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Martin MS, Potter BK, Crocker AG, Wells GA, Colman I. Yield and Efficiency of Mental Health Screening: A Comparison of Screening Protocols at Intake to Prison. PLoS One 2016; 11:e0154106. [PMID: 27167222 PMCID: PMC4864401 DOI: 10.1371/journal.pone.0154106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background The value of screening for mental illness has increasingly been questioned in low prevalence settings due to high false positive rates. However, since false positive rates are related to prevalence, screening may be more effective in higher prevalence settings, including correctional institutions. We compared the yield (i.e. newly detected cases) and efficiency (i.e. false positives) of five screening protocols to detect mental illness in prisons against the use of mental health history taking (the prior approach to detecting mental illness). Methods and Findings We estimated the accuracy of the six approaches to detect an Axis I disorder among a sample of 467 newly admitted male inmates (83.1% participation rate). Mental health history taking identified only 41.0% (95% CI 32.1, 50.6) of all inmates with mental illness. Screening protocols identified between 61.9 and 85.7% of all cases, but referred between 2 and 3 additional individuals who did not have a mental illness for every additional case detected compared to the mental health history taking approach. In low prevalence settings (i.e. 10% or less) the screening protocols would have had between 4.6 and 16.2 false positives per true positive. Conclusions While screening may not be practical in low prevalence settings, it may be beneficial in jails and prisons where the prevalence of mental illness is higher. Further consideration of the context in which screening is being implemented, and of the impacts of policies and clinical practices on the benefits and harms of screening is needed to determine the effectiveness of screening in these settings.
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Affiliation(s)
- Michael S. Martin
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Beth K. Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne G. Crocker
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada
| | - George A. Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Pederson JL, Warkentin LM, Majumdar SR, McAlister FA. Depressive symptoms are associated with higher rates of readmission or mortality after medical hospitalization: A systematic review and meta-analysis. J Hosp Med 2016; 11:373-80. [PMID: 26824220 PMCID: PMC5066695 DOI: 10.1002/jhm.2547] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 12/02/2022]
Abstract
Depressive symptoms during a medical hospitalization may be an overlooked prognostic factor for adverse events postdischarge. Our aim was to evaluate whether depressive symptoms predict 30-day readmission or death after medical hospitalization. We conducted a systematic review of studies that compared postdischarge outcomes by in-hospital depressive status. We assessed study quality and pooled published and unpublished data using random effects models. Overall, one-third of 6104 patients discharged from medical wards were depressed (interquartile range, 27%-40%). Compared to inpatients without depression, those discharged with depressive symptoms were more likely to be readmitted (20.4% vs 13.7%, risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.16-2.58) or die (2.8% vs 1.5%, RR: 2.13, 95% CI: 1.31-3.44) within 30 days. Depressive symptoms were common in medical inpatients and are associated with an increased risk of adverse events postdischarge. Journal of Hospital Medicine 2016;11:373-380. © 2016 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.
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Affiliation(s)
- Jenelle L. Pederson
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Lindsey M. Warkentin
- Division of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Sumit R. Majumdar
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
- Alberta Diabetes InstituteEdmontonCanada
| | - Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
- The Patient Health Outcomes Research and Clinical Effectiveness Unit, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
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Prady SL, Pickett KE, Petherick ES, Gilbody S, Croudace T, Mason D, Sheldon TA, Wright J. Evaluation of ethnic disparities in detection of depression and anxiety in primary care during the maternal period: combined analysis of routine and cohort data. Br J Psychiatry 2016; 208:453-61. [PMID: 26795424 PMCID: PMC4853643 DOI: 10.1192/bjp.bp.114.158832] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited data on detection disparities of common mental disorders in minority ethnic women. AIMS Describe the natural history of common mental disorders in primary care in the maternal period, characterise women with, and explore ethnic disparities in, detected and potentially missed common mental disorders. METHOD Secondary analyses of linked birth cohort and primary care data involving 8991 (39.4% White British) women in Bradford. Common mental disorders were characterised through indications in the electronic medical record. Potentially missed common mental disorders were defined as an elevated General Health Questionnaire (GHQ-28) score during pregnancy with no corresponding common mental disorder markers in the medical record. RESULTS Estimated prevalence of pre-birth common mental disorders was 9.5%, rising to 14.0% 3 years postnatally. Up to half of cases were potentially missed. Compared with White British women, minority ethnic women were twice as likely to have potentially missed common mental disorders and half as likely to have a marker of screening for common mental disorders. CONCLUSIONS Common mental disorder detection disparities exist for minority ethnic women in the maternal period.
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Affiliation(s)
- Stephanie L Prady
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Kate E Pickett
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Emily S Petherick
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Simon Gilbody
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Tim Croudace
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Dan Mason
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Trevor A Sheldon
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Stephanie L. Prady, PhD, Kate E. Pickett, PhD, Department of Health Sciences, University of York, York; Emily S. Petherick, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Simon Gilbody, DPhil, FRCPsych, Tim Croudace, PhD, Department of Health Sciences and Hull York Medical School, University of York, York; Dan Mason, PhD, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford; Trevor A. Sheldon, DSc, Hull York Medical School, University of York, York; John Wright, FRCP, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Hudson JL, Moss-Morris R, Game D, Carroll A, McCrone P, Hotopf M, Yardley L, Chilcot J. Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis. BMJ Open 2016; 6:e011286. [PMID: 27072573 PMCID: PMC4838682 DOI: 10.1136/bmjopen-2016-011286] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. METHODS Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. ETHICS AND DISSEMINATION A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis. Any amendments to the protocol will be submitted to the NHS committee and study sponsor. TRIAL REGISTRATION NUMBER NCT023528702; Pre-results.
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Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Game
- Guy's and St Thomas’ NHS Trust, London, UK
| | | | - Paul McCrone
- Health Services & Population Research, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lucy Yardley
- Psychology Department, University of Southampton, Southampton, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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155
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Variation and ethnic inequalities in treatment of common mental disorders before, during and after pregnancy: combined analysis of routine and research data in the Born in Bradford cohort. BMC Psychiatry 2016; 16:99. [PMID: 27071711 PMCID: PMC4830046 DOI: 10.1186/s12888-016-0805-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/05/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) such as anxiety and depression during the maternal period can cause significant morbidity to the mother in addition to disrupting biological, attachment and parenting processes that affect child development. Pharmacological treatment is a first-line option for moderate to severe episodes. Many women prescribed pharmacological treatments cease them during pregnancy but it is unclear to what extent non-pharmacological options are offered as replacement. There are also concerns that treatments offered may not be proportionate to need in minority ethnic groups, but few data exist on treatment disparities in the maternal period. We examined these questions in a multi-ethnic cohort of women with CMD living in Bradford, England before, during and up to one year after pregnancy. METHODS We searched the primary care records of women enrolled in the Born in Bradford cohort for diagnoses, symptoms, signs ('identification'), referrals for treatment, non-pharmacological and pharmacological treatment and monitoring ('treatment') related to CMD. Records were linked with maternity data to classify women identified with a CMD as treated prior to, and one year after, delivery. We examined rates and types of treatment during pregnancy, and analysed potential ethnic group differences using adjusted Poisson and multinomial logistic regression models. RESULTS We analysed data on 2,234 women with indicators of CMD. Most women were discontinued from pharmacological treatment early in pregnancy, but this was accompanied by recorded access to non-drug treatments in only 15 % at the time of delivery. Fewer minority ethnic women accessed treatments compared to White British women despite minority ethnic women being 55-70 % more likely than White British women to have been identified with anxiety in their medical record. CONCLUSIONS Very few women who discontinued pharmacological treatment early in their pregnancy were offered other non-pharmacological treatments as replacement, and most appeared to complete their pregnancy untreated. Further investigation is warranted to replicate the finding that minority ethnic women are more likely to be identified as being anxious or having anxiety and understand what causes the variation in access to treatments.
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156
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John A, McGregor J, Fone D, Dunstan F, Cornish R, Lyons RA, Lloyd KR. Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data. BMC Med Inform Decis Mak 2016; 16:35. [PMID: 26979325 PMCID: PMC4791907 DOI: 10.1186/s12911-016-0274-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 03/10/2016] [Indexed: 11/21/2022] Open
Abstract
Background The robustness of epidemiological research using routinely collected primary care electronic data to support policy and practice for common mental disorders (CMD) anxiety and depression would be greatly enhanced by appropriate validation of diagnostic codes and algorithms for data extraction. We aimed to create a robust research platform for CMD using population-based, routinely collected primary care electronic data. Methods We developed a set of Read code lists (diagnosis, symptoms, treatments) for the identification of anxiety and depression in the General Practice Database (GPD) within the Secure Anonymised Information Linkage Databank at Swansea University, and assessed 12 algorithms for Read codes to define cases according to various criteria. Annual incidence rates were calculated per 1000 person years at risk (PYAR) to assess recording practice for these CMD between January 1st 2000 and December 31st 2009. We anonymously linked the 2799 MHI-5 Caerphilly Health and Social Needs Survey (CHSNS) respondents aged 18 to 74 years to their routinely collected GP data in SAIL. We estimated the sensitivity, specificity and positive predictive value of the various algorithms using the MHI-5 as the gold standard. Results The incidence of combined depression/anxiety diagnoses remained stable over the ten-year period in a population of over 500,000 but symptoms increased from 6.5 to 20.7 per 1000 PYAR. A ‘historical’ GP diagnosis for depression/anxiety currently treated plus a current diagnosis (treated or untreated) resulted in a specificity of 0.96, sensitivity 0.29 and PPV 0.76. Adding current symptom codes improved sensitivity (0.32) with a marginal effect on specificity (0.95) and PPV (0.74). Conclusions We have developed an algorithm with a high specificity and PPV of detecting cases of anxiety and depression from routine GP data that incorporates symptom codes to reflect GP coding behaviour. We have demonstrated that using diagnosis and current treatment alone to identify cases for depression and anxiety using routinely collected primary care data will miss a number of true cases given changes in GP recording behaviour. The Read code lists plus the developed algorithms will be applicable to other routinely collected primary care datasets, creating a platform for future e-cohort research into these conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0274-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann John
- Farr Institute of Health Informatics Research, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK. .,Public Health Wales NHS Trust, Cardiff, UK.
| | - Joanne McGregor
- Farr Institute of Health Informatics Research, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
| | - David Fone
- Public Health Wales NHS Trust, Cardiff, UK.,Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Frank Dunstan
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Rosie Cornish
- School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Ronan A Lyons
- Farr Institute of Health Informatics Research, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK.,Public Health Wales NHS Trust, Cardiff, UK
| | - Keith R Lloyd
- Farr Institute of Health Informatics Research, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, UK
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Ribeiro dos Santos E, Huang H, Menezes PR, Scazufca M. Prevalence of Depression and Depression Care for Populations Registered in Primary Care in Two Remote Cities in the Brazilian Amazon. PLoS One 2016; 11:e0150046. [PMID: 26930353 PMCID: PMC4773106 DOI: 10.1371/journal.pone.0150046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil. Objectives The objectives of this study are to estimate the prevalence of depression in adults registered with the Family Health Strategy in two remote cities in the Brazilian Amazon and to investigate the proportion of individuals with depression that received mental health care. Methods This is a cross-sectional study of an adult population registered with primary care clinics in the cities of Coari and Tefé, State of Amazon, Brazil. Depression was defined as a score of ≥10 on the Patient Health Questionnaire-9. Depression care was evaluated by asking participants with depression if they received antidepressants and/or had been seen by a health professional at a community mental health center in the three months prior to the interview. Poisson regression was used to examine the unadjusted and adjusted associations between depression and exposure variables. Results The overall prevalence of depression was 19.1% (95% CI: 17.2–21.1), with 22.2% (95% CI: 19.3–25.0) among women and 16.0% (95% CI: 13.4–18.5) among men. The prevalence of depression in Coari and Tefé were 18.3% (CI 95% 15.7–21.0) and 19.9% (95% CI:17.2–22.7), respectively. Being a woman, lacking social support, increasing exposure to stressful life events and having a higher number medical comorbidities were consistently associated with depression. Lower educational attainment and income, tobacco use, and risky alcohol use were also associated with depression in the unadjusted analyses. Only 11.5% of those with depression were receiving antidepressants and/or visited the mental health care facility during the three months prior to the interview. Conclusion Approximately one in five adults in our sample had depression. A high proportion of participants presented indicators of social disadvantage and other risk factors previously associated with depression worldwide. There was a large treatment gap for depression in the Amazonian region, which demonstrates the need for innovative models of depression care in primary care settings in Brazil
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Affiliation(s)
- Edinilza Ribeiro dos Santos
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Health Sciences School, University of the State of Amazonas, Manaus, Brazil
- * E-mail:
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, United States of America
- Institute of Psychiatry and LIM-23, Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcia Scazufca
- Institute of Psychiatry and LIM-23, Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Pederson JL, Majumdar SR, Forhan M, Johnson JA, McAlister FA. Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study. Gen Hosp Psychiatry 2016; 39:80-5. [PMID: 26804774 DOI: 10.1016/j.genhosppsych.2015.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/15/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards. METHODS Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge. RESULTS Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days. CONCLUSIONS Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
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Affiliation(s)
- Jenelle L Pederson
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Sumit R Majumdar
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Jeffrey A Johnson
- Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Finlay A McAlister
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3.
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Psychosocial interventions for people with diabetes and co-morbid depression. A systematic review. Int J Nurs Stud 2015; 52:1625-39. [DOI: 10.1016/j.ijnurstu.2015.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 04/07/2015] [Accepted: 05/29/2015] [Indexed: 12/14/2022]
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160
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Kendrick T, Stuart B, Newell C, Geraghty AWA, Moore M. Changes in rates of recorded depression in English primary care 2003-2013: Time trend analyses of effects of the economic recession, and the GP contract quality outcomes framework (QOF). J Affect Disord 2015; 180:68-78. [PMID: 25881283 DOI: 10.1016/j.jad.2015.03.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/16/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression may be increasing, particularly since the economic recession. Introduction of quality outcomes framework (QOF) performance indicators may have altered GP recording of depression. METHODS Time trend analyses of GP recording of depression before and after the recession (from April 2008), and the QOF (from April 2006) were conducted on anonymised consultation data from 142 English practices contributing to the Clinical Practice Research Datalink, April 2003-March 2013. RESULTS 293,596 patients had computer codes for depressive diagnoses or symptoms in the 10 years. Prevalence of depression codes fell from 44.6 (95% CI 44.2, 45.0) per 1000 person years at risk (PYAR) in 2003/2004 to 38.0 (37.7, 38.3) in 2008/2009, rising to 39.5 (39.2, 39.9) in 2012/2013. Incidence of first-ever depression codes fell from 11.9 (95% CI 11.7, 12.1) per 1000 PYAR in 2003/2004 to 9.5 (9.3, 9.7) in 2008/2009, rising to 10.0 (9.8, 10.2) in 2012/1203. Prevalence increased in men but not women following the recession, associated with increased unemployment. Following introduction of the QOF, GPs used more non-QOF-qualifying symptom or other codes than QOF-qualifying diagnostic codes for new episodes. LIMITATIONS Clinical data recording is probably incomplete. Participating practices were relatively large and not representative across English regions. CONCLUSIONS Rates of recorded depression in English general practices were falling prior to the economic recession but increased again subsequently, among men, associated with increased unemployment. GPs responded to the QOF by switching from diagnostic to symptom codes, removing most depressed patients from the denominator for measuring GP performance in assessing depression.
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Affiliation(s)
- Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK.
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Colin Newell
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Adam W A Geraghty
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
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Watanabe SY, Iga JI, Ishii K, Numata S, Shimodera S, Fujita H, Ohmori T. Biological tests for major depressive disorder that involve leukocyte gene expression assays. J Psychiatr Res 2015; 66-67:1-6. [PMID: 25943949 DOI: 10.1016/j.jpsychires.2015.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 02/17/2015] [Accepted: 03/09/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Development of easy-to-use biological diagnostic tests for major depressive disorder (MDD) may facilitate MDD diagnosis and delivery of optimal treatment. Here, we examined leukocyte gene expression to develop a biological diagnostic test for MDD. METHODS 25 drug-naive MDD patients (MDDs) and 25 age- and sex-matched healthy subjects (Controls) participated in a pilot study. A subsequent replication study involved 20 MDDs and 18 Controls. We used custom-made PCR array plates to examine mRNA levels of 40 candidate genes in leukocyte samples to assess whether any combination of these genes could be used to differentiate MDDs from Controls based on expression profiles. RESULTS Among 40 candidate genes, we identified a set of seven genes (PDGFC, SLC6A4, PDLIM5, ARHGAP24, PRNP, HDAC5, and IL1R2), each of which had expression levels that differed significantly between MDD and Control samples in the pilot study. To identify genes whose expression best differentiated between MDDs and Controls, a linear discriminant function was developed to discriminate between MDDs and Controls based on the standardized values of gene expression after Z-score transformation. Ultimately, five genes (PDGFC, SLC6A4, ARHGAP24, PRNP, and HDAC5) were selected for a multi-assay diagnostic test. In the pilot study, this diagnostic test demonstrated sensitivity and specificity of 80% and 92%, respectively. The replication study yielded nearly identical results, sensitivity of 85% and specificity of 89%. CONCLUSIONS Using leukocyte gene expression profiles, we could differentiate MDDs from Controls with adequate sensitivity and specificity. Additional markers not yet identified might further improve the performance of this test.
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Affiliation(s)
- Shin-Ya Watanabe
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima 770-8503, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
| | - Kazuo Ishii
- Department of Applied Biological Science, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Saiwai, Fuchu, Tokyo, 183-8509, Japan
| | - Shusuke Numata
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima 770-8503, Japan
| | - Shinji Shimodera
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hirokazu Fujita
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Course of Integrated Brain Sciences, University of Tokushima School of Medicine, Tokushima 770-8503, Japan
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162
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Hwang S, Jayadevappa R, Zee J, Zivin K, Bogner HR, Raue PJ, Bruce ML, Reynolds CF, Gallo JJ. Concordance Between Clinical Diagnosis and Medicare Claims of Depression Among Older Primary Care Patients. Am J Geriatr Psychiatry 2015; 23:726-34. [PMID: 25256215 PMCID: PMC4634645 DOI: 10.1016/j.jagp.2014.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify patient characteristics associated with concordance of Medicare claims with clinically identified depression. METHODS The authors studied a cohort of 742 older primary care patients linked to Medicare claims data using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive disorder and clinically significant minor depression. RESULTS Among 474 patients with depression, 198 patients had a Medicare claim for depression (sensitivity: 42%; 95% confidence interval [CI]: 37%-46%). Among 268 patients who did not meet criteria for depression, 235 patients did not have a Medicare claim for depression (specificity: 88%; 95% CI: 83%-91%). After adjustment for demographic and clinical characteristics, non-white participants were nearly twice as likely not to have Medicare claims for depression among patients who met criteria for depression ("false negatives"). Smoking status, depression severity (Hamilton Depression Rating Scale), cardiovascular disease, and more primary care physician office visits were also significantly associated with decreased odds to be false negatives. In contrast, after covariate adjustment, white race and chronic pulmonary disease were associated with increased odds of a Medicare claim for depression among patients who did not meet criteria for depression ("false positives"). Using weights based on the screened sample, the positive predictive value of a Medicare claim for depression was 66% (95% CI [63%, 69%]), whereas the negative predictive value was 77% (95% CI [76%, 78%]). CONCLUSION Investigators using Medicare data to study depression must recognize that diagnoses of depression from Medicare data may be biased by patient ethnicity and the presence of medical comorbidity.
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Affiliation(s)
- Seungyoung Hwang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jarcy Zee
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kara Zivin
- VA Ann Arbor Health System and University of Michigan Medical School, Ann Arbor, Michigan
| | - Hillary R. Bogner
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Joseph J. Gallo
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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163
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Browne TK. Is premenstrual dysphoric disorder really a disorder? JOURNAL OF BIOETHICAL INQUIRY 2015; 12:313-330. [PMID: 25164305 DOI: 10.1007/s11673-014-9567-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
Premenstrual dysphoric disorder (PMDD) was recently moved to a full category in the DSM-5 (the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders). It also appears set for inclusion as a separate disorder in the ICD-11 (the upcoming edition of the World Health Organization's International Statistical Classification of Diseases and Related Health Problems). This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD is a culture-bound phenomenon, not a universal one. I also argue that even if (1) medication produces a desired effect, (2) there are biological correlates with premenstrual anger/distress, (3) such anger/distress seems to occur monthly, and (4) women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one's environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women's suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women's suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications.
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Affiliation(s)
- Tamara Kayali Browne
- Biology Teaching and Learning Centre, Research School of Biology, The Australian National University, R.N. Robertson Building, Building 46, Canberra, ACT 0200, Australia,
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164
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Karmen C, Hsiung RC, Wetter T. Screening Internet forum participants for depression symptoms by assembling and enhancing multiple NLP methods. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 120:27-36. [PMID: 25891366 DOI: 10.1016/j.cmpb.2015.03.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 03/10/2015] [Accepted: 03/20/2015] [Indexed: 05/27/2023]
Abstract
Depression is a disease that can dramatically lower quality of life. Symptoms of depression can range from temporary sadness to suicide. Embarrassment, shyness, and the stigma of depression are some of the factors preventing people from getting help for their problems. Contemporary social media technologies like Internet forums or micro-blogs give people the opportunity to talk about their feelings in a confidential anonymous environment. However, many participants in such networks may not recognize the severity of their depression and their need for professional help. Our approach is to develop a method that detects symptoms of depression in free text, such as posts in Internet forums, chat rooms and the like. This could help people appreciate the significance of their depression and realize they need to seek help. In this work Natural Language Processing methods are used to break the textual information into its grammatical units. Further analysis involves detection of depression symptoms and their frequency with the help of words known as indicators of depression and their synonyms. Finally, similar to common paper-based depression scales, e.g., the CES-D, that information is incorporated into a single depression score. In this evaluation study, our depressive mood detection system, DepreSD (Depression Symptom Detection), had an average precision of 0.84 (range 0.72-1.0 depending on the specific measure) and an average F measure of 0.79 (range 0.72-0.9).
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Affiliation(s)
- Christian Karmen
- Heidelberg University Hospital, Institute of Medical Biometry and Informatics, Medical Informatics Unit, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany.
| | - Robert C Hsiung
- Dr. Bob LLC, PO Box 14579, Chicago, IL 60614-0579, United States
| | - Thomas Wetter
- Heidelberg University Hospital, Institute of Medical Biometry and Informatics, Medical Informatics Unit, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany; University of Washington, Department of Biomedical Informatics and Medical Education, 1959 NE Pacific Street, Seattle, WA 98195-7240, United States.
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165
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Prevalence of comorbid depression and obesity in general practice: a cross-sectional survey. Br J Gen Pract 2015; 64:e122-7. [PMID: 24567650 PMCID: PMC3933857 DOI: 10.3399/bjgp14x677482] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background General practice is a common setting for the provision of weight-management advice, as well as the treatment of depression. While there is some evidence of a reciprocal relationship between obesity and depression, there are limited data about the rates of depression among general practice patients who are underweight, normal weight, overweight, and obese. Aim To explore the prevalence of depression among underweight, normal weight, overweight, and obese general practice patients. Design and setting A cross-sectional survey was conducted in 12 Australian general practices. Method Patients aged ≥18 years and older who were presenting for general practice care were eligible to participate. Consenting patients completed a touchscreen computer survey assessing self-reported weight and height. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a score of ≥10 used to indicate possible depression. Results Data were obtained from 3361 participants. The prevalence of depression was 24% (95% confidence interval [CI] = 11.86 to 39.28) among underweight participants, 11% (95% CI = 8.5 to 14.0) among normal weight participants, 12% (95% CI = 0.9 to 15.2) among overweight participants, and 23% (95% CI = 17.8 to 29.0) among obese participants. The prevalence of depression was higher for women than for men across all weight categories except underweight. Conclusion Weight and depression demonstrated a U-shaped relationship, with higher prevalence of depression observed among underweight and obese general practice patients. These conditions may act as red flags for opportunistic screening of depression in the general practice setting.
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166
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Abstract
The dual combination of a physical long-term condition coupled with mental health illness can increase the complexities of effective patient care. Greater integration of services spanning the health and social care spectrum have the potential to reduce fragmentation, enhance communications and ultimately support patient care. This short article discusses the reasons for this being a worthwhile philosophy and the case for change.
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Affiliation(s)
- Rona Dury
- Senior Lecturer in Primary Care, University of Greenwich, London
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167
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Ghio L, Gotelli S, Cervetti A, Respino M, Natta W, Marcenaro M, Serafini G, Vaggi M, Amore M, Belvederi Murri M. Duration of untreated depression influences clinical outcomes and disability. J Affect Disord 2015; 175:224-8. [PMID: 25658495 DOI: 10.1016/j.jad.2015.01.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The duration of untreated depression (DUD) might have a substantial impact on the clinical outcomes; however, there are important knowledge gaps including the effects on disability and potential differences between first-episode and recurrent episodes of depression. METHODS We recruited 121 outpatients with first episode and recurrent major depression, and conducted prospective clinical assessments over six months. Clinical outcomes included response to antidepressant therapy, remission and changes in disability. RESULTS Patients with a DUD of six months or shorter were more frequently young, unemployed and had higher levels of physical illnesses than those with a longer DUD (all p<0.05). A shorter DUD was associated with significantly higher odds of response at 12 weeks (adjusted odds ratio 2.8; 95% CI: 1.2-6.8) and remission at 24 weeks (4.1; 95% CI: 1.6-10.5) after adjusting for relevant confounders. Changes in disability ratings were analyzed with growth curve analysis and showed steeper declines among those with a shorter DUD. The associations of DUD on clinical outcomes were evident both in patients with first-episode and recurrent depression. LIMITATIONS Naturalistic design. Self-rated assessment of disability. Findings from subgroup analyses should be replicated in larger sample size. CONCLUSIONS A shorter duration of untreated depression is associated with more favorable outcomes for major depression, including depression-related disability. This association seems to work both at the first and recurrent episodes, which might have direct implications for both primary and secondary prevention.
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Affiliation(s)
- Lucio Ghio
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy.
| | | | - Alice Cervetti
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Matteo Respino
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Werner Natta
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Maurizio Marcenaro
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Marco Vaggi
- Department of Mental Health, ASL3, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience, Ophthalmology and Genetics, Psychiatry Section, University of Genoa, Italy
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168
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Cook BL, Liu Z, Lessios AS, Loder S, McGuire T. The costs and benefits of reducing racial-ethnic disparities in mental health care. Psychiatr Serv 2015; 66:389-96. [PMID: 25588417 PMCID: PMC7595243 DOI: 10.1176/appi.ps.201400070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies have found that timely mental health treatment can result in savings in both mental health and general medical care expenditures. This study examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. METHODS Data were from a subsample of 6,206 individuals with probable mental illness from the 2004-2010 Medical Expenditure Panel Survey (MEPS). First, disparities in mental health treatment were analyzed. Second, two-year panel data were used to determine the offset of year 1 mental health outpatient and pharmacy treatment on year 2 mental and general medical expenditures. Third, savings were estimated by combining results from steps 1 and 2. RESULTS Compared with whites, blacks and Latinos with year 1 outpatient mental health care spent less on inpatient and emergency general medical care in year 2. Latinos receiving mental health care in year 1 spent less than others on inpatient general medical care in year 2. Latinos taking psychotropic drugs in year 1 showed reductions in inpatient general medical care. Reducing racial-ethnic disparities in mental health care and in psychotropic drug use led to savings in acute medical care expenditures. CONCLUSIONS Savings in acute care expenditures resulting from eliminating disparities in racial-ethnic mental health care access were greater than costs in some but not all areas of acute mental health and general medical care. For blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial (as much as $1 billion nationwide), suggesting that financial and equity considerations can be aligned when planning disparity reduction programs.
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Affiliation(s)
- Benjamin Lê Cook
- Dr. Cook, Mr. Liu, Ms. Lessios, and Mr. Loder are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts (e-mail: ). Dr. Cook is also with the Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts. Dr. McGuire is with the Department of Health Care Policy, Harvard Medical School, Boston. This work was presented in part at the following meetings: AcademyHealth, June 24-26, 2012, Orlando, Florida; National Hispanic Science Network, September 26-29, 2012, San Diego; Eleventh Workshop on Costs and Assessment in Psychiatry, International Center of Mental Health Policy and Economics, March 22-24, 2013, Venice, Italy
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169
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Menear M, Doré I, Cloutier AM, Perrier L, Roberge P, Duhoux A, Houle J, Fournier L. The influence of comorbid chronic physical conditions on depression recognition in primary care: a systematic review. J Psychosom Res 2015; 78:304-13. [PMID: 25676334 DOI: 10.1016/j.jpsychores.2014.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/14/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE People with depression often suffer from comorbid chronic physical conditions and such conditions are widely believed to interfere with primary care providers' ability to recognize their depression. We aimed to examine the evidence related to the influence of chronic physical comorbidity burden on depression recognition in routine, community-based primary care settings. METHODS We conducted a systematic review of the literature on depression recognition in primary care that featured comparisons between patient groups with higher and lower burdens of chronic physical comorbidity. Medline, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched from inception to July 2013. Reference list and reverse citation searches were also performed. A narrative synthesis was conducted given clinical and methodological heterogeneity between studies. RESULTS Our search identified 5817 unique citations, out of which we identified 13 studies reporting data on the relationship between chronic physical comorbidity burden and depression recognition in primary care. Four studies provided some evidence that higher chronic physical comorbidity burden negatively affected primary care providers' ability to recognize depression. In contrast, two studies reported higher rates of recognition in patients with higher comorbidity burden and seven studies reported no differences in recognition between comorbidity groups. CONCLUSION Chronic physical comorbidity burden does not consistently affect depression recognition negatively in primary care. Instead, recognition seems to vary depending on the specific conditions or combination of conditions examined. Methodological choices of authors, such as approaches to measuring recognition and chronic medical comorbidity, also likely explain some divergent results across studies.
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Affiliation(s)
- Matthew Menear
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | - Isabelle Doré
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | | | - Laure Perrier
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Canada
| | - Arnaud Duhoux
- School of Public Health, University of Montreal, Canada; Faculty of Nursing, University of Montreal, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Canada
| | - Louise Fournier
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada.
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170
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van den Berg N, Grabe HJ, Baumeister SE, Freyberger HJ, Hoffmann W. A Telephone- and Text Message-Based Telemedicine Concept for Patients with Mental Health Disorders: Results of a Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:82-89. [PMID: 25721861 DOI: 10.1159/000369468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 10/29/2014] [Indexed: 11/19/2022]
Abstract
Background: A telemedicine care concept based on telephone contacts and individualized text messages was developed for patients with mental disorders to continue treatment after therapy in a psychiatric day hospital. The primary objective of this study was to evaluate the effectiveness of the telemedicine interventions. Methods: The study had a 3-armed, randomized design with 2 intervention arms (intervention 1: telephone contacts; intervention 2: telephone contacts and short text messages; both took place over a period of 6 months and in addition to usual care), and a control group with usual care. Primary outcomes were 18-item Brief Symptom Inventory (BSI-18) scores for anxiety, depression and somatization. All participants were recruited from psychiatric day hospitals. The study was registered in the German Clinical Trials Register (DRKS00000662). Results: 113 participants were analyzed 6 months after starting the intervention. The average BSI-18 anxiety score after 6 months was -2.04 points lower in intervention group 2 than in the control group (p value: 0.042). The difference in BSI depression score between these two groups was marginally significant (p value: 0.1), with an average treatment effect of -1.73. In an exploratory sensitivity analysis restricted to the 75% of patients with the highest symptom scores at baseline, intervention group 1 yielded a significant effect for anxiety and depression compared to the control group (p = 0.036 and 0.046, respectively). Conclusions: Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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171
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Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients. J Affect Disord 2015; 172:462-71. [PMID: 25451451 DOI: 10.1016/j.jad.2014.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Clinical diagnosis of depressive and anxiety disorders has poor sensitivity, and treatment is often not guideline-concordant. This longitudinal study aims to compare diagnostic validity and treatment adequacy in primary care (PC) and specialized care (SC), to assess associated risk factors, and to evaluate their impact on clinical outcome at one-month and three-month follow-ups. METHODS Two hundred twelve patients with depressive and anxious symptoms were recruited from 3 PC and 1 SC centers in Barcelona, Spain. Sensitivity and specificity were calculated comparing medical records׳ diagnoses with a reference (MINI interview). Adequate treatment was defined according to clinical guidelines. Logistic regression was used to estimate associations with risk factors. Impact on outcome was assessed with MANOVA models. RESULTS Valid diagnosis of depression was more frequent in patients attending SC. Sensitivity for depression was 0.75 in SC and 0.49 in PC (adjusted OR=17.34, 95% CI=4.73-63.61). Detection of anxious comorbidity in depressed patients was low (50%) in SC. Treatment adequacy of depressive disorders was higher in SC than in PC (94.4% vs. 80.6%, adjusted OR=8.11, 95% CI=1.39-47.34). Depression severity was associated with valid diagnosis. LIMITATIONS Only four disorders (major depression, dysthymia, panic disorder and generalized anxiety disorder) were evaluated with the MINI interview in a convenience clinical sample. Treatment dosage was unavailable. CONCLUSIONS Our results suggest that GPs need tools to improve detection of depression and its severity. Psychiatrists should enhance recognition of anxious comorbidity. Evaluation of the impact on outcome deserves further research.
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172
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Abstract
BACKGROUND Despite the prevalence of depressive symptoms and increased risk for future cardiovascular events, depressive symptoms frequently go underrecognized in patients hospitalized for acute coronary syndrome (ACS). Identifying an effective approach to depressive symptom screening is imperative in this population. OBJECTIVE The purpose of this cross-sectional study was to explore the agreement between Beck Depression Inventory-II (BDI-II) scores and a single screening question for depressive symptoms in 1122 patients hospitalized for ACS. METHODS Independent-samples t tests and χ tests were used to compare the groups with BDI-II scores of 14 or higher and lower than 14. Three separate agreement analyses were conducted using categorized BDI-II scores (≥14, ≥20, and ≥29). Agreement of the BDI-II categories with the responses to the single screening question was assessed with the simple κ statistic. Sensitivity and specificity were calculated using the BDI-II categories as the criterion standards for depressive symptom screening. RESULTS The agreement analysis revealed a moderate level of agreement (κ coefficient = 0.42) between the BDI-II scores of 14 or higher and the single screening question. Of the participants who reported a BDI-II score of 14 or higher, 61.65% answered yes to the single screening question (sensitivity, 0.62). For those who had BDI-II scores of lower than 14, a total of 82% responded no to the single screening question (specificity, 0.82). When using higher BDI-II scores to define depressive symptoms (≥20 and ≥29), the level of agreement decreased, whereas sensitivity increased to 0.76 and 0.90, with a trade-off in specificity (0.79 and 0.74, respectively). CONCLUSIONS These results suggest that the single screening question for depressive symptoms correctly identifies depressive symptoms 62% of the time but inappropriately identifies depressive symptoms 18% of the time in patients hospitalized for ACS. This suggests that the single screening question for depressive symptoms may be used with caution to initially screen patients with ACS, who can then undergo a more thorough assessment for clinical depression.
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173
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Ma S, Qu S, Huang Y, Chen J, Lin R, Wang C, Li G, Zhao C, Guo S, Zhang Z. Improvement in quality of life in depressed patients following verum acupuncture or electroacupuncture plus paroxetine: A randomized controlled study of 157 cases. Neural Regen Res 2015; 7:2123-9. [PMID: 25558225 PMCID: PMC4281413 DOI: 10.3969/j.issn.1673-5374.2012.27.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/17/2012] [Indexed: 11/18/2022] Open
Abstract
Depressed patients with scores of 17 or more on the 17 items of the Hamilton Depression Rating Scale were treated with the antidepressant drug paroxetine. They also underwent verum acupuncture or electroacupuncture at Baihui (GV20) and Yintang (GV29). The World Health Organization Quality of Life Scale Brief Version showed a significant increase in the total scores of patients who underwent verum acupuncture and electroacupuncture for 6 weeks compared with those who were given paroxetine only; significantly increased physical domain and social relationship scores in verum acupuncture patients compared with paroxetine only; and significantly elevated psychological domain scores with electroacupuncture compared with paroxetine only. These results indicate that both verum acupuncture and electroacupuncture can improve quality of life in depressed patients undergoing paroxetine treatment.
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Affiliation(s)
- Shenghui Ma
- First Clinical Medical College, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Shanshan Qu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yong Huang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Junqi Chen
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Renyong Lin
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Chongqi Wang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ganlong Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Canghuan Zhao
- Guangzhou Overseas Chinese Hospital, Guangzhou 510630, Guangdong Province, China
| | - Shenchang Guo
- Guangdong 999 Brain Hospital, Guangzhou 510510, Guangdong Province, China
| | - Zhangjin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region 999077, China
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174
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Abstract
Brain tumor (BT) is often a devastating disease associated with poor prognosis. Depression is a common complication in BT patients that often remains under-recognized and untreated. Implementation of reliable depression screening algorithms in routine neuro-oncology setting could potentially improve recognition of depression. The Hospital Anxiety and Depression scale-Depression subscale and Patient Health Questionnaire-9 demonstrated adequate psychometric properties for depressive disorder screening in glioma patients. Patients screened positive for depression should be referred for detailed psychiatric assessment prior to initiating anti-depressive treatment. Further methodologically rigorous studies investigating psychometric properties of single-item and multiple-item depression scales are urgently warranted. Studies evaluating anti-depressive treatments' efficacy and clinical value of depression biomarkers are important avenues for future research endeavors in BT patients.
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Affiliation(s)
- Aiste Pranckeviciene
- Neuroscience Institute, Laboratory of Clinical Research, Lithuanian University of Health Sciences, Eiveniu g. 4, LT-50009 Kaunas, Lithuania
| | - Adomas Bunevicius
- Neuroscience Institute, Laboratory of Clinical Research, Lithuanian University of Health Sciences, Eiveniu g. 4, LT-50009 Kaunas, Lithuania
- Department of Neurosurgery, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50009 Kaunas, Lithuania
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175
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Abstract
Comorbid depression and anxiety disorders occur in up to 25% of general practice patients. About 85% of patients with depression have significant anxiety, and 90% of patients with anxiety disorder have depression. Symptomatology may initially seem vague and non-specific. A careful history and examination with relevant investigations should be used to make the diagnosis. Once the diagnosis is made, rating scales may identify illness severity and help in monitoring treatment progress. Both the depression disorder and the specific anxiety disorder require appropriate treatment. Psychological therapies, such as cognitive behaviour therapy, and antidepressants, occasionally augmented with antipsychotics, have proven benefit for treating both depression and anxiety. Benzodiazepines may help alleviate insomnia and anxiety but not depression. They have dependency and withdrawal issues for some people, and may increase the risk of falls in older people. Despite the availability of treatments, 40% of patients with depression or anxiety do not seek treatment, and of those who do, less than half are offered beneficial treatment.
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176
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Stewart RW, Hardcastle VG, Zelinsky A. Health Disparities, Social Determinants of Health, and Health Insurance. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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177
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Katzman MA, Anand L, Furtado M, Chokka P. Food for thought: understanding the value, variety and usage of management algorithms for major depressive disorder. Psychiatry Res 2014; 220 Suppl 1:S3-14. [PMID: 25539872 DOI: 10.1016/s0165-1781(14)70002-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/11/2014] [Indexed: 12/28/2022]
Abstract
By 2020, depression is projected to be among the most important contributors to the global burden of disease. A plethora of data confirms that despite the availability of effective therapies, major depressive disorder continues to exact an enormous toll; this, in part, is due to difficulties reaching complete remission, as well as the specific associated costs of both the disorder's morbidity and mortality. The negative effects of depression include those on patients' occupational functioning, including absenteeism, presenteeism, and reduced opportunities for educational and work success. The use of management algorithms has been shown to improve treatment outcomes in major depressive disorder and may be less costly than "usual care" practices. Nevertheless, many patients with depression remain untreated. As well, even those who are treated often continue to experience suboptimal quality of life. As such, the treatment algorithms in this article may improve outcomes for patients suffering with depression. This paper introduces some of the principal reasons underlying these treatment gaps and examines measures or recommendations that might be changed or strengthened in future practice guidelines to bridge them.
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Affiliation(s)
- Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada; Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Department of Psychology, Lakehead University, Thunder Bay, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Adler Graduate Professional School, Toronto, ON, Canada.
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Pratap Chokka
- University of Alberta, Edmonton, AB, Canada; Chokka Center for Integrative Health, Edmonton, AB, Canada
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178
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Davidsen AS, Fosgerau CF. What is depression? Psychiatrists' and GPs' experiences of diagnosis and the diagnostic process. Int J Qual Stud Health Well-being 2014; 9:24866. [PMID: 25381757 PMCID: PMC4224702 DOI: 10.3402/qhw.v9.24866] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/21/2022] Open
Abstract
The diagnosis of depression is defined by psychiatrists, and guidelines for treatment of patients with depression are created in psychiatry. However, most patients with depression are treated exclusively in general practice. Psychiatrists point out that general practitioners' (GPs') treatment of depression is insufficient and a collaborative care (CC) model between general practice and psychiatry has been proposed to overcome this. However, for successful implementation, a CC model demands shared agreement about the concept of depression and the diagnostic process in the two sectors. We aimed to explore how depression is understood by GPs and clinical psychiatrists. We carried out qualitative in-depth interviews with 11 psychiatrists and 12 GPs. Analysis was made by Interpretative Phenomenological Analysis. We found that the two groups of physicians differed considerably in their views on the usefulness of the concept of depression and in their language and narrative styles when telling stories about depressed patients. The differences were captured in three polarities which expressed the range of experiences in the two groups. Psychiatrists considered the diagnosis of depression as a pragmatic and agreed construct and they did not question its validity. GPs thought depression was a "gray area" and questioned the clinical utility in general practice. Nevertheless, GPs felt a demand from psychiatry to make their diagnosis based on instruments created in psychiatry, whereas psychiatrists based their diagnosis on clinical impression but used instruments to assess severity. GPs were wholly skeptical about instruments which they felt could be misleading. The different understandings could possibly lead to a clash of interests in any proposed CC model. The findings provide fertile ground for organizational research into the actual implementation of cooperation between sectors to explore how differences are dealt with.
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Affiliation(s)
- Annette S Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark;
| | - Christina F Fosgerau
- Department of Scandinavian Studies and Linguistics, University of Copenhagen, Copenhagen, Denmark
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179
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Chan CMH, Wan Ahmad WA, Yusof MMD, Ho GF, Krupat E. Effects of depression and anxiety on mortality in a mixed cancer group: a longitudinal approach using standardised diagnostic interviews. Psychooncology 2014; 24:718-25. [PMID: 25345781 DOI: 10.1002/pon.3714] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In this study, we examined the prevalence of psychiatric morbidity and its association with cancer survival over time. METHODS Participants were 467 consecutive adult cancer patients attending oncology follow-ups at a single academic medical centre. Assessment consisted of the Hospital Anxiety and Depression Scale and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Comparison between co-morbid psychiatric cases and non-cases was made in follow-ups of up to 24 months. RESULTS Of the 467 patients, 217 of 220 patients with elevated total Hospital Anxiety and Depression Scale scores (≥16) met the criteria for an Axis I disorder at 6 months follow-up, with 102 of the follow-up sample having a persistent diagnosable psychiatric disorder after 1 year. The most frequent initial diagnoses were minor depression (17.6%), major depressive disorder (15.8%) and adjustment disorder (15.8%). Cancer patients without psychiatric morbidity had a survival benefit of 2.24 months or 67 days. Mean survival at 24 months was 20.87 months (95% CI 20.06-21.69) for cancer patients with psychiatric morbidity versus 23.11 months (95% CI 22.78-23.43) for those without (p < 0.001 for log rank). After adjusting for demographics and cancer stage on a Cox proportional hazards model, psychiatric morbidity remained associated with worse survival (hazard ratio 4.13, 95% CI 1.32-12.92, p = 0.015). CONCLUSIONS This study contributes to the growing body of evidence linking psychiatric morbidity to cancer mortality. Treating underlying psychiatric conditions in cancer may therefore improve not just quality of life but also survival.
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Affiliation(s)
- Caryn Mei Hsien Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Mastura M D Yusof
- Department of Clinical Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Gwo-Fuang Ho
- Department of Clinical Oncology, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Edward Krupat
- Center for Evaluation, Harvard Medical School, Boston, MA, USA
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180
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Applications of blood-based protein biomarker strategies in the study of psychiatric disorders. Prog Neurobiol 2014; 122:45-72. [PMID: 25173695 DOI: 10.1016/j.pneurobio.2014.08.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/11/2014] [Accepted: 08/19/2014] [Indexed: 02/07/2023]
Abstract
Major psychiatric disorders such as schizophrenia, major depressive and bipolar disorders are severe, chronic and debilitating, and are associated with high disease burden and healthcare costs. Currently, diagnoses of these disorders rely on interview-based assessments of subjective self-reported symptoms. Early diagnosis is difficult, misdiagnosis is a frequent occurrence and there are no objective tests that aid in the prediction of individual responses to treatment. Consequently, validated biomarkers are urgently needed to help address these unmet clinical needs. Historically, psychiatric disorders are viewed as brain disorders and consequently only a few researchers have as yet evaluated systemic changes in psychiatric patients. However, promising research has begun to challenge this concept and there is an increasing awareness that disease-related changes can be traced in the peripheral system which may even be involved in the precipitation of disease onset and course. Converging evidence from molecular profiling analysis of blood serum/plasma have revealed robust molecular changes in psychiatric patients, suggesting that these disorders may be detectable in other systems of the body such as the circulating blood. In this review, we discuss the current clinical needs in psychiatry, highlight the importance of biomarkers in the field, and review a representative selection of biomarker studies to highlight opportunities for the implementation of personalized medicine approaches in the field of psychiatry. It is anticipated that the implementation of validated biomarker tests will not only improve the diagnosis and more effective treatment of psychiatric patients, but also improve prognosis and disease outcome.
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181
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Can Problem Solving Therapy Solve the Problem of Late Life Depression? A Systematic Review of Randomized Trials. JOURNAL OF EUROPEAN PSYCHOLOGY STUDENTS 2014. [DOI: 10.5334/jeps.cd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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182
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Karger A. Geschlechtsspezifische Aspekte bei depressiven Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:1092-8. [DOI: 10.1007/s00103-014-2019-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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183
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Fisch MJ, Zhao F, Manola J, Miller AH, Pirl WF, Wagner LI. Patterns and predictors of antidepressant use in ambulatory cancer patients with common solid tumors. Psychooncology 2014; 24:523-32. [PMID: 24930693 DOI: 10.1002/pon.3606] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE Depressive symptoms and antidepressant use are prevalent among cancer patients. We sought to identify determinants of prescribing commonly used antidepressants. PATIENTS AND METHODS This multi-institutional study enrolled 3106 ambulatory patients with cancer of the breast, prostate, colon/rectum, or lung. Five case-finding methods were used to identify patients with depressive symptoms. Logistic models were used to examine factors that impact antidepressant use. RESULTS Approximately, 47% of patients were defined as having depressive symptoms. Clinicians rated being sad/depressed as one of the top three priority problems for 10.5% of patients. Antidepressants were prescribed in 19% of all patients, 25% with depressive symptoms and 14% nondepressed patients. After adjusting for other covariates, these variable categories were significantly associated with greater use of antidepressants: depressive symptoms, family history of depression, concurrent medication use, cancer treatment status, and certain other clinical and demographic variables. The strongest individual predictors were concurrent use of more than 10 medications (odds ratio [OR] = 3.3), a family history of depression (OR = 2.2), sedative use (OR = 2.1), non-Hispanic white race (OR = 2.0), and anxiolytics use (OR = 2.0). CONCLUSIONS Depressive symptoms are found in nearly half of outpatients with cancer, and one-fourth of patients with depressive symptoms are taking an antidepressant. Patients receiving antidepressants are more often those taking multiple medications, those with a depression diathesis, and those with more extensive cancer treatment. Patients who were younger, white, and female were also more likely to be taking antidepressants.
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Affiliation(s)
- Michael J Fisch
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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184
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Whalley B, Thompson DR, Taylor RS. Psychological interventions for coronary heart disease: cochrane systematic review and meta-analysis. Int J Behav Med 2014. [PMID: 23179678 DOI: 10.1007/s12529-012-9282-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression and anxiety are common in cardiac patients, and psychological interventions may also be used as part of general cardiac rehabilitation programs. PURPOSE This study aims to estimate effects of psychological interventions on mortality and psychological symptoms in this group, updating an existing Cochrane Review. METHOD Systematic review and meta-regression analyses of randomized trials evaluating a psychological treatment delivered by trained staff to patients with a diagnosed cardiac disease, with a follow-up of at least 6 months, were used. RESULTS There was no strong evidence that psychological intervention reduced total deaths, risk of revascularization, or non-fatal infarction. Psychological intervention did result in small/moderate improvements in depression and anxiety, and there was a small effect for cardiac mortality. CONCLUSION Psychological treatments appear effective in treating patients with psychological symptoms of coronary heart disease. Uncertainty remains regarding the subgroups of patients who would benefit most from treatment and the characteristics of successful interventions.
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Affiliation(s)
- Ben Whalley
- School of Psychology, University of Plymouth, Plymouth, UK
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185
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Gagné S, Vasiliadis HM, Préville M. Gender differences in general and specialty outpatient mental health service use for depression. BMC Psychiatry 2014; 14:135. [PMID: 24884891 PMCID: PMC4028012 DOI: 10.1186/1471-244x-14-135] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/02/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND This study ascertained gender-specific determinants of outpatient mental health (MH) service use for depression to highlight any gender disparities in barriers to care and explain how depressed men and women in need of care might differ in their help-seeking behaviour. METHODS Data used in this study came from the Canadian Community Health Survey on Mental Health and Well Being, cycle 1.2 (CCHS 1.2) conducted by Statistics Canada in 2002 (N = 36,984). The sample was limited to respondents filling criteria for a probable major depression in the 12 months prior to the interview (n = 1743). Gender-specific multivariate logistic regression analyses were carried out. RESULTS The results showed that 54.3% of respondents meeting criteria for major depression had consulted for mental health reasons in the year prior to interview. When looking at type of outpatient mental health service use, males were more likely to consult a general practitioner and a mental health specialist in the past year as opposed to females. However, females were more likely to consult a general practitioner only as opposed to no service use than males. Gender specific differences in determinants associated with outpatient service use included for males, lower adjusted household income, and for females, a younger age, the presence of social support, self-reported availability barriers, the presence of self-reported suicidal thoughts or attempt and a poorer self- perceived mental health. CONCLUSIONS Continued efforts to promote access to mental health care are needed for men and women affected by depression, and this, to target specific vulnerable populations and increase utilization rates.
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Affiliation(s)
- Sarah Gagné
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada.
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada,Charles Lemoyne Research Centre, 150, place Charles-LeMoyne, Bureau 200, Longueuil, (Québec) J4K 0A8, Canada
| | - Michel Préville
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbooke, Canada,Charles Lemoyne Research Centre, 150, place Charles-LeMoyne, Bureau 200, Longueuil, (Québec) J4K 0A8, Canada
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186
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Rayner L, Matcham F, Hutton J, Stringer C, Dobson J, Steer S, Hotopf M. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatry 2014; 36:318-24. [PMID: 24630892 DOI: 10.1016/j.genhosppsych.2013.12.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 12/05/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.
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Affiliation(s)
- L Rayner
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
| | - F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - J Hutton
- South London and Maudsley and King's College Hospital NHS Foundation Trusts, UK
| | - C Stringer
- Information and Communication Technology, King's College Hospital NHS Foundation Trust, UK
| | - J Dobson
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - S Steer
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
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187
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Walker S, Walker J, Richardson G, Palmer S, Wu Q, Gilbody S, Martin P, Hansen CH, Sawhney A, Murray G, Sculpher M, Sharpe M. Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: the example of cancer. Psychol Med 2014; 44:1451-1460. [PMID: 23962484 DOI: 10.1017/s0033291713002079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Co-morbid major depression occurs in approximately 10% of people suffering from a chronic medical condition such as cancer. Systematic integrated management that includes both identification and treatment has been advocated. However, we lack information on the cost-effectiveness of this combined approach, as published evaluations have focused solely on the systematic (collaborative care) treatment stage. We therefore aimed to use the best available evidence to estimate the cost-effectiveness of systematic integrated management (both identification and treatment) compared with usual practice, for patients attending specialist cancer clinics. METHOD We conducted a cost-effectiveness analysis using a decision analytic model structured to reflect both the identification and treatment processes. Evidence was taken from reviews of relevant clinical trials and from observational studies, together with data from a large depression screening service. Sensitivity and scenario analyses were undertaken to determine the effects of variations in depression incidence rates, time horizons and patient characteristics. RESULTS Systematic integrated depression management generated more costs than usual practice, but also more quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was £11,765 per QALY. This finding was robust to tests of uncertainty and variation in key model parameters. CONCLUSIONS Systematic integrated management of co-morbid major depression in cancer patients is likely to be cost-effective at widely accepted threshold values and may be a better way of generating QALYs for cancer patients than some existing medical and surgical treatments. It could usefully be applied to other chronic medical conditions.
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Affiliation(s)
- S Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - J Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, UK
| | - S Palmer
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Q Wu
- Department of Health Sciences, University of York, Heslington, York, UK
| | - S Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - P Martin
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - C Holm Hansen
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - A Sawhney
- Psychological Medicine Research, University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - G Murray
- University of Edinburgh Centre for Population Health Sciences, Edinburgh, UK
| | - M Sculpher
- Centre for Health Economics, University of York, Heslington, York, UK
| | - M Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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188
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Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care. J Clin Psychol Med Settings 2014; 20:311-22. [PMID: 23549666 DOI: 10.1007/s10880-013-9363-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to examine the factorial and diagnostic validity of the Beck Depression Inventory-Second Edition (BDI-II) in Croatian primary health care. Data were collected using a medical outpatient sample (N = 314). Reliability measured by internal consistency proved to be high. While the Velicer MAP Test showed that extraction of only one factor is satisfactory, confirmatory factor analysis indicated the best fit for a 3-factor structure model consisting of cognitive, affective and somatic dimensions. Receiver operating characteristics (ROC) analysis demonstrated the BDI-II to have a satisfactory diagnostic validity in differentiating between healthy and depressed individuals in this setting. The area under the curve (AUC), sensitivity and specificity were high with an optimal cut-off score of 15/16. The implications of these findings are discussed regarding the use of the BDI-II as a screening instrument in primary health care settings.
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189
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Gidding LG, Spigt MG, Dinant GJ. Stepped collaborative depression care: primary care results before and after implementation of a stepped collaborative depression programme. Fam Pract 2014; 31:180-92. [PMID: 24277384 DOI: 10.1093/fampra/cmt072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Numerous intensive research projects to assess the effects of stepped collaborative care (SCC) for depressed patients have been reported in primary care, yet it is unclear how SCC is sustained in usual care. OBJECTIVE To assess how SCC for depression is actually being used and how it performs in usual primary care by studying medical data that are routinely collected in family practice, outside the research setting. METHODS Retrospective before and after comparison of electronic medical records (EMR) regarding the implementation of an SCC depression programme in a large primary care organization from 2003 to 2012. Depression care parameters included prevalences, minimal interventions, Beck Depression Inventory-2 (BDI-2), antidepressants, referrals to psychologists and psychiatrists and primary health care consumption. RESULTS After programme implementation, differentiation between levels of depression severity increased, more patients were treated with minimal interventions and more patients were monitored with BDI-2. These effects occurred in both nonseverely and severely depressed patients, although they were larger for patients registered as nonseverely depressed. Antidepressant prescription rates and referral rates seemed not to have been influenced by the SCC programme. Health care consumption of the depressed patients increased significantly. CONCLUSIONS The depression care parameters changed to a different extent and at a different pace than after previous implementation initiatives. Future research should identify whether SCC uptake in primary care is best enhanced by intensive external guidance or by making care providers themselves responsible for the implementation. Analyses of EMR can be valuable in monitoring the implementation effects, especially after research projects are completed.
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Affiliation(s)
- Luc G Gidding
- Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
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190
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White JH, Attia J, Sturm J, Carter G, Magin P. Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study. Disabil Rehabil 2014; 36:1975-82. [DOI: 10.3109/09638288.2014.884172] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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191
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Biddulph JP, Iliffe S, Kharicha K, Harari D, Swift C, Gillmann G, Stuck AE. Risk factors for depressed mood amongst a community dwelling older age population in England: cross-sectional survey data from the PRO-AGE study. BMC Geriatr 2014; 14:5. [PMID: 24450968 PMCID: PMC3905671 DOI: 10.1186/1471-2318-14-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Quality and Outcomes Framework in the United Kingdom (UK) National Health Service previously highlighted case finding of depression amongst patients with diabetes or coronary heart disease. However, depression in older people remains under-recognized. Comprehensive data for analyses of the association of depression in older age with other health and functional measures, and demographic factors from community populations within England, are lacking. METHODS Secondary analyses of cross-sectional baseline survey data from the England arm of a randomised controlled trial of health risk appraisal for older people in Europe; PRO-AGE study. Data from 1085 community-dwelling non-disabled people aged 65 years or more from three group practices in suburban London contributed to this study. Depressed mood was ascertained from the 5-item Mental Health Inventory Screening test. Exploratory multivariable logistic regression was used to identify the strongest associations of depressed mood with a previous diagnosis of a specified physical/mental health condition, health and functional measures, and demographic factors. RESULTS Depressed mood occurred in 14% (155/1085) of participants. A previous diagnoses of depression (OR 3.39; P < 0.001) and poor vision as determined from a Visual Function Questionnaire (OR 2.37; P = 0.001) were amongst the strongest factors associated with depressed mood that were independent of functional impairment, other co-morbidities, and demographic factors. A subgroup analyses on those without a previous diagnosis of depression also indicated that within this group, poor vision (OR 2.51; P = 0.002) was amongst the strongest independent factors associated with depressed mood. CONCLUSIONS Previous case-finding strategies in primary care focussed on heart disease and diabetes but health-related conditions other than coronary heart disease and diabetes are also associated with an increased risk for depression. Complex issues of multi-morbidity occur within aging populations. 'Risk' factors that appeared stronger than those, such as, diabetes and coronary heart disease that until recently prompted for screening in the UK due to the QOF, were identified, and independent of other morbidities associated with depressed mood. From the health and functional factors investigated, amongst the strongest factors associated with depressed mood was poor vision. Consideration to case finding for depressed mood among older people with visual impairment might be justified.
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Affiliation(s)
- Jane P Biddulph
- Research Department of Epidemiology and Public Health, UCL, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Kalpa Kharicha
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Danielle Harari
- Department of Ageing and Health, St. Thomas’ Hospital, London, UK
| | - Cameron Swift
- Clinical Age Research Unit, Kings College London, London, UK
| | - Gerhard Gillmann
- Department of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital and University of Bern Hospital, Bern, Switzerland
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192
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Davydow DS, Zivin K, Langa KM. Hospitalization, depression and dementia in community-dwelling older Americans: findings from the national health and aging trends study. Gen Hosp Psychiatry 2014; 36:135-41. [PMID: 24388630 PMCID: PMC3951607 DOI: 10.1016/j.genhosppsych.2013.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective was to estimate the prevalence of both dementia and depression among community-dwelling older Americans and to determine if hospitalization is independently associated with dementia or depression in this population. METHOD This cross-sectional study utilized data from a nationally representative, population-based sample of 7197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self- or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2. RESULTS An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval [95% CI]: 1.16-1.73) and substantial depressive symptoms (OR: 1.60, 95% CI: 1.29-1.99). CONCLUSIONS Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bidirectional relationship between hospitalizations, dementia and depression, along with targeted interventions to reduce hospitalizations, is needed.
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Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Kara Zivin
- Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry and Behavioral Sciences University of Michigan, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Langa
- Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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193
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The Validity and Reliability of the Sinhala Translation of the Patient Health Questionnaire (PHQ-9) and PHQ-2 Screener. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:768978. [PMID: 24795822 PMCID: PMC3985147 DOI: 10.1155/2014/768978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/06/2014] [Indexed: 11/18/2022]
Abstract
The Patient Health Questionnaire (PHQ-9) was adapted and translated into Sinhala. Sample consisted of 75 participants diagnosed with MDD according to DSM-IV criteria and 75 gender matched controls. Concurrent validity was assessed by correlating total score of PHQ-9 with that of Centre for Epidemiological Studies Depression Scale (CESD). The Structured Clinical Interview for DSM-IV (SCID-II) conducted by a psychiatrist was the gold standard. Mean age of the sample was 33.0 years. There were 91 females (60.7%). There was significant difference in the mean PHQ-9 scores between cases (14.71) and controls (2.55) (P < 0.001). The specificity of the categorical algorithm was 0.97; the sensitivity was 0.58. Receiver operating characteristic (ROC) analysis found that cut-off score of ≥10 had sensitivity of 0.75 and specificity of 0.97. The area under the curve (AOC) was 0.93. The sensitivity of the two-item screener (PHQ-2) was 0.80 and the specificity was 0.97. Cronbach's alpha was 0.90. The PHQ-9 is a valid and reliable instrument for diagnosing MDD in a non-Western population. The threshold algorithm is recommended for screening rather than the categorical algorithm. The PHQ-2 screener has good sensitivity and specificity and is recommended as a quick screening instrument.
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194
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Moayedoddin B, Rubovszky G, Mammana L, Jeannot E, Sartori M, Garin N, Andreoli A, Canuto A, Perrier A. Prevalence and clinical characteristics of the DSM IV major depression among general internal medicine patients. Eur J Intern Med 2013; 24:763-6. [PMID: 23816277 DOI: 10.1016/j.ejim.2013.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/26/2013] [Accepted: 05/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital. METHOD 557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire. RESULTS 69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p=.004). Among subjects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients. CONCLUSIONS This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.
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Affiliation(s)
- Babak Moayedoddin
- Liaison Psychiatry and Crisis Intervention Service, Department of Psychiatry, University Hospitals of Geneva (HUG), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland.
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195
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Gerrits MMJG, van Marwijk HWJ, van Oppen P, van der Horst H, Penninx BWJH. The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners. J Affect Disord 2013; 151:1025-32. [PMID: 24119920 DOI: 10.1016/j.jad.2013.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety. METHODS We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs' registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview. RESULTS Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR=1.18, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms. LIMITATIONS Some specific chronic diseases had low prevalence. CONCLUSIONS This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain.
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Affiliation(s)
- Marloes M J G Gerrits
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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196
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Nobis S, Lehr D, Ebert DD, Berking M, Heber E, Baumeister H, Becker A, Snoek F, Riper H. Efficacy and cost-effectiveness of a web-based intervention with mobile phone support to treat depressive symptoms in adults with diabetes mellitus type 1 and type 2: design of a randomised controlled trial. BMC Psychiatry 2013; 13:306. [PMID: 24238346 PMCID: PMC4225701 DOI: 10.1186/1471-244x-13-306] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/22/2013] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A diagnosis of diabetes mellitus types 1 or 2 doubles the odds of a comorbid depressive disorder. The combined diseases have a wide range of adverse outcomes, such as a lower quality of life, poorer diabetes outcomes and increased healthcare utilisation. Diabetes patients with depression can be treated effectively with psychotherapy, but access to psychological care is limited. In this study we will examine the efficacy and cost-effectiveness of a newly developed web-based intervention (GET.ON Mood Enhancer Diabetes) for people with diabetes and comorbid depressive symptoms. METHODS/DESIGN A two-arm randomised controlled trial will be conducted. Adults with diabetes (type 1 or type 2) with increased depression scores (> 22 on the German version of the Center for Epidemiological Studies Depression Scale (CES-D)) will be included. Eligible participants will be recruited through advertisement in diabetes patient journals and via a large-scale German health insurance company. The participants will be randomly assigned to either a 6-week minimally guided web-based self-help program or an online psychoeducation program on depression. The study will include 260 participants, which will enable us to detect a statistically significant difference with a group effect size of d = 0.35 at a power of 80% and a significance level of p = 0.05. The primary outcome measure will be the level of depression as assessed by the CES-D. The secondary outcome measures will be: diabetes-specific emotional distress, glycaemic control, self-management behaviour and the participants' satisfaction with the intervention. Online self-assessments will be collected at baseline and after a 2 months period, with additional follow-up measurements 6 and 12 months after randomisation. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct an economic evaluation from a societal perspective. DISCUSSION If this intervention is shown to be cost-effective, it has considerable potential for implementing psychological care for large numbers of people with diabetes and comorbid depression in routine practice and improve health outcomes. TRIAL REGISTRATION German Clinical Trial Register (DRKS): DRKS00004748.
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Affiliation(s)
- Stephanie Nobis
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Dirk Lehr
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany,Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - David Daniel Ebert
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany,Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Matthias Berking
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany,Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Elena Heber
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany
| | | | - Annette Becker
- Department of General Medicine/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | - Frank Snoek
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Heleen Riper
- Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Lüneburg, Germany,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands,Institute for Health and Care Research (EMGO), VU University Medical Centre, Amsterdam, The Netherlands
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197
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Mojtabai R. Clinician-identified depression in community settings: concordance with structured-interview diagnoses. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:161-9. [PMID: 23548817 DOI: 10.1159/000345968] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 11/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Relatively little is known about the prevalence and correlates of overdiagnosis of depression in community settings. This study examined the extent to which individuals with clinician-identified depression in the community meet the criteria for DSM-IV major depressive episodes (MDE) and characteristics of these individuals. METHODS In a sample of 5,639 participants with clinician-identified depression drawn from the 2009-2010 United States National Survey of Drug Use and Health, the proportion of participants who met the 12-month MDE criteria, ascertained by a structured interview, and variations in MDE diagnosis across different groups of participants were examined. Mental health profiles and service use of participants who met the MDE criteria were compared to those who did not meet these criteria. RESULTS Only 38.4% of participants with 12-month clinician-identified depression met the 12-month MDE criteria. Older adults were less likely than younger adults to meet the criteria - only 14.3% of those 65 years old or older met the criteria, whereas participants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications. CONCLUSIONS Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
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198
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Effectiveness of collaborative care for depression in Italy. A randomized controlled trial. Gen Hosp Psychiatry 2013; 35:579-86. [PMID: 23969143 DOI: 10.1016/j.genhosppsych.2013.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 06/14/2013] [Accepted: 07/09/2013] [Indexed: 01/25/2023]
Abstract
TRIAL DESIGN This was a multicenter cluster-randomized controlled trial. PARTICIPANTS A total of 227 patients ≥18 years old with a new onset of depressive symptoms who screened positive on the first two items of the Patient Health Questionnaire-9 (PHQ-9) were recruited by primary care physicians (PCPs) of eight health districts of three Italian regions from September 2009 to June 2011. INTERVENTION PCPs of the intervention group received a specific collaborative care program including 2 days of intensive training, implementation of a stepped care protocol, depression management toolkit and scheduled meetings with a dedicated consultant psychiatrist. OBJECTIVE The objective was to determine whether a collaborative care program for depression management in primary care leads to higher remission rate than usual PCP care. OUTCOMES Outcome was clinical remission as expressed on PHQ-9 <5 at 3 months. RANDOMIZATION An independent researcher used computer-generated randomization to assign involved primary care groups to the two alternative arms. BLINDING PCPs and research personnel were not blinded. RESULTS The 223 PCPs enrolled recruited 227 patients (128 in collaborative care arm, 99 in the usual care arm). At 3 months (n=210), the proportion of patients who achieved remission was higher, though the difference was not statistically significant, in the collaborative care group. The effect size was of 0.11. When considering only patients with minor/major depression, collaborative care appeared to be more effective than usual care (P=.015). CONCLUSIONS The present intervention for managing depression in primary care, designed to be applicable to the Italian context, appears to be effective and feasible.
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199
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Gregg JJ, Fiske A, Gatz M. Physicians' detection of late-life depression: the roles of dysphoria and cognitive impairment. Aging Ment Health 2013; 17:1030-6. [PMID: 23767897 PMCID: PMC3797862 DOI: 10.1080/13607863.2013.805403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine factors that impede or facilitate physicians' detection of depression in later life, including cognitive impairment and patients' endorsement of dysphoria. METHODS A population-based sample of 344 adults from the Swedish Adoption/Twin Study of Aging (SATSA) was utilized. Physician detection of depression was determined by (1) outpatient medical records, (2) antidepressant prescription, and/or (3) inpatient hospitalization. Depressive symptoms were measured by highest score on the Center for Epidemiologic Studies - Depression Scale (CES-D), administered on six occasions between 1986 and 1994. Endorsement of dysphoria was examined using two items on the CES-D. The Mini-Mental State Examination (MMSE) was used to indicate cognitive impairment. RESULTS One-hundred thirty-six individuals were above the cut-off on the CES-D on at least one occasion; however, only 14 of these individuals (10%) were detected as depressed by a physician. Higher CES-D total score was significantly related to physician detection. Furthermore, physicians were most likely to detect depression if the individual endorsed the single CES-D item regarding feeling depressed. A significant interaction was found, such that overall CES-D score was only associated with physician detection among those with higher endorsement of the depressed item. The association between total CES-D and physician detection was not affected by presence of cognitive impairment. CONCLUSIONS Depression in later life often goes undetected by physicians. Factors associated with detection include the frequency/severity of symptoms and patients' endorsement specifically of feeling depressed. Results suggest that physicians should routinely assess for other symptoms associated with late-life depression besides dysphoria (e.g., appetite loss, crying spells).
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Affiliation(s)
- Jeffrey J. Gregg
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles, California,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Aras N, Oral E, Aydin N, Gulec M. Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age. Int J Psychiatry Clin Pract 2013; 17:298-306. [PMID: 23822181 DOI: 10.3109/13651501.2013.821493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age. METHOD This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders. RESULTS The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic. CONCLUSION Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age.
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Affiliation(s)
- Neriman Aras
- Department of Psychiatry, Trabzon Kanuni Research and Training Hospital , Trabzon , Turkey
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