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Persin MJ, Payen A, Bateman JR, Alessi MG, Price BC, Bennett JM. Depressive Symptoms Affect Cognitive Functioning from Middle to Late Adulthood: Ethnoracial Minorities Experience Greater Repercussions. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02121-x. [PMID: 39145835 DOI: 10.1007/s40615-024-02121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/27/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
Cognitive deficits, a diagnostic criterion for depressive disorders, may precede or follow the development of depressive symptoms and major depressive disorder. However, an individual can report an increase in depressive symptoms without any change in cognitive functioning. While ethnoracial minority group differences exist, little is known to date about how the relationship between depressive symptoms and cognitive function may differ by ethnoracial minority status. Utilizing data from the Midlife in the United States (MIDUS) study waves II (M2) and III (M3), this study examines the relationship between depressive symptoms and cognitive functioning concurrently and longitudinally in community-dwelling adults, as well as whether the results differed by ethnoracial minority status. Our participants included 910 adults (43.8% male, 80.8% White, 54.4 ± 11.5 years old at M2). Cross-sectionally, depressive symptoms, ethnoracial minority status, and their interaction had significant effects on cognitive function, consistent with previous investigations. Longitudinally, higher M2 depressive symptoms predicted poorer cognitive function at M3 over and above M2 cognitive functioning, but only within the ethnoracial minority sample. Our finding suggests that depressive symptoms predict cognitive functioning both concurrently and across time, and this relationship is moderated by ethnoracial identity, resulting in greater cognitive deficits among ethnoracial minority groups compared to their non-Hispanic White counterparts.
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Affiliation(s)
- Michael J Persin
- Department of Psychological Science, UNC Charlotte, 9201 University City Blvd, 4018 Colvard, Charlotte, NC, 28223, USA
| | - Ameanté Payen
- Health Psychology PhD Program, UNC Charlotte, Charlotte, USA
| | - James R Bateman
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, USA
- Alzheimer's Disease Research Center, Wake Forest University School of Medicine, Winston-Salem, USA
| | - Maria G Alessi
- Health Psychology PhD Program, UNC Charlotte, Charlotte, USA
| | | | - Jeanette M Bennett
- Department of Psychological Science, UNC Charlotte, 9201 University City Blvd, 4018 Colvard, Charlotte, NC, 28223, USA.
- Health Psychology PhD Program, UNC Charlotte, Charlotte, USA.
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LaMotte ME, Elliott M, Mouzon DM. Revisiting the Black-White Mental Health Paradox During the Coronavirus Pandemic. J Racial Ethn Health Disparities 2023; 10:2802-2815. [PMID: 36441494 PMCID: PMC9707209 DOI: 10.1007/s40615-022-01457-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022]
Abstract
Black Americans have lower rates of depression and anxiety than Whites, despite greater exposure to stressors known to negatively impact mental health, characterized as the Black-White mental health paradox. This study revisited the paradox during the coronavirus pandemic. Drawing on stress process theory, minority stress theory, and the rejection-identification model of discrimination, in-group identity, and well-being, we analyzed original survey data from a quota sample of African American and White adults (N = 594). The survey included a range of stressors and coping resources, including those relevant to the pandemic (e.g., COVID-19 illness) and race (e.g., witnessing anti-Black police violence). Results indicate that despite African Americans' greater exposure and vulnerability to racial discrimination, the Black-White mental health paradox holds, owing in part to protective effects of African American's higher self-esteem. Directions for future exploration of the paradox are presented based on this study's findings.
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Affiliation(s)
- Megan E LaMotte
- Interdisciplinary Social Psychology Program, University of Nevada, Reno, 1664 N Virginia St, Reno, NV, 89557, USA.
| | - Marta Elliott
- Department of Sociology, University of Nevada, Reno, Reno, NV, USA
| | - Dawne M Mouzon
- Department of Sociology, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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3
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Müller F, Munagala A, Arnetz JE, Achtyes ED, Alshaarawy O, Holman HT. Racial disparities in emergency department utilization among patients with newly diagnosed depression. Gen Hosp Psychiatry 2023; 85:163-170. [PMID: 37926052 DOI: 10.1016/j.genhosppsych.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To test the hypothesis that racial and ethnic minorities have increased emergency department visit rates, despite being established with a primary care provider. METHODS In this retrospective cohort study, ED visits without hospital admission in a 12-month period among patients with a new primary care provider-issued diagnosis of depression were assessed. Electronic medical record (EMR) data was obtained from 47 family medicine clinics in a large Michigan-based healthcare system. General linear regression models with Poisson distribution were used to predict frequency of ED visits. RESULTS A total of 4159 patients were included in the analyses. In multivariable analyses, Black / African American race was associated with an additional 0.90 (95% CI 0.64, 1.16) ED visits and American Indian or Alaska Native race was associated with an additional 1.39 (95% CI 0.92, 1.87) ED visits compared to White or Caucasians (null value 0). These risks were only exceeded by patients who received a prescription for a typical antipsychotic drug agent. CONCLUSION Despite being established patients at primary care providers and having follow-up encounters, Black / African American and American Indian or Alaska Native patients with depression were considerably more likely to seek ED treatment compared to White/Caucasian patients with depression.
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Affiliation(s)
- Frank Müller
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA; Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
| | - Akhilesh Munagala
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA.
| | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Omayma Alshaarawy
- Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Harland T Holman
- Department of Family Medicine, Michigan State University, Grand Rapids, MI, USA; Corewell Health Family Medicine Residency Clinic, Grand Rapids, MI, USA.
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OUP accepted manuscript. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care 2021; 20:2325958220985665. [PMID: 33472517 PMCID: PMC7829520 DOI: 10.1177/2325958220985665] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic
stress symptoms at higher rates than their male counterparts and more often than
HIV-unaffected women. These mental health issues affect not only the well-being
and quality of life of WLWH, but have implications for HIV management and
transmission prevention. Despite these ramifications, WLWH are under-treated for
mental health concerns and they are underrepresented in the mental health
treatment literature. In this review, we illustrate the unique mental health
issues faced by WLWH such as a high prevalence of physical and sexual abuse
histories, caregiving stress, and elevated internalized stigma as well as myriad
barriers to care. We examine the feasibility and outcomes of mental health
interventions that have been tested in WLWH including cognitive behavioral
therapy, mindfulness-based interventions, and supportive counseling. Future
research is required to address individual and systemic barriers to mental
health care for WLWH.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Victoria Wee
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Yiukee Warren Ng
- Department of Psychiatry, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Linda J Koenig
- Division of HIV/AIDS Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aderonke Bamgbose Pederson
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Evelyn Tomaszewski
- Department of Social Work, College of Health and Human Services, 49340George Mason University, Fairfax, VA, USA
| | - Emily S Miller
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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Miller PK, Weller BE. Uncovering Profiles of Economic, Social, and Cultural Capital to Explore Depression Across Racial Groups. J Racial Ethn Health Disparities 2019; 6:1167-1181. [PMID: 31346966 DOI: 10.1007/s40615-019-00618-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/07/2019] [Accepted: 07/16/2019] [Indexed: 12/01/2022]
Abstract
Research exploring the association between socio-economic status (SES) and depression is limited by conceptualizations of SES and conflicting findings across racial groups. We broaden previous research by (1) reconceptualizing SES through the lens of Bourdieusian theory to identify profiles of economic, social, and cultural capital; (2) investigating whether these profiles differ for Black and white adults; and (3) exploring whether specific profiles of capital are associated with increased depression scores. This study analyzed secondary data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US individuals. A sub-population of the sample was used, which was comprised of 4339 Black and white participants from wave IV. To address the study aims, we used the new three-step approach to conducting latent class analysis. We identified five profiles of capital, the composition of which varied by race. Compared to Blacks, whites were more likely to be in the "cultural-economic capital" (14% vs. 10%), "elevated overall capital" (35% vs. 14%), and "social-economic capital" (13% vs. 10%) profiles, whereas Blacks were more likely to be in the "limited overall capital" (35% vs. 16%) and "moderate economic capital" (32% vs 22%) profiles. Profiles differed in risk for depression; the "limited overall capital" profile had the highest depression scores, whereas the "elevated overall capital" profile had the lowest depression scores. This research has the potential to reduce health disparities, by providing policy makers and researchers with information that will allow them to target populations that are most at risk for depression.
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Affiliation(s)
- Paula K Miller
- Department of Sociology and Anthropology, Ohio University, 6 President St., Bentley Annex 162, Athens, OH, 45701, USA.
| | - Bridget E Weller
- School of Social Work, Western Michigan University, 1903 W. Michigan Ave., Kalamazoo, MI, 49008, USA
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Choi SW, Ramos C, Kim K, Azim SF. The Association of Racial and Ethnic Social Networks with Mental Health Service Utilization Across Minority Groups in the USA. J Racial Ethn Health Disparities 2019; 6:836-850. [DOI: 10.1007/s40615-019-00583-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
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Pino EC, Zuo Y, Schor SH, Zatwarnicki S, Henderson DC, Borba CP, Milanovic SM, Kalesan B. Temporal trends of co-diagnosis of depression and/or anxiety among female maternal and non-maternal hospitalizations: Results from Nationwide Inpatient Sample 2004-2013. Psychiatry Res 2019; 272:42-50. [PMID: 30579180 DOI: 10.1016/j.psychres.2018.12.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 01/23/2023]
Abstract
Perinatal depression/anxiety is considered the most underdiagnosed pregnancy complication in the US and is associated with poor maternal and fetal outcomes. However, despite its prevalence, most women who present with depressive symptoms are not screened and do not receive adequate treatment. We examined the clinical co-diagnosis of depression and/or anxiety among maternal and non-maternal hospitalizations among females aged 14-49 from the Nationwide Inpatient Sample (NIS) between 2004 and 2013 (n = 83,472,775). Meta-regression was used to determine annual change and presence of temporal trends. Survey logistic regression was used to examine the association with sociodemographic factors. Rates of diagnosis of depression and/or anxiety disorders demonstrated a temporal increase from 2004-2013, and this increase was mainly driven by non-maternal hospitalizations compared to maternal. Furthermore, non-maternal hospitalizations demonstrated a greater prevalence of depression and/or anxiety diagnoses compared to maternal hospitalizations over the same time period (21•7% versus 2•8%). Among all female hospitalizations, whites were roughly twice as likely as minorities to have a diagnosis of depression and/or anxiety. These results add to the evidence suggestive of the underdiagnosed depression/anxiety present among women of reproductive age, particularly pregnant women and minorities, and underscore the critical role of obstetricians in treating both physical and mental health.
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Affiliation(s)
- Elizabeth C Pino
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA
| | - Yi Zuo
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA
| | - Shayna H Schor
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Stephanie Zatwarnicki
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - David C Henderson
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Christina Pc Borba
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Snezana M Milanovic
- Boston Medical Center, Boston University, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Bindu Kalesan
- Center for Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA, USA.
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9
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Alang SM. Mental health care among blacks in America: Confronting racism and constructing solutions. Health Serv Res 2019; 54:346-355. [PMID: 30687928 DOI: 10.1111/1475-6773.13115] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. DATA SOURCES Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling. STUDY DESIGN Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. PRINCIPAL FINDINGS Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college-educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti-racism education and community-driven practice in reducing unmet need. CONCLUSION Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self-reflection at the individual level and racial equity analysis at the organizational level are critical.
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Affiliation(s)
- Sirry M Alang
- Program in Health, Medicine, and Society, Department of Sociology and Anthropology, Lehigh University, Bethlehem, Pennsylvania
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10
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Ebong IM, Lopez MR, Kanner AM, Wallace DM. The relationship between mood disorder and insomnia depends on race in US veterans with epilepsy. Epilepsy Behav 2017; 70:80-86. [PMID: 28411520 DOI: 10.1016/j.yebeh.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/02/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE Few data exist on race, medical/psychiatric comorbidities, and insomnia symptoms in US veterans with epilepsy. Our aims were to examine 1) whether insomnia symptom prevalence was different between Black and White veterans and 2) whether predictors of insomnia symptoms varied by race. METHODS This retrospective, cross-sectional study included veterans evaluated in an epilepsy clinic over the course of 1.5years. Individuals completed standardized assessments for epilepsy and sleep complaints. Insomnia criteria were met by 1) report of difficulty with sleep initiation, maintenance, or premature awakenings accompanied by daytime impairment or 2) sedative-hypnotic use on most days of the month. Demographics, medical/psychiatric comorbidities, and medications were determined per electronic medical record review. Hierarchical multivariable logistic regression analyses were performed to determine if race, medical/mental health comorbidities, and the potential interaction of race with each comorbid condition were associated with insomnia. RESULTS Our sample consisted of 165 veterans (32% Black). The unadjusted prevalence of insomnia was not different between Black and White veterans (42% vs 39%, p=0.68). In adjusted analyses, the association between mood disorder and insomnia varied by race. Depressed White veterans had over 11-times higher predicted odds of insomnia (OR 11.4, p<0.001) than non-depressed White veterans, while depressed Black veterans had 4-times higher predicted odds of insomnia (OR 4.1, p=0.06) than non-depressed Black veterans. Although mood disorder diagnosis was associated with insomnia for both racial groups, White veterans had a stronger association between mood disorder diagnosis and insomnia than Black veterans. CONCLUSIONS The relationship between mood disorder diagnosis and insomnia was stronger for White than Black veterans with epilepsy. Future studies are needed to explore mental health symptoms and psychosocial determinants of insomnia with larger samples of minority individuals with epilepsy.
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Affiliation(s)
- Ima M Ebong
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maria R Lopez
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Andres M Kanner
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Douglas M Wallace
- Neurology Service, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States; Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States.
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Ramirez M, Wu S, Jin H, Ell K, Gross-Schulman S, Myerchin Sklaroff L, Guterman J. Automated Remote Monitoring of Depression: Acceptance Among Low-Income Patients in Diabetes Disease Management. JMIR Ment Health 2016; 3:e6. [PMID: 26810139 PMCID: PMC4736285 DOI: 10.2196/mental.4823] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/11/2015] [Accepted: 09/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Remote patient monitoring is increasingly integrated into health care delivery to expand access and increase effectiveness. Automation can add efficiency to remote monitoring, but patient acceptance of automated tools is critical for success. From 2010 to 2013, the Diabetes-Depression Care-management Adoption Trial (DCAT)-a quasi-experimental comparative effectiveness research trial aimed at accelerating the adoption of collaborative depression care in a safety-net health care system-tested a fully automated telephonic assessment (ATA) depression monitoring system serving low-income patients with diabetes. OBJECTIVE The aim of this study was to determine patient acceptance of ATA calls over time, and to identify factors predicting long-term patient acceptance of ATA calls. METHODS We conducted two analyses using data from the DCAT technology-facilitated care arm, in which for 12 months the ATA system periodically assessed depression symptoms, monitored treatment adherence, prompted self-care behaviors, and inquired about patients' needs for provider contact. Patients received assessments at 6, 12, and 18 months using Likert-scale measures of willingness to use ATA calls, preferred mode of reach, perceived ease of use, usefulness, nonintrusiveness, privacy/security, and long-term usefulness. For the first analysis (patient acceptance over time), we computed descriptive statistics of these measures. In the second analysis (predictive factors), we collapsed patients into two groups: those reporting "high" versus "low" willingness to use ATA calls. To compare them, we used independent t tests for continuous variables and Pearson chi-square tests for categorical variables. Next, we jointly entered independent factors found to be significantly associated with 18-month willingness to use ATA calls at the univariate level into a logistic regression model with backward selection to identify predictive factors. We performed a final logistic regression model with the identified significant predictive factors and reported the odds ratio estimates and 95% confidence intervals. RESULTS At 6 and 12 months, respectively, 89.6% (69/77) and 63.7% (49/77) of patients "agreed" or "strongly agreed" that they would be willing to use ATA calls in the future. At 18 months, 51.0% (64/125) of patients perceived ATA calls as useful and 59.7% (46/77) were willing to use the technology. Moreover, in the first 6 months, most patients reported that ATA calls felt private/secure (75.9%, 82/108) and were easy to use (86.2%, 94/109), useful (65.1%, 71/109), and nonintrusive (87.2%, 95/109). Perceived usefulness, however, decreased to 54.1% (59/109) in the second 6 months of the trial. Factors predicting willingness to use ATA calls at the 18-month follow-up were perceived privacy/security and long-term perceived usefulness of ATA calls. No patient characteristics were significant predictors of long-term acceptance. CONCLUSIONS In the short term, patients are generally accepting of ATA calls for depression monitoring, with ATA call design and the care management intervention being primary factors influencing patient acceptance. Acceptance over the long term requires that the system be perceived as private/secure, and that it be constantly useful for patients' needs of awareness of feelings, self-care reminders, and connectivity with health care providers. TRIAL REGISTRATION ClinicalTrials.gov NCT01781013; https://clinicaltrials.gov/ct2/show/NCT01781013 (Archived by WebCite at http://www.webcitation.org/6e7NGku56).
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Affiliation(s)
- Magaly Ramirez
- Daniel J Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, United States
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Nitzan U, Bekerman T, Becker G, Lichtenberg P, Lev-Ran S, Walter G, Maoz H, Bloch Y. Physician perception regarding side-effect profile at the onset of antidepressant treatment: a survey of Israeli psychiatrists and primary care physicians. Ann Gen Psychiatry 2016; 15:5. [PMID: 26834821 PMCID: PMC4731968 DOI: 10.1186/s12991-016-0090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to the onset of treatment. METHODS A cross-sectional questionnaire survey was conducted among PC physicians (N = 123) and psychiatrists (N = 105). Questionnaires were distributed using a mixed-modality design, combining a web survey and in-person delivery of questionnaires. RESULTS A significant percentage of our respondents reported that they rarely discuss psychological (60 %) or severe (29 %) SEs of SSRIs. Nearly half (41 %) admitted to avoiding discussion of impact on suicidal ideation. Specialists were noted to discuss and evaluate SEs significantly more than residents, and Psychiatrists more than PC physicians. Specifically, psychiatrists more often discussed the possibility of sexual dysfunction (t (225) = 2.23; p < 0.05) and suicidal ideation (t (225) = 2.11; p < 0.05). CONCLUSIONS It seems that PC physicians and psychiatrists surveyed in this study do not share sufficient information regarding the SEs of SSRIs with their patients at the onset of treatment. In improving this practice, the integration of proper SE management into educational interventions has potential in enhancing compliance and improving expertise and level of care.
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Affiliation(s)
- Uri Nitzan
- Shalvata Mental Health Care Center, 13 Aliyat Hanoar St, 45100 Hod-Hasharon, Israel ; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Tal Bekerman
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Gideon Becker
- Shalvata Mental Health Care Center, 13 Aliyat Hanoar St, 45100 Hod-Hasharon, Israel
| | - Pesach Lichtenberg
- Herzog Hospital, Givat Shaul, Jerusalem, Israel ; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Shaul Lev-Ran
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel ; Addiction Medicine Services, Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Tel Aviv, Israel
| | - Garry Walter
- Discipline of Psychiatry, University of Sydney, Sydney, NSW Australia ; Northern Sydney Local Health District, Sydney, Australia
| | - Hagai Maoz
- Shalvata Mental Health Care Center, 13 Aliyat Hanoar St, 45100 Hod-Hasharon, Israel ; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Yuval Bloch
- Shalvata Mental Health Care Center, 13 Aliyat Hanoar St, 45100 Hod-Hasharon, Israel ; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Shao Z, Richie WD, Bailey RK. Racial and Ethnic Disparity in Major Depressive Disorder. J Racial Ethn Health Disparities 2015; 3:692-705. [DOI: 10.1007/s40615-015-0188-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 12/15/2022]
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Neumiller JJ, Sclar DA, Robison LM, Setter SM, Skaer TL. Prevalence of depression and use of antidepressant pharmacotherapy among ambulatory patients with diabetes mellitus in the United States. Curr Ther Res Clin Exp 2014; 70:472-6. [PMID: 24692839 DOI: 10.1016/j.curtheres.2009.12.001] [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] [Accepted: 08/12/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Persons with diabetes mellitus (DM) exhibit a higher rate of depressive illness than does the general US population. Despite this finding, previous research has documented a low rate of diagnosis and/or treatment with antidepressant pharmacotherapy among persons with DM. OBJECTIVE The aim of this study was to examine the current rate of diagnosis of depression and use of antidepressant pharmacotherapy among persons with DM. RESULTS We examined data from the 2005 US National Ambulatory Medical Care Survey. In 2005, there were an estimated 35,345,845 persons with an office-based visit for DM and, of these, 3,823,508 (10.8%) had a concomitant diagnosis of depression. Within this subset, 1,830,620 (47.9%) were prescribed antidepressant pharmacotherapy. CONCLUSION Our findings serve to quantify the prevalence of a diagnosis of depression and use of antidepressant pharmacotherapy for its treatment among persons with DM in the United States.
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington
| | - David A Sclar
- Department of Pharmacotherapy, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington
| | - Linda M Robison
- Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington
| | - Stephen M Setter
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, Washington
| | - Tracy L Skaer
- Department of Pharmacotherapy, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Pullman, Washington
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15
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Abstract
The purpose of this review is to look at racial/ethnic disparities in the diagnosis of depression and its treatment and to explain the dynamics and causes of these racial/ethnic disparities in depression by looking at several theories, such as perceived racism, cultural competency, and other theories. Perceived racism is that the perceptions of an environmental stimulus as being racist affects the coping responses of ethnic/racial minorities, which alters psychological and physiological stress responses, and finally affects health outcomes negatively. A lower level of cultural competence can lead to health disparities. In addition, lower socioeconomic status and health care providers' beliefs and behaviors about patients' race/ethnicity and class can affect depressive symptoms as well as diagnosis and treatment. In order to reduce these racial/ethnic disparities in depression, diverse interventions should be developed to improve depression outcomes for ethnic minority populations based on these theoretical perspectives.
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Affiliation(s)
- Minjeong Kim
- School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, USA,
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Sadoughi A, Roberts KE, Preston IR, Lai GP, McCollister DH, Farber HW, Hill NS. Use of selective serotonin reuptake inhibitors and outcomes in pulmonary arterial hypertension. Chest 2014; 144:531-541. [PMID: 23558791 DOI: 10.1378/chest.12-2081] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) have been suggested to offer therapeutic benefit in patients with pulmonary arterial hypertension (PAH). We conducted two analyses to explore the association between SSRI use and PAH outcomes using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry). METHODS First, new users (SSRI-naive patients who initiated treatment after enrollment, incident use analysis, n = 220) were matched (1:2) with non-SSRI users (nonusers, n = 440) by enrollment center, sex, date of most recent visit, age, and 6-min walk distance. Second, a cross-sectional design was used to compare nonusers (n = 2,463), high-affinity SSRI users (n = 430), and non-high-affinity SSRI users (n = 125) at enrollment. Mortality and a composite end point defined by events indicative of clinical worsening were evaluated. RESULTS New users had a higher risk of death (unadjusted hazard ratio [HR], 1.74; 95% CI, 1.19-2.54; P = .004) and were less likely to be free from the composite end point 2 years after enrollment vs nonusers (25.7% vs 43.2%, respectively; P < .001). Similarly, among prevalent SSRI users (patients with a history of SSRI use at enrollment), high-affinity SSRI users were less likely to be free from the composite end point vs nonusers (unadjusted HR, 1.20; 95% CI, 1.07-1.36; P = .003). In both analyses, differences in outcome were maintained after adjustment for clinical variables previously associated with PAH outcomes. CONCLUSIONS In a large population of patients with PAH, incident SSRI use was associated with increased mortality and a greater risk of clinical worsening, although we could not adjust for all potential confounders.
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Affiliation(s)
- Ali Sadoughi
- Department of Medicine, Hofstra-North Shore LIJ School of Medicine, New Hyde Park, NY
| | - Kari E Roberts
- Department of Medicine, Tufts Medical Center, Boston, MA
| | | | - Ginny P Lai
- ICON Late Phase & Outcomes Research, San Francisco, CA
| | | | - Harrison W Farber
- Department of Medicine, Boston University School of Medicine, Boston, MA
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17
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Abstract
This article explored the origins and implications of the underdiagnosis of affective disorders in African-Americans. MEDLINE and old collections were searched using relevant key words. Reference lists from the articles that were gathered from this procedure were reviewed. The historical record indicated that the psychiatric perception of African-Americans with affective disorders changed significantly during the last 200 years. In the antebellum period, the mental disorders of slaves mostly went unnoticed. By the early 20th century, African-Americans were reported to have high rates of manic-depressive disorder compared with whites. By the mid-century, rates of manic-depressive disorder in African-Americans plummeted, whereas depression remained virtually nonexistent. In recent decades, diagnosed depression and bipolar disorder, whether in clinical or research settings, were inexplicably low in African-Americans compared with whites. Given these findings, American psychiatry needs to appraise the deep-seated effects of historical stereotypes on the diagnosis and treatment of African-Americans.
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18
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Sclar DA, Robison LM, Schmidt JM, Bowen KA, Castillo LV, Oganov AM. Diagnosis of depression and use of antidepressant pharmacotherapy among adults in the United States: does a disparity persist by ethnicity/race? Clin Drug Investig 2012; 32:139-44. [PMID: 22220929 DOI: 10.2165/11598950-000000000-00000] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND AND OBJECTIVE Both the rate of diagnosis of depression in the US and the rate of prescribing an antidepressant for its treatment have increased substantially over the past two decades. Previous research has also indicated that the rates of diagnosis and treatment of depression with an antidepressant vary widely by ethnicity/race. The objective of this study was to discern ethnic/race-specific (non-Hispanic Black; Hispanic; non-Hispanic White) population-adjusted rates of US office-based physician-patient encounters (office-based visits) documenting a diagnosis of depression, and the extent of the use of antidepressant pharmacotherapy for its treatment. METHODS Data from the US National Ambulatory Medical Care Survey (NAMCS) for the years 1992-1997 and 2003-2008 were utilized for this analysis. The years 1998-2002 were excluded due to the magnitude of missing data for the variable ethnicity. The US NAMCS is a national probability sample designed and conducted by the US National Center for Health Statistics of the US Centers for Disease Control and Prevention. Depression was defined via International Classification of Diseases, 9th Revision, Clinical Modification codes 296.2-296.36; 300.4; 311. Antidepressants were defined as US National Drug Code category 0630 prior to 2005, and category 249 in Lexicon Plus® thereafter. Data were partitioned into six 2-year time intervals for trend analysis of population-adjusted rates (per 100) among patients aged 20-79 years. Rates per 2-year time interval are based on US Census Bureau national resident population estimates for the ethnicity/race categories examined. Comparisons within and across time-frames were assessed by chi-squared (χ2) analysis. The a priori level of significance for all statistical tests was set at p < 0.05. Analyses were performed using SAS Release 9.1.3. RESULTS Over the 12-year time-frame examined, the rate of office-based visits documenting a diagnosis of depression increased 28.4% for non-Hispanic Whites (from 10.9 to 14.0 per 100; p < 0.001), 54.8% for non-Hispanic Blacks (from 4.2 to 6.5 per 100; p < 0.001), and 37.5% for Hispanics (from 4.8 to 6.6 per 100; p < 0.001). The rate of office-based visits with a recorded diagnosis of depression in concert with the prescribing of an antidepressant increased 66.2% for non-Hispanic Whites (from 6.5 to 10.8 per 100; p < 0.001), 69.2% for non-Hispanic Blacks (from 2.6 to 4.4 per 100; p < 0.001), and 36.7% for Hispanics (from 3.0 to 4.1 per 100; p < 0.001). CONCLUSION By 2003-2004, the population-adjusted rates for non-Hispanic Blacks and Hispanics were similar, and remained so through 2007-2008. However, over the 12-year time-frame examined, the rates for both minority groups were, in each 2-year interval, far less than that observed in non-Hispanic Whites. Disparities remain by ethnicity/race in the diagnosis and treatment of depression in the US.
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Affiliation(s)
- David A Sclar
- Pharmacoeconomics and Pharmacoepidemiology Research Unit, Washington State University, Spokane, WA, USA.
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19
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Sclar DA, Robison LM, Castillo LV, Bowen KA, Schmidt JM, Oganov AM. Attention Deficit/Hyperactivity Disorder among Adults in the United States. Pharmaceut Med 2012. [DOI: 10.1007/bf03256898] [Citation(s) in RCA: 5] [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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20
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Wu CH, Erickson SR, Piette JD, Balkrishnan R. Mental health resource utilization and health care costs associated with race and comorbid anxiety among Medicaid enrollees with major depressive disorder. J Natl Med Assoc 2012; 104:78-88. [PMID: 22708251 DOI: 10.1016/s0027-9684(15)30121-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to assess the association among race, comorbid anxiety, and mental health resource utilization among Medicaid enrollees with major depressive disorder (MDD). METHODS A retrospective cross-sectional study design was used to identify adult patients with MDD newly initiating an antidepressant between January 1, 2004, and December 31, 2006, from the MarketScan Multi-State Medicaid Database. Measures of mental health resource utilization included mental health-related office visits, hospitalizations, emergency department visits, and health care costs. The associations of mental health resource utilization with race and comorbid anxiety were examined respectively using multivariable logistic regression, negative binominal regression, and log-transformed linear regression models. RESULTS A total of 3083 Medicaid enrollees with MDD were included. Approximately 25% of patients had comorbid anxiety. Caucasians were more likely to have comorbid anxiety than African Americans (30.2% vs 16.4%, p < .01). After controlling for covariates, comorbid anxiety was significantly associated with more frequent mental health resource utilization. African Americans were significantly less likely than Caucasians to have mental health-related office visits (OR, 0.54; 95% CI, 0.45-0.66) but more likely to be hospitalized (OR, 2.57; 95% CI, 1.84-3.60) and to have emergency department visits (OR, 1.52; 95% CI, 1.05-2.19). CONCLUSIONS Comorbid anxiety was positively associated with mental health resource utilization among Medicaid enrollees with MDD. Health disparities in health care utilization between African Americans and Caucasians still exist.
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Affiliation(s)
- Chung-Hsuen Wu
- Human/HCA/UNC Pharmaceutical Outcomes, Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA.
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21
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Sclar DA, Robison LM, Bowen KA, Schmidt JM, Castillo LV, Oganov AM. Attention-deficit/hyperactivity disorder among children and adolescents in the United States: trend in diagnosis and use of pharmacotherapy by gender. Clin Pediatr (Phila) 2012; 51:584-9. [PMID: 22399571 DOI: 10.1177/0009922812439621] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Sclar
- Pharmacoeconomics and Pharmacoepidemiology Research Unit, Department of Health Policy and Administration, College of Pharmacy, Washington State University, Spokane,WA 99210-1495, USA.
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22
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Trends in health-related quality of life and health service use associated with comorbid diabetes and major depression in South Australia, 1998-2008. Soc Psychiatry Psychiatr Epidemiol 2012; 47:871-7. [PMID: 21590369 DOI: 10.1007/s00127-011-0394-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 05/05/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the trends in health-related quality of life and health service use associated with diabetes and/or major depression in South Australia from 1998 to 2008. METHODS Data analyzed were from 9,059 persons aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004 and 2008. Major depression was determined using the mood module of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Diagnosed diabetes and health service use were determined by self-report. Health-related quality of life was assessed using the 36-item Short-Form Health Survey (SF-36) and the 15-item Assessment of Quality of Life (AQoL) instruments. Socio-demographics (including mental health literacy), arthritis, asthma, osteoporosis, and obesity covariates were determined by self-report. Weighted age-standardized and multiple covariate-adjusted means of dependent measures were computed. RESULTS The prevalence of diabetes only, major depression only, and comorbid diabetes and major depression increased by 3.0 (74%), 2.6 (36%), and 0.4 (53%) percentage points, respectively, from 1998 to 2008. Mean health-related quality of life scores were 9 to 41% lower (worse), and health service use was 49% higher for persons with comorbid diabetes and major depression than for those with diabetes only (all P values <0.05) independent of all covariates, consistently over the 10-year period. CONCLUSIONS If past trends continue, our results suggest that the increased population health and economic burden of comorbid diabetes and major depression could persist over the next decade or so. These trends have important implications for making health policy and resource allocation decisions.
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Stewart SM, Simmons A, Habibpour E. Treatment of culturally diverse children and adolescents with depression. J Child Adolesc Psychopharmacol 2012; 22:72-9. [PMID: 22251021 DOI: 10.1089/cap.2011.0051] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. Some aspects of culture that are likely to influence service utilization include health beliefs, particularly regarding models of mental illness, and level of stigma toward mental health treatment, which are frequently shared by individuals in a cultural group. However, some caveats for the explanatory potential of "culture" should be kept in mind. Conventions for naming groups vary between investigators and over time (e.g., the restriction of the category "White" into "White NonHispanic," is quite recent). Although heterogeneity is assumed within a named cultural or racial group, the terms Hispanic, Asian, and African-American incorporate subgroups can be very different in linguistic, historical, and geographical ancestry (e.g., Stewart 2008 ), and each group incorporates individuals who may not share any components of their historical heritage. Even among those with historical ties, values, beliefs, and social behaviors can vary according to the extent to which they identify with the mainstream culture. Social class frequently creates a "culture" of its own, with individuals in the same social class across traditional cultural groupings sharing disparities in care, and many beliefs and values. Individuals are likely to belong to numerous "cultures," and may not share specific typical behaviors or beliefs with any of them.
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Affiliation(s)
- Sunita M Stewart
- Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-8589, USA.
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Akincigil A, Olfson M, Siegel M, Zurlo KA, Walkup JT, Crystal S. Racial and ethnic disparities in depression care in community-dwelling elderly in the United States. Am J Public Health 2012; 102:319-28. [PMID: 22390446 PMCID: PMC3483986 DOI: 10.2105/ajph.2011.300349] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 01/19/2023]
Abstract
OBJECTIVES We investigated racial/ethnic disparities in the diagnosis and treatment of depression among community-dwelling elderly. METHODS We performed a secondary analysis of Medicare Current Beneficiary Survey data (n = 33,708) for 2001 through 2005. We estimated logistic regression models to assess the association of race/ethnicity with the probability of being diagnosed and treated for depression with either antidepressant medication or psychotherapy. RESULTS Depression diagnosis rates were 6.4% for non-Hispanic Whites, 4.2% for African Americans, 7.2% for Hispanics, and 3.8% for others. After we adjusted for a range of covariates including a 2-item depression screener, we found that African Americans were significantly less likely to receive a depression diagnosis from a health care provider (adjusted odds ratio [AOR] = 0.53; 95% confidence interval [CI] = 0.41, 0.69) than were non-Hispanic Whites; those diagnosed were less likely to be treated for depression (AOR = 0.45; 95% CI = 0.30, 0.66). CONCLUSIONS Among elderly Medicare beneficiaries, significant racial/ethnic differences exist in the diagnosis and treatment of depression. Vigorous clinical and public health initiatives are needed to address this persisting disparity in care.
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Affiliation(s)
- Ayse Akincigil
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
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25
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Sclar DA, Robison LM, Castillo LV, Schmidt JM, Bowen KA, Oganov AM, Skaer TL, Kogut SJ. Concomitant use of triptan, and SSRI or SNRI after the US Food and Drug Administration alert on serotonin syndrome. Headache 2012; 52:198-203. [PMID: 22289074 DOI: 10.1111/j.1526-4610.2011.02067.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study was designed to discern the prevalence of concomitant use of a 5-hydroxytryptamine receptor agonist (triptan), and a selective serotonin reuptake inhibitor (SSRI) or a selective serotonin/norepinephrine reuptake inhibitor (SNRI) after the US Food and Drug Administration issued an alert regarding serotonin syndrome in 2006 and to contrast findings with data published prior to the federal warning. BACKGROUND In July 2006, the US Food and Drug Administration warned patients and health-care professionals to be aware that use of a triptan in combination with an SSRI or SNRI may result in a potentially life-threatening problem known as serotonin syndrome. In 2010, the American Headache Society published a position paper noting that there existed conflicting and insufficient information to discern the risk of serotonin syndrome with the use of triptan, and SSRI or SNRI, and that said Class IV data were not to be used as the basis for limiting the prescribing of triptan with SSRI or SNRI (Level U). Clinicians were cautioned as to the seriousness of serotonin toxicity and that monitoring was warranted. METHODS We used weighted data from the US National Ambulatory Medical Care Survey for years 2007 and 2008 to derive national estimates of the number of office-based physician-patient encounters (visits), documenting the concomitant use of triptan, and SSRI or SNRI. Results are compared with previously published findings for the years 2003 and 2004. RESULTS During the time-frame 2007-2008, an annualized mean of 5,256,958 patients were prescribed a triptan (vs 3,874,367 in 2003-2004, a 35.7% increase), and 68,603,600 patients were prescribed an SSRI or SNRI (vs 50,402,149 in 2003-2004, a 36.1% increase). An annualized mean of 1,319,763 patients were simultaneously prescribed or continued use of triptan, along with SSRI or SNRI (vs 694,276 in 2003-2004, a 90.1% increase). CONCLUSION Our study documents that 1.8% (1,319,763/73,860,558) of patients in 2007-2008 were prescribed triptan, and SSRI or SNRI (vs 1.3% in 2003-04, an increase of 38.5%). While this is a small fraction overall, the actual number of patients on a nationwide basis is substantial. What remains missing from the literature is documentation as to the number of cases of serotonin syndrome and resulting consequences (clinical and economic) because of the concomitant use of triptan, and SSRI or SNRI in the time-frame 2007-2008. Absent in these data, it remains difficult to assess the risk benefit associated with the use of triptan, and SSRI or SNRI.
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Affiliation(s)
- David A Sclar
- Pharmacoeconomics and Pharmacoepidemiology Research Unit, College of Pharmacy, Washington State University, Spokane, WA 99210-1495, USA.
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Weissman J, Meyers BS, Ghosh S, Bruce ML. Sociodemographic and clinical factors associated with antidepressant type in a national sample of the home health care elderly. Gen Hosp Psychiatry 2011; 33:587-93. [PMID: 21920609 PMCID: PMC3208729 DOI: 10.1016/j.genhosppsych.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/18/2011] [Accepted: 07/26/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study examined in home health care (HHC) the demographic, functional and clinical factors by antidepressant (AD) type including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs) and "Other" ADs such as bupropion and mirtazapine. METHOD Cross-sectional sample (N=909) was analyzed from the 2007 National Home Health and Hospice Care Survey that included patients 65 years and older [mean=78.79 years, confidence interval (CI)=77.88-79.69 years] taking one AD. RESULTS Selective serotonin reuptake inhibitors were the most commonly used (63.89%) AD, followed by "Other" ADs (14.29%), TCAs (11.31%) and SNRIs. In a multinomial regression referencing SSRIs, blacks had increased odds of tricyclic use compared to whites [odds ratio (OR)=5.96, CI=1.85-19.19]. Hispanics had decreased odds of "Other" AD (OR=0.13, CI=0.02-0.73) and SNRI use (OR=0.06, CI=0.008-0.45) compared to non-Hispanics. The HHC elderly taking psychotropic medications besides ADs were less likely to use SNRIs (OR=0.31, CI=0.11-0.88) and tricyclics (OR=0.27, CI=0.08-0.87). Advancing age was marginally associated with tricyclic use (OR=1.04, CI=0.99-1.09). CONCLUSION Race/ethnicity and age differences by AD type - including blacks' increased TCA use, Hispanics' decreased SNRI and "Other" AD use, and older elderly's increased tricyclic use - suggest systematic differences in prescribing practice variations including differences by geography, patient preferences or access to care in the HHC elderly.
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Affiliation(s)
- Judith Weissman
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10601, USA.
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Fleming M, Barner JC, Brown CM, Smith T. Treatment disparities for major depressive disorder: Implications for pharmacists. J Am Pharm Assoc (2003) 2011; 51:605-12. [PMID: 21896458 DOI: 10.1331/japha.2011.10125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether differences exist in overall antidepressant use and specific antidepressant drug class (selective serotonin reuptake inhibitor [SSRI]/ serotonin norepinephrine reuptake inhibitor [SNRI] versus other) use among patients of different race/ethnicity groups (blacks and Hispanics compared with whites) with a diagnosis of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) 12-month major depressive disorder (MDD) and to discuss ways in which pharmacists can decrease the gap in treatment disparities. DESIGN Cross-sectional study. SETTING United States from February 2001 through April 2003. PARTICIPANTS Respondents of the National Comorbidity Survey-Replication with DSM-IV 12-month MDD. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Previous 12-month overall antidepressant use and previous 12-month specific antidepressant drug class (SSRI/SNRI versus other) use. RESULTS For respondents who screened positive for 12-month MDD (n = 362.3), only 34% reported antidepressant use in the previous 12-month period. Blacks (17.5%) and Hispanics (21.8%) reported significantly (P < 0.0001) lower overall use of antidepressants in the unadjusted analysis compared with whites (37.6%). Although not statistically significant, odds ratios (ORs) indicated that blacks and Hispanics were 61% and 47% less likely to report use of antidepressants (OR = 0.39 [95% CI 0.20-0.77], P = 0.10, and 0.53 [0.31-0.91], P = 0.61, respectively). CONCLUSION Among respondents with a diagnosis of MDD, race/ethnicity plays an important role in the use of antidepressants. The results of this study indicate a need for pharmacists to proactively interact and manage their patients' antidepressant therapy.
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Affiliation(s)
- Marc Fleming
- College of Pharmacy, University of Texas at Austin, USA
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Blumenthal JA. New frontiers in cardiovascular behavioral medicine: comparative effectiveness of exercise and medication in treating depression. Cleve Clin J Med 2011; 78 Suppl 1:S35-43. [PMID: 21972328 PMCID: PMC3749736 DOI: 10.3949/ccjm.78.s1.06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Exercise, considered a mainstay of cardiac rehabilitation, has been shown to reduce cardiac risk factors such as hyperlipidemia and hypertension. Growing evidence also suggests that exercise has beneficial effects on mental health, which is relevant for cardiac patients because of the prognostic significance of depression in patients with coronary heart disease (CHD). Depression has been associated with increased mortality and nonfatal cardiac events in patients with CHD; it is also associated with worse outcomes in patients who undergo coronary artery bypass graft surgery and those who have heart failure. The standard therapy for depression is pharmacologic treatment, often with second-generation antidepressants such as selective serotonin reuptake inhibitors. Despite their widespread use, antidepressants have only modest effects on depression for many patients compared with placebo controls. Exercise therapy, already an established component of cardiac rehabilitation, has potential efficacy as a treatment for depression in cardiac disease patients. Randomized controlled trials are needed to determine the clinical effects of exercise in this population and to compare the effects of exercise with those of antidepressants.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Chen SY, Hansen RA, Gaynes BN, Farley JF, Morrissey JP, Maciejewski ML. Guideline-concordant antidepressant use among patients with major depressive disorder. Gen Hosp Psychiatry 2010; 32:360-7. [PMID: 20633739 DOI: 10.1016/j.genhosppsych.2010.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/12/2010] [Accepted: 03/15/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine whether prescriber specialty and guideline-concordant follow-up visits were associated with antidepressant treatment completion among patients with major depressive disorder (MDD). METHODS This study analyzed medical and prescription claims from a large national health plan. Patients were grouped based on initial prescriber specialty. Receipt of guideline-concordant follow-ups was defined as having > or =3 visits during the treatment phase. Completion of acute phase (first 90 days) and continuation phase (Days 91-270) was defined by adherence > or = 80% without significant gaps in treatment. Logistic regressions were used to examine factors associated with treatment completion. RESULTS Forty-seven percent of the 4102 newly diagnosed patients completed the acute phase, 45% of whom also completed the continuation phase. Among those initially prescribed by primary care providers (PCPs), patients with guideline-concordant follow-ups were more likely (13.1 percentage points, P<.0001) to complete acute phase than patients without guideline-concordant follow-ups. Receipt of guideline-concordant follow-ups increased the probability of acute phase completion by an additional 6.8 percentage points if initially treated by psychiatrists. Patients prescribed by psychiatrists were less likely to complete acute phase treatment (-4.6 percentage points, P=.04) if they did not have guideline-concordant follow-ups. CONCLUSION A large gap remains between guideline recommendations and actual antidepressant treatment. Frequent follow-up corresponds with better antidepressant adherence.
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Affiliation(s)
- Shih-Yin Chen
- Abt Bio-Pharma Solutions, Inc., Lexington, MA 02421, USA.
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Wells TS, LeardMann CA, Fortuna SO, Smith B, Smith TC, Ryan MAK, Boyko EJ, Blazer D. A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. Am J Public Health 2010; 100:90-9. [PMID: 19910353 DOI: 10.2105/ajph.2008.155432] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We investigated relations between deployment and new-onset depression among US service members recently deployed to the wars in Iraq and Afghanistan. METHODS We included 40 219 Millennium Cohort Study participants who completed baseline and follow-up questionnaires and met inclusion criteria. Participants were identified with depression if they met the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire criteria for depression at follow-up, but not at baseline. RESULTS Deployed men and women with combat exposures had the highest onset of depression, followed by those not deployed and those deployed without combat exposures. Combat-deployed men and women were at increased risk for new-onset depression compared with nondeployed men and women (men: adjusted odds ratio [AOR]=1.32; 95% confidence interval [CI]=1.13, 1.54; women: AOR=2.13; 95% CI=1.70, 2.65). Conversely, deployment without combat exposures led to decreased risk for new-onset depression compared with those who did not deploy (men: AOR=0.66; 95% CI=0.53, 0.83; women: AOR=0.65; 95% CI=0.47, 0.89). CONCLUSIONS Deployment with combat exposures is a risk factor for new-onset depression among US service members. Post-deployment screening may be beneficial for US service members exposed to combat.
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Affiliation(s)
- Timothy S Wells
- US Air Force Research Laboratory, 711th HPW/RHPA, Building 824 Room 206, 2800 Q St, Wright-Patterson AFB, OH 45433-7947, USA.
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Patient motivation for participating in clinical trials for depression: validation of the motivation for clinical trials inventory-depression. Int Clin Psychopharmacol 2010; 25:7-16. [PMID: 19901843 DOI: 10.1097/yic.0b013e328332055c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The motivation for clinical trials inventory-depression (MCTI-D) was developed and evaluated for assessing motivations to participate in clinical trials on depression. Sixty-four participants completed the MCTI-D: 40 individuals expressing interest in participating in a randomized clinical trial (RCT); and 24 clinic patients receiving traditional care for depression. Content validity was supported by feedback derived from a panel of experts in depression research and respondents completing the measure. The motivation most frequently endorsed for participating in an RCT was the desire to help others and/or to further science. The potential stigma associated with seeing a psychiatrist was reported to have the least influence. Patients expressed a greater likelihood to participate in RCTs that involved psychotherapy than in experimental medication or placebo-controlled trials. Data from the MCTI-D may provide useful information for depression researchers to consider as possible influences on patients' decisions about whether or not they will participate.
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Davis RN, Caldwell CH, Clark SJ, Davis MM. Depressive symptoms in nonresident african american fathers and involvement with their sons. Pediatrics 2009; 124:1611-8. [PMID: 19948630 DOI: 10.1542/peds.2009-0718] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our objective was to determine whether paternal depressive symptoms were associated with less father involvement among African American fathers not living with their children (ie, nonresident fathers). METHODS We analyzed survey data for 345 fathers enrolled in a program for nonresident African American fathers and their preteen sons. Father involvement included measures of contact, closeness, monitoring, communication, and conflict. We used bivariate analyses and multivariate logistic regression analysis to examine associations between father involvement and depressive symptoms. RESULTS Thirty-six percent of fathers reported moderate depressive symptoms, and 11% reported severe depressive symptoms. In bivariate analyses, depressive symptoms were associated with less contact, less closeness, low monitoring, and increased conflict. In multivariate analyses controlling for basic demographic features, fathers with moderate depressive symptoms were more likely to have less contact (adjusted odds ratio: 1.7 [95% confidence interval: 1.1-2.8]), less closeness (adjusted odds ratio: 2.1 [95% confidence interval: 1.3-3.5]), low monitoring (adjusted odds ratio: 2.7 [95% confidence interval: 1.4-5.2]), and high conflict (adjusted odds ratio: 2.1 [95% confidence interval: 1.2-3.6]). Fathers with severe depressive symptoms also were more likely to have less contact (adjusted odds ratio: 3.1 [95% confidence interval: 1.4-7.2]), less closeness (adjusted odds ratio: 2.6 [95% confidence interval: 1.2-5.7]), low monitoring (adjusted odds ratio: 2.8 [95% confidence interval: 1.1-7.1]), and high conflict (adjusted odds ratio: 2.6 [95% confidence interval: 1.1-5.9]). CONCLUSION Paternal depressive symptoms may be an important, but modifiable, barrier for nonresident African American fathers willing to be more involved with their children.
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Affiliation(s)
- R Neal Davis
- Child Health and Evaluation Research Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, School ofMedicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Blumenthal JA, Waldman S, Babyak MA, Sherwood A, Watkins LL, Sketch M. TREATING DEPRESSION IN PATIENTS WITH HEART DISEASE: Is the Glass Half Empty or Half Full? Am Heart J 2009; 157:e35-e37. [PMID: 20706603 DOI: 10.1016/j.ahj.2009.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wu CH, Erickson SR, Kennedy J. Patient characteristics associated with the use of antidepressants among people diagnosed with DSM-IV mood disorders: results from the National Comorbidity Survey Replication. Curr Med Res Opin 2009; 25:471-82. [PMID: 19192992 DOI: 10.1185/03007990802646642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression is one of the most common mental illnesses in the United States. However, research on antidepressant usage patterns in a large nationally representative sample is limited. OBJECTIVES The aims of this study were (1) to examine factors associated with the use of antidepressants in patients with DSM-IV mood disorders, and (2) to determine reasons for inadequate and non-persistent medication taking behaviors. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted using the National Comorbidity Survey Replication (NCS-R) dataset in the U.S. People within the dataset with DSM-IV mood disorders were qualified as the sample population (n = 1798). Selected factors based on the Andersen's Behavioral Model of Health Services Use were assessed among antidepressant users (n = 473) and nonusers (n = 1322). The logistic regression analysis was used to examine the association between the dependent variable, the use of antidepressants, and the independent variables, predisposing, enabling and need factors. Descriptive statistics were used to determine reasons of inadequate and non-persistent medication taking behaviors. RESULTS Antidepressant use was more prevalent in patients who were middle age (30-59) (p < 0.01), non-Hispanic white (p < 0.001), unemployed (p < 0.001), living in the South (p < 0.01), having a regular source of care (p < 0.001), and having high severity of emotional distress (p < 0.001). About 41% of patients reported that they forgot to take or took less medication in the study period. Reasons for stopping medication included: "The medication was not helping" (30.8%), followed by "Side effects" (13.8%) and "Couldn't afford to pay for the medicine" (13.0%). LIMITATIONS A small sample size in racial/ethnic minority groups; a small sample size in the reasons of stopping taking medications due to the missing values in consecutive questions. CONCLUSIONS The factors associated with use of antidepressants and reasons of inadequate and non-persistent medication taking behaviors in patients with mood disorders are many and varied. Health care providers need to understand these factors as they work with their patients to improve the likelihood of patients' successfully to complete their course of treatment.
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Affiliation(s)
- Chung-Hsuen Wu
- Department of Clinical, Social and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109-1065, USA.
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ELL KATHLEEN, KATON WAYNE, CABASSA LEOPOLDOJ, XIE BIN, LEE PEYJIUAN, KAPETANOVIC SUAD, GUTERMAN JEFFRY. Depression and diabetes among low-income Hispanics: design elements of a socioculturally adapted collaborative care model randomized controlled trial. Int J Psychiatry Med 2009; 39:113-32. [PMID: 19860071 PMCID: PMC3387981 DOI: 10.2190/pm.39.2.a] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This article describes design elements of the Multifaceted Depression and Diabetes Program (MDDP) randomized clinical trial. The MDDP trial hypothesizes that a socioculturally adapted collaborative care depression management intervention will reduce depressive symptoms and improve patient adherence to diabetes self-care regimens, glycemic control, and quality-of-life. In addition, baseline data of 387 low-income, 96% Hispanic, enrolled patients with major depression and diabetes are examined to identify study population characteristics consistent with trial design adaptations. METHODS The PHQ-9 depression scale was used to identify patients meeting criteria for major depressive disorder (1 cardinal depression symptom + a PHQ-9 score of > or = 10) from two community safety net clinics. Design elements included sociocultural adaptations in recruitment and efforts to reduce attrition and collaborative depression care management. RESULTS Of 1,803 diabetes patients screened, 30.2% met criteria for major depressive disorder. Of 387 patients enrolled in the clinical trial, 98% had Type 2 diabetes, and 83% had glycated hemoglobin (HbA1c) levels > or = 7%. Study recruitment rates and baseline data analyses identified socioeconomic and clinical factors that support trial design and intervention adaptations. Depression severity was significantly associated with diabetes complications, medical comorbidity, greater anxiety, dysthymia, financial worries, social stress, and poorer quality-of-life. CONCLUSION Low-income Hispanic patients with diabetes experience high prevalence of depressive disorder and depression severity is associated with socioeconomic stressors and clinical severity. Improving depression care management among Hispanic patients in public sector clinics should include intervention components that address self-care of diabetes and socioeconomic stressors.
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Affiliation(s)
| | | | | | - BIN XIE
- University of Southern California, Los Angeles
| | | | | | - JEFFRY GUTERMAN
- University of Southern California, Los Angeles, and Los Angeles County Department of Health Services
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Skaer TL, Sclar DA, Robison LM. Trends in prescriptions for antidepressant pharmacotherapy among US children and adolescents diagnosed with depression, 1990 through 2001: An assessment of accordance with treatment recommendations from the American Academy of Child and Adolescent Psychiatry. Clin Ther 2009; 31 Pt 1:1478-87. [DOI: 10.1016/j.clinthera.2009.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2009] [Indexed: 11/25/2022]
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