Socioeconomic Status, Quality Of Life, Depression And Post-Traumatic Stress Disorder In College Students

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Baltimore, MD, USA, 3John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 4Johns Hopkins Hopital, Baltimore, MD, USA, 5University of Maryland School of Medicine, Baltimore, MD, USA

Objectives: To identify parent/caregiver priorities when initiating ADHD medication for their child and clinicians’ perceptions of parental priorities and the concordance between the two.  Methods: Clinicians treating and caregivers of a child aged 4-14 years diagnosed with ADHD were recruited from primary care and mental health clinics and support groups across Maryland. A case 1 best-worst scaling (BWS) experiment assessed considerations when initiating ADHD treatment via 16 choice tasks, each displaying 6 considerations. Caregivers selected one most and one least important consideration. Clinicians completed the same BWS, but selected items based on a typical patient’s caregiver. Estimated mean scores were tested for statistical significance using two-tailed t-tests. The concordance between clinicians’ expectations of caregivers’ priorities and caregivers’ self-report was examined.  Results: The 184 caregivers (m= 42 years) were Caucasian (68%) and the biological mother. Children were mostly male (71%) and using medication (81%). Among caregivers, most important considerations were the child becoming a successful adult (0.41, p< .0001), school behavior (0.37, p< .0001), the doctor addressing their concerns (0.31, p< .0001), and better grades (0.30, p< .0001). Caregivers’ least important considerations were others thinking badly of the child (-0.49, p< .0001), school pressures to medicate (-0.37, p< .0001), and friends supporting their decision (-0.36, p< .0001). Clinicians (n= 40) were mostly female (68%) and equally a child psychiatrist (33%) or general pediatrician (33%). Clinicians perceived caregivers’ most important considerations were school behavior (0.67, p< .0001), better grades (0.38, p< .0001), and the doctor addressing their concerns (0.33, p< .0001), while least important considerations were ADHD medicine limiting career options (0.57, p< .0001) and hurting the child’s self-esteem (0.37, p< .0001) and others thinking badly of the child (0.36, p< .0001).  Conclusions: Caregivers’ and clinicians’ considerations when initiating ADHD medicine were mostly consistent. However, caregivers’ concerns focus on long-term outcomes, suggesting the importance of providers making clear connections between short- and long-term goals to effectively engage families in treatment. PMH52 Identifying Meaningful Outcomes For Caregivers Of Children With Mental Health Multimorbidity: Pilot And Validation Of A Best Worst Scaling Instrument Camelo Castillo W, Ross MM, Tariq S, dosReis S University of Maryland School of Pharmacy, Baltimore, MD, USA

Objectives: Prioritization of meaningful outcomes that encompass domains beyond clinical measures is poorly understood. Our goal was to pilot and validate a patient-centered Best-Worst Scaling (BWS) instrument to identify outcome priorities among caregivers of youth < 21 years, with developmental and mental health conditions.  Methods: A paper- based survey was developed which included three components (BWS instrument, demographic survey and a survey validation tool), and administered in-person to a community based sample of eligible caregivers in Maryland. We used a BWS Case 1 design to assess trade-offs among 16 attributes across four main conceptual domains (school or behavioral functioning, social issues, independence). The instrument comprised 16 outcome choice-task profiles, each displaying six attributes. Best-worst scores, estimated as mean utilities (U), were ranked to assess relative importance. Statistical significance was estimated via t-tests and 95% confidence intervals. The validation tool provided structured feedback after completing the survey, where participants answered two sets of questions for all attributes in the instrument. The first set assessed whether statements were relevant and tradeable (identification of substitutes or complements); the second evaluated clarity of language to identify items problematic in their interpretation (ambiguity).  Results: The survey was completed by 38 caregivers, who were mostly white (63%), the biological mother (86%), and on average 47 (SD 9.4) years-old. The most important outcomes when considering medication treatment were: the child not hurting him/herself (U 0.32), child not hurting others (U 0.24), and child being able to live independently (U 0.23). All outcomes were considered tradeable and relevant by 75% or more of the participants. Five outcomes were considered ambiguous and therefore rephrased for the final version of the instrument.  Conclusions: In settings where attributes could be highly dependent on context, such as those in mental health, assessment of ambiguity needs to be considered as part of the validation of a BWS instrument. PMH53 Examining The Utility Of The Everyday Cognition Memory Test To Identify Mild Cognitive Impairment In African American Elders Allaire JC1, Gamaldo AA2, Whitfield KE3 Solutions Group, Cary, NC, USA, 2University of South Florida, Tampa, FL, USA, 3Duke University, Durham, NC, USA

1Generativity

Objectives: There is growing interest in Mild Cognitive Impairment (MCI), which represents a transition between normal cognition and dementia. Tools that easily and accurately identify adults with MCI would aid in the development of targeted interventions, both psycho-social and pharmacological, that may delay the onset of dementia. The current study sought to determine if a brief, patient-reported measure of everyday memory can significantly predict MCI status in older African American adults.  Methods: A total of 454 African American adults ≥ 60 years (mean: 72.02; SD: 7.41; 93% female) completed a battery of assessments including cognitive tests, Mini-Mental Status Exam (MMSE), Short Portable Mental Status Questionnaire (SPMSQ), and the Everyday Cognition Memory Test (ECMT) as part of the Baltimore Study of Black Aging. The 30-item ECMT included two real-world stimuli (medication and nutrition labels) within three domains (medication, financial, and nutrition). Participants had 60 seconds to study a stimuli and 60 seconds to answer five multiple-choice questions.  Results: The reliability estimate for the ECMT was acceptable (α  =  0.71). Performance on the psychometric cognitive tests was used to classify participants as either non-MCI (n= 357) or MCI (n= 97). In the first

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step of a logistic regression predicting MCI status, the MMSE (OR: 0.88; CI: 0.79–0.95) was a significant predictor and the SPMSQ was not (OR: 0.78; CI: 0.59–1.05). The ECMT was added in the second step and was a significant predictor (OR: 0.86; CI: 0.82–0.91), indicating that participants with higher scores on the ECMT were less likely to be diagnosed with MCI. The MMSE was not a significant predictor with ECMT in the model.  Conclusions: These findings suggest that the ECMT, a brief, patient-reported measure of cognitive competency, may be a better predictor of MCI status among older African American adults than the MMSE or the SPMSQ two widely used screeners for cognitive impairment. PMH54 Impact Of Perceived Stress, Perceived Social Support, And Personality On The Perceived Health Status Among West Virginia University Students Feng X1, Alenzi EO1, Dwibedi N2 University, School of Pharmacy, Morgantown, WV, USA, 2West Virginia University, Morgantown, WV, USA

1West Virginia

Objectives: Stress is very common among university students. Social support and personality traits could change or buffer the effect of accumulative stress on students’ health. The objective of this study is to examine the relative association between psychosocial factors (perceived stress, perceived social support, and personality) and health status perception among West Virginia University (WVU) students.  Methods: An online survey was conducted with a structured questionnaire consisting of Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support (MSPSS), and Ten Item Personality Measure (TIPI), among WVU students between September 2015 and December 2015. Linear regression model was used to examine association between perceived health status and the psychosocial factors.  Results: A total of 207 participants met the inclusion criteria. The response rate was 161/207 (77.8%). The majority of our sample was females (68.9%), pursuing Bachelor’s Degree (70.2%), and not married (91.3%). Mean age was 23.69±6.87 years. The average of the student’s perceived stress scores and perceived social support scores were 21.55± 6.91, and 5.13± 1.18 respectively. Better perceived health status was associated with less perceived stress (β = 0.11, p< 0.001), better perceived social support (β = -0.23, p= 0.003), being more conscientious (β = -0.45, p= 0.02), and emotional stability (β  = 0.37, p< 0.001). Perceived stress was significantly negatively associated with perceived social support (p= 0.003).  Conclusions: Perceived stress, perceived social support and personality of the students affect their health status. Attention is required to highlight these factors on students’ health. PMH55 Caregiver Burden In Schizophrenia: Pooled Analysis Of The Involvement Evaluation Questionnaire Data For Paliperidone Palmitate 3-Month Formulation Gopal S1, Xu H1, McQuarrie K2, Savitz A1, Nuamah I1, Woodruff K3, Mathews M1 1Janssen Research & Development, New Jersey, NJ, USA, 2Janssen Global Services, LLC, Raritan, NJ, USA, 3Janssen Global Services, LLC, Titusville, NJ, USA

Objectives: Schizophrenia-related caregiver burden is often under-recognized and associated with significant psychological and physical stress and increased indirect costs on the caregiver. The pooled analysis of 2 double-blind, randomized, multicenter, phase 3 studies (NCT01529515 and NCT01515423) evaluated the predictors of improvement or worsening of schizophrenia-related caregiver burden following paliperidone palmitate (including 1-month and 3-month formulations) treatment.  Methods: Caregivers (family members/friends who had ≥ 1 hour of contact per week with the patients treated with PP 1-month) were offered to complete the involvement evaluation questionnaire (IEQ; 46 items; each item score: 0-4; total score: sum of all items in module 2 [0-124]).  Results: Total, 1497 caregivers (mean [SD] age: 51.5 [13.02] years) were included: 49.3% were parents and > 50% of caregivers spent > 32 hours/week in caregiving. Caregivers had significant improvement in IEQ sum scores from baseline to end-of-study (n= 756; mean [SD] baseline score: 28.3 [15.34] points; mean [SD] improvement: 8.9 [14.73] points); most improvements seen in worrying (2.6 points) and urging (3.7 points) domains. There was significant relationship between improvement in IEQ sum scores and relapse status (p< 0.001), and patient age (p< 0.05); age of diagnosis, long-acting injectable (LAI) use at baseline, number and duration of prior psychiatric hospitalizations (< 24 months) had no significant effect on improvement. Caregiver burden improvement was significant in patients on prior oral antipsychotics post switching to LAI with less leisure days being impacted and less hours spent in caregiving (p< 0.001).  Conclusions: Caregiver burden in family members of patients treated for schizophrenia is considerable. Switching from an oral antipsychotic to an LAI can provide a meaningful and significant improvement in caregiver burden. PMH56 Socioeconomic Status, Quality Of Life, Depression And PostTraumatic Stress Disorder In College Students Bastardo YM, Mendoza FJ Central University of Venezuela, Caracas, Venezuela

Objectives: Recently considerable attention had been devoted to the study of health-related quality of life (hrQoL) in college students. These individuals are under considerable stress and have less control over their lives than older individuals already well established. This has a major impact on their health, particularly in the psychological domains, affecting their quality of life. The objectives of this study were to describe hrQoL of college students in Venezuela and to examine its relationships with depression, post-traumatic stress disorder and socioeconomic status (SES).  Methods: A random sample of students from the Central University of Venezuela was surveyed using a written questionnaire. hrQoL was measured using a Spanish version of EuroQol comprising the health states descriptive system (EQ-5D) and the EQ visual analogue scale (EQ VAS). Breslau’s 7-item screener was used to identify PTSD symptoms in the past month. Depressive symptoms were assessed using the 10-item version of the CES-D. The associations among hrQoL, depression,

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post-traumatic stress disorder and demographical variables were examined using both bivariate and multivariate models.  Results: Of 559 participants, 335 (59.9%) were female. The sample had a mean age of 20.52 years (SD= 2.756). For the EQ-5D, the dimensions with the higher proportions of reported problems were pain/discomfort and anxiety/depression. The dimension with the lowest reported problems was self-care. Neither age nor gender was associated with hrQoL in our population. In multiple regression analysis, depressive symptoms, post-traumatic stress, and SES explained a significant amount of variance on the EQ VAS score.  Conclusions: Study limitations include the use of a sample of students from only one university in Venezuela. Quality of life is associated to depressive symptoms, post-traumatic stress, and SES. The study identified a group of students with poor quality of life, particularly in the mental domain. Health promoting interventions are needed for those of students. PMH57 Psychopharmacotherapy And Health-Related Quality Of Life: Analysis Of Medical Expenditure Panel Survey Lai L1, Almohammed O1, Althemery AU1, Ting A2 Southeastern University, Davie, FL, USA, 2University of Florida, Ft. Lauderdale, FL, USA

1Nova

Objectives: Approximately 1 in 5 adults in the U.S. experiences mental illness every year. Despite the empirical literature demonstrating the efficacy of psychotherapeutic medications for a wide range of mental disorders, the patient’s overall well-being and quality of life still remain controversial. The study aims to investigate the effect of psychopharmacotherapy on patient reported health-related quality of life (HRQOL).  Methods: A retrospective cohort study was conducted by analyzing the Medical Expenditure Panel Survey (MEPS) longitudinal data 2012-13. Adults with a diagnosis of mental disorder were identified using the clinical classification codes (CCS 640-670). The Multum drug database was used to identify psychotherapy medications in four categories: antidepressants, antipsychotics, anxiolytics/sedatives, and CNS stimulants. Univariate quantile-quantile (Q-Q) plots and kernel density estimations (KDE) were performed to assess the normality of HRQOL scores. Repeated t-tests were used to examine the effect of psychopharmacotherapy on patients’ quality of life. HRQOL was measured using the SF-12 Physical (PCS) and Mental (MCS) Component Summary. All analyses utilized SAS PROC SURVEY applications and incorporated sample weights and standard errors to adjust the complex sampling design.  Results: An Estimated 46.5 million adult patients were diagnosed with mental disorder in two consecutive years 2012-13. Females accounted for a much higher prevalence than males (62% vs. 38%). 12.3 million (26.5%) patients received at least one antipsychotherapeutic agent. The results from Q-Q plots and KDE showed a normal distribution of each outcome measure. The adjusted difference in HRQOL among patients with psychopharmacotherapy and those without it showed no significant difference in both PCS (P= 0.48) and MCS (P= 0.58). The adjusted association between each antipsychotherapeutic category and its MCS/PCS also showed no significant difference.  Conclusions: The effect of psychopharmacotherapy on HRQOL were small and no statistically significant. These findings suggest that the choice of medication and/or psychotherapy could be critical to a patient’s overall quality of life.

MENTAL HEALTH – Health Care Use & Policy Studies PMH58 Optimal Minimum Length Of Treatment With Buprenorphine: An Analysis Of Resource Use And Costs After Medically Controlled Discontinuation Zah V1, Matveev N1, Berjan M2, Thompson S3, Ruby J4 Outcomes Research Inc., Mississauga, ON, Canada, 2ZRx Outcomes Research Inc., Rancho Cucamonga, CA, USA, 3ZRx Outcomes Research, Berlin, Germany, 4Indivior, Inc., Richmond, VA, USA 1ZRx

Objectives: To identify an optimal minimum length of treatment (LOT) for opioid dependence with buprenorphine in order to begin the evidentiary discussion of appropriate treatment length.  Methods: A retrospective claims analysis was conducted on the (January 2007 – June 2014) Truven Health Analytics MarketScan® Medicaid Research Database in all ICD diagnoses related to opioid dependent adults 16-65 years old (N= 23,022), who received BMAT for at least 3 months and whose treatment was medically discontinued. The assumption was that higher resource use and costs after the planned end of treatment represented inadequate treatment time, compared to lower resource use and costs which represented the optimal minimum LOT. The study compared resource use (number of inpatient admissions, outpatient visits and prescriptions filled) and the associated costs for patients who remained in their plans for 6 and 12 months post BMAT. Comparisons were made between the following LOT groups: 3-5, 6-8, 9-11, 12-17, 18-23, and 24+ months. Regression analyses was conducted to test influence of key variables (i.e. LOT) on resource use and healthcare costs.  Results: Regression analyses demonstrated a strong negative association with higher resource use and total healthcare costs (i.e. longer treatment duration is associated with lower post-BMAT resource use and costs). Resource use correlation coefficient analysis identified outpatient services as the most influential parameter (integrative parameter). When combined, analyses of the proportion of patients with high resource use and a mean resource use, the study demonstrated that 9-17 months were the optimal minimum LOT in the general population. Analysis of the total healthcare costs and the subgroup with high total healthcare costs both indicated the optimal minimum LOT was 12-17 months.  Conclusions: This study is the first retrospective evidence that identifies the optimal minimum length of treatment with buprenorphine to treat opioid dependence. For the general population, it appears that the optimal minimum length of treatment with buprenorphine is 12-17 months. PMH59 Communimetric Decision-Support Algorithms And Outcomes Monitoring Improves Clinical Outcomes For Youth With Serious

Emotional Disturbance In Pennsylvania’s Community Behavioral Health System Warner D1, Suhring S2, Marple P3, Keleti D4, Laughman JA5 1Community Data Roundtable, Harrisburg, PA, USA, 2Capital Area Behavioral Health Collaborative, Harrisburg, PA, USA, 3Behavioral Health Services of Somerset and Bedford Counties, Somerset, PA, USA, 4Keystone First, Philadelphia, PA, USA, 5PerformCare, Harrisburg, PA, USA

Objectives: Applying communimetric outcomes monitoring, analysis, and decision-support algorithms to locally validated decision-support tools for psychologist evaluators to improve clinical outcomes for youth with serious emotional disturbance (SED).  Methods: From 11/2013–10/2015, psychologist evaluators prescribing youth behavioral health services were provided with DataPool™, a cloud-based data analytic platform for analyzing Child and Adolescent Needs & Strengths (CANS) assessment data. In July 2014, DataPool™’s communimetrics-based, decisionsupport algorithms were used to: stratify subjects into four risk/severity-scored cohorts (1 [low] to 4 [high]); identify subjects benefiting from treatment-as-usual (TAU) or more specialized levels of care based on their clinical profiles; and monitor outcomes system-wide.  Results: Subjects were youth (mean age, 7; range, 3-21) with SED (±autism), primarily male (70%) and Caucasian (63%), with local minority concentrations (black, 15%; Asian 2%; other, 20%; Latinos, 18%), living in seven Pennsylvania counties. Treatment trajectories for youth in different severity cohorts differed dramatically; subjects beginning treatment with lower severity scores showing progressively worse outcomes over time, whereas subjects beginning treatment with higher severity scores showed improved outcomes. Only 5% of children matched for evidence-based treatment (scores 1-2) at baseline were receiving the appropriate level of care. After utilization of the algorithms from 8/2014–10/2015, the proportion of subjects in the TAU population with score 3 and 4 significantly increased from 48% to 65% (P< 0.05), with a concomitant increase in use of evidencebased programs for the low-risk cohort (9%; P< 0.05). This improved prescribing pattern resulted in an 11% decrease in payer expenditures per subject per month without a concomitant rise in emergency services.  Conclusions: DataPool™ was effective in stratifying subjects into risk/severity-based, CANS-assessed cohorts recording distinct care responses, thereby augmenting the prescribing effectiveness of psychologist evaluators by providing the appropriate level and intensity of evidence-based care for subjects at different risk/severity levels, and contributing to system-wide cost savings. PMH60 Disparities In The Process And The Outcomes Of Depression Management Between Pediatric Major Depressive Disorder Cases Identified By Primary Care Providers Versus Psychiatrists Yucel A1, Chen H1, Essien EJ1, Aparasu R1, Mgbere O2, Bhatara V3, Alonzo J1 of Houston, Houston, TX, USA, 2Houston Department of Health and Human Services, Houston, TX, USA, 3University of South Dakota, Vermillion, SD, USA

1University

Objectives: Antidepressant medication (AD) is standard treatment for moderate to severe MDD. Guidelines recommend physicians’ frequent monitoring and adherence to AD. Mental health (MH) related hospitalization is an important concern among children and adolescents. This study examined the disparities between PCP and PSY identified pediatric MDD follow-up visits, AD adherence and hospitalization.  Methods: 2006 and 2007 Medicaid Analytical Extract (MAX) data from New York State was utilized. 850 children/adolescents aged 10-20 years, who received a minimum of two consecutive ICD-9-CM diagnosis codes for MDD (296.2, 296.3, 300.4 and 311), without a bipolar diagnosis; treated with an antidepressant prescription were identified. Patients were categorized as PCP identified (N= 587(69%)) or PSY identified (N= 263 (31%)) by the designated specialty of the physician providing the index MDD diagnosis. These patients were then followed for 6 months to observe the difference in the number of MDD related follow up visits, AD adherence and the risk of MH related hospitalization. AD adherence was measured using HEDIS criteria which defined “adherent” as having 84 days of antidepressant use out of the first 114 days of index prescription. Chi-square and Wilcoxon tests were used to identify the difference between PCP and PSY patients.  Results: Findings indicate that pediatric depression cases first identified by PSY were relatively younger 10-13 years-old (PSY:27%; PCP:20%,p= 0.02)than those identified by PCPs, more likely to be male (PSY:44%, 22%, p< 0.001), white (PSY:48%, PCP:37%, p= 0.02) and with pre-index psychiatric comorbidities (PSY:79%, PCP:64%, p< 0.001). As compared to PCP identified patients, those who were identified by PSY received more follow-up visits [Mean (SD): PSY:9.57(9.06), PCP:7.36(7.67), p= 0.007]; had better medication adherence (PSY: 54%, PCP:45%, p= 0.01); and less MH related hospitalization (PCP:15%, PSY: 2%, p= 0.002).  Conclusions: Children and adolescents identified by PSY received better quality of MDD care and experienced less hospitalization than those identified by PCPs. PMH61 Care Seeking Pathway Of Depression In Children And Adolescents: Differences In The Need For Care Coordination Between Patients Managed By Primary Care Providers Or Psychiatrists Yucel A1, Chen H1, Essien EJ1, Aparasu R1, Mgbere O2, Bhatara V3, Alonzo J1 of Houston, Houston, TX, USA, 2Houston Department of Health and Human Services, Houston, TX, USA, 3University of South Dakota, Vermillion, SD, USA

1University

Objectives: Major depressive disorder (MDD) is a prevalent mood disorder among children and adolescents and has severe consequences if not treated appropriately such as academic failure, substance abuse, attempted suicide, and increased risk of adult depression. To track quality and design improvement strategies in MDD treatment, it is important to assess how the care seeking pathway is shaped after initial MDD diagnosis by primary care providers (PCP) versus psychiatrists (PSY).  Methods: 2006 and 2007 Medicaid Analytical Extract (MAX) data from New York State was utilized. 850 children and adolescents aged 10-20 years, who received a minimum of two consecutive ICD-9-CM diagnosis codes for MDD (296.2, 296.3, 300.4, 311) without bipolar disorder; and received antidepressant medication were identified. Patients were categorized as PCP identified [N= 587(69%)] or PSY identified