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A Narrative Review on REM Sleep Deprivation: A Promising Non-Pharmaceutical Alternative for Treating Endogenous Depression. J Pers Med 2023; 13:jpm13020306. [PMID: 36836540 PMCID: PMC9960519 DOI: 10.3390/jpm13020306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023] Open
Abstract
Endogenous depression represents a severe mental health condition projected to become one of the worldwide leading causes of years lived with disability. The currently available clinical and non-clinical interventions designed to alleviate endogenous depression-associated symptoms encounter a series of inconveniences, from the lack of intervention effectiveness and medication adherence to unpleasant side effects. In addition, depressive individuals tend to be more frequent users of primary care units, which markedly affects the overall treatment costs. In parallel with the growing incidence of endogenous depression, researchers in sleep science have discovered multiple links between rapid eye movement (REM) sleep patterns and endogenous depression. Recent findings suggest that prolonged periods of REM sleep are associated with different psychiatric disorders, including endogenous depression. In addition, a growing body of experimental work confidently describes REM sleep deprivation (REM-D) as the underlying mechanism of most pharmaceutical antidepressants, proving its utility as either an independent or adjuvant approach to alleviating the symptoms of endogenous depression. In this regard, REM-D is currently being explored for its potential value as a sleep intervention-based method for improving the clinical management of endogenous depression. Therefore, this narrative review represents a comprehensive inventory of the currently available evidence supporting the potential use of REM-D as a reliable, non-pharmaceutical approach for treating endogenous depression, or as an adjuvant practice that could improve the effectiveness of currently used medication.
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The Relationship Between Neuropsychiatric Diagnoses and Revision Surgery After Breast Reconstruction. Ann Plast Surg 2022; 89:615-621. [DOI: 10.1097/sap.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zhang L, Shooshtari S, St. John P, Menec VH. Multimorbidity and depressive symptoms in older adults and the role of social support: Evidence using Canadian Longitudinal Study on Aging (CLSA) data. PLoS One 2022; 17:e0276279. [PMID: 36355773 PMCID: PMC9648733 DOI: 10.1371/journal.pone.0276279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The rising prevalence of multimorbidity poses challenges to health systems globally. The objectives of this study were to investigate: 1) the association between multimorbidity and depressive symptoms; and 2) whether social support plays a protective role in this association. METHODS A prospective population-based cohort study was conducted to analyze baseline and 3-year follow-up data of 16,729 community dwelling participants aged 65 and above in the Canadian Longitudinal Study of Aging (CLSA). Multimorbidity was defined as having three or more chronic conditions. The 10-item Center for Epidemiologic Studies Depression scale (CESD-10) was used to measure depressive symptoms. The 19-item Medical Outcomes Study (MOS) Social Support Survey was employed to assess perceived social support. Multivariate logistic regression models were used to examine the association between multimorbidity, social support and depressive symptoms. RESULTS Multimorbidity was very common among participants with a prevalence of 70.6%. Fifteen percent of participants had depressive symptoms at baseline. Multimorbidity was associated with increased odds of having depressive symptoms at 3-year follow-up (adjusted odds ratio, aOR = 1.51, 95% CI 1.33, 1.71), and developing depressive symptoms by follow-up among those with no depressive symptoms at baseline (aOR = 1.65, 95% CI 1.42, 1.92). Social support was consistently associated with decreased odds of depressive symptoms, regardless of level of multimorbidity. CONCLUSION Multimorbidity was positively associated with depressive symptoms over time, but social support served as a protective factor. As a modifiable, protective factor, emphasis should be placed in clinical practice to assess social support and refer patients to appropriate services, such as support groups. Similarly, health policy should focus on ensuring that older adults have access to social support opportunities as a way to promote mental health among older adults. Community organizations that offer social activities or support groups play a key role in this respect and should be adequately supported (e.g., with funding).
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Affiliation(s)
- Lixia Zhang
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip St. John
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Verena H. Menec
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Meng Y, Luo Y, Yue J, Nie M, Fan L, Li T, Tong C. The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis. Arch Psychiatr Nurs 2022; 40:167-173. [PMID: 36064241 DOI: 10.1016/j.apnu.2022.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/16/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022]
Abstract
The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.
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Affiliation(s)
- Yanting Meng
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China; Medical College of Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Yang Luo
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China.
| | - Jing Yue
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Min Nie
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Ling Fan
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Ting Li
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
| | - Chenxi Tong
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, China
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Qiu H, Wang L, Zeng X, Pan J. Comorbidity patterns in depression: A disease network analysis using regional hospital discharge records. J Affect Disord 2022; 296:418-427. [PMID: 34606805 DOI: 10.1016/j.jad.2021.09.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is a psychiatric disorder with a high comorbidity burden; however, previous comorbidity studies predominately focused on a few common diseases and relied on self-reported data. We aimed to investigate the comorbid status of depression concerning the entire spectrum of chronic diseases using network analysis. METHOD Totally, 22,872 depressed inpatients and one-to-one matched controls were enrolled in the retrospective study. Hospital discharge records were aggregated to measure the comorbidities, where those with a prevalence ≥ 1% were selected for further analysis. Based on the co-occurrence frequency, sex- and age-specific comorbidity networks in depressed patients were constructed and the results were compared with the controls. Louvain algorithm was used to detect the highly interlinked communities. RESULTS Depressed patients had 4 comorbidities on average, and 84.4% had at least one comorbidity. The comorbidity network in depression cases was more complex than controls (connections of 839 vs. 369). Intricate but distinct communities appeared within the comorbidity network in depressed patients, where the largest community included cerebrovascular diseases, chronic ischaemia heart disease, atherosclerosis and osteoporosis. Sex-specific central diseases existed, and cardiovascular diseases were the major central diseases to both gender. The older the depressed patients, the more severe the central diseases in the comorbidity network. LIMITATIONS The causality of the observed interactions could not be determined. CONCLUSIONS The application of network analysis on longitudinal healthcare datasets to assess comorbidity patterns can supplement the traditional clinical study approaches. The findings would improve our understanding of depression-related comorbidities and enhance the integrated management of depression.
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Affiliation(s)
- Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China; Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianrong Zeng
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingping Pan
- Health Information Center of Sichuan Province, Chengdu, China
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Hamm ME, Karp JF, Lenard E, Dawdani A, Lavretsky H, Lenze EJ, Mulsant BH, Reynolds CF, Roose SP, Brown PJ. "What else can we do?"-Provider perspectives on treatment-resistant depression in late life. J Am Geriatr Soc 2021; 70:1190-1197. [PMID: 34862593 DOI: 10.1111/jgs.17592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Treatment-resistant depression in late-life (TRLLD) is common. Perspectives of primary care providers (PCPs) and psychiatrists treating TRLLD could give insights into the challenges and potential solutions for managing this condition. METHODS To identify perspectives of providers who treat TRLLD, we conducted a qualitative descriptive study using semi-structured interviews with providers treating older adults with TRLLD in five locations across North America (i.e., Los Angeles, New York City, Pittsburgh, St. Louis, and Toronto). We conducted semi-structured interviews with 50 care providers (24 primary care providers [PCPs], 22 psychiatrists, and 4 depression care managers). Interviews elicited providers' perspectives on treatment options for TRLLD, including treatment within the primary care setting and referral to psychiatry, and sought suggestions for improvement. RESULTS We identified four themes. (1) Treating TRLLD takes an emotional toll on providers; (2) existing psychiatric services are inadequate to meet the needs of patients with TRLLD, mainly because of lack of access; (3) PCPs often attempt to treat TRLLD, even when they are not comfortable doing so; and (4) to better meet the needs of patients with TRLLD, providers recommend integrated care models involving PCPs, psychiatrists, and psychotherapists, potentially made more feasible by the growth of telehealth. CONCLUSIONS Findings from these qualitative interviews show the challenges in providing care for TRLLD. These findings can guide knowledge dissemination to psychiatrists, PCPs, policy-makers, and other stakeholders involved in the mental health system. They can also inform structural changes to clinical practice that may increase the implementation of the best treatment strategies across settings to improve long-term outcomes for TRLLD.
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Affiliation(s)
- Megan E Hamm
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Emily Lenard
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Alicia Dawdani
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles F Reynolds
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven P Roose
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
| | - Patrick J Brown
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, New York, USA
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G. Lazar S. Il ruolo della terapia psicodinamica e gli ostacoli alla sua diffusione. PSICOTERAPIA E SCIENZE UMANE 2021. [DOI: 10.3280/pu2021-004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Dalle ricerche emerge che la terapia psicodinamica è efficace in modo specifico per pazienti con disturbi di personalità, disturbi cronici d'ansia e depressivi e anche disturbi cronici complessi. Inoltre, la frequenza settimanale e la durata della terapia hanno effetti positivi indipendenti tra loro. Uno degli ostacoli alla diffusione della terapia psicodinamica è il fatto che vengono preferiti i trattamenti brevi, in particolar modo la terapia cognitivo-comportamentale (CBT), considerata spesso il gold standard (cioè la terapia migliore che ci sia) nonostante i problemi che sono stati rilevati nelle metodologie delle ricerche sperimentali, nella validità dei risultati in suo favore, nella generalizzabilità dei risultati e nei metodi diagnostici utilizzati. Un altro ostacolo all'erogazione della terapia psicodinamica risiede nei protocolli delle compagnie assicurative vigenti in molti Paesi, che guardano al contenimento dei costi anziché fornire ai pazienti un trattamento ottimale; negli Stati Uniti, ad esempio, tradiscono il mandato del Mental Health Parity Act, la legge che obbliga che i limiti massimi di copertura assicurativa per i disturbi mentali non seguano criteri diversi da quelli per i trattamenti ottimali dei problemi medici o chirurgici.
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Lazar SG. The Cost-Effectiveness of Psychodynamic Therapy: The Obstacles, the Law, and a Landmark Lawsuit. PSYCHOANALYTIC INQUIRY 2021. [DOI: 10.1080/07351690.2021.1983404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Association of co-occurring opioid or other substance use disorders with increased healthcare utilization in patients with depression. Transl Psychiatry 2021; 11:265. [PMID: 33941761 PMCID: PMC8093211 DOI: 10.1038/s41398-021-01372-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 02/03/2023] Open
Abstract
Substance use disorders (SUDs) commonly co-occur with mental illness. However, the ongoing addiction crisis raises the question of how opioid use disorder (OUD) impacts healthcare utilization relative to other SUDs. This study examines the utilization patterns of patients with major depressive disorder (MDD) and: (1) co-occurring OUD (MDD-OUD); (2) a co-occurring SUD other than OUD (MDD-NOUD); and (3) no co-occurring SUD (MDD-NSUD). We analyzed electronic health records (EHRs) derived from multiple health systems across the New York City (NYC) metropolitan area between January 2008 and December 2017. 11,275 patients aged ≥18 years with a gap of 30-180 days between 2 consecutive MDD diagnoses and an antidepressant prescribed 0-180 days after any MDD diagnosis were selected, and prevalence of any SUD was 24%. Individuals were stratified into comparison groups and matched on age, gender, and select underlying comorbidities. Prevalence rates and encounter frequencies were measured and compared across outpatient, inpatient, and emergency department (ED) settings. Our key findings showed that relative to other co-occurring SUDs, OUD was associated with larger increases in the rates and odds of using substance-use-related services in all settings, as well as services that integrate mental health and substance abuse treatments in inpatient and ED settings. OUD was also associated with larger increases in total encounters across all settings. These findings and our proposed policy recommendations could inform efforts towards targeted OUD interventions, particularly for individuals with underlying mental illness whose treatment and recovery are often more challenging.
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Wu CY, Chan TF, Shi HY, Kuo YL. Psychiatric problems of anxiety and depression disorder are associated with medical service utilization and survival among patients with cervical cancer. Taiwan J Obstet Gynecol 2021; 60:474-479. [PMID: 33966731 DOI: 10.1016/j.tjog.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There are few nationwide studies regarding the long-term analysis of cervical cancer patients in Taiwan. Thus, this study aimed to evaluate medical service utilization, and survival among cervical cancer patients initially diagnosed with or without anxiety and/or depressive disorders. MATERIALS AND METHODS This was a retrospective longitudinal study using data from the National Health Insurance Research Database from 1996 to 2010. The study subjects were cervical cancer patients identified by ICD-9-CM codes 180.X, while subjects with anxiety and/or depressive disorders were identified using the following codes: 300.0X-300.9X (minus 300.4X) for anxiety disorder, and 296.2X, 296.3X, 300.4, and 311.X for depressive disorder. The cervical patients with anxiety or/and depression disorder were classified as anxiety/depression (AD) group or the non-disorder (ND) group. Propensity score matching (PSM) was used to adjust for differences between the AD and ND groups. T-tests were used to evaluate differences in medical utilization and the Kaplan-Meier method was used to evaluate survival conditions between the two groups. Statistical analyses were performed using SPSS Statistics 20.0. RESULTS A total of 3664 patients were identified, with 862 (23.5%) having anxiety, 149 (4.1%) with depression, and 349 (9.5%) having both anxiety and depression. In total, 1360 cervical cancer patients had anxiety/depression disorders. After PSM, the AD group had significantly more outpatient department (OPD) visits than the ND group (p < 0.001) but the survival status was better in the AD group than the ND group (p < 0.001). CONCLUSIONS Cervical cancer patients with anxiety/depression disorders visited the OPD more frequently than those without anxiety/depression disorders but had better survival status. Gynecologists should also consider cancer patients' mental status during follow-up, referring patients to psychiatric professionals for appropriate psychiatric care if appropriate.
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Affiliation(s)
- Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Fu Chan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine & Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Ling Kuo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Armbrecht E, Shah R, Poorman GW, Luo L, Stephens JM, Li B, Pappadopulos E, Haider S, McIntyre RS. Economic and Humanistic Burden Associated with Depression and Anxiety Among Adults with Non-Communicable Chronic Diseases (NCCDs) in the United States. J Multidiscip Healthc 2021; 14:887-896. [PMID: 33935498 PMCID: PMC8079356 DOI: 10.2147/jmdh.s280200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with both major depressive disorder (MDD) and generalized anxiety disorder (GAD) in addition to one or multiple comorbid non-communicable chronic diseases (NCCDs) face unique challenges. However, few studies have characterized how the burden of co-occurring MDD and GAD differs from that of only MDD or only GAD among patients with NCCDs. METHODS In this study, we used Medical Expenditures Panel Survey data from 2010-2017 to understand how the economic and humanistic burden of co-occurring MDD and GAD differs from that of MDD or GAD alone among patients with NCCDs. We used generalized linear models to investigate this relationship and controlled for patient sociodemographics and clinical characteristics. RESULTS Co-occurring MDD and GAD was associated with increases in mean annual per patient inpatient visits, office visits, emergency department visits, annual drug costs, and total medical costs. Among patients with 3+ NCCDs, MDD or GAD only was associated with lower odds ratios (ORs) of limitations in activities of daily living (ADLs; 0.532 and 0.508, respectively) and social (0.503, 0.526) and physical limitations (0.613, 0.613) compared to co-occurring MDD and GAD. Compared to patients with co-occurring MDD and GAD, having MDD only or GAD only was associated with significantly lower odds of cognitive limitations (0.659 and 0.461, respectively) in patients with 1-2 NCCDs and patients with 3+ NCCDs (0.511, 0.416). DISCUSSION Comorbid MDD and GAD was associated with higher economic burden, lower quality of life, and greater limitations in daily living compared to MDD or GAD alone. Health-related economic and humanistic burden increased with number of NCCDs.
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Affiliation(s)
- Eric Armbrecht
- Saint Louis University Center for Health Outcomes Research, Saint Louis University, Saint Louis, MO, USA
| | | | | | - Linlin Luo
- Pharmerit International, Bethesda, MD, USA
| | | | | | | | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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Villela RM, Lazar SG. Moving Forward While Standing Still: A Case of Mental Health Advocacy Evolving in the Time of COVID-19. J Psychiatr Pract 2021; 27:121-125. [PMID: 33656818 PMCID: PMC8043331 DOI: 10.1097/pra.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There have been shifts over time in the value placed on long-term psychotherapeutic modalities even though they can be life-saving. For example, the province of Ontario in Canada has been dealing with a government proposal put forward in 2019 to limit the length of psychotherapy treatment. In response, stakeholders from numerous groups came together to advocate for the importance of continuing unrestricted access to long-term psychotherapy. Approaches to this advocacy then had to unexpectedly adapt to the Coronavirus Disease 2019 (COVID-19) pandemic that came to the forefront in 2020 and will continue to develop in response to this changing landscape.
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Poulsen K, Pachana NA. Depression and Anxiety in Older and Middle‐aged Adults With Diabetes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2010.00020.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Horenstein A, Heimberg RG. Anxiety disorders and healthcare utilization: A systematic review. Clin Psychol Rev 2020; 81:101894. [DOI: 10.1016/j.cpr.2020.101894] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 07/21/2020] [Accepted: 07/29/2020] [Indexed: 12/18/2022]
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Mausbach BT, Decastro G, Schwab RB, Tiamson-Kassab M, Irwin SA. Healthcare use and costs in adult cancer patients with anxiety and depression. Depress Anxiety 2020; 37:908-915. [PMID: 32485033 PMCID: PMC7484454 DOI: 10.1002/da.23059] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Anxiety and depression are common in individuals with cancer and may impact healthcare service use and costs in this population. This study examined the effects of anxiety alone, depression alone, and comorbid anxiety and depressive disorder on healthcare use and costs among patients with cancer. METHOD This was a retrospective cohort analysis of administrative data of patients aged 18 or older with an International Classification of Diseases, Ninth Revision diagnosis of cancer. Key outcomes were any visit to emergency department (ED), any inpatient hospitalization, length of hospital stays, and annual healthcare costs 1 year from cancer diagnosis. RESULTS A total of 13,426 patients were included. Relative to patients with neither anxiety nor depression, those with anxiety alone, depression alone, or comorbid anxiety and depression were more likely to experience an ED visit and be hospitalized. Length of hospital stays were also longer and annual healthcare costs were significantly higher in all three clinical groups. CONCLUSIONS Cancer patients with anxiety and depression were at greater risk for ED visits and hospitalizations, experienced longer hospital stays, and accrued higher healthcare costs. Future researchers should determine whether screening and treating comorbid anxiety and depression may decrease healthcare utilization and improve turnover wellbeing among cancer patients.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Gabrielle Decastro
- Departments of Psychology, Ohio University, Athens, OH and San Diego State University, San Diego, CA
| | - Richard B Schwab
- Moores Cancer Center, University of California San Diego, La Jolla, CA,Division of Hematology/Oncology, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Maria Tiamson-Kassab
- Department of Psychiatry, University of California San Diego, La Jolla, CA,Moores Cancer Center, University of California San Diego, La Jolla, CA
| | - Scott A Irwin
- Cedars-Sinai Cancer & Department of Psychiatry and Behavioral Neurosciences, Cedars Sinai Health System, Los Angeles CA
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Read J, Sharpe L, Burton AL, Arean PA, Raue PJ, McDonald S, Titov N, Gandy M, Dear BF. A randomized controlled trial of internet-delivered cognitive behaviour therapy to prevent the development of depressive disorders in older adults with multimorbidity. J Affect Disord 2020; 264:464-473. [PMID: 31767215 DOI: 10.1016/j.jad.2019.11.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 10/03/2019] [Accepted: 11/12/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Multimorbidity, which commonly impacts older adults is associated with higher rates of depression. We aimed to investigate whether internet delivered cognitive-behaviour therapy (iCBT) could prevent depressive disorders in older adults with multimorbidity who were not currently depressed. METHOD 302 primary care and community participants aged 65 years and over, who had multimorbidity but did not meet criteria for a depressive disorder were randomised to an intervention group who received an eight-week, five session iCBT (n = 150) or to a control group (n = 152) who received treatment as usual. Diagnostic interviews were conducted at baseline, and three and six months after the intervention period, where indicated, and the presence of depressive disorder was the primary outcome. RESULTS The intention to treat, chi-square analyses indicated there were significantly fewer cases of depressive disorder in the treatment group compared to the control group by six-month follow-up (χ²(1,302) = 5.21, p = .02). LIMITATIONS The main limitations of this RCT are a short follow up period and low proportion of participants who developed depressive disorders. Participants were relatively well educated, with a majority having English as their first language. CONCLUSIONS These results indicate that depressive disorder was prevented in the first six months following iCBT with three times the number of cases of depressive disorder in the control group compared to the treatment group. Further research is required to determine whether iCBT can be effective for preventing depressive disorder in this population over a longer time period.
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O'Hea E, Kroll-Desrosiers A, Cutillo AS, Michalak HR, Barton BA, Harralson T, Carmack C, McMahon C, Boudreaux ED. Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes, health care utilization, and health provider behaviors: A multi-site randomized control trial. PATIENT EDUCATION AND COUNSELING 2020; 103:607-616. [PMID: 31753521 PMCID: PMC7061075 DOI: 10.1016/j.pec.2019.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO's effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors. METHODS 836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months. RESULTS The intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments. CONCLUSION The MHADRO may increase access to mental health care, lessen utilization, and improve providers' management of psychosocial needs, but does not appear to impact overall functioning over time. PRACTICE IMPLICATIONS Providers are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients' psychosocial needs.
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Affiliation(s)
- Erin O'Hea
- University of Massachusetts Medical School, Worcester, MA, and Department of Psychology, Stonehill University, Easton, MA, 320 Washington Street, Shields Science Center 212, Easton, MA, USA.
| | - Aimee Kroll-Desrosiers
- Biostatistician, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandra S Cutillo
- Medical/Clinical Psychology Doctoral Program, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hannah R Michalak
- Yale University Alzheimer's Disease Research Unit, One Church Street, Suite 600, New Haven, CT, 06510, United States
| | - Bruce A Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Cori McMahon
- Anderson at Cooper Cancer Center, Camden, NJ, USA
| | - Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Patel JS, Oh Y, Rand KL, Wu W, Cyders MA, Kroenke K, Stewart JC. Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005-2016. Depress Anxiety 2019; 36:813-823. [PMID: 31356710 PMCID: PMC6736700 DOI: 10.1002/da.22940] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. METHODS U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. RESULTS Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01. CONCLUSIONS We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.
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Affiliation(s)
- Jay S. Patel
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Youngha Oh
- Educational Psychology, Research, Evaluation, Measurement, and Statistics (REMS), Texas Tech University, Lubbock, TX
| | - Kevin L. Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Melissa A. Cyders
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Stasak B, Epps J, Goecke R. An investigation of linguistic stress and articulatory vowel characteristics for automatic depression classification. COMPUT SPEECH LANG 2019. [DOI: 10.1016/j.csl.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Aronow H, Fila S, Martinez B, Sosna T. Depression and Coleman Care Transitions Intervention. SOCIAL WORK IN HEALTH CARE 2018; 57:750-761. [PMID: 30015601 DOI: 10.1080/00981389.2018.1496514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Coleman Care Transitions Intervention (CTI) is a "Patient Activation Model." Depression can be a barrier to activation and may challenge CTI. This study addressed whether CTI coaches modified the intervention for older adults who screened positive for depression. Over 4,500 clients in a Centers for Medicare and Medicaid Services demonstration completed screening for depression with the PHQ-9; one in five screened positive (score = 9+). Our findings suggest that coaches modified CTI and played a more directive role for clients who screened positive for depression, resulting in similar 30-day readmission rates among patients who screened positive for depression risk and those who did not. That finding stands in contrast to the widely reported higher readmission rates among people screening positive for depression.
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Affiliation(s)
- Harriet Aronow
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Susan Fila
- b Santa Monica College , Department of Health and Wellbeing Services , Los Angeles , CA , USA
| | - Bibiana Martinez
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Todd Sosna
- c Jewish Family Service of Los Angeles , Los Angeles , USA
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Abstract
Psychodynamic treatment provides benefits for patients with personality disorders, chronic depressive and anxiety disorders, and chronic complex disorders, and its intensity and duration have independent positive effects. Obstacles to its provision include a bias privileging brief treatments, especially cognitive behavior therapy, seen as a gold standard of treatment, despite difficulties with the design of, and ability to generalize from, its supporting research and the diagnostic nosology of the illnesses studied. Another obstacle lies in insurance company protocols that violate the mandate for mental health parity and focus on conserving insurers' costs rather than the provision of optimum treatment to patients.
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Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. J Psychiatr Pract 2018; 24:179-193. [PMID: 30015788 DOI: 10.1097/pra.0000000000000309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The founding members of the Coalition for Psychotherapy Parity present Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity. These guidelines support access to psychotherapy as prescribed by the clinician without arbitrary limitations on duration or frequency. The authors of the guidelines first review the evidence that psychotherapy is effective, cost-effective, and often provides a cost-offset in decreased overall medical expenses, morbidity, mortality, and disability. They highlight the disparity between clinicians' knowledge of generally accepted standards of care for mental health and substance use disorders and the much more limited "crisis stabilization" focus of many insurance companies. The clinical trials that health insurers cite as justification for authorizing only brief treatment for all patients involve highly selected, atypical populations that are not representative of the general population of patients in need of mental health care, who typically have complex conditions and chronic, recurring symptoms requiring ongoing availability of treatment. The standard for other medical conditions reimbursed by insurance is continuation of effective treatment until meaningful recovery, which is therefore the standard required by the Mental Health Parity and Addiction Equity Act for mental health care. However, insurance companies frequently evade the legal requirement to cover treatment of mental illness at parity with other medical conditions. They do this by applying inaccurate proprietary definitions of medical necessity and imposing utilization review procedures much more restrictively for mental health treatment than for other medical care to block access to ongoing care, thus containing insurance company costs in the short term without consideration of the adverse sequelae of undertreated illness (eg, increased costs of other medical services and increased morbidity, mortality, and costs to society in increased disability). The authors of the guidelines conclude that, given appropriate medical necessity guidelines at parity with other medical care, consistent with provider expertise and a broad range of psychotherapy research, there would be no need or place for utilization review protocols. Individuals and psychotherapy organizations are invited to visit the website psychotherapyparity.org to sign on to the guidelines to indicate agreement and support.
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Mausbach BT, Yeung P, Bos T, Irwin SA. Health care costs of depression in patients diagnosed with cancer. Psychooncology 2018; 27:1735-1741. [DOI: 10.1002/pon.4716] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Brent T. Mausbach
- Department of Psychiatry; University of California San Diego; La Jolla CA USA
- Patient and Family Support Services, Moores Cancer Center; University of California San Diego; La Jolla CA USA
| | - Philip Yeung
- University of California San Diego Master of Advanced Studies (MAS) Program in Clinical Research; La Jolla CA USA
| | - Taylor Bos
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; La Jolla CA USA
| | - Scott A. Irwin
- Department of Psychiatry and Samuel Oschin Comprehensive Cancer Institute's Supportive Care Services; Cedars-Sinai Health System; Los Angeles CA USA
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Abstract
BACKGROUND Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression. METHOD A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity. RESULTS Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62-2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06-4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28-1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18-0.33) p <0.001]. LIMITATIONS Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures. CONCLUSIONS Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.
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Depression, quality of life, and medical resource utilization in sickle cell disease. Blood Adv 2017; 1:1983-1992. [PMID: 29296845 DOI: 10.1182/bloodadvances.2017006940] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 09/18/2017] [Indexed: 01/08/2023] Open
Abstract
Sickle cell disease (SCD) is a chronic, debilitating disorder. Chronically ill patients are at risk for depression, which can affect health-related quality of life (HRQoL), health care utilization, and cost. We performed an analytic epidemiologic prospective study to determine the prevalence of depression in adult patients with SCD and its association with HRQoL and medical resource utilization. Depression was measured by the Beck Depression Inventory and clinical history in adult SCD outpatients at a comprehensive SCD center. HRQoL was assessed using the SF36 form, and data were collected on medical resource utilization and corresponding cost. Neurocognitive functions were assessed using the CNS Vital Signs tool. Pain diaries were used to record daily pain. Out of 142 enrolled patients, 42 (35.2%) had depression. Depression was associated with worse physical and mental HRQoL scores (P < .0001 and P < .0001, respectively). Mean total inpatient costs ($25 000 vs $7487, P = .02) and total health care costs ($30 665 vs $13 016, P = .01) were significantly higher in patients with depression during the 12 months preceding diagnosis. Similarly, during the 6 months following diagnosis, mean total health care costs were significantly higher in depressed patients than in nondepressed patients ($13 766 vs $8670, P = .04). Depression is prevalent in adult patients with SCD and is associated with worse HRQoL and higher total health care costs. Efforts should focus on prevention, early diagnosis, and therapy for depression in SCD.
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Evaluating Excessive Burden of Depression on Health Status and Health Care Utilization Among Patients With Hypertension in a Nationally Representative Sample From the Medial Expenditure Panel Survey (MEPS 2012). J Nerv Ment Dis 2017; 205:397-404. [PMID: 28107250 DOI: 10.1097/nmd.0000000000000618] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression and hypertension frequently present together in clinical practice. Evaluating the interaction between depression and hypertension would help stakeholders better understand the value of depression prevention in primary care. This retrospective study aimed to evaluate the excessive burden of depression on overall health and on health care utilization expenditure among hypertensive patients. A total of 7019 hypertensive patients (ICD-9-CM: 401) were identified from the 2012 Medical Expenditure Panel Survey (MEPS 2012) data, of which 936 patients had depression (ICD-9-CM: 311). Hypertension with depression was associated with worse health status (physical component score, -3.97 [17.9% reduction]; mental component score, -9.14 [9% reduction]), higher utilization of health care services (outpatient visits, 6.4 [63.8% higher]; nights of hospitalization, 0.9 [100% higher]; medication prescription, 22.6 [76.8% higher]), and higher health care expenditures (inpatient, $1953.2 [72% higher]; prescription drugs, $1995.5 [82% higher]).
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Landry CM, Jackson AP, Tang L, Miranda J, Chung B, Jones F, Ong MK, Wells K. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery. Psychiatr Serv 2017; 68:123-130. [PMID: 27629796 PMCID: PMC6320755 DOI: 10.1176/appi.ps.201500550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. METHODS The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. RESULTS CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (p<.05). CONCLUSIONS Training participation, time spent providing services in community settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.
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Affiliation(s)
- Craig M Landry
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Aurora P Jackson
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Lingqi Tang
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Jeanne Miranda
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Bowen Chung
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Felica Jones
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Michael K Ong
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Kenneth Wells
- Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
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Hensel JM, Taylor VH, Fung K, Vigod SN. Rates of Mental Illness and Addiction among High-Cost Users of Medical Services in Ontario. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:358-66. [PMID: 27254845 PMCID: PMC4872244 DOI: 10.1177/0706743716644764] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantify the burden of mental illness and addiction among high-costing users of medical services (HCUs) using population-level data from Ontario, and compare to a referent group of nonusers. METHOD We conducted a population-level cohort study using health administrative data from fiscal year 2011-2012 for all Ontarians with valid health insurance as of April 1, 2011 (N = 10,909,351). Individuals were grouped based on medical costs for hospital, emergency, home, complex continuing, and rehabilitation care in 2011-2012: top 1%, top 2% to 5%, top 6% to 50%, bottom 50%, and a zero-cost nonuser group. The rate of diagnosed psychotic, major mood, and substance use disorders in each group was compared to the zero-cost referent group with adjusted odds ratios (AORs) for age, sex, and socioeconomic status. A sensitivity analysis included anxiety and other disorders. RESULTS Mental illness and addiction rates increased across cost groups affecting 17.0% of the top 1% of users versus 5.7% of the zero-cost group (AOR, 3.70; 95% confidence interval [CI], 3.59 to 3.81). This finding was most pronounced for psychotic disorders (3.7% vs. 0.7%; AOR, 5.07; 95% CI, 4.77 to 5.38) and persisted for mood disorders (10.0% vs. 3.3%; AOR, 3.52; 95% CI, 3.39 to 3.66) and substance use disorders (7.0% vs. 2.3%; AOR, 3.82; 95% CI, 3.66 to 3.99). When anxiety and other disorders were included, the rate of mental illness was 39.3% in the top 1% compared to 21.3% (AOR, 2.39; 95% CI, 2.34 to 2.45). CONCLUSIONS A high burden of mental illness and addiction among HCUs warrants its consideration in the design and delivery of services targeting HCUs.
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Affiliation(s)
- Jennifer M Hensel
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Valerie H Taylor
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario
| | - Kinwah Fung
- Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario Women's College Research Institute, Toronto, Ontario Institute for Clinical Evaluative Sciences, Toronto, Ontario
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Mausbach BT, Irwin SA. Depression and healthcare service utilization in patients with cancer. Psychooncology 2016; 26:1133-1139. [PMID: 27102731 DOI: 10.1002/pon.4133] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/02/2016] [Accepted: 03/20/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE It is estimated that as many as 38% of cancer patients suffer from depression, which may have distal impacts on cancer care, including clinical outcomes, health care utilization, and cost of care. The purpose of this study was to determine the impact of depression on overall healthcare utilization among patients with cancer. METHODS A retrospective analysis of administrative data was conducted on 5055 patients with an ICD-9 diagnosis of cancer from a single large healthcare system. Of these, 561 (11.1%) had ICD-9 diagnoses consistent with a depressive disorder. Negative binomial regression modeling was used to test the association between depression status and total annual healthcare visits for the year 2011. Logistic regression was used to examine the association between depression and secondary outcomes of emergency department visit, overnight hospitalization, and 30-day hospital readmission. RESULTS After adjusting for age, gender, race/ethnicity, insurance type, medical comorbidities, length of time with cancer, and metastatic status, depressed patients had significantly more annual non-mental health provider healthcare visits (aRR = 1.76, 95% CI = 1.61-1.93), and were significantly more likely to have an ED visit (OR = 2.45; 95% CI = 1.97-3.04), overnight hospitalization (OR = 1.81; 95% CI = 1.49-2.20), and 30-day hospital readmission (OR = 2.03; 95% CI = 1.48-2.79) than non-depressed patients with cancer. CONCLUSIONS Among patients with cancer, the presence of depression was associated with greater healthcare utilization. Effective screening for, and management of, depression may help reduce overall healthcare utilization and cost while improving care quality. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Brent T Mausbach
- Department of Psychiatry, University of California San Diego, and Patient and Family Support Services, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Scott A Irwin
- Department of Psychiatry, University of California San Diego, and Patient and Family Support Services, Moores Cancer Center, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry and Samuel Oschin Comprehensive Cancer Institute's Supportive Care Services, Cedars-Sinai Health System, USA
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Leibold ML, Holm MB, Raina KD, Reynolds CF, Rogers JC. Activities and adaptation in late-life depression: a qualitative study. Am J Occup Ther 2015; 68:570-7. [PMID: 25184470 DOI: 10.5014/ajot.2014.011130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We sought to understand activity choices of older adults when they were depressed. METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes. RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped. CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies.
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Affiliation(s)
- Mary Lou Leibold
- Mary Lou Leibold, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260;
| | - Margo B Holm
- Margo B. Holm, PhD, OTR/L, FAOTA, ABDA, is Professor Emerita, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ketki D Raina
- Ketki D. Raina, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Charles F Reynolds
- Charles F. Reynolds, III, MD, is Professor, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Joan C Rogers
- Joan C. Rogers, PhD, OTR/L, FAOTA, is Professor and Chair, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
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Hadidi NN, Lindquist R, Buckwalter K, Savik K. Feasibility of a Pilot Study of Problem-Solving Therapy for Stroke Survivors. Rehabil Nurs 2015; 40:327-37. [DOI: 10.1002/rnj.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/11/2022]
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Seok Seo J, Rim Song H, Bin Lee H, Park YM, Hong JW, Kim W, Wang HR, Lim ES, Jeong JH, Jon DI, Joon Min K, Sup Woo Y, Bahk WM. The Korean Medication Algorithm for Depressive Disorder: second revision. J Affect Disord 2015; 167:312-21. [PMID: 25010375 DOI: 10.1016/j.jad.2014.05.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/27/2022]
Abstract
AIM This study constitutes a revision of the guidelines for the treatment of major depressive disorder (MDD) issued by the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006. In incorporates changes in the experts׳ consensus that occurred between 2006 and 2012 as well as information regarding newly developed and recently published clinical trials. METHODS Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for (1) non-psychotic MDD, (2) psychotic MDD, (3) dysthymia and depression subtypes, (4) continuous and maintenance treatment, and (5) special populations; consensus was also obtained regarding (6) the choice of an antidepressant (AD) in the context of safety and adverse effects, and (7) non-pharmacological biological therapies. RESULTS AD monotherapy was recommended as the first-line strategy for nonpsychotic depression in adults, children and adolescents, elderly adults, and patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression. The duration of the initial AD treatment for psychotic depression depends on the number of depressive episodes. Most experts recommended stopping the initial AD and AAP therapy after a certain period in patients with one or two depressive episodes. However, for those with three or more episodes, maintenance of the initial treatment was recommended for as long as possible. Monotherapy with various selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) was recommended for dysthymic disorder and melancholic type MDD. CONCLUSION The pharmacological treatment strategy of KMAP-DD 2012 is similar to that of KMAP-DD 2006; however, the preference for the first-line use of AAPs was stronger in 2012 than in 2006.
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Affiliation(s)
- Jeong Seok Seo
- Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea
| | - Hoo Rim Song
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwang Bin Lee
- Department of Psychiatry, Seoul National Hospital, Seoul, Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Jeong-Wan Hong
- Department of Psychiatry, Namwon Sungil Mental Hospital, Namwon, Korea
| | - Won Kim
- Department of Psychiatry, Seoul Paik Hospital, School of Medicine, Inje University, Seoul, Korea/Stress Research Institute, Inje University, Seoul, Korea
| | - Hee-Ryung Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Sung Lim
- Department of Psychiatry, Shinsegae Hospital, KimJe, Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Duk-In Jon
- Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
| | - Kyung Joon Min
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
| | - Young Sup Woo
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Cook BL, Liu Z, Lessios AS, Loder S, McGuire T. The costs and benefits of reducing racial-ethnic disparities in mental health care. Psychiatr Serv 2015; 66:389-96. [PMID: 25588417 PMCID: PMC7595243 DOI: 10.1176/appi.ps.201400070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Previous studies have found that timely mental health treatment can result in savings in both mental health and general medical care expenditures. This study examined whether reducing racial-ethnic disparities in mental health care offsets costs of care. METHODS Data were from a subsample of 6,206 individuals with probable mental illness from the 2004-2010 Medical Expenditure Panel Survey (MEPS). First, disparities in mental health treatment were analyzed. Second, two-year panel data were used to determine the offset of year 1 mental health outpatient and pharmacy treatment on year 2 mental and general medical expenditures. Third, savings were estimated by combining results from steps 1 and 2. RESULTS Compared with whites, blacks and Latinos with year 1 outpatient mental health care spent less on inpatient and emergency general medical care in year 2. Latinos receiving mental health care in year 1 spent less than others on inpatient general medical care in year 2. Latinos taking psychotropic drugs in year 1 showed reductions in inpatient general medical care. Reducing racial-ethnic disparities in mental health care and in psychotropic drug use led to savings in acute medical care expenditures. CONCLUSIONS Savings in acute care expenditures resulting from eliminating disparities in racial-ethnic mental health care access were greater than costs in some but not all areas of acute mental health and general medical care. For blacks and Latinos, the potential savings from eliminating disparities in inpatient general medical expenditures are substantial (as much as $1 billion nationwide), suggesting that financial and equity considerations can be aligned when planning disparity reduction programs.
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Affiliation(s)
- Benjamin Lê Cook
- Dr. Cook, Mr. Liu, Ms. Lessios, and Mr. Loder are with the Center for Multicultural Mental Health Research, Cambridge Health Alliance, Somerville, Massachusetts (e-mail: ). Dr. Cook is also with the Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts. Dr. McGuire is with the Department of Health Care Policy, Harvard Medical School, Boston. This work was presented in part at the following meetings: AcademyHealth, June 24-26, 2012, Orlando, Florida; National Hispanic Science Network, September 26-29, 2012, San Diego; Eleventh Workshop on Costs and Assessment in Psychiatry, International Center of Mental Health Policy and Economics, March 22-24, 2013, Venice, Italy
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Poulsen KM, Pachana NA, McDermott BM. Health professionals' detection of depression and anxiety in their patients with diabetes: The influence of patient, illness and psychological factors. J Health Psychol 2014; 21:1566-75. [PMID: 25512198 DOI: 10.1177/1359105314559618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examines how often depression and anxiety, in patients with diabetes, are detected by health professionals; and whether detection is influenced by patient characteristics (age, gender), illness factors (duration of illness, diabetes control), and self-reported levels of depression and anxiety. Prevalence rates of clinically significant depression and anxiety were high (57% and 36%, respectively); however, of those identified, only 44 and 36 per cent, respectively, were detected by staff as depressed or anxious. The only significant predictors of detection were severity of depressive and anxious symptoms. Patient and illness characteristics did not influence whether professionals identified emotional problems in their patients.
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Affiliation(s)
- Kellee M Poulsen
- Mater Child and Youth Mental Health Service, Brisbane, Australia
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Hall CA, Reynolds-Iii CF. Late-life depression in the primary care setting: challenges, collaborative care, and prevention. Maturitas 2014; 79:147-52. [PMID: 24996484 PMCID: PMC4169311 DOI: 10.1016/j.maturitas.2014.05.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/07/2023]
Abstract
Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy.
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Affiliation(s)
- Charles A Hall
- SUNY Downstate Medical Center, College of Medicine, University of Pittsburgh School of Medicine, Department of Psychiatry, United States
| | - Charles F Reynolds-Iii
- NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh School of Medicine and Graduate School of Public Health, United States.
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Abstract
Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.
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Affiliation(s)
- Susan G Lazar
- Clinical Professor of Psychiatry: Georgetown University School of Medicine, George Washington University School of Medicine, Uniformed Services University of the Health Sciences; Supervising and Training Analyst, Washington Psychoanalytic Institute
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Malhi GS, Coulston CM, Fritz K, Lampe L, Bargh DM, Ablett M, Lyndon B, Sapsford R, Theodoros M, Woolfall D, van der Zypp A, Hopwood M, Mitchell AJ. Unlocking the diagnosis of depression in primary care: Which key symptoms are GPs using to determine diagnosis and severity? Aust N Z J Psychiatry 2014; 48:542-7. [PMID: 24270311 DOI: 10.1177/0004867413513342] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diagnosing depression in primary care settings is challenging. Patients are more likely to present with somatic symptoms, and typically with mild depression. Use of assessment scales is variable. In this context, it is uncertain how general practitioners (GPs) determine the severity of depressive illness in clinical practice. The aim of the current paper was to identify which symptoms are used by GPs when diagnosing depression and when determining severity. METHOD A total of 1760 GPs participated in the RADAR Program, an educational program focusing on the diagnosis and management of clinical depression. GPs identified a maximum of four patients whom they diagnosed with depression and answered questions regarding their diagnostic decision-making process for each patient. RESULTS Overall, assessment of depression severity was influenced more by somatic symptoms collectively than emotional symptoms. Suicidal thoughts, risk of self-harm, lack of enjoyment and difficulty with activities were amongst the strongest predictors of a diagnosis of severe depression. CONCLUSIONS The conclusions are threefold: (1) collectively, somatic symptoms are the most important predictors of determining depression severity in primary care; (2) GPs may equate risk of self-harm with suicidal intent; (3) educational initiatives need to focus on key depressive subtypes derived from emotional, somatic and associated symptoms.
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Affiliation(s)
- Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Carissa M Coulston
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kristina Fritz
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Lisa Lampe
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Danielle M Bargh
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, Australia Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Bill Lyndon
- Mood Disorders Unit, Northside Clinic, Greenwich, Australia
| | - Rick Sapsford
- Albany Hills Radius Medical Centre, Brendale Radius Medical Centre, Brisbane, Australia
| | - Mike Theodoros
- Mood Disorders Programme, New Farm Clinic, Brisbane, Australia
| | | | | | - Malcolm Hopwood
- Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Australia
| | - Alex J Mitchell
- Psycho-oncology Department, University of Leicester, Leicester, UK
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Ho RCM, Mak KK, Chua ANC, Ho CSH, Mak A. The effect of severity of depressive disorder on economic burden in a university hospital in Singapore. Expert Rev Pharmacoecon Outcomes Res 2014; 13:549-59. [PMID: 23977979 DOI: 10.1586/14737167.2013.815409] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Depressive disorder is treatable but costly, thus influencing quality of life of people. AIM Determine direct and indirect costs incurred by depressive disorder in Singapore. METHODS A 1-year prospective naturalistic study was conducted in a university mood disorder center between 2007 and 2008. Patients with primary International Classification of Disease-10 diagnosis of depressive disorder were recruited. Disease costs between mild, moderate and severe depression, and cost predictors were analyzed and determined. RESULTS Forty nine patients completed the study. Mean annual total costs per patient were US$7638. Indirect costs (81%) dominated the total costs. Approximately 50% of indirect costs were associated with loss of productivity and unemployment. Higher education level, higher mean Hamilton Rating Scale for Depression score and number of suicide attempts were independent variables associated with increased direct costs while mean Hamilton Rating Scale for Depression scale score was an independent variable for indirect costs. CONCLUSION Medical cost saving strategies should focus on indirect costs.
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Affiliation(s)
- Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, 119074, Singapore.
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Malhi GS, Fritz K, Coulston CM, Lampe L, Bargh DM, Ablett M, Lyndon B, Sapsford R, Theodoros M, Woolfall D, van der Zypp A, Hopwood M. Severity alone should no longer determine therapeutic choice in the management of depression in primary care: findings from a survey of general practitioners. J Affect Disord 2014; 152-154:375-80. [PMID: 24268593 DOI: 10.1016/j.jad.2013.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The treatment of depression in primary care remains suboptimal for reasons that are complex and multifactorial. Typically GPs have to make difficult decisions in limited time and therefore, the aim of this study was to examine the management of depression of varying severity and the factors associated with treatment choices. METHOD Nested within a primary care educational initiative we conducted a survey of 1760 GPs. The GPs each identified four patients with clinical depression whom they had treated recently and then answered questions regarding their diagnosis and management of each patient. RESULTS Comorbid anxiety, sadness and decreased concentration appeared to direct the management of depression toward psychological therapy, whereas comorbid pain and a patient's overall functioning, such as the ability to do simple everyday activities, directed the initiation of pharmacological treatment. The use of antidepressants with a broader spectrum of actions (acting on multiple neurotransmitters) increased from mild to severe depression, whereas this did not occur with the more selective agents. SSRIs were prescribed more frequently compared with all other antidepressants, irrespective of depression severity. LIMITATIONS GPs chose the RADAR programme and therefore they were potentially more likely to have an interest in mental health compared to GPs who did not participate. CONCLUSIONS GPs do not appear to be determining pharmacological treatment based on depression subtype and specificity, but rather on the basis of the total number of symptoms and overall severity. While acknowledging important differences between primary care and specialist practice, it is suggested that guidelines to assist GPs in matching treatment to depression subtype may be of practical assistance in decision-making, and the delivery of more effective treatments.
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Affiliation(s)
- G S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonard's, Sydney 2065, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.
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Neurologists' diagnostic accuracy of depression and cognitive problems in patients with parkinsonism. BMC Neurol 2012; 12:37. [PMID: 22702891 PMCID: PMC3465198 DOI: 10.1186/1471-2377-12-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 05/18/2012] [Indexed: 12/18/2022] Open
Abstract
Background Depression and cognitive impairment (CI) are important non-motor symptoms in Parkinson’s Disease (PD) and related syndromes, but it is not clear how well they are recognised in daily practice. We have studied the diagnostic performance of experienced neurologists on the topics depression and cognitive impairment during a routine encounter with a patient with recent-onset parkinsonian symptoms. Methods Two experienced neurologists took the history and examined 104 patients with a recent-onset parkinsonian disorder, and assessed the presence of depression and cognitive impairment. On the same day, all patients underwent a Hamilton Depression Rating Scale test, and a Scales for Outcomes in Parkinson’s Disease-Cognition-test (SCOPA-COG). Results The sensitivity of the neurologists for the topic depression was poor: 33.3%. However, the specificity varied from 90.8 to 94.7%. The patients’ sensitivity was higher, although the specificity was lower. On the topic CI, the sensitivity of the neurologists was again low, in a range from 30.4 up to 34.8%: however the specificity was high, with 92.9%. The patients’ sensitivity and specificity were both lower, compared to the number of the neurologists. Conclusions Neurologists’ intuition and clinical judgment alone are not accurate for detection of depression or cognitive impairment in patients with recent-onset parkinsonian symptoms because of low sensitivity despite of high specificity. Trial registration (ITRSCC)NCT0036819.
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Duffy SA, Missel AL, Waltje AH, Ronis DL, Fowler KE, Hong O. Health behaviors of Operating Engineers. AAOHN JOURNAL : OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION OF OCCUPATIONAL HEALTH NURSES 2011; 59:293-301. [PMID: 21688764 PMCID: PMC3721724 DOI: 10.3928/08910162-20110616-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/25/2011] [Indexed: 11/20/2022]
Abstract
Operating Engineers (heavy equipment operators in construction) may be at particular risk for heart disease and cancer related to their exposure to environmental dust and smoking, the sedentary nature of their job, and long hours of exposure to the sun. The aim of this study was to characterize the health behaviors of Operating Engineers. This cross-sectional survey from a convenience sample of Operating Engineers (N = 498) used validated instruments to measure smoking, drinking, diet, exercise, sleep, and sun exposure. Univariate and bivariate analyses to detect differences by age were conducted. The sample scored significantly worse on all five health behaviors compared to population norms. Those who were older were less likely to smoke and chew tobacco and more likely to eat fruits and vegetables. Many were interested in services to improve their health behaviors. Health behavior interventions are needed and wanted by Operating Engineers.
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Affiliation(s)
- Sonia A Duffy
- Department of Psychiatry, University of Michigan, School of Nursing, Ann Arbor, MI 48109-0482, USA.
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Langlieb AM, Guico-Pabia CJ. Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694113 DOI: 10.4088/pcc.09r00826blu] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described. DATA SOURCES PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search. STUDY SELECTION Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning. DATA EXTRACTION Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described. DATA SYNTHESIS MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs. CONCLUSIONS In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.
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Affiliation(s)
- Alan M Langlieb
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland and Pfizer Inc, formerly Wyeth Research, Collegeville, Pennsylvania.
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McCormack B, Boldy D, Lewin G, McCormack GR. Screening for Depression Among Older Adults Referred to Home Care Services: A Single-Item Depression Screener Versus the Geriatric Depression Scale. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2010. [DOI: 10.1177/1084822309360380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Older adults requiring home care service have a high risk of depression. Instruments for detecting depression among older adults, however, are often too long and detailed for easy administration by nontrained staff in large service-based settings.This study examined the measurement properties (test—retest reliability, concurrent validity, and cross-modality correspondence) of a single-item screener for depressive symptoms among older adults receiving home care services. Reliability was assessed ( n = 65) by administering the single-item depression screener to the same participants on two occasions 7 days apart. Validity was assessed ( n = 191) by comparing depressed participants from the single-item depression screener versus Geriatric Depression Scale (criterion measure). Responses to the single-item depression screener administered by telephone and face-to-face interview were also compared. Findings suggest that the single-item depression screener has fair levels of reliability, validity, and cross-modality correspondence and could be used among home care recipients as a screening tool, provided that depression status is confirmed via in-depth questionnaires, interviews, or a clinical diagnosis.
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Affiliation(s)
| | - Duncan Boldy
- Curtin University of Technology, Perth, Western Australia, Australia
| | - Gill Lewin
- Curtin University of Technology, Perth, Western Australia, Australia
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Hamre HJ, Witt CM, Glockmann A, Ziegler R, Kienle GS, Willich SN, Kiene H. Health costs in patients treated for depression, in patients with depressive symptoms treated for another chronic disorder, and in non-depressed patients: a two-year prospective cohort study in anthroposophic outpatient settings. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:77-94. [PMID: 19911209 PMCID: PMC2816246 DOI: 10.1007/s10198-009-0203-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 10/20/2009] [Indexed: 05/23/2023]
Abstract
We studied costs of healthcare and productivity loss in 487 German outpatients starting anthroposophic treatment: Group 1 was treated for depression, Group 2 had depressive symptoms but were treated for another chronic disorder, while Group 3 did not have depressive symptoms. Costs were adjusted for socio-demographics, comorbidity, and baseline health status. Total costs in groups 1-3 averaged euro7,129, euro4,371, and euro3,532 in the pre-study year (P = 0.008); euro6,029, euro3,522, and euro3,353 in the first year (P = 0.083); and euro4,929, euro3,792, and euro4,031 in the second year (P = 0.460). In the 2nd year, costs were significantly reduced in Group 1. This study underlines the importance of depression for health costs, and suggests that treatment of depression could be associated with long-term cost reductions.
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Affiliation(s)
- Harald J Hamre
- Institute for Applied Epistemology and Medical Methodology, Zechenweg 6, 79111 Freiburg, Germany.
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Bosmans JE, Hermens MLM, de Bruijne MC, van Hout HPJ, Terluin B, Bouter LM, Stalman WAB, van Tulder MW. Cost-effectiveness of usual general practitioner care with or without antidepressant medication for patients with minor or mild-major depression. J Affect Disord 2008; 111:106-12. [PMID: 18342952 DOI: 10.1016/j.jad.2008.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 01/31/2008] [Accepted: 02/01/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Minor depression is common in primary care and associated with increased health care costs. Many mildly depressed patients are prescribed antidepressants, although there is insufficient information on the cost-effectiveness of antidepressants for these patients. The objective of this study was to evaluate whether usual care without antidepressants is equivalent to (i.e. as effective as and as expensive as) usual care with antidepressants in patients with minor or mild-major depression. METHODS Severity of depression was measured using the Montgomery Asberg Depression Rating Scale (MADRS) and quality-adjusted life-years (QALYs) using the EuroQol. Resource use was measured from a societal perspective using cost diaries. Bootstrapping was used to analyze the cost-effectiveness data. RESULTS Equivalence could not be shown for improvement in MADRS score or QALYs gained at 52 weeks. The mean (95% CI) difference in total costs between usual care without antidepressants and usual care with antidepressants was -euro751 (-3601; 1522). Using an equivalence margin of euro500 equivalence in costs could not be shown. In the cost-effectiveness analyses equivalence also could not be shown. LIMITATIONS This study was underpowered for economic outcomes. Another limitation was the loss-to-follow-up. CONCLUSIONS Although equivalence could not be shown in the costs and cost-effectiveness analyses, 95% confidence intervals also did not show that usual care without antidepressants was vastly superior or inferior to usual care with antidepressants. Therefore, we recommend general practitioners to show restraint when prescribing antidepressants to mildly depressed patients.
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Affiliation(s)
- Judith E Bosmans
- Health Technology Assessment Unit, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Bazargan M, Ani CO, Hindman DW, Bazargan-Hejazi S, Baker RS, Bell D, Rodriquez M. Correlates of complementary and alternative medicine utilization in depressed, underserved african american and Hispanic patients in primary care settings. J Altern Complement Med 2008; 14:537-44. [PMID: 18537468 DOI: 10.1089/acm.2007.0821] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES This study seeks to examine the correlates of complementary and alternative medicine (CAM) use in depressed underserved minority populations receiving medical care in primary care settings. METHODS A prospective study using interviewer-administered surveys and medical record reviews was conducted at 2 large outpatient primary care clinics providing care primarily to underserved African American and Hispanic individuals located in Los Angeles, California. A total of 2321 patients were screened for depression. Of these, 315 met the Patient Health Questionnaire-9 criteria for mild to severe depression. RESULTS Over 57% of the sample reported using CAM sometimes or often (24%) and frequently (33%) for treatment of their depressive symptoms. Controlling for demographic characteristics, lack of health care coverage remained one of the strongest predictors of CAM use. Additionally, being moderately depressed, using psychotherapeutic prescription medications, and poorer self-reported health status were all associated with increased frequency of CAM utilization for treating depression. CONCLUSIONS The underserved African American and Hispanic individuals meeting the diagnostic criteria for depression or subsyndromal depression use CAM extensively for symptoms of depression. CAM is used as a substitute for conventional care when access to care is not available or limited. Since CAM is used so extensively for depression, understanding domains, types, and correlates of such use is imperative. This knowledge could be used to design interventions aimed at improving care for depression.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles Drew University of Medicine & Science, Los Angeles, CA 90059, USA.
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Pieper L, Schulz H, Klotsche J, Eichler T, Wittchen HU. Depression als komorbide Störung in der primärärztlichen Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:411-21. [PMID: 18385962 DOI: 10.1007/s00103-008-0509-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Waal MWM, Arnold IA, Eekhof JAH, Assendelft WJJ, van Hemert AM. Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care. BMC FAMILY PRACTICE 2008; 9:5. [PMID: 18218070 PMCID: PMC2267194 DOI: 10.1186/1471-2296-9-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 01/24/2008] [Indexed: 11/10/2022]
Abstract
Background Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively. Methods In eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP). Results In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect. Conclusion Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders.
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Affiliation(s)
- Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Ani C, Bazargan M, Hindman D, Bell D, Farooq MA, Akhanjee L, Yemofio F, Baker R, Rodriguez M. Depression symptomatology and diagnosis: discordance between patients and physicians in primary care settings. BMC FAMILY PRACTICE 2008; 9:1. [PMID: 18173835 PMCID: PMC2254627 DOI: 10.1186/1471-2296-9-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 01/03/2008] [Indexed: 11/30/2022]
Abstract
Background To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings. Methods Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community settings. Results Of the 2321 participants screened for depression 304 were positive for depression and of these 75.3% (n = 229) were significantly depressed (PHQ-9 score ≥ 10). Of these, 31.0% were diagnosed by a physician with a depressive disorder. A total of 57.6% (n = 175) of study participants had both significant depression symptoms and functional impairment. Of these 37.7% were diagnosed by physicians as depressed. Cohen's Kappa analysis, used to determine the agreement between depression symptoms elicited using the PHQ-9 and physician documentation of these symptoms showed only slight agreement (0.001–0.101) for all depression symptoms using standard agreement rating scales. Further analysis showed that only suicidal ideation and hypersomnia or insomnia were associated with an increased likelihood of physician depression diagnosis (OR 5.41 P sig < .01 and (OR 2.02 P sig < .05 respectively). Other depression symptoms and chronic medical conditions had no affect on physician depression diagnosis. Conclusion Two-thirds of individuals with depression are undiagnosed in primary care settings. While functional impairment increases the rate of physician diagnosis of depression, the agreement between a structured assessment and physician elicited and or documented symptoms during a clinical encounter is very low. Suicidality, hypersomnia and insomnia are associated with an increase in the rate of depression diagnosis even when physician and self report of the symptom differ. Interventions that emphasize the use of routine structured screening of primary care patients might also improve the rate of diagnosis of depression in these settings. Further studies are needed to explore depression symptom assessment during physician patient encounter in primary care settings.
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Affiliation(s)
- Chizobam Ani
- Family Medicine Department Charles R Drew University of Medicine and Science, 2594 Industryway, Lynwood, CA 90262, USA.
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Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25-36. [PMID: 17968628 PMCID: PMC2173927 DOI: 10.1007/s11606-007-0428-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression, with up to 11.9% prevalence in the general population, is a common disorder strongly associated with increased morbidity. The accuracy of non-psychiatric physicians in recognizing depression may influence the outcome of the illness, as unrecognized patients are not offered treatment for depression. OBJECTIVES To describe and quantitatively summarize the existing data on recognition of depression by non-psychiatric physicians. METHODS We searched the following databases: MEDLINE (1966-2005), Psych INFO (1967-2005) and CINAHL (1982-2005). To summarize data presented in the papers reviewed, we calculated the Summary receiver operating characteristic (ROC) and the summary sensitivity, specificity and odds ratios (ORs) of recognition, and their 95% confidence intervals using the random effects model. MEASUREMENTS AND MAIN RESULTS The summary sensitivity, specificity, and OR of recognition using the random effects model were: 36.4% (95% CI: 27.9-44.8), 83.7% (95% CI: 77.5-90.0), and 4.0 (95% CI: 3.2-4.9), respectively. We also calculated the Summary ROC. We performed a metaregression analysis, which showed that the method of documentation of recognition, the age of the sample, and the date of study publication have significant effect on the summary sensitivity and the odds of recognition, in the univariate model. Only the method of documentation had a significant effect on summary sensitivity, when the age of the sample and the date of publication were added to the model. CONCLUSION The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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