April 2004: This Month's Highlights

The use of antidepressants to treat depression among pediatric patients is controversial. In a study reported in this month's issue, Thomas Delate, Ph.D., and his colleagues used nationwide data to estimate the prevalence of use of prescription antidepressants among children and adolescents and examined trends in use from 1998 to 2002. They found that the overall prevalence of use in this population increased from 1.6 percent in 1998 to 2.4 percent in 2002, for an adjusted annual increase of 9.2 percent, and that the growth in overall prevalence was greater among girls than among boys. Among the authors' conclusions was that the growth in the prevalence of antidepressant use among youths appears to be continuing and is similar to that reported for the late 1980s to mid-1990s (see page 387).

Despite strong empirical support for the role of supported employment in helping adults with severe mental illness obtain and keep jobs, access to such programs is limited and funding insufficient, partly because of a perception that supported employment services are too expensive. Eric A. Latimer, Ph.D., and his coauthors used data from supported employment programs in seven states to assess program fidelity and obtain information about program costs, service use, and staffing. They noted a wide variation in annual direct costs per client served, ranging from $860 in New Hampshire to $2,723 in Oregon. They also estimated an average cost per full-year-equivalent client of $2,449 per year, assuming a typical caseload of about 18 clients. The authors are hopeful that their cost estimates will be useful to service providers contemplating the development of supported employment services and to state governments or other insurers who seek to set appropriate reimbursement levels for these services (see page 401).

When young adults are placed in unstructured settings in the New York City adult residential system for persons with mental illness, they must live with an older adult who is already in the system. "What would be completely unacceptable on a college campus, having persons aged 18 and 19 years room with persons aged 40 and 45 years, is accepted practice in the mental health system," writes Robert J. Giugliano, Ph.D., in an Open Forum piece. He describes a system that appears to be blind to young adults' needs for structured residential settings with appropriate levels of supportive programming to help them make the transition to adulthood (see page 451). In an accompanying Taking Issue piece, Bert Pepper, M.D., who was among the first clinicians to identify the special needs of "the young adult chronic patient," presents sobering statistics suggesting that little has changed (see page 343).

Despite the existence of effective and relatively cost-effective depression treatments, many depressed patients do not receive appropriate care. To evaluate the market for effective depression care, Michael Schoenbaum, Ph.D., and his colleagues interviewed representatives from large employers, medical and behavioral health insurance carriers, and primary and behavioral health care providers. Respondents were asked to assess barriers to and opportunities for increasing the rates of depression treatment. Dr. Schoenbaum and colleagues found that there is currently little demand among purchasers for improving depression care and that there is little interest among insurers and providers in improving care in the absence of purchaser demand. Even stakeholders who identified depression as an important problem could not agree about who should be responsible for addressing the problem. The researchers concluded that it will be difficult to increase rates of effective depression care without an increase in the demand for such care (see page 392).

• A study of the effects of establishing a multidisciplinary mental health primary care team in a Department of Veterans Affairs internal medical clinical suggests that such a team can dramatically improve patient care (see page 442).

• The books section opens with a review of three volumes about posttraumatic stress disorder (see page 456).

• A brief report describes the unique treatment needs of psychiatric inpatients who are deaf (see page 439).

• The Law & Psychiatry column discusses the reentry of offenders with mental illness into the community (see page 373).