This Month’s Highlights

Because there is no evidence to date that any screening test accurately identifies people in the general population who are at risk of suicide, the U.S. Preventive Services Task Force and others do not recommend such screening. However, clinicians frequently encounter patients who report suicidal ideation on routinely administered questionnaires. For example, item 9 of the Patient Health Questionnaire for depression (PHQ-9) asks patients about whether and how often they have “thoughts that you would be better off dead, or of hurting yourself in some way.” A research team led by Gregory E. Simon, M.D., M.P.H., investigated whether responses to item 9 predicted a subsequent suicide attempt or suicide death. The team used electronic medical records, insurance claims, and death certificate data to document what happened to more than 84,000 outpatients age 13 and older who completed the PHQ-9 between 2007 and 2011. At Seattle’s Group Health Cooperative, where the study was conducted, patients complete the PHQ-9 at every visit for depression treatment. Even after the analyses adjusted for age, sex, treatment history, and overall depression severity, responses to item 9 of the PHQ-9 remained a strong predictor of suicide attempt (page 1195).

Recent research runs counter to the long-held belief that serious mental illnesses are chronic and deteriorating disorders. Significant proportions of people with these illnesses improve greatly or recover completely. Are there clear-cut longitudinal patterns of recovery, and if so, what factors distinguish these trajectories? Carla A. Green, Ph.D., M.P.H., and her colleagues investigated these questions by looking at two-year recovery patterns for 177 people with serious mental illnesses in an integrated health plan. Using factor analyses of data from in-depth interviews and other sources, they identified four trajectories—two stable (high and low levels of recovery) and two fluctuating (higher and lower). Further analytical approaches allowed them to detect distinctive markers for the trajectories, such as differences in psychiatric symptoms, general medical health, satisfaction with services, and service use. The authors concluded that having access to good-quality mental health care, which entails an array of services and supports, appears to improve recovery trajectories (page 1203). Another article in this month’s issue by Dr. Green and colleagues describes the development and evaluation of a promising low-cost, strengths-based group intervention led jointly by peer counselors and professional counselors to foster recovery among adults with serious mental illnesses (page 1211).

Three studies in this issue examine factors that predict hospitalization, an expensive treatment alternative that accounts for as much as 80% of the cost of mental health care. In a study of Florida Medicaid beneficiaries with schizophrenia who had an inpatient admission between 2004 and 2008 and were receiving an antipsychotic at discharge, Timothy L. Boaz, Ph.D., and colleagues found that nearly a quarter (23%) were back in the hospital within 30 days. Those at the highest risk had shorter hospital stays and appeared not to have been stabilized on the medication (page 1225). In another study, Mark A. Turner, Ph.D., and others identified predictors of hospitalization after treatment for first-episode psychosis. About a third of the sample was hospitalized in the two years after discharge from the early intervention program. The authors concluded that such programs should address cultural appropriateness of treatments and engage partners and families (page 1230). In a study of more than 10,000 patients with schizophrenia who had frequent hospital admissions, Shiau-Shian Huang, M.D., and colleagues sought to determine whether rehospitalization rates varied by whether the patients were receiving oral or long-acting injectable antipsychotics (page 1259).

Decisions about whether to disclose a history of mental illness, and to whom, are difficult—and the decision seems particularly fraught for providers of mental health care. In this month’s Personal Accounts column, Amy C. Watson, Ph.D., movingly describes her struggle—not only as an adolescent facing a severe eating disorder but also as an adult mental health professional thinking about whether to risk disclosing her history to colleagues (page 1193). In the Taking Issue commentary, Psychiatric Services’ editor, Howard H. Goldman, M.D., Ph.D., describes initially reading Dr. Watson’s submission and discovering much to his surprise that he is a featured character in her account (page 1183). At about the same time, the journal received a letter about “prosumers”—mental health professionals who have experienced mental illness—from Harriet P. Lefley, Ph.D., who praises them for their “enormous courage in overcoming deficits and turning them into strengths” (page 1278).