Biomedical subjects

Rani A Desai

Publications and source records attributed to Rani A Desai.

17 recordsLinked to original sources

PubMed2006

Characteristics of adolescent past-year gamblers and non-gamblers in relation to alcohol drinking.

A preliminary examination of mental health and gambling characteristics as a function of alcohol use in adolescents was conducted in a nationally representative sample of 16- and 17-year-olds using data from the 1998 Gambling Impact and Behavior Study. Adolescents were stratified by past-year alcohol use into abstainers/low-frequency (ALF) drinkers and moderate to high-frequency (MHF) drinkers as done previously [Desai, R. A., Maciejewski, P. K., Pantalon, M. V., & Potenza, M. N. (in press). Gender differences among recreational gamblers: Association with the frequency of alcohol use. Psychology of Addictive Behaviors]. A greater proportion of MHF drinkers reported past-year gambling than did ALF drinkers (66.1% vs. 38.2%). In the ALF drinking group but not the MHF one, past-year gambling was associated with dysphoria/depression (odds ratio for ALF: 1.94, odds ratio for MHF: 0.88) and drug use (odds ratio for ALF: 2.57, odds ratio for MHF: 0.49). A significant gambling-by-alcohol-use group interaction was observed for drug use (p<0.01). Among past-year gamblers, MHF drinkers were more likely than ALF ones to report frequent gambling. These results suggest a complex relationship between gambling alcohol use, drug use, and mental health in adolescents.

Adolescent↗

PubMed2006

Mental health service provision in juvenile justice facilities: pre- and postrelease psychiatric care.

High prevalence rates of mental illness among adolescents in juvenile justice facilities require multifaceted interventions. Children entering justice systems are frequently underserved and having their first contact with psychiatric services. Programming must be multidisciplinary and multifaceted, combining treatment within the facility with postrelease planning. It examines the role of the psychiatrist and the structure of mental health services within juvenile justice facilities.

Adolescent↗

PubMed2006

Gender differences among recreational gamblers: association with the frequency of alcohol use.

This study examines the interactive effects of alcohol use and gender on health and gambling attitudes and behaviors in recreational gamblers. The Gambling Impact and Behavior Study (D. Gerstein et al., 1999) surveyed by telephone 2,417 adults targeted to be representative of the U.S. adult population. The authors compared male and female recreational gamblers (n = 1,471) who were stratified by frequency of alcohol use on measures of health and gambling. Significant Gender x Alcohol Use group interactions were observed such that moderate-to-high frequency alcohol consumption correlated with heavier gambling in men than in women, whereas such an association did not exist among abstinent or low frequency drinkers. There were few gender differences in the correlations between alcohol consumption and health. Future research should consider gender-related influences when examining alcohol use and gambling behaviors.

Adolescent↗

PubMed2006

Pathological gambling.

Explore the source record for details and available documents.

Disruptive, Impulse Control, and Conduct Disorders↗

PubMed2006

Mental health care in juvenile detention facilities: a review.

Juvenile detention facilities have come under increasing legal pressure to provide mental health services to detainees, and mental health clinicians may be asked to design and implement programs in detention facilities. However, there is little consensus on what types of services should be provided, and virtually no data on the effectiveness of such services in a detention setting. The objective of this article is to provide an overview of the existing literature on mental health services in juvenile detention and to make suggestions about future research needs. Specifically, it highlights the tension surrounding the provision of mental health care in juvenile detention, presents data on the prevalence of psychiatric problems in detention settings and what types of services are currently provided, and draws on the larger child and adolescent mental health literature to suggest what types of services might be most appropriate for juvenile detention settings. We conclude that, although there are some suggestions of promising interventions that may be appropriate, much more research, specifically in detention settings, is needed to determine their effectiveness.

Adolescent↗

PubMed2005

The effects of federal versus state funding and academic affiliation on mental health services.

This study compares mental health services in three facilities on two domains: federal versus state funding and academic affiliation. Data from a cross-sectional study of psychiatric outpatients is utilized to compare 196 VA patients to 337 non-VA patients treated in two state mental health agencies. The strength of academic affiliation of the facilities and the degree of participation in research and training activities differs significantly across facilities but is not associated with quality of care, clinical outcomes, or satisfaction with care. Compliance with schizophrenia PORT treatment recommendations is low but similar across sites. These findings suggest that, unlike findings from the general medical literature, academic affiliation is unrelated to the quality and delivery of mental health care.

Connecticut↗

PubMed2005

The role of psychiatric diagnosis in satisfaction with primary care: data from the department of veterans affairs.

BACKGROUND: Although patient satisfaction is widely used as a quality indicator, most such measures do not account for patient subgroups such as those with psychiatric illness. There is also very little data on satisfaction of psychiatric patients with their medical care. OBJECTIVE: The objective of this study was to assess the role of psychiatric illness in satisfaction with outpatient primary care services in the Department of Veterans Affairs (VA). METHOD: Data from the VA Customer Feedback Survey (n = 50,532) were merged with administrative data to determine diagnoses and other characteristics. Satisfaction ratings were compared across psychiatric diagnoses and across various aspects of satisfaction with care. RESULTS: After controlling for patient characteristics (eg, gender, age, disability, acute vs. routine visit) and subjective health, patients with schizophrenia, posttraumatic stress disorder, drug abuse, depression, and other psychiatric disorders reported significantly lower satisfaction with their outpatient primary care. Dissatisfaction was particularly reported for access to care and overall coordination of care. CONCLUSIONS: Despite VA characteristics that might be thought to improve satisfaction (eg, easier access to specialty mental health services as a result of the integrated VA system), patients with psychiatric disorders are significantly less satisfied than patients without such disorders. Possible explanations include both lower technical quality of care and poorer interpersonal communication between providers and patients with mental illness, including the negative effects of stigma. These findings highlight the need for satisfaction ratings to be case-mix-adjusted, including the incorporation of health and mental health diagnoses, and the need for further research that elucidates the reasons behind lower satisfaction ratings.

Adolescent↗

PubMed2005

Mental health service delivery and suicide risk: the role of individual patient and facility factors.

OBJECTIVE: This study explores suicide rates as a quality measure and identifies risk factors for suicide among psychiatric inpatients. METHOD: Data from a prospective mortality study of psychiatric inpatients from 128 U.S. Department of Veterans Affairs hospitals throughout the United States were utilized to examine the relationship of death by suicide to patient-level sociodemographic, clinical, and mental health service delivery characteristics, as well as to facility-level measures of service delivery. Data were collected on all patients discharged with a diagnosis of schizophrenia, major depression, posttraumatic stress disorder, or bipolar disorder (N=121,933) between 1994 and 1998. RESULTS: There were 481 suicides in the study sample. Several variables were associated with higher risk for suicide risk, including length of stay less than 14 days, poorer continuity of care, and lack of readmission within 6 months. These variables were significant even after adjustment for state suicide rates, the proportion of members of racial minority groups in the state population, and state-level social capital. CONCLUSIONS: Suicide rates are not likely to be a useful indicator of the quality of mental health care because of the instability of suicide rates, difficulty collecting data, and the lack of association between suicide and facility quality of care. The lack of association with facility-level variables suggests that systemic changes in these performance measures would be unlikely to significantly reduce suicide rates.

Ambulatory Care↗

PubMed2005

Association between community and client characteristics and subjective measures of the quality of housing.

OBJECTIVE: The objective of this study was to examine the relationship between subjective perceptions of the quality of housing among mental health consumers and both client characteristics and objective measures of the client's neighborhood. METHODS: A cross-sectional survey of a random sample of 468 male clients who were recruited from three mental health centers in Connecticut was used to assess client characteristics, including sociodemographic and clinical status, and measures of subjective quality of housing that reflected perception of both the client's residence and the neighborhood. Data describing the objective characteristics of the 233 census-tract block-group neighborhoods in which clients lived were obtained from the 2000 decennial census, from which three measures were created by using principal components analysis: average household income, affordability, and availability of plumbing and cooking facilities. Ordinary-least-squares regression analyses were used to identify client and neighborhood correlates of subjective quality of housing. RESULTS: Neither psychiatric diagnosis nor substance abuse were found to be significantly associated with any of the subjective housing quality measures. Clients who were living in their own place with others, those who were less bothered by side effects of medications, and those who were living in higher-income neighborhoods were more satisfied with the overall quality of their housing. CONCLUSIONS: Client assessments of subjective quality of housing, both overall and along specific subdimensions, are largely independent of commonly used diagnostic and symptom measures of mental health status. Consumers' subjective experience of housing quality are significantly associated with objective measures of neighborhood characteristics, particularly the mean household income of the neighborhood.

Adult↗

PubMed2004

Health correlates of recreational gambling in older adults.

OBJECTIVE: Prior studies have found high rates of alcohol use and abuse/dependence, depression, bankruptcy, and incarceration associated with recreational gambling. Despite growing rates of recreational gambling in older adults, little is known regarding its health correlates in this age group. The objective of this study was to identify health and well-being correlates of past-year recreational gambling in adults age 65 years and older, compared to adults age 18-64 years. METHOD: The Gambling Impact and Behavior Study surveyed by telephone a nationally representative sample of 2,417 adults. Multivariate analyses were used to compare past-year recreational gamblers and nongamblers in the older and younger age groups on measures of alcohol use and abuse/dependence, substance abuse/dependence, depression, mental health treatment, subjective general health, incarceration, and bankruptcy. Additional analyses compared the gambling patterns in older and younger adult past-year recreational gamblers. RESULTS: After the effects of sociodemographic factors were controlled, older adult past-year recreational gamblers were more likely to report past-year alcohol use and better health than were older nongamblers. Multivariate analyses investigating interactions of gambling and age found that higher rates of good to excellent subjective general health in recreational gamblers were mainly attributable to the older age group. Older adult gamblers were more likely than younger adult gamblers to begin gambling after age 18 years, to gamble more frequently, and to report a larger maximum win. CONCLUSIONS: Recreational gambling patterns of older adults differ from those of younger adults. In contrast to findings in younger adults, recreational gambling in older adults is not associated with negative measures of health and well-being.

Adolescent↗

PubMed2003

Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse.

BACKGROUND: Despite reports of high rates of suicidal behavior among mentally ill homeless persons, it remains unknown whether the well-established suicide risks of increased age and comorbid psychiatric and substance abuse disorders ("dual diagnosis") documented in the general population are also markers for increased suicide risk among homeless persons. METHODS: Data from a multi-site outreach program (ACCESS) (N = 7,224) were used to investigate whether rates of serious suicidal ideation and recent suicide attempts varied with the age and substance abuse diagnosis(es) (drug abuse and/or alcohol abuse disorders) among homeless mentally ill clients. RESULTS: The prevalence of 30-day suicidal ideation and suicide attempts (37.5 % and 7.9 %, respectively) was extremely high. Although the risk of serious suicidal ideation and suicide attempts was greater among the younger compared with the older homeless mentally ill clients, risks were not significantly increased by co-morbid alcohol and/or drug abuse. However, a significant interaction between age and co-morbid substance abuse was observed showing that among older clients but not younger clients, those with drug and alcohol abuse were at significantly greater risk of suicidal ideation than those without substance use problems, controlling for confounding factors. CONCLUSION: Efforts to prevent suicide should recognize that among homeless people with mental illness, young-middle-aged (30- to 39-year-old) clients are at greatest risk of suicidal behavior. Among older clients the presence of both drug and alcohol abuse significantly increases suicide risk. These patterns are of special importance because they are quite different from those that are well documented in non-homeless populations.

Adolescent↗

PubMed2003

Prevalence of Hepatitis C virus infection in a sample of homeless veterans.

OBJECTIVE: This study measures the prevalence of Hepatitis C Virus (HCV) infection in a sample of homeless veterans treated in a Domiciliary Care for Homeless Veterans (DCHV) program in Massachusetts. We also examine risk factors and correlates for HCV infection, including substance abuse and service in Vietnam. METHODS: Patients admitted to the DCHV program over a 5-year period (n=418) were systematically tested for HCV infection. Blood test data were merged with standardized data collection forms to assess socio-demographic characteristics, military history, and medical and psychiatric history. RESULTS: The overall prevalence rate of HCV infection was 44.02%, a rate more than ten times higher than the national rate for men age 20-59 and more than twice as high as other VA patient samples. Adjusting for age, significant risk factors in this sample included a history of substance abuse (OR=6.86, p<0.0001) and service during the Vietnam era (OR=4.66, p=0.01). Comparisons of the tested sample with other homeless veterans treated in 34 similar programs nationally indicated that this sample did not significantly differ from other treated homeless veterans with respect to demographics or HCV risk factors. CONCLUSIONS: We found a high prevalence of HCV infection in this population that is not likely to be geographically unique, and may indicate particularly high risk for homeless men. Substance abuse is the most important risk factor, and we hypothesize that the effect of Vietnam-era service is a proxy for unreported drug use. We advise an increase in screening and education for all homeless populations, particularly those with a history of injection drug use. Public systems of care, including the VA, should expect increasing costs of care related to HCV infection as prevalent cases develop serious medical sequelae of HCV infection.

Adult↗

PubMed2003

Psychiatric comorbidity and the prevalence of HIV infection in a sample of patients in treatment for substance abuse.

This article compares the differences in HIV prevalence and risk behaviors in singly diagnosed patients with substance abuse problems and dually diagnosed patients with comorbid psychiatric and substance abuse problems. The National Treatment Improvement Evaluation Study (NTIES) was used to conduct a cross-sectional study on 6593 persons treated for substance abuse disorders. Logistic regression using hierarchal linear modeling (HLM) was utilized to compare risk behaviors of singly and dually diagnosed persons. Compared with singly diagnosed patients, dually diagnosed patients were more likely to share a needle, have sex for money or gifts, have sex with an intravenous drug user, and report being raped. Patients dually diagnosed with psychiatric and substance abuse disorders are an especially high-risk group for HIV infection, in part due to a higher likelihood of engaging in high-risk behavior, and should be targeted for more intense HIV interventions.

Adolescent↗

PubMed2003

Suicidal ideation and suicide attempts in a sample of homeless people with mental illness.

This study utilized data from the national ACCESS program (N = 7224) to investigate the prevalence of suicidal ideation and suicide attempts in a sample of homeless people with mental illness. The prevalence of suicidal ideation in this sample was high (66.2% lifetime prevalence). In addition, 51.3% of the sample reported that they had ever attempted suicide, 26.9% reported an attempt that resulted in a nonpsychiatric hospitalization, and 8% reported an attempt in the previous 30 days. Youth, substance abuse, and psychiatric symptoms were all significantly associated with suicide attempts. Those who reported a recent attempt also reported higher rates of mental health care utilization, particularly inpatient care. The authors conclude that homeless people with mental illness are at particularly high risk for suicidal behavior, however, only in part because of the high prevalence of traditional risk factors.

Adolescent↗

PubMed2002

The impact of managed care on cross-system use of mental health services by veterans in Colorado.

OBJECTIVES: Some state mental health systems have implemented capitated managed care as a strategy for lowering mental health care costs. There has been concern that this strategy has left vulnerable populations at risk of not being able to obtain adequate care. This study examined whether the advent of managed care in Colorado resulted in lower rates of use of both state and Department of Veterans Affairs (VA) mental health care services (cross-system use). METHODS: A cohort of 10,950 veterans who had used VA mental health services between 1995 and 1997 were studied to determine whether veterans who lived in counties that had implemented managed care were less likely to be cross-system users over time. VA data were matched with state mental health data to determine who was using both types of services. RESULTS: Rates of cross-system use were generally low. Veterans who lived in a county that had implemented managed care were less likely to be cross-system users than veterans who lived in other counties. However, the proportions of cross system users in managed care counties and in other counties did not change significantly over time. Veterans who were cross-system users were more likely to be younger, to live farther away from a VA hospital and closer to a non-VA hospital, and to have received inpatient VA care. CONCLUSIONS: The implementation of managed care in Colorado did not appear to have affected rates of cross-system use of state and VA mental health care.

Colorado↗

PubMed2002

Why do foreign-born blacks have lower infant mortality than native-born blacks? New directions in African-American infant mortality research.

OBJECTIVE: This study focuses attention on maternal nutrition and stress as possible reasons for excess black infant mortality after exploring lower infant mortality for the infants of foreign-born black mothers compared to native-born black mothers. METHODS: All births to non-Hispanic black women in New York City from 1988-1992 were examined and infant mortality for the infants of native-born women was compared to infant mortality for the infants of foreign-born women. RESULTS: Before controlling for potential confounders on the birth certificate, the infants of native-born black women had a greater risk of infant mortality than the infants of foreign-born black women: OR = 1.48 (95% confidence interval [CI] = 1.38, 1.58). After controlling for potential confounders, the infants of native-born black women still had a greater risk of infant mortality than the infants of foreign-born black women: OR(a) = 1.32 (95% Cl = 1.21, 1.43). CONCLUSIONS: Maternal nutrition and stress are possible causes of excess black infant mortality. They should be topics for research and program development.

Black or African American↗

PubMedDate not supplied

Gender differences in adolescent gambling.

BACKGROUND: Although adolescent gambling has been linked to a wide array of risk behaviors, little is known regarding the correlates of gambling in adolescent girls as compared with adolescent boys. METHODS: We examined by logistic regression a nationally representative U.S. sample (n = 534) of 16- and 17-year-olds from the 1998 Gambling Impact and Behavior Study (GIBS) (1) to investigate the influence of gender on: 1) the association between gambling and psychiatric symptomatology; and, 2) gambling attitudes and behaviors. RESULTS: Gambling was associated with elevated rates of alcohol use and abuse/dependence in both boys and girls, and dysphoria/depression in girls only. Boy gamblers reported heavier gambling and higher rates of gambling problems than did girl gamblers. CONCLUSIONS: Adolescent gambling may be associated with more severe psychiatric symptoms in girls than in boys, though future research will be needed to replicate and extend these findings. Gender considerations are important in understanding youth gambling and the relationship between gambling and psychiatric disorders in adolescents.

Adolescent↗