RESEARCH

Anxiety disorders affect more than 20 percent of youth, often interfering with self-esteem, confidence, family relationships, friendships, or school performance. Although psychological and medication therapies are helpful to many patients, not all patients respond to a given therapy, and those who do frequently respond relapse later. Treatment of a child who has an anxiety disorder begins with the question of which treatment to begin first: psychological or medication therapy. Few studies, however, have compared these two treatments directly, leaving patients, parents, and clinicians without scientific evidence for which treatment is likely to be most helpful. Another question is what to do when the initial treatment is not as helpful as desired: Should the initial single treatment be intensified, or should the other treatment be added to the first, producing a combined psychological and medication therapy? This randomized trial will clarify whether treatment of anxiety should be initiated with medication or cognitive-behavioral therapy and how to proceed if the initial treatment is not as successful as desired.

Our project seeks to develop metrics to measure fidelity and outcomes for the National Zero Suicide Model components implemented in each system using electronic health records and insurance claims data sources that are easily extractable and generalizable to other systems. Then, we propose to use these metrics to conduct fidelity and outcome evaluation of the various Zero Suicide Initiative approaches in each system using Interrupted Time Series Designs, which are among the strongest, pragmatic designs appropriate for evaluating care system intervention and policy changes in ‘Learning Healthcare Systems.’ We hypothesize that the implementation of various National Zero Suicide Model components will significantly reduce suicidal behavior within and across the participating systems. We seek to accomplish the following aims: 1) Collaborate with health system leaders to develop EHR metrics to measure specific quality improvement targets and care processes tailored to local Zero Suicide Initiative implementation; 2) examine the fidelity of the specific Zero Suicide Initiative care processes implemented in each system; and 3) investigate suicide attempt and mortality outcomes within and across Zero Suicide Initiative healthcare system models.

There is considerable optimism that telehealth – especially telephone and video-based visits – can transform care delivery within Kaiser Permanente (KP) and across the United States. Mental health and wellness is the service line with the greatest potential to realize the benefits of expanding telehealth and transfer learning across service lines and regions. The current project aims to improve our understanding of clinical, technical, and legal barriers and facilitators to telehealth as well as to further our ability to measure telehealth encounters and the relationship between telehealth and face-to-face care.

The aim of this project is to examine cellular and genomic markers of inflammation, telomere erosion, telomere length, and microarray data of 300 breast cancer survivors and comparison women who are enrolled in the KPSC-UCLA collaborative STRIVE1 and STRIVE2 studies.

This is a large multisite observational study to evaluate the effects of initiating buprenorphine treatment on subsequent suicidal behavior among people with opioid use disorder, including those with and without co-occurring mental health conditions or other known risk factors for suicidal behavior.

KPSC is one of nine sites throughout the country funded by an Innovation Award from the Centers of Medicare and Medicaid to implement a coordinated care model for depressed patients with cardiovascular disease. We have the following goals for this project: 1. To implement in three stages a multiple condition collaborative care management model in primary care clinics of care systems in states. 2. To demonstrate that this model improves care quality, patient experience and health, provider satisfaction, and total healthcare costs for the Medicare and Medicaid patients with the targeted conditions. 3. To develop role descriptions and training for the two new types of workers required for this model – care managers and care consultants. 4. To identify the costs and payment models needed by care systems to sustain and spread this care model.

This is a longitudinal observational study of the biological causes and functional consequences of depression in patients with stable COPD.

Anxiety disorders among youth are extremely common and without effective treatment can lead to depression, substance use, suicide, and deficits in functioning into adulthood. Although pediatric anxiety interventions, such as cognitive behavioral therapy and antidepressant medications, are highly efficacious, many clinicians are under-using these evidence-based treatments. We will develop and test two complementary casemix-adjusted pediatric anxiety outcome quality measures using the GAD-7 instrument: (1) a measure of whether patients are responding to treatment (treatment response) and (2) whether patients’ anxiety remitted (remission), which will provide a critical tool for improving outcomes from anxiety treatment.

We will use population-based data from seven large health systems to develop an evidence-based risk calculator for mental health and primary care clinicians. In order to address the gaps in evidence described above, we will expand current MHRN work on prediction of suicide risk by (1) expansion to a larger and more diverse sample, (2) Inclusion of encounters with “missing” risk assessments, (3) Examination of specific psychiatric and substance use diagnoses, and (4) applying analytic methods to account for potential biases due to patient- and provider-driven timing of assessments.

Mindfulness Based Cognitive Therapy (MBCT) an 8-session in-person intervention using mindfulness meditation and cognitive-behavioral strategies, has shown effectiveness in reducing residual depressive symptoms and risk for recurrence among pregnant women with histories of depression. A digital adaptation of MBCT for pregnant women, Mindful Mood Balance for Moms (MMBFM), was recently developed to overcome access barriers to in-person groups and increase potential for scale-up in OB care settings. We will address the following aims for this study: 1) Compare the clinical effectiveness (i.e. engagement and symptom reduction) of MMBFM supported by clinician vs. peer coaches among women with a history of prior depressive episodes; 2) examine specific mechanisms of action for MMBFM participants receiving clinician vs. peer coaching; 3) examine the effects of specific implementation strategies on reach of the MMBFM program; and 4) estimate the cost-effectiveness of MMBFM supported by clinician vs. peer coaches. We hypothesize that MMBFM will be more cost-effective when supported by peer vs. clinician coaches.

We have established a Mental Health Research Network including 13 established public-domain research centers based in integrated not-for-profit health systems. These systems provide care to a diverse population of 10 million people in 11 states, and they share rich and compatible data resources to support a range of effectiveness research. Diversity of member demographics, insurance coverage, and organization of health services make this network an ideal environment for studying variation in care, comparing effectiveness and cost of treatments across practice environments, and studying dissemination and health policies. Participating research centers are experienced in a wide range of clinical areas and research methods. The long-term objectives are to expand the Mental Health Research Network to include additional health systems and external investigators, to conduct multi-site observational and experimental studies of comparative effectiveness, to develop and evaluate methods for dissemination and implementation, and to become a national resource of research methods and effectiveness evidence for researchers, patients, providers and healthcare leaders.

This study will incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. Our scientific premise is that by 1) understanding the stakeholder perspective on the role of health systems in opioid-related overdoses, and 2) involving these stakeholders in all aspects of developing strategies that health systems can use to prevent opioid-related overdoses within the implementation of the Zero Suicide framework, we will have a much greater impact on reducing the mortality rates associated with opioid use.

This study will estimate the epidemiologic and economic outcomes associated with the adult attention deficit hyperactivity disorder (ADHD). We also assess characteristics, predictors, and time frame for patients who transition to more complex ADHD within the inception cohort and generate prediction models for transition. The study also examines treatment patterns, medication adherence and healthcare utilization patterns of the inception cohort.

This study examines if depression and its treatment can affect the course of prostate cancer.

The goal of this prospective recruitment study is to evaluate longitudinal differences in the rates of change in inflammation and telomere erosion in breast cancer survivors vs. non-cancer comparison women to determine if such molecular changes are due to cancer biology, or its treatment, or consequences of aging.

The aim of this prospective study is to examine the association between sleep disturbance, cellular and genomic markers of inflammation, and depression occurrence in breast cancer survivors.

This observational, data-only study will use diagnostic and treatment data from the electronic medical records (EMR) and administrative systems from three Kaiser regions (Northwest, Southern California, and Georgia) including depression screening rates, rates of depression treatment initiation and receipt of different depression treatment services. The overall goal is to examine how race/ethnicity impacts these services. The study aims are: Aim 1: Examine how race/ethnicity impacts receipt of screening for depression in all settings or service types for adults at 3 sites, including examining unadjusted differences, and differences controlling for other patient-level factors (age, socioeconomic status, insurance coverage, other social determinants of health). Aim 2: Controlling for severity of depression symptoms (PHQ-9 category) and other sociodemographic characteristics, do racial and ethnic groups of patients have different patterns of depression diagnosis and treatment initiation compared to White patients? Aim 3: Do racial and ethnic groups of patients who screen positive for depression (PHQ-9 score above 9) have different longer-term outcomes compared to White patients? Aim 4: Explore whether response to depression treatment is associated with treatment outcomes, and whether these outcomes are different for racial and ethnic groups of patients compared to White patients.