Ramin Mojtabai

Ramin Mojtabai
Johns Hopkins Bloomberg School of Public Health | JHSPH · Department of Mental Health

About

358
Publications
40,467
Reads
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15,561
Citations
Citations since 2016
175 Research Items
10238 Citations
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201620172018201920202021202205001,0001,500
201620172018201920202021202205001,0001,500
Additional affiliations
October 2014 - present
Johns Hopkins University
Position
  • Professor (Full)
August 2008 - present
Johns Hopkins Medicine
Position
  • Attending physician
August 2008 - September 2014
Johns Hopkins Bloomberg School of Public Health
Position
  • Professor (Associate)

Publications

Publications (358)
Article
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
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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...
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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...
Article
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...
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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...
Article
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...
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Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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...
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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...
Article
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...
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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...
Article
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...
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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...
Article
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...
Article
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...
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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...
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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...
Article
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...
Article
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...
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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...
Article
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...
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Full-text available
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...
Article
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...
Article
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...
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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...
Article
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...
Article
Background While use of digital media and alcohol are common among adolescent females and males, longitudinal evidence on their association is scant. This study examined the association of digital media use frequency with subsequent initiation and progression of alcohol use. We also examined whether these associations were moderated by gender and r...
Article
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...
Article
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...
Article
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...
Article
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...
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Full-text available
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...
Article
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...
Article
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...
Preprint
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...
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Full-text available
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...
Article
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...
Article
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.
Article
Background: Studies have shown that rates of lithium use for bipolar disorder in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined trends of medications for bipolar disorder from 1996 to 2015. Methods: Twenty years of data from the Nati...
Article
This 6 month randomized control trial investigated whether a novel text-messaging program impacted targeted clinical outcomes in patients with schizophrenia and schizoaffective disorder (SAD). Forty patients were enrolled and completed baseline, 3-month and 6-month assessments. The intervention group received daily symptom check-in text messages, p...
Preprint
Background: Secondary analysis of data from completed randomized controlled trials (RCTs) is a critical and efficient way to maximize the potential benefit from past research. De-identified primary data from completed RCTs have been increasingly available in recent years; however, the lack of standardized data products is a major barrier to further...
Article
Background Persons who interact with criminal justice and hospital systems are particularly vulnerable to negative health outcomes, including overdose. However, the relationship between justice involvement, healthcare utilization and overdose risk is not well-understood. This data linkage study seeks to improve our understanding of the link between...
Article
Objective Little is known about the correlates of and recent trends in implementation of Integrated Dual Diagnosis model, an evidence-based approach for dual diagnosis services, in US mental health facilities between 2010 and 2018. Methods Changes over time in Integrated Dual Diagnosis Treatment use were examined using multiple waves of a national...
Article
Objective: This study aimed to assess the validity of the psychiatric problems subscale of the Addiction Severity Index (ASI-psych) to ascertain psychiatric comorbidity among individuals participating in randomized controlled trials (RCTs) of substance use disorder (SUD) treatments. Methods: The ASI-psych score among 1,660 RCT participants of Natio...
Article
The role of smoking cessation treatments in the link between clean indoor air laws and cigarette taxes with smoking cessation is not known. This study examined whether the use of smoking cessation treatments mediates the association between clean indoor air laws and cigarette excise taxes, on the one hand, and recent smoking cessation, on the other...
Article
Importance The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined. Objective To examine national trends in the care...
Article
Background and Aims Misuse of tramadol, an opioid prescription analgesic, is known as a public health challenge globally. We aimed to systematically review studies on the prevalence of non‐prescribed use, regular tramadol use and dependence, tramadol‐induced poisoning and mortality in Iran. Methods Consistent with PRISMA guidelines, international...
Article
Background and aims: Evidence from randomized controlled trials establishes that medication treatment with methadone and buprenorphine reduces opioid use and improves treatment retention. However, little is known about the role of such medications compared with non-medication treatments in mitigating overdose risk among US patient populations rece...
Article
In 2011, Florida established a Prescription Drug Monitoring Program and adopted new regulations for independent pain-management clinics. This paper examines the association of those reforms with drug overdose deaths and other injury fatalities. Florida's post-reform monthly mortality rates - for drug-involved deaths, motor vehicle crashes, and suic...
Article
Full-text available
Background: WHO recommends the use of psychological interventions as first-line treatment for depression in low-income and middle-income countries. However, evaluations of the effectiveness and cost-effectiveness of such interventions among people with HIV are scarce. Our aim was to establish the effectiveness of group support psychotherapy (GSP)...
Preprint
Full-text available
Background Studies have shown that rates of lithium use for bipolar disorder (BPD) in the United States declined through the 1990s as other mood stabilizing anticonvulsants and second-generation antipsychotics (SGAs) became more popular. We examined recent prescribing trends of medications for BPD over the past two decades. Methods Twenty years of...
Article
In Reply In our study,¹ we used 3 waves of data from the longitudinal Population Assessment of Tobacco and Health study to show that adolescents who report more frequent social media use report greater symptoms of psychopathology 1 year later. In their letter, Keyes and Kreski replicated our findings. They then showed that, after further adjusting...
Article
Objective: To examine the impact of Section 1115 waivers on Medicaid coverage and opioid agonist therapy (OAT) utilization among substance use treatment admissions. Data source: Treatment Episode Data Set-Admissions (TEDS-A) (2001-2012). Study design: We examined effects of 1115 waiver implementation on proportions of substance use treatment a...
Preprint
We focus on estimating the average treatment effect in clinical trials that involve stratified randomization, which is commonly used. It is important to understand the large sample properties of estimators that adjust for stratum variables (those used in the randomization procedure) and additional baseline variables, since this can lead to substant...