Abstract: Purpose: Exploring three perspectives on differences between general practitioners (GP) and psychiatrists in clinical decision making about depressed patients. The gold standard perspective focuses on differences in decisions (output) as a result of lack of expertise, the input perspective relates differences to different information use and to other roles, and the throughput perspective attributes differences to other information processing.Methods: 26 psychiatrists and 25 general practitioners (GPs) gave their clinical judgment on four on-line vignettes of increasingly severely depressed patients. Supplementary information on 15 themes could be asked for by clicking on underlined phrases.

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Abstract: Objective: The number of psychiatric hospital beds in England has declined since the 1950s. Since the early 2000s mental health staff increasingly work in community treatment teams.We analysed recent trends in hospital and community treatment in England for eight mental health diagnoses.Method: We obtained data from the UK Government Health and Social Care Information Centre covering the period 1998 to 2012.

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Abstract: Objective: This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions.Method: Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions.Results: Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care (OR=1.61; 95% CI 1.13-2.30). Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18-2.65), high value given to teamwork (OR=2.48; 95% CI=1.40-4.38), having at least one GP at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07-2.21), and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30-3.46).Conclusions: Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.

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Just returning from the World Economic Forum (WEF) in Davos, Switzerland. While media reports covered speeches from some of the 40 heads of state attending or skewered the over-the-top parties of the rich and famous associated with this annual meeting, they missed a remarkable story: this was the year that mental health became a hot topic at the WEF.

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One worked for the CIA as a code breaker. Another was an electrical engineer designing high tech circuits.

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Abstract: Objective: To examine primary care clinician actions following positive suicide risk assessments administered to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans.Methods: We identified OEF/OIF veterans with positive templated suicide risk assessments administered in primary care settings of three VA Medical Centers. National VA datasets and manual record review were used to identify and code clinician discussions and actions following positive assessments. Bivariate analyses were used to examine relationships between patient characteristics and discussions of firearms access and alcohol/drug use.Results: Primary care clinicians documented awareness of suicide risk assessment results for 157 of 199 (79%) patients with positive assessments.

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It’s time again for the year’s ten best from NIMH. A year that included a 16-day government shutdown and a 5.2 percent sequester also saw some outstanding scientific breakthroughs and historic changes in policy.

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The recently published article, “Advancing the adoption, integration and testing of technological advancements within existing care systems, ” explored the need to better understand both the causes and strategies for overcoming barriers to uptake of health information technology (HIT) in mental health settings. The authors suggest that observational studies could help to better elucidate the barriers to adoption of HIT that are unique or disproportionate in mental health populations. They also feel that implementation science studies are needed to better identify strategies for addressing these barriers and optimizing uptake of mental health HIT interventions .

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I had not planned to add another posting to the “2014 predictions” blogosphere, but after reading Nicholas Kristof’s column in the New York Times, I can’t resist. Kristof, who has won two Pulitzer Prizes for reporting on social injustice, is perhaps best known for bringing international attention to human trafficking and the suffering in Darfur. In his first column of 2014 he tells readers, “Those of us in the pundit world tend to blather on about what happened yesterday, while often ignoring what happens every day

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The mental health evaluation of the patient requesting physician-assisted death (PAD) has two goals, often written into laws that permit PAD. One goal is to ensure that the patient does not have a potentially treatable mental disorder influencing the decision to hasten death. Most discussions of relevant mental disorders point to the roles of anxiety and depression, particularly major depressive disorder, in which possibly treatable and reversible hopelessness, sadness and anhedonia may impact views about suicide

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