This Week in JAMA FREE

A JAMA THEME ISSUE

Edited by Richard M. Glass, MD

In a randomized trial that enrolled primary care patients with 4 common anxiety disorders, Roy-Byrne and colleagues compared usual care with a flexible treatment delivery model that allowed a choice of cognitive behavior therapy, medication, or both and included Web-based and computer-assisted treatment supports and the assistance of clinical care managers. The authors found that compared with usual care, the flexible treatment model was associated with greater improvement in anxiety symptoms, functional disability, and quality of care during 18 months of follow-up.

In a randomized trial of children and adolescents with moderate to severe Tourette or chronic tic disorder, Piacentini and colleagues found that a comprehensive behavioral intervention that involved habit reversal training was more effective in reducing tics and tic-related impairment than a control treatment consisting of supportive therapy and education.

During the year following hospitalization for complicated traumatic brain injury, Bombardier and colleagues conducted multiple structured telephone interviews with 559 adult patients. The authors found that 297 patients (53%) met criteria for major depressive disorder at least once in the first year after injury. Major depressive disorder following traumatic brain injury was associated with a history of major depressive disorder and was an independent predictor of less favorable health-related quality of life.

Depression is estimated to affect up to 20% of patients with chronic kidney disease before dialysis is initiated. Hedayati and colleagues examined the association between a current major depressive episode and poor outcomes (eg, dialysis initiation, hospitalization, or death) in a prospective cohort of 267 patients with chronic kidney disease who had not yet initiated dialysis. The authors report the prevalence of major depressive episode was 21% (95% confidence interval, 3%-31%), and the presence of a major depressive episode was associated with an increased risk of poor outcomes, independent of comorbid conditions and kidney disease severity.

In a previously reported natural experiment in which an income supplement moved some American Indian families out of poverty, a significant reduction in behavioral symptoms among adolescents in the income-supplemented families was found. Costello and colleagues analyzed data from an additional 6 years of follow-up to assess rates of psychiatric and substance use disorders in the youth through 21 years of age. The authors found that compared with a non–American Indian population living in the surrounding area and not receiving the income supplement, lower rates of psychopathology persisted into adulthood among the American Indian youth whose families received income supplements.

In a systematic literature review and meta-analysis of data from 43 studies, Paulson and Bazemore found that approximately 10% of men experience prenatal or postpartum depression, with the highest rate in 3 to 6 months postpartum. In addition, the authors found a moderate correlation between depression in fathers and mothers.

“I was able to maintain a high level of professional achievement while using drugs.” From “Intellectualization of Drug Abuse.”

Concern about widespread prescribing of antipsychotic drugs to pediatric patients is spurred by data suggesting that physicians often fail to take precautions to minimize serious metabolic adverse effects associated with use of these drugs.

Rethinking mental illness

Improving the health of persons with mental illness

Importance of DSM-5

Global mental health

Mental health vs mental disorders

How would you counsel a 42-year-old man with hypercholesterolemia who is considering whether to drink alcohol to improve his cardiovascular health? Go to www.jama.com to read the case, and submit your response, which may be selected for online publication. Submission deadline is May 23.

For your patients: Information about depression.