Psychiatric services (Washington, D.C.)最新文献

{"title":"Sexual and Reproductive Health Recommendations for Women and Nonbinary Young Adults With Early Psychosis: A Qualitative Study.","authors":"Hannah Kearney, Juveria Zaheer, Zakia Hussain, Julia France, Ananka Rodriguez, Shakked Lubotzky-Gete, Suze Berkhout, Robert Dmytryshyn, Sheila Dunn, Renu Gupta, Fardous Hosseiny, Frank Sirotich, Sophie Soklaridis, Aristotle N Voineskos, Simone N Vigod, Lucy C Barker","doi":"10.1176/appi.ps.20250514","DOIUrl":"10.1176/appi.ps.20250514","url":null,"abstract":"<p><strong>Objective: </strong>Psychosis can adversely affect sexual and reproductive health outcomes. In this study, the authors explored the recommendations of women and nonbinary young adults experiencing early psychosis and of clinicians on how sexual and reproductive health care should be delivered.</p><p><strong>Methods: </strong>This qualitative study used semistructured interviews and focus groups to explore recommendations on how sexual and reproductive health care should be delivered to young adults experiencing early psychosis, including the potential role for integration within early psychosis intervention programs. Participants included service users (N=19, ages 18-31) and clinicians providing either mental health or sexual and reproductive health care to this population (N=36) in Canada. Transcripts were analyzed through thematic analysis.</p><p><strong>Results: </strong>Three key themes were identified: sexual and reproductive health care should be integrated into various clinical settings, including early psychosis intervention; sexual and reproductive health interventions should encompass many topics (including adverse effects of medications) and use flexible delivery methods; and such interventions should be guided by the principles of autonomy and inclusivity.</p><p><strong>Conclusions: </strong>The findings of this study highlight the importance of integrated approaches to delivering sexual and reproductive health care for young adults with early psychosis, including in early psychosis intervention services. Clinical interventions should prioritize flexibility, service user-identified topics of interest, and autonomy.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"963-971"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"Sexual and Reproductive Health Recommendations for Women and Nonbinary Young Adults With Early Psychosis: A Qualitative Study\".","authors":"Jocelyn Marrow","doi":"10.1176/appi.ps.20260390","DOIUrl":"https://doi.org/10.1176/appi.ps.20260390","url":null,"abstract":"","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":"77 10","pages":"988-989"},"PeriodicalIF":3.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Telehealth Use With Health Outcomes Among Young People With Autism Spectrum Disorder.","authors":"Ping-I Lin, Hannah Korach, Yi-Chia Chen","doi":"10.1176/appi.ps.20260256","DOIUrl":"https://doi.org/10.1176/appi.ps.20260256","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare clinical outcomes among children and adolescents with autism spectrum disorder (ASD) who did or did not have documented telehealth (TH) utilization.</p><p><strong>Methods: </strong>Data were aggregated from electronic health records of 112 health care organizations (queried in March 2026). Patients ages 5-18 years who had received a diagnosis of autistic disorder (<i>ICD-10-CM</i> code F84.0) were assigned to a TH or non-TH cohort. After 1:1 propensity score matching (PSM) across 14 comorbid condition categories, the analysis included 12,380 patients per cohort at 6 months and 15,689 patients per cohort at 12 months. Eight outcomes were assessed: medical noncompliance, antipsychotic initiation, emergency department (ED) visit, inpatient hospitalization, antidepressant initiation, attention-deficit hyperactivity disorder (ADHD) medication initiation, irritability-related encounters, and adaptive behavior treatment. Risk ratios (RRs), hazard ratios, and encounter frequencies were derived.</p><p><strong>Results: </strong>PSM cohorts were well balanced. In the 6-month analysis, TH use was associated with lower antipsychotic initiation (RR=0.81) and hospitalization (RR=0.69) but more ED visits (RR=1.39), irritability-related encounters (RR=2.49), and adaptive behavior treatment (RR=5.17). In the 12-month analysis, higher irritability (RR=2.29) and adaptive behavior treatment (RR=3.40) persisted in the TH cohort, which also had increased antidepressant (RR=1.17) and ADHD medication initiation (RR=1.12) and greater medical noncompliance (RR=1.84).</p><p><strong>Conclusions: </strong>TH use by young people with ASD was associated with lower rates of hospitalization and antipsychotic initiation at 6 months, although not at 12 months. TH use was also associated with increased irritability-related encounters and adaptive behavior treatment. These findings highlight the need for tailored hybrid care strategies.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20260256"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149033023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Measurement-Based Care to Inform Antidepressant Medication Management Among Veterans: A Pilot Study.","authors":"Lauren R DiPaolo, Kevin G Lynch, Erin Niedererr, Ryan M Bremseth-Vining, Kevin Kennedy, David W Oslin","doi":"10.1176/appi.ps.20250192","DOIUrl":"https://doi.org/10.1176/appi.ps.20250192","url":null,"abstract":"<p><strong>Objective: </strong>This pilot study examined the effectiveness of high and low measurement-based care (MBC) feedback strategies for depression treatment.</p><p><strong>Methods: </strong>Twenty providers at a U.S. Department of Veterans Affairs facility were randomly assigned to a no-feedback, low-feedback (automated collection and scoring of a depression self-report measure), or high-feedback (automated collection and scoring plus automated decision support) condition. Patients (N=336) completed the electronic version of the Patient Health Questionnaire-9 biweekly for 16 weeks. Outcomes included number of medication changes and depression symptom severity.</p><p><strong>Results: </strong>Patients completed 75% of the assessments. No statistically significant differences in medication changes or depression symptom severity were observed by condition. Approximately 46% of the patients received a medication change. The MBC groups had lower variability in management compared with the control group. Depression symptoms improved among all patients.</p><p><strong>Conclusions: </strong>MBC may reduce variability in medication management; however, automated collection was insufficient. Further research is needed to support implementation of all components of MBC.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20250192"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stigma and Mental Health Treatment Utilization Among Black and Asian American Young Adults.","authors":"Hans Oh, Trevor A Pickering, Leona Ofei, John Bunyi, Eric R Pedersen, Bruce Link","doi":"10.1176/appi.ps.20250420","DOIUrl":"https://doi.org/10.1176/appi.ps.20250420","url":null,"abstract":"<p><strong>Objective: </strong>Black and Asian American young adults underuse mental health services, yet little is known about how different forms of stigma influence help seeking among 18- to 29-year-olds in these communities.</p><p><strong>Methods: </strong>A national sample of 2,801 emerging adults (ages 18-29), comprising Black (N=1,224) and Asian American, Native Hawaiian, and Pacific Islander (AANHPI; N=1,577) individuals, was recruited via Qualtrics Panels. Modified Poisson regression models adjusted for sociodemographic characteristics were used to estimate associations of stigma with help-seeking outcomes.</p><p><strong>Results: </strong>Personal attitudes toward individuals receiving treatment were generally favorable, with ≥90% of the participants endorsing agreement of accepting a close friendship with someone who receives mental health treatment. However, moderate stigma persisted around dating. Perceived public stigma was increased, with most respondents overestimating how many people would likely reject individuals who receive mental health treatment. Among participants with depression, more than half were not receiving care. Personal stigma was positively associated with treatment use among Black respondents but negatively associated among AANHPI respondents, was linked to lower perceived need in both groups, and was associated with lower intention to continue treatment. Perceived public stigma was largely unrelated to treatment behaviors except for a positive association with perceived need among AANHPI respondents.</p><p><strong>Conclusions: </strong>Personal stigma plays a nuanced role in treatment engagement among Black and AANHPI emerging adults, underscoring the importance of culturally targeted stigma reduction efforts.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20250420"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149033038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Inpatient Psychiatric Services for the Next Generation: Moving Beyond the Crisis Stabilization Model.","authors":"Benjamin D Brody, Dora Kanellopoulos, Leonardo V Lopez","doi":"10.1176/appi.ps.20260235","DOIUrl":"https://doi.org/10.1176/appi.ps.20260235","url":null,"abstract":"<p><p>A short-stay, crisis stabilization model has been the predominant organizing principle for inpatient psychiatric care for two generations. This model has long been criticized as insufficiently patient (or person) centered and overly focused on psychopharmacological treatment and outpatient care coordination. Since the beginning of 2026, the Patient Experience Survey is now mandatory for Medicare-reimbursed psychiatric facilities. In this Open Forum, three inpatient psychiatric administrators argue that this important step, while necessary, must be paired with increased adoption of interventional treatments and integrated general medical services to improve the quality of inpatient mental health care.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20260235"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149033012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid Work Requirements: Implementation Risks for Adults Experiencing Mental Illness and Substance Use Disorders.","authors":"Daniel Holguin, Christian Rivera Nolan","doi":"10.1176/appi.ps.20260150","DOIUrl":"https://doi.org/10.1176/appi.ps.20260150","url":null,"abstract":"<p><p>The One Big Beautiful Bill Act (H.R. 1), signed July 4, 2025, requires states to condition Medicaid eligibility, among the population covered under the Affordable Care Act (ACA) expansion, on participation in 80 hours per month of qualifying work, training, or community engagement activity. The U.S. Department of Health and Human Services was required to publish an interim final rule, exempted from public notice and comment, by June 1, 2026. States must implement the law by January 1, 2027. Several states have started sooner (Nebraska, May 1, 2026; Montana and Arkansas, July 1, 2026) or will start early (Iowa, December 1, 2026). The statute exempts individuals deemed \"medically frail,\" including those with disabling mental or substance use disorders (or both). These are people the law clearly intends to protect yet whose illness characteristics will make performing the administrative filing for such exemptions difficult. This Federal Policy Assessment draws on Arkansas' natural experiment in implementing work requirements, the Georgia Pathways to Coverage program, and states' early implementations of H.R. 1 to identify the medically frail exemption as the central determinant of the law's impact on individuals experiencing psychiatric illness. Four recommendations for federal rulemaking, state implementation, and professional society action are offered.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20260150"},"PeriodicalIF":3.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149033013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated Mental Health Care for Perinatal Anxiety and Depression in the United States: A Systematic Review.","authors":"Katherine Steele, Carolyn Cunningham, Andrew D Carlo, Clare McNutt","doi":"10.1176/appi.ps.20250639","DOIUrl":"https://doi.org/10.1176/appi.ps.20250639","url":null,"abstract":"<p><strong>Objective: </strong>The ongoing maternal mental health crisis highlights the urgent need to improve access to integrated behavioral health care within medical settings for perinatal individuals. This review aimed to synthesize the current evidence on integrated models of care in the United States targeting depression and anxiety among perinatal individuals, with attention to clinical outcomes, implementation feasibility, and sustainability.</p><p><strong>Methods: </strong>A systematic search was conducted across MEDLINE, PsycInfo, Cochrane Library, CINAHL, and Embase, supplemented by manual searches of reference lists from key articles. Eligible studies were randomized controlled trials that were conducted in the United States and that evaluated integrated care programs for perinatal adults with depression or anxiety. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized controlled trials, which evaluated five domains: randomization, intervention deviation, missing data, appropriate measurement, and selective reporting.</p><p><strong>Results: </strong>Fifteen articles met inclusion criteria, with six focused on collaborative care. Seven articles reported statistically significant improvements in clinical outcomes among patients receiving integrated care compared with usual care, whereas the remaining articles reported no significant differences. Limited data were available on patient and provider acceptability and financial sustainability.</p><p><strong>Conclusions: </strong>Integrated care models show promise for reducing depression and anxiety symptoms among perinatal individuals, although the evidence varies across program types and populations. By synthesizing U.S.-based trials and identifying both meaningful clinical gains and gaps in implementation, acceptability, and financial sustainability, this review underscores that addressing these gaps is essential to realizing the potential of integrated care as a scalable solution to the maternal mental health crisis.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20250639"},"PeriodicalIF":3.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Growing Need to Address Mental Health Vulnerabilities to Artificial Intelligence.","authors":"Robert Klitzman","doi":"10.1176/appi.ps.20260131","DOIUrl":"https://doi.org/10.1176/appi.ps.20260131","url":null,"abstract":"<p><p>Use of artificial intelligence (AI) may be contributing to mental health problems, including delusions, but reports to date have largely been anecdotal and focused on users with prior psychiatric diagnoses. Crucial questions remain with regard to the prevalence, types, predictors, outcomes, and prevention of AI-induced mental health problems, and practice, policy, educational, and research implications are not yet clear. Several of these problems may resemble those that arise with membership in cults-which similarly attract people who become deeply involved psychologically and which seek to distance individuals from outsiders-and with social media use. Provider and public awareness of concerns about AI needs to increase. Technology companies and several policymakers have resisted oversight of AI and may be underestimating rates of AI-induced problems. Researchers should pursue studies concerning these challenges.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20260131"},"PeriodicalIF":3.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Client-Level Effects of States' Mental Health Agency Expenditures and Mental Health Parity Legislation.","authors":"Jenna Morales Ledbetter, Ronald W Manderscheid","doi":"10.1176/appi.ps.20260087","DOIUrl":"https://doi.org/10.1176/appi.ps.20260087","url":null,"abstract":"<p><strong>Objective: </strong>Despite federal parity legislation, gaps in access to behavioral health care persist across the United States. Stronger parity implementation has been associated with an improved system-level mental health infrastructure. The authors determined whether parity and higher per capita expenditures lead to better client-level access and outcomes.</p><p><strong>Methods: </strong>This analysis of individual-level data extends previous system-level work by examining client-level outcomes across the top 10 and bottom 10 states for per capita state mental health agency (SMHA) expenditures and parity implementation (comprehensive vs. limited). Five outcomes were assessed: treatment receipt, unmet need, cost-related barriers to care among adults with ≥14 days of mental illness per month, drug overdose mortality, and suicide mortality. Group differences were compared with Mann-Whitney U tests.</p><p><strong>Results: </strong>Across the two analytic stratifications-top 10 versus bottom 10 states and comprehensive parity versus noncomprehensive parity-few statistically significant differences emerged. States with higher SMHA expenditures and those with comprehensive parity had significantly lower cost-related barriers to care for adults experiencing frequent mentally unhealthy days. No significant differences between the two analytic stratifications were observed for treatment receipt, unmet need, or overdose or suicide mortality rate, although directional trends favored states that had greater expenditures and comprehensive parity.</p><p><strong>Conclusions: </strong>These findings suggest that parity implementation and mental health spending alone may not meaningfully improve most client-level outcomes. Additional mechanisms, including adequate mental health workforce availability, insurance networks, community-level mental health investment, and parity enforcement, may mediate the relationship between public health policies and individual care experiences.</p>","PeriodicalId":520759,"journal":{"name":"Psychiatric services (Washington, D.C.)","volume":" ","pages":"appips20260087"},"PeriodicalIF":3.2,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}