Mark Olfson

Columbia University | CU · Department of Psychiatry

Importance Given the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services. Objective To examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity. Design, Setting, and P...

Importance: Diagnostic codes in the Electronic Health Record (EHR) are known to be limited in reporting patient suicidality, and especially in differentiating the levels of suicide severity. Objective: The authors developed and validated a portable natural language processing (NLP) algorithm for detection of suicidal ideation (SI) and suicide-relat...

Importance While access to psychotherapy has recently increased in the US, concern exists that recent gains may be unevenly distributed despite teletherapy expansion. Objective To characterize recent trends and patterns in outpatient psychotherapy by US adults. Design, Setting, and Participants This is a repeated cross-sectional study of psychoth...

Objective: The prevalence of depressive and anxiety disorders is higher in women than in men. In contrast, there is still no clear consensus on the existence of sex-related differences in the effectiveness of antidepressant treatments for these disorders. This real-world study used filled prescription sequences to compare antidepressant medications...

Despite the high correlation between anxiety and depression, little remains known about the course of each condition when presenting concurrently. This study aimed to identify longitudinal patterns during antidepressant treatment in patients with depression and anxiety, and evaluate related factors associated with these patterns. By analyzing longi...

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Background: Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Administration (VA) patients with psychiatric disorders compared to patients with no disorder. However, VA patient samples are not representative of all U.S. adults, so results on disproportionate increases in CUD prevalence could have been biased. To...

Objectives Social support (SS) and social isolation (SI) are social determinants of health (SDOH) associated with psychiatric outcomes. In electronic health records (EHRs), individual-level SS/SI is typically documented in narrative clinical notes rather than as structured coded data. Natural language processing (NLP) algorithms can automate the ot...

Objective: The large body of literature examining the association between parenthood and mortality in the general population contrasts with a lack of studies among older adults with schizophrenia. Identifying potential protective factors of premature death in this population is important to help guide prevention measures. Here, we examined whether...

Objective: This report describes characteristics of patients who had high out-of-pocket (OOP) spending on mental health care relative to income. Methods: A sample of 8,923 U.S. adults with outpatient mental health visits was drawn from the 2018-2021 Medical Expenditure Panel Survey. Respondents who spent ≥10% of their disposable family incomes o...

We examined the prospective associations between nicotine dependence and the likelihood of psychiatric and substance use disorders in the general adult population. Participants came from a nationally representative sample of US adults aged 18 years or older, who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Rela...

Background and aims Extended‐release naltrexone (XR‐NTX) and sublingual buprenorphine (SL‐BUP) are both approved for opioid use disorder (OUD) treatment in any medical setting. We aimed to compare the real‐world effectiveness of XR‐NTX and SL‐BUP. Design and setting This was an observational active comparator, new user cohort study of Medicaid cla...

The spread of suicidal behavior among individuals is often described as a contagion; however, rigorous modeling of suicide as a dynamic, contagious process is minimal. Here, we develop and validate a model-inference system depicting suicide ideation and death and use it to quantify the contagion processes in the US associated with two prominent cel...

Importance Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study. Objective To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized...

Introduction Emergency department patients presenting with non-fatal suicidal behaviour face elevated risk of suicide and all-cause mortality, but the extent to which this has changed over time is unknown. This study tracked trends in mortality risks faced by emergency department patients presenting with deliberate self-harm and suicidal ideation i...

Objective: This report uses data from Mental Disorders Prevalence Study (MDPS), a large epidemiologic study that provided national prevalence estimates of seven mental disorders based on the Structured Clinical Interview for DSM-5 (SCID), to assess the odds of treatment disruption during COVID for SMI and non-SMI groups. Methods: This cross-section...

Background and Hypothesis In the United States, women with schizophrenia face challenges in receiving gynecologic care, but little is known about how cervical cancer screening rates vary across time or states in a publicly insured population. We hypothesized that women Medicaid beneficiaries with schizophrenia would be less likely to receive cervic...

Objective: This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020. Methods: Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. V...

Background There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availabilit...

Background Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis, in order to determine if anesthesia and surgery in childhood were specifically as...

This cohort study investigates the risk of alcohol-related death among US health care workers compared with non–health care workers.

Objective: The aim of this study was to examine the association between emergency department (ED) safety planning and subsequent use of mental health care among individuals treated in the ED for suicidal behavior and to determine whether subsequent use differed by patients' receipt of recent mental health care. Methods: Data from 130 hospitals,...

Purpose Household economic adversity during adolescence is hypothesized to be a risk factor for poor mental health later in life. To test this hypothesis, we conducted a quasi-experimental analysis of an economic shock, the Great Recession of 2007–2009. We tested if going through adolescence during the Great Recession was associated with increased...

Importance Despite a federal declaration of a national child and adolescent mental health crisis in 2021, little is known about recent national trends in mental health impairment and outpatient mental health treatment of US children and adolescents. Objective To characterize trends in mental health impairment and outpatient mental health care amon...

Study Objectives To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications. Methods Within a commercial claims database (January 1, 2016–December 31, 2021), we identified children and youth (2–24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and...

Objective: Rates of cannabis use disorder (CUD) have increased disproportionately among Veterans Health Administration (VHA) patients with psychiatric disorders, but determining whether such an increase occurred more generally among U.S. adults requires nationally representative data. Methods: Data came from 2001-2002 (n=43,093) and 2012-2013 (n=36...

Importance Not all people who die by suicide have a psychiatric diagnosis; yet, little is known about the percentage and demographics of individuals with lifetime suicide attempts who are apparently psychiatrically healthy. If such suicide attempts are common, there are implications for suicide risk screening, research, policy, and nosology. Objec...

Background: In addition to the physical disease burden of the COVID-19 pandemic, concern exists over its adverse mental health effects. Objective: To characterize trends in psychological distress and outpatient mental health care among U.S. adults from 2018 to 2021 and to describe patterns of in-person, telephone, and video outpatient mental hea...

Excess mortality observed in people with schizophrenia may persist in later life. The specific causes of increased mortality observed in older adults with schizophrenia and the potential influence of psychotropic medications remain partly unknown. We compared 5-year mortality and its causes of older adults with schizophrenia to bipolar disorder (BD...

Aims To compare the real-world effectiveness of extended release naltrexone (XR-NTX) and sublingual buprenorphine (SL-BUP) for the treatment of opioid use disorder (OUD) Design An observational active comparator, new user cohort study Setting Medicaid claims records for patients in New Jersey and California, 2016-2019 Participants/Cases Adult Me...

Objective The Mental and Substance Use Disorders Prevalence Study (MDPS) builds upon previous epidemiologic studies to provide estimates of prevalence and treatment rates of mental and substance use disorders among adults aged 18–65 in the U.S. The study background and methods are described. Method The MDPS employed novel techniques such as the in...

Background: Although cannabis legalization is associated with increases in self-report cannabis use, biological measures of cannabis use are needed to address potential bias introduced by improved self-reporting of cannabis use in states enacting medical cannabis laws (MCL) and recreational cannabis laws (RCL). Objective: Quantify the role of MCL a...

Objective:: Recent increases in suicide deaths among Black women in the US warrant further investigation. Our objective was to clarify the epidemiology of suicide among Black girls and women, by estimating age-period-cohort effects on suicide rates among decedents coded as female aged 15-84 years. Methods:: The present study examined annual time...

Objective: Cannabis use disorder diagnoses are increasing among U.S. adults and are more prevalent among people with comorbid psychiatric disorders. Recent changes in cannabis laws, increasing cannabis availability, and higher-potency cannabis may have placed people with cannabis use and psychiatric disorders at disproportionately increasing risk...

Importance Dose-related effects of antipsychotic medications may increase mortality in children and young adults. Objective To compare mortality for patients aged 5 to 24 years beginning treatment with antipsychotic vs control psychiatric medications. Design, Setting, and Participants This was a US national retrospective cohort study of Medicaid...

Introduction Suicide rates are elevated after cancer diagnosis. Existential distress caused by awareness of one’s impending death is well‐described in patients with cancer. The authors hypothesized that suicide risk is associated with cancer prognosis, and the impact of prognosis on suicide risk is greatest for populations with higher baseline suic...

Background Chronic pain has been extensively explored as a risk factor for opioid misuse, resulting in increased focus on opioid prescribing practices for individuals with such conditions. Physical disability sometimes co-occurs with chronic pain but may also represent an independent risk factor for opioid misuse. However, previous research has not...

Suicide rates have increased in the U.S. over the past 15 years with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes by intercept and slope or to identify the economic precursors of increases. We used Vital Statistics data and growth mixture models to...

Background and aims: Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiati...

BACKGROUND The rate of suicide death has been increasing, making understanding risk factors of growing importance. While exposure to explicit suicide-related media, such as description of means in news reports or sensationalized fictional portrayal, is known to increase population suicide rates, it is not known whether pro-suicide website forums, w...

Background The rate of suicide death has been increasing, making understanding risk factors of growing importance. While exposure to explicit suicide-related media, such as description of means in news reports or sensationalized fictional portrayal, is known to increase population suicide rates, it is not known whether prosuicide website forums, wh...

Objective: The study aims to quantify differential changes in outpatient mental health service utilization among 3,724,348 individuals, contrasting those with Severe Mental Illness (SMI) to those without, in the context of the COVID-19 pandemic. Design & Setting: A retrospective cohort study was conducted, utilizing data from Healthix, the second-l...

Importance Historically elevated risks of suicide among physicians may have declined in recent decades. Yet there remains a paucity of information concerning suicide risks among other health care workers. Objective To estimate risks of death by suicide among US health care workers. Design, Setting, and Participants Cohort study of a nationally re...

Depression and anxiety are highly correlated, yet little is known about the course of each condition when presenting concurrently. This study aimed to identify longitudinal patterns and changes in depression and anxiety symptoms during antidepressant treatment, and evaluate clinical factors associated with each response pattern. Self-report Patient...

Questions remain regarding whether the transition and continued use of telehealth was associated with changes in treatment engagement among patients with serious mental illness (SMI). Using NYS Medicaid claims, we identified 116,497 individuals with SMI receiving outpatient mental health services from September 1, 2019–February 28, 2021 and a compa...

Introduction COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natu...

UNSTRUCTURED This letter aims to look at the search patterns for self-harm forums after a high-profile publication on the topic.

Searches for “pro-suicide” websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications.

Background: Despite an unprecedented increase in drug overdose deaths in the United States, the risks faced by U.S. health care workers, who often have access to controlled prescription drugs, are not known. Objective: To estimate risks for drug overdose death among health care workers relative to non-health care workers. Design: Prospective c...

Objective: To evaluate whether timely follow-up outpatient mental health care is associated with reduced short-term suicide risk following hospitalization for suicidal thoughts or behaviors. Methods: Retrospective cohort analysis using 2015 Medicare data for adults aged ≥ 65 years who were hospitalized for suicidal ideation or behaviors (n = 36,...

Objective: To describe associations between patient race and ethnicity with emergency department disposition for mental health visits in the United States. Methods: We identified 674,821 visits for mental health in the 2019 National Emergency Department Sample and classified them by ICD-10 diagnostic group: schizophrenia-spectrum, bipolar, major de...

Background The risk for cannabis use disorder (CUD) is elevated among U.S. adults with chronic pain, and CUD rates are disproportionately increasing in this group. Little is known about the role of medical cannabis laws (MCL) and recreational cannabis laws (RCL) in these increases. Among U.S. Veterans Health Administration (VHA) patients, we examin...

Objectives: This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18-34, 35-64, and 65-75 years), sex, and race, and ethnicity. Method:...

Background: Anxiety and depression are frequently comorbid yet phenotypically distinct. This study identifies differences in the clinically observable phenome across a wide variety of physical and mental disorders comparing patients with diagnoses of depression without anxiety, anxiety without depression, or both depression and anxiety. Methods:...

After the rapid growth of pediatric antipsychotic prescribing in the early 2000s, especially in the Medicaid population, concerns regarding the safety and appropriateness of such prescribing increased. Many states implemented policy and educational initiatives aimed at safer and more judicious antipsychotic use. Antipsychotic use leveled off in the...

Objective Geography may influence the relationships of predictors for suicidal ideation (SI) and suicide attempts (SA) in children and youth. Method This is a nationwide retrospective cohort study of 124,424 individuals less than 25 years of age using commercial claims data (2011–2015) from the Health Care Cost Institute. Outcomes were time to SI...

6634 Background: Suicide rates are elevated acutely after cancer diagnosis. We sought to create a unifying theory that explains variations in suicide risk across cancer sites, stages, and demographics. Based on the stress-diathesis model, we hypothesized that suicide risk correlates with cancer prognosis and that the impact of prognosis on suicide...

Objective: Cannabis use disorders (CUD) are increasing among U.S. adults and are more prevalent among cannabis users with comorbid psychiatric disorders. Changing cannabis laws, increasing cannabis availability, and higher potency cannabis may have recently placed cannabis users with psychiatric disorders at disproportionately increasing risk for C...

Objective: To determine whether use of medications with potential depressive symptom side effects is associated with a higher level of depressive symptoms in adults with antidepressant-treated major depressive disorder (MDD). Methods: The study was based on the 2013-2014, 2015-2016, and 2017-2018 National Health and Nutrition Examination Survey (NH...

Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared to the general US population. Little is known about how healthcare delivery system factors impact testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative...

Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data we...

Background: Common adolescent psychiatric symptoms cluster into two dominant domains: internalizing and externalizing. Both domains are linked to self-esteem, which serves as a protective factor against a wide range of internalizing and externalizing problems. This study examined trends in US adolescents' self-esteem and externalizing symptoms, an...