This Month's Highlights

Many veterans who need mental health care do not receive it, and a great deal of research has elucidated treatment barriers for this population. Another approach to closing the treatment gap is to identify factors that motivate the veterans who do seek care or that characterize these veterans—an approach taken by three studies in this issue. Authors of the lead article, Alejandro Interian, Ph.D., and colleagues, hypothesized that readjustment stressors, which are often experienced by soldiers who return from combat to resume responsibilities of family, marriage, and employment, would play a role in treatment seeking, especially among veterans with posttraumatic stress disorder (PTSD). The authors surveyed a sample of National Guard soldiers with PTSD three months after they returned from Iraq. Nearly three-quarters reported readjustment stressors. Among older soldiers who had family and occupational responsibilities, these stressors were strong motivators to seek PTSD treatment, even stronger than their symptoms of PTSD and depression (page 855). In the second study, Elizabeth Brooks, Ph.D., and colleagues analyzed national data for more than 400,000 veterans with PTSD and found that those in rural areas used significantly less care than urban-dwelling veterans and that veterans from the current service era (Iraq and Afghanistan) used less care than those from earlier eras, even if they lived in urban areas where care was readily available (page 862). In a third study, Kristin Naragon-Gainey, Ph.D., and colleagues explored the role played by symptoms of distress (PTSD, depression, panic, and pain) and by high-risk behaviors (alcohol misuse and aggression) in treatment seeking among Iraq and Afghanistan veterans. The investigators found that these symptoms and behaviors were differentially associated with treatment seeking in five settings and that veterans appeared to be overutilizing emergency care (page 942).

Among African Americans seeking mental health care, a striking and consistent disparity is the higher rate at which they receive a diagnosis of schizophrenia. A research team led by Shaun M. Eack, Ph.D., reanalyzed data from the MacArthur Study in which more than 700 African-American and white inpatients underwent in-depth assessments. The African-American patients were more than three times as likely as the white patients to receive a schizophrenia diagnosis. The diagnosing clinicians were asked, “Did the patient appear to be responding honestly?” Eack and colleagues' analyses indicated that the steep disparity in schizophrenia diagnosis was strongly related to whether the interviewer perceived the patient to be honest and trustworthy during their interaction (page 875).

Dialectical behavior therapy (DBT), an empirically supported treatment for people with borderline personality disorder, was developed specifically for outpatients. To what extent has it been adapted for inpatient settings, and with what outcomes? To answer these questions, Jill Myerow Bloom, M.A., and colleagues conducted a literature review and found 11 studies that addressed implementation of DBT in an inpatient setting for patients with borderline personality disorder. Many variations of standard DBT have been used in inpatient settings, including approaches that include group therapy only and that vary in treatment duration from two weeks to three months. Most studies reported reductions in suicidal ideation, self-injurious behaviors, and symptoms of depression and anxiety, whereas results for reducing anger and violent behaviors were mixed (page 881).