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Alcalde E, Rouquette A, Wiernik E, Rigal L. How do men and women differ in their depressive symptomatology? A gendered network analysis of depressive symptoms in a French population-based cohort. J Affect Disord 2024; 353:1-10. [PMID: 38395202 DOI: 10.1016/j.jad.2024.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The experience of depressive manifestations and the presentation of symptoms in clinical settings may differ in men and women. Despite the extensive literature, it remains unclear how depressive manifestations interact at symptom levels in men and women. First, we aimed to describe and compare depressive networks by sex. Second, we examined symptom connections to Clinical depression and Functional Limitations as a proxy of self-recognition of a depressive episode. METHODS We estimated networks from the 20 CES-D items in men and women from a large population-based French cohort. We computed centrality measures and ran comparisons. Then, we re-estimated two networks in men and women separately, adding, on the one hand, Clinical Depression and, on the other hand, Limitations due to a depressive episode. RESULTS Over 200,000 participants were included in this study. Women were twice as likely to have a previous diagnosis of depression. Sex-ratio was less pronounced (1,7:1) for Limitations due to depression. Centrality measures revealed similar symptom patterns. However, network structures differed between men and women. We found some symptom connections to Clinical depression and Limitations to be non-invariant according to sex. LIMITATIONS Cross-sectional data does not capture the direction of the connections between symptoms and an eventual diagnosis. We lacked data about the diagnosis's context and could not account for other factors influencing depressive symptomatology. CONCLUSIONS Network structures differed, suggesting gender-specific mechanisms in activating symptoms and depressive states. Addressing central symptoms evoking depressed moods with tailored interventions may serve to tackle depressive states in men and women.
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Affiliation(s)
- Eugenia Alcalde
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; IRIS, INSERM U997, Aubervilliers, France.
| | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; Public Health and Epidemiology Department, AP-HP Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Emmanuel Wiernik
- Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, INSERM, UMS 011 Population-based Cohorts Unit, Paris, France
| | - Laurent Rigal
- Université Paris-Saclay, UVSQ, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, France; Public Health and Epidemiology Department, AP-HP Paris-Saclay University, Le Kremlin-Bicêtre, France
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2
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Senoo K, Kaneko H, Ueno K, Suzuki Y, Okada A, Fujiu K, Jo T, Takeda N, Morita H, Kamiya K, Ako J, Node K, Yasunaga H, Komuro I. Sex Differences in the Association Between Depression and Incident Cardiovascular Disease. JACC. ASIA 2024; 4:279-288. [PMID: 38660110 PMCID: PMC11035952 DOI: 10.1016/j.jacasi.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 04/26/2024]
Abstract
Background Depression is a known risk factor for cardiovascular disease (CVD), but the potential sex differences in this association remain unclear. Objectives The aim of this study was to investigate the association between depression and subsequent CVD events, and to explore potential sex differences. Methods The authors conducted a retrospective analysis using the JMDC Claims Database between 2005 and 2022. The study population included 4,125,720 individuals aged 18 to 75 years without a history of cardiovascular disease or renal failure and missing data at baseline. Participants were followed up for a mean of 1,288 days to assess the association between depression and subsequent CVD events, such as myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation. Results Our analysis revealed a significant association between depression and subsequent composite CVD events in both men and women, with a stronger association observed in women. The HR for the composite endpoint was 1.64 (95% CI: 1.59-1.70) in women and 1.39 (95% CI: 1.35-1.42) in men after multivariable adjustment (P for interaction <0.001). Furthermore, the individual components of the composite endpoint were also associated with depression in both men and women, each of which was also observed to be more strongly associated in women. Conclusions Our study provides evidence of a significant association between depression and subsequent CVD events in both men and women, with a more pronounced association observed in women. These findings highlight the importance of addressing depression and tailoring prevention and management strategies according to sex-specific factors.
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Affiliation(s)
- Keitaro Senoo
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Kensuke Ueno
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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Knox J, Morgan P, Kay-Lambkin F, Wilson J, Wallis K, Mallise C, Barclay B, Young M. Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review. CURRENT PSYCHOLOGY 2022; 42:1-16. [PMID: 36531196 PMCID: PMC9735062 DOI: 10.1007/s12144-022-04017-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/11/2022]
Abstract
The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression. Supplementary information The online version contains supplementary material available at 10.1007/s12144-022-04017-7.
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Affiliation(s)
- James Knox
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Philip Morgan
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Education, University of Newcastle, Callaghan, Australia
- Centre for Active Living and Learning, University of Newcastle, Callaghan, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jessica Wilson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Kimberley Wallis
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Carly Mallise
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Briana Barclay
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
- School of Education, University of Newcastle, Callaghan, Australia
- Centre for Active Living and Learning, University of Newcastle, Callaghan, Australia
| | - Myles Young
- School of Psychological Science, University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
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4
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Olsson S, Burström B, Hensing G, Löve J. Poorer mental well-being and prior unmet need for mental healthcare: a longitudinal population-based study on men in Sweden. ACTA ACUST UNITED AC 2021; 79:189. [PMID: 34732262 PMCID: PMC8564598 DOI: 10.1186/s13690-021-00706-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022]
Abstract
Background Depression and anxiety disorder contribute to a significant part of the disease burden among men, yet many men refrain from seeking care or receive insufficient care when they do seek it. This is plausibly associated with poorer mental well-being, but there is a lack of population-based research. This study investigated 1) if men who had refrained from seeking mental healthcare at any time in life had poorer mental well-being than those who sought care, 2) if those who had sought care but perceived it as insufficient had poorer mental well-being than those who had perceived care as sufficient, and 3) if these differences persisted after 1 year. Methods This longitudinal study used questionnaire data from a population-based sample of 1240 men, aged 19–64 years, in Sweden. Having refrained from seeking mental healthcare, or perceiving the care as insufficient, at any time in life, was assessed in a questionnaire, 2008. Current mental well-being was assessed in 2008 and 2009 using mean scores on the WHO (Ten) Well-being Index. Lower scores indicate poorer mental well-being. Group differences were calculated using t-tests and multivariable linear regression analysis. Results Of the men who had perceived a need for mental healthcare, 37% had refrained from seeking such care. They had lower mental well-being scores in 2008, compared to those who sought care. Of those seeking care, 29% had perceived it as insufficient. They had lower mental well-being scores in 2008, compared to those who perceived the care as sufficient, but this was not statistically significant when controlling for potential confounders. There were no differences in mental well-being scores based on care-seeking or perceived care-sufficiency in 2009. Conclusions This population-based study indicates that men who have previously refrained from seeking mental healthcare, or perceived the care as insufficient, have poorer mental well-being. However, the lack of differences at the one-year follow-up contradicts these results. The results highlight the need for larger longitudinal studies, measuring care-seeking within a more specified time frame. This should be combined with efforts to increase men’s mental healthcare-seeking and to provide mental healthcare that is perceived as sufficient. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00706-0.
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Affiliation(s)
- Sara Olsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden
| | - Jesper Löve
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Box 453, 405 30, Gothenburg, Sweden.
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5
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Batchelder AW, Stanton AM, Kirakosian N, King D, Grasso C, Potter J, Mayer KH, O'Cleirigh C. Mental Health and Substance Use Diagnoses and Treatment Disparities by Sexual Orientation and Gender in a Community Health Center Sample. LGBT Health 2021; 8:290-299. [PMID: 34080895 DOI: 10.1089/lgbt.2020.0293] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Purpose: This study assessed disparities in screener- and provider-identified mental health and substance use diagnoses and treatment attendance by sexual orientation and gender in an urban community health center focused on sexual and gender minority individuals. Methods: Using an electronic data query (October 2015 to October 2018), computerized screening results assessing likely depression, anxiety, alcohol use disorder (AUD), and substance use disorder (SUDs); provider diagnoses; and treatment initiation related to mental health and substance use were compared across sexual orientation (heterosexual, gay/lesbian, bisexual, and other) and gender categories (men and women, inclusive of cisgender and transgender individuals; N = 24,325). Results: Bisexual and other-identified individuals were more likely to screen positive for depression and anxiety, followed by gay/lesbian women, compared with heterosexual individuals and gay men (χ2 = 463.22, p < 0.001 and χ2 = 263.36, p < 0.001, respectively). Of those who screened positive for AUDs, women were less likely to be diagnosed by a professional (χ2 = 63.79, p < 0.001) and of those who screened positive for either alcohol or other SUDs, women were less likely to attend one or more substance use-related behavioral health appointments, regardless of sexual orientation (contingency coefficient = 0.14, p < 0.001). Conclusion: This community health center study identified a need for increased mental health services for bisexual and other-identified individuals and increased assessment and initiation of substance use treatment for women, including sexual minority women.
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Affiliation(s)
- Abigail W Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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Cárdenas Charry MP, Jassir Acosta MP, Uribe Restrepo JM, Cepeda M, Martinez Camblor P, Cubillos L, Bartels SM, Castro S, Marsch LA, Gómez-Restrepo C. Relationship between the sociodemographic characteristics of participants in the DIADA project and the rate of compliance with follow-up assessments in the initial stage of the intervention. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 50 Suppl 1:102-109. [PMID: 34301528 PMCID: PMC8658751 DOI: 10.1016/j.rcpeng.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care. METHODS A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation. RESULTS At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment. CONCLUSIONS The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
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Affiliation(s)
- María Paula Cárdenas Charry
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Maria Paula Jassir Acosta
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez Camblor
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Sophia M Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Sergio Castro
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, United States of America
| | - Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia
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7
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Cabezas-Rodríguez A, Bacigalupe A, Martín U. Diagnosis and Treatment of Depression in Spain: Are There Gender Inequalities? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249232. [PMID: 33321853 PMCID: PMC7763221 DOI: 10.3390/ijerph17249232] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/16/2022]
Abstract
It is well known that women are more likely than men to be diagnosed with depression and to consume antidepressants. The factors related to the medicalisation of depression and their social distribution remain unclear. The aim of this study was to analyse gender inequalities in the medicalisation of depression from an intersectional perspective. This was a cross-sectional study based on data from the European Health Survey relating to Spain. Gender inequalities were calculated using prevalence ratios of women compared to men with a diagnosis of depression and antidepressant use, adjusted for age, depressive symptoms, primary care visits and diagnosis of depression in the case of antidepressant use. After adjustments, the diagnosis of depression and the use of antidepressants were more prevalent in women, especially of lower socioeconomic levels. Gender inequalities in the diagnosis of depression also increased with decreasing level of education. Regarding the use of antidepressants, gender inequalities were not significant in university graduates and people of higher social. The gender inequalities found in the diagnosis and treatment of depression cannot be completely attributed to a higher level of depressive symptoms in women or their greater frequency of visits to primary care. Inequalities are greater in more vulnerable social groups.
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Affiliation(s)
- Andrea Cabezas-Rodríguez
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; (A.B.); (U.M.)
- Doctorate Program in Public Health, Department of Preventive Medicine and Public Health, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Social Determinants of Health and Demographic Change—Opik Research Group, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Correspondence:
| | - Amaia Bacigalupe
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; (A.B.); (U.M.)
- Social Determinants of Health and Demographic Change—Opik Research Group, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Unai Martín
- Department of Sociology and Social Work, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain; (A.B.); (U.M.)
- Social Determinants of Health and Demographic Change—Opik Research Group, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
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8
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Torrey WC, Cepeda M, Castro S, Bartels SM, Cubillos L, Obando FS, Camblor PM, Uribe-Restrepo JM, Williams M, Gómez-Restrepo C, Marsch LA. Implementing Technology-Supported Care for Depression and Alcohol Use Disorder in Primary Care in Colombia: Preliminary Findings. Psychiatr Serv 2020; 71:678-683. [PMID: 32151216 PMCID: PMC7332379 DOI: 10.1176/appi.ps.201900457] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Depression and alcohol use disorder are among the most common causes of disability and death worldwide. Health care systems are seeking ways to leverage technology to screen, evaluate, and treat these conditions, because workforce interventions alone, particularly in low- and middle-income countries, are insufficient. This article reports data from the first year of implementation of a technology-supported, systematic approach to identify and care for persons with these disorders in primary care in Colombia. METHODS A care process that includes waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics as a treatment option was implemented in two primary care clinics, one urban and one in a small town. The project collected data on the number of people screened, diagnosed, and engaged in the research and their demographic characteristics. RESULTS In the first year, 2,656 individuals were screened for depression and unhealthy alcohol use in the two clinics. Primary care doctors increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively. CONCLUSIONS Early experience with implementing technology-supported screening and decision support for depression and alcohol use disorder into the workflow of busy primary care clinics in Colombia indicates that this care model is feasible and leads to dramatically higher rates of diagnoses of these conditions. Diagnosis in these settings appeared to be easier for depression than for alcohol use disorder.
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Affiliation(s)
- William C Torrey
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Magda Cepeda
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Sergio Castro
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Sophia M Bartels
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Leonardo Cubillos
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Fernando Suárez Obando
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Pablo Martínez Camblor
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - José Miguel Uribe-Restrepo
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Makeda Williams
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Carlos Gómez-Restrepo
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
| | - Lisa A Marsch
- Department of Psychiatry (Torrey, Bartels, Cubillos, Marsch) and Department of Biomedical Data Science (Camblor), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Castro, Gómez-Restrepo), Institute of Human Genetics (Suárez Obando), and Department of Psychiatry and Mental Health (Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia; Office for Research on Disparities and Global Mental Health, National Institute of Mental Health, Bethesda, Maryland (Williams)
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9
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Hu J, Wu T, Damodaran S, Tabb KM, Bauer A, Huang H. The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review. PSYCHOSOMATICS 2020; 61:632-644. [PMID: 32381258 DOI: 10.1016/j.psym.2020.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Racial/ethnic minorities experience a greater burden of mental health problems than white adults in the United States. The collaborative care model is increasingly being adopted to improve access to services and to promote diagnosis and treatment of psychiatric diseases. OBJECTIVE This systematic review seeks to summarize what is known about collaborative care on depression outcomes for racial/ethnic minorities in the United States. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. Collaborative care studies were included if they comprised adults from at least one racial/ethnic minority group, were located in primary care clinics in the United States, and had depression outcome measures. Core principles described by the University of Washington Advancing Integrated Mental Health Solutions Center were used to define the components of collaborative care. RESULTS Of 398 titles screened, 169 full-length articles were assessed for eligibility, and 19 studies were included in our review (10 randomized controlled trials, 9 observational). Results show there is potential that collaborative care, with or without cultural/linguistic tailoring, is effective in improving depression for racial/ethnic minorities, including those from low socioeconomic backgrounds. CONCLUSIONS Collaborative care should be explored as an intervention for treating depression for racial/ethnic minority patients in primary care. Questions remain as to what elements of cultural adaptation are most helpful, factors behind the difficulty in recruiting minority patients for these studies, and how the inclusion of virtual components changes access to and delivery of care. Future research should also recruit individuals from less studied populations.
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Affiliation(s)
- Jennifer Hu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Tina Wu
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
| | - Swathi Damodaran
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Amy Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Hsiang Huang
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
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10
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Assari S, Dejman M. Gender, Depressive Symptoms, Chronic Medical Conditions, and Time to First Psychiatric Diagnosis among American Older Adults. Int J Prev Med 2019; 10:182. [PMID: 32133100 PMCID: PMC6826688 DOI: 10.4103/ijpvm.ijpvm_333_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background: To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults. Methods: Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis. Results: In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26–2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63–0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87–2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69–0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21–1.83) but not CMC (HR, 1.06; 95% CI, 0.91–1.23) were associated with time to receiving a psychiatric diagnosis over time. Conclusions: Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Masoumeh Dejman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Brännström J, Lövheim H, Gustafson Y, Nordström P. Association Between Antidepressant Drug Use and Hip Fracture in Older People Before and After Treatment Initiation. JAMA Psychiatry 2019; 76:172-179. [PMID: 30601883 PMCID: PMC6440395 DOI: 10.1001/jamapsychiatry.2018.3679] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Treatment with antidepressants has been associated with hip fracture. This association could restrict the treatment options, especially in older patients. OBJECTIVE To investigate the association between antidepressant drug treatment and hip fracture starting 1 year before the initiation of treatment. DESIGN, SETTING, AND PARTICIPANTS In this nationwide cohort study, 204 072 individuals in the Prescribed Drugs Register of Sweden's National Board of Health and Welfare aged 65 years or older who had a prescription of antidepressants filled between July 1, 2006, and December 31, 2011, were matched by birth year and sex to 1 control participant who was not prescribed antidepressants (for a total of 408 144 people in the register). Outcome data were collected from 1 year before to 1 year after the index date (date of prescription being filled). Data analysis was performed from July 1, 2005, to December 31, 2012. EXPOSURES First filled prescription of an antidepressant drug. MAIN OUTCOMES AND MEASURES Incident hip fractures occurring in the year before and year after initiation of antidepressant therapy were registered. Associations were investigated using multivariable conditional logistic regression models and flexible parametric models. RESULTS Of the 408 144 people in the register who were included in the study, 257 486 (63.1%) were women, with a mean (SD) age of 80.1 (7.2) years. Antidepressant users sustained more than twice as many hip fractures than did nonusers in the year before and year after the initiation of therapy (2.8% vs 1.1% and 3.5% vs 1.3%, respectively, per actual incidence figures). In adjusted analyses, the odds ratios were highest for the associations between antidepressant use and hip fracture 16 to 30 days before the prescription was filled (odds ratio, 5.76; 95% CI, 4.73-7.01). In all separate analyses of age groups, of men and women, and of individual antidepressants, the highest odds ratios were seen 16 to 30 days before initiation of treatment, and no clear dose-response relationship was seen. CONCLUSIONS AND RELEVANCE The present study found an association between antidepressant drug use and hip fracture before and after the initiation of therapy. This finding raises questions about the association that should be further investigated in treatment studies.
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Affiliation(s)
- Jon Brännström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
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12
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Murillo LA, Grekoff GA, Sheffield JC. Assessing the effect of patient to provider language discordance on depression screening utilizing the Patient Health Questionnaire: an epidemiology study. Fam Pract 2019; 36:27-31. [PMID: 30299462 DOI: 10.1093/fampra/cmy097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As depression screening becomes a standard in primary care, the question remains of how effective and equitable screening can be implemented to avoid cultural and language-related disparities. METHODS In this retrospective cohort study, rates of depression screening were compared for 3626 adult patients at a family medicine residency-based health centre in Pennsylvania, USA. The PHQ-2/PHQ-9 modality was verbally administered by nursing staff at the time of patient intake as part of a universal screening initiative. Chi-square analysis was used to determine the univariate associations of performed depression screening with variables of language, ethnicity, gender and number of office visits. A binary logistic regression was then performed to measure whether univariate associations remain significant after correction for other variables. RESULTS Chi-square analysis revealed significant differences in screening based on univariate associations of language, gender and number of office visits. No significant difference was found for age or ethnicity. Binary logistic regression revealed the following odds ratio of being screened for depression for each variable: Spanish language (OR = 0.694, CI = 0.559 to 0.862), female gender (OR = 1.155, CI = 1.005 to 1.328) and office visit frequency of three or more office visits per year (OR = 2.103, CI = 1.835 to 2.410). CONCLUSIONS Spanish-speaking adults were significantly less likely to be screened for depression than their English-speaking counterparts. Women were more likely to be screened than men, and the odds of screening increased with more frequent exposure to the office. Future studies should be directed at validating these findings in multiple clinical settings.
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Affiliation(s)
- Luis A Murillo
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
| | - Georgi Alex Grekoff
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
| | - John C Sheffield
- Reading Hospital Department of Family Medicine Residency, Tower Health, West Reading, USA
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Wilson DM, Cohen J, MacLeod R, Houttekier D. Bereavement grief: A population-based foundational evidence study. DEATH STUDIES 2018; 42:463-469. [PMID: 28985143 DOI: 10.1080/07481187.2017.1382609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Information is needed on the incidence and prevalence of bereavement grief, and factors associated with severe or prolonged grief. Among 1,208 representative Canadian adults, 96% had experienced bereavement grief and 78% were actively grieving at interview. Grief levels were higher among women, Protestants, and Catholics, when the death was under 2 years previously, when a spouse, parent, or child had died, and when the perceived death quality was lower. This study reveals the importance of good deaths; they are essential for dying people and also those who mourn their deaths.
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Affiliation(s)
- Donna M Wilson
- a Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | - Joachim Cohen
- b End-of-Life Care Research Group , Vrije Universiteit Brussel, and Ghent University , Brussels , Belgium
| | - Rod MacLeod
- c HammondCare and University of Sydney , Sydney , Australia
| | - Dirk Houttekier
- b End-of-Life Care Research Group , Vrije Universiteit Brussel, and Ghent University , Brussels , Belgium
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Quercioli C, Nisticò F, Messina G, Maccari M, Barducci M, Carriero G, Nante N. Gender differences in health expenditure determinants: A follow-up study. Health Care Women Int 2018; 40:33-46. [PMID: 29494785 DOI: 10.1080/07399332.2018.1445252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Researchers' aim was to investigate if patients/physicians characteristics could differently affect males/females health care expenditure. In 2009/2010, a health-related-quality-of-life (HRQL) measure was distributed to 887 general practitioners' (GP) patients in Siena's province-Italy. Severity of diseases was calculated through Cumulative Illness Rating Scale Severity Index (CIRS-SI). Information about GPs' gender and age and patients' gender, age, and socio-economic variables were recorded. 2012 data about pharmaceutical, outpatient and hospital expenditure were obtained. Multivariate regression was carried out. In males, hospital expenditure increased with higher CIRS-SI and female GP whilst in females it was not influenced by any of the variables. Outpatient and pharmaceutical expenditure increased with aging, higher CIRS-SI, and lower HRQL and education, both in males and females. Gender differences in health expenditure determinants emerged for hospital expenditure.
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Affiliation(s)
- Cecilia Quercioli
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,b Healthcare Management - Local Health Unit 7 , Siena , Italy
| | - Francesca Nisticò
- a Postgraduate School of Public Health , University of Siena , Siena , Italy
| | - Gabriele Messina
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,c Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
| | - Mauro Maccari
- b Healthcare Management - Local Health Unit 7 , Siena , Italy
| | - Massimo Barducci
- a Postgraduate School of Public Health , University of Siena , Siena , Italy
| | | | - Nicola Nante
- a Postgraduate School of Public Health , University of Siena , Siena , Italy.,c Department of Molecular and Developmental Medicine , University of Siena , Siena , Italy
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15
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Srivatsan S, Guduguntla V, Young KZ, Arastu A, Strong CR, Cassidy R, Ghaferi AA. Clinical versus patient-reported measures of depression in bariatric surgery. Surg Endosc 2018; 32:3683-3690. [PMID: 29435747 DOI: 10.1007/s00464-018-6101-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Bariatric surgery patients with mental illness may experience worse surgical outcomes compared to those without. Depression is the most prevalent mental health diagnosis amongst Americans with obesity. Accurate diagnosis and treatment is of paramount importance to mitigate perioperative risk. Unfortunately, there is no standard method to screen patients for depression prior to surgery. Our goal was to understand the relationship between traditional clinical screening tools and a novel patient-reported depression screening survey, Patient Health Questionnaire 8 (PHQ-8), in the setting of the bariatric surgery preoperative assessment. METHODS The study included all adult bariatric surgery patients from January 2014 through June 2016. Patients who were not assessed using both the PHQ-8 and a traditional clinical depression screening were excluded from the study. There were a total of 4486 patients who met the eligibility criteria and were included in analysis. We used comparative statistics to examine the association between these screening tools and to test for contributing demographic, surgical, and socioeconomic factors. RESULTS The overall rate of clinically diagnosed depression in the study cohort was 45.6%. In comparison, 14.8% of all patients screened positive for depression using the PHQ-8. Of the patients without a traditional clinical diagnosis of depression, 10.2% screened positive for depression using the PHQ-8. This subset of undiagnosed patients was more likely to be non-white, employed, and had a higher BMI than their clinically diagnosed counterparts. CONCLUSIONS AND RELEVANCE We found a higher rate of clinically diagnosed depression in our cohort compared to the general population. However, when using the validated PHQ-8 survey, the rate of depression more closely approximated the national incidence. Further, a significant proportion of patients were undiagnosed and/or misdiagnosed by current clinical assessments. Standardizing preoperative depression screening using validated patient-centered tools may prevent the consequences of untreated depression.
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Affiliation(s)
| | | | - Kelly Z Young
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Ruth Cassidy
- Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- University of Michigan Medical School, Ann Arbor, MI, USA.
- Michigan Bariatric Surgery Collaborative, Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
- Department of Surgery, Center for Health Outcomes and Policy, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, NCRC B016/Rm140-E, Ann Arbor, MI, 48109, USA.
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16
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Mehta P, Brown A, Chung B, Jones F, Tang L, Gilmore J, Miranda J, Wells K. Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants. Ethn Dis 2017; 27:223-232. [PMID: 28811733 DOI: 10.18865/ed.27.3.223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC). DESIGN Community partnered, cluster, randomized trial. SETTING Hollywood-Metropolitan and South Los Angeles, California. PARTICIPANTS 423 adult male clients with modified depression (PHQ-8 score≥10). INTERVENTIONS Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS). MAIN OUTCOME MEASURES Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings. RESULTS At screening, levels of probable depression were moderate to high (17.5%-47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00-3.42) and reduced hospitalizations (OR .40, 95% CI .16-.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15-.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99-8.45). CONCLUSIONS Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multi-sector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.
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Affiliation(s)
- Pratik Mehta
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif
| | - Anthony Brown
- Healthy African American Families, Los Angeles, Calif
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - Felica Jones
- Healthy African American Families, Los Angeles, Calif
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - James Gilmore
- Behavioral Health Services, Inc., Los Angeles, Calif
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, UCLA Medical Center, Los Angeles, Calif.,Center for Health Services and Society, UCLA Semel Institute, Los Angeles, Calif.,Department of Health Services and Society, UCLA Medical Center, Los Angeles, Calif
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17
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What a Shame: Increased Rates of OMS Resident Burnout May Be Related to the Frequency of Shamed Events During Training. J Oral Maxillofac Surg 2017; 75:449-457. [DOI: 10.1016/j.joms.2016.08.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
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Cwik JC, Papen F, Lemke JE, Margraf J. An Investigation of Diagnostic Accuracy and Confidence Associated with Diagnostic Checklists as Well as Gender Biases in Relation to Mental Disorders. Front Psychol 2016; 7:1813. [PMID: 27920738 PMCID: PMC5118628 DOI: 10.3389/fpsyg.2016.01813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022] Open
Abstract
This study examines the utility of checklists in attaining more accurate diagnoses in the context of diagnostic decision-making for mental disorders. The study also aimed to replicate results from a meta-analysis indicating that there is no association between patients’ gender and misdiagnoses. To this end, 475 psychotherapists were asked to judge three case vignettes describing patients with Major Depressive Disorder (MDD), Generalized Anxiety Disorder, and Borderline Personality Disorder. Therapists were randomly assigned to experimental conditions in a 2 (diagnostic method: with using diagnostic checklists vs. without using diagnostic checklists) × 2 (gender: male vs. female case vignettes) between-subjects design. Multinomial logistic and linear regression analyses were used to examine the association between the usage of diagnostic checklists as well as patients’ gender and diagnostic decisions. The results showed that when checklists were used, fewer incorrect co-morbid diagnoses were made, but clinicians were less likely to diagnose MDD even when the criteria were met. Additionally, checklists improved therapists’ confidence with diagnostic decisions, but were not associated with estimations of patients’ characteristics. As expected, there were no significant associations between gender and diagnostic decisions.
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Affiliation(s)
- Jan C Cwik
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Fabienne Papen
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Jan-Erik Lemke
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
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Hughes-Morley A, Young B, Hempel RJ, Russell IT, Waheed W, Bower P. What can we learn from trial decliners about improving recruitment? Qualitative study. Trials 2016; 17:494. [PMID: 27733181 PMCID: PMC5062905 DOI: 10.1186/s13063-016-1626-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Trials increasingly experience problems in recruiting participants. Understanding the causes of poor recruitment is critical to developing solutions. We interviewed people who had declined a trial of an innovative psychological therapy for depression (REFRAMED) about their response to the trial invitation, in order to understand their decision and identify ways to improve recruitment. Methods Of 214 people who declined the trial, 35 (16 %) gave permission to be contacted about a qualitative study to explore their decision. Analysis of transcripts of semi-structured interviews was informed by grounded theory. Results We interviewed 20 informants: 14 women and six men, aged 18 to 77 years. Many interviewees had prior experience of research participation and positive views of the trial. Interviewees’ decision making resembled a four-stage sequential process; in each stage they either decided not to participate in the trial or progressed to the next stage. In stage 1, interviewees assessed the invitation in the context of their experiences and attitudes; we term those who opted out at this stage ‘prior decliners’ as they had an established position of declining trials. In stage 2, interviewees assessed their own eligibility; those who judged themselves ineligible and opted out at this stage are termed ‘self-excluders’. In stage 3, interviewees assessed their need for the trial therapy and potential to benefit; we term those who decided they did not need the trial therapy and opted out at this stage ‘treatment decliners’. In stage 4, interviewees deliberated the benefits and costs of trial participation; those who opted out after judging that disadvantages outweighed advantages are termed ‘trial decliners’. Across all stages, most individuals declined because they judged themselves ineligible or not in need of the trial therapy. While ‘prior decliners’ are unlikely to respond to any trial recruitment initiative, the factors leading others to decline are amenable to amelioration as they do not arise from a rejection of trials or a personal stance. Conclusions To improve recruitment in similar trials, the most successful interventions are likely to address patients’ assessments of their eligibility and their potential to benefit from the trial treatment, rather than reducing trial burden. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN85784627. Registration date 10 August 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1626-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adwoa Hughes-Morley
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK. .,York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Psychology, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Roelie J Hempel
- School of Psychology, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ian T Russell
- Swansea University Medical School, Swansea University, Swansea, SA2 8PP, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Manchester, M13 9PT, UK
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20
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Wei W, Akincigil A, Crystal S, Sambamoorthi U. Gender Differences in Out-of-Pocket Prescription Drug Expenditures Among the Elderly. Res Aging 2016. [DOI: 10.1177/0164027505284046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many elderly in the United States face high out-of-pocket prescription drug (OOP-PD) expenditures, with elderly women being disproportionably affected. Using Medicare Current Beneficiary Survey data for 1992 to 2000, the authors examined the gender differences in OOP-PD expenditures and burden among community-dwelling elderly Medicare beneficiaries. Oaxaca-Blinder decomposition techniques were used to evaluate the contribution of observed demographic, socioeconomic, and utilization factors on the gender gap in OOP-PD expenditures and burden. Among observed characteristics, differences in utilization and supplemental insurance coverage were the major drivers of the gender gap in OOP-PD expenditures and burden. Unobservable factors contributed to the majority of the gender gap in OOP-PD expenditures.
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Carey M, Yoong SL, Grady A, Bryant J, Jayakody A, Sanson-Fisher R, Inder KJ. Unassisted detection of depression by GPs: who is most likely to be misclassified? Fam Pract 2015; 32:282-7. [PMID: 25722482 DOI: 10.1093/fampra/cmu087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Meta-analyses indicate 50% of cases of depression are not detected by GPs. It is important to examine patient and GP characteristics associated with misclassification so that systems can be improved to increase accurate detection and optimal management for groups at risk of depression. OBJECTIVE To examine patient and GP characteristics associated with GP misclassification of depression for patients classified by the Patient Health Questionnaire-9 as depressed. METHODS A cross-sectional study within general practices in two states of Australia. GPs completed a one-page paper and pencil survey indicating whether they thought each patient was clinically depressed. Patients completed a computer tablet survey while waiting for their appointment to provide demographic information and indicate depression status. Chi-square analyses were used to determine whether patient and GP characteristics were associated with a false-negative and false-positive result. The probability of misclassification was modelled using Generalized Estimating Equations to account for clustering of patients. RESULTS Fifty GPs from 12 practices participated. GPs completed surveys for 1880 patients. Younger patients aged 25-44, and those with a health care card were less likely to have a false-negative assessment. Patients with 0-3 GP visits in the past 12 months, and those with private health insurance were less likely to have a false-positive assessment. GPs who worked five sessions or fewer per week were more likely to make false-positive assessments.
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Affiliation(s)
- Mariko Carey
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights,
| | | | - Alice Grady
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Jamie Bryant
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Amanda Jayakody
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Callaghan, Hunter Medical Research Institute, New Lambton Heights
| | - Kerry J Inder
- Hunter Medical Research Institute, New Lambton Heights, NHMRC Centre for Research Excellence in Mental Health and Substance Use, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Callaghan, Australia
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Hahm HC, Cook BL, Ault-Brutus A, Alegría M. Intersection of race-ethnicity and gender in depression care: screening, access, and minimally adequate treatment. Psychiatr Serv 2015; 66:258-64. [PMID: 25727113 PMCID: PMC4408551 DOI: 10.1176/appi.ps.201400116] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined the interaction of race-ethnicity and gender in depression screening, receipt of any mental health care, and receipt of adequate care. METHODS Data from electronic health records (2010-2012) of adult primary care patients from a New England urban health care system were used (N=65,079). Multivariate logit regression models were estimated to assess associations between race-ethnicity, gender, and other covariates and depression screening, any depression care among those with a positive screen, and adequate depression care. To measure disparities in utilization, we controlled for need variables but not for non-need variables, including insurance, marital status, and socioeconomic status. RESULTS Among males and females, blacks and Asians were less likely and Latinos were more likely to be screened for depression compared with whites. Among those with moderate or severe depression, black males and females, Latino males, and Asian males and females were less likely than whites to receive any mental health care. The disparity in screening between blacks and whites was greater among females compared with males. The disparity between Latinos and whites in receipt of any mental health care and of adequate care was greater among males than females. CONCLUSIONS This approach underscored the importance of identifying disparities at each step of depression care by both race-ethnicity and gender. Targeting certain groups in specific stages of care, for example, screening of black females or providing any mental health care and adequate care for Latino males, would be more effective than a blanket approach to disparities reduction.
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Affiliation(s)
- Hyeouk Chris Hahm
- Dr. Hahm is with the School of Social Work, Boston University, Boston (e-mail: ). At the time the paper was written, Dr. Hahm was with the Department of Psychiatry, Harvard Medical School, Boston, where the other authors are affiliated. Dr. Cook, Dr. Ault-Brutus, and Dr. Alegría are also with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts
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BinDhim NF, Shaman AM, Trevena L, Basyouni MH, Pont LG, Alhawassi TM. Depression screening via a smartphone app: cross-country user characteristics and feasibility. J Am Med Inform Assoc 2014; 22:29-34. [PMID: 25326599 DOI: 10.1136/amiajnl-2014-002840] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Smartphone applications (apps) have the potential to be valuable self-help interventions for depression screening. However, information about their feasibility and effectiveness and the characteristics of app users is limited. The aim of this study is to explore the uptake, utilization, and characteristics of voluntary users of an app for depression screening. METHODS This was a cross-sectional study of a free depression screening smartphone app that contains the demographics, patient health questionnaire (PHQ-9), brief anxiety test, personalized recommendation based on the participant's results, and links to depression-relevant websites. The free app was released globally via Apple's App Store. Participants aged 18 and older downloaded the study app and were recruited passively between September 2012 and January 2013. FINDINGS 8241 participants from 66 countries had downloaded the app, with a response rate of 73.9%. While one quarter of the participants had a previous diagnosis of depression, the prevalence of participants with a higher risk of depression was 82.5% and 66.8% at PHQ-9 cut-off 11 and cut-off 15, respectively. Many of the participants had one or more physical comorbid conditions and suicidal ideation. The cut-off 11 (OR: 1.4; 95% CI 1.2 to 1.6), previous depression diagnosis (OR: 1.3; 95% CI1.2 to 1.5), and postgraduate educational level (OR: 1.2; 95% CI 1.0 to 1.5) were associated with completing the PHQ-9 questionnaire more than once. CONCLUSIONS Smartphone apps can be used to deliver a screening tool for depression across a large number of countries. Apps have the potential to play a significant role in disease screening, self-management, monitoring, and health education, particularly among younger adults.
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Affiliation(s)
- Nasser F BinDhim
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia Public Health and Health Informatics School, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Ahmed M Shaman
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lyndal Trevena
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mada H Basyouni
- Pharmacy School, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa G Pont
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
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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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Alzahrani H, Barton P, Brijnath B. Self-reported depression and its associated factors among male inpatients admitted for substance use disorders in Saudi Arabia. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2014.923054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Relationship of age and gender to the prevalence and correlates of psychological distress in later life. Int Psychogeriatr 2012; 24:1009-18. [PMID: 22244348 DOI: 10.1017/s1041610211002602] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As populations age, psychological distress in late life will become of increasing public health and social importance. This study seeks to bridge the gap in information that exists about psychological distress in late life, by exploring the prevalence of psychological distress among a very large sample of older adults to determine the impact of age and gender, and the modifying effect of these factors on the associations between measures of psychological distress and sociodemographic and comorbid conditions. METHODS We analyzed self-reported data from 236,508 men and women in the New South Wales 45 and Up Study, to determine the impact of age and gender, and the modifying effects of these factors on associations between psychological distress and sociodemographic and comorbid conditions. RESULTS Higher education, married status, and higher income were associated with lower risk of psychological distress. Although overall prevalence of psychological distress is lower at older ages, this increases after age 80, and is particularly associated with physical disabilities. Some older people (such as those requiring help because of disability and those with multiple comorbid health conditions) are at increased risk of psychological distress. CONCLUSION These findings have implications for both healthcare providers and policy-makers in identifying and responding to the needs of older people in our aging society.
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Sinclair SL, Myers JE. The Relationship Between Objectified Body Consciousness and Wellness in a Group of College Women. JOURNAL OF COLLEGE COUNSELING 2011. [DOI: 10.1002/j.2161-1882.2004.tb00246.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cameron IM, Lawton K, Reid IC. Recognition and subsequent treatment of patients with sub-threshold symptoms of depression in primary care. J Affect Disord 2011; 130:99-105. [PMID: 21055827 DOI: 10.1016/j.jad.2010.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Non-psychiatric physicians are better at correctly ruling out depressive disorders than appropriately recognising them. However, given large numbers of non-depressed patients, a small percentage of false positives equates to a greater number of patients than the number of depressed patients that GPs fail to detect. Concern thus arises that substantial numbers of patients with falsely identified depression may receive inappropriate interventions. METHODS Unselected GP consulters were screened with the Hospital Anxiety and Depression Scale (HADS). GPs' perceptions of depression were independently rated on an ICD-10 scale. Case records were reviewed. Analysis related to participants with HADS-D<8. Data were assessed of 660 participants with sub-threshold symptoms. Factors were assessed according to GP ratings. RESULTS GP perceived depression in false positive cases were more likely at index visit, to have a mental health presenting problem (OR=6.74 (95% CI=3.21, 14.16); receive antidepressant prescriptions (OR 3.79 (95% CI=1.69, 8.49) and have greater severity of HADS-D score (OR 1.18 (95% CI=1.01, 1.38). Subthreshold cases that GPs identified as depressed, more often had a recording, over subsequent six months, of: depressive symptoms (16 (35%) versus 26 (7%), p<0.001); antidepressant prescriptions (11 (24%) versus 25 (7%), p=0.001); and Community Mental Health Team referrals (4 (9%) versus 1 (<1%), p=0.001). They also consulted GPs more frequently than those not identified (median=5 (IQR 2.8, 6.3) versus median=3 (IQR=2, 5), p=0.004 over six months. LIMITATIONS The HADS is not a diagnostic tool. CONCLUSIONS GPs' diagnoses of depressive disorder in patients with sub-threshold symptoms were appropriate. Interventions offered to this group were consistent with documented previous histories.
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Affiliation(s)
- Isobel M Cameron
- Applied Health Sciences (Mental Health), University of Aberdeen, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, United Kingdom.
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Scott T, Matsuyama R, Mezuk B. The relationship between treatment settings and diagnostic attributions of depression among African Americans. Gen Hosp Psychiatry 2011; 33:66-74. [PMID: 21353130 PMCID: PMC3073627 DOI: 10.1016/j.genhosppsych.2010.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the relationship between treatment setting characteristics and diagnostic attributions of depression among community-dwelling African Americans. METHODS Data come from the National Survey of American Life, a nationally representative sample of African Americans and Caribbean Blacks. Major Depression (MD) was assessed using the Composite International Diagnostic Inventory. Participants were categorized into four diagnostic groups: never MD, MD never attributed to physical health problems (i.e., affective depression), MD sometimes attributed to physical health problems (i.e., complicated depression), and MD always attributed to physical health problems (i.e., physical depression). Multinomial regression was used for assessment. RESULTS Among 441 participants, 66.4% were classified as affective depression, 17.8% as complicated depression and 15.8% as physical depression. Seeking treatment from a mental health professional was associated with increased likelihood of being in the complicated depression group [adjusted odds ratio (AOR): 5.52; 95% confidence interval (CI): 2.28-13.36]. Seeking treatment from a family doctor was associated with physical depression (AOR: 2.93; 95% CI: 1.18-7.26). Seeking care from three or more different health care providers was associated with complicated depression (AOR: 1.99; 95% CI: 1.17-3.40). CONCLUSION Results suggest that encounters with health care providers influence the diagnostic attribution of depression in a systematic manner.
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Affiliation(s)
- Tamara Scott
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond VA
| | - Robin Matsuyama
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond VA
| | - Briana Mezuk
- Department of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond VA
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Peripartum depression – does it occur in fathers and does it matter? JOURNAL OF MENS HEALTH 2010. [DOI: 10.1016/j.jomh.2010.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Paterniti DA, Fancher TL, Cipri CS, Timmermans S, Heritage J, Kravitz RL. Getting to "no": strategies primary care physicians use to deny patient requests. ACTA ACUST UNITED AC 2010; 170:381-8. [PMID: 20177043 DOI: 10.1001/archinternmed.2009.533] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Physicians need strategies for addressing patient requests for medically inappropriate tests and treatments. We examined communication processes that physicians use to deal with patient requests of questionable appropriateness. METHODS Data come from audio-recorded visits and postvisit questionnaires of standardized patient visits to primary care offices in Sacramento and San Francisco, California, and Rochester, New York, from May 2003 to May 2004. Investigators performed an iterative review of visit transcripts in which patients requested, but did not receive, an antidepressant prescription. Measurements include qualitative analysis of strategies for communicating request denial. The relationship between strategies and satisfaction reports in postvisit questionnaires was examined using the Fisher exact test. RESULTS Standardized patients requested antidepressants in 199 visits; the antidepressants were not prescribed in 88 visits (44%), 84 of which were available for analysis. In 53 of 84 visits (63%), physicians used 1 or more of the following 3 strategies that explicitly incorporated the patient perspective: (1) exploring the context of the request, (2) referring to a mental health professional, and (3) offering an alternative diagnosis. Twenty-six visits (31%) involved emphasis on biomedical approaches: prescribing a sleep aid or ordering a diagnostic workup. In 5 visits (6%), physicians rejected the request outright. Standardized patients reported significantly higher visit satisfaction when approaches relying on the patient perspective were used to deny the request (P = .001). CONCLUSIONS Strategies for saying no may be used to communicate appropriate care plans, to reduce provision of medically inappropriate services, and to preserve the physician-patient relationship. These findings should be considered in the context of physician education and training in light of increasing health care costs.
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Affiliation(s)
- Debora A Paterniti
- Division of General Medicine, University of California-Davis, 4150 V Street, Sacramento, CA 95817, USA.
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Kouros CD, Cummings EM. Longitudinal Associations Between Husbands' and Wives' Depressive Symptoms. JOURNAL OF MARRIAGE AND THE FAMILY 2010; 72:135-147. [PMID: 21603113 PMCID: PMC3097072 DOI: 10.1111/j.1741-3737.2009.00688.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Although concordance between husbands' and wives' mental health problems is often reported, questions remain about the nature of these relations. Extending research in this area, this study examined dynamic-longitudinal pathways among husbands' and wives' depressive symptoms and marital satisfaction as a moderator of associations. Participants were 296 heterosexual couples. Husbands and wives reported on their depressive symptoms and marital satisfaction. Results from dynamic bivariate latent difference score analyses indicated unidirectional longitudinal coupling such that higher levels of husbands' depressive symptoms predicted subsequent elevations in wives' depressive symptoms over time. This relation was stronger among couples reporting marital distress as compared to couples reporting higher marital satisfaction. The findings underscore the importance of considering one's spouses' depressive symptoms in treatment efforts.
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Affiliation(s)
| | - E. Mark Cummings
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
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Bertakis KD. The influence of gender on the doctor-patient interaction. PATIENT EDUCATION AND COUNSELING 2009; 76:356-360. [PMID: 19647968 DOI: 10.1016/j.pec.2009.07.022] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This paper discusses the research focused on gender issues in healthcare communication. METHODS The majority of papers discussed here are based on a research study in which 509 new adult patients were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for one year of care. RESULTS There are significant differences in the practice style behaviors of female and male doctors. Female doctors provide more preventive services and psychosocial counseling; male doctors spend more time on technical practice behaviors, such as medical history taking and physical examination. The patients of female doctors are more satisfied, even after adjusting for patient characteristics and physician practice style. Female patients make more medical visits and have higher total annual medical charges; their visits include more preventive services, less physical examination, and fewer discussions about tobacco, alcohol and other substance abuse (controlling for health status and sociodemographic variables). The examination of gender concordant and discordant doctor-patient dyads provides a unique strategy for assessing the effect of gender on what takes place during the medical visit. CONCLUSION Doctor and patient gender can impact the physician-patient interaction and its outcomes. PRACTICE IMPLICATIONS The development of appropriate strategies for the implementation of knowledge about physician and patient gender differences will be crucial for the delivery of high quality gender-sensitive healthcare.
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Affiliation(s)
- Klea D Bertakis
- Department of Family and Community Medicine, University of California at Davis, CA, USA.
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Vasiliadis HM, Tempier R, Lesage A, Kates N. General practice and mental health care: determinants of outpatient service use. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:468-76. [PMID: 19660169 DOI: 10.1177/070674370905400708] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types. METHOD Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35,236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants. RESULT Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers. CONCLUSION Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Quebec.
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Abstract
Women with systemic lupus erythematosus (SLE or lupus) often experience a protracted diagnostic period in which their symptoms are treated as medically unexplained. Although they know they are ill, their symptoms have not been validated as indicative of disease by a health care professional. Consequently, the diagnostic period can be viewed as liminal, the middle stage in the rites of passage and what Turner (1969/1997) has labeled "betwixt and between." Drawing on the analysis of narratives solicited from 23 women recruited from online lupus support groups, I explore the gendered nature of diagnosis for women with lupus using van Gennep's (1960) rites of passage as a conceptual framework.
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Affiliation(s)
- Cindy Mendelson
- College of Nursing, University of New Mexico, Albuquerque, New Mexico 87131, USA.
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Johansson EE, Bengs C, Danielsson U, Lehti A, Hammarström A. Gaps between patients, media, and academic medicine in discourses on gender and depression: a metasynthesis. QUALITATIVE HEALTH RESEARCH 2009; 19:633-644. [PMID: 19380499 DOI: 10.1177/1049732309333920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For reasons that are not yet fully understood, depression affects women twice as often as men. In this article we describe an investigation of how depression is understood in relation to men and women by the patients themselves, the media, and the medical research establishment. We do this by undertaking a metasynthesis of data from three different sources: interviews with depressed patients, media portrayals of depressed individuals in Sweden, and international medical articles about depression. The findings reveal that there are differences in (a) the recognition of depression, (b) the understanding of the reasons for depression, and (c) the contextualization of depression. Although women and men describe different symptoms and reasons for falling ill, these gendered expressions are not acknowledged in articles coming from Western medical settings. We discuss the implications of these findings and conclude that an integrated model for understanding biological, gender, and cultural aspects of depression has yet to be developed.
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Recognition and treatment of depression in primary care: effect of patients' presentation and frequency of consultation. J Psychosom Res 2009; 66:335-41. [PMID: 19302892 DOI: 10.1016/j.jpsychores.2008.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 10/06/2008] [Accepted: 10/14/2008] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Primary care physicians (PCPs) are expected to recognize depression and appropriately prescribe antidepressants. This article investigated the single and combined effects of different patient presentations and frequency of visits on detection and antidepressant use. METHODS Data came from an Italian nationwide survey on depressive disorders in primary care, involving 191 PCPs and 1910 attenders. Two hundred fifty patients suffering from major or subthreshold depression were compared in relation to their presentation (psychological, physical, and pain) and frequency of visits (low and high). RESULTS Recognition of depression significantly varied according to both presentation and frequency of visits. When compared to patients with psychological complaints, the odds ratios for nonrecognition of depression were higher for patients presenting with physical symptoms [2.3; 95% confidence interval (CI)=1.1-5.3] and with pain (4.1; 95% CI=1.6-9.9). Subjects who rarely attended the practice were 2.3 times less likely to receive a diagnosis of depression, compared with those having a high frequency of visits (95% CI=1.2-4.6). Similarly, patients presenting with physical symptoms or with pain and those with a low frequency of visits were rarely treated with antidepressants. The combination of physical or pain presentation with low frequency of visits further increased the risk for nonrecognition, which was sixfold that of the reference category. CONCLUSIONS Some subgroups of depressed patients still run a high risk of having their depression unrecognized by the PCP. Screening for depression among patients presenting with pain might be useful in order to improve recognition and management.
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Abstract
Gender bias has implications in the treatment of both male and female patients and it is important to take into consideration in most fields of medical research, clinical practice and education. Gender blindness and stereotyped preconceptions about men and women are identified as key causes to gender bias. However, exaggeration of observed sex and gender differences can also lead to bias. This article will examine the phenomenon of gender bias in medicine, present useful concepts and models for the understanding of bias, and outline areas of interest for further research.
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Affiliation(s)
- Katarina Hamberg
- The Department of Public Health & Clinical Medicine, Family Medicine, & Centre for Gender Excellence at Umeå University, Research Programme Challenging Gender, Umeå University, 90185 Umeå, Sweden.
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Comorbid chronic illness and the diagnosis and treatment of depression in safety net primary care settings. J Am Board Fam Med 2009; 22:123-35. [PMID: 19264935 PMCID: PMC3782997 DOI: 10.3122/jabfm.2009.02.080035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To estimate the impact of chronic medical conditions on depression diagnosis, treatment, and follow-up care in primary care settings. DESIGN This was a cross-sectional study that used interviewer-administered surveys and medical record reviews. Three hundred fifteen participants were recruited from 3 public primary care clinics. Depression diagnosis, guideline-concordant treatment, and follow-up care were the primary outcomes examined in individuals with depression alone compared with individuals with depression and chronic medical conditions measured using the Charlson Comorbidity Index (CCI). RESULTS Physician diagnosis of depression (32.6%), guideline-concordant depression treatment (32.7%), and guideline-concordant follow-up care (16.3%) were all low. Logistic regression analysis showed no significant difference in the likelihood of depression diagnosis, guideline-concordant treatment, or follow-up care in individuals with depression alone compared with those with both depression and chronic medical conditions. Participants with severe depression were, however, twice as likely to receive a diagnosis of depression as participants with moderate depression. In addition, participants with moderately severe and severe depression received much less appropriate follow-up care than participants with moderate depression. Among participants receiving a depression diagnosis, 74% received guideline-concordant treatment. CONCLUSION Physician depression care in primary care settings is not influenced by competing demands for care for other comorbid medical conditions.
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Latino Population Demographics, Risk Factors, and Depression: A Case Study of the Mexican American Prevalence and Services Survey. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/978-0-387-78512-7_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Rifel J, Švab I, Šter MP, Pavlič DR, King M, Nazareth I. Impact of demographic factors on recognition of persons with depression and anxiety in primary care in Slovenia. BMC Psychiatry 2008; 8:96. [PMID: 19108731 PMCID: PMC2639378 DOI: 10.1186/1471-244x-8-96] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 12/24/2008] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Research has repeatedly shown that family physicians fail to diagnose up to 70% of patients with common mental disorders. Objective of the study is to investigate associations between persons' gender, age and educational level and detection of depression and anxiety by their family physicians. METHODS We compared the results of two independent observational studies that were performed at the same time on a representative sample of family medicine practice attendees in Slovenia. 10710 patients participated in Slovenian Cross-sectional survey and 1118 patients participated in a first round of a cohort study (PREDICT-D study). Logistic regression was used to examine the effects of age, gender and educational level on detection of depression and anxiety. RESULTS The prevalence of major depression and Other Anxiety Syndrome (OAS) amongst family practice attendees was low. The prevalence of Panic Syndrome (PS) was comparable to rates reported in the literature. A statistical model with merged data from both studies showed that it was over 15 times more likely for patients with ICD-10 criteria depression to be detected in PREDICT-D study as in SCS survey. In PREDICT-D study it was more likely for people with higher education to be diagnosed with ICD-10 criteria depression than in SCS survey. CONCLUSION People with higher levels of education should probably be interviewed in a more standardized way to be recognised as having depression by Slovenian family physicians. This finding requires further validation.
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Affiliation(s)
- Janez Rifel
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia.
| | - Igor Švab
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Danica Rotar Pavlič
- Department of family medicine, Medical faculty, University in Ljubljana, Slovenia
| | - Michael King
- Department of Mental Health Sciences, Royal Free and University College Medical School, University College London, Hampstead Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Irwin Nazareth
- General Practice Research Framework, University College London, Rowland Hill Street, London NW3 2PF, UK
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Beseler CL, Stallones L, Hoppin JA, Alavanja MCR, Blair A, Keefe T, Kamel F. Depression and pesticide exposures among private pesticide applicators enrolled in the Agricultural Health Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1713-9. [PMID: 19079725 PMCID: PMC2599768 DOI: 10.1289/ehp.11091] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 09/09/2008] [Indexed: 05/03/2023]
Abstract
BACKGROUND We evaluated the relationship between diagnosed depression and pesticide exposure using information from private pesticide applicators enrolled in the Agricultural Health Study between 1993 and 1997 in Iowa and North Carolina. METHODS There were 534 cases who self-reported a physician-diagnosed depression and 17,051 controls who reported never having been diagnosed with depression and did not feel depressed more than once a week in the past year. Lifetime pesticide exposure was categorized in three mutually exclusive groups: low (< 226 days, the reference group), intermediate (226-752 days), and high (> 752 days). Two additional measures represented acute high-intensity pesticide exposures: an unusually high pesticide exposure event (HPEE) and physician-diagnosed pesticide poisoning. Logistic regression analyses were performed relating pesticide exposure to depression. RESULTS After adjusting for state, age, education, marital status, doctor visits, alcohol use, smoking, solvent exposure, not currently having crops or animals, and ever working a job off the farm, pesticide poisoning was more strongly associated with depression [odds ratio (OR) = 2.57; 95% confidence interval (CI), 1.74-3.79] than intermediate (OR = 1.07; 95% CI, 0.87-1.31) or high (OR = 1.11; 95% CI, 0.87-1.42) cumulative exposure or an HPEE (OR = 1.65; 95% CI, 1.33-2.05). In analysis of a subgroup without a history of acute poisoning, high cumulative exposure was significantly associated with depression (OR = 1.54; 95% CI, 1.16-2.04). CONCLUSION These findings suggest that both acute high-intensity and cumulative pesticide exposure may contribute to depression in pesticide applicators. Our study is unique in reporting that depression is also associated with chronic pesticide exposure in the absence of a physician-diagnosed poisoning.
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Affiliation(s)
- Cheryl L Beseler
- Colorado Injury Control Research Center, Department of Psychology, Colorado State University, Fort Collins, CO, USA.
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Effect of age, gender, menopausal status, and ovarian hormonal level on rTMS in treatment-resistant depression. Psychoneuroendocrinology 2008; 33:821-31. [PMID: 18468810 DOI: 10.1016/j.psyneuen.2008.03.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 03/20/2008] [Accepted: 03/20/2008] [Indexed: 11/23/2022]
Abstract
This study examines how gender and menopausal status contribute to age effect on the antidepressant efficacy of repetitive transcranial stimulation (rTMS). Thirty-one women (17 premenopausal, 14 postmenopausal), and 16 men with treatment-refractory bipolar/major depression underwent 10 consecutive sessions of rTMS. Mood symptoms and female hormones were measured. ANOVA-R revealed a significant gender (p<0.05) and time effect (p<0.001) on the Hamilton Depression Rating Scale (HAM-D) score. Percentage reduction of the rating correlated negatively with age in women (p<0.001). While no difference in the rTMS response was observed between male and premenopausal female patients (68.8% and 70.6%, respectively), postmenopausal women responded least (0%). We also found that greater improvement of depression score was associated with a higher estradiol/progesterone ratio in premenopausal women (p<0.05), suggesting an important role of female hormones in the therapeutic response. Regression analysis revealed that menopausal status and ovarian steroid levels, but not age, were the main determinants of antidepressant efficacy of rTMS in females. This is the first study to specifically investigate the effect of female hormones on rTMS therapeutic effect. Our data support changes in menopausal status and ovarian steroid levels as effectors of mood and the CNS neural substrate response to rTMS in refractory depression. However, the restricted number of patients and the shorter duration of rTMS treatment and follow-up might influence its generalization. Further study examining the interactions between mood, ovarian hormones, and rTMS treatment is warranted.
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Detection and prevalence of abuse of older males: perspectives from family practice. J Elder Abuse Negl 2008; 19:47-60, table of contents. [PMID: 18077269 DOI: 10.1300/j084v19n01_04] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Family doctors' frequent contact with seniors put them in reasonable positions to detect elder abuse and initiate referral to adult protective services. Since doctor reporting is low, however, this paper explores whether the gender of patient and/or doctor impacts on identification of elder mistreatment, or creates differential detection of one gender over the other. Use of the validated Elder Abuse Suspicion Index (EASI), and a structured social work evaluation, is described to provide some gender-based data from Canadian family practice. Specifically, while the prevalence of elder abuse is estimated to range from 12.0% to 13.3%, the specific prevalence was found for females to be 13.6% to 15.2% and for males 9.1% to 9.7%.
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Perry CD. Does treating maternal depression improve child health management? The case of pediatric asthma. JOURNAL OF HEALTH ECONOMICS 2008; 27:157-73. [PMID: 17498828 DOI: 10.1016/j.jhealeco.2007.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 02/06/2007] [Accepted: 03/15/2007] [Indexed: 05/15/2023]
Abstract
Past studies have demonstrated an association between maternal depression and poor management of pediatric asthma. Using an instrumental variables strategy to address the endogeneity of depression treatment, I build on this literature to answer the question of whether treating maternal depression leads to an improvement in pediatric asthma management. I show that treatment of mother's depression improves management of child's asthma, resulting in a reduction in asthma costs in the 6-month period following diagnosis of $798 per asthmatic child whose mother is treated for depression.
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Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25-36. [PMID: 17968628 PMCID: PMC2173927 DOI: 10.1007/s11606-007-0428-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression, with up to 11.9% prevalence in the general population, is a common disorder strongly associated with increased morbidity. The accuracy of non-psychiatric physicians in recognizing depression may influence the outcome of the illness, as unrecognized patients are not offered treatment for depression. OBJECTIVES To describe and quantitatively summarize the existing data on recognition of depression by non-psychiatric physicians. METHODS We searched the following databases: MEDLINE (1966-2005), Psych INFO (1967-2005) and CINAHL (1982-2005). To summarize data presented in the papers reviewed, we calculated the Summary receiver operating characteristic (ROC) and the summary sensitivity, specificity and odds ratios (ORs) of recognition, and their 95% confidence intervals using the random effects model. MEASUREMENTS AND MAIN RESULTS The summary sensitivity, specificity, and OR of recognition using the random effects model were: 36.4% (95% CI: 27.9-44.8), 83.7% (95% CI: 77.5-90.0), and 4.0 (95% CI: 3.2-4.9), respectively. We also calculated the Summary ROC. We performed a metaregression analysis, which showed that the method of documentation of recognition, the age of the sample, and the date of study publication have significant effect on the summary sensitivity and the odds of recognition, in the univariate model. Only the method of documentation had a significant effect on summary sensitivity, when the age of the sample and the date of publication were added to the model. CONCLUSION The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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Schoenthaler A, Ogedegbe G, Allegrante JP. Self-efficacy mediates the relationship between depressive symptoms and medication adherence among hypertensive African Americans. HEALTH EDUCATION & BEHAVIOR 2007; 36:127-37. [PMID: 18077654 DOI: 10.1177/1090198107309459] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many studies have documented the negative effects of depression on adherence to recommended treatment; however, little is known about the mechanism underlying this relationship. Using the Kenny and Baron analytic framework of mediation, the authors assessed whether self-efficacy mediated the relationship between depression and medication adherence in 167 hypertensive African Americans followed in a primary care practice. Depressive symptoms are associated with poor medication adherence (beta=.013, p=.036) and low self-efficacy (beta=-.008, p=.023). Self-efficacy is negatively associated with medication adherence at follow-up (beta=-.612, p<.001). The relationship between depressive symptoms and medication adherence becomes nonsignificant when controlling for self-efficacy (beta=.010, p=.087). Implications for further examination into the mediating role of self-efficacy and the deleterious effect of depression on medication adherence are discussed.
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Affiliation(s)
- Antoinette Schoenthaler
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY 10027, USA.
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Abstract
BACKGROUND Patient and physician gender may impact the process of medical care and its outcomes. Our objective was to investigate the influence of patient gender on what takes place during initial primary care visits while controlling for other variables previously demonstrated to affect the physician-patient interaction, such as physician gender and specialty, patient health status, pain, depression, obesity, age, education, and income. METHODS New patients (315 women, 194 men) were randomized for care by 105 primary care physicians. Sociodemographic information, self-reported health status and pain measures, a depression evaluation, screening for alcoholism, history of tobacco use, and measured body mass index (BMI) were collected during a previsit interview. The entire medical visit was videotaped, and then analyzed using the Davis Observation Code (DOC) system. RESULTS There was no significant difference in the visit length or work intensity (number of behavioral codes) for female patients compared with male patients; however, women's visits had more discussions regarding the results of the therapeutic interventions, more preventive services, less physical examination, and fewer discussions about tobacco, alcohol, and other substance abuse. CONCLUSIONS There are significant differences in the process of care between female and male patients. Physicians may be making medical decisions based on gender-related considerations. Strategies for implementing knowledge about these gender differences are crucial for the delivery of gender-sensitive care.
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Affiliation(s)
- Klea D Bertakis
- Department of Family and Community Medicine, University of California, Davis, Sacramento, California 95817, USA.
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Bertakis KD, Azari R. Determinants of physician discussion regarding tobacco and alcohol abuse. JOURNAL OF HEALTH COMMUNICATION 2007; 12:513-25. [PMID: 17763050 DOI: 10.1080/10810730701508187] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions. This study employed direct observation and interactional analysis of medical visits to investigate factors associated with physician discussion of tobacco and alcohol use with patients. New adult patients were randomly assigned to primary care at a university medical center. Videotapes of the visits were analyzed using the Davis observation code. Regression equations related discussions of substance use (alcohol and other substances), smoking, and health promotion to patient health status, depression, age, education, income, gender, alcohol abuse, and current smoking. Patients reporting better physical health were more likely to have their physicians employ a practice style emphasizing addiction behaviors (p = .0186). Substance use (p = .0117) and health promotion counseling (p = .0130) occurred more frequently with younger patients. Physicians discussed substance use (p = < .0001) and addiction (p < .0001) more often with male patients. Problem drinkers were more likely to have physicians address their substance use (p = .0069) and focus on addiction behaviors (p = .0017). Physicians adopted an addiction-oriented practice style (p < .0001), addressing substance use (p = .0009) and smoking (p < .0001), more often with patients who smoked. Physicians appear more apt to discuss these behavioral risk factors with healthier, younger, male patients who abuse tobacco and alcohol.
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Affiliation(s)
- Klea D Bertakis
- Department of Family and Community Medicine, University of California, Davis, California 95817, USA.
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Castelo-Branco C, Figueras F, Eixarch E, Quereda F, Cancelo MJ, González S, Balasch J. Stress symptoms and burnout in obstetric and gynaecology residents. BJOG 2007; 114:94-8. [PMID: 17233864 DOI: 10.1111/j.1471-0528.2006.01155.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was designed to examine the burnout syndrome among residents in obstetrics and gynaecology in Spain, and to analyse the predisposing factors for this condition. SETTING Eight Spanish University hospitals. SAMPLE A total of 162 residents representative of all active residents in obstetrics and gynaecology in Spain with regards to age, sex and year of residency were asked to take part in this survey. METHODS The Maslach Burnout Inventory was mailed to each resident of eight Spanish hospitals representative of all active residents in obstetrics and gynaecology in Spain with regards to age, sex and year of residency. Burnout was defined as a high score on the emotional exhaustion or depersonalisation subscores, according to validated standard cutoff values. The demographic and predisposing work factors were noted for each participant using a self-reported questionnaire. A binary logistic regression model was constructed from all predisposing factors as covariates for the prediction of the burnout syndrome. RESULTS Sixty-seven percent of the 162 eligible residents returned their questionnaires within a 3-month period. Of those, 58% fulfilled the criteria for the burnout syndrome. In the multivariate analysis, marital status and workload in office practice were found to be significant predisposing factors. Single marital status increased the odds ratio for burnout by 5.2 (95% CI 1.3-21). For every extra ten patients attended in the office per week, the odds ratio for burnout increased by 1.25 (95% CI 1.0-1.5). A stratified multivariate subanalysis showed that this risk remained significant only in the group of residents without staff supervision with an odds ratio of 2.1 (95% CI 1.3-2.9). CONCLUSION The prevalence of the burnout syndrome during obstetrics and gynaecology residency is high. Single marital status and workload in office practice without staff supervision are significant predisposing factors.
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Affiliation(s)
- C Castelo-Branco
- Institut Clinic of Gynaecology, Obstetrics and Neonatology, Faculty of Medicine-University of Barcelona, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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