Psychiatr Serv 58:299, March 2007
doi: 10.1176/appi.ps.58.3.299
© 2007 American Psychiatric Association
March 2007: This Month's Highlights
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Two Studies of Employment Outcomes
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The critical role of gainful employment in community integration of individuals with serious mental illness has received renewed attention since publication of the President's New Freedom Commission's report in 2003. Two studies in this month's issue examine factors related to employment in this population. David S. Salkever, Ph.D., and colleagues examined data from the U.S. Schizophrenia Care and Assessment Program (US-SCAP), a naturalistic study of more than 2,300 participants randomly selected from organized care systems in six U.S. regions. Data on employment were gathered at more than 7,000 assessments over three years. The overall employment rate in nonsheltered jobs was 17.2%. Rates of attaining a recovery threshold of employment—defined as 40 hours of work per month—were even lower at 9.7%. The mean monthly wage among those who worked was $494 (page 315). The second study examined outcomes of a supported employment program implemented at nine Veterans Affairs (VA) medical centers for homeless veterans with mental disorders, substance use disorders, or both. Robert A. Rosenheck, M.D., and Alvin S. Mares, Ph.D., found that over two years program participants showed better work outcomes than veterans in a comparison group. Days competitively employed per month were 15% higher (8.4 days compared with 7.3 days), and average annualized employment income was about $1,300 higher ($8,889 compared with $7,590) (page 325). In a commentary on the VA study, Gary R. Bond, Ph.D., warns that accepting marginal improvements is setting the bar too low and notes that we can do better (page 334).
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Assessing Treatment Need
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Epidemiologic studies estimate the prevalence of mental disorders in the population. However, prevalence estimates are not an ideal proxy for treatment need. Need for treatment is not simply a function of diagnosis. In a study reported by Erick Messias, M.D., Ph.D., and colleagues, population estimates of need for treatment were based on direct assessments by psychiatrists of treatment need in a subsample of 816 participants in the original Epidemiologic Catchment Area study in Baltimore who were followed up more than 12 years later. On the basis of these assessments, the estimated population prevalence of the need for treatment was 28.7%. The greatest need was for treatment for alcohol dependence, followed by major depression, social phobia, panic disorder, and agoraphobia (page 373). In a related Taking Issue, Benjamin G. Druss, M.D., M.P.H., discusses the complexity of defining need for mental health treatment (page 295).
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Research and the U.S. Hispanic Population
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Increased recognition of disparities in treatment for ethnic minority groups has spurred new research. Sandy M. Magaña, Ph.D., M.S.W., and coauthors report on a study of psychological distress among 85 Latino family caregivers of adult relatives with schizophrenia. Forty percent of the caregivers met criteria for depression, which was significantly related to caregivers' perceived burden and stigma (page 378). Another report summarizes recommendations of a consensus panel of 15 senior researchers convened by the National Institute of Mental Health (NIMH). The panel members identified research issues in five broad areas that they deemed most pertinent for improving treatment for Hispanic individuals with persistent mental disorders (page 385). The summary report is accompanied by a commentary by Thomas R. Insel, M.D., director of NIMH, who emphasizes the need to create a more equitable and responsive system to address the needs of all who enter it (page 395).
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Complementary and Alternative Therapies
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Many studies have documented high rates of use of complementary and alternative medicine to treat physical and mental disorders. Use of such therapies is increasingly common among Americans with depression. Ping Wu, Ph.D., and colleagues focused on the use of three types of such therapies—manual therapies (such as chiropractic treatment and massage), herbs, and vitamins—in a nationally representative sample of 220 women with depression. Fifty-four percent of the women reported use of at least one of these therapies in the past year (page 349). In a study conducted by Lin Fang, Ph.D., and Steven P. Schinke, Ph.D., at a community mental health center, 82% of 153 Chinese Americans were found to be currently using some form of alternative therapy (page 402).
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Briefly Noted ...
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• A literature review examines current theories about how to change clinicians' behavior (page 342).
• Is the treatment alliance affected when a clinician is also a representative payee (page 365)?
• Formulary coverage of major classifications of psychotropic drugs by Medicare Part D prescription drug plans is examined in the Economic Grand Rounds column (page 308).
Related Articles:
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Do We Know Need When We See It?
- Benjamin G. Druss
Psychiatr Serv 2007 58: 295.
[Full Text]
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Economic Grand Rounds: Coverage and Prior Authorization of Psychotropic Drugs Under Medicare Part D
- Haiden A. Huskamp, David G. Stevenson, Julie M. Donohue, Joseph P. Newhouse, and Nancy L. Keating
Psychiatr Serv 2007 58: 308-310.
[Abstract]
[Full Text]
[PDF]
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Measures and Predictors of Community-Based Employment and Earnings of Persons With Schizophrenia in a Multisite Study
- David S. Salkever, Mustafa C. Karakus, Eric P. Slade, Courtenay M. Harding, Richard L. Hough, Robert A. Rosenheck, Marvin S. Swartz, Concepcion Barrio, and Anne Marie Yamada
Psychiatr Serv 2007 58: 315-324.
[Abstract]
[Full Text]
[PDF]
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Implementation of Supported Employment for Homeless Veterans With Psychiatric or Addiction Disorders: Two-Year Outcomes
- Robert A. Rosenheck and Alvin S. Mares
Psychiatr Serv 2007 58: 325-333.
[Abstract]
[Full Text]
[PDF]
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Modest Implementation Efforts, Modest Fidelity, and Modest Outcomes
- Gary R. Bond
Psychiatr Serv 2007 58: 334.
[Full Text]
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Applying Theory-Driven Approaches to Understanding and Modifying Clinicians' Behavior: What Do We Know?
- Matthew B. Perkins, Peter S. Jensen, James Jaccard, Peter Gollwitzer, Gabriele Oettingen, Elizabeth Pappadopulos, and Kimberly E. Hoagwood
Psychiatr Serv 2007 58: 342-348.
[Abstract]
[Full Text]
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Use of Complementary and Alternative Medicine Among Women With Depression: Results of a National Survey
- Ping Wu, Cordelia Fuller, Xinhua Liu, Hsin-Chien Lee, Bin Fan, Christina W. Hoven, Donald Mandell, Christine Wade, and Fredi Kronenberg
Psychiatr Serv 2007 58: 349-356.
[Abstract]
[Full Text]
[PDF]
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Payeeship, Financial Leverage, and the Client-Provider Relationship
- Beth Angell, Noriko I. Martinez, Colleen A. Mahoney, and Patrick W. Corrigan
Psychiatr Serv 2007 58: 365-372.
[Abstract]
[Full Text]
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Psychiatrists' Ascertained Treatment Needs for Mental Disorders in a Population-Based Sample
- Erick Messias, William Eaton, Gerald Nestadt, O. Joseph Bienvenu, and Jack Samuels
Psychiatr Serv 2007 58: 373-377.
[Abstract]
[Full Text]
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Psychological Distress Among Latino Family Caregivers of Adults With Schizophrenia: The Roles of Burden and Stigma
- Sandy M. Magaña, Jorge I. Ramírez García, María G. Hernández, and Raymond Cortez
Psychiatr Serv 2007 58: 378-384.
[Abstract]
[Full Text]
[PDF]
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Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders
- William Armando Vega, Marvin Karno, Margerita Alegria, Jennifer Alvidrez, Guillermo Bernal, Michael Escamilla, Javier Escobar, Peter Guarnaccia, Janis Jenkins, Alex Kopelowicz, Isabel T. Lagomasino, Roberto Lewis-Fernandez, Humberto Marin, Steven Lopez, and Sana Loue
Psychiatr Serv 2007 58: 385-394.
[Abstract]
[Full Text]
[PDF]
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Commentary: Devising Prevention and Treatment Strategies for the Nation's Diverse Populations With Mental Illness
- Thomas R. Insel
Psychiatr Serv 2007 58: 395.
[Full Text]
[PDF]
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Complementary Alternative Medicine Use Among Chinese Americans: Findings From a Community Mental Health Service Population
- Lin Fang and Steven P. Schinke
Psychiatr Serv 2007 58: 402-404.
[Abstract]
[Full Text]
[PDF]
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Two Studies of Employment...
Assessing Treatment Need
