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Power JD, Perruccio AV, Gandhi R, Veillette C, Davey JR, Lewis SJ, Syed K, Mahomed NN, Rampersaud YR. Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients. Arthritis Care Res (Hoboken) 2019; 71:1178-1185. [DOI: 10.1002/acr.23831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/08/2019] [Indexed: 01/16/2023]
Affiliation(s)
- J. Denise Power
- Arthritis Program and Krembil Research InstituteUniversity Health Network Toronto Ontario Canada
| | - Anthony V. Perruccio
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Rajiv Gandhi
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Christian Veillette
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - J. Roderick Davey
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Stephen J. Lewis
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Khalid Syed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Nizar N. Mahomed
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
| | - Y. Raja Rampersaud
- Arthritis Program and Krembil Research InstituteUniversity Health Network and University of Toronto Toronto Ontario Canada
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O'moore KA, Newby JM, Andrews G, Hunter DJ, Bennell K, Smith J, Williams AD. Internet Cognitive-Behavioral Therapy for Depression in Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 70:61-70. [DOI: 10.1002/acr.23257] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/11/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Kathleen A. O'moore
- St. Vincent's Hospital; and University of New South Wales, and The Black Dog Institute; Prince of Wales Hospital; Sydney Australia
| | - Jill M. Newby
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Gavin Andrews
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - David J. Hunter
- University of Sydney; Sydney Medical School; and Royal North Shore Hospital
| | - Kim Bennell
- University of Melbourne; School of Health Sciences; Melbourne Australia
| | - Jessica Smith
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
| | - Alishia D. Williams
- St. Vincent's Hospital; and University of New South Wales; Sydney Australia
- Utrecht University; Utrecht The Netherlands
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Polenick CA, Brooks JM, Birditt KS. Own and partner pain intensity in older couples: longitudinal effects on depressive symptoms. Pain 2017; 158:1546-1553. [PMID: 28489621 PMCID: PMC5631540 DOI: 10.1097/j.pain.0000000000000949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pain has been linked to depression among individuals and their partners. Yet, little is known about long-term mutual influences between pain intensity and depressive symptoms within couples as they age. Using a nationally representative U.S. sample of wives and husbands aged 50 and older (mean = 64.53, SD = 7.86), this study explored the links between own and partner pain intensity and depressive symptoms across an 8-year period. A total of 963 heterosexual married couples drawn from the Health and Retirement Study completed interviews biennially from 2006 to 2014. Dyadic growth curve models examined mutual associations within couples and controlled for sociodemographic characteristics, length of marriage, and marital quality, along with self-rated health, number of chronic health conditions, and functional disability. For wives and husbands, their own greater baseline pain intensity was significantly linked to their own higher levels of depressive symptoms. Unexpectedly, wives with greater baseline pain intensity reported decreases in their depressive symptoms over time. There were also partner effects such that husbands' greater pain intensity at baseline was associated with increases in wives' depressive symptoms over time. Findings highlight the importance of considering both individual and spousal associations between pain intensity and depressive symptoms in later life. Understanding how individual and couple processes unfold may yield critical insights for the development of intervention and prevention efforts to maintain mental health among older chronic pain patients and their spouses.
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Affiliation(s)
| | | | - Kira S. Birditt
- Institute for Social Research, University of Michigan. Ann Arbor MI 48104
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Yu NX, Mols F, Stewart SM, Zhang J. The moderation effect of personality on healthcare utilization in Chinese people living with HIV. AIDS Care 2016; 29:729-733. [PMID: 27774809 DOI: 10.1080/09540121.2016.1248350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is evidence that Type D personality can predict impaired quality of life and health status in various chronic conditions. The evidence is conflicting as to whether Type D is associated with increased healthcare services, and no study has reported on the healthcare utilization of people living with HIV (PLWH) who have a Type D personality. This study investigated the impact of Type D personality on healthcare utilization in a sample of Chinese PLWH and examined physical and emotional symptoms as possible mechanisms of healthcare utilization. This was a cross-sectional study of 199 PLWH in rural China. Participants completed a survey on physical symptoms, emotional symptoms, healthcare utilization, and Type D personality. Those PLWH with a Type D personality reported more physical and emotional symptoms and healthcare utilization than patients without this personality. Among PLWH who had a Type D personality, physical symptoms had a direct effect on healthcare utilization, and emotional symptoms did not significantly mediate this association. However, among PLWH without a Type D personality, emotional symptoms significantly mediated the effects of physical symptoms on healthcare utilization. PLWH with a Type D personality reported more healthcare utilization, which was attributed to their high physical symptoms rather than their emotional symptoms. These findings suggest that PLWH with a Type D personality might be bothered by intensified emotional symptoms, which might be too severe to be associated with physical symptoms and healthcare utilization. New prospective studies should focus on the pattern of healthcare utilization among patients with a Type D personality and their intensified physical and emotional symptoms.
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Affiliation(s)
- Nancy Xiaonan Yu
- a Department of Applied Social Sciences , City University of Hong Kong , Hong Kong , People's Republic of China.,b School of Public Health, University of Hong Kong , Hong Kong , People's Republic of China
| | - Floortje Mols
- c Center of Research on Psychology in Somatic Diseases (CoRPS) , Tilburg University , Tilburg , The Netherlands
| | - Sunita M Stewart
- d Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Jianxin Zhang
- e Institute of Psychology, Chinese Academy of Sciences , Beijing , People's Republic of China
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Fuller-Thomson E, Battiston M, Gadalla TM, Shaked Y, Raza F. Remission from Depression among Adults with Arthritis: A 12-Year Followup of a Population-Based Study. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:828965. [PMID: 24587900 PMCID: PMC3921939 DOI: 10.1155/2014/828965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/27/2013] [Accepted: 10/29/2013] [Indexed: 12/02/2022]
Abstract
Individuals with arthritis are vulnerable to depression. In this study, we calculated time to remission from depression in a representative community-based sample of depressed Canadians with arthritis who were followed for 12 years. We conducted secondary analysis of a longitudinal panel study, the National Population Health Survey, which was begun in 1994/95 and has included biennial assessment of depression since that time. Our analysis focused on a total of 216 respondents with arthritis who were depressed at baseline. The mean time to remission from depression was calculated using the Kaplan-Meier procedure and compared across categories of each of the potential predictors. The percentage of those no longer screening positive for depression was calculated at two years after baseline. At two years after baseline, 71% of the sample had achieved remission from depression. Time to remission was significantly longer for those depressed adults who were under the age of 55, those who reported more chronic pain at baseline, those with comorbid migraine, and those who experienced childhood physical abuse or parental addictions. These findings highlight the importance of screening for these factors to improve the targeting of interventions to depressed patients with arthritis.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada M5S 1V4
| | - Marla Battiston
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada M5S 1V4
| | - Tahany M. Gadalla
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada M5S 1V4
| | - Yael Shaked
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada M5S 1V4
| | - Ferrah Raza
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada M5S 1V4
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6
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Nichol MB, Zhang L. Depression and health-related quality of life in patients with rheumatoid arthritis. Expert Rev Pharmacoecon Outcomes Res 2014; 5:645-53. [DOI: 10.1586/14737167.5.5.645] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Beehler GP, Rodrigues AE, Mercurio-Riley D, Dunn AS. Primary Care Utilization among Veterans with Chronic Musculoskeletal Pain: A Retrospective Chart Review. PAIN MEDICINE 2013; 14:1021-31. [DOI: 10.1111/pme.12126] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fuller-Thomson E, Shaked Y. Factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism: findings from a representative community survey. ACTA ACUST UNITED AC 2009; 61:944-50. [PMID: 19565540 DOI: 10.1002/art.24615] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism. METHODS The nationally representative Canadian Community Health Survey 2000-2001 included 130,880 respondents (response rate 84.7%). Respondents were diagnosed as depressed using a subset of items from the Composite International Diagnostic Interview. There were 23,405 respondents age > or =20 years who reported that they had been diagnosed with arthritis or rheumatism by a health professional. Logistic regression analyses were conducted to investigate depression and suicidal ideation. RESULTS One in 10 Canadians with arthritis had clinically relevant levels of major depression. The age- and sex-adjusted odds ratios (ORs) of major depression (OR 2.24, 95% confidence interval [95% CI] 2.11-2.38) and suicidal ideation (OR 2.01, 95% CI 1.75-2.31) among those with arthritis were approximately twice that of those without arthritis. The adjusted ORs of major depression among those with arthritis were significantly higher among women, the unmarried, younger, and poorer individuals. Individuals in pain, with limitations in activities of daily living, with limitations in instrumental activities of daily living, and with greater numbers of chronic conditions had higher odds of major depression. Less than half of those with major depression had consulted a mental health professional. One in 5 individuals with arthritis and major depression had been suicidal in the past year. CONCLUSION The majority of individuals with arthritis and major depression were not receiving adequate treatment for major depression. Clients should be screened for major depression and suicidal ideation, particularly if they fall into the identified vulnerable groups.
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He Y, Zhang M, Lin EHB, Bruffaerts R, Posada-Villa J, Angermeyer MC, Levinson D, de Girolamo G, Uda H, Mneimneh Z, Benjet C, de Graaf R, Scott KM, Gureje O, Seedat S, Haro JM, Bromet EJ, Alonso J, von Korff M, Kessler R. Mental disorders among persons with arthritis: results from the World Mental Health Surveys. Psychol Med 2008; 38:1639-1650. [PMID: 18298879 PMCID: PMC2736852 DOI: 10.1017/s0033291707002474] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prior studies in the USA have reported higher rates of mental disorders among persons with arthritis but no cross-national studies have been conducted. In this study the prevalence of specific mental disorders among persons with arthritis was estimated and their association with arthritis across diverse countries assessed. METHOD The study was a series of cross-sectional population sample surveys. Eighteen population surveys of household-residing adults were carried out in 17 countries in different regions of the world. Most were carried out between 2001 and 2002, but others were completed as late as 2007. Mental disorders were assessed with the World Health Organization (WHO) World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). Arthritis was ascertained by self-report. The association of anxiety disorders, mood disorders and alcohol use disorders with arthritis was assessed, controlling for age and sex. Prevalence rates for specific mental disorders among persons with and without arthritis were calculated and odds ratios (ORs) with 95% confidence intervals were used to estimate the association. RESULTS After adjusting for age and sex, specific mood and anxiety disorders occurred among persons with arthritis at higher rates than among persons without arthritis. Alcohol abuse/dependence showed a weaker and less consistent association with arthritis. The pooled estimates of the age- and sex-adjusted ORs were about 1.9 for mood disorders and for anxiety disorders and about 1.5 for alcohol abuse/dependence among persons with versus without arthritis. The pattern of association between specific mood and anxiety disorders and arthritis was similar across countries. CONCLUSIONS Mood and anxiety disorders occur with greater frequency among persons with arthritis than those without arthritis across diverse countries. The strength of association of specific mood and anxiety disorders with arthritis was generally consistent across disorders and across countries.
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Affiliation(s)
- Y He
- Shanghai Mental Health Center, 600 Wan Ping Nan Road, Shanghai, China.
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Simpson JSA, Carlson LE, Trew ME. Effect of Group Therapy for Breast Cancer on Healthcare Utilization. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1523-5394.2001.91005.pp.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zyrianova Y, Kelly BD, Gallagher C, McCarthy C, Molloy MG, Sheehan J, Dinan TG. Depression and anxiety in rheumatoid arthritis: the role of perceived social support. Ir J Med Sci 2007; 175:32-6. [PMID: 16872026 DOI: 10.1007/bf03167946] [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: 11/25/2022]
Abstract
BACKGROUND Rheumatoid arthritis is a common, disabling, autoimmune disease with significant psychiatric sequelae. AIMS We aimed to identify the prevalence of depression and anxiety in patients with rheumatoid arthritis attending hospitals, and to elucidate the role played by illness variables, disability variables and psychosocial variables in predicting levels of depression and anxiety. METHODS We assessed depression, anxiety, arthritis-related pain, arthritis-related disability and perceived social support in 68 adults with rheumatoid arthritis. RESULTS Sixty-five per cent of patients had evidence of depression (37.5% moderate or severe) and 44.4% had evidence of anxiety (17.8% moderate or severe). Both depression and anxiety were highly correlated with several measures of arthritis-related pain and functional impairment. After controlling for age, gender, marital status and duration of arthritis, perceived social support was a highly significant independent predictor of both depression and anxiety. CONCLUSIONS These findings suggest that increasing social support may be particularly important in the management of depression and anxiety in rheumatoid arthritis.
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Affiliation(s)
- Y Zyrianova
- Dept of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital
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Na YM, Kim KS, Lee KU, Chae JH, Kim JH, Kim DJ, Bahk WM, Jang YS, Lee AK, Woo YS, Lee PS. The relationship between depressive symptoms in outpatients with chronic illness and health care costs. Yonsei Med J 2007; 48:787-94. [PMID: 17963335 PMCID: PMC2628144 DOI: 10.3349/ymj.2007.48.5.787] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs. PATIENTS AND METHODS Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder. RESULTS A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms. CONCLUSION In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.
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Affiliation(s)
- Yu-Mi Na
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Kwang-Soo Kim
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Kyoung-Uk Lee
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Jin-Ho Kim
- Department of Management, Korea National Defense University, Seoul, Korea
| | - Dai-Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Yun-Sig Jang
- Department of Internal Medicine, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Ae-Kyoung Lee
- Health Insurance Research Center, National Health Insurance Corporation of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, The Catholic University of Korea, Medical College, Seoul, Korea
| | - Pyeoung-Soo Lee
- Health Insurance Research Center, National Health Insurance Corporation of Korea, Seoul, Korea
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Lemieux J, Topp A, Chappell H, Ennis M, Goodwin PJ. Economic Analysis of Psychosocial Group Therapy in Women with Metastatic Breast Cancer. Breast Cancer Res Treat 2006; 100:183-90. [PMID: 16773438 DOI: 10.1007/s10549-006-9249-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Metastatic breast cancer is associated with psychological distress in one-third of patients. We examined the impact of group psychosocial support on health care costs in metastatic breast cancer. Psychosocial interventions have been shown to reduce psychological distress in these patients. In other diseases, depression and anxiety have been associated with higher health care system resource utilization. METHODS Data on health care system resources utilization were collected as part of a Canadian multicenter randomized controlled trial of a supportive-expressive group support in metastatic breast cancer. Costs were obtained from one tertiary care hospital in Toronto. A cost minimization analysis was conducted since there was no survival difference; the primary endpoint of the study. Cost-effectiveness analyses were conducted for mood and pain. RESULTS Total health care utilization costs (including costs of the group therapy intervention) for the intervention and control groups were $31,715 and $28,189, respectively per patient. The difference in total costs between groups ($3,526) was not statistically significant (P = 0.53). The cost-effectiveness analysis for mood showed the intervention group to have an increased cost of $5,550 per patient for an effect size of 0.5 on the POMS scale. The corresponding cost for pain was $4,309. An exploratory analysis on patients who were more distressed at baseline showed a non-significant decrease in cost in favor of the intervention arm (difference of $3,911 P = 0.66). CONCLUSION Psychosocial intervention, in the form of supportive-expressive group support for metastatic breast cancer, does not lower health care system resource utilization.
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Affiliation(s)
- Julie Lemieux
- Samuel Lunenfeld Research Institute of the Mount Sinai Hospital, University of Toronto, 1284-600 University Ave, M5G 1X5 Toronto, ON, Canada.
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Richman LS, Kubzansky L, Maselko J, Kawachi I, Choo P, Bauer M. Positive emotion and health: going beyond the negative. Health Psychol 2005; 24:422-9. [PMID: 16045378 DOI: 10.1037/0278-6133.24.4.422] [Citation(s) in RCA: 201] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the relationships between positive emotions and health. Two positive emotions were considered, hope and curiosity, in conjunction with 3 physician-diagnosed disease outcomes: hypertension, diabetes mellitus, and respiratory tract infections. Medical data were abstracted over a 2-year period from 1,041 patient records from a multispecialty medical practice, and emotions were assessed through a mailed questionnaire. Across 3 disease outcomes, higher levels of hope were associated with a decreased likelihood of having or developing a disease. Higher levels of curiosity were also associated with decreased likelihood of hypertension and diabetes mellitus. Results suggest that positive emotion may play a protective role in the development of disease.
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Affiliation(s)
- Laura Smart Richman
- Department of Society, Human Development, and Health, Harvard School of Public Health, Cambridge, MA, USA.
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Suh M, Kim K, Kim I, Cho N, Choi H, Noh S. Caregiver's burden, depression and support as predictors of post-stroke depression: a cross-sectional survey. Int J Nurs Stud 2005; 42:611-8. [PMID: 15967452 DOI: 10.1016/j.ijnurstu.2004.10.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2003] [Revised: 10/08/2004] [Accepted: 10/14/2004] [Indexed: 02/01/2023]
Abstract
To examine the effects of caregiver's burden, depression, and support on post-stroke depression (PSD), cross-sectional data were obtained from an epidemiologic survey of 225 stroke survivors and their caregivers living in Seoul, Korea. Multivariate analyses showed that, taking the clinical status of patients into account, caregiver's burden, depression and support were related to higher PSD. Perceived burden exerts adverse effects on PSD through its influence on the depression in caregivers. Hence, the care of stroke survivors that incorporates the care of caregivers is likely to reduce the risk of post-stroke depression in patients.
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Affiliation(s)
- M Suh
- School of Nursing, Seoul National University, 28 Yeongun-dong, Jongro-gu, Seoul 110-799, Korea
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Strine TW, Hootman JM, Okoro CA, Balluz L, Moriarty DG, Owens M, Mokdad A. Frequent mental distress status among adults with arthritis age 45 years and older, 2001. Arthritis Care Res (Hoboken) 2004; 51:533-7. [PMID: 15334424 DOI: 10.1002/art.20530] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify characteristics and behaviors among persons with arthritis through evaluation of self-perceived mental health status. METHODS Data were analyzed for adults with arthritis age 45 years or older from the 2001 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults living in the United States. RESULTS The prevalence of frequent mental distress (FMD; > or =14 self-reported mentally unhealthy days in the past 30 days) among persons with arthritis was 13.4%. Among persons with arthritis, those with FMD as compared with those without FMD were more likely to be underweight and obese than normal weight; they also were more likely to be insufficiently active or inactive than following recommended physical activity guidelines. In addition, those with arthritis and FMD were more likely to report disability and impaired physical and general health than were those with arthritis but without FMD. CONCLUSION Physicians should encourage their patients with arthritis and mental distress to participate in educational and behavioral interventions shown to have both physical and psychological benefits.
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Affiliation(s)
- Tara W Strine
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Dominick KL, Ahern FM, Gold CH, Heller DA. Health-related quality of life and health service use among older adults with osteoarthritis. Arthritis Care Res (Hoboken) 2004; 51:326-31. [PMID: 15188315 DOI: 10.1002/art.20390] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relationship between health-related quality of life (HRQOL) and health service use among older adults with osteoarthritis (OA). METHODS Subjects were 9,043 Medicare-enrolled survey respondents with a prior International Classification of Diseases, Ninth Revision code for OA. Analyses examined the relationship of 5 Centers for Disease Control and Prevention HRQOL items (general health, mental health, pain, activity limitation, and sleep) to physician visits, prescription analgesic or antiinflammatory use, and arthroplasty during 1 year of followup. RESULTS In analyses controlling for demographic and health-related variables, greater pain frequency was associated with increased odds of visiting a physician, using analgesic or antiinflammatory drugs, and having arthroplasty (P < 0.001). Poorer general health was associated with increased odds of analgesic or antiinflammatory use but decreased odds of arthroplasty (P < 0.01). More days of activity limitation and poor mental health were associated with decreased odds of analgesic or antiinflammatory use (P < 0.01). CONCLUSION These HRQOL variables, especially pain frequency, can be valuable tools for estimating future health care use among older adults with OA.
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Affiliation(s)
- Kelli L Dominick
- Durham Veterans Administration Medical Center, HSR&D, Durham North Carolina 27705, USA
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Dunlop DD, Lyons JS, Manheim LM, Song J, Chang RW. Arthritis and Heart Disease as Risk Factors for Major Depression. Med Care 2004; 42:502-11. [PMID: 15167318 DOI: 10.1097/01.mlr.0000127997.51128.81] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major depression in later life is highest among people with chronic illness. Identifying amenable factors that mediate the relationship between known risk factors such as arthritis and heart disease with major depression is important to the design of clinical and public health strategies to reduce depression and its consequences. OBJECTIVE This study investigates factors amenable to clinical and public health intervention that could mediate the relationship between chronic illness and major depression. DESIGN Population-based national sample. SETTING United States preretirement age (54-65) adults. PARTICIPANTS A total of 7825 participants from the 1996 Health and Retirement Survey. MEASUREMENT The outcome is major depression based on standardized assessment. Independent variables include sociodemographics chronic illness profile, functional limitation, health and medical access. RESULTS A substantial burden of major depression is related to chronic illness, particularly arthritis (attributable risk [AR], 18.1%; 95% confidence interval [CI], 9.9-25.6) and heart disease (AR, 17.6%; 95% CI, 13.4-21.7). Functional limitation is the strongest investigated factor associated with depression (AR, 34.4%; 95% CI, 24.8-42.7) and attenuates the associations of arthritis and heart disease with depression. CONCLUSION Functional limitation mediates the association of arthritis and heart disease with major depression. This relationship offers potential clinical and public health strategies to reduce major depression in older adults through intervention and management of functional limitation. Alternatively, it might be possible to reduce functional loss through screening for depression, particularly among people with functional limitation, and effective mental health treatment. The importance for clinical management of depression, comorbidity, and functional limitation spectrum supports the value of systems-based medicine.
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Affiliation(s)
- Dorothy D Dunlop
- Institute for Health Services Research and Policy Studies, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Reid MC, Williams CS, Gill TM. The relationship between psychological factors and disabling musculoskeletal pain in community-dwelling older persons. J Am Geriatr Soc 2003; 51:1092-8. [PMID: 12890071 DOI: 10.1046/j.1532-5415.2003.51357.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To determine the relationship between two psychological factors (depressive symptoms and low functional self-efficacy) and the occurrence of disabling musculoskeletal pain in community-dwelling older persons. DESIGN A 12-month prospective cohort study. SETTING Community-based. PARTICIPANTS Two hundred twenty-six community-dwelling persons residing in the greater New Haven, Connecticut, region, aged 70 and older, who had a history of clinically evident musculoskeletal pain and were independent in bathing, walking, dressing, and transferring. MEASUREMENTS Levels of depressive symptoms and functional self-efficacy were determined during a comprehensive baseline assessment along with information regarding participants' demographic, medical, and physical/cognitive status. The occurrence of disabling musculoskeletal pain, defined as staying in bed for at least one-half day or cutting down on one's usual activities due to joint or back pain, was ascertained during monthly interviews. RESULTS The mean number of months of disabling musculoskeletal pain, adjusted for baseline covariates, increased from the lowest to the highest quartile of depressive symptoms: 1.2 (95% confidence intervals = 0.8-1.7), 1.4 (1.0-2.0), 2.0 (1.5-2.8), 2.3 (1.7-3.1), respectively, P for trend =.002. The corresponding results for functional self-efficacy were (from highest to lowest quartile) 1.4 (1.0-2.0), 1.6 (1.2-2.2), 1.6 (1.2-2.2), 2.2 (1.6-3.0), P for trend =.068. There was no interaction between depressive symptoms and functional self-efficacy. CONCLUSION Depressive symptoms and, to a lesser extent, low functional self-efficacy were each associated with the occurrence of disabling musculoskeletal pain among community-dwelling older persons.
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Affiliation(s)
- M Carrington Reid
- Clinical Epidemiology Unit, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
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20
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Abstract
Social and economic effects of mood disorders include functional impairment, disability or lost work productivity, and increased use of health services. Evidence for these impacts includes cross-sectional studies, longitudinal studies, and true experiments (randomized trials of specific treatments or treatment programs). With respect to unipolar depression, strong evidence demonstrates that depression is associated with significant functional impairment and that effective treatment helps to restore function. Studies of the effect of depression on work disability and health care costs show strong cross-sectional associations (i.e., greater disability and higher costs among those with depression) and longitudinal associations (i.e., improvement in depression is associated with reduced disability and lower costs). All of these findings regarding unipolar depression seem as consistent in the subgroup of patients with comorbid chronic medical illness as in the total population with depressive disorders. Fewer data are available regarding social and economic burden of bipolar disorder, but available data show cross-sectional associations between mood symptoms and functional impairment, disability, and health care costs. Taken together, these data describe the substantial social and economic burden of mood disorders and the potential benefits of more effective treatment. We must recall, however, that economic benefits of treatment for mood disorders are secondary to the principal objective of relieving human suffering.
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Affiliation(s)
- Gregory E Simon
- Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101, USA
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Hunkeler EM, Spector WD, Fireman B, Rice DP, Weisner C. Psychiatric symptoms, impaired function, and medical care costs in an HMO setting. Gen Hosp Psychiatry 2003; 25:178-84. [PMID: 12748030 DOI: 10.1016/s0163-8343(03)00018-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
More information is needed regarding the medical care utilization and costs of individuals who report depressed mood, persistent anxiety, brief anxiety, panic, and trouble controlling violent behavior. We present findings from a 1-year prospective follow-up study of a stratified random sample of adult HMO enrollees (N = 10,377) originally interviewed by telephone. A strong association was observed between these psychiatric symptoms, associated impaired function, and general medical care costs during the year following the interview. After controlling for age, gender, race, medical conditions, and smoking, the mean costs of general medical care were $1,948 for respondents who reported none of the psychiatric symptoms or impaired function: $3,006 for respondents with all 5 symptoms but no impaired function; and $3,906 for those with all 5 symptoms and pervasive functional impairment. Persistent anxiety and depressed mood had the greatest impact on total general medical costs, while impaired function was associated with increased likelihood of hospital admission and emergency room use. We conclude that depressed mood, persistent anxiety, and related impaired function are associated with substantial increases in the use and cost of general medical care.
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Affiliation(s)
- Enid M Hunkeler
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
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Cote MP, Mullins LL, Hartman V, Hoff A, Balderson BHK, Chaney J, Domek D. Psychosocial Correlates of Health Care Utilization for Children and Adolescents With Type 1 Diabetes Mellitus. CHILDRENS HEALTH CARE 2003. [DOI: 10.1207/s15326888chc3201_1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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23
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Abstract
Chronic medical conditions drastically affect the lives of those afflicted, leading to pain, disability, and disruption. Comorbid depression can exacerbate the effects of medical illness and may be an independent source of suffering and disability. Data from the Epidemiological Follow-Up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I) are used to examine the manner in which depression and comorbid medical conditions interact to affect health-related quality of life (HRQOL). The findings suggest a) that the effects of depression are comparable with those of arthritis, diabetes, and hypertension; and b) that depression and chronic medical illnesses interact to amplify the effects of the medical illness. The data also support the merit of adopting a multidimensional approach to HRQOL rather than treating it unidimensionally.
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Affiliation(s)
- Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, Chapel Hill, North Carolina 27599-7160, USA
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24
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Gustafsson D, Olofsson N, Andersson F, Lindberg B, Schollin J. Effect of asthma in childhood on psycho-social problems in the family. J Psychosom Res 2002; 53:1071-5. [PMID: 12479988 DOI: 10.1016/s0022-3999(02)00340-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The responsibility for treating children with asthma has gradually shifted from the medical health service to the family and parents, which may cause new psycho-social problems in the family. This study aimed at describing the psycho-social effects on families having a child with asthma, and at determining whether a relation exists between the medical severity of disease and psycho-social problems. METHODS The findings are based on a questionnaire with the following domains: economy, work, free time, health, environment, and family, as well as a health-related medical questionnaire. They are built on psycho-social problems and on medical records. RESULTS The frequency of psycho-social problems was high regarding single questions in the evaluated psycho-social domains. A relation was found between high drug consumption and severe psycho-social problems. However, no positive correlation was detected among visits at the hospital's emergency department, absence from school due to asthma or disturbed sleep, and psycho-social problems. On the contrary, a negative correlation was found between absence from school due to asthma and psycho-social problems. CONCLUSION We conclude that for single questions in each psycho-social domain, the problem rate is high, but when taking into account the mean value of different psycho-social problems in each domain, the reported problem rate is fairly low. This method permits selection of the psycho-social domains with the most severe problems in each family. It can, therefore, be used to direct help from the medical service. We also found a relation between the medical severity of asthma and the extent of the psycho-social problems caused by the disease.
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Affiliation(s)
- Dan Gustafsson
- Department of Paediatrics, Orebro University Hospital, Sweden.
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25
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Leon AC, Portera L, Walkup JT. The development and evaluation of the brief depression screen in medically ill disability claimants. Int J Psychiatry Med 2002; 31:389-400. [PMID: 11949737 DOI: 10.2190/a2e4-976y-bw2q-d9xx] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There is literature demonstrating elevated prevalence of depression in primary care. Yet there remains a need for a brief depression screen designed and evaluated specifically for use among medically ill patients. Our objective was to develop and validate a brief, unobtrusive screen for depression among severely medically ill long-term disability claimants. METHODS The study sample consisted of 480 long-term disability claimants, less than 55 years of age, with one of the following illnesses: cancer, diabetes, myocardial infarction, rheumatoid arthritis, stroke, or multiple sclerosis. Each subject completed a questionnaire that included 26 potential screening items. A subset of subjects was administered the SCID, which served as the gold standard for the DSM-IV depression and dysthymia diagnoses. RESULTS The Brief Depression Screen, a three-item screen for major depressive disorder and dysthymia, was developed. About 34 percent of the sample met criteria for major depressive disorder or dysthymia. The Brief Depression Screen detected 75 percent of those subjects in this sample. Furthermore, nearly half of the subjects with positive screen results met criteria for depression or dysthymia. These results are comparable to those of the eight-item Burnam screen, but not as sensitive as the more widely used, twenty item CES-D. CONCLUSION The Brief Depression Screen was developed and evaluated for use with severely ill long-term disability claimants. In practice, a positive screen for depression is to be followed with a comprehensive diagnostic assessment that could be conducted by a trained clinician. Further research is warranted to determine whether the identification and treatment of depression in disability claimants with non-psychiatric medical illnesses will facilitate return to work, even in the presence of comorbid medical illnesses.
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Affiliation(s)
- A C Leon
- Weill Medical College of Cornell University, Department of Psychiatry, New York, NY 10021, USA
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26
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Oslin DW, Datto CJ, Kallan MJ, Katz IR, Edell WS, TenHave T. Association between medical comorbidity and treatment outcomes in late-life depression. J Am Geriatr Soc 2002; 50:823-8. [PMID: 12028167 DOI: 10.1046/j.1532-5415.2002.50206.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Previous studies have demonstrated an association between major depression and physical disability in late life. The objectives of this study were to examine the relationship between specific medical illnesses and the outcomes of treatment for late-life depression. DESIGN The study was a longitudinal assessment of medical illness, depression, and disability. Patients were assessed during an initial inpatient psychiatric hospitalization and 3 months postdischarge. SETTING All patients were initially evaluated after admission to one of 71 inpatient psychiatric treatment facilities. PARTICIPANTS A sample of 671 older patients who received inpatient treatment for depression was evaluated at entry into the hospital and 3 months after discharge. MEASUREMENTS Depressive symptoms were measured using the Geriatric Depression Scale. Disability was measured using the instrumental activities of daily living scale and the Medical Outcomes Study 36-item short form. Medical illness was assessed using the medical illness checklist. RESULTS As previously reported, physical disability and the total number of medical illnesses were significantly related to change in depressive symptoms. In this study, we find that arthritis, circulatory problems, a speech disorder, or a skin problem, but not other general medical conditions, were related to a worse outcome with respect to depression symptoms. The effect of these problems was statistically and clinically significant. After controlling for pretreatment disability, arthritis and skin problems continued to predict a worse outcome. However, the apparent effect of each of these conditions was mediated by the residual disability after treatment. CONCLUSION The results of this study support the hypothesis that certain somatic disorders play a role in the treatment response of late-life depression and suggest that the effect of specific illnesses on depression may be mediated by the presence of functional disability.
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Affiliation(s)
- David W Oslin
- Section of Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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27
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Abstract
The consequences of depression in medically ill children include the disability and morbidity that is associated with depression in any patient. They also include an exacerbation of the underlying medical disease and nonadherence to treatment. Thus, medically ill children who are depressed constitute a special, high-risk group of patients who may suffer from severe consequences above and beyond those that are expected in a medically sound population. This manuscript reviews methodologic and practical difficulties that are associated with the diagnosis and treatment of depression in this group of patients. Because treatment of depression in medically ill children may well lead to improvement in medical and psychiatric outcome, there is pressing need for the careful study of potential treatment options in this specific group of patients.
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Affiliation(s)
- Eyal Shemesh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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Simpson JS, Carlson LE, Trew ME. Effect of group therapy for breast cancer on healthcare utilization. CANCER PRACTICE 2001; 9:19-26. [PMID: 11879269 DOI: 10.1046/j.1523-5394.2001.91005.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to determine whether participation in a group psychosocial intervention by patients with breast cancer would result in an improvement in psychological measures and in reduced billings in general medical expenses. DESCRIPTION OF STUDY Eligible women who had completed treatment for stage 0, I, or II primary breast cancer were prospectively and randomly assigned to either the intervention (n=46) or control (n=43) group. Both groups received the usual psychosocial care; however, the intervention group also participated in six weekly cognitive/behavioral psychosocial meetings. All were assessed on psychiatric symptoms, mood, depression, and coping strategies at four time periods: pre-intervention, post-intervention, 1-year follow-up, and 2-year follow-up. Alberta Healthcare billing records were obtained covering the 2-year follow-up period to determine the amount billed per person over the course of the study. RESULTS Women in the intervention group had less depression, less overall mood disturbance, better overall quality of life, and fewer psychiatric symptoms than those in the control group, beginning immediately post-intervention and remaining so at 2 years post-intervention. Billing in the intervention group was an average of $147 less than in the control group, a 23.5% reduction. CLINICAL IMPLICATIONS This is the first study to show that a psychosocial intervention can reduce direct healthcare billings in a sample of patients with cancer. Importantly, these findings help to justify the routine availability of such programs in cancer treatment facilities worldwide.
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Affiliation(s)
- J S Simpson
- Department of Psychiatry, University of Calgary, Alberta, Canada.
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Sambamoorthi U, Walkup J, Olfson M, Crystal S. Antidepressant treatment and health services utilization among HIV-infected medicaid patients diagnosed with depression. J Gen Intern Med 2000; 15:311-20. [PMID: 10840266 PMCID: PMC1495453 DOI: 10.1046/j.1525-1497.2000.06219.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the prevalence and predictors of diagnosed depression among persons with HIV on Medicaid and antidepressant treatment among those diagnosed, and to compare utilization and costs between depressed HIV-infected individuals treated with and without antidepressant medications. DESIGN Merged Medicaid and surveillance data were used to compare health services utilized by depressed individuals who were or were not treated with antidepressant medications, controlling for other characteristics. SETTING AND PARTICIPANTS The study population comprised Medicaid recipients in New Jersey who were diagnosed with HIV or AIDS by March 1996 and received Medicaid services between 1991 and 1996. MEASUREMENTS AND MAIN RESULTS Logistic regression and ordinary least squares regressions were employed. Women were more likely and African Americans were less likely to be diagnosed with depression. Women and drug users in treatment were more likely to receive antidepressant treatment. Depressed patients treated with antidepressants were more likely to receive antiretroviral treatment than those not treated with antidepressants. Monthly total expenditures were significantly lower for individuals diagnosed with depression and receiving antidepressant therapy than for those not treated with antidepressants. After controlling for socioeconomic and clinical characteristics, treatment with antidepressant medications was associated with a 24% reduction in monthly total health care costs. CONCLUSIONS Depressed HIV-infected patients treated with antidepressants were more likely than untreated subjects to receive appropriate care for their HIV disease. Antidepressant therapy for treatment of depression is associated with a significantly lower monthly cost of medical care services.
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Affiliation(s)
- U Sambamoorthi
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08901, USA.
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30
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Abstract
Research over the last 20 years in Mind-Body Medicine has made significant contributions to the treatment of rheumatic disease. This approach is based on the concept that patients have the ability to influence their experience of illness through directed modification of their thoughts, emotions, and behaviors. This article finds that Mind-Body treatment results in significant, incremental symptom relief and improvement in disability status and well-being beyond that achieved through routine medical care. There is also evidence that these interventions reduce utilization of health care services, despite continuing progression of disease, a finding that has major economic implications for health policy.
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Affiliation(s)
- J E Broderick
- Department of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook, USA
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31
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Abstract
Psychological factors influence the results of self-reports of pain, function and global severity in questionnaires such as the HAQ, SF-36 and the WOMAC. Persons with psychological distress use more resources, including medications, and have greater rates of work disability and joint surgery. Psychological status is influenced only very slightly by disease severity and tends to remain relatively constant over the course of the rheumatic disease. The psychological status of patients with differing rheumatic diseases is similar, and patients with rheumatoid arthritis do not have special psychological problems or psychological characteristics.
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