This Month's Highlights

In the Economic Grand Rounds column, Martin Fleishman, M.D., Ph.D., discusses issues in "psychopharmacosocioeconomics," or societal changes that have occurred in relation to the development of psychotropic medications. He focuses in particular on atypical antipsychotics and argues that macroeconomic justifications for the high prices of these drugs have blinded many to the consequences for consumers, many of whom are "locked into a social class that is dependent on government subsidies" to pay for the medications that allow them to remain in the community. Dr. Fleishman also discusses factors that have led to the greater complexity—and higher costs—of medication regimens for some patients. He describes regimens for two of his patients who were recently discharged from short-term hospitalizations to board-and-care homes. Monthly medication costs for each patient exceed $1,000 (see page 1532).

In this issue of Psychiatric Services, a special section focuses on disparities in mental health care for U.S. Latino populations. In the first of four papers, Margarita Alegría, Ph.D., and her colleagues report the results of a study that found a significantly lower rate of access to specialty mental health care among poor Latinos. The authors point out that the results of their analyses, which examined a wide array of variables, suggest that ethnicity and race are part of a more complex socioeconomic construct that must be taken into account in efforts to address inequalities in access to care (see page 1547). In the second study, Richard L. Hough, Ph.D., and his associates examined data from a stratified random sample of more than 1,100 high-risk adolescents who were receiving public-sector care. They found that Latinos were significantly less likely than whites to use specialty mental health care regardless of diagnosis, gender, and age (see page 1556). The third article, by Sergio A. Aguilar-Gaxiola, M.D., Ph.D., and his colleagues, describes a community-driven, consumer-oriented initiative that sought to translate the results of epidemiologic and clinical research into specific actions to address the mental health needs of Mexican Americans in Fresno County, California (see page 1563). In the fourth article, Steven Regeser López, Ph.D., who is also the editor of the special section, discusses ways in which researchers can increase the applicability of their findings to the improvement of care for Latinos (see page 1569).

In the Clinical Computing column, Joshua Freedman, M.D., the column's editor, wonders why computer-based assessment and treatment applications have not swept into clinical use even though studies published in top-tier psychiatric journals have provided abundant evidence of their effectiveness for some patients and in some areas of practice. He addresses this question by examining the wider topic of factors that influence the diffusion of innovations among particular groups—such as the beliefs and perceptions that prevented rural Peruvians from boiling their drinking water to prevent typhus despite a two-year effort to persuade them to do so. He describes aspects of psychiatry and psychiatrists that may blunt consideration of scientific evidence and acceptance of innovations (see page 1539).

Annual suicide attempts among 15-to-24-year olds in the United States exceed one million. Although some youths require the security of hospitalization, the associated stresses and stigma can disrupt the lives of adolescents and their families. In this issue, Brian Greenfield, M.D., and his colleagues describe a study in which nearly 300 suicidal adolescents who came to a pediatric emergency department in Montreal were assigned to a rapid-response outpatient team or to a control group that received usual care. The team focused on immediate assessment of the patient and his or her family and on outpatient interventions designed to reduce maladaptive behaviors and improve family functioning. At baseline and at two- and six-month follow-up, the hospitalization rate among youths treated by the rapid-response team was much lower even though the level of suicidality was similar for both groups throughout the follow-up period (see page 1574).

• A training video designed to increase clinicians' attention to cultural factors that play a role in assessment and treatment is discussed in the Multimedia Reviews column (see page 1537).

• An examination of behavioral health claims data from 211 employer groups suggests an association between higher copayments and recurrence of substance abuse treatment (see page 1605).

• A review of 22 studies of partial or total smoking bans in treatment settings found little evidence of negative behavioral consequences among patients (see page 1617).