December 2010: This Month's Highlights
Focus on Suicide
Four studies in this issue explored various aspects of suicide. Analyses presented in Datapoints point to a "hidden epidemic of suicide" among younger women with military service—including veterans and active-duty personnel and members of the reserve and National Guard. Bentson H. McFarland, M.D., Ph.D., and coauthors urge clinicians to inquire about women's military service ( Original article: page 1177 ). Prevention efforts in the United States have not reduced suicide incidence rates. Individuals seen in emergency settings after a suicide attempt are difficult to engage in treatment: up to 50% refuse outpatient care, and up to 60% drop out after one session. Is treatment engagement a neglected aspect in the care of these patients? The lead article is a literature review of 13 empirical studies of efforts to engage this population. Dana Lizardi, Ph.D., and Barbara Stanley, Ph.D., found that postdischarge follow-up by phone or letter or in person must be immediate, substantial, and multifaceted to be effective, even over the short term ( Original article: page 1183 ). Lauren M. Denneson, Ph.D., and other Department of Veterans Affairs (VA) researchers in Oregon analyzed medical records of 112 veterans who completed suicide and who had at least one contact with VA health care in the year before death. Of those assessed for suicidal ideation at their final contact, 71% denied such thoughts ( Original article: page 1192 ). Nestor D. Kapusta, M.D., and colleagues used Bayesian modeling techniques to examine whether the population density of mental health professionals had an impact on suicide rates in Austria. Regional socioeconomic conditions, which affected the distribution of these professionals, were stronger predictors of suicide rates than access to care per se ( Original article: page 1198 ). In a Taking Issue commentary on these reports, Eric D. Caine, M.D., describes five major challenges in suicide prevention ( Original article: page 1171 ).
Treatment Setting Matters for Diabetes Care
The prevalence of diabetes is twice as high among people with mental illness as in the general population, and they may not receive the same quality of diabetes preventive care. In a study of more than 8,800 diabetic patients with and without mental illness seen in either an emergency or outpatient setting, Jacqueline Lynn Green, M.D., M.P.H., and colleagues found that the care setting mattered more than a diagnosis of mental illness in whether patients received diabetes-related preventive care, such as high- and low-density lipoprotein testing. Patients with mental illness had twice as many visits to an emergency setting, where all patients, regardless of psychiatric status, received fewer diabetes preventive services ( Original article: page 1204 ).
A Brief Instrument to Improve Child Treatment
Successful treatment of children requires an ongoing and effective partnership between parents and clinicians. Can use of a brief instrument improve that therapeutic relationship, keeping treatment on track and contributing to improved child functioning? The Child Outcomes Survey is a brief strengths-based measure that is completed by parents before or during each session. Clinicians and parents are encouraged to discuss during the current session the information from the previous week's survey. Bradley D. Stein, M.D., Ph.D., and colleagues analyzed more than 1,200 completed surveys, particularly in regard to levels of discussion of the previous week's survey. Sixty-one percent of parents reported high levels of such discussion, and these high rates were associated with improved child functioning and a stronger clinician-family relationship. The authors note that this pilot study provides encouraging support for routinely gathering and using process and outcomes data ( Original article: page 1211 ).
Testing the Criminalization Hypothesis
A large proportion of jail and prison inmates have serious mental illness. The criminalization hypothesis posits that these individuals become entangled in the justice system because mental health services are not available in the community, which in turn implies that untreated symptoms are the main source of their criminal behavior. Jillian Peterson, M.A., and colleagues used data from interviews with and records of 220 parolees with and without mental illness to test the implication that persons with mental illness have unique patterns of offending. Using a five-group offender typology, they categorized parolees on the basis of their offense patterns and found that only a small percentage fit the criminalization hypothesis ( Original article: page 1217 ).
Briefly Noted …
• In the Personal Accounts column, a psychiatrist who is also the mother of two children with ADHD, describes her experience of coping with an additional layer of stigmatization ( Original article: page 1181 ).
• As in past December issues, the book review section is devoted to novels that mental health professionals may wish to read or give to colleagues ( Original article: page 1266 ).
