Mental and Behavioral Health
Topic Spotlight
About 1 in 5 American adults lived with a mental illness in 2019. (Centers for Disease Control and Prevention)
Poor mental health is estimated to cost the world economy approximately $6 trillion by 2030. (The Lancet-Global Health)
PCORI supports 157 comparative clinical effectiveness research studies related to mental and behavioral health. (As of February 2022)
Study Results that Support Better-Informed Decisions
ELEKT-D Study: Ketamine as Effective as ECT for Treating Major Depression
An estimated one in three people with clinical depression do not respond to antidepressants, limiting their treatment option to electroconvulsive therapy (ECT), which has been linked to physical and mental side effects and social stigma.
However, the PCORI-funded ELEKT-D study team reported that patients with nonpsychotic, treatment-resistant depression who received ketamine intravenously fared just as well those who received ECT. In the clinical trial, 55 percent of those receiving ketamine and 41 percent of those receiving ECT reported at least a 50 percent improvement in their depressive symptoms. The findings were published in the New England Journal of Medicine.
Mindfulness-Based Stress Reduction Just as Safe, Effective as Common Medication for Anxiety Disorders
Adults with anxiety disorders can experience comparable relief from either meditation or a commonly prescribed medication, according to findings from a PCORI-funded study published in JAMA Psychiatry.
For the study, lead researcher Elizabeth Hoge, MD, at Georgetown University Medical Center (GUMC), and her team compared how patients fared if they either took the drug escitalopram or participated in weekly mindfulness meditation classes with a trained instructor for eight weeks. More than 200 patients in Massachusetts, New York, and Washington, DC, participated in the study.
At the end of the eight weeks, both groups reported about a 20 percent reduction in the severity of their symptoms. The findings of the study provide people living with anxiety disorders information that can help them choose among options to find relief.
Matching Patients with Therapists Improves Mental Health Care
Matching patients seeking mental health care with therapists who have a good track record of treating the patients' particular needs and concerns resulted in better outcomes than not matching patients, according to findings from a PCORI-funded study published in JAMA Psychiatry.
Therapists tend to have areas of greatest experience and skill, according to the research team at University of Massachusetts Amherst. Matched patients had larger reductions in both specific and general mental health symptoms and impaired functioning and reported feeling less distressed. The match system used in the study required minimal disruption within the mental health care system in which it was tested.
Comparing Ways to Address Worry among Older Adults
As reported in Depression and Anxiety, a PCORI-funded research team at Wake Forest University found that cognitive behavioral therapy (CBT) and yoga were both effective at reducing worry and anxiety in older adults, while CBT improved sleep more than yoga.
In its study, the research team assigned half of the older adults to CBT or yoga by chance; the other half chose between CBT and yoga. These results held regardless of whether the participants chose their treatment or were assigned treatment at random.
Consequences of Changing, Adding Medications for People With Schizophrenia
This study reviewed how different drug combinations work for people with schizophrenia, who often take several medications to treat different symptoms of their disease. Through a review of 81,921 Medicaid records, the researchers found that people already taking an antipsychotic drug had different benefits and negative outcomes when they used another antipsychotic or added an antidepressant, anti-anxiety medication or mood stabilizer.
These results, published in JAMA Psychiatry, can help people with schizophrenia and their doctors when they consider adding medicines to patients’ treatment plans.
PCORI Stories
Enhancing the Delivery of Mental Health Services to Children in Underserved Areas
While many individuals have come to rely on telehealth services as a way to receive mental health care during the COVID-19 pandemic, children in lower-income families have experienced barriers to mental health care access that existed prior to the pandemic, and in many ways were exacerbated by it.
This PCORI Story highlights findings from a PCORI-funded study in Seattle that was designed to address these parents’ concerns using telehealth platforms and the community partnerships that came out of it.
Database Identifies Emerging Technologies, Innovations
PCORI’s Horizon Scanning Database offers healthcare decision makers findings about advancements in six key areas of interest: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, COVID-19, mental and behavioral health, and rare diseases. This database can be used by patients, care partners, and others to track advancements in care options.
Evidence Updates from PCORI-Funded Studies
Treating Depression in Patients with Kidney Failure Receiving Dialysis
Depression is common in people who are on dialysis and can affect kidney health, as well as overall well-being. A recent PCORI-funded study looked at how well two treatments for depression — talk therapy and an antidepressant — work for people on dialysis. View our latest Evidence Updates for clinicians and patients.
Treatment Options for Posttraumatic Stress Disorder
This pair of Evidence Updates highlights a review of research that found several kinds of therapies and medicines can reduce or stop symptoms for people who have experienced traumatic events, such as physical abuse, sexual violence, or natural disaster.
Antipsychotic Treatment for Children with Hyperactivity or Disruptive Disorders
Clinicians often prescribe antipsychotics for children and adolescents diagnosed with attention deficit hyperactivity disorder or disruptive, impulse-control, and conduct disorders. New evidence shows the benefits of antipsychotic treatment may be modest and the harms may be significant.
More Study Results that Support Better-Informed Decisions
Supporting Parents’ Mental Health from NICU to Home
A PCORI-funded study — comparing a program with and without peer support for parents leaving the neonatal intensive care unit (NICU) for home — has led to improved mental health screenings and the formation of a mental health taskforce at Children's National Hospital.
Peer Navigators Offer Relief to Latinx Patients with SMIs
In a group of 110 Latinx patients with serious mental illness (SMI) in an integrated care setting, those assigned a peer navigator–compared with those who were not assigned one–reported better outcomes, including quality of life and control over their overall health. Peer navigators can guide and support patients and help them overcome barriers to care.
Community Engagement in Care Improves Outcomes for People with Depression
People with depression who live in areas with fewer care resources had more positive long-term effects from participating in a coalition-based approach to care, compared with those in a program that offered staff training by experts in depression care. Under a coalition-based approach to care, clinicians with expertise in depression care and community members work together to train staff who provide depression care.
Education Program Helps Latino Parents Manage Their Children’s Health Care
Latino children with mental illness are half as likely to get mental health care as non-Latino white children. This study created an education program to teach Latino parents skills to help their children get the mental health care they need. Researchers found that the educational program improved parents’ activation skills as well as their skills for working with their children’s school systems.
Mental and Behavioral Health Study Spotlights
Help for Patients with Serious Mental Illness
People with SMIs are more at risk than the general population for preventable medical conditions, and often don’t receive the basic care they need to address them. Four PCORI-funded projects are using stakeholder input to test ways to help people with SMI get the physical health care they need.
Treating PTSD and Bipolar Disorders in Rural Areas
To help rural patients with PTSD and bipolar disorder improve their quality of life, this study is comparing two telehealth strategies. In one, primary care providers and care managers provide patients with telehealth specialist-prescribed therapies and routine check-ins. In the other, patients have regular video sessions with remote specialists.
Comparing Treatment Options for Adults with Depression
One in three adults with major depression does not feel better after taking antidepressant medicines. To help them, this study compares electroconvulsive therapy and ketamine, a pain medicine, to see which works best for adults with treatment-resistant depression.