Steven C. Marcus

National Patterns in Antidepressant Medication Treatment

CONTEXT Antidepressants have recently become the most commonly prescribed class of medications in the United States. OBJECTIVE To compare sociodemographic and clinical patterns of antidepressant medication treatment in the United States between 1996 and 2005. DESIGN Analysis of antidepressant use data from the 1996 (n = 18 993) and 2005 (n = 28 445) Medical Expenditure Panel Surveys. SETTING Households in the United States. PARTICIPANTS Respondents aged 6 years or older who reported receiving at least 1 antidepressant prescription during that calendar year. MAIN OUTCOME MEASURES Rate of antidepressant use and adjusted rate ratios (ARRs) of year effect on rate of antidepressant use adjusted for age, sex, race/ethnicity, annual family income, self-perceived mental health, and insurance status. RESULTS The rate of antidepressant treatment increased from 5.84% (95% confidence interval [CI], 5.47-6.23) in 1996 to 10.12% (9.58-10.69) in 2005 (ARR, 1.68; 95% CI, 1.55-1.81), or from 13.3 to 27.0 million persons. Significant increases in antidepressant use were evident across all sociodemographic groups examined, except African Americans (ARR, 1.13; 95% CI, 0.89-1.44), who had comparatively low rates of use in both years (1996, 3.61%; 2005, 4.51%). Although antidepressant treatment increased for Hispanics (ARR, 1.75; 95% CI, 1.60-1.90), it remained comparatively low (1996, 3.72%; 2005, 5.21%). Among antidepressant users, the percentage of patients treated for depression did not significantly change (1996, 26.25% vs 2005, 26.85%; ARR, 0.95; 95% CI, 0.83-1.07), although the percentage of patients receiving antipsychotic medications (5.46% vs 8.86%; ARR, 1.77; 95% CI, 1.31-2.38) increased and those undergoing psychotherapy declined (31.50% vs 19.87%; ARR, 0.65; 95% CI, 0.56-0.72). CONCLUSIONS From 1996 to 2005, there was a marked and broad expansion in antidepressant treatment in the United States, with persisting low rates of treatment among racial/ethnic minorities. During this period, individuals treated with antidepressants became more likely to also receive treatment with antipsychotic medications and less likely to undergo psychotherapy.

National trends in the use of psychotropic medications by children.

OBJECTIVES Little information exists on national trends in the use of psychotropic medication by children and adolescents. The objective of this report is to compare patterns and predictors of psychotropic medication use by children and adolescents in the United States in 1987 and 1996. METHOD An analysis of medication use data is presented from two nationally representative surveys of the general population focusing on children 18 years of age and younger who used one or more prescribed psychotropic medication during the survey years. Rates of stimulant, antidepressant, and other psychotropic medication use are reported. RESULTS The overall annual rate of psychotropic medication use by children increased from 1.4 per 100 persons in 1987 to 3.9 in 1996 (p < .0001). Significant increases were found in the rate of stimulant use (0.6 per 100 persons to 2.4 per 100 persons), antidepressant use (0.3 per 100 persons to 1.0 per 100 persons), other psychotropic medications (0.6 per 100 persons to 1.2 per 100 persons), and coprescription of different classes of psychotropic medications (0.03 per 100 persons to 0.23 per 100 persons), especially antidepressants and stimulants. Rates of antipsychotic and benzodiazepine use remained stable. In 1996, stimulant use was especially common in children aged 6 to 14 years (4.1 per 100), and antidepressant use was common in children aged 15 to 18 years (2.1 per 100 persons). CONCLUSION Between 1987 and 1996, there was a marked expansion in use of psychotropic medications by children, especially stimulants and antidepressants.

Domestic Violence and Children: Prevalence and Risk in Five Major U.S. Cities

OBJECTIVE Children witnessing domestic violence is a major national concern. The present study provided data on the prevalence of childrens exposure to substantiated cases of adult female assaults in five U.S. cities. METHOD Data for this study were drawn from the Spouse Assault Replication Program (SARP) database, collected from police officers and female victims of misdemeanor domestic violence. In addition, household demographic data and data on involvement of children in the violent incidents were collected. Data from the SARP households were compared with census data from each city. RESULTS Results indicated that children were disproportionately present in households with domestic violence and that young children were disproportionately represented among these children. Moreover, these children were exposed to excessive levels of additional developmental risk factors and they were involved in the incidents to varying degrees. CONCLUSIONS These findings underscore the importance of establishing a more rigorous interdisciplinary, scientific research agenda to inform assessment and treatment efforts for a very vulnerable group of children who witness domestic violence, children aged 0 through 5 years.

Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey.

BackgroundAlthough growing concern has been expressed about premature medical mortality in persons with mental illness, limited data are available quantifying the extent and correlates of this problem using population-based, nationally representative samples. MethodsThe study used data from the 1989 National Health Interview Survey mental health supplement, with mortality data through 2006 linked through the National Death Index (80,850 participants, 16,435 deaths). Multivariable models adjusting for demographic factors assessed the increased hazard of mortality adding socioeconomic status, healthcare variables, clinical factors first separately, and then together. ResultsPersons with mental disorders died an average of 8.2 years younger than the rest of the population (P < 0.001). Adjusting for demographic factors, presence of a mental illness was associated with a significant risk of excess mortality, (hazard ratio=2.06, 95% confidence interval=1.71-2.40), with 95.4% of deaths owing to medical rather than unnatural causes. Adding socioeconomic variables to the model, the hazard ratio was 1.77 (P < 0.001); adding health system factors, it was 1.80 (P < 0.001)); adding baseline clinical characteristics, the hazard ratio was 1.32 (P < 0.001). After adding all the 3 groups of variables simultaneously, the association was reduced by 82% from baseline and became statistically nonsignificant (hazard ratio=1.19, P=0.053). ConclusionsThe results of the study underscore the complex causes and high burden of medical mortality among persons with mental disorders in the United States. Efforts to address this public health problem will need to address the socioeconomic, healthcare, and clinical risk factors that underlie it.

National Trends in the Treatment for Depression From 1998 to 2007

CONTEXT The rate of outpatient treatment of depression increased markedly in the United States between 1987 and 1997; it is not known whether this trend has continued. OBJECTIVE To assess national trends in the outpatient treatment of depression between 1998 and 2007. DESIGN AND SETTING Analysis of service utilization data from 2 nationally representative surveys of the US household population, the 1998 (n = 22 953) and 2007 (n = 29 370) Medical Expenditure Panel Surveys. PARTICIPANTS Nationally representative sample of the US household population. MAIN OUTCOME MEASURES The rate of depression treatment and, among patients who received treatment, the rate of antidepressant medication use, psychotherapy, number of outpatient treatment visits, and expenditures. RESULTS The rate of outpatient treatment for depression increased from 2.37 per 100 persons in 1998 to 2.88 per 100 persons in 2007 (adjusted odds ratio [AOR], 1.18; 95% confidence interval [CI], 1.03-1.35). The percentage of treated patients who used antidepressants was little changed from 73.8% (1998) to 75.3% (2007) (AOR, 1.14; 95% CI, 0.85-1.51), but the percentage of those receiving psychotherapy declined from 53.6% (1998) to 43.1% (2007) (AOR, 0.71; 95% CI, 0.53-0.95). National expenditures for the outpatient treatment of depression increased from

National Trends in Outpatient Psychotherapy

10.05 billion to

Effectiveness of electroconvulsive therapy in community settings

12.45 billion (z = 1.73, P = .08). This was primarily driven by an increase in medication expenditures from

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

4.59 billion (1998) to

Training and Consultation to Promote Implementation of an Empirically Supported Treatment: A Randomized Trial

6.60 billion (2007) (z = 2.88, P = .004), which in turn was related to an increase in Medicare expenditures for depression treatment from

Implications of Childhood Autism for Parental Employment and Earnings

0.52 billion (1998) to