In This Issue

Jeste et al. (CME, p. 188) were surprised to find that self-rated “successful aging” was more common in the oldest respondents to a survey of 1,006 community-dwelling adults ages 50 to 99. Greater age was associated with worse physical and cognitive functioning but also with higher levels of optimism and resilience and less depression. People with the poorest physical functioning who had high degrees of resilience had self-ratings of successful aging similar to those of physically healthy people with low resilience (figure). In an editorial, Grodstein (p. 143) advocates prospective research that could help establish causal relationships among subjective and objective responses to aging.

The low prevalence rates, 0.8% to 3.3%, for the new diagnosis of disruptive mood dysregulation disorder in three large community samples of children suggest that the diagnosis will not be extensively applied to children with normal behavior. Copeland et al. (p. 173) found that although the core symptoms are common, the criteria regarding frequency, duration, and context exclude most children. The diagnosis is associated with high levels of social impairment, school suspension, service use, and poverty. It frequently co-occurs with other psychiatric conditions, especially oppositional defiant disorder and depressive disorders, but Axelson notes in an editorial (p. 136) that disruptive mood dysregulation disorder overlapped only partially with severe mood dysregulation, the research diagnosis on which it was based.

Total spending for patients with bipolar disorder or major depression did not change significantly after the 2001 implementation of insurance parity for mental health and substance use disorders in the Federal Employees Health Benefits Program. For a less severe illness, adjustment disorder, overall spending and psychotherapy visits did decline, perhaps as a result of benefit management. Busch et al. (p. 180) report that out-of-pocket spending decreased for all three diagnoses. McCarty points out in an editorial (p. 140) that empirical evidence consistently finds little or no impact on costs related to the introduction of parity. Lower out-of-pocket costs protect patients’ financial stability but do not cause more individuals to enter care for severe mood disorder.