This study of depression treatment in the wake of FDA warnings regarding suicide in children taking antidepressants found that the frequency of depression diagnoses decreased and continues to decrease.  Substitute care did not compensate in non-adult groups and the authors conclude that the spillover effects of the FDA warnings were non-transitory, substantial, and diffuse in a large population.   

Libby, A. M., H. D. Orton, et al. (2009). Persisting decline in depression treatment after FDA warnings. Arch Gen Psychiatry. 66(6), 633-9. http://archpsyc.ama-assn.org/cgi/content/short/66/6/633

Authors: Anne M. Libby, Heather D. Orton, Robert J. Valuck.

This study found that, after years of increased use of antidepressants, a trend reversal began in the early 2000s which included decreasing rates of adequate antidepressant treatment.  The downward trend preceded FDA black-box warnings institute in 2004.   

Harman, J. S., M. J. Edlund, et al. (2009). Trends in antidepressant utilization from 2001 to 2004. Psychiatr Serv. 60(5), 611-6. DOI: 10.1176/appi.ps.60.5.611 http://psychservices.psychiatryonline.org/cgi/content/abstract/60/5/611 

Authors: Jeffrey S. Harman, Mark J. Edlund, John C. Fortne.

This study found that significant variation across states in both the rates of mental illness among nursing home admissions and estimated rates of admission among people with mental illness.  The study also found that newly admitted individuals with mental illness were younger and more likely to become long-stay residents than non-mentally ill individuals.  The authors suggest that state-level mental health and nursing home factors may influence the likelihood of long-term nursing home use for people with mental illnesses.

Grabowski, D. C., K. A. Aschbrenner, et al. (2009). Mental illness in nursing homes: variations across States. Health Affairs, 28(3), 689-700. DOI: 10.1377/hlthaff.28.3.689 http://content.healthaffairs.org/cgi/content/abstract/28/3/689

Authors: David C. Grabowski, Kelly A. Aschbrenner, Zhanlian Feng, Vincent Mor.

Examining data from 1999-2005, this study finds that the proportion of nursing home admissions with mental illness has overtaken the proportion with dementia.  The authors suggest that the new trends may be related to increased recognition of depression, availability of alternatives to nursing homes for persons with dementia, and increased specialization among nursing homes in the care of postacute, rehabilitation residents.  They suggest that, in light of these findings, it is crucial that nursing homes be allocated sufficient funding and resources to treat mental illness.

Fullerton, C. A., T. G. McGuire, et al. (2009). Trends in mental health admissions to nursing homes, 1999-2005. Psychiatr Serv, 60(7), 965-71. DOI: 10.1176/appi.ps.60.7.965 http://psychservices.psychiatryonline.org/cgi/content/abstract/60/7/965 

Authors: Catherine Anne Fullerton, Thomas G. McGuire, Zhanlian Feng, Vincent Mor, David C. Grabowski.

This paper examines the changing role of the state psychiatric hospital as the country's state hospital population has declined 95 percent over 50 years.  The authors discuss the forces shaping public mental hospitals, the challenges they face, and their potential role in a new mental health care system.   

Fisher, W. H., J. L. Geller, et al. (2009). The changing role of the state psychiatric hospital. Health Affairs, 28(3), 676-84. DOI: 10.1377/hlthaff.28.3.676 http://content.healthaffairs.org/cgi/content/abstract/28/3/676 

Authors: William H. Fisher, Jeffrey L. Geller, John A. Pandiani. 

This article examines the effects of economic policy on the provision of psychiatric hospital care.  The authors discuss the shift from long-stay public hospitals to private acute care and the cost shifting from states to federal and private payers through managed care.  The authors note that the result has been a shortage of psychiatric beds but also a better continuum of care, increased specialization within hospital psychiatry units, and an increased emphasis on patient choice and recovery.  

Sharfstein, S. S. and F. B. Dickerson (2009). Hospital psychiatry for the twenty-first century. Health Affairs, 28(3), 685-8. DOI: 10.1377/hlthaff.28.3.685 http://content.healthaffairs.org/cgi/content/abstract/28/3/685 

Authors: Steven S. Sharfstein, Faith B. Dickerson.