Jonathan S. Comer

Director, Early Childhood Interventions Program

Boston University

www.bu.edu/card/profile/jonathan-s-comer-ph-d

What does your research focus on?

Broadly speaking, my research examines the complex interplays among psychological, physiological, and socio-contextual aspects of childhood mental disorders and their treatments. In particular, my work focuses on the development of innovative methods for expanding the quality and accessibility of mental health care for early-onset disorders, placing central emphasis on the two most prevalent classes of youth disorders — anxiety disorders and disruptive behavior disorders — as well as the effects of disasters, war, and terrorism. To address shortages in the availability and accessibility of supported treatments, much of my research focuses on the use of new technologies for extending the scope and reach of supported interventions.

What drew you to this line of research and why is it exciting to you?

Children’s mental illness imposes a staggering public health burden. Despite recent advances in the identification of evidence-based psychological interventions, considerable gaps persist between treatment in experimental settings and services available in the community. Inadequate numbers of mental health professionals, particularly in remote regions, impinge on the availability of care, and current mental health delivery models fail to reach adequate numbers of affected children. Despite this state of affairs, I believe technological innovations offer a promising vehicle for overcoming traditional barriers to care. In recent years, rapidly developing computer technology, the broadening availability of the Internet, and increasingly sophisticated capacities for live broadcasting via affordable webcams have already transformed many aspects of our daily lives. In mental health care — a discipline that relies primarily on verbal communication and visual observation — I’m excited by the possibility that innovative telemethods can extend the availability of services by addressing regional workforce shortages in care. Children living in regions with insufficient mental health care availability can participate in real-time interactive treatment with a provider, regardless of geographic proximity to a mental health facility.

Who were/are your mentors or scientific influences?

I have been extraordinarily lucky to have worked with some of the true mentoring treasures of clinical science. I completed my doctoral training with Philip Kendall. In addition to his contagious enthusiasm for science, his tremendous record of accomplishments, and his approachability, he has a terrific gift for engaging students in casual conversation about the large issues and then helping students reframe their ideas in terms of testable empirical questions. I still consult with him on anything I can. On post doc, I worked with Anne Marie Albano — an amazing professional advocate who always modeled how much fun being a clinical scientist and doing meaningful collaborative work can be — and with Mark Olfson, who taught me how to approach questions from a public health perspective. In working with him I learned to think more critically and with more clarity. To this day, every conversation I have with him is intellectually stimulating. Finally, as a junior faculty member, I have been extraordinarily lucky to receive continued mentorship from David Barlow. In addition to his unwavering support of my professional development, our field has no greater ambassador of clinical science for young professionals. Given his unparalleled perspective on the field, I’ve learned so much having the opportunity to think critically with him about clinical science and the state of our field, and to collaborate on papers together.

What’s your future research agenda?

Under the influence of the Patient Protection and Affordable Care Act, it is envisioned that mental health care will be increasingly integrated into primary care settings. I’m very interested in how innovative technologies can be used to facilitate the co-location of mental health care and primary care, and how such technologies can optimize the accessibility and quality of mental health care for all children, regardless of geography or income.

What publication are you most proud of?

Comer, J. S., Mojtabai, R., & Olfson, M. (2011). National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders. American Journal of Psychiatry, 168, 1057–1065.

In this paper, I documented that antipsychotic medications are becoming increasingly prescribed off-label to patients with anxiety disorders (currently one in five visits for an anxiety disorder results in an antipsychotic prescription), even though we know very little about their effectiveness and safety in treating anxiety disorders. The potential adverse effects of antipsychotics — including metabolic, endocrine, and cerebrovascular risks — have been well documented. I see this epidemiologic analysis as setting the context for much of my work expanding the reach of psychological treatments — limitations in the availability of supported psychological treatments place heavy clinical demands on the pharmacologic dimensions of mental health care. Findings like these really bring a renewed sense of urgency to efforts to improve access to psychological treatments.