Secondary Data Projects
Secondary data research projects are projects that use existing data, often from prior research or public surveys, to answer new research questions. Secondary research can also analyze the results of multiple research projects compared to each other, often in the form of a meta-analysis.
Click on “Project Goals & Methods” below each project title to learn more about the secondary data research projects happening at the Center of Excellence.
Current Projects
Prevention in Psychiatric Healthcare
Real-World Approach to Screening for Attenuated and Early Psychotic Symptoms using the MGH Psychosis Clinical and Research Program (PCRP) Referral Database
The MGH Psychosis Clinical and Research Program (PCRP) offers evaluation and treatment for people with psychosis-risk syndrome and psychotic disorders. PRCRP offers a variety of specialized programs, including the Resilience Evaluation-Social Emotional Training (RE-SET) program for youths at clinical high risk for psychosis (CHR-P), the First-Episode and Early Psychosis Program (FEPP) for young adults experiencing their first episode of psychosis, and the Recovery and Ongoing Care Clinic (ROCC) for people with ongoing psychotic illness.
Family members, clinical providers, or patients self-referring to PCRP complete a screening form assessing lifetime behaviors, psychiatric diagnosis, psychiatric service use, and psychotic symptoms using the Adolescent Psychotic-like Symptom Screener (APSS). To determine eligibility for RE-SET, eligible patients and their caregivers complete a battery of measures of symptoms of psychosis, anxiety, attention, and mood; traumatic experiences; social functioning; caregiver burden; and developmental history, and may complete the Structured Interview for Psychosis-Risk Syndromes (SIPS), a gold-standard assessment for CHR-P.
This project is a series of studies using this database of referral and clinical measures from the MGH PCRP to examine:
1) Predictive ability and incremental validity of clinical risk factors at referral to detect CHR-P status and
2) Predictive ability of APSS In identifying CHR-P or primary psychotic disorder.
Study results found that 1) a recent decline in social functioning, an ASD diagnosis, attenuated psychotic symptoms, and lesser sleep are significant risk factors for CHR-P, and 2) endorsing one of two items for visual or auditory hallucinations on the APSS was highly sensitive for identifying outpatients who meet criteria for CHR-P or primary psychotic disorder.A systematic review has been completed and focuses on psychosis screening in general mental health settings.
Our manuscript has been accepted by the Harvard Review of Psychiatry on Preventative Psychiatry and is currently under review:
Clauss JA*, Foo CYS*, Leonard CJ, Dokhoylan N, Cather C+, Holt DJ+. Screening for psychotic experiences and psychotic disorders in general psychiatric settings: A systematic review and meta-analysis. medRxiv 2024.04.14.24305796. Accepted in Harvard Review of Psychiatry.
*Contributed to work equally. + Co-senior authors.
The project team, with endorsement from MGH pediatric psychiatry and team-based outpatient psychiatry clinics’ leadership, have also proposed to MGB Patient-Reported Outcome Measures (PROMs) program service to include a two-item psychosis screener in outpatient psychiatry settings within the Mass General Brigham hospitals.
Improving Outcomes for People with Serious Mental Illness (SMI)
Daily Functioning and Neighborhood Characteristics in Black Americans with Schizophrenia Spectrum Disorders (SSDs)
Black Americans are disproportionately diagnosed with SSDs and are more likely to experience worse outcomes over the course of the illness, such as higher rates of incarceration, homelessness, unemployment, and psychiatric hospitalizations. This project is designed to help increase understanding of the mechanisms underlying these effects.
This study seeks to identify:
1) If there are ethnoracial differences between Black, white, and Latinx people with serious mental health conditions in terms of how they spend their time; and
2) The extent to which neighborhood socioeconomic status impacts any observed differences.
We hypothesize that due to structural racism, Black and Latinx communities may live in neighborhoods with fewer resources (e.g., fewer parks), which may limit opportunities and affect time allocation to different activities (e.g., working, socializing, exercising).
This project is a secondary data analysis of 110 white and 131 Black individuals with SSDs. We are examining racial differences in time allocation using ecological momentary assessment (EMA), a cellphone-app-based method which provides real-time information about daily activities. We also use geocoding methods to evaluate the extent to which neighborhood characteristics (which may reflect the consequences of racist policies) contributed to any disparities observed in our EMA data.
Effective Care Transition Interventions for Individuals with Serious Mental Illness and Their Families: A Systematic Review and Meta-Analysis
Individuals with serious mental illness face the highest risk for relapse, suicide, and symptom exacerbation following discharge from inpatient psychiatric care, and yet the care transition period is when they receive the least amount of support. One in four Medicaid patients hospitalized for schizophrenia spectrum disorders are readmitted 30 days following discharge, and about two-thirds of first-episode psychosis patients do not attend their first post-discharge outpatient appointment.
The objectives of this systematic review and meta-analysis are to:
1) Describe and characterize the types of care transition interventions for individuals with serious mental illness (SMI) following discharge from a psychiatric hospitalization to outpatient mental health/community care services that have been evaluated in controlled studies;
2) Assess the effectiveness of these care transition interventions in improving clinical (relapse prevention, clinical symptoms, functioning) and continuity of care (treatment initiation, engagement, and adherence) outcomes for patients; and
3) Propose recommendations for scalable and effective care transition interventions that can be implemented for this population post-hospitalization.
Currently, the project team has identified 929 studies for the initial title and abstract screening. We have also prepared a protocol paper and the review is registered on PROSPERO. The team has completed title and abstract screening, full-text review, and data extraction from the papers included in the review. We are beginning quality assessment ratings of the papers to be included.
Smoking Cessation and Substance Use
Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed Methods Process Evaluation
There are disproportionally high rates of tobacco use disorder (TUD) and risk of smoking-related illness among people with serious mental illness (SMI), but community health worker (CHW) interventions can address the treatment gap for evidence-based tobacco cessation care for this at-risk population.
The present study is a mixed-methods process evaluation of Dr. Eden Evins’ PCORI study, which compared usual care to provider education with or without the extra support of a community health worker who provided: home visits, transportation, encouragement and behavioral support for quitting, assistance with access and adherence to smoking cessation pharmacotherapy, and access to group behavioral treatment.
Our aims are:
1) To assess the relationships between community health workers’ and patients’ treatment engagement (attendance, time spent, goals attained) and patients’ smoking quit status, and
2) To identify and compare barriers and facilitators to treatment engagement among community health workers and patients with high and low engagement levels, respectively.
We found that participants who had more contact with CHWs—whether via home/community visits, group counseling sessions, or accompanied PCP visits—were much more likely to quit smoking after two years compared with adults who had less CHW engagement. Interviews with patients, PCPs and CHWs also revealed that CHWs were instrumental in breaking down structural barriers to treatment by helping to schedule appointments, provide transport, and ensuring insurance was up to date.
The manuscript for this project is in press in Psychiatric Services:
Foo CYS, Potter K, Nielsen L, Rohila A, Maravic MC, Schnitzer K, Pachas GN, Levy DE, Reyering S, Thorndike AN*, Cather C*, Evins AE*. Implementation of community health worker support for tobacco cessation: A mixed-methods study. medRxiv, 2024.01.26.24301835. In press in Psychiatric Services. https://doi.org/10.1101/2024.01.26.24301835
*Co-senior authors.
Given the demonstrated effectiveness of CHW support for tobacco cessation, Drs. Evins, Streck, and Cather submitted two R01s (NIDA resubmission; NIMH under review) to extend study of CHW deployment for behavioral health within Medicaid-funded care structures. The proposed studies will test CHW support delivered by existing community behavioral health staff for Medicaideligible adults with any SMI, and determine if CHW effectiveness on tobacco outcomes is mediated by remediation of adverse social determinants of health. If effective, this intervention has the potential to be widely disseminated in existing, Medicaid funded systems of behavioral health care and transformative in overcoming adverse SDOH to improve the delivery of first-line, evidencebased medical care, reducing the enormous mortality disparity faced by people with SMI.
Associations Between Recreational Cannabis Retail Sales and THC Detected in Psychiatric Emergency Department Presentations
Cannabis policy, including the legalization and commercial expansion of recreational cannabis, is rapidly evolving with mixed evidence on how it affects adolescents and young adults. Massachusetts (MA) voted to legalize cannabis in November 2016, with the first dispensaries opening in November 2018.
Population-level surveys in the US and Canada find no evidence that cannabis legalization or commercialization increased the rate of adolescent self-reported cannabis use. However, youth with existing or emerging psychiatric illnesses constitute a particularly high-risk group who are disproportionately impacted by substance use.
Using data collated from the MGH emergency department in APS using the Research Patient Data Registry (RPDR) database, we aimed to examine age-varying changes in cannabis use, detected by urine toxicology screens, after the legalization and commercialization of recreational cannabis in Massachusetts.
We have completed data analyses and are currently preparing the manuscript. Our findings suggest that expanding recreational cannabis availability and accessibility may be disproportionately affecting adolescents with psychiatric vulnerabilities, and deserves attention given known risks of early and heavy cannabis use on developing and worsening progression of psychotic disorders and other serious mental illnesses.
First-Episode Psychosis (FEP)
Characterizing Family Involvement During Index Psychiatric Hospitalization for First-Episode Psychosis
Despite the robust evidence supporting family support and psychoeducation in schizophrenia treatment, the role of family engagement during and following acute treatment on engagement in coordinated specialty care treatment has been under-studied.
A retrospective chart review of 179 psychiatric inpatients from New York found that patients with family involvement in discharge planning had three times higher odds of attending their outpatient appointments within a week of discharge than patients without family involvement. This finding suggests that family engagement can help with timely treatment initiation post-hospitalization and reduce the duration of untreated psychosis.
In collaboration with a team from McLean Hospital, we aim to:
1) Characterize family involvement during index hospitalization for first-episode psychosis clients at MGH First Episode for Psychosis Program (FEPP) and McLean OnTrack using electronic medical record data, and
2) Examine associations between family involvement during hospitalization and engagement delay (operationalized as time from hospital discharge to date of first attended appointment at FEPP or OnTrack).
Data has been extracted from the Mass General Brigham Research Patient Data Registry and Electronic Data Warehouse. Data cleaning is currently in progress.
Delays in Hospital Care Transitions for First-Episode Psychosis:
A Retrospective Chart Review
Individuals with first-episode psychosis experience substantial delays in engaging with coordinated specialty care following discharge from acute psychiatric services, prolonging the duration of untreated psychosis and worsening prognosis. This is the first of a three-phase mixed methods study that aims to understand how hospital care transitions can be improved for first-episode psychosis.
Aims: To characterize engagement delays from hospital discharge to CSC enrollment and associated demographic and clinical variables for individuals with first-episode psychosis.
We will extract data from electronic medical records of first-episode psychosis patients who received an index schizophrenia spectrum disorder diagnosis at inpatient/emergency department settings and were enrolled in the MGH First Episode and Early Psychosis Program from 2005 to 2023. Associations between engagement delays from hospital discharge to date of initial attended appointment at MGH FEPP, and demographic and clinical variables will be evaluated.
Prospective Relationships between Social Functioning and Insight in Recovery After a First Episode of Psychosis
The Recovery After an Initial Schizophrenia Early Treatment Program (RAISE-ETP) study is the largest randomized controlled trial conducted in the United States that demonstrates the efficacy of specialized coordinated specialty care services for first episode psychosis. RAISE-ETP specifically evaluated NAVIGATE, a comprehensive treatment program for first-episode psychosis, compared to usual care/community care (CC) over two years. We are completing three secondary analyses of the RAISE-ETP study, examining:
1) Dynamic interrelationships between social functioning and insight in NAVIGATE vs. CC groups using path analyses;
2) Predictors of treatment disengagement in NAVIGATE vs. CC groups using survival analysis; and
3) Concordance of parent vs. self/clinician-report on patient’s occupational functioning.
Analyses have been completed and the manuscript is currently in process.
Completed Projects
Neighborhood Socioeconomic Status and Racial Disparities in Schizophrenia: An Exploration of Domains of Functioning.
Black Americans are diagnosed with schizophrenia at a disproportionally higher rate than White counterparts, and experience worse outcomes due to schizophrenia. This project examined psychological pathways that impact the cognitive, social, and everyday living outcomes for Black Americans with schizophrenia. Five specific domains of functioning were examined: 1) neurocognition, 2) social cognition, 3) social skills, 4) everyday living skills, and 5) community functioning. Black individuals with schizophrenia had lower functioning in neurocognition, social cognition, and everyday living skills than White individuals with schizophrenia. Differences in neighborhood socioeconomic status explained a portion of relationship between race and neurocognition, but did not mediate the relationship between race and social cognition or race and everyday living skills. Additional research examining the nuances and variables present in the relationship between race, socioeconomic status, and schizophrenia outcomes is needed in order to understand how to improve outcomes for Black Americans with schizophrenia.
Published Manuscript: Nagendra A, Halverson TF, Pinkham AE, Harvey PD, Jarskog LF, de Mamani AW, Penn DL. (2020). Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning. Schizophrenia Research, 224, 95-101. https://doi.org/10.1016/j.schres.2020.09.020
For Homeless People with Serious Mental Illness, Can a State Transitional Shelter Promote Racial Equity in Housing Outcomes?
There is little research examining the variables impacting duration of homelessness and exit from homelessness, especially for people with serious mental illness. This retrospective chart review sought to understand the effect of race, sex, arrest history, and psychiatric diagnoses on duration of shelter tenure and housing outcomes for individuals residing in Massachusetts transitional homeless shelters. While there is a disproportionality high number of Black Americans represented at homeless shelters, this study found that race did not impact the length of stay at transitional shelters, nor did it impact people’s ability to secure housing after leaving the shelters. History of arrest, diagnosis of a psychotic disorder, and diagnosis of a substance use disorder were predictive factors for people to have worse outcomes after leaving homeless shelters. Further research examining clinical and structural variables, as well as populations in other states, will be invaluable in creating informed interventions and training service providers to increase positive outcomes for people staying at homeless shelters.
Published Manuscript: Schnitzer K, Cather C, Potter K, Kaba H, Marsden J, Hoffman D, Shtasel D. (2021). For homeless people with serious mental illness, can a state transitional shelter promote racial equity in housing outcomes? J Health Care Poor Underserved. 2021;32(1):232-244. https://doi.org/10.1353/hpu.2021.0021
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