Mental Health Research Topics Among IOM's 100 Priority Areas

In the American Recovery and Reinvestment Act (ARRA) of 2009, Congress tasked the Institute of Medicine (IOM) to recommend national priorities for research questions to be addressed by comparative effectiveness research (CER) and supported by $1.1 billion in ARRA funds. In June 2009 IOM released Initial National Priorities for Comparative Effectiveness Research, which establishes a working definition of CER and presents a priority list of research topics. It also details specific actions to ensure that the CER initiative will be a sustained effort with a process for updating priorities as needed and that the results are put into clinical practice.

The definition developed by IOM's Committee on Comparative Effectiveness Research is as follows: "CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels."

To develop a list of high-priority research questions, the committee made more than 20,000 solicitations to stakeholders and received input from direct mail, a public session of 54 stakeholders, and a Web-based questionnaire that garnered nearly 1,800 submissions suggesting more than 2,600 topics. The committee developed criteria to assess their importance and a process for prioritization. Through three rounds of voting, the list was narrowed to 100 highest-priority topics, which are organized into quartiles of importance.

The list includes nine research topics in the area of mental health:

• Compare the effectiveness of various primary care treatment strategies (such as symptom management, cognitive-behavioral therapy, and pharmacologic treatment) for attention-deficit hyperactivity disorder among children.

• Compare the effectiveness of wraparound home- and community-based services and residential treatment in managing serious emotional disorders of children and adults.

• Compare the effectiveness of the colocation model (mental health and primary care practitioners) and usual care (identification and referral) in identifying and treating disorders among children up to age three.

• Compare the effectiveness of strategies for enhancing patients' adherence to medication regimens.

• Compare the effectiveness of pharmacologic treatment and behavioral interventions in managing major depressive disorder among adolescents and adults in diverse treatment settings.

• Compare the effectiveness of treatment strategies for posttraumatic stress disorder stemming from diverse sources of trauma.

• Compare the effectiveness of management strategies (such as hospitalization, extended observation, and intensive outpatient care) for adolescents and adults following a suicide attempt.

• Compare the effectiveness of various treatment approaches (such as integrating mental health and primary care and improving consumer self-care) in avoiding early mortality and comorbidity among people with serious mental illness.

• Compare the effectiveness of traditional mental health training of primary care providers in three systems (primary care, mental health, and colocated systems) on outcomes of depression, anxiety, physical symptoms and disability, prescription drug abuse, mental and physical function, satisfaction with the provider, and cost.

The 220-page report is available on the National Academies Press Web site at www.nap.edu .