further study is its effect on suicidality. A randomized controlled trial, the InterSePT study, yielded evidence that clozapine reduces suicidality mor...

Drug use is an increasing global public health concern. We reviewed the prevalence and patterns of drug use, drug use disorders, and the extent of treatment services in 21 countries and one territory in the Eastern Mediterranean region from 2010 to 2022. Online databases were systematically searched on April 17, 2022, along with other sources for g...

Background This study examines changes in the substance use disorder (SUD) treatment gap and barriers to treatment for low-income adults following Affordable Care Act (ACA) implementation. Methods National Survey on Drug Use and Health (NSDUH) data were pooled to assess pre-ACA (2009–2013) and post-ACA (2015–2019) implementation. The sample (n = 4...

Importance Integrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care. Objectives To explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care. Design, Setting, and Pa...

Objective: In light of historical racial-ethnic disparities in health care coverage, the authors assessed changes in coverage in nationally representative samples of Black, White, and Hispanic low-income adults with substance use disorders after the 2014 Affordable Care Act Medicaid expansion. Methods: Data from 12 years of the annual National S...

Objective: State insurance departments enforce the federal Mental Health Parity and Addiction Equity Act (MHPAEA) for fully insured employer-sponsored health plans and plans on the individual marketplace. Variable enforcement among states may drive patients' difficulties in accessing behavioral health treatment. This study explored insurance commi...

Importance: Prevalence estimates of substance use disorders in the US rely on general population surveys. However, major population groups, such as homeless individuals and institutionalized individuals, are not captured by these surveys, and participants may underreport substance use. Objective: To estimate the prevalence of substance use disor...

Context: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires coverage for mental health and substance use disorder (MH/SUD) benefits be no more restrictive than for medical/surgical benefits in commercial health plans. State insurance departments oversee enforcement for certain plans. Insufficient enforcement is one potential source...

Objective: To determine the effect of group support psychotherapy (GSP) compared to group HIV education (GHE) on depression and HIV treatment outcomes 24 months after treatment. We further aimed to investigate the mediating role of depression and anti-retroviral therapy (ART) adherence in the relationship between GSP and viral load suppression. M...

The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the...

Study objectives: Recent initiatives to discourage over-prescription of sleep medications have increased awareness of their potential adverse effects; however, it is unknown whether these efforts translated into a decline in use of these medications in the United States. We assessed recent national trends in the use of medications used for sleep d...

Introduction: Longitudinal research assessing whether mood disorders predict substance use behaviors is limited. We extend our prior work evaluating transition patterns with alcohol use to assess patterns with alcohol and drug use problems. Method: Using National Epidemiologic Survey on Alcohol and Related Conditions prospective data, waves 1 an...

This study assessed trends in provision of trauma-specific services, defined as dedicated programming for persons with a history of trauma, in US Substance Use Disorder (SUD) and other Mental Health (MH) facilities. Facility level data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey (201...

Background Childhood adversity is associated with the onset of harmful adult substance use and related health problems, but most research on adversity has been conducted in general population samples. This study describes the prevalence of adverse childhood experiences in a cohort of people who have injected drugs and examines the association of th...

Background There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. Methods We searched Internati...

Introduction Early drinkers have been found to have higher risk of developing alcohol use disorder; however, the association of early drinking with progression to problematic alcohol involvement that does not meet disorder criteria (i.e., subclinical problems) or to severe stages of alcohol involvement, sex-specific associations, and relationship o...

Background and Aims There is a paucity of data on outcomes of opioid use disorder (OUD) from low and middle-income countries. We aimed to investigate the mortality as well as negative social and health outcomes in a 6-year follow-up study of a cohort of individuals with opioid use including those with OUD, in Iran. Design and setting Participants w...

Recent initiatives to discourage over-prescription of sleep medications have increased awareness of their potential adverse effects in older adults; however, it is unknown whether these efforts translated into a decline in use of these medications in the United States. We assessed recent national trends in the use of medications for sleep disorders...

Purpose To assess the validity of a single question on medication use for depression in a general population survey. Methods Using data from 2015–2016 and 2017–2018 National Health and Nutrition Examination Survey, we compared responses to a single question on medication use for depression with responses to a detailed questionnaire confirmed by in...

Background : Evidence suggests that the prevalence of self-rated psychological symptoms among children and adolescents has changed in the past two decades. Our objective was to examine if similar trends are apparent in parent-rated assessments of psychological symptoms. Methods : Participants were a nationally-representative sample of parents who...

Introduction Although health coverage facilitates service access to adults in the general population, uncertainty exists over the extent to which this relationship extends to low-income adults with substance use disorders. Methods The health status and service use patterns of low-income adults with substance use disorders who had continuous, disco...

Objective: This study examined demographic and diagnostic characteristics associated with self-reported recovery in patients with serious mental illness. Methods: Patient demographics and diagnoses were obtained from a retrospective review of charts from 981 patients attending a community psychiatry outpatient program between January 2015 and De...

Objective: To determine the proportion of adults treated for depression in the US who achieve remission and, among those not achieving remission, the proportion receiving augmentation treatment. Methods: Using data from the US National Health and Nutrition Examination Survey (NHANES) for years 2013-2014, 2015-2016, and 2017-2018, we identified 869...

Importance The prevalence of internalizing problems among US adolescents has risen in the past decade. The extent to which concerns about school violence or shootings are associated with risk of internalizing problems is unknown. Objective To examine the prospective association of concern, worry, and stress related to school violence or shootings...

Introduction Depression screening is universally recommended for adolescents presenting in primary care settings in the U.S. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental health care over time. Methods This longitudinal cohort study used insurance claims...

Aims Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational...

Objective Among persons with opioid use disorder (OUD), co-occurring depression is linked to a greater risk of opioid misuse, overdose and suicide. Less is known about characteristics and other comorbid health conditions of persons with co-occurring opioid use and depressive disorders. Methods: This study used electronic health record (EHR) encount...

We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators...

Two commonly used methods for improving precision and power in clinical trials are stratified randomization and covariate adjustment. However, many trials do not fully capitalize on the combined precision gains from these two methods, which can lead to wasted resources in terms of sample size and trial duration. We derive consistency and asymptotic...

Objective We investigated the impact of stressful life events (SLEs) for males and females on transitions in problematic alcohol involvement, both progression and recovery, over a 3-year interval. Method Participants of both Wave 1 (2001–2002) and Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) we...

Background Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the associations between tobacco policies and treatment use varies across sociodemographic groups. Methods We used data from 62,165 U.S. adult participants in the 2...

Background and aims Cannabis is the most widely used illicit substance globally. In this systematic review, we examined the prevalence and trends of cannabis use and cannabis use disorder in Iran. Methods We searched International and Iranian databases up to March 2021. Pooled prevalence of use among sex subgroups of the general population, univer...

Background Many individuals with cocaine or methamphetamine use disorders who enter treatment do not achieve abstinence but reduce their use of the target drug. We aimed to compare change in pattern of drug use (i.e., achieving “abstinence”, “reduced use” or no reduction in use) among participants in randomized controlled trials (RCTs) of treatment...

Introduction: Buprenorphine maintenance treatment (BMT) is widely used in Iran, and its use is growing continuously. We reviewed studies on buprenorphine use, non-prescribed use, use disorder and treatment-seeking for it, buprenorphine-associated poisoning, and mortality in Iran in the current systematic review. Methods: An Iranian database (Sci...

Background: The Islamic Republic of Iran is a majority Muslim country, with a culturally low acceptance of high-risk behaviours. Aims: To investigate co-occurrence of risk behaviours in the Iranian general population. Methods: This was a cross-sectional study. Data were obtained from a random subsample of 3508 participants in the Iranian Menta...

Objective: The authors assessed changes in health care coverage in nationally representative samples of low- and middle-income adults with and without substance use disorders following the 2014 Affordable Care Act marketplace launch and Medicaid expansion. Methods: Data from the 2012-2018 (N=407,985) National Survey on Drug Use and Health identi...

Background and Objectives The goals of depression screening, which is universally recommended in primary care settings in the U.S., are to identify adolescents with depression and connect them to treatment. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental he...

Background Sleep problems in adolescence, such as insomnia and short sleep duration, are associated with physical and mental health problems. However, little is known about the recent trends in sleep problems among adolescents. Therefore, this study examined trends in sleep problems among Japanese adolescents. Methods Using data from the Lifestyle...

Objective: The authors examined changes in buprenorphine treatment following Medicaid expansion, including the contribution of Medicaid-financed prescriptions. Methods: Buprenorphine pharmacy claims for patients were identified in the 2012-2018 IQVIA Longitudinal Prescription Data (LRx) data set, including 79.8% of U.S. retail prescriptions in 2...

Background Although adolescents commonly use digital media and consume alcohol , longitudinal evidence of the association between these behaviors is scant. This study examined the association between the frequency of digital media use and the subsequent initiation or progression of alcohol use. We also examined whether these associations were moder...

Objectives: To elucidate the main latent classes of substances detected among overdose decedents, and latent class associations with age, sex, race, and jurisdiction of death in Maryland. Methods: We used toxicology data from the Office of the Chief Medical Examiner of Maryland for all decedents. We analyzed all cases of drug overdose deaths tha...

Background Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners’ capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a traini...

The study examined associations between medication assisted treatment (MAT) and psychiatric symptom severity, measured by Positive and Negative Symptom Scale (PANSS), among individuals with serious mental illness and a history of heroin use. Of 271 participants, 32% (n=87) reported a history of heroin use and, of those, 14.9% (n=13) reported MAT. H...

Objective: The author aimed to assess changes in mental health service use, unmet need for mental health care, and barriers to obtaining care among low-income adults after the implementation of the Affordable Care Act in 2014. Methods: Data on 15,968 adults with psychological distress and family income <100% of the federal poverty level were dra...

Objective This study examined Electronic Health Record (EHR) utilization among US substance use disorder (SUD) versus mental health (MH) treatment facilities. Methods Data from the National Survey of Substance Abuse Treatment Services and the National Mental Health Services Survey were used to examine differences in clinical and administrative uti...

Purpose: This study investigated associations between psychiatric symptom severity and delay in seeking general medical services among individuals with serious mental illness. Methods: The association of psychiatric symptom severity, measured by the Positive and Negative Syndrome Scale (PANSS), and general medical care delay was examined among 2...

Background: Secondary analysis of data from completed randomized controlled trials is a critical and efficient way to maximize the potential benefits from past research. De-identified primary data from completed randomized controlled trials have been increasingly available in recent years; however, the lack of standardized data products is a major...

Background The goal of this article is to investigate the relationship of psychiatric symptom severity with internalised stigma, neighbourhood environment, and social support among individuals with serious mental illness. Method Using a longitudinal study design we examined the relationship between psychiatric symptom severity with internalised st...

Problems accessing affordable treatment are common among low-income adults with substance use disorders. A difference-in-differences analysis was performed to assess changes in insurance and treatment of low-income adults with common substance use disorders following the 2014 ACA Medicaid expansion, using data from the 2008–2017 National Surveys on...

Background: Persons with justice-involvement have high rates of opioid use disorder (OUD) and overdose and are a critical target of policy initiatives to improve access to evidence-based medications for OUD. However, less is known about what characteristics of justice-involved persons make them more or less likely to receive evidence-based care. Ob...

Background Tobacco policies, including clean indoor air laws and cigarette taxes, increase smoking cessation in part by stimulating the use of cessation treatments. We explored whether the mediating effect of such treatments varies across socio-demographic groups. Methods We used data from 62,165 U.S. adult participants in the 2003 and 2010/11 Cur...

Many privately insured adults with drug use disorders in the United States do not have health care coverage for drug use treatment. The Affordable Care Act sought to redress this gap by including substance use treatments as essential health benefits under new plans offered. This study used data from 11,732 privately insured adult participants of th...

(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).

Background Adverse childhood experiences (ACEs) are associated with a number of medical comorbidities. However, there is a paucity of data on the role ACEs play in transitions in stages of alcohol involvement. Objective To examine the association between ACEs and transitions in alcohol problems progression and regression between No Problems, Moder...

At its December 2019 meeting, the American Psychiatric Association (APA) Board of Trustees approved “The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia.” The full guideline is available at APA’s Practice Guidelines website.