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Ahmed NN, Reagu S, Alkhoori S, Cherchali A, Purushottamahanti P, Siddiqui U. Improving Mental Health Outcomes in Patients with Major Depressive Disorder in the Gulf States: A Review of the Role of Electronic Enablers in Monitoring Residual Symptoms. J Multidiscip Healthc 2024; 17:3341-3354. [PMID: 39010931 PMCID: PMC11247372 DOI: 10.2147/jmdh.s475078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/27/2024] [Indexed: 07/17/2024] Open
Abstract
Up to 75% of individuals with major depressive disorder (MDD) may have residual symptoms such as amotivation or anhedonia, which prevent full functional recovery and are associated with relapse. Globally and in the Gulf region, primary care physicians (PCPs) have an important role in alleviating stigma and in identifying and monitoring the residual symptoms of depression, as PCPs are the preliminary interface between patients and specialists in the collaborative care model. Therefore, mental healthcare upskilling programmes for PCPs are needed, as are basic instruments to evaluate residual symptoms swiftly and accurately in primary care. Currently, few if any electronic enablers have been designed to specifically monitor residual symptoms in patients with MDD. The objectives of this review are to highlight how accurate evaluation of residual symptoms with an easy-to-use electronic enabler in primary care may improve functional recovery and overall mental health outcomes, and how such an enabler may guide pharmacotherapy selection and positively impact the patient journey. Here, we show the potential advantages of electronic enablers in primary care, which include the possibility for a deeper "dive" into the patient journey and facilitation of treatment optimisation. At the policy and practice levels, electronic enablers endorsed by government agencies and local psychiatric associations may receive greater PCP attention and backing, improve patient involvement in shared clinical decision-making, and help to reduce the general stigma around mental health disorders. In the Gulf region, an easy-to-use electronic enabler in primary care, incorporating aspects of the Hamilton Depression Rating Scale to monitor amotivation, and aspects of the Montgomery-Åsberg Depression Rating Scale to monitor anhedonia, could markedly improve the patient journey from residual symptoms through to full functional recovery in individuals with MDD.
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Affiliation(s)
- Nahida Nayaz Ahmed
- SEHA Mental Health & Wellbeing Services, College of Medicine and Health Sciences of the United Arab Emirates University, Abu Dhabi, United Arab Emirates
| | - Shuja Reagu
- Weill Cornell Medicine, Doha, Qatar; Hamad Medical Corporation, Doha, Qatar
| | - Samia Alkhoori
- Rashid Hospital, Dubai Health, Dubai, United Arab Emirates
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Talebi M, Niroumand S, Gholami M, Samarghandi A, Shaygani F, Radfar M, Nemati A. Epidemiological aspects of individuals with mental disorders in the referral system: the experience of a Community Mental Health Center in the northeast of Iran. DISCOVER MENTAL HEALTH 2024; 4:22. [PMID: 38904905 PMCID: PMC11192706 DOI: 10.1007/s44192-024-00078-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Community Mental Health Centers (CMHCs) offer affordable mental health services in a less stigmatized environment, in a domiciliary setting. This study aimed to shed light on the epidemiological factors of patients attending CMHCs of Mashhad, their referral status, and treatment. METHODS This study was conducted over the medical records of patients seen by psychiatrists between January 2014 and December 2021 in Mashhad's CMHC, the northeast of Iran. A detailed questionnaire was used to extract data from medical records about the epidemiological characteristics, diagnosed mental illnesses, referral status, and how often they visited the psychiatrist. The association between epidemiological findings and patient referral (referral system or self-referral) as well as the association between epidemiological findings and the number of psychiatric revisits were examined using the Chi-square test. RESULTS Out of 662 patients, 472 (71%) were female and 190 (29%) were male, with an average age of 29 years. Among the 475 adult patients, 367 (77.3%) were married, with the majority being homemakers (56.4%). Major Depression Disorder (MDD) (32%) and Generalized Anxiety Disorder (GAD) (18.3%) were the most prevalent mental health conditions among patients. The majority of patients (74.9%) were referred to the CMHC of Mashhad from Primary Healthcare centers (PHCs) and psychiatric hospitals. Furthermore, female gender and patients with lower level of education were associated with more referral through from referral system. Of note, 431 patients (65.1%) did not return for a second visit, the ratio of treatment dropout was higher for patients with lower education levels. CONCLUSIONS Referral system should be more practical in Iran to enhance health services in CMHCs. It is recommended that PHCs undergo certain modifications to enhance the referral process for patients with mental health conditions, focusing on common mental disorders and individuals with low socioeconomic level.
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Affiliation(s)
- Mahdi Talebi
- Department of Community and Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Niroumand
- Department of Community and Family Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mobin Gholami
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azadeh Samarghandi
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Fatemeh Shaygani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Radfar
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Nemati
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Deane AE, Elmore JS, Mayes TL, Robinson S, AlZubi Y, Wakefield SM, Trivedi MH. Shifting From Best Practice to Standard Practice: Implementing Measurement-Based Care in Health Systems. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01715-0. [PMID: 38896285 DOI: 10.1007/s10578-024-01715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.
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Affiliation(s)
- Amber E Deane
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Skylar Robinson
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Yasmin AlZubi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9119, USA.
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Aldis R, Rosenfeld LC, Mulvaney-Day N, Lanca M, Zona K, Lam JA, Asfour J, Meltzer JC, Leff HS, Fulwiler C, Wang P, Progovac AM. Determinants of remote measurement-based care uptake in a safety net outpatient psychiatry department as part of learning health system transition. Learn Health Syst 2024; 8:e10416. [PMID: 38883875 PMCID: PMC11176570 DOI: 10.1002/lrh2.10416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Behavioral measurement-based care (MBC) can improve patient outcomes and has also been advanced as a critical learning health system (LHS) tool for identifying and mitigating potential disparities in mental health treatment. However, little is known about the uptake of remote behavioral MBC in safety net settings, or possible disparities occurring in remote MBC implementation. Methods This study uses electronic health record data to study variation in completion rates at the clinic and patient level of a remote MBC symptom measure tool during the first 6 months of implementation at three adult outpatient psychiatry clinics in a safety net health system. Provider-reported barriers to MBC adoption were also measured using repeated surveys at one of the three sites. Results Out of 1219 patients who were sent an MBC measure request, uptake of completing at least one measure varied by clinic: General Adult Clinic, 38% (n = 262 of 696); Substance Use Clinic, 28% (n = 73 of 265); and Transitions Clinic, 17% (n = 44 of 258). Compared with White patients, Black and Portuguese or Brazilian patients had lower uptake. Older patients also had lower uptake. Spanish language of care was associated with much lower uptake at the patient level. Significant patient-level disparities in uptake persisted after adjusting for the clinic, mental health diagnoses, and number of measure requests sent. Providers cited time within visits and bandwidth in their workflow as the greatest consistent barriers to discussing MBC results with patients. Conclusions There are significant disparities in MBC uptake at the patient and clinic level. From an LHS data infrastructure perspective, safety net health systems may need to address the need for possible ways to adapt MBC to better fit their populations and clinical needs, or identify targeted implementation strategies to close data gaps for the identified disparity populations.
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Affiliation(s)
- Rajendra Aldis
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Lisa C Rosenfeld
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Norah Mulvaney-Day
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Margaret Lanca
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Kate Zona
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Jeffrey A Lam
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Julia Asfour
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - Jonah C Meltzer
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Public Health and Community Medicine Tufts University School of Medicine Boston Massachusetts USA
| | - H Stephen Leff
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Carl Fulwiler
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Philip Wang
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
| | - Ana M Progovac
- Cambridge Health Alliance Department of Psychiatry Cambridge Massachusetts USA
- Harvard Medical School Department of Psychiatry Boston Massachusetts USA
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Weisenburger RL, Mullarkey MC, Labrada J, Labrousse D, Yang MY, MacPherson AH, Hsu KJ, Ugail H, Shumake J, Beevers CG. Conversational assessment using artificial intelligence is as clinically useful as depression scales and preferred by users. J Affect Disord 2024; 351:489-498. [PMID: 38290584 DOI: 10.1016/j.jad.2024.01.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Depression is prevalent, chronic, and burdensome. Due to limited screening access, depression often remains undiagnosed. Artificial intelligence (AI) models based on spoken responses to interview questions may offer an effective, efficient alternative to other screening methods. OBJECTIVE The primary aim was to use a demographically diverse sample to validate an AI model, previously trained on human-administered interviews, on novel bot-administered interviews, and to check for algorithmic biases related to age, sex, race, and ethnicity. METHODS Using the Aiberry app, adults recruited via social media (N = 393) completed a brief bot-administered interview and a depression self-report form. An AI model was used to predict form scores based on interview responses alone. For all meaningful discrepancies between model inference and form score, clinicians performed a masked review to determine which one they preferred. RESULTS There was strong concurrent validity between the model predictions and raw self-report scores (r = 0.73, MAE = 3.3). 90 % of AI predictions either agreed with self-report or with clinical expert opinion when AI contradicted self-report. There was no differential model performance across age, sex, race, or ethnicity. LIMITATIONS Limitations include access restrictions (English-speaking ability and access to smartphone or computer with broadband internet) and potential self-selection of participants more favorably predisposed toward AI technology. CONCLUSION The Aiberry model made accurate predictions of depression severity based on remotely collected spoken responses to a bot-administered interview. This study shows promising results for the use of AI as a mental health screening tool on par with self-report measures.
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Affiliation(s)
- Rachel L Weisenburger
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America.
| | | | | | - Daniel Labrousse
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Michelle Y Yang
- Department of Psychiatry, Georgetown University Medical Center, United States of America
| | - Allison Huff MacPherson
- Department of Family and Community Medicine, College of Medicine, University of Arizona, United States of America
| | - Kean J Hsu
- Department of Psychiatry, Georgetown University Medical Center, United States of America; Department of Psychology, National University of Singapore, Singapore
| | - Hassan Ugail
- Centre for Visual Computing, University of Bradford, United Kingdom of Great Britain and Northern Ireland
| | | | - Christopher G Beevers
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, United States of America
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Ayvaci ER, Minhajuddin A, Elmore JS, Yagnik K, Jha MK, Emslie GJ, Mayes TL, Trivedi MH. Treatment of Adolescent Depression: Comparison of Psychiatric and Pediatric Settings at an Academic Medical Center Using the VitalSign 6 Application. J Child Adolesc Psychopharmacol 2024; 34:80-88. [PMID: 38252552 DOI: 10.1089/cap.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: Similar outcomes and remission rates have been found for the treatment of depression in adults in primary and psychiatric care settings. However, comparatively little is known about how pediatric depression is managed across different settings. This study aims to address this gap by comparing depression treatment in pediatric and psychiatric settings. We hypothesized that pediatric care settings would be more likely to treat individuals with lower depression severity and would select pharmacotherapy less frequently as a treatment option. Methods: Patients (n = 3498) were screened for depression at a children's hospital from May 2017 to May 2022 as part of the VitalSign6 project, a web-based application for depression management. The two-item patient health questionnaire (PHQ) was used for screening, and the data set contains patient-reported measures and provider-reported diagnoses and treatment selections at each clinic visit. Patients with nine-item PHQ (PHQ-9) scores ≥10 at baseline were included in the analysis to compare diagnosis and treatment recommendations between pediatric and psychiatric settings. Results: Among the 1323 patients who screened positive for depression, those in psychiatric settings had higher PHQ-9 scores (15.9 ± 5.0 vs. 12.1 ± 5.5; p < 0.0001). Patients with PHQ-9 ≥ 10 in psychiatric settings were more likely to be diagnosed with major depressive disorder (60.6% vs. 24.7%, p < 0.0001) and receive pharmacotherapy (54.8% vs. 6.6%) than those in pediatric settings. Pediatric setting patients were more likely to receive nonpharmacological treatment alone (36.3% vs. 4.3%) or an outside referral (27.7% vs. 5.7%). Remission rates did not significantly differ between the two settings. Conclusions: Youth in psychiatric settings are more likely to screen positive for depression and to have greater depression severity than those in pediatric settings. Both settings provide treatment recommendations for moderate-to-severe depression, but treatment types vary substantially. Yet, remission rates remain similar. Further research is needed to understand the nuances of treatment differences and their implications.
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Affiliation(s)
- Emine Rabia Ayvaci
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joshua S Elmore
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kush Yagnik
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K Jha
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Taryn L Mayes
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
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Mitchell TB, Wakefield SM, Rezaeizadeh A, Minhajuddin A, Pipes R, Mayes TL, Elmore JS, Trivedi MH. Integration of Measurement-Based Care for Youth Depression and Suicidality Using VitalSign 6. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01680-8. [PMID: 38372870 DOI: 10.1007/s10578-024-01680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
Depression and suicidality are prevalent in youth and are associated with a range of negative outcomes. The current study aimed to evaluate a measurement-based care (MBC) software (VitalSign6) tool to improve the screening and treatment of depression and suicidality in youth aged 8-17 years within a rural, underserved population. To assess for depression and suicidality, the Patient Health Questionnaire-2 was administered as an initial screen, and the Patient Health Questionnaire-9 Modified for Adolescents (PHQ-9-A) was administered if the initial screen was positive. Data were collected at medical clinics over one year, and descriptive statistics and t-tests or Wilcoxon-Mann-Whitney tests were conducted. A total of 1,984 youth were initially screened (mean age of 13 years; 51.6% female); 24.2% screened positive for depression, and 14.9% endorsed suicidality. Of those who screened positive, the mean PHQ-9-A score was 12.8; 66.9% had PHQ-9-A scores in the moderate to severe range, and 44.2% endorsed suicidality. Almost half of the youth who screened positive for depression had at least one follow-up assessment, and about one quarter achieved remission 4 months after initial screening. Adolescents (12-17 years) had higher PHQ-9-A scores, higher suicidality, and more follow-up assessments than younger youth (8-11 years). Younger youth had higher rates of remission. The widespread use of MBC was feasible in this setting. It is important to utilize MBC to identify and treat youth with depression and suicidality and to do so in younger populations to improve their trajectory over time; VitalSign6 is one tool to help achieve these goals.
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Affiliation(s)
- Tarrah B Mitchell
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Afsaneh Rezaeizadeh
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ronny Pipes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joshua S Elmore
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Parker CP, McMahan K, Rhodes B, Lokken K, Jain G. A Novel Nephropsychology Clinic: Partnering With Patients in the Era of Value-Based Care in Nephrology. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:46-51. [PMID: 38403393 DOI: 10.1053/j.akdh.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
CKD and end-stage kidney disease are highly prevalent and complex chronic conditions with a high disease burden that corresponds to a high cost of care. Mental health conditions have a high prevalence in this population and add to the burden of disease, increase the cost of care, and are co-related with worse clinical outcomes. Despite these clear co-relations, mental health disorders remain underdiagnosed and undertreated in this population, secondary to multiple reasons, including patient-specific factors as well as systematic issues, including difficulty in accessing mental health experts. Here we describe a novel collaborative care model for patients with advanced CKD within the nephrology clinic space, in the form of a nephropsychology clinic. We present the details of our clinic, our preliminary findings, and propose that an integrated behavioral health model offers convenience for the patient and improves workflow for the physician, allowing a pathway to timely mental health interventions.
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Affiliation(s)
- Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristina McMahan
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brody Rhodes
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristine Lokken
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gaurav Jain
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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Miller A, Skoranski AK, Prior B, Fitzpatrick R, Morgan C, Hepschmidt P, Smith BA, Cella M, Brown McGlotten D, Pitt K, Polomano RC. An "Engage to Sustain" Intervention to Improve Process Performance Measures in Ambulatory Care. J Ambul Care Manage 2023; 46:284-297. [PMID: 37540113 DOI: 10.1097/jac.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, "Engage to Sustain," for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use screening and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. These results suggest that shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs may improve screening rates.
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Affiliation(s)
- Angela Miller
- Penn Medicine Clinical Practices of the University of Pennsylvania, Philadelphia (Drs Miller and Fitzpatrick and Mss Prior and Pitt); Penn Medicine Medical Group, Penn Primary Care & Penn Specialty Practices, Philadelphia, Pennsylvania (Mr Skoranski); Corporate Information Services (Dr Brown McGlotten), Penn Medicine, Philadelphia, Pennsylvania (Mss Morgan and Hepschmidt); Hospital of the University of Pennsylvania, Philadelphia (Ms Smith); Primary Care and Penn Specialty Practices, Bala Cynwyd, Pennsylvania (Mr Cella); and University of Pennsylvania School of Nursing, Philadelphia (Dr Polomano)
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Bezerra HDS, Barbosa IR. Poor access to health services for depression treatment in Brazil. Rev Saude Publica 2023; 57:49. [PMID: 37585948 PMCID: PMC10392771 DOI: 10.11606/s1518-8787.2023057004654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/26/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To analyze the factors associated with poor access to health services for the depression treatment in Brazil. METHODS This study used data from the Brazilian National Survey of Health, conducted in the years 2019 and 2020. The sample consisted of 8,332 individuals with a self-reported diagnosis of depression, and poor access to healthcare was identified from the question "what is the main reason for you to not visit the physician/health service regularly for your depression?" From which poor access was identified by the affirmative answer reporting distance of health services or difficulties with transportation; waiting time at the health service; financial difficulties; opening hours of the health service; Not being able to schedule a consultation via health insurance; does not know who to look for or where to go, among others. Sociodemographic aspects and health conditions were analyzed. Bivariate and multivariate analysis was performed using Poisson Regression. RESULTS The prevalence of poor access to health services for depression treatment was 14.9% (95%CI: 13.6-16.2), relating to individuals aged 15-29 years (PR = 1.52) and 30-59 years old (PR = 1.22), without education (PR = 1.43), who rate their health as regular/poor/very poor (PR = 1.26), who have some limitation in their usual activities (PR = 2.71), who had the last consultation within 6 months of less than 2 years (PR = 2.63) and for more than 2 years (PR = 2.25) and who do not undergo psychotherapy (PR = 4.28). CONCLUSION Poor access to health services for depression treatment was associated with individual factors and health conditions.
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Affiliation(s)
- Héllyda de Souza Bezerra
- Universidade Federal do Rio Grande do NortePrograma de Pós-Graduação em Saúde ColetivaNatalRNBrazilUniversidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brazil.
| | - Isabelle Ribeiro Barbosa
- Universidade Federal do Rio Grande do NorteFaculdade de Ciências da Saúde do TrairiSanta CruzRNBrazil Universidade Federal do Rio Grande do Norte. Faculdade de Ciências da Saúde do Trairi. Santa Cruz, RN, Brazil
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Little V, Gatanaga OS, Hutchins S, Gloria CT. Prevalence of suicide risk among a national sample of individuals referred from a primary care subpopulation, 2017-2020. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad029. [PMID: 38756240 PMCID: PMC10986202 DOI: 10.1093/haschl/qxad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/02/2023] [Accepted: 07/20/2023] [Indexed: 05/18/2024]
Abstract
Over the past decade, the age-adjusted suicide rate has increased by 35.2% in the United States. In primary care, practitioners often interact with patients at risk of dying by suicide, yet little is known about the prevalence of suicide risk in primary care populations. Patient data from 2017-2020, consisting of a national sample of patients referred from primary care and enrolled in collaborative care behavioral health services (n = 37 666), were analyzed. Controlling for demographic characteristics, logistic models were used to compare suicide risk prevalence by behavioral health diagnosis. An estimated 9.96% (95% confidence interval [CI]: 9.65-10.27)-or approximately 3751 individuals-of the total sample screened positively for suicide risk. Compared with individuals diagnosed with generalized anxiety disorder, individuals diagnosed with bipolar disorder had 8.21 times the odds (95% CI: 6.66-10.10) of screening for suicide risk. Practitioners and health care systems may benefit from adding suicide risk screeners as a standard practice for referred patients, which may lead to further development of clinical pathways and provider training. The high rate of suicide risk across the sample suggests that more research is needed to understand suicide risk prevalence across primary care and collaborative care populations.
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Affiliation(s)
- Virna Little
- Concert Health, San Diego, CA 92101, United States
| | - Ohshue S Gatanaga
- Concert Health, San Diego, CA 92101, United States
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY 10032, United States
| | | | - Christian T Gloria
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY 10032, United States
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12
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Staab EM, Franco MI, Zhu M, Wan W, Gibbons RD, Vinci LM, Beckman N, Yohanna D, Laiteerapong N. Population Health Management Approach to Depression Symptom Monitoring in Primary Care via Patient Portal: A Randomized Controlled Trial. Am J Med Qual 2023; 38:188-195. [PMID: 37314235 DOI: 10.1097/jmq.0000000000000126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Depression is undertreated in primary care. Using patient portals to administer regular symptom assessments could facilitate more timely care. At an urban academic medical center outpatient clinic, patients with active portal accounts and depression on their problem list or a positive screen in the past year were randomized to assessment during triage at visits (usual care) versus usual care plus assessment via portal (population health care). Portal invitations were sent regardless of whether patients had scheduled appointments. More patients completed assessments in the population health care arm than usual care: 59% versus 18%, P < 0.001. Depression symptoms were more common among patients who completed their initial assessment via the portal versus in the clinic. In the population health care arm, 57% (N = 80/140) of patients with moderate-to-severe symptoms completed at least 1 follow-up assessment versus 37% (N = 13/35) in usual care. A portal-based population health approach could improve depression monitoring in primary care.
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Affiliation(s)
- Erin M Staab
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL
| | - Wen Wan
- Department of Medicine, University of Chicago, Chicago, IL
| | - Robert D Gibbons
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Lisa M Vinci
- Department of Medicine, University of Chicago, Chicago, IL
| | - Nancy Beckman
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | - Daniel Yohanna
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
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13
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Antony A, Parida SP, Behera P, Padhy SK. Geriatric depression: prevalence and its associated factors in rural Odisha. Front Public Health 2023; 11:1180446. [PMID: 37397716 PMCID: PMC10311027 DOI: 10.3389/fpubh.2023.1180446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/28/2023] [Indexed: 07/04/2023] Open
Abstract
The world's population is aging rapidly, and the epidemiological transition has led to increased mental disorders worldwide. Geriatric depression is masked by multiple comorbidities or the natural process of aging. Our study aims to estimate the prevalence of geriatric depression and find the risk factors associated with geriatric depression in rural Odisha. The study was a multistage cross-sectional study conducted in the Tangi block, district Khordha, Odisha, from August 2020 to September 2022, among 520 participants selected by probability proportional to size sampling. From the selected participants, eligible 479 older adults were interviewed using a semi-structured interview schedule, Hindi Mini Mental Scale, Geriatric Depression Scale-15, and Hamilton Depression Rating Scale. The step forward multivariable logistic regression was used to assess the associated factors of depression among older adults. Among our participants, 44.4% (213) of older adults were depressed. Substance abuse in family members [AOR: 16.7 (9.1-30.9)], history of elder abuse [AOR: 3.7 (2.1-6.7)], physical dependency [AOR: 2.2 (1.3-3.6)], and financial dependency [AOR: 2.2 (1.3-3.6)] are significant independent risk factors associated with geriatric depression. Living with children [AOR: 0.33 (0.18-0.59)] and recreational activity [AOR: 0.54 (0.34-0.85)] are significant protective factors of geriatric depression. Our study found that geriatric depression is highly prevalent in rural Odisha. Poor quality of family life and physical and financial dependency was found to be the most significant risk factor for geriatric depression.
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Affiliation(s)
- Annu Antony
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Swayam Pragyan Parida
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Priyamadhaba Behera
- Department of Community Medicine and Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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14
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Méndez-López F, Oliván-Blázquez B, Domínguez-García M, Bartolomé-Moreno C, Rabanaque I, Magallón-Botaya R. Protocol for an observational cohort study on psychological, addictive, lifestyle behavior and highly prevalent affective disorders in primary health care adults. Front Psychiatry 2023; 14:1121389. [PMID: 37363179 PMCID: PMC10288582 DOI: 10.3389/fpsyt.2023.1121389] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Background Depression and anxious symptoms are prevalent in the general population, and their onset and persistence may be linked to biological and psychosocial factors, many of which are lifestyle-related. The way we manage our care, physical and emotional health and/or discomfort is highly influenced by our own abilities, skills and attitudes despite life's circumstances. The main aim of this protocol to analyze the relationship between psychological constructs (self-efficacy, activation, health literacy, resilience, personality traits, sense of coherence, self-esteem), and the presence of affective-emotional problems (anxiety, depression) and addictions in primary health care. Methods This is a protocol of a prospective longitudinal cohort study including people of 35-74 years old of Aragon primary health care centers (Spain). Three evaluations will be conducted: baseline evaluation, and follow-up assessments five and ten years after recruitment. The primary outcomes will be severity of depression, severity of anxiety, and addictive behaviors. A detailed set of secondary outcomes will be assessed across all three assessments. This will include psychosocial or personal factors on health behavior, social support, lifestyle patterns, quality of life, the use of health and social resources, and chronic comorbid pathology. Discussion The analysis of the impact of psychological constructs and lifestyles on the mental health of people and communities will provide evidence that will make it possible to better address and prevent these prevalent problems and address their improvement from a more global and holistic perspective. The evaluation of psychological constructs should be incorporated into health services to improve people's ability their self-care, the level of knowledge of managing their disease and their physical, mental and social health. Clinical trial registration https://www.isrctn.com/, identifier ISRCTN12820058.
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Affiliation(s)
- Fátima Méndez-López
- Aragonese Primary Care Research Group, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Aragonese Primary Care Research Group, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Marta Domínguez-García
- Aragonese Primary Care Research Group, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
| | - Cruz Bartolomé-Moreno
- Aragonese Primary Care Research Group, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Aragonese Healthcare Service (SALUD), Zaragoza, Spain
- Department of Family and Community Care Teaching - Sector I, Aragonese Healthcare Service, Zaragoza, Spain
| | - Isabel Rabanaque
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Aragonese Primary Care Research Group, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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15
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DiGiovanni SS, Hoffmann Frances RJ, Brown RS, Wilkinson BT, Coates GE, Faherty LJ, Craig AK, Andrews ER, Gabrielson SMB. Pediatric Trauma and Posttraumatic Symptom Screening at Well-child Visits. Pediatr Qual Saf 2023; 8:e640. [PMID: 37250613 PMCID: PMC10219716 DOI: 10.1097/pq9.0000000000000640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 02/15/2023] [Indexed: 05/31/2023] Open
Abstract
Adverse childhood experiences (ACEs), including abuse or neglect, parental substance abuse, mental illness, or separation, are public health crises that require identification and response. We aimed to increase annual rates of trauma screening during well-child visits from 0% to 70%, post-traumatic stress disorder (PTSD) symptom screening for children with identified trauma from 0% to 30%, and connection to behavioral health for children with symptoms from 0% to 60%. Methods Our interdisciplinary behavioral and medical health team implemented 3 plan-do-study-act cycles to improve screening and response to pediatric traumatic experiences. Automated reports and chart reviews measured progress toward goals as we changed screening methods and provider training. Results During plan-do-study-act cycle 1, a chart review of patients with positive trauma screenings identified various trauma types. During cycle 2, a comparison of screening methods demonstrated that written screening identified trauma among more children than verbal screening (8.3% versus 1.7%). During cycle 3, practices completed trauma screenings at 25,287 (89.8%) well-child visits. Among screenings, 2,441 (9.7%) identified trauma. The abbreviated Post Traumatic Stress Disorder Reaction Index was conducted at 907 (37.2%) encounters and identified 520 children (57.3%) with PTSD symptoms. Among a sample of 250, 26.4% were referred to behavioral health, 43.2% were already connected, and 30.4% had no connection. Conclusions It is feasible to screen and respond to trauma during well-child visits. Screening method and training implementation changes can improve screening and response to pediatric trauma and PTSD. Further work is needed to increase rates of PTSD symptomology screening and connection to behavioral health.
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Affiliation(s)
- Stephen S. DiGiovanni
- From the Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Portland, Maine
| | | | | | | | | | - Laura J. Faherty
- From the Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Portland, Maine
- RAND Corporation, Boston, Massachusetts
| | - Alexa K. Craig
- From the Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Portland, Maine
| | - Elizabeth R. Andrews
- From the Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Portland, Maine
| | - Sarah M. B. Gabrielson
- From the Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Portland, Maine
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16
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Vanderkruik R, Freeman MP, Nonacs R, Jellinek M, Gaw ML, Clifford CA, Bartels S, Cohen LS. To screen or not to screen: Are we asking the right question? In response to considering de-implementation of universal perinatal depression screening. Gen Hosp Psychiatry 2023; 83:81-85. [PMID: 37141774 DOI: 10.1016/j.genhosppsych.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
This Editorial is a response to the Canadian Task Force on Preventive Health Care's recent recommendation "against instrument-based depression screening using a questionnaire with cut-off score to distinguish 'screen positive' and 'screen negative' administered to all individuals during pregnancy and the postpartum period (up to 1 year after childbirth)." While we acknowledge the gaps and limitations in research on perinatal mental health screening, we have concerns regarding the potential impact of a recommendation against screening and for "de-implementation" of existing perinatal depression screening practices, particularly if there is not careful attention to the specificity as well as limitations of the recommendation, or if there are not clear alternative systems put in place to support the detection of perinatal depression. In this manuscript, we highlight some of our key concerns and suggest considerations for perinatal mental health practitioners and researchers.
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Affiliation(s)
- Rachel Vanderkruik
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA.
| | - Marlene P Freeman
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | - Ruta Nonacs
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
| | | | - Margaret L Gaw
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Charlotte A Clifford
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America
| | - Stephen Bartels
- Harvard Medical School, Boston, MA, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lee S Cohen
- Massachusetts General Hospital, Ammon Pinizzotto Center for Women's Mental Health, Boston, MA, United States of America; Harvard Medical School, Boston, MA, USA
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17
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Parish AL, Gillis B, Anthamatten A. Pharmacotherapy for Depression and Anxiety in the Primary Care Setting. J Nurse Pract 2023; 19:104556. [PMID: 36855373 PMCID: PMC9951804 DOI: 10.1016/j.nurpra.2023.104556] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The prevalence of mental health disorders is rising with the coronavirus of 2019 pandemic, and millions of Americans reside in areas with mental health professional shortages. Primary care providers have an opportunity to provide care for commonly occurring mental health disorders. Using a holistic conceptualization of recovery in mental illness, this report provides evidence-based guidance for initiation, titration, and discontinuation of pharmacotherapy for mild to moderate depression and anxiety in the primary care setting. The use of measurement-based care, selection of appropriate class and agent for individual candidates, and patient education are addressed. Best practices for troubleshooting, titration, and referral are discussed.
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18
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Reist C, Petiwala I, Latimer J, Raffaelli SB, Chiang M, Eisenberg D, Campbell S. Collaborative mental health care: A narrative review. Medicine (Baltimore) 2022; 101:e32554. [PMID: 36595989 PMCID: PMC9803502 DOI: 10.1097/md.0000000000032554] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The Collaborative Care model is a systematic strategy for treating behavioral health conditions in primary care through the integration of care managers and psychiatric consultants. Several randomized controlled trials have demonstrated that Collaborative Care increases access to mental health care and is more effective and cost efficient than the current standard of care for treating common mental illnesses. Large healthcare systems and organizations have begun to adopt Collaborative Care initiatives and are seeing improved treatment outcomes and provider and patient satisfaction. This review discusses current research on the effectiveness and cost-efficiency of Collaborative Care. In addition, this paper discusses its ability to adapt to specific patient populations, such as geriatrics, students, substance use, and women with perinatal depression, as well as the significance of measurement-based care and mental health screening in achieving improved clinical outcomes. Current data suggests that Collaborative Care may significantly improve patient outcomes and time-to-treatment in all reviewed settings, and successfully adapts to special patient populations. Despite the high upfront implementation burden of launching a Collaborative Care model program, these costs are generally offset by long term healthcare savings.
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Affiliation(s)
- Christopher Reist
- University of California, Irvine, Irvine, CA
- Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | | | | | | | - Maurice Chiang
- Carbon Health Technologies, Inc, Oakland, CA
- * Correspondence: Maurice Chiang, Carbon Health Technologies, Inc. 2100 Franklin Street, Suite 355, Oakland CA 94612 (e-mail: )
| | | | - Scott Campbell
- Department of Psychiatry & Behavioral Neurosciences, Cedars-Sinai Medical Care Foundation, Los Angeles, CA
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19
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Jones G, Drake C, Lewis CF. Explanations Underlying the Lack of Utility of Diagnostic Depression Scales in Black Americans. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20221206-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Staab EM, Wan W, Campbell A, Gedeon S, Schaefer C, Quinn MT, Laiteerapong N. Elements of Integrated Behavioral Health Associated with Primary Care Provider Confidence in Managing Depression at Community Health Centers. J Gen Intern Med 2022; 37:2931-2940. [PMID: 34981360 PMCID: PMC9485335 DOI: 10.1007/s11606-021-07294-3] [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: 04/05/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Depression is most often treated by primary care providers (PCPs), but low self-efficacy in caring for depression may impede adequate management. We aimed to identify which elements of integrated behavioral health (BH) were associated with greater confidence among PCPs in identifying and managing depression. DESIGN Mailed cross-sectional surveys in 2016. PARTICIPANTS BH leaders and PCPs caring for adult patients at community health centers (CHCs) in 10 midwestern states. MAIN MEASURES Survey items asked about depression screening, systems to support care, availability and integration of BH, and PCP attitudes and experiences. PCPs rated their confidence in diagnosing, assessing severity, providing counseling, and prescribing medication for depression on a 5-point scale. An overall confidence score was calculated (range 4 (low) to 20 (high)). Multilevel linear mixed models were used to identify factors associated with confidence. KEY RESULTS Response rates were 60% (N=77/128) and 52% (N=538/1039) for BH leaders and PCPs, respectively. Mean overall confidence score was 15.25±2.36. Confidence was higher among PCPs who were satisfied with the accuracy of depression screening (0.38, p=0.01), worked at CHCs with depression tracking systems (0.48, p=0.045), had access to patients' BH treatment plans (1.59, p=0.002), and cared for more patients with depression (0.29, p=0.003). PCPs who reported their CHC had a sufficient number of psychiatrists were more confident diagnosing depression (0.20, p=0.02) and assessing severity (0.24, p=0.03). Confidence in prescribing was lower at CHCs with more patients living below poverty (-0.66, p<0.001). Confidence in diagnosing was lower at CHCs with more Black/African American patients (-0.20, p=0.03). CONCLUSIONS PCPs who had access to BH treatment plans, a system for tracking patients with depression, screening protocols, and a sufficient number of psychiatrists were more confident identifying and managing depression. Efforts are needed to address disparities and support PCPs caring for vulnerable patients with depression.
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Affiliation(s)
| | - Wen Wan
- University of Chicago, Chicago, IL, USA
| | | | - Stacey Gedeon
- Mid-Michigan Community Health Services, Houghton Lake, MI, USA
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21
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Sedeeq ST, AlTamimi MJM, Hamed E, Syed MA. Diagnostic accuracy of the Patient Health Questionnaire 2 (PHQ-2) in Qatar's primary care settings. Prim Health Care Res Dev 2022; 23:e5. [PMID: 35094724 PMCID: PMC8822324 DOI: 10.1017/s146342362100089x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/23/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
This cross-sectional study was designed to establish diagnostic accuracy of the Patient Health Questionnaire 2 in Qatar's primary care population. The data required for the study were anonymously extracted from Qatar's primary care electronic medical record system. The sensitivity, specificity, predictive values, negative values and optimal cut-off points were calculated for the tool. A total of 6921 individuals met the study's inclusion criteria. The diagnostic accuracy of cut-off values was calculated for scores 1-6. Based on the Youden's index (0.58), a score of 2 was identified as the most optimal cut-off. It offers a sensitivity of 88.73% and specificity of 69.31%. Further studies should aim to confirm the results using alternative study designs and to report them in accordance to population characteristics both in Qatar and internationally.
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Affiliation(s)
- Saad Thamer Sedeeq
- Department of Clinical Research, Directorate of Clinical Operations, Qatar University Health Centre, Primary Health Care, Doha, Qatar
| | - Mohammad Jamil Mohammad AlTamimi
- Department of Clinical Research, Directorate of Clinical Operations, Qatar University Health Centre, Primary Health Care, Doha, Qatar
| | - Ehab Hamed
- Department of Clinical Research, Directorate of Clinical Operations, Qatar University Health Centre, Primary Health Care, Doha, Qatar
| | - Mohamed Ahmed Syed
- Department of Clinical Research, Directorate of Clinical Affairs, Primary Health Care, Doha, Qatar
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22
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Wang MZ, Jha MK, Minhajuddin A, Pipes R, Levinson S, Mayes TL, Greer TL, Trivedi MH. A primary care first (PCP-first) model to screen and treat depression: A VitalSign 6 report from a second cohort of 32,106 patients. Gen Hosp Psychiatry 2022; 74:1-8. [PMID: 34784574 DOI: 10.1016/j.genhosppsych.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE This report from VitalSign6 project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model. METHODS This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC). RESULTS Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 < 10) and 2238 had moderate-severe depression (PHQ-9 ≥ 10). Of the 333 patients with none-mild depression and 2238 patients with moderate-severe depression, 266 and 1929 had at least 18 weeks of data available. Of these, 54.9% (146/266) with none-mild depression and 69.1% (1332/1929) with moderate-severe depression were started on pharmacotherapy. Of the 1478 patients with clinical diagnosis of depression, initiated on pharmacotherapy, 1046 returned for ≥1 follow-up and 616 returned for ≥3 follow-ups over 18 weeks. Of the 1046 patients with ≥1 follow-up visit within 18 weeks, remission rates for patients with mild depression, moderate-severe depression, and overall were 55.6% (66/99), 30% (282/941), and 32.4% (338/1040) respectively. CONCLUSIONS Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.
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Affiliation(s)
- Margaret Z Wang
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Ronny Pipes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Sara Levinson
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Department of Psychology, University of Texas at Arlington, Arlington, TX, United States.
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
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23
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Park SH. Comparison of the Center for Epidemiologic Studies Depression Scale and other tools to screen depression in patients with chronic disease. Gen Hosp Psychiatry 2022; 74:144-146. [PMID: 34654547 DOI: 10.1016/j.genhosppsych.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Seong-Hi Park
- School of Nursing, Soonchunhyang University, South Korea.
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