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Article: Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression.

Belanger, Heather G / Winsberg, Mirène

2023 Volume 13, Page(s) 1026361

Abstract: Background: Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving ... ...

Abstract	Background: Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. Methods: Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples ( Results: Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. Conclusion: Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.
Language	English
Publishing date	2023-01-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2022.1026361
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Article ; Online: Introduction to a special issue on military neuropsychology: Serving those who serve.

Belanger, Heather G

The Clinical neuropsychologist

2020 Volume 34, Issue 6, Page(s) 1065–1069

Abstract: Objective: The military has a long history with neuropsychology and its precursors. From developing intelligence tests during World War I, to developing early capacity and personality assessments during World War II, to forward deploying for the ... ...

Abstract	Objective: The military has a long history with neuropsychology and its precursors. From developing intelligence tests during World War I, to developing early capacity and personality assessments during World War II, to forward deploying for the evaluation and treatment of frequent concussive brain injuries during more recent conflicts, clinical neuropsychology has been at the forefront of military selection, healthcare and research. The objective of this special issue is to provide an overview of the latest clinical research relevant to military neuropsychology-some contributors address assessment and treatment issues that are relevant to current practice and others foretell the future of our field. Method: We solicited papers from established researchers and issued a general call for papers for the special issue on military neuropsychology. Results: We received submissions from several authors, eleven of which are included in this issue. These submissions cover assessment and treatment issues, as well as healthcare utilization and return to duty issues. Two apparent themes are the importance of assessing, treating, and attending to comorbidities following traumatic brain injury (TBI) and future assessment techniques moving beyond traditional cognitive performance assessment. Conclusions: The issue highlights the importance of research in clinical neuropsychology to the practice and advancement of military neuropsychology.
MeSH term(s)	Humans ; Military Personnel/psychology ; Neuropsychological Tests/standards ; Neuropsychology/methods
Language	English
Publishing date	2020-07-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639080-8
ISSN	1744-4144 ; 0920-1637 ; 1385-4046
ISSN (online)	1744-4144
ISSN	0920-1637 ; 1385-4046
DOI	10.1080/13854046.2020.1786605
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Article ; Online: Recovery from stroke: factors affecting prognosis.

Belanger, Heather G

The Clinical neuropsychologist

2019 Volume 33, Issue 5, Page(s) 813–816

Abstract: ... ...

Abstract	Objective
MeSH term(s)	Humans ; Neuropsychological Tests/standards ; Prognosis ; Stroke/therapy ; Stroke Rehabilitation/methods
Language	English
Publishing date	2019-03-18
Publishing country	England
Document type	Editorial ; Introductory Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	639080-8
ISSN	1744-4144 ; 0920-1637 ; 1385-4046
ISSN (online)	1744-4144
ISSN	0920-1637 ; 1385-4046
DOI	10.1080/13854046.2019.1578899
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Article: Do older adults benefit from telepsychiatric care: Comparison to younger adults.

Belanger, Heather G / Winsberg, Mirène

Frontiers in psychiatry

2022 Volume 13, Page(s) 998401

Abstract: Background: Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The ... ...

Abstract	Background: Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression Method: Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. Results: Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. Conclusion: Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment
Language	English
Publishing date	2022-08-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564218-2
ISSN	1664-0640
ISSN	1664-0640
DOI	10.3389/fpsyt.2022.998401
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Article ; Online: Symptom clustering of major depression in a national telehealth sample.

Belanger, Heather G / Lee, Christine / Winsberg, Mirène

Journal of affective disorders

2023 Volume 338, Page(s) 129–134

Abstract: Background: Major depressive disorder (MDD) is a heterogeneous disorder whose possible symptom combinations have not been well delineated. The aim of this study was to explore the heterogeneity of symptoms experienced by those with MDD to characterize ... ...

Abstract	Background: Major depressive disorder (MDD) is a heterogeneous disorder whose possible symptom combinations have not been well delineated. The aim of this study was to explore the heterogeneity of symptoms experienced by those with MDD to characterize phenotypic presentations. Methods: Cross-sectional data (N = 10,158) from a large telemental health platform were used to identify subtypes of MDD. Symptom data, gathered from both clinically-validated surveys and intake questions, were analyzed via polychoric correlations, principal component analysis, and cluster analysis. Results: Principal components analysis (PCA) of baseline symptom data revealed 5 components, including anxious distress, core emotional, agitation/irritability, insomnia, and anergic/apathy components. PCA-based cluster analysis resulted in four MDD phenotypes, the largest of which was characterized by a prominent elevation on the anergic/apathy component, but also core emotional. The four clusters differed on demographic and clinical characteristics. Limitations: The primary limitation of this study is that the phenotypes uncovered are limited by the questions asked. These phenotypes will need to be cross validated with other samples, potentially expanded to include biological/genetic variables, and followed longitudinally. Conclusions: The heterogeneity in MDD, as illustrated by the phenotypes in this sample, may explain the heterogeneity of treatment response in large-scale treatment trials. These phenotypes can be used to study varying rates of recovery following treatment and to develop clinical decision support tools and artificial intelligence algorithms. Strengths of this study include its size, breadth of included symptoms, and novel use of a telehealth platform.
MeSH term(s)	Humans ; Depressive Disorder, Major/diagnosis ; Depressive Disorder, Major/epidemiology ; Depressive Disorder, Major/drug therapy ; Depression/psychology ; Cross-Sectional Studies ; Artificial Intelligence ; Telemedicine ; Cluster Analysis
Language	English
Publishing date	2023-05-27
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	135449-8
ISSN	1573-2517 ; 0165-0327
ISSN (online)	1573-2517
ISSN	0165-0327
DOI	10.1016/j.jad.2023.05.026
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Article ; Online: Does Bupropion Increase Anxiety?: A Naturalistic Study Over 12 Weeks.

Poliacoff, Zachary / Belanger, Heather G / Winsberg, Mirène

Journal of clinical psychopharmacology

2023 Volume 43, Issue 2, Page(s) 152–156

Abstract: Purpose/background: There has long been a clinical belief that bupropion exacerbates anxiety. The purpose of the current retrospective study is to compare anxiety severity over time in those prescribed selective serotonin reuptake inhibitors (SSRIs) ... ...

Abstract	Purpose/background: There has long been a clinical belief that bupropion exacerbates anxiety. The purpose of the current retrospective study is to compare anxiety severity over time in those prescribed selective serotonin reuptake inhibitors (SSRIs) versus bupropion. Methods/procedures: Archival data (N = 8457) from patients receiving psychiatric care from a national tele-mental health company were used. Propensity matching was used to create SSRI and bupropion groups using 17 covariates. These samples were then compared using repeated measures analysis of variance on Generalized Anxiety Disorder Scale 7 scores at start of treatment, 6 weeks, and 12 weeks. Findings/results: The SSRI and bupropion groups were significantly different across a number of variables. In the entire sample, the bupropion group had significantly greater anxiety levels. However, for propensity-matched comparisons, there were no significant interactions between group and time (ie, groups did not differ and improved comparably over time). Implications/conclusions: Using propensity matching, there were no differences in anxiety outcome between those prescribed selective serotonin reuptake inhibitor versus bupropion across 12 weeks of treatment.
MeSH term(s)	Humans ; Bupropion/therapeutic use ; Retrospective Studies ; Depressive Disorder, Major/drug therapy ; Selective Serotonin Reuptake Inhibitors ; Anxiety
Chemical Substances	Bupropion (01ZG3TPX31) ; Selective Serotonin Reuptake Inhibitors
Language	English
Publishing date	2023-01-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	604631-9
ISSN	1533-712X ; 0271-0749
ISSN (online)	1533-712X
ISSN	0271-0749
DOI	10.1097/JCP.0000000000001658
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Article: Low-Level Blast Exposure in Humans A Systematic Review of Acute and Chronic Effects.

Belanger, Heather G / Bowling, F / Yao, Eveline F

Journal of special operations medicine : a peer reviewed journal for SOF medical professionals

2020 Volume 20, Issue 1, Page(s) 87–93

Abstract: ... domain (e.g., cognitive), findings were largely inconsistent. Research with larger sample sizes, followed ...

Abstract	There is growing concern that military breaching and training and firing artillery and mortars, grenades, and shoulder-fired weapons may have some type of cumulative deleterious effects. There are anecdotal reports of those with repetitive exposure to low-level blast complaining of various symptoms, as well as increasing empirical evidence. The purpose of this report is to provide a systematic review of the literature on repetitive lowlevel blast as it pertains to military and police training protocols. An extensive literature search was conducted, resulting in detailed review of 18 studies. Results suggest few consistent findings, likely due to the heterogeneity of methods, high risk of bias, and lack of reliance on objective blast-exposure data. Adverse effects, when present, dissipated over time. All studies that used blast gauges found significant associations, though only a subset actually reported using the blast-gauge data (to correlate objective exposure with outcomes). When comparing studies within an outcome domain (e.g., cognitive), findings were largely inconsistent. Research with larger sample sizes, followed longitudinally, is needed.
MeSH term(s)	Blast Injuries/epidemiology ; Explosions ; Humans ; Military Personnel/education ; Police/education
Language	English
Publishing date	2020-02-17
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	3006517-3
ISSN	1553-9768
ISSN	1553-9768
DOI	10.55460/3AC6-AX9I
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Article ; Online: The utility of completing adjuvant video lessons based on the unified protocol during psychotherapy: A retrospective study using a telehealth platform in routine clinical care.

Belanger, Heather G / Long, Laura J / Winsberg, Mirène / Sullivan, Scott / Farchione, Todd J / O'Callaghan, Erin

Psychotherapy research : journal of the Society for Psychotherapy Research

2023 Volume 34, Issue 2, Page(s) 228–240

Abstract: Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically ... ...

Abstract	Digital supplements to tele-psychotherapy are increasingly needed. The purpose of this retrospective study was to investigate the association between outcomes and the use of supplemental video lessons based on the Unified Protocol (UP), an empirically supported transdiagnostic treatment. Participants included 7,326 adults in psychotherapy for depression and/or anxiety. Partial correlations were calculated between number of UP video lessons completed and change in outcomes after 10 weeks, controlling for number of therapy sessions and baseline scores. Then, participants were divided into those who did not complete any UP video lessons ( Among the entire sample, symptom severity decreased as the number of UP video lessons completed increased, with the exception of lessons on avoidance and exposure. Those watching at least 7 lessons showed significantly greater reduction in both depression and anxiety symptoms than those who did not watch any. Viewing supplemental UP video lessons in addition to tele-psychotherapy had a positive and significant association with symptom improvement and may provide an additional tool for clinicians to implement UP components virtually.
MeSH term(s)	Adult ; Humans ; Psychotherapy/methods ; Retrospective Studies ; Telemedicine/methods ; Anxiety Disorders/therapy ; Anxiety/therapy
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Video-Audio Media ; Journal Article
ZDB-ID	1080323-3
ISSN	1468-4381 ; 1050-3307
ISSN (online)	1468-4381
ISSN	1050-3307
DOI	10.1080/10503307.2023.2174460
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Article ; Online: Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression.

O'Callaghan, Erin / Sullivan, Scott / Gupta, Carina / Belanger, Heather G / Winsberg, Mirène

BMC psychiatry

2022 Volume 22, Issue 1, Page(s) 483

Abstract: Background: Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe ... ...

Abstract	Background: Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. Methods: Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. Results: Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. Conclusions: Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
MeSH term(s)	Adult ; Anxiety/therapy ; Anxiety Disorders/drug therapy ; Depression/therapy ; Depressive Disorder, Major/diagnosis ; Depressive Disorder, Major/drug therapy ; Feasibility Studies ; Humans ; Psychiatry ; Telemedicine/methods
Language	English
Publishing date	2022-07-19
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2050438-X
ISSN	1471-244X ; 1471-244X
ISSN (online)	1471-244X
ISSN	1471-244X
DOI	10.1186/s12888-022-04113-9
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Article ; Online: Mental health treatment utilization patterns among 108,457 Afghanistan and Iraq veterans with depression.

Panaite, Vanessa / Cohen, Nathan J / Luther, Stephen L / Finch, Dezon K / Alman, Amy / Schultz, Susan K / Haun, Jolie / Miles, Shannon R / Belanger, Heather G / Kozel, F Andrew / Rottenberg, Jonathan / Pfeiffer, Paul N

Psychological services

2024

Abstract: People with depression often underutilize mental health care. This study was conceived as a first step toward a clinical decision support tool that helps identify patients who are at higher risk of underutilizing care. The primary goals were to (a) ... ...

Abstract	People with depression often underutilize mental health care. This study was conceived as a first step toward a clinical decision support tool that helps identify patients who are at higher risk of underutilizing care. The primary goals were to (a) describe treatment utilization patterns, early termination, and return to care; (b) identify factors associated with early termination of treatment; and (c) evaluate the accuracy of regression models to predict early termination. These goals were evaluated in a retrospective cohort analysis of 108,457 U.S. veterans who received care from the Veterans Health Administration between 2001 and 2021. Our final sample was 16.5% female with an average age of 34.5. Veterans were included if they had a depression diagnosis, a positive depression screen, and received general health care services at least a year before and after their depression diagnosis. Using treatment quality guidelines, the threshold for treatment underutilization was defined as receiving fewer than four psychotherapy sessions or less than 84 days of antidepressants. Over one fifth of veterans (21.6%) received less than the minimally recommended care for depression. The odds of underutilizing treatment increased with lack of Veterans Administration benefits, male gender, racial/ethnic minority status, and having received mental health treatment in the past (adjusted
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2156662-8
ISSN	1939-148X ; 1541-1559
ISSN (online)	1939-148X
ISSN	1541-1559
DOI	10.1037/ser0000819
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