March 2009: This Month's Highlights

This issue includes eight studies that looked at depression from a variety of perspectives: prevalence, screening and treatment, public attitudes, depression and comorbid pain, and the effects of depression on parenting and substance use. Ramin Mojtabai, M.D., Ph.D., analyzed two years of data from the U.S. National Survey on Drug Use and Health and found that although rates of treatment seeking have increased, many persons with major depression continue to go without needed care ( page 297 ). An examination of depression data from the 1996 and 2006 General Social Survey by Kate H. Blumner, M.D., M.P.H., and Steven C. Marcus, Ph.D., showed that significantly more Americans now believe that depression has a biological cause and that treatment should have a biological focus, although many continue to endorse nonbiological causes such as "bad character" ( page 306 ). Patrick J. Raue, Ph.D., and colleagues sought to determine whether patients who received their preferred treatment for depression—either medication or psychotherapy—were more adherent and had better outcomes ( page 337 ). Bruce A. Arnow, Ph.D., and colleagues calculated the costs of general medical and psychiatric care for more than 5,800 Kaiser Permanente patients. Among the patients with major depressive disorder, costs for those with disabling chronic pain were 25% higher than costs for those with nondisabling chronic pain and 37% higher than costs for patients with major depressive disorder and no chronic pain ( page 344 ). Finally, Gaëlle Encrenaz, Ph.D., and coauthors report findings from a large population-based study of mental health in France. Among adults who met criteria for depression, 13% of men and 5% of women reported that they used substances as a way of dealing with symptoms ( page 351 ).

Three of the depression studies focused on women. Nancy K. Grote, Ph.D., and colleagues found that brief interpersonal psychotherapy that was adapted for low-income, pregnant women lessened their depressive symptoms and improved functioning up to six months postpartum ( page 313 ). In a related Taking Issue commentary, Jeanne Miranda, Ph.D., and coauthors note that there is a growing literature showing the robustness of depression treatments for diverse groups when consideration is given to making treatment accessible and acceptable ( page 283 ). Kimberly A. Yonkers, M.D., and coauthors report that a universal depression screening initiative linked to a Healthy Start program had no effect on depressive symptoms or receipt of treatment among pregnant and postpartum women and may even have decreased treatment referrals ( page 322 ). A study of mothers and their young children by Anne W. Riley, Ph.D., and colleagues underlines the importance of providing depression treatment to perinatal women. The authors found that children of mothers with major depression had significantly more emotional, behavioral, and functional problems than children of mothers who were not depressed. Poor parenting appeared to be the mechanism that linked maternal depression to these child outcomes ( page 329 ).

The President's New Freedom Commission recommended that consumers play an active role in policy reform. Many states have responded by developing statewide consumer networks (SCNs). In the State Mental Health Policy column, LaVerne D. Miller and Latrease R. Moore, M.A., describe SCNs in five states. An SCN is a group of consumers and family members, advocacy groups, and other organizations that supports states in policy development and quality assurance activities. Participation in SCNs helps consumers to develop leadership and business management skills and to play leading roles in ensuring that services are recovery oriented. Some SCNs are not-for-profit organizations that serve as fiscal pass-throughs for state funding, which the SCNs oversee via contractual arrangements. Other SCNs have less formal models and focus on advocacy and member support. The authors encourage states without SCNs that wish to achieve transformation goals to take advantage of assistance from states with SCNs ( page 291 ). This article is the 13th in a series of reports addressing the goals that were established by the President's Commission. The series is supported by a contract with the Substance Abuse and Mental Health Services Administration.

• Are depressed patients who have suicidal tendencies at heightened risk of suicide as they begin to recover and their energy returns? Authors of two Open Forum pieces examine this question ( page 384 ).

• A decisional framework is presented for evaluating the level of risk that research studies pose to participants who have mental illness ( page 374 ).