Developing mental health-care quality indicators: toward a common framework.

OBJECTIVE: Inconsistent performance measurement schemes hinder attempts to make international comparisons about mental health-care quality. This report describes a project undertaken by an international collaborative group that aims to develop a common framework of measures that will allow for international comparisons of mental health system performance. DESIGN: Representatives from each country submitted reports of quality measurement initiatives in mental health. Indicators were reviewed, and all measurable indicators were compiled and organized. Sample Twenty-nine programs from 11 countries and two cross-national programs submitted reports. METHODS: Indicators were evaluated according to measurable inclusion criteria. RESULTS: These methods yielded 656 total measures that were organized into 17 domains and 80 subdomains. CONCLUSIONS: No single program contained indicators in all domains, highlighting the need for a comprehensive, shared scheme for international measurement. By collecting and organizing measures through an inductive compilation of existing programs, the present study has generated a maximally inclusive basis for the creation of a common framework of international mental health quality indicators.

Parental depression, child mental health problems, and health care utilization.

BACKGROUND: Small controlled studies suggest that depression and other mental health problems are more common in children of parents with depression than in children of parents without depression. OBJECTIVES: This article examines relationships between parental depression and children's mental health problems and health care utilization in a nationally representative household sample of parents and their children. RESEARCH DESIGN: Cross sectional comparisons of sociodemographic characteristics, mental health problems and health expenditures of children whose parents either do or do not report depression in the 1997 Medical Expenditure Panel Survey data. SUBJECTS: A nationally representative sample of children, 3 to 18 years of age (n = 8,360) with one or more parents living in the household. MEASURES: Mental health problems, total health expenditures, and mental health expenditures. RESULTS: Children of parents with depression were approximately twice as likely as children of parents without depression to have a variety of mental health problems and were 2.8 times more likely to use mental health services in adjusted analyses. Among children with health and mental health expenditures, those whose parents report depression had significantly higher mean total annual child health expenditures ($282 vs. $214, t = 3.5, P = 0.0006) and child mental health expenditures ($513 vs. $338, t = 2.0, P = 0.05) than children whose parents did not report depression. CONCLUSIONS: Children of parents with depression are at increased risk for a range of health problems. Parental depression is also related to an increased child health and mental health service utilization and expenditure.