January 2011: This Month's Highlights

Five articles this month examine issues related to the mental health of veterans—in particular, veterans of Iraq and Afghanistan. In the first article, Gerald E. Larson, Ph.D., and colleagues report on diagnoses given to 1,078 American military personnel who sought services at a mental health clinic in an Iraqi war zone. The most frequent diagnoses were anxiety (24%), adjustment (23%), and mood (19%) disorders. Military medical records indicated that 29% of the 1,078 personnel had received a psychiatric diagnosis before they deployed. Because more than half of these diagnoses were received in the nine months before deployment, the authors suggest that a time-based algorithm for deployability may be advisable (page 15). There are growing concerns that returning veterans with posttraumatic stress disorder (PTSD) are not engaging in needed treatment. Ilan Harpaz-Rotem, Ph.D., and Robert A. Rosenheck, M.D., analyzed data for more than 204,000 veterans who received a new PTSD diagnosis between 2004 and 2007 to determine whether Iraq and Afghanistan veterans are being retained in PTSD treatment at the same rate as veterans from other service eras (page 22). The third article reports on a sample of more than 300 returning National Guard members and their significant others who were surveyed about mental health symptoms and service use. Lisa A. Gorman, Ph.D., and colleagues found that 40% of the Guard members and 34% of their significant others met screening criteria for one or more mental health problems. Of this group, 53% reported seeking some kind of help. High on the list of barriers was a concern about service use appearing on military records (page 28). To examine the relationship between mental health and labor force status, Kara Zivin, Ph.D., and colleagues analyzed data from a national sample of users of Department of Veterans Affairs health care. Thirty-five percent were employed, 36% were disabled, 20% were retired, and 7% were unemployed. The study confirmed a strong negative relationship between having a mental disorder and being employed (page 35). In a sample of nearly 800 veterans who had returned from a combat deployment and who were referred by their primary care provider for a psychiatric evaluation, David A. Adler, M.D., and colleagues found that psychiatric symptoms contributed to a substantial loss in work productivity among employed individuals (page 39). The Taking Issue commentary, by Debra Lerner, M.S., Ph.D., and Dr. Adler, calls for new service approaches to ensure that adults with depression, including returning veterans, will be able to participate fully in the workforce (page 3).

Three studies this month analyzed data from the criminal justice system. A study by William H. Fisher, Ph.D., and colleagues identified more than 10,500 adults with severe and persistent mental illness who were arrested over nine years in Massachusetts. Compared with all arrestees over the period, those with mental illness had higher odds of being arrested in all eight offense categories examined, with odds ratios ranging from 1.8 for drug-related offenses to nearly 6.0 for assault and battery on a police officer (page 67). When discharge managers were placed in three Oklahoma state prisons in 2007, one of their tasks was to ensure that inmates with serious mental illness would be enrolled in Medicaid by their release date. Audra T. Wenzlow, Ph.D., and colleagues found that the program increased such enrollment from 8% to 25% (page 73). A Florida study by John Petrila, J.D., LL.M., and colleagues found that among all persons arrested in 2006, 9.5% were enrolled in Medicaid in the 12 months before arrest, and 5.5% were still enrolled at the time of arrest. Because Medicaid plays such a critical role in postrelease access to community services, this substantial loss in enrollment among arrestees has important policy implications, the authors note (page 93).

Three urban mental health centers implemented an electronic system to promote shared decision making, particularly in regard to incorporating consumers' priorities into treatment plans. An evaluation conducted by Emily M. Woltmann, M.S.W., Ph.D., and colleagues found that clients in the intervention group had significantly greater recall of their care plans than those in a control group (page 54). In an analysis of data from a survey of U.S. nursing homes, Xueya Cai, Ph.D., and colleagues found that residents with serious mental illness were significantly less likely to have medical advance directives (page 61).