Consumer advertising of psychiatric medications biases the public against nonpharmacological treatment.

In the United States, antidepressant medications are heavily promoted through direct-to-consumer advertising, which is regulated by the Food and Drug Administration (FDA). Advertisements for selective serotonin reuptake inhibitors frequently contain information inconsistent with the scientific evidence on the treatment of depression with antidepressants. The information presented serves to promote the use of antidepressants by biasing the public against nonpharmacological treatment of depression. While the FDA enforces regulations requiring fair and balanced presentation when comparing one medication to another, there appears to be no action taken against pharmaceutical companies that distort scientific evidence in order to disparage nonmedical approaches to depression.

Self-directed care: participants' service utilization and outcomes.

OBJECTIVE: Self-directed care (SDC) is a mental health service delivery model in which participants budget the state dollars allotted for their care to purchase the goods and services they deem most appropriate for achieving their recovery goals. This study examines the demographic characteristics, service utilization patterns, and outcomes of individuals enrolled in the Florida Self-Directed Care (FloridaSDC) program, which is the oldest and most established SDC program in the United States for individuals diagnosed with a severe and persistent mental illness. METHOD: This is a naturalistic descriptive study in which demographic, service utilization, and outcome data (i.e., Functional Assessment Rating Scale (FARS) scores, days in the community, days worked, monthly income, discharge status) were collected from the clinical and fiscal records of 136 FloridaSDC participants. RESULTS: Key findings suggest that FloridaSDC participants had very little income and largely utilized their budgets to subsidize their living expenses. Though most participants did not work or earn income and very few left the program due to employment, participants' FARS scores improved modestly and nearly all participants remained in the community throughout the study period. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Participants' service purchases were rational given the poverty in which they live, and their outcomes did not suffer when they controlled decisions regarding their service needs. These findings highlight the utility and value of the personalized budgeting and individualized planning components of SDC. Findings also point to the need for practitioners to implement innovative strategies to enhance participants' employment readiness and supported employment opportunities. (PsycINFO Database Record

Prescribing of psychiatric medication to bereaved parents following perinatal/neonatal death: an observational study.

To examine psychiatric prescribing in response to perinatal/neonatal death, we analyzed data from a cross-sectional survey of 235 bereaved parents participating in an online support community. Of the 88 respondents prescribed medication, antidepressants were most common (n = 70, 79.5%) followed by benzodiazepines/sleep aids (n = 18, 20.5%). Many prescriptions were written shortly after the death (32.2% within 48 hr, 43.7% within a week, and 74.7% within a month). Obstetrician/gynecologists wrote most prescriptions given shortly after loss. Most respondents prescribed antidepressants took them long-term. This sample is select, but these data raise disturbing questions about prescribing practices for grieving parents.

Child death in the United States: productivity and the economic burden of parental grief.

This article examines the economic consequences associated with the death of a child. The economic costs (funeral and medical expenses and productivity losses) of child death 6 months following the death were estimated based on 213 parents who had experienced the death of a child (usually unexpectedly and predominantly mothers). Findings suggest that productivity losses associated with child death comprise most of the costs and that the economic effects are substantial. Costs associated with on-the-job productivity losses ("presenteeism") outweigh the costs associated with absenteeism. To date, no research has empirically measured both absenteeism and presenteeism following bereavement.

A parent's tears: primary results from the traumatic experiences and resiliency study.

This study examined health/mental health status, family functioning, and resiliency among a sample of bereaved parents (N = 503). Participants were recruited from an online support community to complete an online survey instrument (response rate = 51.75%). The questionnaire contained an array of self-report instruments, such as the Hopkins Symptoms Checklist-25 (HSCL-25), the Impact of Event Scale-Revised (IES-R), and the Family Assessment Device (FAD), as well as open-ended questions. Many respondents scored over the clinical cut-off for the HSCL-25 (51.3%, n = 258) and IES-R (42.3%, n = 213). IES-R scores were negatively correlated with years-since loss (r = -0.24, p < .05). In narrative responses, participants described a wide range of deeply impactful mental and physical health problems. The results indicate significant clinical distress in this sample of bereaved parents, with many reporting enduring psychological, familial, and health consequences following the death of a child.

Knowledge of undisclosed corporate authorship ("ghostwriting") reduces the perceived credibility of antidepressant research: a randomized vignette study with experienced nurses.

BACKGROUND: There is much concern regarding undisclosed corporate authorship ("ghostwriting") in the peer-reviewed medical literature. However, there are no studies of how disclosure of ghostwriting alone impacts the perceived credibility of research results. FINDINGS: We conducted a randomized vignette study with experienced nurses (n = 67), using a fictional study of antidepressant medication. The vignette described a randomized controlled trial and gave efficacy and adverse effect rates. Participants were randomly assigned to one of two authorship conditions, either (a) traditional authorship (n = 35) or (b) ghostwritten paper (n = 32), and then completed a perceived credibility scale. Our primary hypothesis was that the median perceived credibility score total would be lower in the group assigned to the ghostwritten paper. Our secondary hypotheses were that participants randomized to the ghostwritten condition would be less likely to (a) recommend the medication, and (b) want the psychiatrist in the vignette as their own clinician. We also asked respondents to estimate efficacy and adverse effect rates for the medication.There was a statistically significant difference in perceived credibility among those assigned to the ghostwriting condition. This amounted to a difference of 9.0 points on the 35-point perceived credibility scale as tested through the Mann-Whitney U test. There was no statistically significant difference between groups in terms of recommending the medication, wanting the featured clinician as their own, or in estimates of efficacy or adverse effects (p > .05 for all such comparisons). CONCLUSION: In this study, disclosure of ghostwriting resulted in lower perceived credibility ratings.

Knowledge of ghostwriting and financial conflicts-of-interest reduces the perceived credibility of biomedical research.

BACKGROUND: While the impact of conflicts-of-interest (COI) is of increasing concern in academic medicine, there is little research on the reaction of practicing clinicians to the disclosure of such conflicts. We developed two research vignettes presenting a fictional antidepressant medication study, one in which the principal investigator had no COI and another in which there were multiple COI disclosed. We confirmed the face validity of the COI vignette through consultation with experts. Hospital-based clinicians were randomly assigned to read one of these two vignettes and then administered a credibility scale. FINDINGS: Perceived credibility ratings were much lower in the COI group, with a difference of 11.00 points (31.42%) on the credibility scale total as calculated through the Mann-Whitney U test (95% CI = 6.99 - 15.00, p < .001). Clinicians in the COI group were also less likely to recommend the antidepressant medication discussed in the vignette (Odds Ratio = 0.163, 95% CI = .03 = 0.875). CONCLUSIONS: In this study, increased disclosure of COI resulted in lower credibility ratings.