Britney Needs Privacy, Mental Illness Group Says

Pop singer Britney Spears, hospitalized in Los Angeles, for psychiatric treatment, needs privacy, according to a mental illness group.

"A media circus and reckless speculation has surrounded events in the life of pop singer Britney Spears and her family," says Michael Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI). "Professional ethics require that mental health professionals who have not examined or treated individuals not presume to diagnose them. A person's treatment and recovery from any illness also is entitled to privacy -- which in fact may be an important factor in recovery."

Spears was hospitalized this week at UCLA after an escort involving multiple police vehicles, including helicopters. Media scrutiny of Britney Spears has been intense this week, with mainstream media giving her story prominent play. Some journalists have been quoting mental health professionals to get their take on Spears' condition.

Spears' hospitalization follows a year of increasingly erratic behavior in which Spears' two young children were removed from her custody.

"In the case of Britney Spears, professional ethics also are involved which the media must confront," NAMI's Fitzpatrick says. "Roy Peter Clark, vice-president of the Poynter Institute, a leading center of journalism training and ethics, recently wrote. 'There is clearly a danger zone, when life and health are at stake, when the best thing the press can do is back off. That time for Spears is probably now.'"

However, the Spears case does offer a chance to discuss mental illness more broadly and just focus on Britney Spears, Fitzpatrick says.

"NAMI believes it is important that such discussions in our homes, offices,
schools, and stores, as well as in the media, be based on facts," he says. "What is needed--for anyone--is understanding and support. We encourage everyone to focus not on Britney Spears, but on all the ordinary people in our own communities who deserve our attention."

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Religion Might Keep Anxiety at Bay

For many, religious activity changes between childhood and adulthood, and a new study finds this could affect one’s mental health.

According to Temple University’s Joanna Maselko, women who had stopped being religiously active were more than three times more likely to have suffered generalized anxiety and alcohol abuse/dependence than women who reported always having been active.

“One’s lifetime pattern of religious service attendance can be related to psychiatric illness,” says Maselko, an assistant professor of public health and co-author of the study, which appears in the January issue of Social Psychiatry and Psychiatric Epidemiology.

Conversely, men who stopped being religiously active were less likely to suffer major depression when compared to men who had always been religiously active.

Maselko offers one possible explanation for the gender differences in the relationship between religious activity and mental health.

“Women are simply more integrated into the social networks of their religious communities. When they stop attending religious services, they lose access to that network and all its potential benefits. Men may not be as integrated into the religious community in the first place and so may not suffer the negative consequences of leaving,” Maselko says.

The study expands on previous research in the field by analyzing the relationship between mental health — anxiety, depression and alcohol dependence or abuse — and spirituality using current and past levels, said Maselko, who conducted the research when she was at Harvard University.

In the study sample, comprising 718 adults, a majority of men and women changed their level of religious activity between childhood and adulthood, which was critical information for the researchers.

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Patients with Depression Seeing Primary Care Physicians Frequently Don't Receive High Quality Care

Most patients with depression who are treated by primary care physicians do not receive care consistent with quality standards, according to a new RAND Corporation study.

Physicians had high rates of adherence to just one-third of the 20 measures of quality that researchers examined and had low rates of adherence to nearly half of the treatment recommendations studied, according to the report in the Sept. 4 edition of the Annals of Internal Medicine.

“These findings are important for patients since most cases of depression are diagnosed and treated in primary care settings,” says senior author Dr. Lisa Rubenstein, the study's senior author, and a senior scientist at RAND, a nonprofit research organization, and a physician at the Veterans Affairs Greater Los Angeles Healthcare System. “This shows that additional efforts are needed to improve the treatment of depression.”

The study also found that patients who received better-quality care reported fewer symptoms of depression up to two years after the start of treatment. The findings are among the first linking quality guidelines for depression treatment with improved patient outcomes in community settings.

“These are initial findings, but they suggest that programs that encourage doctors to follow treatment guidelines can help improve the long-term outlook for people with depression,” says Rubenstein, who also is affiliated with the David Geffen School of Medicine at UCLA.

Previous studies have shown that primary care providers do a poor job following guidelines for antidepressant use or psychotherapy. The RAND study is one of the first to assess primary care providers' adherence to a comprehensive set of treatment guidelines for depression.

Researchers from RAND Health examined the experiences of health care providers and patients who took part from 1996 to 1998 in the Quality Improvement for Depression collaboration, which was designed to encourage primary care providers to adopt comprehensive depression treatment guidelines developed by the U.S. Agency for Healthcare Research and Quality.

The RAND study examined the experiences of 1,131 patients with depression who were treated in 45 primary care practices across 13 states. Study sites ranged from small private practices to large managed care organizations. About 10 percent of patients in the study were from Veterans Affairs practices.

Researchers examined whether physicians and other health providers followed 20 different measures of quality, as well as analyzing patients' reports about the status of their depression at 12, 18 and 24 months after starting treatment.

The study found that most primary care physicians did a good job of diagnosing and beginning treatment for depression, with guidelines aimed at these issues followed more than 70 percent of the time. These guidelines includes items such as talking to patients about depression and closely monitoring patients newly placed on antidepressant medication.

But researchers found that primary care clinicians did less well following up with treatment over time. Fewer than half of the patients in the study completed the minimal course of treatment for either antidepressant drugs or psychotherapy, and only slightly more than half the depressed patients who were not treated were monitored closely.

The lowest quality of care occurred among the patients who exhibited the most serious symptoms, including patients who showed evidence of suicide or substance abuse. For example, among patients who had a previous suicide attempt, just 35 percent were referred to a mental health specialist over the next six months.

“Primary care physicians were good at diagnosing depression, but they did not do as good a good job of managing the sickest patients,” Rubenstein says. “Right now, primary care physicians don't have the tools necessary to decide which patients to treat and which to refer on to specialized mental health care.”

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