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Faculty & Staff

Stephen Crystal

Distinguished Research Professor

MA, PhD, Harvard University

Dr. Crystal's research interests include AIDS, long-term care, homelessness, and longitudinal data analysis.

Bio: 

Stephen Crystal (Ph. D., Harvard, 1981) is Board of Governors Professor in the Institute for Health, Health Care Policy and Aging Research and the School of Social Work. At the Institute, he directs the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, whose programs include the AHRQ-funded Center for Education and Research on Mental Health Therapeutics. He also is Chair of the Institute's Division on Aging and Associate Institute Director for Health Services Research. Dr. Crystal's work, which has resulted in more than 250 publications, includes many widely cited books and research articles on old-age policy and services for the elderly; on the use and outcomes of psychotropic medications and other mental health treatments; on HIV/AIDS care; and on numerous other health care and social policy topics. His work on gerontological policy and inequality has been particularly influential nationally, as the cumulative advantage model of aging which he originally proposed in the 1980s and has developed in a line of subsequent work has contributed to understanding of late-life inequalities and the way in which initial advantages such as educational attainment; social structures; health and economic events over the lifecourse; and public policies interact to shape late-life outcomes. He has also been an important contributor to research on long-term care and mental health among the elderly. His work on mental health services has contributed importantly to understanding problems of healthcare access, quality and disparities in large usual care populations, particularly those served by Medicare and Medicaid. Much of his recent work has focused on prescription drug use in society where he has pioneered important studies on treatment use, safety, and effectiveness, including current work on comparative effectiveness of treatments funded by the FDA and the Agency for Healthcare Research and Quality. In 2009, his contributions to scholarship on health services and outcomes were recognized by his appointment as Board of Governors Professor of Health Services Research at Rutgers University, with the university's Board of Governors citing his "major theoretical, methodological, and research contributions in the fields of aging, HIV care, and behavioral health; his highly influential and social policy scholarship; the impressive rigor of his cross-disciplinary research contributions that have shaped thinking, both in the U.S. and abroad, on issues confronting some of the most vulnerable groups in our society" and for his "numerous and enormously influential books, journal articles, reports, and other publications . and his outstanding contributions to improving decision-making in public policy as evidenced by his frequent invitations to testify before and advise Congress and other policymakers."

Selected Recent Publications: 

Research Articles

Olfson M, Crystal S, Wall M, Wang S, Liu SM, Blanco C. Causes of Death Following Nonfatal Opioid Overdose.  JAMA Psychiatry 75(8): 820-827, 2018.  doi:10.1001/jamapsychiatry.2018.1471

Samples H, Williams AR, Olfson M, Crystal S.  Risk Factors for Premature Discontinuation of Buprenorphine Treatment for Opioid Use Disorders in a Multi-State Sample of Medicaid Enrollees.  Journal of Substance Abuse Treatment 95: 8-17, December 2018.

Williams AR, Samples H, Crystal S, Olfson M.  Acute Care, Prescription Opioid Use, and Overdose Following Discontinuation of Long-Term Buprenorphine Treatment for Opioid Use Disorder.  In press, American Journal of Psychiatry.

Patel N, Hayden J, Horter L, Parsons T, Ruble M, Townsend S, Klein C, Patino Duran L, Welge J, Crystal S, Correll C, DelBello M.  Metabolic Monitoring Rates of Youth Treated with Second-Generation Antipsychotics in Usual Care: Results of a Large US National Commercial Health Plan.  In press, Journal of Child and Adolescent Psychopharmacology.

Sultan R, Wang S, Crystal S, Olfson M. Cohort Analysis of Antipsychotic Treatment of Youth with ADHD in Attention/Deficit Hyperactivity Disorder.  In press, JAMA Network Open.

Olfson M, Wall M, Wang S, Crystal S, Blanco C.  Risks of Fatal Opioid Overdose During the First Year Following Nonfatal Overdose.  Drug and Alcohol Dependence 190:112-119, 2018 (September 1).  doi: 10.1016/j.drugalcdep.2018.06.004.

Stroup TS, Gerhard T, Huang C, Tan Z, Wall M, Crystal S, Mathai C, Olfson M.  Psychotropic Medication Use in Adults with Schizophrenia and Schizoaffective Disorder in the United States.  Psychiatric Services 69(5):605-608, 2018.   doi: 10.1176/appi.ps.20170035. 

Mackie T, Olfson M, Crystal S, Cook S, Akincigil A.  Antipsychotic Use Among Youth in Foster Care Enrolled in a Specialized Managed Care Organization Intervention.  In press, Journal of the American Association of Child and Adolescent Psychiatry.

Bushnell GA, Crystal S, Olfson M.  Prescription Benzodiazepine Use in Privately Insured US Children and Adolescents.  In Press, American Journal of Preventive Medicine.

Olfson M, Wall M, Wang S, Crystal S, Bridge JA, Liu SM, Blanco C. Suicide Following Deliberate Self-harm in Adolescents and Young Adults. Pediatrics 141(4): e20173517, April 2018.

Crystal S.  Cumulative Advantage and the Retirement Prospects of the Hollowed-Out Generation: A Tale of Two Cohorts.  Public Policy and Aging Report 28(1):14-18, 2018.  doi:10.1093/ppar/pry004.

Olfson M, Wall M, Wang S, Crystal S, Blanco C.  Service Use Preceding Opioid-Related Fatality.  American Journal of Psychiatry 175(6):538-544, 2017.   https://doi.org/10.1176/appi.ajp.2017.17070808

Crystal S, Shea D, Reyes A.  Cumulative Advantage, Cumulative Disadvantage, and Evolving Patterns of Late-Life Inequality.  The Gerontologist 57(5):910-921, 2016.   doi:10.1093/geront/gnw056.

Olfson M, Wall M, Wang S, Crystal S, Gerhard T, Blanco C.  Short-Term Suicide Risk Following Psychiatric Hospital Discharge.  JAMA Psychiatry 73(11):1119-26, 2016. doi: 10.1001/jamapsychiatry.2016.2035.

Gerhard T, Stroup S, Correll CU, Huang C, Tan Z, Crystal S, Olfson M. Antipsychotic Medication Treatment Patterns in Adult Depression.  Journal of Clinical Psychiatry, e-pub ahead of print, July 5, 2017.  Published with commentary: Thase M, Gauging the Use of Second-Generation Antipsychotics: Medicaid Benefits Data Suggest Much Room for Improvement.  Journal of Clinical Psychiatry, July 5, 2017.

Crystal S.  Late-Life Inequality in the Second Gilded Age: Policy Choices in a New Context.  Public Policy and Aging Report 26(2):42-47, 2016.  Editor’s Choice article, full-text available at https://academic.oup.com/ppar/article/26/2/42/2460947/Late-Life-Inequali....

Stroup S, Olfson M, Huang C, Crystal S, Gerhard T.  Comparative Effectiveness of Clozapine and Standard Antipsychotic Treatment in Adults with Schizophrenia.  American Journal of Psychiatry 173:166–173, 2016.  doi: 10.1176/appi.ajp.2015.15030332.   Published with editorial: Marder S.  Community Evidence of Clozapine’s Effectiveness.  American Journal of Psychiatry 173: 103-104, 2016.

Crystal S, Mackie T, Fenton M, Amin S, Neese-Todd S, Olfson M, Bilder S.  Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain.  Health Affairs 35(6): 974-982, 2016.

Olfson M, Wall M, Wang S, Crystal S, Gerhard T, Blanco C.  Suicide Following Deliberate Self-Harm.  American Journal of Psychiatry. 2017 Aug 1;174(8):765-774. doi: 10.1176/appi.ajp.2017.16111288.

Gerhard TA, Akincigil A, Correll CU, Foglio N, Crystal S, Olfson M. National Trends in Second-Generation Antipsychotic Augmentation for Nonpsychotic Depression. J Clin Psychiatry 75 (5): 490-7, 2014.  doi: 10.4088/JCP.13m08675. PMID: 24500284.

Olfson M, Gerhard T, Huang C, Crystal S, Stroup S.  Premature Mortality among Adults with Schizophrenia in the United States.  JAMA Psychiatry 72(12):1172-1181, December 2015.  doi:10.1001/jamapsychiatry.2015.1737.

Olfson M, Gerhard T, Crystal S, Stroup TS.  Clozapine for Schizophrenia: State Variation in Evidence-Based Practice.  Psychiatric Services 67(2):152, 2016. doi: 10.1176/appi.ps.201500324.

Finnerty M, Neese-Todd S, Pritam R, Leckman-Westin E, Bilder S, Byron S, Scholle SH, Crystal S, Olfson M.  Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid Insured Youth.  Journal of the American Academy of Child and Adolescent Psychiatry 55(1):69-76 e3, 2016.  doi: 10.1016/j.jaac.2015.09.020. PMID: 26703912.

Huybrechts KF, Schneeweiss S, Gerhard T, Avorn J, Olfson M, Levin R, Lucas J, Crystal S.  Comparative Safety of Antipsychotic Medications in Nursing Home Residents.  Journal of the American Geriatrics Society, epub ahead of print, DOI 10.1111/j.1532-5415.2011.03853.x, February 2012.

Huybrechts K, Gerhard T, Crystal S, Olfson M, Avorn J, Levin R, Lucas J, Schneeweiss S.  Differential Risk of Death in Older Nursing Home Patients Prescribed Specific Antipsychotic Medications: Population-Based Cohort Study.  BMJ 344:e977, epub ahead of print, doi 10.1136/bmj.e977, 2012.

Scotto Rosato N, Correll C, Pappadopulos E, Chait A, Crystal S, Jensen P, and the T-MAY Steering Group.  Treatment of Maladaptive Aggression in Youth (T-MAY): CERTs Guidelines II.  Psychosocial Interventions, Medication Treatments, and Side Effects Management.  Pediatrics 129(6):e-1577-1586, doi 10.1542/peds.2010-1361,  June 2012.

Olfson M, Wang S, Iza M, Crystal S, Blanco C.  National Trends in the Office-Based Prescription of Schedule II Opioids.  Journal of Clinical Psychiatry 74(9):932-939, 2013.

Akincigil A, Olfson M, Siegel M, Zurlo K, Walkup JT, Amin S, Crystal S.  Racial Disparities in Depression Care in Community Dwelling Elderly in the United States.  American Journal of Public Health, 102(2):319-328, 2012.

Townsend L, Walkup JT, Crystal S, Olfson M.  A Systematic Review of Validated Methods for Identifying Depression Using Administrative Data.  Pharmacoepidemiology and Drug Safety 21(S1):163-173, 2012.

Olfson M, Huang C, Gerhard T, Winterstein A, Crystal S, Allison P, Marcus S.  Stimulants and Cardiovascular Events in Youth with Attention-Deficit/Hyperactivity Disorder.  Journal of the American Academy of Child and Adolescent Psychiatry 51(2): 147-156, 2012.

Lucas J, Chakravarty S, Bowblis J, Gerhard T, Kalay E, Paek K, Crystal S.  Antipsychotic Medication Use in Nursing Homes: A Proposed Measure of Quality.  International Journal of Geriatric Psychiatry  29(10):1049-61, 2014.  DOI: 10.1002/gps.4098. 

Walkup J, Townsend L, Crystal S, Olfson M.  A Systematic Review of Validated Methods for Identifying Suicide or Suicidal Ideation Using Administrative or Claims Data.  Pharmacoepidemiology and Drug Safety 21(S1):174-182, 2012.

Akincigil A, Olfson M, Walkup J, Siegel M, Amin S, Zurlo K, Crystal S.  Diagnosis and Treatment of Depression in the Community Dwelling Elderly, 1992-2005.  Journal of the American Geriatrics Society 59 (6):1042-1051, 2011.

Olfson M, Gerhard T, Huang C, Lieberman JA, Bobo WV, Crystal S.  Comparative Effectiveness of Second Generation Antipsychotic Medications in Early Onset Schizophrenia.  Schizophrenia Bulletin. 38(4):845-53, 2012.  doi: 10.1093/schbul/sbq172. 

Bowblis J, Crystal S, Intrator O, Lucas J. The Impact of Regulation on the Rate of Antipsychotic Medication Use in Nursing Homes.  Health Economics  21(8):977-93, 2012.  E-pub in advance of print, September 2011.  DOI: 10.1002/hec.1775.

Pappadopulos E, Scotto Rosato N, Correll C, Findling RL, Lucas J, Crystal S, Jensen P.  Experts’ Recommendations for Treating Maladaptive Aggression in Youth.  Journal of Child and Adolescent Psychopharmacology 21(6):505-15. DOI: 10.1089/cap.2010.0128, December 2011.

Olfson M, Crystal S, Gerhard T, Huang C, Carlson G.  Mental Health Treatment by Youths in the Year Before and After a New Diagnosis of Bipolar Disorder.  Psychiatric Services 60:1098-1106, 2009.  Press coverage in Wilson D, Child’s Ordeal Shows Risk of Psychosis Drugs for Young, The New York Times, September 1, 2010.

Crystal S, Olfson M, Huang C, Pincus H, Gerhard T.  Increasing Use of Atypical Antipsychotic Drugs: Challenges for Policymakers, Clinicians and Patients.   Health Affairs 28(5):w770-781, 2009.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896705/.  Front-page coverage in Wilson D. Poor Children Likelier to Get Antipsychotics, page A1, The New York Times, December 12, 2009.  Findings summarized in Kuehn B, Medical News and Perspectives, JAMA 303(19): 1901-1903, 2010.

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