Four articles in this issue present initial results from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the prevalence and correlates of DSM-IV disorders. In the first article, Kessler et alArticle show that the majority of Americans meet criteria for at least 1 DSM-IV disorder at some time in their life, with first onset usually occurring either in childhood or in adolescence. Prevalence appears to have increased in recent cohorts.
Wang et alArticle, in a second NCS-R report, show that the vast majority of people with lifetime mental disorders eventually seek treatment if the disorders persist. However, long delays are the norm, ranging between 6 and 8 years for mood disorders and 9 and 23 years for anxiety disorders, with even longer delays among early-onset cases and among people in disadvantaged social positions. The authors conclude that interventions are needed to reduce delays in initial treatment contact.
High prevalence estimates in epidemiological surveys have led to speculation that many community cases are mild. Kessler et alArticle confirm this suspicion in a third NCS-R report, which finds that most cases of 12-month DSM-IV disorder are either mild (40.4%) or moderate (37.3%). The remaining 22.3% are classified as serious. Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
In the final NCS-R article, Wang et alArticle show that the majority of 12-month cases remain untreated (59.1%). Furthermore, even though a higher proportion of patients in specialty (48.0%) than general medical (12.8%) care receive treatment that exceeds a minimal threshold of adequacy, a majority in both sectors remain undertreated. This is especially true in traditionally underserved groups. These results suggest that interventions are sorely needed to enhance treatment initiation and quality.
Using a large case-control study, Green and colleaguesArticle investigated the possible role of the schizophrenia susceptibility gene, neuregulin 1 (NRG1), in bipolar disorder. They found that NRG1 influenced susceptibility in bipolar disorder, particularly the subset of cases with mood-incongruent psychotic features. Their findings, which demonstrate the existence of biological overlap across the traditional kraepelinian divide, have implications for the understanding of pathogenesis and nosology of the functional psychoses.
Sacco et alArticle demonstrate that cigarette smoking may selectively enhance visuospatial working memory and sustained attention in patients with schizophrenia and that this enhancement may depend on nicotinic acetylcholine receptor stimulation. These findings suggest that smoking-related remediation of neuropsychological deficits may be an important determinant for high rates of smoking in schizophrenia, which may have implications for treatment of nicotine dependence and cognitive deficits in this disorder.
To examine the association between depression and heart rate variability, Gehi et alArticle assessed major depression and 24-hour heart rate variability (HRV) in 873 older adults with stable coronary heart disease. Of these, 195 (22%) had major depression. Overall, they found no evidence of an association between depression and HRV. These findings raise questions about whether low HRV mediates the association between depression and adverse outcomes in patients with stable coronary disease.
Abelson et alArticle examined the impact of a brief cognitive intervention on subjective and hypothalamic-pituitary-adrenal axis responses to pentagastrin, a cholecystokinin-B agonist that releases cortisol and triggers panic attacks. The intervention attempted to reduce “stress” by enhancing familiarity, coping, and sense of control. It significantly reduced cortisol responses in healthy subjects and in patients with panic disorder and attenuated exaggerated anxiety responses in patients. Familiarity, control, and/or coping can modulate biological stress systems in healthy people, and sensitivity to such factors may shape laboratory abnormalities in psychiatric patients.
Problem and pathological gambling are associated with many negative life events and with co-occurring psychiatric and substance use disorders. Scherrer et alArticle used a cohort and co-twin design to determine if health-related quality of life was impaired in problem and pathological gamblers. Poor quality of life in pathological gamblers is partly explained by genetics, family environment, and co-occurring substance use disorders.
Most investigations of sex differences in Alzheimer disease (AD) focus on differences in risk of disease. Barnes et alArticle used clinical and postmortem data to examine whether the relation between AD pathology and clinical status proximate to death differs for men and women. They found a substantially stronger association between AD pathology and clinical AD in women than in men, suggesting that AD pathology is more likely to be expressed clinically as dementia in women.