Ramin Mojtabai

Increase in antidepressant medication in the US adult population between 1990 and 2003

Background: The rate of antidepressant treatment in the US has significantly increased in the past decade. There are, however, concerns about undertreatment among traditionally underserved groups and overtreatment in less severely ill individuals. This study examines trends in the prevalence of antidepressant drug treatment in two US general population surveys. Methods: The prevalence of antidepressant treatment within a 12-month period was compared in the US National Comorbidity Survey (1990–1992) and the National Comorbidity Survey-Replication (2001–2003). Variations in trends across groups were examined using bivariate and multivariate logistic regression models. Results: The rate of antidepressant drug treatment increased more than four times between early 1990s and early 2000s. The trend was similar across sociodemographic groups. Younger adults, men and racial/ethnic minorities continued to receive antidepressant treatment at a lower rate compared to middle-aged adults, women and non-Hispanic whites, respectively. The rate of antidepressant treatment increased more in the group of less severely ill individuals than in those with more severe psychopathology. Conclusions: Sociodemographic disparities in antidepressant treatment persisted over the last decade in the US, lending support to concerns about undertreatment among traditionally underserved groups, whereas the greater increase in the rate of antidepressant treatment in the less severely ill group lends support to concerns about antidepressant overtreatment in this population.

Trends in Contacts With Mental Health Professionals and Cost Barriers to Mental Health Care Among Adults With Significant Psychological Distress in the United States: 1997–2002

OBJECTIVESnI assessed recent trends in prevalence of any contact with mental health professionals and nonuse of mental health care or prescription medications owing to cost among adults with significant psychological distress.nnnMETHODSnIn samples drawn from the National Health Interview Survey of 1997-2002, multiple logistic regression analysis was used to examine the association of survey year with mental health professional contacts and nonuse of mental health care or prescription medications owing to cost.nnnRESULTSnThe prevalence of any contact with mental health professionals increased from 29.1% in 1997 to 35.5% in 2002 (P<.05). The prevalence of nonuse of services because of cost also increased-from 15.6% to 20.0% for mental health care (P<.05) and from 27.7% to 34.1% for medication use (P<.001). Age, racial/ethnic, income, and insurance status disparities in receiving care persisted over the study period.nnnCONCLUSIONSnThe number of individuals in need of mental health care who contacted mental health professionals grew in recent years, as did the number of individuals who encountered cost barriers to such care. Barring dramatic improvements in health insurance coverage, more individuals will likely face such barriers in coming years.

Comparison of Sexual Offenders Against Children with Sexual Offenders Against Adolescents and Adults: Data from the New York State Sex Offender Registry

Objective. To examine whether sexual offenders against children have fewer characteristics associated with impulsive-aggression and more characteristics associated with aberrant sexual arousal than do sexual offenders against adolescents and adults. Methods. Data on 837 sex offenders from the New York State Sex Offender Registry for the five counties of New York City were analyzed using multinomial logistic regression. Results. Compared to offenders against older age groups, offenders against children were older and less likely to use force or a weapon. They were more likely to molest males or victims of both genders than female victims only, and they were also more likely to molest known victims. They were also more likely to commit multiple acts and deviate intercourse and less likely to commit sexual intercourse. Offenders against adolescents largely fell between the two other groups. Conclusions. Relative to sexual offenders against adults, pedophiles may be characterized more by aberrant sexual arousal than by impulsivity and aggression. This distinction has significant implications for the selection of targeted treatments and for the direction of future research.

Psychometric Properties of a Persian-Language Version of the Automatic Thoughts Questionnaire: ATQ-Persian

Aims: To examine the psychometric properties of a Persian-language version of Hollon and Kendalls (1980) Automatic Thoughts Questionnaire (ATQ-Persian) – a measure of negative automatic thoughts in depression. Methods: In a sample of 125 student volunteers from two Iranian universities we assessed the internal consistency and test–retest reliability of ATQ-Persian, and examined its concurrent validity against the Beck Depression Inventory (Beck et al., 1996). We also examined the factor structure of the test through comparing the fit of various proposed factor-analytic models to the data using confirmatory factor analysis. Results: ATQ-Persian had excellent internal consistency (Cronbachs alpha = 0.96), test–retest reliability (r = 0.84) and correlation with the Beck Depression Inventory (r = 0.77). Using a receiver operating characteristics curve, a score of 53 on ATQ-Persian was associated with a sensitivity of 89% and a specificity of 78% for detecting moderate to severe depression defined through Beck Depression Inventory. None of the proposed factorial models fitted the data well. However, models with correlated factors generally provided better fit than models with orthogonal factors, suggesting that the latent factors underlying ATQ-Persian are highly correlated. Conclusions: These data support the reliability and validity of ATQ-Persian as a measure of negative automatic thoughts in depression.