Paul J. Sirovatka

Quality of care measures for the treatment of bipolar disorder.

The staff of the American Psychiatric Assocition (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA’s evidence-based Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002 (1) and the Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder, 2000 (2) These quality indicators can be used for quality monitoring, benchmarking, and quality improvement efforts across health plans, systems of care, and health care providers to improve quality and outcomes of care for patients with bipolar disorder.

Mental Health, Disabilities, and Women: A Policy-Oriented Data Review

Ongoing development and reform of health care systems worldwide are directing the attention of policymakers to the significance of mental disorders and ensuing disabilities. While this awareness has encouraged empirical work and scientific literature on disabilities associated with mental disorders, insufficient attention has been paid to issues of gender in the context of mental disorder and disability. This paper draws on four data sets-the 1994-96 Disability Survey; the 1992 National Health Interview Survey (NHIS); Social Security Disability Programs; and the recent international measure of Disability-Adjusted Life Years-to explore relationships among gender, mental disorders, and disability in the United States and to consider the special needs presented by women disabled by mental disorders for service development and service configuration. Generally younger than women disabled by physical disorders, women with mental disorders tend to be in their prime child-bearing years. While in the United States private sector managed care programs increasingly are perceived as the most reasonable way to provide health services in a fiscally responsible way, there appears to exist an implicit notion that managed care is intended exclusively for provision of acute care and preventive services. There is little discussion or exploration of the use of managed care systems for rehabilitation generally, or of the particular rehabilitation needs of young women. The implications for the additional “burden” of disabilities along with the potential risk factor of traditional female roles require serious consideration and enlightened policies. Mental

Epidemiology and Costs of Depression

SummaryThis paper reviews the most recent epidemiological, clinical services and economic literature on depression. The epidemiological section discusses the intriguing question if there has been a change in the frequency of depression during the last decade and concludes that there is not enough empirical evidence to support the presence of an epidemic in depression. The clinical services section addresses the issue of the unmet need for treatment and finds that to date, no criteria have been developed to decide who should be treated if not everybody can be treated due to scarce resources. The economic section describes the various approaches used to estimate the economic burden of depression on society. The paper points out that the discrepancy between diagnostic and treated prevalence implies that many untreated cases are hidden for various reasons and this results in unnecessary, hidden economic loss.