OBJECTIVE: This study explored how HIV care differs for infected persons with and without severe mental illness. METHODS: Data were obtained through interviews with and chart review of 295 patients with severe mental illness and HIV from public mental health agencies in Los Angeles County and New York City. Data were compared with data from 1,294 HIV patients without severe mental illness from a separate national probability sample. Measures were difficulty obtaining care, whether patients recommend their HIV care provider, hospital problem score, functional health status, and disability days. RESULTS: In Los Angeles, HIV patients with severe mental illness were more likely than those without severe mental illness to have difficulty obtaining care (p

OBJECTIVE: This study examined the relationship between social networks and mental health services utilization and expenditures. METHODS: A sample of 522 Medicaid mental health consumers was randomly selected from the administrative records of Colorado's Department of Health Care Policy and Financing. The administrative records contain information on utilization of services and expenditures of Medicaid beneficiaries within Colorado's Mental Health Services. In addition to the administrative records, social network and psychosocial data were gathered through longitudinal survey interviews. The interviews were conducted at six-month intervals between 1994 and 1997. Measures used in the regression analysis included demographic characteristics, clinical diagnoses, the social network index, expenditures, and utilization variables. RESULTS: The social network index was positively associated with utilization of and expenditures for inpatient services in local hospitals but negatively associated with expenditures for inpatient services in state hospitals or outpatient services. Relationships with family were negatively related to expenditures for outpatient services. Relationships with friends were positively associated with utilization of and expenditures for psychiatric inpatient services in local hospitals. CONCLUSIONS: Consumers who had higher social network index scores utilized more inpatient psychiatric services in local hospitals and had higher expenditures than those who had lower scores. Consumers who had higher social network index scores also had lower expenditures for inpatient services in state hospitals and outpatient services than those who have lower scores. Findings suggest that social network is associated with mental health utilization and expenditures in various ways, associations that need to be researched further.

OBJECTIVES: This study explored tensions between biomedical and psychosocial illness models and between the public health goal of stigma reduction and patients' perceptions of helplessness. Patients' etiological beliefs and use of language are considered as possible pathways to improved care. METHODS: Qualitative and quantitative data were obtained from 18 adults attending a mood disorders support group in Dublin, Ireland. RESULTS: Respondents reported feelings of helplessness concerning the occurrence of depressive episodes. When describing episodes of wellness and depression, respondents used a "light switch" metaphor to indicate this lack of control. For several respondents, acceptance of biomedical causality was linked to helplessness. In contrast, spiritual beliefs offered hope. CONCLUSIONS: Alleviating patients' sense of responsibility may reduce their guilt, but patients' perceptions of illness uncontrollability may diminish their sense of agency, reinforce depressive attributional styles, and undermine overall treatment outcomes. Communication and the patients' involvement in decisions are vital to treatment.

OBJECTIVE: This study sought to examine whether ethnic differences occur in the presentation of patients with complicated grief or their treatment outcome. METHODS: Analyses of a randomized controlled trial comparing a novel psychotherapy for complicated grief with interpersonal psychotherapy contrasted the clinical presentation, treatment alliance, and rates of treatment completion and response for 19 African Americans with complicated grief and 19 Caucasian Americans with complicated grief matched by sex, age, and baseline grief severity. Participants were randomly assigned to receive 16 sessions of either standard interpersonal psychotherapy or interpersonal psychotherapy enhanced with focused complicated grief components. RESULTS: No differences were found in any clinical or treatment-related measure. CONCLUSIONS: African Americans and Caucasian Americans with complicated grief did not differ significantly in clinical presentation, treatment alliance, treatment completion, and outcome. The results suggest that standard treatment for complicated grief can be provided successfully for different racial and economic groups.

OBJECTIVE: This study aimed to increase the understanding of the clinical characteristics and utilization of health services among veterans with comorbid bipolar disorder and posttraumatic stress disorder (PTSD). METHODS: A retrospective chart review was conducted that examined the clinical and health service use data of 139 male veterans with bipolar disorder (N=49), PTSD (N=49), or comorbid bipolar disorder and PTSD (N=41) who obtained services over two years from the Department of Veterans Affairs Salt Lake City Health Care System. RESULTS: Compared with patients with bipolar disorder or those with PTSD alone, those with both conditions had significantly higher mean Clinical Global Impression-Severity scores and required more frequent inpatient psychiatric treatment. Patients with both conditions and those with bipolar disorder were significantly less likely to have received psychotherapy and antidepressant pharmacotherapy than patients with PTSD. CONCLUSIONS: Patients with both conditions have a more severe illness course than those with bipolar disorder alone. Psychotherapy and antidepressant pharmacotherapy may be underutilized among patients with comorbid bipolar disorder and PTSD.

Seven years ago the South Carolina Department of Mental Health developed a statewide effort to improve its response to consumers who are trauma survivors. The initiative's goals included sensitizing stakeholders to the impact of trauma, influencing policies, educating and training clinicians, addressing concerns about the safety and dignity of psychiatric settings (for example, sanctuary trauma), and increasing knowledge by supporting a strong empirical research platform. In the brief report presented here, the authors describe the past seven years in terms of obstacles encountered, progress, and future directions of this initiative in the hope of providing information and guidance to other state systems.