Norah Mulvaney-Day’s research while affiliated with Truven Health Analytics and other places

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Publications (4)


Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature
  • Literature Review

September 2017

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138 Reads

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123 Citations

Journal of General Internal Medicine

Norah Mulvaney-Day

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Tina Marshall

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Kathryn Downey Piscopo

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[...]

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Sushmita Shoma Ghose

Background Mounting evidence indicates that early recognition and treatment of behavioral health disorders can prevent complications, improve quality of life, and help reduce health care costs. The aim of this systematic literature review was to identify and evaluate publicly available, psychometrically tested tools that primary care physicians (PCPs) can use to screen adult patients for common mental and substance use disorders such as depression, anxiety, and alcohol use disorders. Methods We followed the Institute of Medicine (IOM) systematic review guidelines and searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify literature addressing tools for screening of behavioral health conditions. We gathered information on each tool’s psychometrics, applicability in primary care, and characteristics such as number of items and mode of administration. We included tools focused on adults and the most common behavioral health conditions; we excluded tools designed for children, youth, or older adults; holistic health scales; and tools screening for serious but less frequently encountered disorders, such as bipolar disorder. Results We identified 24 screening tools that met the inclusion criteria. Fifteen tools were subscales stemming from multiple-disorder assessments or tools that assessed more than one mental disorder or more than one substance use disorder in a single instrument. Nine were ultra-short, single-disorder tools. The tools varied in psychometrics and the extent to which they had been administered and studied in primary care settings. Discussion Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.


How States Are Tackling the Opioid Crisis
  • Article
  • Full-text available

February 2017

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205 Reads

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58 Citations

Public Health Reports

Objectives: We used data from the 2015 National Association of State Alcohol and Drug Abuse Directors Web-based questionnaire and other sources to demonstrate the range and scope of state initiatives being used to deal with the opioid crisis in the United States. Methods: State alcohol and drug agency directors and designated senior agency managers responded to the questionnaire, which asked respondents about recent opioid-related state-level public health initiatives at their agencies. Results: State alcohol and drug agencies in all 50 states and the District of Columbia responded, all of which reported that prescription drug misuse was a high priority or the highest priority area for their agencies. Of the 51 respondents, states reported initiatives to educate the general public (n = 48), prescribers (n = 31), patients and families (n = 24), and pharmacists (n = 22) about the risks of opioids. In addition, 29 states had increased funding for medication-assisted treatment of opioid addiction, 28 had expanded the availability of naloxone (an opioid antidote), 26 had established guidelines for safe opioid prescribing, 23 had launched requirements for prescriber use of prescription monitoring programs, 23 had passed Good Samaritan laws to protect those helping treat overdoses, and 14 had enacted legislation to regulate pain clinics. Conclusions: US state alcohol and drug agencies demonstrated a robust response to the opioid crisis in the United States. They have pursued and expanded on an array of evidence-based initiatives aimed at the opioid crisis. Future public health efforts should focus on maintenance and further expansion of high-quality, evidence-based practices, policies, and programs.

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PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War

January 2016

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38 Reads

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15 Citations

Psychiatric services (Washington, D.C.)

Objective: The primary goal of this analysis was to assess whether recent use of outpatient services for general medical concerns by Vietnam veterans varies according to level of posttraumatic stress disorder (PTSD) symptomatology over time. Another goal was to determine whether PTSD symptomatology was associated with veterans' reports of discussing behavioral health issues as part of a general medical visit. Methods: Self-reported service use data and measures of PTSD were from a nationally representative sample of 848 male and female Vietnam theater veterans (individuals who were deployed to the Vietnam theater of operations) who participated in the National Vietnam Veterans Longitudinal Study, a 25-year follow-up of a cohort of veterans originally interviewed from 1984-1988 as part of the National Vietnam Veterans Readjustment Study. Four categories of PTSD symptomatology course over 25 years were defined, and logistic regression models were used to assess their relationship with recent use of outpatient general medical services. Results: Male and female theater veterans with high or increasing PTSD symptomatology over the period were more likely than those with low symptomatology to report recent VA outpatient visits. Males in the increasing and high categories were also more likely to discuss behavioral health issues at general medical visits. Conclusions: Vietnam veterans with high and increasing PTSD symptomatology over time were likely to use VA outpatient general health services. Attention to stressors of the aging process and to persistence of PTSD symptoms is important for Vietnam veterans, as is addressing PTSD with other psychiatric and medical comorbidities within the context of outpatient general medical care.


Table 1 . Continued 
Table 1 . Characteristics of the Study Sample (n = 2,348), National Vietnam Veterans Longitudinal Study, 1987-2011 
Table 2 . Description of Causes of Death for Vietnam Theater and Vietnam War-Era Veterans, National Vietnam Veterans Longitudinal Study, 1987-2011 
Table 3 . All-Cause Mortality for Vietnam Theater and Vietnam War-Era Veterans According to Selected Characteristics, National Vietnam Veterans Longitudinal Study, 1987-2011 
Table 3 . Continued 

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A Prospective Study of Mortality and Trauma-Related Risk Factors Among a Nationally Representative Sample of Vietnam Veterans

December 2015

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414 Reads

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79 Citations

American Journal of Epidemiology

Because Vietnam veterans comprise the majority of all living veterans and most are now older adults, the urgency and potential value of studying the long-term health effects of service in the Vietnam War, including effects on mortality, is increasing. The present study is the first prospective mortality assessment of a representative sample of Vietnam veterans. We used one of the longest follow-up periods to date (spanning older adulthood) and conducted one of the most comprehensive assessments of potential risk factors. Vital status and cause of death were ascertained for the 1,632 veterans who fought in the Vietnam theater (hereafter referred to as theater veterans) and for 716 Vietnam War-era veterans (hereafter referred to as era veterans) who participated in the National Vietnam Veterans Readjustment Study (1987-2011). As of April 2011, 16.0% (95% confidence interval: 13.1, 19.0) of all Vietnam veterans who were alive in the 1980s were deceased. Male theater veterans with a high probability of posttraumatic stress disorder (PTSD) were nearly 2 times more likely to have died than were those without PTSD, even after adjustment for sociodemographic and other characteristics. A high level of exposure to war zone stress was independently associated with mortality for both male and female theater veterans after adjustment for sociodemographic characteristics, PTSD, and physical comorbid conditions. Theater veterans with a high level of exposure to war zone stress and a high probability of PTSD had the greatest mortality risk (adjusted hazard ratio = 2.34, 95% confidence interval: 1.24, 4.43).

Citations (4)


... Primary healthcare (PHC) is the most accessible institutionalized health service for most people (Bofill Moscardó et al., 2010;Wissow et al., 2016;Mulvaney-Day et al., 2018;Brino, 2020;Charach et al., 2020). It can then be the most appropriate setting to provide comprehensive healthcare given its accessibility, continuity of care, and the confluence of health data, creating a space in which relationships of trust between service users and healthcare professionals can be developed (Bofill Moscardó et al., 2010;Ministerio de Sanidad, 2011;Buitrago Ramírez et al., 2018;Zurro, Pérez, and Badia, 2019;Brino, 2020). ...

Reference:

A qualitative exploration of Gestalt therapy and systemic pedagogy paediatric primary healthcare consultations in Agramunt (Spain)
Screening for Behavioral Health Conditions in Primary Care Settings: A Systematic Review of the Literature
  • Citing Article
  • September 2017

Journal of General Internal Medicine

... IS documents were coded for each of eight types of programs for addressing OUD: SUD treatment; primary care; emergency department services; risk/harm reduction and education; social determinants; community coalition approaches; prescriber guidelines; and policy advocacy ( Table 1). All coding and analysis of CHNAs and IS documents occurred in 2018 and 2019 and followed the process described by Wickramatilake and colleagues [28]. ...

How States Are Tackling the Opioid Crisis

Public Health Reports

... Most research on Vietnam War veterans has been conducted in the United States and has focused on the course of PTSD symptoms, 55,56 factors contributing to PTSD symptom severity, 56 and the physical and mental health and social impact of PTSD symptoms. 57 However, to date, no studies have measured embitterment in Vietnam War veterans and explored its association with other psychopathological factors. ...

PTSD and Use of Outpatient General Medical Services Among Veterans of the Vietnam War
  • Citing Article
  • January 2016

Psychiatric services (Washington, D.C.)

... In light of the growing evidence of adverse health and functional outcomes associated with post-traumatic symptoms [20,21], and the high annual incidence of sepsis [2] describing the trajectories and potentially modifiable risk factors for adverse mental health outcomes after sepsis has important implications for population health, for example to identify patient groups at particular risk [22]. ...

A Prospective Study of Mortality and Trauma-Related Risk Factors Among a Nationally Representative Sample of Vietnam Veterans

American Journal of Epidemiology