Over 26% of adults in the United States suffer from mental illness, an affliction more debilitating than heart disease, diabetes and cancer. Almost 9% of adults suffer from major depressive disorder and almost 2% from bipolar disorder. More than one million people attempt suicide each year. Annual costs related to mental health care and lost productivity/years of life have been estimated at almost 300 billion dollars. Mental health researchers at the Division of Research have conducted research in depression, bipolar disorder, suicide, medication adherence, smoking and serious mental illness, health effects of gender reassignment therapies, costs of mental health care, and the use of modern technology to treat and prevent mental illness. They use epidemiologic, comparative effectiveness and clinical trial methodologies to: 1) answer questions about the prevalence of different types of mental illness and the types of care dispensed to diverse populations; 2) study the effectiveness of different treatments; and 3) develop and test new models of care.
Our researchers work closely with both primary and specialty care providers of mental health care when conducting research and disseminating and implementing new evidence-based clinical practices. They also conduct quality improvement projects such as exploring how transcranial magnetic stimulation might best be used to treat depression.
Our researchers are active participants and leaders in the Mental Health Research Network (MHRN), funded by the National Institute of Mental Health. The MHRN is a consortium of research centers affiliated with 13 large nonprofit integrated health care systems serving a diverse and representative population of over 12 million members across 15 states. Recently our researchers were partners in a widely publicized MHRN study which found that safety warnings about anti-depressants were associated with a significant drop in anti-depressant use and a simultaneous increase in suicide attempts.
Kaiser Permanente researchers and clinicians developed one of the first effective tele-health programs for depression. The widely disseminated program, delivered by primary care nurses, was shown to significantly reduce depression, improve mental functioning and increase patient satisfaction with treatment. Kaiser Permanente researchers and clinicians also have participated in one of the largest clinical trials for depression, the IMPACT collaborative care management program for late life depression. IMPACT participants experienced less depression, less functional impairment and a better quality of life than study participants randomized to usual primary care for depression. The IMPACT collaborative care model has since been broadly propagated.
Researchers — in partnership with clinicians, patients and colleagues — have developed an effective, web-delivered program to reduce depression known as eCare for Moods™. The program includes interactive care management, patient self-management, and clinical decision and panel management support. Over two years, eCare participants experienced less severe and less frequent depression, better overall mental health, better coping skills, and more satisfaction with their mental health care compared to individuals receiving usual specialty psychiatric care.
Serious Mental Illness
Individuals with serious mental illness (SMI) have high utilization of health care services, suffer disproportionately from chronic diseases and substance abuse, and die, on average, 25 years prematurely. Bringing recognition to this underserved group, we have conducted research that emphasizes the need for progressive interventions that account for "upstream" social determinants of health, including the social, political, and economic context in which individuals with SMI are embedded. For example, our researchers have found that persons with SMI live in neighborhoods with a greater density of tobacco outlets relative to the general population, and among those with SMI, greater tobacco outlet density is associated with heavier smoking, lowered self-efficacy with quitting, and poorer mental health.
Results from our studies have also indicated that individuals with SMI, particularly those who are younger, have racial/ethnic minority status, and have been diagnosed with a psychotic disorder, are vulnerable to menthol cigarette use, suggesting that FDA regulation of menthol may prevent initiation and may encourage cessation in this vulnerable group.
Adverse Childhood Experiences
Adverse childhood experiences (ACEs) — including physical, sexual or emotional abuse, neglect, living with a substance abusing or mentally ill parent, having a parent who is incarcerated, and witnessing domestic violence — are alarmingly common. ACEs are robust predictors of long-term psychological and physical health consequences as well as greater healthcare utilization and healthcare costs in adulthood. Researchers have investigated the association between ACEs and problematic drinking in adulthood, with key results indicating that exposure to ACEs increases vulnerability to stress-related drinking in women. In addition, the relation between ACEs and alcohol use disorders may be partially mediated by broader exposure to chronic family stressors (e.g., parental drug use, low socioeconomic status) in men.
ACES are also associated with increased risk for a variety of negative prenatal and perinatal outcomes in women, including prenatal depression and anxiety, obstetric problems and premature delivery. The prenatal period provides a unique window of opportunity to impact a family's long-term health through standardized screening for ACEs and identification of women who may be in need of extra support or services. We are beginning to conduct research to evaluate the feasibility and acceptability of screening for ACES as part of standard prenatal care in order to learn more about the barriers to or facilitators of implementing an ACEs screening in a real-world health care setting.