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Publications
Publications (173)
Introduction
Psychiatric measurement‐based care (MBC) can be more effective than usual care, but health systems face implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few studies incorporate perspectives from multiple stakeholders this early in planning. This analysis identifies alignment and themes...
Introduction
Behavioral measurement‐based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible dispariti...
BACKGROUND
The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population.
OBJECTIVE
In this context, CHAMindWell was developed to improve resilience and reduce symptom severity among a public hospital s...
Background
The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a...
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address...
Achieving population behavioral health is urgently needed. The mental health system struggles with enormous challenges of providing access to mental health services, improving quality and equitability of care, and ensuring good health outcomes across subpopulations. Little data exists about increasing access within highly constrained resources, sta...
Background
Comorbidity of psychiatric and medical illnesses among older adult populations is highly prevalent and associated with adverse outcomes. Care management is a common form of outpatient support for both psychiatric and medical conditions in which assessment, care planning, and care coordination are provided. Although care management is oft...
The COVID-19 pandemic has been expected to lead to substantial increases in need for behavioral health care. A population health framework can facilitate the development of interventions and policies to promote the equitable distribution of care across the population. This column describes the application of population behavioral health principles...
Major depressive disorder is a common mental health condition that affects an estimated 16.2 million adults and 3.1 million adolescents in the United States. Yet, a lack of uniformity remains in measurements and monitoring for depression both in clinical practice and in research settings. This project aimed to develop a minimum set of standardized...
Quality of care and cost containment issues have put a spotlight on patient outcomes with questions being asked about appropriate types and levels of care associated with variation in medical practice. As such, clinicians' interest in obtaining objective information about their practices has increased, and patients and purchasers want to know more...
With thousands of smartphone apps targeting mental health, it is difficult to ignore the rapidly expanding use of apps in the treatment of psychiatric disorders. Patients with psychiatric conditions are interested in mental health apps and have begun to use them. That does not mean that clinicians must support, endorse, or even adopt the use of app...
Objective:
To declare a call to action to improve mental health in the workplace.
Methods:
We convened a public health summit and assembled an Advisory Council consisting of experts in the field of occupational health and safety, workplace wellness, and public policy to offer recommendations for action steps to improve health and well-being of w...
Objective:
Lack of access to mental health treatment remains a significant problem in the United States, even after implementation of mental health parity legislation. This study examined availability of psychiatrists listed in insurance carrier network provider databases in the Washington, D.C., area.
Methods:
Contact information was obtained f...
Patients seen in general medical settings commonly have behavioral health conditions comorbid with other chronic medical disorders, each requiring high levels of integrated care management. With recent health care policy reform, the number of such patients recognized in the US health care system will likely increase, intensifying the need for pract...
The Oxford Textbook of Community Mental Health is the most comprehensive and authoritative review published in this field.
Introduction Overview of psychopharmacoepidemiology Sources of data Examples of recent psychopharmacoepidemiologic studies Conclusions Acknowledgements References
Suicidal behavior has gained attention as an adverse outcome of prescription drug use. Hospitalizations for intentional self-harm, including suicide, can be identified in administrative claims databases using external cause of injury codes (E-codes). However, rates of E-code completeness in US government and commercial claims databases are low due...
Neuropsychopharmacology, the official publication of the American College of Neuropsychopharmacology, publishing the highest quality original research and advancing our understanding of the brain and behavior.
The aim was to examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the US general population.
Respondents in the National Comorbidity Survey Replication with common 12-month DSM-IV mood, anxiety, substance, impulse control and childhood disorders were asked about perceived need for treatmen...
There exists a divide between findings from integrative neuroscience and clinical research focused on mechanisms of psychopathology. Specifically, a clear correspondence does not emerge between clusters of complex clinical symptoms and dysregulated neurobiological systems, with many apparent redundancies. For instance, many mental disorders involve...
Current versions of the DSM and ICD have facilitated reliable clinical diagnosis and research. However, problems have increasingly been documented over the past several years, both in clinical and research arenas (e.g., 1, 2). Diagnostic categories based on clinical consensus fail to align with findings emerging from clinical neuroscience and genet...
In the first 2010 issue of Nature, the editor, Philip Campbell,1 suggested that the next 10-year period is likely to be the “decade for psychiatric disorders.” This was not a prediction of an epidemic, although mental illnesses are highly prevalent, nor a suggestion that new illnesses would emerge. The key point was that research on mental illness...
The objective of this study was to assess the risk of suicide attempts and suicides after initiation of antidepressant medication use by children and adolescents, for individual agents.
We conducted a 9-year cohort study by using population-wide data from British Columbia. We identified new users of antidepressants who were 10 to 18 years of age wi...
Methods of Assessing Mental Disorders in Epidemiological SurveysPrevalence of Mental DisordersAge-of-Onset DistributionsCourse of IllnessComorbidityThe Societal Costs of Mental DisordersTreatment of Mental DisordersConclusions
AcknowledgementsReferences
Depression imposes enormous burdens on the elderly. Despite this, rates of initiation of and adherence to recommended pharmacotherapy are frequently low in this population. Although initiatives such as the Medicare Modernization Act (MMA) have improved seniors' access to antidepressants, there are concerns that the patient cost-sharing incorporated...
The word epidemiology is derived from the Greek words epidemos, meaning “among the people.” Epidemiology is the branch of public health concerned with understanding and controlling disease in the population by investigating correlates of illness that might provide clues about disease-causing agents (Susser, 1973). Because the ultimate goals of epid...
Neuropsychiatric disorders are leading causes of disability worldwide, accounting for 37 % of all healthy life years lost from disease (Lopez et al., 2006). They are among the most disabling conditions even in low-income countries, where detection of emotional problems and access to treatment are lowest. Although efficacious and tolerable treatment...
This chapter reviews the epidemiological literature on the prevalence and adverse societal consequences of anxiety and mood disorders. A special emphasis is put on the recently collected data from the completed World Health Organization (WHO) World Mental Health (WMH) Surveys (Kessler and Üstün, 2008). The first section of the chapter discusses the...
In 2003, more intense monitoring of patients initiating antidepressants was advised because of emerging concerns of suicidality. We sought to identify patterns of patient monitoring after antidepressant initiation in British Columbia before and after issuance of health advisories.
We conducted a cohort study of antidepressant initiators between 199...
STAR*D (Sequenced Treatment Alternatives to Relieve Depression) continues to stimulate debate. The landmark trial demonstrated the feasibility of large-scale, community-based studies conducted without pharmaceutical company support. The results provided insight into nonresponse to initial treatment with selective serotonin reuptake inhibitors and a...
This study sought to determine whether previously reported poor outcomes among patients of low socioeconomic status who have depression and anxiety could result from not receiving mental health treatment or from receiving minimally adequate treatment.
The study sample consisted of 1,772 participants in the National Comorbidity Survey Replication (N...
Although mental health treatment dropout is common, patterns and predictors of dropout are poorly understood. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample.
Data were from the National Comorbidity Survey Replication, a nationally representative household survey. Respondents who...
INTRODUCTION Hurricane Katrina was one of the strongest and deadliest hurricanes ever to make landfall in the United States and the costliest hurricane in U.S. recorded history. Katrina first made landfall on August 23, 2005, in southwestern Florida. It then gained force and crossed into the Gulf Coast region of Alabama, Louisiana, and Mississippi....
The potential of personalized medicine to transform the treatment of mood disorders has been widely touted in psychiatry, but has not been quantified. We estimated the costs and benefits of a putative pharmacogenetic test for antidepressant response in the treatment of major depressive disorder (MDD) from the societal perspective. Specifically, we...
Making decisions about medical treatments based upon valid evidence is critical to improve health-care quality, outcomes,
and value. Although such research commonly connotes the use of randomized controlled trials, experimental methods are not
always feasible, and research using observational, quasi-experimental, and other nonexperimental methods m...
We report the lifetime and 12-month prevalence and associations of mental health treatment among Mexican adolescents with suicide-related outcomes (SROs; including ideation, plans, gestures and attempts).
A representative multistage probability household survey of 3005 adolescents aged 12 to 17 years residing in the Mexico City Metropolitan Area wa...
There is a pressing need for comparative effectiveness research to improve mental health treatments. Although U.S. mental health spending has increased dramatically, mainly because of the rapid adoption of newer psychotropic medications, fewer than a quarter of people with serious mental illnesses receive appropriate care. Because of a general lack...
Supplemental Figure 2. Three-way sensitivity analysis of prevalence of positive test for SSRI response, relative risk of remission in test+ versus test- subjects, and utility of depressed state.
Supplemental Figure 1. Schematic Diagram of the State-transition Model
Supplemental Figure 1 presents a schematic diagram of the state-transition model used in this analysis. All subjects begin in the “depressed, on antidepressant” state. Probabilities of transitions between states are adjusted based upon treatment selection and test results.
The paper reviews recent findings from the WHO World Mental Health (WMH) surveys on the global burden of mental disorders.
The WMH surveys are representative community surveys in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, distribution, burden, and unmet need for treatment of...
Nonrandomised studies on the causal effects of psychotropic medications may be biased by patient characteristics that are not fully adjusted.
Studies using linked claims databases found that typical antipsychotic medications were associated with increased short-term mortality compared with atypical antipsychotics. It has been suggested that such re...
Mental disorders impose considerable socioeconomic costs due to their episodic/chronic nature, their relatively early ages at onset, and the highly disabling nature of inadequately treated mental illness. Despite substantial increases in the volume of mental health treatment for disorders in the past two decades, particularly pharmacotherapies, the...
Translational research is urgently needed to turn basic scientific discoveries into widespread health gains and nowhere are these needs greater than in conditions such as schizophrenia and other psychotic disorders. In this article, we discuss one type of translational research--called T1--which is needed to take advantage of developments in the ba...
To investigate the potential mechanisms through which conventional antipsychotic medication (APM) might act, the specific causes of death in elderly patients newly started on conventional APM were compared with those of patients taking atypical APM.
Cohort study.
Community.
All British Columbia residents aged 65 and older who initiated a convention...
The discipline of psychiatric epidemiology is, at its most basic level, the study of the patterns of mental disorders. Recently, the scope of the field has greatly expanded and now includes detailed examinations of the natural history of psychiatric disorders, genetic and epigenetic risk factors, the relationships between physical and mental disord...
There is limited occupational health industry data pertaining to 1) the prevalence of psychological distress in various employee subtypes and 2) risk factors for employee psychological distress.
The employees of 58 large public and private sector employers were invited to complete the Kessler 6 (K6) as part of the Health and Performance at Work Que...
The purpose of this report was to update previous estimates of the association between mental disorders and earnings. Current estimates for 2002 are based on data from the National Comorbidity Survey Replication (NCS-R).
The NCS-R is a nationally representative survey of the U.S. household population that was administered from 2001 to 2003. Followi...
Atypical antipsychotic drugs have been used off label in clinical practice for treatment of serious dementia-associated agitation and aggression. Following reports of cerebrovascular adverse events associated with the use of atypical antipsychotics in elderly patients with dementia, the U.S. Food and Drug Administration (FDA) issued black box warni...
To review evidence on the workplace prevalence and correlates of major depressive episodes, with a particular focus on the National Comorbidity Survey Replication, the most recent national survey to focus on these issues.
Nationally representative survey of Diagnostic and Statistical Manual, 4th Revision Mental Disorders.
A total of 6.4% of employe...
Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers.
Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study.
This randomized controlled trial compared telephon...
Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential cost-sharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to 10-25 dollars copayments (copay) in January 20...
Objective:
Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential cost-sharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to 10-25 dollars copayments (copay) i...
This study presents national data on the comparative role impairments of common mental and chronic medical disorders in the general population. These data come from the National Comorbidity Survey Replication, a nationally representative household survey. Disorder-specific role impairment was assessed with the Sheehan Disability Scales, a multidime...
Data are reviewed on the descriptive epidemiology of commonly occurring DSM-IV mental disorders in the United States. These disorders are highly prevalent: Roughly half the population meets criteria for one or more such disorders in their lifetimes, and roughly one fourth of the population meets criteria in any given year. Most people with a histor...
The authors examined the disruption of ongoing treatments among individuals with preexisting mental disorders and the failure to initiate treatment among individuals with new-onset mental disorders in the aftermath of Hurricane Katrina.
English-speaking adult Katrina survivors (N=1,043) responded to a telephone survey administered between January a...
An abstract is unavailable. This article is available as HTML full text and PDF.
This study examined use of mental health services among adult survivors of Hurricane Katrina in order to improve understanding of the impact of disasters on persons with mental disorders.
A geographically representative telephone survey was conducted between January 19 and March 31, 2006, with 1,043 displaced and nondisplaced English-speaking Katri...
Data are presented on patterns of failure and delay in making initial treatment contact after first onset of a mental disorder in 15 countries in the World Health Organization (WHO)'s World Mental Health (WMH) Surveys. Representative face-to-face household surveys were conducted among 76,012 respondents aged 18 and older in Belgium, Colombia, Franc...
Epidemiologic surveys have consistently found that approximately half of respondents who obtained treatment for mental or substance use disorders in the year before interview did not meet the criteria for any of the disorders assessed in the survey. Concerns have been raised that this pattern might represent evidence of misallocation of treatment r...
Postmarketing studies of prescription drugs are challenging because prognostic variables that determine treatment choices are often unmeasured. In this setting, instrumental variable (IV) methods that exploit differences in prescribing patterns between physicians may be used to estimate treatment effects; however, IV methods require strong assumpti...
Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer purchasers have been slow to adopt these programs based on lack of evidence for cost-effectiveness from their perspective.
To...
Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment.
Face-to-face household surveys were undertaken...
We studied failure and delay in making initial treatment contact after the first onset of a mental or substance use disorder in Mexico as a first step to understanding barriers to providing effective treatment in Mexico.
Data were from the Mexican National Comorbidity Survey (2001-2002), a representative, face-to-face household survey of urban resi...
State Medicaid programs use prior authorization (PA) to control drug spending by requiring that specific conditions be met before allowing reimbursement. The extent to which PA policies respond to new developments concerning medication safety is not known. In April 2005 the Food and Drug Administration (FDA) issued an advisory describing increased...
Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsychotic medications.
We used linked health care utiliz...
The results of recent community epidemiological research are reviewed, documenting that major depressive disorder (MDD) is a highly prevalent, persistent, and often seriously impairing disorder, and that bipolar disorder (BPD) is less prevalent but more persistent and more impairing than MDD. The higher persistence and severity of BPD results in a...
This study compared the prevalence of depression and the determinants of mental health service use in Canada and the United States.
The study used data from preliminary analyses of the 2003 Joint Canada/United States Survey of Health, which measured Canadian (N=3,505) and United States (N=5,183) resident ratings of health and health care services....
This study evaluated Medicaid's prior-authorization policies restricting the prescribing of antidepressant medications for children.
Medicaid program prior-authorization policies for antidepressant medications were obtained for all available states. All criteria needed for authorization were recorded, with a focus on policies that applied specifica...
Pharmacoepidemiology, the study of the effects of drugs in large numbers of people, is a relatively new discipline that applies the methods of epidemiology to clinical pharmacology. Premarketing clinical trials remain the only way to scientifically determine whether a drug is causally effective, yet these trials do not provide information that allo...
Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return on investment.
To estimate the costs and benefits of enhanced depression care for workers from the societal and employer-purchaser perspectives.
Cost-effectiveness and cost-benefit anal...
Behavioral disturbances associated with dementia are common and burdensome. Although no psychotropic medications are currently approved by the US Food and Drug Administration (FDA) to treat such behavioral symptoms, a variety of drug classes are commonly used for these purposes. Atypical antipsychotic medications may be somewhat effective and are g...
To simultaneously assess the short-term reduction in risk of gastrointestinal (GI) complications and increase in risk of acute myocardial infarction (MI) by celecoxib compared with rofecoxib and several nonselective nonsteroidal antiinflammatory drugs (NSAIDs) using instrumental variable analysis.
A population of 49,711 Medicare beneficiaries ages...
Research on the workplace costs of mood disorders has focused largely on major depressive episodes. Bipolar disorder has been overlooked both because of the failure to distinguish between major depressive disorder and bipolar disorder and by the failure to evaluate the workplace costs of mania/hypomania.
The National Comorbidity Survey Replication...