May 2007: This Month's Highlights

Despite the intense media focus on children's mental health problems and medications to treat them, there is a lack of empirical evidence about public perceptions of child and adolescent disorders and their treatment. A special section of four reports presents data to close this knowledge gap. The research team, led by Bernice A. Pescosolido, Ph.D., a sociologist at Indiana University, analyzed data from the National Stigma Study-Children (NSS-C), the first large-scale nationally representative survey about public knowledge, attitudes, and beliefs in regard to children's mental health. The 2002 survey involved 1,393 adults interviewed as part of the General Social Survey (GSS), the longest-running monitor of American opinions. Overall, the NSS-C findings suggest that pervasive stigmatizing beliefs and attitudes may prevent children from receiving effective treatments. For example, nearly half the respondents believed that rejection at school is a likely consequence of getting treatment and that stigma associated with childhood treatment will have negative ramifications into adulthood. Negative attitudes toward medications predominated. Most respondents felt that doctors overmedicate children and that giving children medications "only delays dealing with their real problems." The media focus on attention-deficit hyperactivity disorder (ADHD) has raised awareness but appears to have been less successful in educating the public. Two-thirds of respondents said that they had heard of ADHD, but less than half were able to provide an answer that indicated specific knowledge about the disorder ( page 611–635 ).

Two other studies reported in this issue take a closer look at Americans' stigmatizing beliefs about mental disorders and their treatment. In a qualitative study that sought to understand pathways to treatment for childhood ADHD, Susan dosReis, Ph.D., and colleagues conducted interviews with parents of 26 children ages six to 18 years who were given a diagnosis of ADHD in the past month. Twenty-five of the children were African American. Four distinct patterns emerged in the process of parents' coming to terms with their child's ADHD and the need for care. Stigmatizing beliefs about the disorder and its treatment were evident in parents' acceptance of the diagnosis ( page 636 ). In another study Ramin Mojtabai, M.D., Ph.D., compared data from 5,388 participants in the National Comorbidity Survey (NCS) in 1990–1992 and 4,319 in the NCS Replication in 2001–2003 to examine recent trends in Americans' attitudes toward treatment seeking. Findings indicated that Americans' perceived stigma has lessened, although improvements in attitudes were modest. In the recent survey, respondents reported being more willing to seek professional help, more comfortable talking with a professional about personal problems, and less likely to be embarrassed if others found out about their seeking help. Attitudes of younger participants improved more than those of middle-aged participants ( page 642 ).

Two studies in this issue analyzed data from Canadian population surveys to better understand disability in the workplace. Carolyn S. Dewa, Ph.D., M.P.H., and colleagues examined how chronic work stress, psychiatric disorders, and chronic physical conditions contribute—alone and in combination—to the ability to work among more than 22,000 working respondents in the Canadian Community Health Survey 1.2. Nearly a third (31%) experienced chronic work stress, either alone or in combination with one or both of the other conditions. Nearly half (46%) reported at least one chronic physical condition, alone or in combination. Eleven percent had a psychiatric disorder. Disability increased with an increasing number of combined conditions (see page 652 ). In another analysis of data from the same Canadian survey, Nady el-Guebaly, M.D., and colleagues found significant levels of absence from work in the preceding week among respondent subgroups with mood, anxiety, and substance use disorders ( page 659 ).

Findings from two studies illustrate the impact of co-occurring disorders on health and well-being. In a longitudinal, community-based investigation, Melnee D. McPherson, M.S.W., Ph.D., and associates interviewed 324 mothers with severe mental illness at baseline and 20 months later. The prevalence rate of intimate partner violence was 19%, and it was highest among those who had a comorbid substance use disorder ( page 675 ). In a study of 295 patients with HIV infection and severe mental illness in New York and Los Angeles, Allen M. Fremont, M.D., Ph.D., and colleagues found that participants had more difficulty obtaining care than 1,294 HIV-infected patients without mental illness ( page 681 ).