Clinical epidemiology of urban violence: responding to children exposed to violence in ten communities

This study explores the clinical epidemiology of children's exposure to violence as addressed by a program in which mental health clinicians work with law-enforcement agents in 10 U.S. cities. Data were collected on all participants contacted by the Child Development Community Policing Program (N = 7,313 individuals involved in 2,466 community incidents). Multivariate regression was used to examine sociodemographic and clinical correlates of the role of participants (victim, offender, or witness), location, and type of incident. The majority of incidents occurred in participants' homes. Adolescents were at a higher risk than children of being: (a) victimized, (b) involved in incidents outside their home, (c) experiencing a threat to their lives, and (d) suffering physical injuries. Males were more likely to be offenders than females, and to be subjected to physical injuries or involved in incidents that imposed a threat to their life. Females were significantly more likely to be victimized.     

Incarceration among male veterans: relative risk of imprisonment and differences between veteran and nonveteran inmates

Using data from national surveys of jail and prison inmates conducted in 2002 and 2004, the authors found that male veterans in the age group that entered military service in the early years of the All Volunteer Force (AVF) were at greater risk of incarceration than nonveterans of similar age and ethnicity, whereas veterans who enlisted in later years of the AVF had less risk of incarceration than nonveterans. Although White veterans tend to have greater risk of incarceration than nonveteran Whites, Black and Hispanic veterans were at less risk than their nonveteran peers, although they are at greater risk than White veterans. These patterns are best explained by changes over time and in differential effects across racial/ethnic groups of recruiting practices, accession standards, and in civilian employment opportunities rather than combat trauma or other adverse experiences in the military. For example, reductions in the relative risk for incarceration of veterans during the AVF appear to generally result from increases in recruit qualifications and socioeconomic status due to greater military pay, improved skill in recruiting, and higher accession standards.     

The growth of psychopharmacology in the 1990s: evidence-based practice or irrational exuberance

The rapid growth in sales of psychotropic medications during the late 1980s and 1990s, eventually reaching $20 billion/year, reflected the increased use of seritonin reuptake inhibitors for depression and atypical antipsychotics for schizophrenia. Recently, however, some of the therapeutic claims for these medications have been challenged, and under-appreciated risks have turned out to be significant liabilities. Drug manufacturers increasingly dominate clinical trials research and evidence suggests that study designs and data presentations have been slanted to show products in a favorable light while unfavorable data were suppressed. At the same time, during the 1990s, potentially independent voices did not effectively or consistently present countervailing views. The extensive financial ties between the pharmaceutical industry and academic researchers, professional associations, and consumer groups may also have discouraged expression of critical views. Additionally, the narrow legal mandate of the FDA to evaluate the safety and efficacy of new drugs only in comparison to placebo (rather than in comparison to other treatments) probably limited its contribution. In the absence of reliable, impartial research on the risk and benefits of psychotropic medications, both before and after they are brought to market, pharmacy benefits management cannot achieve its goal of maximizing health care benefits per dollar spent. Further institutional support is needed for independent research, either conducted or funded by the federal government.     

Elevated Risk of Arrest for Veteran's Administration Behavioral Health Service Recipients in Four Florida Counties

This paper examines the relative contribution of mental and substance abuse disorders to criminal justice involvement by examining the relative risk of arrest for three groups of adult male recipients of VA behavioral health care services. These groups include men served for both substance abuse and mental health, for only substance abuse, and for only mental health. The relative risk of multiple offences is compared to relative risk of a single offense for each group. Results indicated that relative risk of multiple arrests for the dual diagnosis group is substantially greater than for either of the single diagnosis groups, and greater than the relative risk for recipients of nonbehavioral health services. Relative risk of arrest for recipients of only mental health services is no different than the relative risk for other veterans living in the region under examination.