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Ruiz-Cosignani D, Chen Y, Cheung G, Lawrence M, Lyndon MP, Ma’u E, Ramalho R. Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review. J Telemed Telecare 2024; 30:466-474. [PMID: 34989643 PMCID: PMC10928963 DOI: 10.1177/1357633x211069664] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/08/2021] [Indexed: 01/18/2023]
Abstract
Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users' socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.
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Affiliation(s)
- Daniela Ruiz-Cosignani
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gary Cheung
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark Lawrence
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Mataroria P Lyndon
- Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Etuini Ma’u
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Rodrigo Ramalho
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
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Park SH, Lee YB, Lee KN, Kim B, Cho SH, Kwon SY, Park J, Kim G, Jin SM, Hur KY, Han K, Kim JH. Risk of Depression according to Cumulative Exposure to a Low-Household Income Status in Individuals with Type 2 Diabetes Mellitus: A Nationwide Population- Based Study. Diabetes Metab J 2024; 48:290-301. [PMID: 38171143 PMCID: PMC10995483 DOI: 10.4093/dmj.2022.0299] [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: 08/23/2022] [Accepted: 02/07/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGRUOUND We aimed to identify the risk of incident depression according to cumulative exposure to a low-household income status in individuals with type 2 diabetes mellitus (T2DM). METHODS For this retrospective longitudinal population-based cohort study, we used Korean National Health Insurance Service data from 2002 to 2018. Risk of depression was assessed according to cumulative exposure to low-household income status (defined as Medical Aid registration) during the previous 5 years among adults (aged ≥20 years) with T2DM and without baseline depression who underwent health examinations from 2009 to 2012 (n=2,027,317). RESULTS During an average 6.23 years of follow-up, 401,175 incident depression cases occurred. Advance in cumulative number of years registered for medical aid during the previous 5 years from baseline was associated with an increased risk of depression in a dose-dependent manner (hazard ratio [HR], 1.44 [95% confidence interval (CI), 1.38 to 1.50]; HR, 1.40 [95% CI, 1.35 to 1.46]; HR, 1.42, [95% CI, 1.37 to 1.48]; HR, 1.46, [95% CI, 1.40 to 1.53]; HR, 1.69, [95% CI, 1.63 to 1.74] in groups with 1 to 5 exposed years, respectively). Insulin users exposed for 5 years to a low-household income state had the highest risk of depression among groups categorized by insulin use and duration of low-household income status. CONCLUSION Cumulative duration of low-household income status, defined as medical aid registration, was associated with an increased risk of depression in a dose-response manner in individuals with T2DM.
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Affiliation(s)
- So Hee Park
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You-Bin Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-na Lee
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bongsung Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - So Hyun Cho
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yoon Kwon
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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Tobin JN, Weiss ES, Cassells A, Lin TJ, Holder T, Carrozzi G, Barsanti F, Morales A, Mailing A, Espejo M, Gilbert E, Casiano L, O’Hara-Cicero E, Weed J, Dietrich AJ. A Randomized Controlled Trial to Increase Cancer Screening and Reduce Depression Among Low-Income Women. JOURNAL OF PREVENTION AND HEALTH PROMOTION 2022; 3:271-299. [PMID: 38566802 PMCID: PMC10986328 DOI: 10.1177/26320770221096098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Low-income women of color receive fewer cancer screenings and have higher rates of depression, which can interfere with cancer screening participation. This study assessed the comparative effectiveness of two interventions for improving colorectal, breast, and cervical cancer screening participation and reducing depression among underserved women in Bronx, NY, with depression. This comparative effectiveness randomized controlled trial (RCT) with assessments at study entry, 6, and 12 months utilized an intent-to-treat statistical approach. Eligible women were aged 50 to 64, screened positive for depression, and were overdue for ≥ 1 cancer screening (colorectal, breast, and/or cervical). Participants were randomized to a collaborative depression care plus cancer screening intervention (CCI + PCM) or cancer screening intervention alone (PCM). Interventions were telephone-based, available in English or Spanish, delivered over 12 months, and facilitated by a skilled care manager. Cancer screening data were extracted from electronic health records. Depression was measured with a validated self-report instrument (PHQ-9). Seven hundred fifty seven women consented and were randomized (CCI + PCM, n = 378; PCM, n = 379). Analyses revealed statistically significant increases in up-to-date status for all three cancer screenings; depression improved in both intervention groups. There were no statistically significant differences between the interventions in improving cancer screening rates or reducing depression. CCI and PCM both improved breast, cervical, and colorectal cancer screening and depression in clinical settings in underserved communities; however, neither intervention showed an advantage in outcomes. Decisions about which approach to implement may depend on the nature of the practice and alignment of the interventions with other ongoing priorities and resources.
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Affiliation(s)
| | | | | | - TJ Lin
- Clinical Directors Network (CDN), New York, NY, USA
| | | | - Gianni Carrozzi
- Montefiore Family Care Center, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Maria Espejo
- Lincoln Hospital Ambulatory Care Services, Bronx, NY, USA
| | - Erica Gilbert
- Segundo Ruiz Belvis Diagnostic &Treatment Center, Bronx, NY, USA
| | - Louann Casiano
- Morrisania Diagnostic & Treatment Center, Bronx, NY, USA
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Gómez-Rivera D, Cumba-Avilés E. Comorbid Chronic Physical Illnesses in Type 1 Diabetes Adolescents: Personal, Caregiver, and Family Functioning. SALUD Y CONDUCTA HUMANA 2021; 8:66-81. [PMID: 35855399 PMCID: PMC9291632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Having diabetes and comorbid chronic physical illnesses (CCPIs) suggests a higher risk for depression and lower health-related quality of life and treatment adherence. Caring for these patients is often overwhelming. Although CCPIs affect youths with type 1 diabetes (T1D), no study has examined the psychosocial or health-related impact of CCPIs in this population. We examined individual, caregiver, and family functioning differences among T1D adolescents with (G1; n = 25) and without (G2; n = 26) CCPIs. Participants were 51 youth (aged 12-17 years) enrolled in a depression treatment study. We administered diagnostic interviews and rating scales to assess each domain of interest. Using MANOVA, followed by individual univariate analyses, and Chi-square tests, we compared groups in continuous and categorical variables, respectively. MANOVA results were significant, F(4, 46) = 2.62, p = .047. Participants from G1 obtained lower global functioning scores compared to G2. Caregivers whose offspring had CCPIs were more depressed and reported higher burden but lower family functioning scores than their counterparts did. A higher percent of youths with CCPIs needed reminders about insulin use and met the criteria for major depression, but a lower proportion had access to insulin pumps. Taking care of youths from G1 was associated with a lifetime history of depressive disorder or suicidality. Our findings support the existence of individual, caregiver, and family functioning differences between T1D adolescents with vs. without CCPIs. Psychosocial interventions should consider the incremental burden that CCPIs may pose over these youth and their families.
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Affiliation(s)
| | - Eduardo Cumba-Avilés
- Institute for Psychological Research, University of Puerto Rico-Rio Piedras Campus
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Zabell V, Rønne ST, Høgsgaard D, Jørgensen R, Gaede PH, Arnfred SM. Interventions involving own treatment choice for people living with coexisting severe mental illness and type 1 or 2 diabetes: A scoping review. Diabet Med 2021; 38:e14626. [PMID: 34152639 DOI: 10.1111/dme.14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/19/2021] [Indexed: 12/16/2022]
Abstract
AIM The objective of this scoping review was to summarize, understand and provide an overview of the empirical literature on interventions involving own treatment choice for people with coexisting diabetes (type 1 and 2) and severe mental illness (SMI). METHODS This scoping review undertook a systematic literature assessment. Searches were performed in MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, the Cochrane Library and grey literature (OpenGrey, Google Scholar and Danish Health and Medicine Authority databases). Publications from 2000 to July 2020 were of interest. Studies were included if they involved the users' own choice of treatment. INCLUDED STUDIES RCT, intervention, cohort and case-based studies. RESULTS A total of 4320 articles were screened, of which nine were included. The review identified eight studies from the United States and one from Canada testing different interventions for people with SMI and diabetes (one diabetes education program, five randomized controlled trials, one retrospective cohort study, one naturalistic intervention program and one case vignette). The interventions described in the nine articles involved service users, the majority incorporated individualized healthcare plans, and all interventions were based on multidisciplinary teamwork. CONCLUSIONS Research in the area is limited. Care management interventions tend to focus on a single condition, paradoxically excluding SMI during enrolment. Interventions aimed at people with both conditions often prioritize one condition treatment leading to an unbalanced care.
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Affiliation(s)
- Vicki Zabell
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina T Rønne
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Høgsgaard
- Primary and eHealth Care, Slagelse, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Peter H Gaede
- Department of Internal Medicine Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sidse M Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Charlesworth CJ, Zhu JM, Horvitz-Lennon M, McConnell KJ. Use of behavioral health care in Medicaid managed care carve-out versus carve-in arrangements. Health Serv Res 2021; 56:805-816. [PMID: 34312839 DOI: 10.1111/1475-6773.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate differences in access to behavioral health services for Medicaid enrollees covered by a Medicaid entity that integrated the financing of behavioral and physical health care ("carve-in group") versus a Medicaid entity that separated this financing ("carve-out group"). DATA SOURCES/STUDY SETTING Medicaid claims data from two Medicaid entities in the Portland, Oregon tri-county area in 2016. STUDY DESIGN In this cross-sectional study, we compared differences across enrollees in the carve-in versus carve-out group, using a machine learning approach to incorporate a large set of covariates and minimize potential selection bias. Our primary outcomes included behavioral health visits for a variety of different provider types. Secondary outcomes included inpatient, emergency department, and primary care visits. DATA COLLECTION We used Medicaid claims, including adults with at least 9 months of enrollment. PRINCIPAL FINDINGS The study population included 45,786 adults with mental health conditions. Relative to the carve-out group, individuals in the carve-in group were more likely to access outpatient behavioral health (2.39 percentage points, p < 0.0001, with a baseline rate of approximately 73%). The carve-in group was also more likely to access primary care physicians, psychologists, and social workers and less likely to access psychiatrists and behavioral health specialists. Access to outpatient behavioral health visits was more likely in the carve-in arrangement among individuals with mild or moderate mental health conditions (compared to individuals with severe mental illness) and among black enrollees (compared to white enrollees). CONCLUSIONS Financial integration of physical and behavioral health in Medicaid managed care was associated with greater access to behavioral health services, particularly for individuals with mild or moderate mental health conditions and for black enrollees. Recent changes to incentivize financial integration should be monitored to assess differential impacts by illness severity, race and ethnicity, provider types, and other factors.
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Affiliation(s)
- Christina J Charlesworth
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane M Zhu
- Division of General Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, Cambridge Heath Alliance and Harvard Medical School, Boston, Massachusetts, USA
| | - K John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA
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Lu X, Yang D, Liang J, Xie G, Li X, Xu C, Liao H, Zhou H, Xu Z, Ye C, Chen H, Liang M, Shen Q, Sun T, Hu Y, Zhang W, Ning Y. Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: A meta-analysis of randomized controlled studies. Prim Care Diabetes 2021; 15:428-434. [PMID: 33551333 DOI: 10.1016/j.pcd.2021.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022]
Abstract
AIM The glycaemic control of diabetes with depression was inconsistent from randomized controlled studies. This meta-analysis aimed to explore the effectiveness of intervention methods in diabetes with depression. METHODS This study systematically searched electronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) for studies published up to August 17, 2020. Standardized mean difference (SMD) and 95%CI were used to evaluate the effectiveness of interventions on HbA1c. Heterogeneity was estimated using the I2 statistic. Begg's test was used to assess the possible publication bias among studies. RESULTS Twelve studies of 2444 cases were included in this study. The overall SMD is -0.22 and 95%CI -0.33 to -0.10 in 0-6 months of intervention group. The I2 and P were 18.4% and 0.26. There are no publication bias tested (z = 0.37, P = 0.72). CONCLUSION Cognitive behavioral therapy and mindful self-compassion might be effective method to improve glycaemic control of diabetes with depression in 0-6 months.
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Affiliation(s)
- Xiaobing Lu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Dongying Yang
- Department of Psychological Behavior, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Jiaquan Liang
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Guojun Xie
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Xuesong Li
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Caixia Xu
- Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Hairong Liao
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Hui Zhou
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, The Third People's Hospital of Foshan, Foshan, China
| | - Zhenyu Xu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chan Ye
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixia Chen
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Psychiatric, Zhongshan Third People's Hospital, Zhongshan, China
| | - Meihong Liang
- Department of Psychiatry, Guangzhou Medical University, Foshan Third People's Hospital, Foshan, China
| | - Qi Shen
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Sun
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yutong Hu
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weizhi Zhang
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatric, Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.
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Ebrahim M, Tamiru D, Hawulte B, Misgana T. Prevalence and associated factors of depression among diabetic outpatients attending diabetic clinic at public hospitals in Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2021; 9:20503121211066244. [PMID: 34992781 PMCID: PMC8725011 DOI: 10.1177/20503121211066244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Depression is one of the most common comorbid psychiatric disorders among diabetic patients. Depression among diabetic people has led to poor treatment adherence, defective treatment outcomes, and consequently worsened quality of life. However, there is a limited study conducted to assess the magnitude and factors associated with depression among diabetic patients in Ethiopia including this study area. Objective: This study aimed to assess the prevalence and factors associated with depression among adult diabetic outpatients attending diabetic clinic in Eastern Ethiopia. Methods: An institution-based cross-sectional study was conducted among 407 adult diabetic outpatients on treatment in Ethiopia in 2020. Patient Health Questionnaire-9 was used to assess depression among randomly selected samples. Bivariate and multivariate logistic regression was fitted to identify factors associated with depression among diabetic outpatients. A p value less than 0.05 with a 95% confidence interval was considered statistically significant. Results: The overall prevalence of depression among diabetic outpatients was found to be 48.9% (95% confidence interval: 44.2%, 53.4%). Being female (adjusted odds ratio = 1.50, 95% confidence interval: 1.39, 2.73), Khat chewing (adjusted odds ratio = 1.88, 95% confidence interval: 1.22, 2.93), having poor and moderate social support (adjusted odds ratio = 1.79, 95% confidence interval: 1.07, 2.98 and adjusted odds ratio = 1.90, 95% confidence interval: 1.14, 3.17, respectively), taking both oral hypoglycemic agents and insulin medication (adjusted odds ratio = 1.33, 95% confidence interval: 1.13, 2.80) and duration of diabetes mellitus for more than 6 years (adjusted odds ratio = 5.40, 95% confidence interval: 3.42, 8.14) were significantly associated with depression. Conclusion: This study revealed a relatively high prevalence of depression in diabetic outpatients. A lesser level of social support, taking oral and insulin treatment regimes, longer duration of illness, using Khat, and being female were associated with depression among diabetic outpatients. Therefore, early screening and identification of such factors could help ameliorate some of the deleterious effects of depression in diabetic outpatients.
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Affiliation(s)
| | - Dawit Tamiru
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Tobin JN, Cassells A, Weiss E, Lin TJ, Holder T, Carrozzi G, Barsanti F, Morales A, Maling A, Espejo M, Ascher A, Gilbert E, Casiano L, O-Hara-Cicero E, Weed J, Dietrich A. Integrating Cancer Screening and Mental Health Services in Primary Care: Protocol and Baseline Results of a Patient-Centered Outcomes Intervention Study. J Health Care Poor Underserved 2021; 32:1907-1934. [PMID: 34803050 PMCID: PMC10999254 DOI: 10.1353/hpu.2021.0173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Low-income and minority women are significantly more likely to be diagnosed with preventable, late-stage cancers and suffer from depression than the general population. Intervention studies aiming to reduce depression to increase cancer screening among underserved minority women are sparse. METHODS This patient-centered outcomes trial compared Collaborative Care Intervention plus Cancer Prevention Care Management (CCI+PCM) versus PCM alone. Participants from six Federally Qualified Health Centers (FQHCs) were interviewed at baseline, 6-and 12-month follow-up to monitor adherence to screening guidelines, depressive symptoms, quality of life, barriers to screening, and other psychosocial and health-related variables. RESULTS Participants included 757 English-or Spanish-speaking women (ages 50-64) who screened positive for depression on the Patient Health Questionnaire (PHQ)-9 and were not up-to-date for breast, cervical, and/or colorectal cancer screening. CONCLUSIONS Study methodology and baseline participant characteristics are reported to contribute to the literature on evidence-based interventions for cancer screening among underserved, depressed women.
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Ee C, Lake J, Firth J, Hargraves F, de Manincor M, Meade T, Marx W, Sarris J. An integrative collaborative care model for people with mental illness and physical comorbidities. Int J Ment Health Syst 2020; 14:83. [PMID: 33292354 PMCID: PMC7659089 DOI: 10.1186/s13033-020-00410-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/28/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Many individuals with mental health problems have comorbid physical conditions, or may present with substance/alcohol misuse or abuse issues. This results in complex treatment challenges that may not be adequately addressed by a model of care that is solely delivered by an individual clinician using a sole intervention. Mainstream pharmacotherapeutic treatment of mental health problems often have limited effectiveness in completely resolving symptoms, and may cause adverse side effects. Adjunctive treatment approaches, including nutraceuticals, lifestyle and behaviour change interventions, are widely used to assist with treatment of mental health problems. However, whilst these can be generally safer with fewer side effects, they have varying levels of evidentiary support. These circumstances warrant reframing the current treatment approach towards a more evidence-based integrative model which may better address the real-world challenges of psychiatric disorders and comorbid physical conditions. In essence, this means developing an integrative model of care which embodies an evidence-informed, personalized stepwise approach using both conventional pharmacological treatments alongside novel adjunctive treatments (where applicable) via the application of a collaborative care approach. DISCUSSION In order to inform this position, a brief review of findings on common patterns of comorbidity in mental illness is presented, followed by identification of limitations of conventional treatments, and potential applications of integrative medicine interventions. Advantages and challenges of integrative mental health care, collaborative models of care, review of research highlights of select integrative approaches, and comment on potential cost advantages are then discussed. We propose that a collaborative care model incorporating evidence-based integrative medicine interventions may more adequately address mental health problems with comorbid medical conditions. Robust research is now required of such a model, potentially within an integrative clinical practice.
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Affiliation(s)
- C. Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - J. Lake
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - J. Firth
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - F. Hargraves
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - M. de Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
| | - T. Meade
- School of Psychology and Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - W. Marx
- IMPACT, Food & Mood Centre, Deakin University, Barwon Health, Geelong, Australia
| | - J. Sarris
- NICM Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Professorial Unit, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Heinrich K, Sanchez K, Hui C, Talabi K, Perry M, Qin H, Nguyen H, Tatachar A. Impact of an electronic medium delivery of warfarin education in a low income, minority outpatient population: a pilot intervention study. BMC Public Health 2019; 19:1050. [PMID: 31382942 PMCID: PMC6683532 DOI: 10.1186/s12889-019-7370-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/25/2019] [Indexed: 12/03/2022] Open
Abstract
Background Warfarin is classified as a high-alert medication for ambulatory healthcare and safe guards for high-alert medications are necessary, including the practice of mandatory patient education. The high cost of hospitalizations related to adverse events combined with the average bleeding event rate of 7–8% in spite of routine patient education, suggests the importance of new approaches to standardized health education on warfarin. We sought to evaluate the impact of a warfarin educational video using an electronic tablet on patient knowledge and to determine patients’ satisfaction with the use of an electronic tablet for educational purposes in outpatient clinics serving a low income, minority population. Methods A warfarin educational video delivered on an electronic tablet (iPad) was delivered at two pharmacist-managed anticoagulation clinics to uninsured patients whose annual income is equal or less than two hundred percent below the poverty level were offered. Patients (n = 18) completed a pre-video and post-video knowledge test on warfarin before and after viewing the warfarin educational video on an electronic tablet and a follow-up test to measure the retention of knowledge and a patient satisfaction survey at 60 days. The primary outcome was change in knowledge test scores. Other outcome measures included adherence rates, adverse events, time in therapeutic INR range, and patient-reported satisfaction scores. Results The majority of patients were uninsured men taking warfarin for atrial fibrillation (n = 5). The median scores at post-video knowledge test and follow-up knowledge test were significantly higher than that for the pre-knowledge test (12 (11–12) vs. 10(8–11), p < 0.001). The study group had a ‘time in therapeutic INR’ range of 56.3%, a rate of adverse events of 24.5%, and a self-reported adherence rate to warfarin of 94.1%. The majority of patients also had positive responses to the patient satisfaction survey. Conclusions Patient education delivered via iPad to facilitate knowledge of medication can serve as a useful tool for educating patients about warfarin and warfarin therapy. Use of an electronic medium may be a unique way to provide standard medication education to patients. Trial registration The study was retrospectively registered with: NCT03650777; 9/18/18.
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Affiliation(s)
- Krista Heinrich
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.
| | - Katherine Sanchez
- Center for Applied Health Research, Baylor Scott and White Research Institute, 8080 North Central Expressway, Suite 1050, Dallas, TX, 75206, USA
| | - Cecilia Hui
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Kiara Talabi
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Marlena Perry
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA
| | - Huanying Qin
- Department of Quantitative Sciences, Baylor Scott and White Health, 8080 N. Central Expressway, Suite 900, Dallas, TX, 75206, USA
| | - Hoa Nguyen
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.,Department of Quantitative Sciences, Baylor Scott and White Health, 8080 N. Central Expressway, Suite 900, Dallas, TX, 75206, USA
| | - Amulya Tatachar
- Department of Clinical Pharmacy, Health Texas Provider Network, Baylor Scott & White Health, 2001 Bryan Street, Suite 2800, Dallas, TX, 75201, USA.,University of North Texas System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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12
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Lake J, Turner MS. Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm J 2018; 21:17-024. [PMID: 28898197 DOI: 10.7812/tpp/17-024] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery. Because of its dominant position in the US health care marketplace and its commitment to research and innovation, Kaiser Permanente (KP) is strategically positioned to make important contributions that will shape the future of mental health care nationally and globally.This article reviews challenges facing mental health care and proposes an agenda for developing a collaborative care model in primary care settings that incorporates conventional biomedical therapies and complementary and alternative medicine approaches. By moving beyond treatment delivery via telephone and secure video and providing earlier interventions through primary care clinics, KP is shifting the paradigm of mental health care to a collaborative care model focusing on prevention. Recommendations are to expand current practices to include integrative treatment strategies incorporating evidence-based biomedical and complementary and alternative medicine modalities that can be provided to patients using a collaborative care model. Recommendations also are made for an internal research program aimed at investigating the efficacy and cost-effectiveness of promising complementary and alternative medicine and integrative treatments addressing the complex needs of patients with severe psychiatric disorders, many of whom respond poorly to treatments available in KP mental health clinics.
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Affiliation(s)
- James Lake
- Staff Psychiatrist at the Oakland Medical Center in CA at the time this article was written, and is a founding member and former Chair of the American Psychiatric Association Caucus on Complementary and Alternative Medicine. He is the author of four books on integrative mental health care.
| | - Mason Spain Turner
- Director of Outpatient Mental Health and Addiction Medicine for Regional Mental Health Services for The Permanente Medical Group, the Chief of the Department of Psychiatry at the San Francisco Medical Center, and an Assistant Clinical Professor at the Univesity of California, San Francisco.
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13
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Hay JW, Lee PJ, Jin H, Guterman JJ, Gross-Schulman S, Ell K, Wu S. Cost-Effectiveness of a Technology-Facilitated Depression Care Management Adoption Model in Safety-Net Primary Care Patients with Type 2 Diabetes. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:561-568. [PMID: 29753353 PMCID: PMC5953558 DOI: 10.1016/j.jval.2017.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/02/2017] [Accepted: 11/11/2017] [Indexed: 05/16/2023]
Abstract
BACKGROUND The Diabetes-Depression Care-Management Adoption Trial is a translational study of safety-net primary care predominantly Hispanic/Latino patients with type 2 diabetes in collaboration with the Los Angeles County Department of Health Services. OBJECTIVES To evaluate the cost-effectiveness of an information and communication technology (ICT)-facilitated depression care management program. METHODS Cost-effectiveness of the ICT-facilitated care (TC) delivery model was evaluated relative to a usual care (UC) and a supported care (SC) model. TC added automated low-intensity periodic depression assessment calls to patients. Patient-reported outcomes included the 12-Item Short Form Health Survey converted into quality-adjusted life-years (QALYs) and the 9-Item Patient Health Questionnaire-calculated depression-free days (DFDs). Costs and outcomes data were collected over a 24-month period (-6 to 0 months baseline, 0 to 18 months study intervention). RESULTS A sample of 1406 patients (484 in UC, 480 in SC, and 442 in TC) was enrolled in the nonrandomized trial. TC had a significant improvement in DFDs (17.3; P = 0.011) and significantly greater 12-Item Short Form Health Survey utility improvement (2.1%; P = 0.031) compared with UC. Medical costs were statistically significantly lower for TC (-$2328; P = 0.001) relative to UC but not significantly lower than for SC. TC had more than a 50% probability of being cost-effective relative to SC at willingness-to-pay thresholds of more than $50,000/QALY. CONCLUSIONS An ICT-facilitated depression care (TC) delivery model improved QALYs, DFDs, and medical costs. It was cost-effective compared with SC and dominant compared with UC.
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Affiliation(s)
- Joel W Hay
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Haomiao Jin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Shinyi Wu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA; Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
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14
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Wu S, Ell K, Jin H, Vidyanti I, Chou CP, Lee PJ, Gross-Schulman S, Sklaroff LM, Belson D, Nezu AM, Hay J, Wang CJ, Scheib G, Di Capua P, Hawkins C, Liu P, Ramirez M, Wu BW, Richman M, Myers C, Agustines D, Dasher R, Kopelowicz A, Allevato J, Roybal M, Ipp E, Haider U, Graham S, Mahabadi V, Guterman J. Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial. J Med Internet Res 2018; 20:e147. [PMID: 29685872 PMCID: PMC5938593 DOI: 10.2196/jmir.7692] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/10/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.
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Affiliation(s)
- Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Haomiao Jin
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Policy Analysis Unit, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chih-Ping Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Pey-Jiuan Lee
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | | | - Laura Myerchin Sklaroff
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,College of Social and Behavioral Sciences, California State University, Northridge, Los Angeles, CA, United States
| | - David Belson
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - Joel Hay
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Chien-Ju Wang
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Geoffrey Scheib
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Paul Di Capua
- Caremore Medical Group, East Haven, CT, United States.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Caitlin Hawkins
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Pai Liu
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Magaly Ramirez
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Brian W Wu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Mark Richman
- Department of Emergency Medicine, Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, United States
| | - Caitlin Myers
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Davin Agustines
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Robert Dasher
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Alex Kopelowicz
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Joseph Allevato
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Mike Roybal
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Eli Ipp
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States.,Los Angeles Biomedical Research Institute, Los Angeles, CA, United States
| | - Uzma Haider
- Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Sharon Graham
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Vahid Mahabadi
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Los Angeles, CA, United States.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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Abstract
OBJECTIVE The study's objective is to examine differences in mental and physical health-related quality of life (HRQOL) in non-Hispanic White, non-Hispanic Black, and Hispanic adults with diabetes. DESIGN A secondary analysis of 2014 Behavioral Risk Factor Surveillance System (BRFSS) data was conducted. A total of 26 states participated in the 2014 BRFSS core and optional diabetes models (n = 17,923). HRQOL was measured by the number of mentally and physically unhealthy days during the past month, respectively. A series of regression models were developed to assess differences in HRQOL without and with inclusion of demographic (age, marital status, income, gender, and education) and diabetes-related (depression, sleep time, insulin use, complications, age of diabetes diagnosis, BMI, smoking, and exercise) factors. RESULTS In the fully adjusted models (inclusion of demographic and diabetes-related factors), non-Hispanic Whites had more mentally (β = 0.88, p = 0.03) and physically (β = 1.35, p = 0.01) unhealthy days per month compared to Hispanics. Non-Hispanic Blacks (β = 1.42, p < 0.01) also had more mentally unhealthy days per month in relation to Hispanics when adjusting for demographic and diabetes-related factors. Depression emerged as a potent predictor of mentally (β = 8.60; p < 0.0001) and physically (β = 4.43; p < 0.0001) unhealthy days in the multivariate models. CONCLUSION Non-Hispanic Black and White adults with diabetes may be more vulnerable to poor HRQOL compared to their Hispanic counterparts. Increased, widened application of diabetes interventions targeting depression appears warranted to improve HRQOL outcomes.
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Collaborative Care for Depression among Patients with Limited English Proficiency: a Systematic Review. J Gen Intern Med 2018; 33:347-357. [PMID: 29256085 PMCID: PMC5834967 DOI: 10.1007/s11606-017-4242-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/13/2017] [Accepted: 11/17/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care. METHODS We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs). RESULTS Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention. DISCUSSION While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
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Sanchez K, Eghaneyan BH, Killian MO, Cabassa L, Trivedi MH. Measurement, Education and Tracking in Integrated Care (METRIC): use of a culturally adapted education tool versus standard education to increase engagement in depression treatment among Hispanic patients: study protocol for a randomized control trial. Trials 2017; 18:363. [PMID: 28774339 PMCID: PMC5543442 DOI: 10.1186/s13063-017-2109-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background Significant mental health disparities exist for Hispanic populations, especially with regard to depression treatment. Stigma and poor communication between patients and their providers result in low use of antidepressant medications and early treatment withdrawal. Cultural factors which influence treatment decisions among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with co-morbid physical health conditions. Hispanics, in particular, are more likely to receive mental healthcare in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up. Methods We are conducting a randomized controlled trial among 150 depressed adult Hispanics in a primary care safety net setting, testing the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multidisciplinary treatment and culturally tailored care management strategies. Discussion This study protocol represents the first randomized control trial of the culturally adapted depression education fotonovela, Secret Feelings, among Hispanics in a primary care setting. The education intervention will be implemented after diagnosis using an innovative screening technology and enrolled in measurement-based integrated care for the treatment of depression, which will help build the evidence around cultural adaptations in treatment to reduce mental health disparities. Trial registration ClinicalTrials.gov, NCT02702596. Registered on 20 March 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2109-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Michael O Killian
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Leopoldo Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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Comorbidity of depression and diabetes: an application of biopsychosocial model. Int J Ment Health Syst 2016; 10:74. [PMID: 27980612 PMCID: PMC5135819 DOI: 10.1186/s13033-016-0106-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/25/2016] [Indexed: 02/06/2023] Open
Abstract
Background Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors. Methods Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis. Results Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score. Conclusion Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users.
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Paulus DJ, Bakhshaie J, Garza M, Ochoa-Perez M, Mayorga NA, Bogiaizian D, Robles Z, Lu Q, Ditre J, Vowles K, Schmidt NB, Zvolensky MJ. Pain severity and emotion dysregulation among Latinos in a community health care setting: relations to mental health. Gen Hosp Psychiatry 2016; 42:41-8. [PMID: 27638971 DOI: 10.1016/j.genhosppsych.2016.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although pain severity is often related to poorer mental health and is one of the most common presenting complaints in community health care settings, there is little understanding of the pain experience in relation to anxiety/depressive symptoms and disorders among Latino populations in medical contexts. METHOD To address this gap, the current study explored an interactive model of pain severity and emotion dysregulation in relation to anxiety/depressive symptoms and psychopathology among 274 Latinos who attended a community-based primary health care clinic [86.9% female; Mage=39.3 (SD=11.2); 96.0% indicated Spanish as their first language]. RESULTS Results indicated a statistically significant interaction between pain severity and emotion dysregulation for suicidal symptoms, social anxiety symptoms and number of mood/anxiety disorders, such that more severe pain and greater levels of emotion dysregulation related to poorer mental health. Both pain severity and emotion dysregulation were significant predictors of depressive symptoms, but only pain severity was a significant predictor of anxious arousal symptoms. CONCLUSIONS These novel findings suggest a clinically significant interplay between pain severity and emotion dysregulation among Latinos in. The results are discussed in relation to the need for new screening and intervention tactics that address interrelations between pain severity and emotional dysregulation among Latinos seeking treatment in community health-care-based settings.
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Affiliation(s)
| | | | | | | | | | - Daniel Bogiaizian
- Psychotherapeutic Area of "Asociación Ayuda," Anxiety Disorders Clinic, Buenos Aires, Argentina
| | | | - Qian Lu
- University of Houston, Department of Psychology
| | | | - Kevin Vowles
- University of New Mexico, Department of Psychology
| | | | - Michael J Zvolensky
- University of Houston, Department of Psychology; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science.
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Sanchez K, Eghaneyan BH, Trivedi MH. Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO): protocol for an educational intervention study. BMC Health Serv Res 2016; 16:322. [PMID: 27473569 PMCID: PMC4966863 DOI: 10.1186/s12913-016-1575-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatments among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. The current manuscript presents the study protocol for the Depression Screening and Education: Options to Reduce Barriers to Treatment (DESEO) study funded by the Center for Medicare and Medicaid Services (CMS) Grants to Support the Hispanic Health Services Research Grant Program. Methods/Design DESEO will implement universal screening with a self-report depression screening tool (the 9-item Patient Health Questionnaire (PHQ-9)) that is presented through a customized web application and a Depression Education Intervention (DEI) designed to increase disease literacy, and dispel myths about depression and its treatment among Hispanic patients thus reducing stigma and increasing treatment engagement. This project will be conducted at one community health center whose patient population is majority Hispanic. The target enrollment for recruitment is 350 patients over the 24-month study period. A one-group, pretest-posttest design will be used to asses knowledge of depression and its treatment and related stigma before, immediately after, and one month post intervention. Discussion Primary care settings often are the gateway to identifying undiagnosed mental health disorders, particularly for people with comorbid physical health conditions. This study is unique in that it aims to examine the specific role of patient education as an intervention to increase engagement in depression treatment. By participating in the DEI, it is expected that patients will have time to understand treatment options, participate in shared decision-making with their provider, and increase engagement in treatment of depression which might lead to improved overall health. It is also expected that implementation of the iPad Depression Screening application will increase provider awareness of the incidence and prevalence of depression in their own practice and improve the performance and care the clinic provides. Trial registration The study was registered with: NCT02491034 July 2, 2015.
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Affiliation(s)
- Katherine Sanchez
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA. .,Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA.
| | - Brittany H Eghaneyan
- School of Social Work, University of Texas at Arlington, 211 South Cooper Street, Arlington, TX, 76019, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9119, USA
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Castañeda SF, Buelna C, Giacinto RE, Gallo LC, Sotres-Alvarez D, Gonzalez P, Fortmann AL, Wassertheil-Smoller S, Gellman MD, Giachello AL, Talavera GA. Cardiovascular disease risk factors and psychological distress among Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med 2016; 87:144-150. [PMID: 26921653 PMCID: PMC4884536 DOI: 10.1016/j.ypmed.2016.02.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/25/2016] [Accepted: 02/22/2016] [Indexed: 12/17/2022]
Abstract
Studies show that cardiovascular disease (CVD) risk factors are correlated with psychological distress, yet research examining these relationships among Hispanic/Latinos is lacking. The population-based Hispanic Community Health Study/Study of Latinos enrolled a cohort of Hispanic/Latino adults (N=16,415) 18-74years of age at the time of recruitment, from four US metropolitan areas, between March 2008 and June 2011. Psychological distress (i.e., 10-item Center for Epidemiological Studies Depression Scale, 10 item Spielberger Trait Anxiety Scale, and a combined depression/anxiety score), socio-demographics (i.e., age, education, income, insurance, sex, and Hispanic/Latino background), acculturation (i.e., country of birth and language preference), and traditional CVD risk factors (i.e., dyslipidemia, obesity, current cigarette smoking, diabetes, and hypertension) were assessed at baseline. Associations between CVD risk factors and psychological distress measures by sex were examined using multiple linear regression models, accounting for complex survey design and sampling weights and controlling for socio-demographic and acculturation covariates. In adjusted analyses, all three psychological distress measures were significantly related to smoking. For females, greater psychological distress was significantly related to obesity and current smoking. For males, diabetes and current smoking were associated with psychological distress. For males and females, dyslipidemia and hypertension were not associated with psychological distress after adjusting for other factors. Elevated depression and anxiety symptoms were associated with CVD risk factors for Hispanic/Latino men and women. However, these results were not consistent across Hispanic/Latino groups. As promoted by the integrative care model, psychosocial concerns should be considered in research on CVD risk and chronic disease prevention.
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Affiliation(s)
- Sheila F Castañeda
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
| | - Christina Buelna
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Rebeca Espinoza Giacinto
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina, 137 E. Franklin Street, Suite 203, CB#8030, Chapel Hill, NC 27514, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, 10140 Campus Point Drive, San Diego, CA 92121, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Room 1312, Bronx, NY 10461, USA
| | - Marc D Gellman
- Behavioral Medicine Research Center, University of Miami, 1251 Stanford Dr, Coral Gables, FL 33146, USA
| | - Aida L Giachello
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr, Suite 1400, Chicago, IL 60611, USA
| | - Gregory A Talavera
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA
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McBain H, Mulligan K, Haddad M, Flood C, Jones J, Simpson A. Self management interventions for type 2 diabetes in adult people with severe mental illness. Cochrane Database Syst Rev 2016; 4:CD011361. [PMID: 27120555 PMCID: PMC10201333 DOI: 10.1002/14651858.cd011361.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with severe mental illness are twice as likely to develop type 2 diabetes as those without severe mental illness. Treatment guidelines for type 2 diabetes recommend that structured education should be integrated into routine care and should be offered to all. However, for people with severe mental illness, physical health may be a low priority, and motivation to change may be limited. These additional challenges mean that the findings reported in previous systematic reviews of diabetes self management interventions may not be generalised to those with severe mental illness, and that tailored approaches to effective diabetes education may be required for this population. OBJECTIVES To assess the effects of diabetes self management interventions specifically tailored for people with type 2 diabetes and severe mental illness. SEARCH METHODS We searched the Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the International Clinical Trials Registry Platform (ICTRP) Search Portal, ClinicalTrials.gov and grey literature. The date of the last search of all databases was 07 March 2016. SELECTION CRITERIA Randomised controlled trials of diabetes self management interventions for people with type 2 diabetes and severe mental illness. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles, extracted data and conducted the risk of bias assessment. We used a taxonomy of behaviour change techniques and the framework for behaviour change theory to describe the theoretical basis of the interventions and active ingredients. We used the GRADE method (Grades of Recommendation, Assessment, Development and Evaluation Working Group) to assess trials for overall quality of evidence. MAIN RESULTS We included one randomised controlled trial involving 64 participants with schizophrenia or schizoaffective disorder. The average age of participants was 54 years; participants had been living with type 2 diabetes for on average nine years, and with their psychiatric diagnosis since they were on average 28 years of age. Investigators evaluated the 24-week Diabetes Awareness and Rehabilitation Training (DART) programme in comparison with usual care plus information (UCI). Follow-up after trial completion was six months. Risk of bias was mostly unclear but was high for selective reporting. Trial authors did not report on diabetes-related complications, all-cause mortality, adverse events, health-related quality of life nor socioeconomic effects. Twelve months of data on self care behaviours as measured by total energy expenditure showed a mean of 2148 kcal for DART and 1496 kcal for UCI (52 participants; very low-quality evidence), indicating no substantial improvement. The intervention did not have a substantial effect on glycosylated haemoglobin A1c (HbA1c) at 6 or 12 months of follow-up (12-month HbA1c data 7.9% for DART vs 6.9% for UCI; 52 participants; very low-quality evidence). Researchers noted small improvements in body mass index immediately after the intervention was provided and at six months, along with improved weight post intervention. Diabetes knowledge and self efficacy improved immediately following receipt of the intervention, and knowledge also at six months. The intervention did not improve blood pressure. AUTHORS' CONCLUSIONS Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes. Researchers must conduct additional trials to establish efficacy, and to identify the active ingredients in these interventions and the people most likely to benefit from them.
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Affiliation(s)
- Hayley McBain
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Kathleen Mulligan
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Mark Haddad
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Chris Flood
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
| | - Julia Jones
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Alan Simpson
- City University LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
- East London NHS Foundation TrustLondonUK
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Habtewold TD, Alemu SM, Haile YG. Sociodemographic, clinical, and psychosocial factors associated with depression among type 2 diabetic outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study. BMC Psychiatry 2016; 16:103. [PMID: 27083154 PMCID: PMC4833927 DOI: 10.1186/s12888-016-0809-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is a common comorbidity among patients with type 2 diabetes. There are several reports supporting a bidirectional association between depression and type 2 diabetes. However, there is limited data from non-western countries. Therefore, the aim of this study was to assess the sociodemographic, clinical, and psychosocial factors associated with co-morbid depression among type 2 diabetic outpatients presenting to Black Lion General Specialized Hospital, Addis Ababa, Ethiopia. METHODS This institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients. Type 2 diabetes patients were evaluated for depression by administering a validated nine-item Patient Health Questionnaire (PHQ-9). Risk factors for depression among type 2 diabetes patients were identified using multiple logistic regression analysis. RESULT In total, 264 study participants were interviewed with a response rate of 95.6%. The prevalence of depression was 44.7%. In the multivariate analysis, the statistically significant risk factors for depression were monthly family income ≤ 650 (p-value = 0.056; OR = 2.0; 95% CI = 1.01, 4.2), presence of ≥3 diabetic complications (p-value = 0.03; OR = 3.3; 95% CI = 1.1, 10.0), diabetic nephropathy (p-value = 0.01; OR = 2.9; 95% CI = 1.2, 6.7), negative life events (p-value = 0.01; OR = 2.4; 95% CI = 1.2, 4.5), and poor social support (p-value = 0.001; OR = 2.7; 95% CI = 1.5, 5.0). CONCLUSION This study demonstrated that depression is a common co-morbid health problem with a prevalence rate of 44.7%. The presence of diabetic complications, low monthly family income, diabetic nephropathy, negative life event, and poor social support were the statistically significant risk factors associated with depression. We presume that the burden of mental health especially depression is high in the population with type 2 diabetes mellitus co-morbidity. Therefore, specific attention is needed to diagnose early and treat promptly.
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Affiliation(s)
- Tesfa Dejenie Habtewold
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, P.O. BOX: 445, Ethiopia.
| | - Sisay Mulugeta Alemu
- International Medical Corps, Mental Health and Psychosocial Support Program, Dollo Ado Refugee Camp, Ethiopia
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Le HN, Hipolito MMS, Lambert S, Terrell-Hamilton F, Rai N, McLean C, Kapetanovic S, Nwulia E. Culturally Sensitive Approaches to Identification and Treatment of Depression among HIV Infected African American Adults: A Qualitative Study of Primary Care Providers' Perspectives. JOURNAL OF DEPRESSION & ANXIETY 2016; 5:223. [PMID: 27347445 PMCID: PMC4916768 DOI: 10.4172/2167-1044.1000223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent among HIV-infected (HIV+) individuals, and is associated with non-adherence to antiretroviral therapy (ART), and accelerated disease progression. MDD is underdiagnosed and undertreated among low-income African Americans, who are disproportionately impacted by the HIV epidemic. To improve detection and treatment of depression among African Americans living with HIV/AIDS, it is important to understand culturally and contextually relevant aspects of MDD and attitudes about mental health treatment. METHODS A focus group session was conducted with seven providers and staff at a primary care center that serves a largely African-American community heavily impacted by the HIV epidemic in Washington, DC. Data were analyzed using an inductive approach to distill prominent themes, perspectives, and experiences among participating providers. RESULTS Five themes emerged to characterize the lived experiences of HIV+ African-American patients: (a) Changes in perceptions of HIV over time; (b) HIV is comorbid with mental illness, particularly depression and substance abuse; (c) Stigma is associated with both HIV and depression; (d) Existing mental health services vary and are insufficient and (e) Suggestions for optimal treatment for comorbid HIV and depression. LIMITATION This study reflects the views of providers from one clinic in this community. CONCLUSION Substantial economic disadvantage, pervasive childhood adversity, limited education and limited resources jointly put members of this community at risk for acquisition of HIV and for development of depression and addictions. These contextual factors provide an important reminder that any patient-level depression identification or intervention in this community will have to be mindful of such circumstances.
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Affiliation(s)
- Huynh-Nhu Le
- Department of Psychology, George Washington University, Washington, D.C., USA
| | - Maria Mananita S Hipolito
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Sharon Lambert
- Department of Psychology, George Washington University, Washington, D.C., USA
| | | | - Narayan Rai
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | - Charlee McLean
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
| | | | - Evaristus Nwulia
- Translational Neuroscience Laboratory, Department of Psychiatry, Howard University, Washington, D.C., USA
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Birhanu AM, Alemu FM, Ashenafie TD, Balcha SA, Dachew BA. Depression in diabetic patients attending University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. Diabetes Metab Syndr Obes 2016; 9:155-62. [PMID: 27274296 PMCID: PMC4869639 DOI: 10.2147/dmso.s97623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetes mellitus, frequently associated with comorbid depression, contributes to the double burden of individual patients and community. Depression remains undiagnosed in as many as 50%-75% of diabetes cases. This study aimed to determine the prevalence and associated factors of depression among diabetic patients attending the University of Gondar Hospital Diabetic Clinic, Northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted from March to May 2014 among 422 sampled diabetic patients attending the University of Gondar Hospital Diabetic Clinic. The participants were selected using systematic random sampling. Data were collected by face-to-face interview using a standardized and pretested questionnaire linked with patient record review. Depression was assessed using the Patient Health Questionnaire-9. Data were entered to EPI INFO version 7 and analyzed by SPSS version 20 software. Binary logistic regression analysis was performed to identify factors associated with depression. RESULTS A total of 415 diabetic patients participated in the study with a response rate of 98.3%. The prevalence of depression among diabetic patients was found to be 15.4% (95% confidence interval (CI): 11.7-19.2). Only religion (adjusted odds ratio [AOR] =2.65 and 95% CI: 1.1-6.0) and duration of diabetes (AOR =0.27 and 95% CI: 0.07-0.92) were the factors associated with depression among diabetic patients. CONCLUSION The prevalence of depression was low as compared to other similar studies elsewhere. Disease (diabetes) duration of 10 years and above and being a Muslim religion follower (as compared to Christian) were the factors significantly associated with depression. Early screening of depression and treating depression as a routine component of diabetes care are recommended. Further research with a large sample size, wider geographical coverage, and segregation of type of diabetes mellitus is recommended.
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Affiliation(s)
- Anteneh Messele Birhanu
- School of Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | | | - Shitaye Alemu Balcha
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berihun Assefa Dachew
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Correspondence: Berihun Assefa Dachew, Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, PO Box 196, Gondar, Ethiopia, Tel +251 91 154 2348, Email
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Cumba-Avilés E, Sáez-Santiago E. Research Program on Type 1 Diabetes and Youth Depression in Puerto Rico. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2016; 27:44-60. [PMID: 27818725 PMCID: PMC5091806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This work reviews the progress and current state of a research program on Diabetes and youth depression in Puerto Rico. Given the high depression rate, its impact in youth with Type 1 Diabetes (T1D), and the lack of interventions to target this link in an integrative way, the manual titled Cognitive-Behavioral Treatment for Depression in Adolescents with T1D was developed. After its first use in an Open Trial, we currently assess the initial efficacy of its revised version to reduce depression and improve glycemic control, self-care, and quality of life. We present its approach, and initial data on its feasibility, acceptability and potential to reduce emotional problems in T1D youth. We discuss implications of this line of research for health psychology, and its utility to model the development of interventions alike focused on other chronic illnesses.
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Affiliation(s)
- Eduardo Cumba-Avilés
- Institute for Psychological Research, University of Puerto Rico, Río Piedras Campus
| | - Emily Sáez-Santiago
- Institute for Psychological Research, University of Puerto Rico, Río Piedras Campus
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Oh H, Ell K. Depression remission, receipt of problem-solving therapy, and self-care behavior frequency among low-income, predominantly Hispanic diabetes patients. Gen Hosp Psychiatry 2016; 41:38-44. [PMID: 27302721 PMCID: PMC4911635 DOI: 10.1016/j.genhosppsych.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/19/2016] [Accepted: 04/21/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study explored whether depression remission and problem-solving therapy (PST) receipt are associated with more frequent self-care behaviors via cross-sectional and prospective analyses. METHOD We analyzed data from a randomized clinical trial (N=387) that tested collaborative depression care among predominantly Hispanic patients with diabetes in safety-net clinics. Data at 12-month follow-up, measured with the Patient Health Questionnaire-9 and Hopkins Symptom Checklist-20, were used to define depression remission. PST was provided by a bilingual social worker. Multivariate regression analysis was used to examine associations between predictors and frequency change of each self-care behavior (healthy diet, exercise, self-blood glucose monitoring, and foot care between baseline and 12-month (N=281), 18-month (N=249), and 24-month (N=235) follow-up surveys. RESULTS Inconsistent relationships were observed depending on the instrument to identify depression remission, type of self-care behaviors, and time when self-care behavior was measured. Significant associations were more likely to be observed in cross-sectional analyses. PST receipt was not associated with self-care behaviors. CONCLUSIONS Depression remission or the receipt of PST may not be a reliable antecedent for more frequent self-care behaviors among this group. A few recommendations for studies were offered to enhance existing depression care for diabetes patients.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University.
| | - Kathleen Ell
- School of Social Work, University of Southern California
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Kaltman S, Serrano A, Talisman N, Magee MF, Cabassa LJ, Pulgar-Vidal O, Peraza D. Type 2 Diabetes and Depression. DIABETES EDUCATOR 2015; 42:87-95. [DOI: 10.1177/0145721715617536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of the current study was to determine the feasibility, acceptability, and preliminary effectiveness of an integrated self-management intervention that simultaneously targets diabetes and depression self-management in a primary care clinic that serves the Latino immigrant community. Methods The integrated intervention included behavioral activation and motivational interviewing techniques. It was developed with patient, family member, and provider stakeholders, and it comprised 6 individual sessions, followed by 2 monthly booster sessions. Eighteen Latino immigrants participated in an open trial of the intervention. A1C levels were examined at baseline and postintervention. Participants also completed measures of depression, diabetes self-management behaviors, patient activation, and diabetes-related self-efficacy and gave open-ended feedback about the intervention. Results Feasibility of delivering the intervention in the primary care setting and acceptability to the target population were demonstrated. Among participants completing the intervention, A1C levels decreased significantly from baseline. A significant reduction in depressive symptoms and an improvement in diabetes self-management behaviors, patient activation, and diabetes-related self-efficacy were observed. Qualitative responses from participants indicated unilateral positive responses to the intervention and endorsed its continuation in the clinic. Conclusions This pilot trial demonstrated the feasibility and acceptability of an integrated self-management intervention for diabetes and depression. In addition, preliminary data suggest that the intervention may have a positive impact on diabetes and depression-related outcomes. Further evaluation is warranted.
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Affiliation(s)
- Stacey Kaltman
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Adriana Serrano
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Nicholas Talisman
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Michelle F. Magee
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Leopoldo J. Cabassa
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Olga Pulgar-Vidal
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
| | - Dorys Peraza
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Kaltman, Ms Serrano, Mr Talisman)
- MedStar Diabetes Institute and MedStar Health Research Institute, Washington, DC (Dr Magee)
- School of Social Work, Columbia University, and the Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, New York (Dr Cabassa)
- Spanish Catholic Center, Washington, DC (Ms Pulgar-Vidal, Ms Peraza)
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Ell K, Aranda MP, Wu S, Oh H, Lee PJ, Guterman J. Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design. Contemp Clin Trials 2015; 46:39-47. [PMID: 26600285 DOI: 10.1016/j.cct.2015.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | - María P Aranda
- School of Social Work, University of Southern California, United States.
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States; Edward R. Roybal Institute on Aging, University of Southern California, United States; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Hyunsung Oh
- School of Social Work, Arizona State University, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Jeffrey Guterman
- Los Angeles County Department of Health Services, Research and Innovation, David Geffen School of Medicine, University of California Los Angeles, United States.
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Nguyen AL, Green J, Enguidanos S. The relationship between depressive symptoms, diabetes symptoms, and self-management among an urban, low-income Latino population. J Diabetes Complications 2015; 29:1003-8. [PMID: 26490755 DOI: 10.1016/j.jdiacomp.2015.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/24/2015] [Accepted: 09/06/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate the prevalence of depression symptoms among Latinos with diabetes following transition from hospital to home and the relationship of depressive symptoms to diabetes symptom severity and self-management activities. METHODS 203 Latino patients with diagnosed diabetes completed a survey assessing depressive symptoms (PHQ-9), diabetes symptom severity, and diabetes self-management activities (SDSCA). Characteristics and diabetes outcomes between patients with and without probable major depression were compared. Associations between PHQ-9 scores and diabetes outcomes were assessed. Multivariate regression models evaluated the relationship between depressive symptoms and diabetes outcomes and exercise after controlling for patient characteristics. RESULTS 31.5% of participants indicated probable major depression (PHQ-9≥10). More severe diabetes symptoms and less reported exercise were associated with higher PHQ-9 scores. Regression models showed no relationship between self-management and depression. More severe diabetes symptoms were significantly associated with being female, married, and having probable major depression. Odds of exercising were reduced by 6% for every one-unit increase in PHQ-9 score. CONCLUSIONS The prevalence of probable depressive symptoms is high in this population. Having depressive symptoms is an indicator of poorer diabetes symptoms. Screening for depressive symptoms may help identify individuals who need additional support with diabetes symptom and self-management.
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Affiliation(s)
- Annie L Nguyen
- Keck School of Medicine at the University of Southern California, Department of Family Medicine, Los Angeles, CA.
| | - Janelle Green
- University of Southern California, Davis School of Gerontology, Los Angeles, CA
| | - Susan Enguidanos
- University of Southern California, Davis School of Gerontology, Los Angeles, CA
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Kwan BM, Valeras AB, Levey SB, Nease DE, Talen ME. An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act. AIMS Public Health 2015; 2:691-717. [PMID: 29546130 PMCID: PMC5690436 DOI: 10.3934/publichealth.2015.4.691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/14/2015] [Indexed: 01/18/2023] Open
Abstract
The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.
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Affiliation(s)
- Bethany M Kwan
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aimee B Valeras
- NH Dartmouth Family Medicine Residency, Concord Hospital Family Health Center, Concord, NH, United States
| | - Shandra Brown Levey
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Donald E Nease
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mary E Talen
- Northwestern Family Medicine Residency, Northwestern McGaw Medical Center and University, Chicago, IL, United States
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Ell K, Katon W, Lee PJ, Guterman J, Wu S. Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care. Gen Hosp Psychiatry 2015; 37:414-9. [PMID: 26059979 DOI: 10.1016/j.genhosppsych.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/15/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes. METHOD A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients. RESULTS Bivariate analyses found depression significantly associated (p<0.05) with female gender, diabetes emotional burden and regimen distress, BMI ≥ 30, lack of an A1C test, diabetes duration, poor self-care, number of diabetes symptoms and complications, functional and physical characteristics (pain, self-rated health condition, Short-Form Health Survey SF-physical, disability score and comorbid illnesses), as well as higher number of ICD-9 diagnoses and emergency room use. A multivariable regression model with stepwise selection identified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, p<.0001). CONCLUSION Knowing biopsychosocial factors could help primary care physicians and endocrinologists identify a high-risk group of patients needing depression screening.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California.
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California.
| | - Jeffrey Guterman
- David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services.
| | - Shinyi Wu
- School of Social Work, University of Southern California; Edward R. Roybal Institute on Aging, University of Southern California; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California.
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Ortega AN, Rodriguez HP, Vargas Bustamante A. Policy dilemmas in Latino health care and implementation of the Affordable Care Act. Annu Rev Public Health 2015; 36:525-44. [PMID: 25581154 DOI: 10.1146/annurev-publhealth-031914-122421] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion;
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Affiliation(s)
- Alexander N Ortega
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; ,
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Prevalence of Depression among Type 2 Diabetic Outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia. DEPRESSION RESEARCH AND TREATMENT 2015; 2015:184902. [PMID: 25789172 PMCID: PMC4350622 DOI: 10.1155/2015/184902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/01/2014] [Accepted: 12/10/2014] [Indexed: 11/17/2022]
Abstract
Background. The emotional consequences of diabetes have been scrutinized by a number of investigative teams and there are varying reports about the association of depression with type 2 diabetes mellitus. However, there is limited data about this in Ethiopia. Therefore, the purpose of this study was to assess the prevalence of comorbid depression among type 2 diabetic outpatients. Methods and Materials. Institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients from Black Lion General Specialized Hospital. Systematic random sampling technique was used to get these individual patients from 920 type 2 diabetic outpatients who have an appointment during the data collection period. Patients' depression status was measured using Patient Health Questionnaire 9 (PHQ 9). Result. Totally 264 type 2 diabetic outpatients were interviewed with a response rate of 95.6%. The prevalence of depression among type 2 diabetic outpatients was 13%. Based on PHQ 9 score, 28.4% (75) fulfilled the criteria for mild depression, 12.1% (32) for moderate depression, 2.7% (7) for moderately severe depression, and 1.5% (4) for severe depression. But 45.8% (121) of patients had no clinically significant depression. Conclusion. This study demonstrated that depression is a common comorbid health problem in type 2 diabetic outpatients with a prevalence rate of 13%.
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Cabassa LJ, Gomes AP, Meyreles Q, Capitelli L, Younge R, Dragatsi D, Alvarez J, Manrique Y, Lewis-Fernández R. Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness. Implement Sci 2014; 9:178. [PMID: 25433494 PMCID: PMC4255430 DOI: 10.1186/s13012-014-0178-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community. Methods The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. Results The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention. Conclusions Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the transportability of a health-care manager intervention in order to improve the health of people with SMI. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0178-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopoldo J Cabassa
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA. .,New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA.
| | - Arminda P Gomes
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Quisqueya Meyreles
- New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA.
| | - Lucia Capitelli
- New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA.
| | - Richard Younge
- Columbia University Medical Center, 100 Haven Suite 27C, New York, NY, 10032, USA.
| | - Dianna Dragatsi
- New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA.
| | - Juana Alvarez
- New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA.
| | - Yamira Manrique
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Roberto Lewis-Fernández
- New York State Psychiatric Institute, Room 3206, Unit 69, 1051 Riverside Drive, New York, NY, 10036, USA. .,Columbia University Medical Center, 100 Haven Suite 27C, New York, NY, 10032, USA.
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Attridge M, Creamer J, Ramsden M, Cannings‐John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD006424. [PMID: 25188210 PMCID: PMC10680058 DOI: 10.1002/14651858.cd006424.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. SEARCH METHODS A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification. MAIN RESULTS A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment. AUTHORS' CONCLUSIONS Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.
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Affiliation(s)
- Madeleine Attridge
- 3rd Floor Neuadd Meirionnydd, Cardiff UniversityCochrane Institute of Primary Care and Public HealthHeath ParkCardiffUKCF14 4YS
| | | | - Michael Ramsden
- 8th Floor, Neuadd Meirionnydd, Cardiff UniversityWales DeaneryHeath ParkCardiffUKCF14 4YS
| | - Rebecca Cannings‐John
- 4th Floor, Neuadd Meirionnydd, Cardiff UniversitySouth East Wales Trials UnitHealth ParkCardiffUKCF14 4XN
| | - Kamila Hawthorne
- 5th Floor, Cochrane Building, School of Medicine, Cardiff UniversityInstitute of Medical EducationHeath ParkCardiffUKCF14 4XN
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Wu B, Jin H, Vidyanti I, Lee PJ, Ell K, Wu S. Collaborative depression care among Latino patients in diabetes disease management, Los Angeles, 2011-2013. Prev Chronic Dis 2014; 11:E148. [PMID: 25167093 PMCID: PMC4149319 DOI: 10.5888/pcd11.140081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction The prevalence of comorbid diabetes and depression is high, especially in low-income Hispanic or Latino patients. The complex mix of factors in safety-net care systems impedes the adoption of evidence-based collaborative depression care and results in persistent disparities in depression outcomes. The Diabetes–Depression Care-Management Adoption Trial examined whether the collaborative depression care model is an effective approach in safety-net clinics to improve clinical care outcomes of depression and diabetes. Methods A sample of 964 patients with diabetes from 5 safety-net clinics were enrolled in a quasi-experimental study that included 2 arms: usual care, in which primary medical providers and staff translated and adopted evidence-based depression care; and supportive care, in which providers of a disease management program delivered protocol-driven depression care. Because the study design established individual treatment centers as separate arms, we calculated propensity scores that interpreted the probability of treatment assignment conditional on observed baseline characteristics. Primary outcomes were 5 depression care outcomes and 7 diabetes care measures. Regression models with propensity score covariate adjustment were applied to analyze 6-month outcomes. Results Compared with usual care, supportive care significantly decreased Patient Health Questionnaire-9 scores, reduced the number of patients with moderate or severe depression, improved depression remission, increased satisfaction in care for patients with emotional problems, and significantly reduced functional impairment. Conclusion Implementing collaborative depression care in a diabetes disease management program is a scalable approach to improve depression outcomes and patient care satisfaction among patients with diabetes in a safety-net care system.
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Affiliation(s)
- Brian Wu
- School of Social Work and Epstein Department of Industrial and Systems Engineering, University of Southern California, 669 W 34th St, Montgomery Ross Fisher Bldg, Los Angeles, CA 90089-0411. E-mail:
| | - Haomiao Jin
- University of Southern California, Los Angeles, California
| | | | - Pey-Jiuan Lee
- University of Southern California, Los Angeles, California
| | - Kathleen Ell
- University of Southern California, Los Angeles, California
| | - Shinyi Wu
- RAND Corporation, Santa Monica, California
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Ell K, Oh H, Lee PJ, Guterman J. Collaborative health literate depression care among predominantly Hispanic patients with coronary heart disease in safety net care. PSYCHOSOMATICS 2014; 55:555-65. [PMID: 25262042 DOI: 10.1016/j.psym.2014.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/20/2014] [Accepted: 03/23/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether evidence-based socioculturally health literate-adapted collaborative depression care improves depression care, depressive symptoms, and quality of life among predominantly Hispanic patients with coronary heart disease. METHODS The 12-month trial included 97 patients with coronary heart disease (79% of eligible patients) who met the depression criteria assessed by the Patient Health Questionnaire-9. Patients were recruited from 3 safety net clinics and offered depression team care by a bilingual clinical social worker and community patient navigator, a consulting psychiatrist, and a primary care physician. The team provided problem-solving therapy (PST) or pharmacotherapy or both, telephone symptom monitoring and behavioral activation, and patient resource navigation support. Recruited patients were given patient and family member health literacy-adapted educational and community resource materials in Spanish or English. RESULTS Overall, depression treatment was 74% (PST, 55%; PST plus antidepressant medications, 18%; and antidepressant medications alone, 2%). Nearly half of the patients showed a 50% reduction of the Symptom Checklist-20 (49% at 6 mo and 48% at 12 mo) and of Patient Health Questionnaire-9 score with 47% of patients at 6 months and 43% at 12 months. The 50% improvement in Patient Health Questionnaire and Symptom Checklist-20 score reduction did not vary significantly between patients who received PST or antidepressant only or those who received PST plus antidepressant. The quality of life Short-Form Health Survey SF-12, the Minnesota Living with Heart Failure questionnaire, and the Sheehan Disability Scale outcomes also improved significantly. CONCLUSIONS Socioculturally literacy-adapted collaborative depression care was accepted by patients with coronary heart disease and improved depression care and symptoms, quality of life, and functional outcomes among predominantly Hispanic patients with heart disease.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
| | - Hyunsung Oh
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL)
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL)
| | - Jeffrey Guterman
- David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Services, Los Angeles County, Los Angeles, CA (JG)
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Wang ML, Lemon SC, Whited MC, Rosal MC. Who Benefits from Diabetes Self-Management Interventions? The Influence of Depression in the Latinos en Control Trial. Ann Behav Med 2014; 48:256-64. [DOI: 10.1007/s12160-014-9606-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Mikaliūkštienė A, Žagminas K, Juozulynas A, Narkauskaitė L, Sąlyga J, Jankauskienė K, Stukas R, Šurkienė G. Prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes in Lithuania. Med Sci Monit 2014; 20:182-90. [PMID: 24492643 PMCID: PMC3930682 DOI: 10.12659/msm.890019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Depression is associated with a variety of diabetes complications, including diabetic retinopathy, nephropathy, neuropathy, and macrovascular complications. The prevalence of the symptoms of anxiety (32%) and depression (22.4%) in patients with diabetes is considerably higher than in general population samples (10%). The aim of this study was to evaluate the prevalence and determinants of anxiety and depression symptoms in patients with type 2 diabetes (T2DM). Material/Methods This survey was conducted during 2007–2010. In total, 1500 patients were invited to participate in the study. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety for the evaluation of the depressive state and anxiety. Statistical analysis was carried out using SPSS 17.0. Results More than 70% of all respondents who participated in the study had diabetes mellitus complications (72.2%). The prevalence of mild to severe depression score was 28.5% (95% CI 25.7–31.4). The prevalence of anxiety was 42.4% (95% CI 39.3–45.5). Anxiety was more frequent among females (46.8%) than among males (34.7%) (p<0.001). A significant negative trend was observed between prevalence of anxiety and depression, and age and education (p for trend <0.001). Conclusions A significant association between depression and diabetic complications was identified (p<0.05). Duration of diabetes was a risk factor significantly associated with higher scores of anxiety among the patients with T2DM.
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Affiliation(s)
| | | | - Algirdas Juozulynas
- Department of Innovative Diagnostic, Treatment and Health Technology, Institute of Innovative Medicine, Vilnius, Lithuania
| | - Laura Narkauskaitė
- Research and Technology Assassment, Institute of Hygiene, Vilnius, Lithuania
| | - Jonas Sąlyga
- Faculty of Health Science, University of Klaipėda, Klaipėda, Lithuania
| | | | | | - Genė Šurkienė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Hansen MC, Cabassa LJ. Pathways to depression care: help-seeking experiences of low-income Latinos with diabetes and depression. J Immigr Minor Health 2013; 14:1097-106. [PMID: 22367667 DOI: 10.1007/s10903-012-9590-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression.
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Affiliation(s)
- Marissa C Hansen
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
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Wu S, Ell K, Gross-Schulman SG, Sklaroff LM, Katon WJ, Nezu AM, Lee PJ, Vidyanti I, Chou CP, Guterman JJ. Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design. Contemp Clin Trials 2013; 37:342-54. [PMID: 24215775 DOI: 10.1016/j.cct.2013.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 01/15/2023]
Abstract
Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities.
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Affiliation(s)
- Shinyi Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States.
| | - Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
| | - Art M Nezu
- Drexel University College of Arts and Sciences, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, United States.
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, United States; David Geffen School of Medicine at UCLA, United States.
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Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression. Cochrane Database Syst Rev 2012; 12:CD008381. [PMID: 23235661 DOI: 10.1002/14651858.cd008381.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression occurs frequently in patients with diabetes mellitus and is associated with a poor prognosis. OBJECTIVES To determine the effects of psychological and pharmacological interventions for depression in patients with diabetes and depression. SEARCH METHODS Electronic databases were searched for records to December 2011. We searched CENTRAL in The Cochrane Library, MEDLINE, EMBASE, PsycINFO, ISRCTN Register and clinicaltrials.gov. We examined reference lists of included RCTs and contacted authors. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating psychological and pharmacological interventions for depression in adults with diabetes and depression. Primary outcomes were depression and glycaemic control. Secondary outcomes were adherence to diabetic treatment regimens, diabetes complications, death from any cause, healthcare costs and health-related quality of life (HRQoL). DATA COLLECTION AND ANALYSIS Two review authors independently examined the identified publications for inclusion and extracted data from included studies. Random-effects model meta-analyses were performed to compute overall estimates of treatment outcomes. MAIN RESULTS The database search identified 3963 references. Nineteen trials with 1592 participants were included. Psychological intervention studies (eight trials, 1122 participants, duration of therapy three weeks to 12 months, follow-up after treatment zero to six months) showed beneficial effects on short (i.e. end of treatment), medium (i.e. one to six months after treatment) and long-term (i.e. more than six months after treatment) depression severity (range of standardised mean differences (SMD) -1.47 to -0.14; eight trials). However, between-study heterogeneity was substantial and meta-analyses were not conducted. Short-term depression remission rates (OR 2.88; 95% confidence intervals (CI) 1.58 to 5.25; P = 0.0006; 647 participants; four trials) and medium-term depression remission rates (OR 2.49; 95% CI 1.44 to 4.32; P = 0.001; 296 participants; two trials) were increased in psychological interventions compared to usual care. Evidence regarding glycaemic control in psychological intervention trials was heterogeneous and inconclusive. QoL did not improve significantly based on the results of three psychological intervention trials compared to usual care. Healthcare costs and adherence to diabetes and depression medication were examined in only one study and reliable conclusions cannot be drawn. Diabetes complications and death from any cause have not been investigated in the included psychological intervention trials.With regards to the comparison of pharmacological interventions versus placebo (eight trials; 377 participants; duration of intervention three weeks to six months, no follow-up after treatment) there was a moderate beneficial effect of antidepressant medication on short-term depression severity (all studies: SMD -0.61; 95% CI -0.94 to -0.27; P = 0.0004; 306 participants; seven trials; selective serotonin reuptake inhibitors (SSRI): SMD -0.39; 95% CI -0.64 to -0.13; P = 0.003; 241 participants; five trials). Short-term depression remission was increased in antidepressant trials (OR 2.50; 95% CI 1.21 to 5.15; P = 0.01; 136 participants; three trials). Glycaemic control improved in the short term (mean difference (MD) for glycosylated haemoglobin A1c (HbA1c) -0.4%; 95% CI -0.6 to -0.1; P = 0.002; 238 participants; five trials). HRQoL and adherence were investigated in only one trial each showing no statistically significant differences. Medium- and long-term depression and glycaemic control outcomes as well as healthcare costs, diabetes complications and mortality have not been examined in pharmacological intervention trials. The comparison of pharmacological interventions versus other pharmacological interventions (three trials, 93 participants, duration of intervention 12 weeks, no follow-up after treatment) did not result in significant differences between the examined pharmacological agents, except for a significantly ameliorated glycaemic control in fluoxetine-treated patients (MD for HbA1c -1.0%; 95% CI -1.9 to -0.2; 40 participants) compared to citalopram in one trial. AUTHORS' CONCLUSIONS Psychological and pharmacological interventions have a moderate and clinically significant effect on depression outcomes in diabetes patients. Glycaemic control improved moderately in pharmacological trials, while the evidence is inconclusive for psychological interventions. Adherence to diabetic treatment regimens, diabetes complications, death from any cause, health economics and QoL have not been investigated sufficiently. Overall, the evidence is sparse and inconclusive due to several low-quality trials with substantial risk of bias and the heterogeneity of examined populations and interventions.
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Affiliation(s)
- Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Debar LL, Kindler L, Keefe FJ, Green CA, Smith DH, Deyo RA, Ames K, Feldstein A. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med 2012; 2:523-530. [PMID: 23440672 DOI: 10.1007/s13142-012-0163-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Chronic pain affects at least 116 million adults in the USA and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, the primary care setting is where most patients seek and receive care for pain. Primary care-based treatment of chronic pain by interdisciplinary teams (including behavioral specialists, nurse case managers, physical therapists, and pharmacists) is one of the most effective approaches for improving outcomes and managing costs. To ensure robust integration of such services into sustainable health-care programs, evaluations must be conducted by researchers well versed in the methodologies of clinical trials, mixed methods and implementation research, bioinformatics, health services, and cost-effectiveness. Recent national health policy changes, in addition to the increasing recognition of the high prevalence and cost of chronic pain conditions, present a unique opportunity to shift the care paradigm for patients with chronic pain.
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Affiliation(s)
- Lynn L Debar
- Kaiser Permanente Center for Health Research, Portland, OR, USA
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Ell K, Katon W, Lee PJ, Kapetanovic S, Guterman J, Xie B, Chou CP. Depressive symptom deterioration among predominantly Hispanic diabetes patients in safety net care. PSYCHOSOMATICS 2012; 53:347-55. [PMID: 22458987 DOI: 10.1016/j.psym.2011.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/13/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study examines clinical predictors of symptom deterioration (relapse/recurrence) at the completion of a clinical intervention trial of depressed, low-income, predominantly Hispanic diabetes patients who were randomized to socio-culturally adapted collaborative depression treatment or usual care and who no longer met clinically significant depression criteria at 12 months post-trial baseline. METHODS A sub-cohort of 193 diabetes patients with major depression symptoms at baseline, who were randomized to a 12-month collaborative care intervention (INT) (problem-solving therapy and/or pharmacotherapy, telephone symptom monitoring/relapse prevention, behavioral activation and patient navigation support) or enhanced usual care (EUC), and who did not meet major depression criteria at 12 months were subsequently observed over 18 to 24 months. RESULTS Post-trial depression symptom deterioration was similar between INT (35.2%) and EUC (35.3%) groups. Among the combined groups, significant predictors of symptom deterioration were baseline history of previous depression and/or dysthymia (odds ratio [OR] = 2.66), 12-month PHQ-9 score (OR = 1.22), antidepressant treatment receipt during the initial 12-months (OR = 2.38), 12-month diabetes symptoms (OR = 2.27), and new ICD-9 medical diagnoses in the initial 12 months (OR = 1.11) (R2 = 27%; max-rescaled R2 = 37%; likelihood ratio test, χ2 = 59.79, df = 5, P < 0.0001). CONCLUSIONS Among predominantly Hispanic diabetes patients in community safety net primary care clinics whose depression had improved over 1 year, more than one-third experienced symptom deterioration over the following year. A primary care management depression care protocol that includes ongoing depression symptom monitoring, antidepressant adherence, and diabetes and co-morbid illness monitoring plus depression medication adjustment and behavioral activation may reduce and/or effectively treat depression symptom deterioration.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California, Los Angeles 90089-0411, USA.
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Kollannoor-Samuel G, Wagner J, Damio G, Segura-Pérez S, Chhabra J, Vega-López S, Pérez-Escamilla R. Social support modifies the association between household food insecurity and depression among Latinos with uncontrolled type 2 diabetes. J Immigr Minor Health 2011; 13:982-9. [PMID: 21789561 PMCID: PMC3205303 DOI: 10.1007/s10903-011-9499-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prevalence of depression is high among individuals with type 2 diabetes (T2D). The objective of the current study was to identify the socio-demographic, psychosocial, cultural, and clinical risk factors that predispose to depression, and resources that protect from depression among low income Latinos with T2D. Participants (N = 211) were interviewed in their homes upon enrollment. Multivariate logistic regression was used to identify factors associated with depressive symptoms based on a score of ≥21 on the Center for Epidemiological Studies Depression scale. Lower household income, interference of diabetes with daily activities, and more T2D clinical symptoms were associated with depression risk in the multivariate analyses. At each level of food insecurity the risk of depression was lower the higher the level of social support (P < 0.05). Findings suggest that social support buffers against the negative influence of household food insecurity on depression risk. A comprehensive approach is necessary to address the mental health needs of low income Latinos with T2D.
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Ell K, Katon W, Xie B, Lee PJ, Kapetanovic S, Guterman J, Chou CP. One-year postcollaborative depression care trial outcomes among predominantly Hispanic diabetes safety net patients. Gen Hosp Psychiatry 2011; 33:436-42. [PMID: 21774987 PMCID: PMC3175272 DOI: 10.1016/j.genhosppsych.2011.05.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/25/2011] [Accepted: 05/27/2011] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to determine sustained effectiveness in reducing depression symptoms and improving depression care 1 year following intervention completion. METHOD Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socioculturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed 2-year follow-up. Depression symptoms (Symptom Checklist-20 [SCL-20], Patient Health Questionnaire-9 [PHQ-9]), treatment receipt, diabetes symptoms and quality of life were assessed 24 months postenrollment using intent-to-treat analyses. RESULTS At 24 months, more intervention patients received ongoing antidepressant treatment (38% vs. 25%, χ(2)=5.11, df=1, P=.02); sustained depression symptom improvement [SCL-20 <0.5 (adjusted odds ratio=2.06, 95% confidence interval=1.09-3.90, P=.03), SCL-20 score (adjusted mean difference -0.22, P=.001) and PHQ-9 ≥50% reduction (adjusted odds ratio=1.87, 95% confidence interval =1.05-3.32, P=.03)]. Over 2 years, improved effects were found in significant study group by time interaction for Short Form-12 mental health, Sheehan Disability Scale (SDS) functional impairment, diabetes symptoms, anxiety and socioeconomic stressors (P=.02 for SDS; P<.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months. CONCLUSIONS Socioculturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, MRF 102R (MC 0411), University of Southern California, Los Angeles, CA 90089-0411, USA.
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California
| | - Suad Kapetanovic
- National Institute of Mental Health, National Institutes of Health
| | - Jeffery Guterman
- David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California
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50
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Waitzfelder B, Gerzoff RB, Karter AJ, Crystal S, Bair MJ, Ettner SL, Brown AF, Subramanian U, Lu SE, Marrero D, Herman WH, Selby JV, Dudley RA. Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study. Prim Care Diabetes 2010; 4:215-222. [PMID: 20832375 PMCID: PMC4269468 DOI: 10.1016/j.pcd.2010.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 05/20/2010] [Accepted: 07/20/2010] [Indexed: 11/28/2022]
Abstract
AIM The broad objective of this study was to examine multiple dimensions of depression in a large, diverse population of adults with diabetes. Specific aims were to measure the association of depression with: (1) patient characteristics; (2) outcomes; and (3) diabetes-related quality of care. METHODS Cross-sectional analyses were performed using survey and chart data from the Translating Research Into Action for Diabetes (TRIAD) study, including 8790 adults with diabetes, enrolled in 10 managed care health plans in 7 states. Depression was measured using the Patient Health Questionnaire (PHQ-8). Patient characteristics, outcomes and quality of care were measured using validated survey items and chart data. RESULTS Nearly 18% of patients had major depression, with prevalence 2-3 times higher among patients with low socioeconomic status. Pain and limited mobility were strongly associated with depression, controlling for other patient characteristics. Depression was associated with slightly worse glycemic control, but not other intermediate clinical outcomes. Depressed patients received slightly fewer recommended diabetes-related processes of care. CONCLUSIONS In a large, diverse cohort of patients with diabetes, depression was most prevalent among patients with low socioeconomic status and those with pain, and was associated with slightly worse glycemic control and quality of care.
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