This Month's Highlights

In May 1996 the Center for Mental Health Research on AIDS convened a national conference of experts to review existing research and design a research agenda on the impact of AIDS on persons with severe mental illness. In response to recommendations stemming from the conference, the Five-Site Health and Risk Study Research Committee conducted a study to gather information on the epidemiology of HIV, hepatitis B, hepatitis C, and other blood-borne infections in relatively large samples of persons with severe mental illness in Connecticut, Maryland, New Hampshire, and North Carolina. In a special section of six articles in this issue of Psychiatric Services, guest editor Stanley D. Rosenberg, Ph.D., and other members of the research committee present the results of this multisite study, covering prevalence rates of blood-borne infections among persons with severe mental illness, sexual and drug-related risk factors, gender differences in prevalence and risk, and access to medical care among at-risk individuals. The implications of the committee's findings for the care of this patient population and for public health policy are also discussed (see page 827).

Primary care physicians play a vital role in providing psychiatric services to depressed patients by either treatment or referral. Using national data, JianLi Wang, M.D., Ph.D., and colleagues investigated rates of mental health treatment among 608 Canadian patients who reported both a major depressive episode and a visit to a primary care physician in the past year. Only 40 percent of the patients received any treatment for their depression. The treatment rate was higher—a rate of 65 percent—among the patients who said that they visited a primary care physician specifically for a mental health problem, but only one in five of the 608 patients did so. Among the patients who received any treatment, only a quarter were referred to a psychiatrist or a psychologist. Severity of depression was related to receipt of treatment but not to referral to specialty care. The results highlight the important role played by primary care physicians in detecting and treating depression. The authors emphasize the need to reduce stigma in order to increase treatment rates (see page 878).

The past few decades have seen dramatic changes in psychiatry. In this month's issue, Herbert Pardes, M.D., reflects on psychiatry's journey over the past 40 years, highlighting the remarkable advances that have been made. In an Open Forum piece—originally presented as the Adolf Meyer Award Lecture at last year's Institute on Psychiatric Services in Chicago—Dr. Pardes provides examples of cutting-edge research in psychiatry and notes the availability of a wide range of research tools that were nonexistent 40 years ago. He draws on psychiatry's past and present achievements to provide insight on the direction the field is taking and on what psychiatrists must do to continue to maximize their effectiveness. He urges psychiatrists to take pride in the value of their work to society—in their ability to really help people—and to continue on the trajectory of progress (see page 896).

As the proportion of adults over 65 increases, the rate of dementia—with its overwhelming impact on patients and caregivers—is increasing as well, and respite care can be essential to caregivers. In this issue, Kye Y. Kim, M.D., and Susan B. Hall, M.S.W., review respite care literature and describe the respite program at their Veterans Affairs medical center. Studies show that functioning deteriorates for many patients during and after respite stays. Caregivers may experience only a temporary relief from their burden—or none at all because of worry about the absent patient. The authors' medical center provides an inpatient respite service that emphasizes extensive information gathering before admission so that caregivers can experience true respite. The program also includes a comprehensive evaluation during the stay and follow-up monitoring after discharge (see page 821).

• In Multimedia Reviews, a psychiatrist who advises filmmakers examines clinical accuracy in recent films (see page 807).

• A study reported in Economic Grand Rounds examines whether Fortune magazine's top 100 revenue-producing companies offer more generous mental health coverage than other employers (see page 815).

• Radioimmunoassay of hair samples appears to be a promising method of detecting illicit substance abuse (see page 891).