January 2004: This Month's Highlights

Depression can have an enormous impact on a person's ability to work. Lynn Elinson, Ph.D., and her colleagues conducted a study to identify factors associated with employment among persons with depression. Using data from the 1994 and 1995 National Health Interview Survey Disability Supplement, they compared sociodemographic, health, functional, and disability variables among working and nonworking persons with depression. About half of the individuals in the sample who reported having major depression were in the workforce. Those who worked tended to be younger, to be male, to be better educated, to have a higher income, to live alone or with a nonrelative, and to live in an urban or suburban location. The depressed individuals who worked also tended to be healthier and less impaired by social, cognitive, and physical limitations than those who did not work. Among the authors' conclusions is that it may be important for policy makers, employers, and clinicians to focus on individuals with both depression and general medical conditions (see page 29).

It has been suggested that second-generation antipsychotics may enhance the rehabilitation of persons with schizophrenia. Gary R. Bond, Ph.D., and his coauthors tested the hypothesis that clients receiving second-generation antipsychotics would use vocational rehabilitation services more effectively than those receiving first-generation agents and thus would have better employment outcomes. In a sample of 90 unemployed persons with schizophrenia who were starting a vocational rehabilitation program and who were followed up for nine months, those receiving olanzapine or risperidone had a significantly higher monthly rate of participation in vocational training than those who received first-generation agents. However, the clients who received second-generation antipsychotics did not differ significantly from those who received first-generation agents in work outcomes, such as obtaining competitive employment. Although the study hypothesis was not upheld, the authors conclude that second-generation antipsychotics appear to be associated with greater participation in vocational rehabilitation programs (see page 59).

Although recent changes in federal regulations governing methadone clinics, along with office-based treatment, have helped reduce the stigma associated with opioid addiction, current diagnostic schemes can encourage a bias against patients with opioid dependence who are receiving effective treatment. In an Open Forum piece in this issue, Christopher J. Welsh, M.D., and his coauthors examine the role of DSM and ICD in the continued stigmatization of such patients. They note that the current diagnostic standards may send a message that opioid dependence is different from other types of substance dependence and from other psychiatric and medical disorders. For example, the fact that a patient who is receiving agonist therapy is doing well cannot be documented as "in sustained full remission" as it can be with any other form of substance dependence. The authors call for a rethinking of the unique position that opioid dependence appears to hold in current diagnostic schemes (see page 86).

Police officers often encounter persons with mental illness, in a variety of situations. Amy C. Watson, Ph.D., and associates conducted a study to examine how police officers' perceptions, attitudes, and responses are influenced by the knowledge that a person has a mental illness. In a sample of 382 officers who were randomly given one of eight vignettes about persons with or without schizophrenia in various roles, these researchers found significant main effects of the schizophrenia label and of whether the individual described was a person in need of assistance, a victim, a witness, or a suspect. The officers viewed persons with schizophrenia as being less responsible for their situation, more worthy of help, and more dangerous than persons for whom no information about mental illness was provided. Among the authors' recommendations is that training aimed at recognizing mental illness, coupled with effective communication and deescalation strategies, should be used to help police officers successfully resolve situations involving mentally ill individuals in crisis (see page 49).

• A report on the American Psychiatric Association's 2003 Institute on Psychiatric Services highlights topics of relevance to public-sector psychiatrists (see page 11).

• The Law & Psychiatry column examines the potential for persons with mental illness to make false confessions during police interrogations (see page 19).