Approximately 20-25% of primary care patients have unhealthy alcohol use, which can have significant impacts on mental health. Screening for unhealthy alcohol use within primary care settings is increasingly used for point-in-time identification of people who could benefit from brief advice or brief interventions. My project will use a large, longitudinal, real-world dataset consisting of electronic health record (EHR) and insurance claims records to test whether longitudinal changes in alcohol screening scores completed by primary care patients as part of routine care are associated with changes in one-year risk for psychiatric acute care utilization (i.e., emergency department visit or hospital encounters primarily for a mental health condition).
Funding Type: State/UW
Self-directed mindfulness in medically hospitalized patients: a pragmatic trial
Consultation-liaison psychiatrists are often asked to manage mood and anxiety symptoms experienced by patients admitted to medical and surgical floors of the hospital. This study aims to determine the feasibility and effectiveness of a self-directed mindfulness intervention as an adjunctive treatment for improving mood, anxiety, and perceived stress in medically hospitalized patients. Participants, consisting of patients evaluated by the consultation-liaison psychiatry service, will be randomized to an adjunctive mindfulness intervention group or a treatment-as-usual control group. Feasibility and acceptability of implementing a mindfulness intervention will be assessed. Group differences in the changes in symptom severity and psychotropic medication administration will be investigated.
Centering community voices in partnered mixed methods approaches to addressing health disparities with diverse communities
Meaningful partnerships between community and academic/public health co-researchers are needed to address community mental health, wellbeing, and health disparities. Partnerships should center the strengths, needs, and interests of communities on the communities’ terms while building relationships on trust and shared power.
UW researchers in partnership with the Community Health Board Coalition (CHBC) have developed an initial draft of a Community-Centered Approaches to Research and Evaluation (CCARE) Toolkit to guide academic, public health, and community researchers in partnering to act on emerging community data during times of crisis and beyond. As a part of this work, we are striving to better understand and support community health priorities.
Community resilience to late life depression among first generation Asian Indian immigrants in the greater Seattle area (The CREED Seattle Study)
Asian Indians, are one of the fastest growing ethnic groups in the country, growing from 1.9 million (2000) to 4.6 million (2020). With a median household income of $119,000, Asian Indians are highly educated (43% have a postgraduate degree), are proficient English speakers (82%) and are often touted as a “model minority”. While these data create an impression of general well-being and success, there is limited information on the mental health of this community, as most research tends to aggregate results of the Asian population. Aging and age related mental health issues, especially late life depression in the community, in particular, has been under-studied. As culture exerts a significant influence on psychiatric morbidity, it is likely that this population has unique drivers to late life syndromic and subsyndromal depression beyond what is known from typical studies. Additionally, migration related, as well as acculturative stress, may provide unique influences. However, immigrant Indian communities are known for community engagement, providing large social networks and support which may reduce risk for depression. As a result, it is possible that higher risk resulting from immigration related stress might be mitigated by social engagement. This project will study older first-generation Asian Indians in the Greater Seattle Area to study the association between community engagement and depression symptoms.
Development of an mHealth support specialist for early psychosis caregivers in Washington State
Early intervention can significantly improve the trajectory of a young adult at risk for psychosis. Specialized treatment programs for youth at risk are associated with reduced symptoms and relapse risk and increased functioning. Family caregivers play a critical role in facilitating treatment engagement and recovery, but too often they lack the support they need. Specialty psychosis services providing psychoeducation for family members are expanding but still difficult to access. Caregivers face many barriers to care: limited providers and session time availability, long travel times, or patient ambivalence about treatment. As a result, a minority of youth with early psychosis have caregivers that have accessed standard-of-care family interventions.
To address these gaps, our team developed Bolster, a mobile health (mHealth) app designed to provide psychoeducation, communication coaching, and self-care support to caregivers to youth at risk for psychosis. In preliminary work, Bolster was feasible to deliver, acceptable to caregivers, and showed promising efficacy. However, mHealth interventions that are supplemented by a human clinical support have higher engagement and effectiveness than those that are purely self-guided. To optimally implement mHealth for early psychosis caregivers, there is a need for development of this clinical workforce.
We propose to develop and pilot an emerging clinical role – the mHealth support specialist (mHSS) – equipped specifically to support caregivers to youth with early psychosis. Specifically, we will (1) develop a training and supervision framework supporting the mHSS for caregivers, (2) test this framework through training and supervising one mHSS, and (3) evaluate this approach as the mHSS provides support to caregivers to young adults with early psychosis throughout Washington State. Delivering this intervention has the potential to greatly expand population access to evidence-based strategies for psychosis. Developing the mHealth support specialist model would make Washington a national leader in scalable digital interventions for caregivers. This study takes a critical step toward realizing that vision.
Improving the implementation of smartphone-based contingency management in medical settings for the treatment of methamphetamine use disorder: a qualitative analysis of patient and clinician experiences
The proposed research is a qualitative analysis of patient and clinician experiences during a pilot study of mHealth-delivered contingency management for the treatment of methamphetamine use disorder and will address perceived facilitators and reinforcing factors, barriers and limitations, and proposals for future improvements including specific recommendations regarding the intervention and its mode of delivery.
A pilot trial on EMA habit formation behavioral strategies for improving engagement of digital mindfulness interventions among non-suicidal self-injury engagers
Non-suicidal self-injury (NSSI), the purposeful, direct damage of one’s body without the intent to die, is a pervasive public health concern with clinically significant long-term consequences. Mindfulness – a core skill in DBT, an evidence-based treatment for NSSI, is designed to target emotion dysregulation and rumination and may be particularly relevant due to the proliferation of digital mindfulness interventions in recent years. To this end, the goal of this study is to expand the use of ecological momentary assessment (EMA) and to develop and evaluate a program of habit-formation strategies (e.g., SMART-goal setting, reinforcement scheduling) to boost user engagement and treatment effects of DMI. Following a 1-week EMA baseline period, participants (N=40) will be randomized to either TAU (Mindfulness only) or Experimental (Mindfulness + Behavioral Prompts) conditions for a 4-week intervention EMA period.
Biomarkers in the retina for prognosticating mental health treatments (BRIGHT)
This clinical trial is designed to pilot an electroretinogram (ERG) biomarker for predicting treatment response to SSRIs in PTSD. Serotonergic brain centers project to the retina, and ERG allows assessment of brain serotonergic signals via retinal signals. In this study we are characterizing the ERG waveform in veterans with PTSD before and after SSRI administration. Patients then enter an open label phase of the study, with those who have initiated an SSRI through routine medication management invited back for a follow up study visit. This pilot data will: 1)be valuable as a feasibility study for assessing the practical application of ERG in the setting of a mental health clinic and 2)serve as a foundation for a long-term goal of developing physiologic biomarkers to match veterans to corresponding pharmacological treatments in PTSD and other mental health disorders.
Debriefing after adverse events using the RECover Framework
This project will evaluate the effect of a debriefing workshop on the knowledge, attitudes, and practice of giving debriefs after adverse events among physicians and their trainees.
Examining the cross-cultural applicability of the Spanish PMQ-9: a comparative validation study
The purpose of this project is to enhance the usefulness and cultural relevance of the Spanish version of the PMQ-9, a questionnaire that assesses manic symptoms in individuals with bipolar disorder.
