Mental illness affects a significant proportion of Americans and their families, and is often associated with physical health problems that can complicate treatment.
Mental health researchers at the Division of Research use epidemiologic, comparative effectiveness, machine learning, and clinical trial methods to: 1) answer questions about the prevalence of different types of mental illness and the types of care dispensed to diverse populations; 2) identify people at the greatest risk of developing mental health problems; 3) study the effectiveness of different treatments; and 4) 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. Our researchers partnered with MHRN investigators to study how evidence-based suicide risk reduction activities — screening, assessment, treatment, and transitions to care — are best implemented in health systems.
Kaiser Permanente researchers and clinicians developed one of the first effective telehealth 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.
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. Research here has confirmed these health disparities, particularly among people with dual mental health and substance use disorders. Current studies focus on how to improve quality of care for patients with comorbid mental health and medical conditions, and how to lower the risk of serious health outcomes for this vulnerable population.
We have also 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.
Suicide and attempted suicide are growing problems, and among the leading causes of mortality and morbidity for some vulnerable populations, such as adolescents. Clinicians and health systems need more effective tools for identifying people at risk of attempting suicide, in order to intervene early. Researchers here have been working to extend the groundbreaking suicide risk prediction models initially developed through the MHRN to maximize their feasibility for clinicians and clinical workflows and minimize any potential racial or ethnic biases
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.
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. Our research has evaluated screening for ACEs as part of standard prenatal care to learn more about implementing an ACEs screening in a real-world health care setting. Our researchers have also collaborated with clinical leaders to study the implementation of ACEs screening in pediatric primary care.