June 2008: This Month's Highlights

The eight articles in this month's issue were selected to highlight the robust connection between epidemiology and services research. Epidemiology, the older and more basic science, underlies and informs the more recent areas of health services research and health policy research. The eight studies use epidemiological methods or analyze trend data with the objective of improving systems and services. The first two articles focus on trauma in two populations. Kim T. Mueser, Ph.D., and Jonas Taub, M.A., examined the prevalence and correlates of posttraumatic stress disorder (PTSD) among adolescents with severe emotional disorders who were involved in multiple service systems. They found that more than a fourth (28%) had current PTSD, which was underdiagnosed in medical records, and that adolescents in this group were more likely to have serious emotional and behavioral problems. The authors recommend routine screening for trauma and PTSD among adolescents receiving mental health services ( page 627 ). In the second article, Rachel Kimerling, Ph.D., and colleagues report on the use of a standard epidemiological tool—universal screening—to identify veterans who had sustained sexual trauma during active military duty. The study is the first to evaluate the Veterans Health Administration's national screening efforts in this area. The authors examined data for nearly 574,000 veterans screened for military-related sexual trauma in 2005 and found significantly increased rates of use of mental health treatment after screening, an indication that the screening program is effective ( page 635 ).

In the third and fourth articles in this month's issue, investigators report on their use of community survey and hospitalization data to determine the prevalence of psychiatric illnesses and their impact in diverse populations—New York City adults and hospitalized immigrants in Illinois. In 2004 the New York City Department of Mental Health and Hygiene conducted the New York City Health and Nutrition Examination Survey (NYC-HANES), the first comprehensive community-level health survey. Modeled after the national HANES, the NYC-HANES sought to determine the prevalence of major depressive disorder and generalized anxiety disorder so that the department could better target efforts to detect and treat mental illness in the city's diverse population, including its many immigrants. R. Charon Gwynn, Ph.D., and colleagues report that the NYC-HANES data yielded current prevalence rates of 8% for major depressive disorder and 4% for generalized anxiety disorder. Only 38% of respondents with these diagnoses were in treatment. Immigrants with depression were significantly less likely to have received a diagnosis (page 641). In an analysis of ten years of data from Illinois public hospitals, Lawrence Appleby, Ph.D., J.D., and colleagues found that the proportion of foreign-born individuals in the hospitalized population rose from 7.3% in 1993 to 13.1% in 2003. Although the proportion of foreign-born hospital admissions for the various immigrant groups was lower than the percentage in the Illinois population, the gap is narrowing. The authors urge public hospitals to prepare for these changing populations ( page 648 ).

A central recommendation of the President's New Freedom Commission on Mental Health is for a fundamental shift toward systems and services that are driven by the needs and preferences of consumers. Two columns focus on treatment models designed to ensure consumer participation. In the Economic Grand Rounds column, Judith A. Cook, Ph.D., and colleagues describe a self-directed care program in Florida for persons with mental illness. The program allots funds directly to consumers to purchase services, and program staff offer them assistance in securing goods and services to support their recovery. An evaluation of one-year outcomes for 106 participants showed significantly less time spent in psychiatric inpatient and criminal justice settings and better functioning ( page 600 ). In the Best Practices column, Patricia E. Deegan, Ph.D., and coauthors describe how the waiting area in an urban psychiatric medication clinic was transformed into a peer-run Decision Support Center that featured touch-screen computers and software to help consumers think about their current symptoms and the role of medications in recovery. The one-page computer-generated report helped them in making shared decisions about medications in the subsequent meeting with their physician ( page 603 ).

• A chance meeting between a psychiatrist and his former patient 35 years after the end of their psychotherapy evoked many memories for both, which they discuss in the Personal Accounts column ( page 609 ).