December 2004: This Month's Highlights

In this issue of Psychiatric Services we focus on mood disorders. Seven articles explore various aspects of depression treatment—costs; quality of care; special patient groups, such as adolescents; risk factors; and impact on quality of life and overall health.

Each year depression costs the United States about $26 billion in medical care and up to $51 billion in terms of lost productivity. Debra Lerner, Ph.D., M.S., and her colleagues compared a sample of 229 employees with dysthymia, depression, or both with groups of healthy individuals and patients with rheumatoid arthritis—a frequent source of work disability—in order to assess multiple outcomes that are relevant to both employees and employers, such as job retention, diminished productivity, absenteeism, and new unemployed status. The findings suggest that patients with depression experience substantial job upheaval (see page 1371).

Two articles in this issue examine the quality of care received by individuals who are in need of treatment for depression. In the first article, Jeffrey S. Harman, Ph.D., and his coauthors address the question of whether observed disparities in depression treatment—by age, race, or type of health insurance—are due to differences in rates of treatment initiation or to differences in quality of care once treatment has been initiated (see page 1379). In the second article, Susan H. Busch, Ph.D., and her colleagues compare the quality of pharmacotherapy for major depression across a sample of patients from the Department of Veterans Affairs and patients from the private sector. The authors note the importance of such comparisons to health systems management (see page 1386).

The important and timely topic of depression and bipolar disorder among youths is addressed in two articles. In the first article, Pamela B. Peele, Ph.D., and her coauthors note that teenagers with bipolar disorder face major health risks given the disorder's association with suicide attempts, substance abuse, and high-risk sexual behaviors. These authors conducted a study to compare the use of medical and behavioral health services between adolescents with and without bipolar disorder and to identify areas that require more clinical attention (see page 1392). In the second article, Eileen P. Ryan, D.O., and Richard E. Redding, J.D., Ph.D., review the current state of knowledge about the prevalence, diagnosis, and effective treatment of mood disorders among youths—in particular, juvenile offenders—as well as the unique problems that arise in the delivery of services to youths involved in the criminal justice system (see page 1397).

Finally, two articles discuss how depression and other mental illnesses affect—and are affected by—various quality-of-life and risk variables. Tara W. Strine, M.P.H., and her colleagues note that emotional states influence a person's assessment of his or her ability to adopt and maintain health-enhancing behaviors and therefore influence vulnerability to illness. These authors used nationally representative data from the Behavioral Risk Factor Surveillance System to examine health-related quality of life and behaviors among noninstitutionalized individuals who reported a primary mental health impairment compared with those who reported a primary physical health impairment and those who reported no impairment (see page 1408). In another article, Menahem I. Krakowski, M.D., Ph.D., and Pal Czobor, Ph.D., studied a sample of psychiatric inpatients to assess relationships between suicide attempts and other violent behaviors and various psychosocial problems, such as history of head trauma, harsh parental discipline, parental psychopathology, truancy, and foster home placement (see page 1414).

The Patient Safety Forum, an occasional feature of Psychiatric Services, returns this month to answer the question, Should psychologists have prescribing authority? Five essays present the opinions of two psychologists—Deanna F. Yates, Ph.D., and Jack G. Wiggins, Ph.D.—and three psychiatrists—Jeremy A. Lazarus, M.D., James H. Scully, Jr., M.D., and Michelle Riba, M.D. (see page 1420).

•An expanded books section reviews novels that may be of interest to mental health professionals over the holidays (see page 1446).