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In This Issue of JAMA Psychiatry
April 2018


JAMA Psychiatry. 2018;75(4):309. doi:10.1001/jamapsychiatry.2017.2972


Posttraumatic stress disorder (PTSD) often interferes with a person’s ability to work, but it is not known which supports are most effective in supporting individuals with PTSD to stay employed. Davis and colleagues conducted a trial in which 541 veterans with chronic PTSD were randomized to individual placement and support or transitional work assignments and found that those receiving individual placement and support were more likely to achieve steady employment over 18 months. In an Editorial, Mueser discusses the implications of this research for vocational rehabilitation in PTSD.


Continuing Medical Education

There is a need for improved shared decision-making approaches to mental health care for ethnic/racial minorities. Alegria and colleagues conducted a randomized clinical trial with 312 community clinic patients in which clinicians and patients received in-person interventions and telephone-based follow-up to improve shared decision making and quality of care. Greatest benefit for both measures was obtained when both patient and clinician received the intervention. This research indicates that shared decision-making interventions can improve clinical outcomes for ethnically/racially diverse patient populations.

No US national data are available on the prevalence and correlates of DSM-5–defined major depressive disorder and its specifiers. Hasin and colleagues used National Epidemiologic Survey on Alcohol and Related Conditions–III survey data from a representative sample of 36 309 US adults and found a lifetime prevalence of 20.6% for major depression; women and white adults were at greater risk, many other psychiatric disorders were highly comorbid, almost 70% of those with lifetime major depression had some treatment, and 75% met criteria for the anxious/distressed specifier. Thus, DSM-5 major depressive disorder is highly prevalent, comorbid, and disabling.

Many different medications are used to treat bipolar disorder, but little is known about the health outcomes associated with specific treatments. Lähteenvuo and colleagues examined risk of hospitalization among all patients in Finland who had been hospitalized for bipolar disorder and found that lithium was associated with lowest risk of all-cause hospitalization, and long-acting injectable antipsychotic medications were associated with better outcomes than identical oral antipsychotics. In an Editorial, Leucht and Davis discuss the use of registry-based real-world effectiveness research in psychiatry.


Depression is common among adults with HIV, but its association with HIV-related outcomes is not well understood. Pence and colleagues examined a clinical cohort of 5927 adult patients with HIV for 10 years and found that higher percentage of days spent with depression was associated with increased risk of missing a scheduled appointment, elevated viral load, and greater mortality. These findings indicate that chronicity of depression has an adverse effect on clinical outcomes for adults with HIV and motivate efforts to identify and treat depression in this population.