Given the limited evidence on care received over time by patients with gambling disorder (GD), this study examined care trajectories and their associations with patients’ conditions, gambling characteristics, and quality of care. Data from 14 Quebec addiction treatment centers were collected for 907 patients with at least 3 years of GD, then linked to provincial administrative databases (1979–2022). Group‑based multi‑trajectory modeling identified 3‑year care trajectories (2009–2022) for GD, mental disorders (MDs), substance‑related disorders (SRDs), and physical health problems, considering most patients had co‑occurring disorders. Multiple multinomial logistic regression assessed covariates. Of the five trajectories identified, only Trajectories 3 and 5 received substantial GD treatment throughout the 3‑year period—less than one-third of the cohort. Trajectory 3 had the most GD treatment and the lowest dropout rates, though about half still discontinued care. These patients were older (similar to Trajectories 2 and 4) and had comparatively better conditions (similar to Trajectory 1), although most had co‑occurring disorders and made minimal use of services that could address these issues. MD‑SRD service use was especially low in Trajectories 1–3 (70
Measurement-based care (MBC) relies on repeated outcome assessment and feedback to guide clinical decision-making. Although recovery curves are central to many MBC systems, they have primarily been developed using session-by-session data. This study developed and validated recovery curves for the PHQ-8 and GAD-7 using monthly assessments within a naturalistic outpatient setting. We generated our recovery curves using mixed-effects models with symptom change over four months of treatment as the dependent variable (N = 1124) and cross-validated the results in a second sample (PHQ-8 N = 734; GAD-7 N = 758). Models were evaluated for predictive performance and calibration. We examined additional baseline predictors and evaluated confidence interval thresholds for identifying patients at risk of treatment failure. Predictive performance was strong in the derivation sample (PHQ-8 R² = 0.44; GAD-7 R² = 0.47) and remained robust in validation (PHQ-8 R² = 0.37; GAD-7 R² = 0.40) with acceptable calibration. Baseline symptom severity was the only clinically meaningful predictor of recovery trajectories. A 60
The Veterans Crisis Line (VCL) launched the Caring Letters (VCL-CL) suicide prevention intervention to support Veterans in crisis in 2020. The intervention mails messages of support to Veterans who contact the VCL and was associated with increased use of mental health services among recipients. VCL-CL might be implemented for other Veterans, but no information exists on the budget impact of a large-scale caring contacts intervention. This budget impact analysis evaluated the costs related to labor, supplies, and information technology during each phase (i.e., development, implementation, maintenance) of VCL-CL from January 2020 to May 2022. We also forecasted the per Veteran costs of sustaining VCL-CL for three years with varying levels of VCL-CL users. The cost of VCL-CL during the intervention development, implementation, and maintenance phase were 54,483,602,534, and 967,174, respectively—for a total cost of1,624,190. This represents approximately 10.94 per Veteran over the duration of the project, or1.22 per Veteran-letter. The forecasted cost to sustain the VCL-CL project was less than 1.40 under all scenarios of Veteran use (stable use, 10
Multisystemic Therapy (MST) is a family-centered, community-based psychosocial treatment and is a leading evidence-based intensive-in-home treatment for youth. Prior findings from well-controlled effectiveness and randomized control trials of MST underscore the potential mental health benefits of targeting youth, family, and community strengths in treatment. However, less is known about the outcomes associated with strength-focused treatment in implemented MST settings, particularly in public mental health care (PMHC). Hierarchical and longitudinal growth modeling techniques were used to analyze archival clinical service data from a sample of 911 youth receiving implemented MST in a statewide PMHC system. Therapeutic focus on strengths was measured as a proportion of overall treatment targets endorsed by therapists that were strength-based (strength proportion [SP]). This study examined the associations between SP and three different treatment outcome measures: discharge status, end-of-treatment functional impairment, and therapist-rated treatment progress. Findings indicated significant positive associations between a greater therapeutic focus on strengths and higher likelihood of successful treatment discharge, better youth functioning at end-of-treatment, and greater treatment progress. Clinical implications and suggestions for future research are provided.
Mental health disorders impose a rapidly growing burden across Asia, where treatment gaps routinely exceed 70
