Multimorbidity and depression treatment

The Relationship of Chronic Disease Burden and Racial-Ethnic Disparities in Depression Treatment

BACKGROUND

Chronic disease and depression are closely related, and depression, if left untreated, can worsen physical disease symptoms. Furthermore, treating depression can improve patient outcomes. Generally, treatment for depression is lower in minority groups.

OBJECTIVE

The aim of this study was to determine the relationship between chronic disease burden and depression treatment and whether that relationship differs between white to non-white patient visits to primary care physicians.

DESIGN

We conducted a quantitative secondary data analysis using data from 2014-2019 National Ambulatory Medical Care Survey (NAMCS).

PARTICIPANTS

Visits by adults with depression to primary care physicians (n = 3832).

MAIN MEASURES

Logistic regressions estimated the odds of medication treatment, mental health counseling treatment, and any treatment.

KEY RESULTS

Visits by patients with 3 or more chronic conditions had 1.39 times the odds of receiving medication treatment (p-value = 0.06). However, when examining treatment by race, visits by white patients with 1-2 chronic conditions had 3.04 times the odds of receiving mental health treatment (p-value = 0.09) compared to visits by non-white patients and 2.09 times the odds of receiving any treatment (p-value = 0.08) compared to visits by non-white patients.

CONCLUSIONS

Although not significant at the p < .05 level, the results suggest that the odds of depression treatment is greater during visits by patients with multiple co-occurring chronic conditions compared to visits by people without chronic conditions. It appears that this effect is larger for visits by white patients compared to visits by non-white patients. Further research is needed to confirm these findings and determine how this association impacts minorities distinctly and what could be the reason behind the disparity. These findings could help physicians be aware of ongoing disparities in depression treatment and provide more equitable depression treatment.

Association between chronic disease and depression among older adults in China: the moderating role of social participation

OBJECTIVES

Depression is an increasingly serious mental health problem worldwide. Therefore, this study aimed to explore the association between chronic disease and depression and to further test the moderating role of social participation in this association.

STUDY DESIGN

This is a cross-sectional study.

METHODS

We screened 6421 subjects from the 2018 wave of the China Health and Retirement Longitudinal Study database. Social participation and depressive symptoms were assessed using the 12-item self-made scale and 10-item Center for Epidemiological Studies Depression Scale, respectively. Hierarchical regression was used to determine the main effect of chronic disease and depression and the moderating effect of social participation on the relationship between chronic disease and depression.

RESULTS

In this study, 3172 (49.40%) eligible participants were male, 4680 (72.90%) older adults were concentrated in the 65-74 years group, and 68.20% reported good health status. In addition, gender, area, education level, marital status, health status, health insurance, health service utilization, and physical activity intensity were significant factors associated with participants' depression status (P < 0.05). The results also showed that a higher number of chronic diseases were associated with a higher depression score after adjusting for confounders (single disease: β = 0.074, P < 0.001; multimorbidity: β = 0.171, P < 0.001) and that social participation played a moderating role in this association (β = -0.030, P < 0.05).

CONCLUSIONS

This study tentatively suggests that a higher number of chronic diseases are associated with rising depression scores in the older Chinese population. In addition, the moderating effect of social participation suggests that more active social engagement should be promoted in this population to alleviate the depressive mood.

An association between multi-morbidity and depressive symptoms among Indian adults based on propensity score matching

Keeping in view the cascade of disturbances caused by the co-existence of multi-morbidity and depression among aged population, this study aims to ascertain the independent impact of multi-morbidity as a risk factor for the development of depressive symptoms among adults living in India. The present study utilizes data from the nationally representative survey “Longitudinal Ageing Study in India” (LASI, Wave-1, 2017–2018). The eligible sample size was 62,244 adults aged 45 years and above. Descriptive statistics along with bivariate analysis was used to understand the prevalence of depressive symptoms. Further, binary logistic regression and Propensity Score Matching (PSM) methods were applied to examine the independent effect of multi-morbidity on depressive symptoms while controlling the selected background characteristics. Overall, around one-third respondents had at least one chronic disease and one-fifth had multi-morbidity. The most prevalent chronic disease reported in the sampled population was hypertension followed by diabetes and joint disease. It is observed that older adults with multiple chronic diseases had 77% higher odds of having depressive symptoms as compared to those without a history of chronic disease in the multivariable logistic regression model. Results obtained from PSM indicate that the risk of having depressive symptoms was 3.7% higher for adults with multi- morbidity. Depressive symptom was identified to be associated with a wider range of multiple physical health problems and people with multi-morbidity are at a higher risk of having depressive symptoms. It is imperative that multi-morbidity can be used as a screener for identifying people with depressive symptoms.

Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010

BACKGROUND

Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings.

OBJECTIVES

Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship.

RESEARCH DESIGN

Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings.

SUBJECTS

Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits).

MEASURES

Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications.

RESULTS

Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (P<0.05). There were no differences in service use by race/ethnicity after controlling for other factors.

CONCLUSIONS

Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves toward an integrated care model.

A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?

Health utilization and need assessment data suggest there is considerable variation in access to outpatient specialist care. However, it is unclear if the types of barriers experienced are specific to chronic disease groups or experienced universally. This systematic review provides a detailed summary of common and unique barriers experienced by chronic disease groups when accessing and receiving care, and a synthesized list of possible health service initiatives to improve equitable delivery of optimal care in high-income countries. Quantitative articles describing barriers to specialist outpatient services were retrieved from CINAHL, MEDLINE, Embase, and PyscINFO. To be eligible for review, studies: were published from 2002 to May 2014; included samples with cancer, diabetes mellitus, osteoporosis, arthritis, ischaemic heart disease, stroke, asthma, chronic pulmonary disorder (COPD) or depression; and, were conducted in high-income countries. Using a previously validated model of access (Penchansky and Thomas' model of fit), barriers were grouped according to five overarching domains and defined in more detail using 33 medical subject headings. Results from reviewed articles, including the scope and frequency of reported barriers, are conceptualized using thematic analysis and framed as possible health service initiatives. A total of 3181 unique records were screened for eligibility, of which 74 studies were included in final analysis. The largest proportion of studies reported acceptability barriers (75.7 %), of which demographic disparities (44.6 %) were reported across all diseases. Other frequently reported barriers included inadequate need assessment (25.7 %), information provision (32.4 %), or health communication (20 %). Unique barriers were identified for oncology, mental health, and COPD samples. Based on the scope, frequency and measurement of reported barriers, eight key themes with associated implications for health services are presented. Examples include: common accommodation and accessibility barriers caused on service organization or physical structure, such as parking and appointment scheduling; common barriers created by poor coordination of care within the healthcare team; and unique barriers resulting from inadequate need assessment and referral practices. Consideration of barriers, across and within chronic diseases, suggests a number of specific initiatives are likely to improve the delivery of patient-centered care and increase equity in access to high-quality health services.

Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?

OBJECTIVES

Depression is common but not always recognized and often undertreated among elderly. Cardiovascular diagnoses have been reported to be associated with depression. The study examined if this association could be confirmed in a frail elderly population. It also assessed the association between high depressive scores and certain health complaints and the use of certain drugs, respectively.

METHOD

A total of 153 frail elderly in ordinary living were included. The association between depressive symptoms, assessed by geriatric depression scale (GDS) 20, and an inpatient diagnose of cerebrovascular disease or heart failure was assessed. Depressive symptoms were also compared with health complaints and background data. Furthermore, the use of certain drugs, such as antidepressants and other psychotropics, was compared with depressive symptoms.

RESULTS

Risk of depression was seen in 52% of the patients. Those showing risk of depression more often received municipal care or help with medication distribution and were more often treated with sedatives. They also had significantly more health complaints. No differences were found between those who had or did not have a diagnosis of heart failure or transient ischemic attack (TIA)/stroke during hospital care the previous year regarding risk for depression or treatment with antidepressants, respectively. Sixteen per cent were treated with antidepressants and this group was significantly younger than those who were not treated.

CONCLUSION

Those elderly with a GDS score indicating a risk for depression have poorer health, are more dependent on help and are more often treated with sedatives. The study could not confirm an association between heart failure or TIA/stroke and risk for depression.

Delays in depression treatment among Korean population

INTRODUCTION

Delays in mental health service utilization for patients with depression have been observed globally. To elucidate some aspects of delays, age-related associations with a series of variables representing different stages of mental health service use were studied concurrently.

METHODS

A total of 1,433 patients with depression participated in a nationwide Korean Depressive Patient Survey through the collaboration of 70 psychiatric clinics and hospitals. Using logistic and Poisson regression, we investigated whether there is variation in the associations by age.

RESULTS

Patients with depression in South Korea spent 3.4 years on average before starting a first depression treatment after the onset of depression, and 58% of them entered depression treatment in the first year of onset. Early onset appeared to lower the chance of "early depression treatment": e.g., adjusted odds ratio (OR)s for onset age of 40-54, 25-39 and <25 versus ≥55 were 0.65 (95% CI = 0.44, 0.94), 0.36 (95% CI = 0.16, 0.81) and 0.18 (95% CI = 0.06, 0.48), respectively. In contrast, favorable associations of early onset with "self-recognition as depression" and "number of nonpsychiatric clinics attended" before visiting psychiatrist were found. Younger cohorts were associated with more positive attitudes toward all mental health utilization measures.

DISCUSSION

Delays in depression treatment are lengthy in South Korea. Those with early onset are more likely to have delayed depression treatment but are more willing to seek help from a psychiatrist once they sought for the treatment.

Quality of depression treatment in Black Americans with major depression and comorbid medical illness

OBJECTIVE

The objective was to evaluate how comorbid type 2 diabetes (T2DM) and hypertension (HT) influence depression treatment and to assess whether these effects operate differently in a nationally representative community-based sample of Black Americans.

METHODS

Data came from the National Survey of American Life (N=3673), and analysis is limited to respondents who met lifetime criteria for major depression (MD) (N=402). Depression care was defined according to American Psychiatric Association (APA) guidelines and included psychotherapy, pharmacotherapy and satisfaction with services. Logistic regression was used to examine the effects of T2DM and HT on quality of depression care.

RESULTS

Only 19.2% of Black Americans with MD alone, 7.8% with comorbid T2DM and 22.3% with comorbid HT reported APA-guideline-concordant psychotherapy or antidepressant treatment. Compared to respondents with MD alone, respondents with MD+T2DM/HT were no more or less likely to receive depression care. Respondents with MD+HT+T2DM were more likely to report any guideline-concordant care (odds ratio=3.32; 95% confidence interval, 1.07-10.31).

CONCLUSIONS

Although individuals with MD and comorbid T2DM+HT were more likely to receive depression care, guideline-concordant depression care is low among Black Americans, including those with comorbid medical conditions.

A qualitative investigation of the impact of multimorbidity on GP diagnosis and treatment of depression in Australia

Primary care providers often struggle to identify depression, with patients with multiple chronic conditions presenting additional unique challenges. Whilst the diagnosis and treatment of depression has been explored in a range of contexts in the literature, there is a paucity of information on the impact of multimorbidity on general practitioners (GPs) attempting to diagnose and manage depression in primary care. Eight GPs with multiple referrals to a multidisciplinary clinic engaged in a semi-structured interview to discuss the impact of multimorbidity on the diagnosis and detection of depression. Interviews were transcribed and thematic analysis was used to identify key themes. Grounded theory was generated from data relating to the role of multimorbidity. Participants described multimorbidity as obscuring symptom causation, but also creating time to investigate causation and negotiate the depression diagnosis with the patient, and generating relationship through frequent presentations. Knowledge of the patient impacted on intervention recommendations, and trust facilitated patient receptivity. Treatment was affected by a range of variables, and included medical and social interventions. GP process for multimorbid patients is similar to that of patients with chronic illness. Further research is needed to know whether different processes or diagnostic categories are warranted where multiple chronic illnesses are present. Also, GPs recommend social interventions where medical interventions are perceived as inappropriate. Research into the efficacy of social interventions in multimorbid patients is needed.

Sickness absence because of musculoskeletal diagnoses and risk of all-cause and cause-specific mortality: a nationwide Swedish cohort study

Knowledge regarding mortality as a potential consequence of being sickness absent because of musculoskeletal diagnoses is almost nonexistent. The association between sickness absence because of musculoskeletal diagnoses and risk of premature death was examined in a prospective, nationwide, population-based cohort study based on Swedish registers. Included were all 4,760,987 individuals who were living in Sweden December 31, 2005, aged 20 to 64 years, and not on disability or old-age pension. Those sickness absent in 2005 because of musculoskeletal diagnoses were compared to those sickness absent because of non-musculoskeletal diagnoses and to those with no sickness absence. Musculoskeletal diagnoses were categorized as follows: 1) artropathies/systemic connective tissue disorders; 2) dorsopathies; and 3) soft tissue disorders/osteopathies/chondropathies/other musculoskeletal disorders. All-cause mortality was followed from 2006 to 2009 and cause-specific mortality was followed from 2006 to 2008. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. In models adjusted for socio-demographic factors, and morbidity, sickness absence because of all 3 categories of musculoskeletal diagnoses was associated with 1.3- to 1.5-fold increased risks of all-cause mortality (adjusted model, category 1 diagnoses, HR=1.50, 95% CI=1.38-1.63). Similar associations were observed among both women and men. Moreover, increased mortality risks due to tumors (HR=1.6-1.7), circulatory diseases (HR=1.2-1.5), mental disorders (HR=1.2-3.2), and suicide (HR=1.5-1.9) were observed among persons sickness absent because of musculoskeletal diagnoses. This nationwide cohort study reveals, for the first time, an increased risk of premature death among both women and men sickness absent because of musculoskeletal diagnoses after adjustment for several potential confounders.