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Grote NK, Simon GE, Russo J, Lohr MJ, Carson K, Katon W. Incremental Benefit-Cost of MOMCare: Collaborative Care for Perinatal Depression Among Economically Disadvantaged Women. Psychiatr Serv 2017; 68:1164-1171. [PMID: 28669288 DOI: 10.1176/appi.ps.201600411] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effectiveness of collaborative care for perinatal depression has been demonstrated for MOMCare, from early pregnancy up to 15 months postpartum, for Medicaid enrollees in a public health system. MOMCare had a greater impact on reducing depression and improving functioning for women with comorbid posttraumatic stress disorder (PTSD) than for those without PTSD. This study estimated the incremental benefit and cost and the net benefit of MOMCare for women with major depression and PTSD. METHODS A randomized trial (September 2009 to December 2014) compared the MOMCare collaborative care depression intervention (choice of brief interpersonal psychotherapy or pharmacotherapy or both) with enhanced maternity support services (MSS-Plus) in the public health system of Seattle-King County. Among pregnant women with a probable diagnosis of major depression or dysthymia (N=164), two-thirds (N=106) met criteria for probable PTSD. Blinded assessments at three, six, 12, and 18 months postbaseline included the Symptom Checklist-20 depression scale and the Cornell Services Index. Analyses of covariance estimated gain in depression free days (DFDs) by intervention and PTSD status. RESULTS When the analysis controlled for baseline depression severity, women with probable depression and PTSD in MOMCare had 68 more depression-free days over 18 months than those in MSS-Plus (p<.05). The additional depression care cost per MOMCare participant with comorbid PTSD was $1,312. The incremental net benefit of MOMCare was positive if a DFD was valued at ≥$20. CONCLUSIONS For women with probable major depression and PTSD, MOMCare had significant clinical benefit over MSS-Plus, with only a moderate increase in health services cost.
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Affiliation(s)
- Nancy K Grote
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Gregory E Simon
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Joan Russo
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Mary Jane Lohr
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Kathy Carson
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
| | - Wayne Katon
- Dr. Grote and Ms. Lohr are with the School of Social Work, University of Washington, Seattle. Dr. Simon is with Kaiser Permanente Washington Health Research Institute, Seattle. Dr. Russo is with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, where the late Dr. Katon was affiliated. Ms. Carson, who is retired, was with Maternity Support Services, Seattle-King County Department of Public Health, Seattle, at the time of this study
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Bauer AM, Rue T, Munson SA, Ghomi RH, Keppel GA, Cole AM, Baldwin LM, Katon W. Patient-oriented health technologies: Patients' perspectives and use. ACTA ACUST UNITED AC 2017; 6:1-10. [PMID: 28936236 DOI: 10.7309/jmtm.6.2.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND For patient-oriented mobile health tools to contribute meaningfully to improving healthcare delivery, widespread acceptance and use of such tools by patients are critical. However, little is known about patients' attitudes toward using health technology and their willingness to share health data with providers. AIMS To investigate primary care patients' comfort sharing health information through mobile devices, and patients' awareness and use of patient portals. METHODS Patients (n=918) who visited one of 6 primary care clinics in the Northwest US completed a survey about health technology use, medical conditions, and demographics. RESULTS More patients were comfortable sharing mobile health information with providers than having third parties store their information (62% vs 30%, Somers D=.33, p<0.001). Patients older than 55 years were less likely to be comfortable sharing with providers (AORs 0.37-0.42, p<0.01). Only 39% of patients knew if their clinic offered a patient portal; however, of these, 67% used it. Health literacy limitations were associated with lower portal awareness (AOR=0.55, p=0.005) but not use. Portal use was higher among patients with a chronic condition (AOR= 3.18, p=0.004). CONCLUSION Comfort, awareness, and use of health technologies were variable. Practices introducing patient-facing health technologies should promote awareness, address concerns about data security, and provide education and training, especially to older adults and those with health literacy limitations. Patient-facing health technologies provide an opportunity for delivering scalable health education and self-management support, particularly for patients with chronic conditions who are already using patient portals.
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Affiliation(s)
- Amy M Bauer
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Tessa Rue
- Biostatistics, University of Washington, Seattle, USA.,Institute of Translational Health Sciences, University of Washington, Seattle, USA
| | - Sean A Munson
- Human Centered Design & Engineering, University of Washington, Seattle, USA
| | | | - Gina A Keppel
- Institute of Translational Health Sciences, University of Washington, Seattle, USA.,Human Centered Design & Engineering, University of Washington, Seattle, USA
| | - Allison M Cole
- Institute of Translational Health Sciences, University of Washington, Seattle, USA.,Human Centered Design & Engineering, University of Washington, Seattle, USA
| | - Laura-Mae Baldwin
- Human Centered Design & Engineering, University of Washington, Seattle, USA
| | - Wayne Katon
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Kowalski AJ, Poongothai S, Chwastiak L, Hutcheson M, Tandon N, Khadgawat R, Sridhar GR, Aravind SR, Sosale B, Anjana RM, Rao D, Sagar R, Mehta N, Narayan KMV, Unutzer J, Katon W, Mohan V, Ali MK. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study: Design and methods to address mental healthcare gaps in India. Contemp Clin Trials 2017. [PMID: 28642211 DOI: 10.1016/j.cct.2017.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Depression and diabetes are highly prevalent worldwide and often co-exist, worsening outcomes for each condition. Barriers to diagnosis and treatment are exacerbated in low and middle-income countries with limited health infrastructure and access to mental health treatment. The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) study tests the sustained effectiveness and cost-effectiveness of a multi-component care model for individuals with poorly-controlled diabetes and depression in diabetes clinics in India. MATERIALS AND METHODS Adults with diabetes, depressive symptoms (Patient Health Questionnaire-9 score≥10), and ≥1 poorly-controlled cardiometabolic indicator (either HbA1c≥8.0%, SBP≥140mmHg, and/or LDL≥130mg/dl) were enrolled and randomized to the intervention or usual care. The intervention combined collaborative care, decision-support, and population health management. The primary outcome is the between-arm difference in the proportion of participants achieving combined depression response (≥50% reduction in Symptom Checklist score from baseline) AND one or more of: ≥0.5% reduction in HbA1c, ≥5mmHg reduction in SBP, or ≥10mg/dl reduction in LDL-c at 24months (12-month intervention; 12-month observational follow-up). Other outcomes include control of individual parameters, patient-centered measures (i.e. treatment satisfaction), and cost-effectiveness. RESULTS The study trained seven care coordinators. Participant recruitment is complete - 940 adults were screened, with 483 eligible, and 404 randomized (196 to intervention; 208 to usual care). Randomization was balanced across clinic sites. CONCLUSIONS The INDEPENDENT model aims to increase access to mental health care and improve depression and cardiometabolic disease outcomes among complex patients with diabetes by leveraging the care provided in diabetes clinics in India (clinicaltrials.gov number: NCT02022111).
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Affiliation(s)
- A J Kowalski
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - S Poongothai
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - L Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - M Hutcheson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - N Tandon
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - R Khadgawat
- All India Institute of Medical Sciences, Department of Endocrinology & Metabolism, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi 110 029, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - S R Aravind
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - B Sosale
- Diacon Hospital, Diabetes Care and Research Center, Rajajinagar, Bangalore 560 010, Karantaka, India
| | - R M Anjana
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - D Rao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - R Sagar
- All India Institute of Medical Sciences, Department of Psychiatry, Ansari Nagar, New Delhi 110 029, India
| | - N Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - K M V Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - J Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - W Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - V Mohan
- Madras Diabetes Research Foundation, Dr. Mohan's Diabetes Specialities Centre, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, Tamil Nadu, India
| | - M K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States.
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Bhat A, Grote NK, Russo J, Lohr MJ, Jung H, Rouse CE, Howell EC, Melville JL, Carson K, Katon W. Collaborative Care for Perinatal Depression Among Socioeconomically Disadvantaged Women: Adverse Neonatal Birth Events and Treatment Response. Psychiatr Serv 2017; 68:17-24. [PMID: 27691376 DOI: 10.1176/appi.ps.201600002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the effectiveness of a perinatal collaborative care intervention in moderating the effects of adverse neonatal birth events on risks of postpartum depressive symptoms and impaired functioning among women of lower socioeconomic status with antenatal depression. METHODS A randomized controlled trial with blinded outcome assessments was conducted in ten public health centers, comparing MOMCare (choice of brief interpersonal psychotherapy, pharmacotherapy, or both) with intensive maternity support services (MSS-Plus). Participants had probable diagnoses of major depressive disorder or dysthymia during pregnancy. Generalized estimating equations estimated differences in depression and functioning measures between groups with and without adverse birth events within the treatment arms. A total of 160 women, 43% of whom experienced at least one adverse birth event, were included in the analyses. RESULTS For women who received MOMCare, postpartum depression scores (measured with the Symptom Checklist-20) did not differ by whether or not they experienced an adverse birth event (mean±SD scores of .86±.51 for mothers with an adverse birth event and .83±.56 for mothers with no event; p=.78). For women who received MSS-Plus, having an adverse birth event was associated with persisting depression in the postpartum period (mean scores of 1.20±.0.61 for mothers with an adverse birth event and .93±.52 for mothers without adverse birth event; p=.04). Similar results were seen for depression response rates and functioning. CONCLUSIONS MOMCare mitigated the risk of postpartum depressive symptoms and impaired functioning among women of low socioeconomic status who had antenatal depression and who experienced adverse birth events.
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Affiliation(s)
- Amritha Bhat
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Nancy K Grote
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Joan Russo
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Mary Jane Lohr
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Hyunzee Jung
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Caroline E Rouse
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Elaine C Howell
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Jennifer L Melville
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Kathy Carson
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
| | - Wayne Katon
- Dr. Bhat and Dr. Russo are with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, where the late Dr. Katon was affiliated (e-mail: ). Dr. Grote, Ms. Lohr, Dr. Jung, and Ms. Howell are with the School of Social Work, University of Washington, Seattle. Dr. Rouse is with the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston. Dr. Melville is with Northwest Women's HealthCare, Swedish Medical Center, Seattle. Ms. Carson is with the Seattle-King County Department of Public Health, Seattle
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Abstract
Aim Women with diabetes have a higher prevalence of chronic kidney disease (CKD) risk factors compared with men, but whether they are at higher risk for incident CKD remains uncertain. Methods This was a prospective, observational cohort study of 1464 patients with diabetes and normal renal function, recruited from primary care clinics at a vertically integrated healthcare system in Seattle, WA, USA. The primary predictor was sex. Incident CKD was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 by Chronic Kidney Disease‐Epidemiology equations or sex‐specific microalbuminuria (urine albumin/creatinine ratio ≥25 mg/g for women or ≥17 mg/g for men). Results Of the 1464 patients (52.0% women), CKD incidence rates were 154.0 and 144.3 cases per 1000 patient‐years for women and men, respectively. In the competing risks regression, women had an increased risk of incident CKD (sub‐hazard ratio 1.37, 95% confidence interval (CI) 1.17, 1.60) compared with men after adjustment for demographics, baseline eGFR and duration of diabetes, which persisted after additional adjustment for CKD risk factors, depressive symptoms and diabetes self‐care (sub‐hazard ratio 1.35, 95% CI 1.15, 1.59). Sex differences in incident CKD were consistent across age groups and appeared to be driven by differences in the development of low eGFR rather than microalbuminuria. Conclusion Women with diabetes had a higher risk of incident CKD compared with men, which could not be entirely explained by differences in biologic CKD risk factors, depression or diabetes self‐care. Additional work is needed determine if these sex differences contribute to worse outcomes in women with diabetes. The authors have evaluated associations between sex and chronic kidney disease (CKD) incidence in a primary care population with diabetes using Chronic Kidney Disease‐Epidemiology equations for estimating glomerular filtration rate (GFR) and sex‐specific definitions of microalbuminuria. They found that women had an increased risk of incident CKD compared with men. They also found that this difference in incident CKD was primarily driven by differences in incident eGFR < 60 mL/min per 1.73 m2.
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Affiliation(s)
- Margaret K Yu
- VA Health Services Research and Development, VA Puget Sound Health Care System, Center for Innovation, Seattle, Washington, USA.,Division of Nephrology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.,Kidney Research Institute, Seattle, Washington, USA
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bessie A Young
- VA Health Services Research and Development, VA Puget Sound Health Care System, Center for Innovation, Seattle, Washington, USA.,Division of Nephrology, Department of Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington, USA.,Kidney Research Institute, Seattle, Washington, USA
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Rao D, Lipira L, Kumar S, Mohanraj R, Poongothai S, Tandon N, Sridhar GR, Katon W, Narayan KV, Chwastiak L, Mohan V, Ali MK. Input of stakeholders on reducing depressive symptoms and improving diabetes outcomes in India: Formative work for the INDEPENDENT Study. Int J Noncommun Dis 2016; 1:65-75. [PMID: 29075675 DOI: 10.4103/2468-8827.191979] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention. METHODS At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach. RESULTS Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma). CONCLUSIONS Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
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Affiliation(s)
- Deepa Rao
- Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington, Seattle, USA
| | - Shuba Kumar
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Samarth, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Subramani Poongothai
- Department of Clinical Trials, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - G R Sridhar
- Endocrine and Diabetes Centre, Visakhapatnam, Andhra Pradesh, India
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Km Venkat Narayan
- Department of Global Health and Epidemiology; Department of Medicine, Emory University, Atlanta, GA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Mohammed K Ali
- Department of Medicine, Emory University, Atlanta, GA, USA
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7
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Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R. Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND). Contemp Clin Trials 2015; 47:1-11. [PMID: 26621218 DOI: 10.1016/j.cct.2015.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, VA North Texas Health Care System, United States; Division of Nephrology, University of Texas Southwestern Medical Center, United States.
| | - Divya M Daniel
- Kidney Research Institute, University of Washington, United States
| | - Scott Cohen
- Division of Nephrology, George Washington University, United States
| | - Bryan Comstock
- School of Public Health, University of Washington, United States
| | - Daniel Cukor
- Department of Psychiatry, SUNY Downstate Medical Center, United States
| | | | - Laura M Dember
- Division of Nephrology, University of Pennsylvania, United States
| | - Amelia Dubovsky
- Department of Psychiatry, University of Washington, United States
| | | | - Nancy Grote
- School of Social Work, University of Washington, United States
| | - Patrick Heagerty
- School of Public Health, University of Washington, United States
| | - Wayne Katon
- Department of Psychiatry, University of Washington, United States
| | - Paul L Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, United States
| | | | - Lori Linke
- Kidney Research Institute, University of Washington, United States
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico, United States
| | - Tessa Rue
- School of Public Health, University of Washington, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States
| | - Mark Unruh
- Division of Nephrology, University of New Mexico, United States
| | - Steven Weisbord
- Division of Nephrology, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, United States
| | - Bessie A Young
- Kidney Research Institute, University of Washington, United States
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, United States
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8
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Ribe AR, Laursen TM, Charles M, Katon W, Fenger-Grøn M, Davydow D, Chwastiak L, Cerimele JM, Vestergaard M. Long-term Risk of Dementia in Persons With Schizophrenia: A Danish Population-Based Cohort Study. JAMA Psychiatry 2015; 72:1095-101. [PMID: 26444987 DOI: 10.1001/jamapsychiatry.2015.1546] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although schizophrenia is associated with several age-related disorders and considerable cognitive impairment, it remains unclear whether the risk of dementia is higher among persons with schizophrenia compared with those without schizophrenia. OBJECTIVE To determine the risk of dementia among persons with schizophrenia compared with those without schizophrenia in a large nationwide cohort study with up to 18 years of follow-up, taking age and established risk factors for dementia into account. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study of more than 2.8 million persons aged 50 years or older used individual data from 6 nationwide registers in Denmark. A total of 20 683 individuals had schizophrenia. Follow-up started on January 1, 1995, and ended on January 1, 2013. Analysis was conducted from January 1, 2015, to April 30, 2015. MAIN OUTCOMES AND MEASURES Incidence rate ratios (IRRs) and cumulative incidence proportions (CIPs) of dementia for persons with schizophrenia compared with persons without schizophrenia. RESULTS During 18 years of follow-up, 136 012 individuals, including 944 individuals with a history of schizophrenia, developed dementia. Schizophrenia was associated with a more than 2-fold higher risk of all-cause dementia (IRR, 2.13; 95% CI, 2.00-2.27) after adjusting for age, sex, and calendar period. The estimates (reported as IRR; 95% CI) did not change substantially when adjusting for medical comorbidities, such as cardiovascular diseases and diabetes mellitus (2.01; 1.89-2.15) but decreased slightly when adjusting for substance abuse (1.71; 1.60-1.82). The association between schizophrenia and dementia risk was stable when evaluated in subgroups characterized by demographics and comorbidities, although the IRR was higher among individuals younger than 65 years (3.77; 3.29-4.33), men (2.38; 2.13-2.66), individuals living with a partner (3.16; 2.71-3.69), those without cerebrovascular disease (2.23; 2.08-2.39), and those without substance abuse (1.96; 1.82-2.11). The CIPs (95% CIs) of developing dementia by the age of 65 years were 1.8% (1.5%-2.2%) for persons with schizophrenia and 0.6% (0.6%-0.7%) for persons without schizophrenia. The respective CIPs for persons with and without schizophrenia were 7.4% (6.8%-8.1%) and 5.8% (5.8%-5.9%) by the age of 80 years. CONCLUSIONS AND RELEVANCE Individuals with schizophrenia, especially those younger than 65 years, had a markedly increased relative risk of dementia that could not be explained by established dementia risk factors.
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Affiliation(s)
- Anette Riisgaard Ribe
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-Based Research, Department of Economics and Business, Aarhus University, Aarhus, Denmark
| | - Morten Charles
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle
| | - Morten Fenger-Grøn
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dimitry Davydow
- Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle
| | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark3Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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9
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Ell K, Katon W, Lee PJ, Guterman J, Wu S. Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care. Gen Hosp Psychiatry 2015; 37:414-9. [PMID: 26059979 DOI: 10.1016/j.genhosppsych.2015.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/15/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes. METHOD A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients. RESULTS Bivariate analyses found depression significantly associated (p<0.05) with female gender, diabetes emotional burden and regimen distress, BMI ≥ 30, lack of an A1C test, diabetes duration, poor self-care, number of diabetes symptoms and complications, functional and physical characteristics (pain, self-rated health condition, Short-Form Health Survey SF-physical, disability score and comorbid illnesses), as well as higher number of ICD-9 diagnoses and emergency room use. A multivariable regression model with stepwise selection identified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, p<.0001). CONCLUSION Knowing biopsychosocial factors could help primary care physicians and endocrinologists identify a high-risk group of patients needing depression screening.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California.
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California.
| | - Jeffrey Guterman
- David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services.
| | - Shinyi Wu
- School of Social Work, University of Southern California; Edward R. Roybal Institute on Aging, University of Southern California; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California.
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10
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Ribe AR, Vestergaard M, Katon W, Charles M, Benros ME, Vanderlip E, Nordentoft M, Laursen TM. Thirty-Day Mortality After Infection Among Persons With Severe Mental Illness: A Population-Based Cohort Study in Denmark. Am J Psychiatry 2015; 172:776-83. [PMID: 25698437 DOI: 10.1176/appi.ajp.2015.14091100] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Persons with severe mental illness die 15-20 years earlier on average than persons without severe mental illness. Although infection is one of the leading overall causes of death, no studies have evaluated whether persons with severe mental illness have a higher mortality after infection than those without. METHOD The authors studied mortality rate ratios and cumulative mortality proportions after an admission for infection for persons with severe mental illness compared with persons without severe mental illness by linking data from Danish national registries. RESULTS The cohort consisted of all persons hospitalized for infection during the period 1995-2011 in Denmark (N=806,835), of whom 11,343 persons had severe mental illness. Within 30 days after an infection, 1,052 (9.3%) persons with a history of severe mental illness and 58,683 (7.4%) persons without a history of severe mental illness died. Thirty-day mortality after any infection was 52% higher in persons with severe mental illness than in persons without (mortality rate ratio=1.52, 95% CI=1.43-1.61). Mortality was increased for all infections, and the mortality rate ratios ranged from 1.27 (95% CI=1.15-1.39) for persons hospitalized for sepsis to 2.61 (95% CI=1.69-4.02) for persons hospitalized for CNS infections. Depending on age, 1.7 (95% CI=1.2-2.2) to 2.9 (95% CI=2.0-3.7) more deaths were observed within 30 days after an infection per 100 persons with a history of severe mental illness compared with 100 persons without such a history. CONCLUSIONS Persons with severe mental illness have a markedly elevated 30-day mortality after infection. Some of these excess deaths may be prevented by offering individualized and targeted interventions.
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Affiliation(s)
- Anette Riisgaard Ribe
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Mogens Vestergaard
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Wayne Katon
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Morten Charles
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Michael Eriksen Benros
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Erik Vanderlip
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Merete Nordentoft
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
| | - Thomas Munk Laursen
- From the Research Unit for General Practice and the Section for General Medical Practice, Department of Public Health, Faculty of Health, and the National Center for Register-Based Research, Department of Economics and Business, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark; the Department of Psychiatry and Behavioral Sciences, School of Public Health, University of Washington, Seattle; and Mental Health Center Copenhagen, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen
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Affiliation(s)
- Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Wayne Katon
- Department of Psychiatry, University of Washington Medical School, Seattle, WA, USA
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12
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Katon W, Pedersen HS, Ribe AR, Fenger-Grøn M, Davydow D, Waldorff FB, Vestergaard M. Effect of depression and diabetes mellitus on the risk for dementia: a national population-based cohort study. JAMA Psychiatry 2015; 72:612-9. [PMID: 25875310 PMCID: PMC4666533 DOI: 10.1001/jamapsychiatry.2015.0082] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Although depression and type 2 diabetes mellitus (DM) may independently increase the risk for dementia, no studies have examined whether the risk for dementia among people with comorbid depression and DM is higher than the sum of each exposure individually. OBJECTIVE To examine the risk for all-cause dementia among persons with depression, DM, or both compared with persons with neither exposure. DESIGN, SETTING, AND PARTICIPANTS We performed a national population-based cohort study of 2 454 532 adults, including 477 133 (19.4%) with depression, 223 174 (9.1%) with DM, and 95 691 (3.9%) with both. We included all living Danish citizens 50 years or older who were free of dementia from January 1, 2007, through December 31, 2013 (followed up through December 31, 2013). Dementia was ascertained by physician diagnosis from the Danish National Patient Register or the Danish Psychiatric Central Register and/or by prescription of a cholinesterase inhibitor or memantine hydrochloride from the Danish National Prescription Registry. Depression was ascertained by psychiatrist diagnosis from the Danish Psychiatric Central Research Register or by prescription of an antidepressant from the Danish National Prescription Registry. Diabetes mellitus was identified using the National Diabetes Register. MAIN OUTCOMES AND MEASURES We estimated the risk for all-cause dementia associated with DM, depression, or both using Cox proportional hazards regression models that adjusted for potential confounding factors (eg, demographics) and potential intermediates (eg, medical comorbidities). RESULTS During 13 834 645 person-years of follow-up, 59 663 participants (2.4%) developed dementia; of these, 6466 (10.8%) had DM, 15 729 (26.4%) had depression, and 4022 (6.7%) had both. The adjusted hazard ratio for developing all-cause dementia was 1.83 (95% CI, 1.80-1.87) for persons with depression, 1.20 (95% CI, 1.17-1.23) for persons with DM, and 2.17 (95% CI, 2.10-2.24) for those with both compared with persons who had neither exposure. The excess risk for all-cause dementia observed for individuals with comorbid depression and DM surpassed the summed risk associated with each exposure individually, especially for persons younger than 65 years (hazard ratio, 4.84 [95% CI, 4.21-5.55]). The corresponding attributable proportion due to the interaction of comorbid depression and DM was 0.25 (95% CI, 0.13-0.36; P < .001) for those younger than 65 years and 0.06 (95% CI, 0.02-0.10; P = .001) for those 65 years or older. CONCLUSIONS AND RELEVANCE Depression and DM were independently associated with a greater risk for dementia, and the combined association of both exposures with the risk for all-cause dementia was stronger than the additive association.
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Affiliation(s)
- Wayne Katon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA
| | | | - Anette Riisgaard Ribe
- Aarhus University, Department of Public Health, Research Unit for General Practice, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Aarhus University, Department of Public Health, Research Unit for General Practice, Aarhus, Denmark
| | - Dimitry Davydow
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA
| | - Frans Boch Waldorff
- University of Copenhagen, Department of Public Health, Research Unit for General Practice and Section of General Practice, Copenhagen, Denmark
| | - Mogens Vestergaard
- Aarhus University, Department of Public Health, Research Unit for General Practice, Aarhus, Denmark
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13
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Katon W, Russo J, Reed SD, Croicu CA, Ludman E, LaRocco A, Melville JL. A randomized trial of collaborative depression care in obstetrics and gynecology clinics: socioeconomic disadvantage and treatment response. Am J Psychiatry 2015; 172:32-40. [PMID: 25157500 PMCID: PMC4301707 DOI: 10.1176/appi.ajp.2014.14020258] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated whether an obstetrics-gynecology clinic-based collaborative depression care intervention is differentially effective compared with usual care for socially disadvantaged women with either no health insurance or with public coverage compared with those with commercial insurance. METHOD The study was a two-site randomized controlled trial with an 18-month follow-up. Women were recruited who screened positive (a score of at least 10 on the Patient Health Questionnaire-9) and met criteria for major depression or dysthymia. The authors tested whether insurance status had a differential effect on continuous depression outcomes between the intervention and usual care over 18 months. They also assessed differences between the intervention and usual care in quality of depression care and dichotomous clinical outcomes (a decrease of at least 50% in depressive symptom severity and patient-rated improvement on the Patient Global Improvement Scale). RESULTS The treatment effect was significantly associated with insurance status. Compared with patients with commercial insurance, those with no insurance or with public coverage had greater recovery from depression symptoms with collaborative care than with usual care over the 18-month follow-up period. At the 12-month follow-up, the effect size for depression improvement compared with usual care among women with no insurance or with public coverage was 0.81 (95% CI=0.41, 0.95), whereas it was 0.39 (95% CI=-0.08, 0.84) for women with commercial insurance. CONCLUSIONS Collaborative depression care adapted to obstetrics-gynecology settings had a greater impact on depression outcomes for socially disadvantaged women with no insurance or with public coverage compared with women with commercial insurance.
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Affiliation(s)
- Wayne Katon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA
| | - Joan Russo
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA
| | - Susan D. Reed
- Harborview Medical Center and University of Washington School of Medicine, Department of Obstetrics and Gynecology, Seattle WA
| | - Carmen A. Croicu
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA, Harborview Medical Center, Department of Psychiatry and Behavioral Sciences, Seattle WA
| | | | - Anna LaRocco
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA
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14
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Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Qiu W, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, Katon W, Majumdar SR. Collaborative care versus screening and follow-up for patients with diabetes and depressive symptoms: results of a primary care-based comparative effectiveness trial. Diabetes Care 2014; 37:3220-6. [PMID: 25315205 DOI: 10.2337/dc14-1308] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depressive symptoms are common and, when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic patients. RESEARCH DESIGN AND METHODS We conducted a controlled implementation trial in four nonmetropolitan primary care networks. Eligible patients had type 2 diabetes and screened positive for depressive symptoms, based on a Patient Health Questionnaire (PHQ) score of ≥10. Patients were allocated using an "on-off" monthly time series. Intervention consisted of case-managers working 1:1 with patients to deliver individualized care. The main outcome was improvement in PHQ scores at 12 months. A concurrent cohort of 71 comparable patients was used as nonscreened usual care control subjects. RESULTS Of 1,924 patients screened, 476 (25%) had a PHQ score >10. Of these, 95 were allocated to intervention and 62 to active control. There were no baseline differences between groups: mean age was 57.8 years, 55% were women, and the mean PHQ score was 14.5 (SD 3.7). Intervention patients had greater 12-month improvements in PHQ (7.3 [SD 5.6]) compared with active-control subjects (5.2 [SD 5.7], P = 0.015). Recovery of depressive symptoms (i.e., PHQ reduced by 50%) was greater among intervention patients (61% vs. 44%, P = 0.03). Compared with trial patients, nonscreened control subjects had significantly less improvement at 12 months in the PHQ score (3.2 [SD 4.9]) and lower rates of recovery (24%, P < 0.05 for both). CONCLUSIONS In patients with type 2 diabetes who screened positive for depressive symptoms, collaborative care improved depressive symptoms, but physician notification and follow-up was also a clinically effective initial strategy compared with usual care.
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Affiliation(s)
- Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Wozniak
- Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Rees
- Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Soprovich
- Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada
| | - Constance L Chik
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Chue
- Alberta Health Services, Edmonton, Alberta, Canada Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jennifer Jacquier
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pauline Lysak
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Opgenorth
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Sumit R Majumdar
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada Alliance for Canadian Health Outcomes Research, University of Alberta, Edmonton, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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15
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Abstract
Individuals with co-morbid chronic medical illness and psychiatric illness are a costly and complex patient population, at high risk for poor outcomes. Health-risk behaviours (e.g. smoking, poor diet, and sedentary lifestyle), side effects from psychiatric medications, and poor quality medical care all contribute to poor outcomes. Individuals with major depression die, on average, 5 to 10 years before their age-matched counterparts. For individuals with severe mental illness such as bipolar disorder or schizophrenia, life expectancy may be up to 20 years shorter. As the majority of this premature mortality is due to cardiovascular disease, there is a critical need to engage these individuals around the care of chronic medical illness.
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Affiliation(s)
- Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington , USA
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16
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Bauer AM, Thielke SM, Katon W, Unützer J, Areán P. Aligning health information technologies with effective service delivery models to improve chronic disease care. Prev Med 2014; 66:167-72. [PMID: 24963895 PMCID: PMC4137765 DOI: 10.1016/j.ypmed.2014.06.017] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. METHOD A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. RESULTS Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. CONCLUSION HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Patricia Areán
- Department of Psychiatry, University of California, San Francisco, United States
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17
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Abstract
Primary care providers play a crucial role in the recognition and appropriate treatment of patients with multiple somatic complaints. Both the number of somatic symptoms and the persistence of symptoms are associated with co-occurring depression or anxiety disorders. It can be challenging to simultaneously address possible medical causes for physical symptoms while also considering an associated psychiatric diagnosis. In this article, strategies to improve the care and outcomes among these patients are described, including collaboration, education about the interaction between psychosocial stressors and somatic symptoms, regularly scheduled visits, focus on improving functional status, and evidence-based treatment of depression and anxiety.
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Affiliation(s)
- Carmen Croicu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359911, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359911, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Wayne Katon
- Division of Health Services and Psychiatric Epidemiology, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, 1959 Northeast Pacific, Seattle, WA 98195, USA
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18
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Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, Katon W. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. JAMA 2014; 312:809-16. [PMID: 25157724 PMCID: PMC4492537 DOI: 10.1001/jama.2014.9259] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. OBJECTIVE To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. DESIGN Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. INTERVENTIONS Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. MAIN OUTCOMES AND MEASURES The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). RESULTS Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007). CONCLUSIONS AND RELEVANCE Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01140464.
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Affiliation(s)
- Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Evette Ludman
- Group Health Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | - Cindy Larison
- Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Greg Clarke
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - David Brent
- University of Pittsburgh, Pittsburgh, Pennsylvania7Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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Abstract
OBJECTIVE To examine sociodemographic factors, pregnancy-associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychiatric illness, pregnancy-related illnesses, and birth outcomes as risk factors for post-partum depression (PPD). METHODS A prospective cohort study screened women at 4 and 8 months of pregnancy and used hierarchical logistic regression analyses to examine predictors of PPD. The study sample include 1,423 pregnant women at a university-based high risk obstetrics clinic. A score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) indicated clinically significant depressive symptoms. RESULTS Compared with women without significant postpartum depressive symptoms, women with PPD were significantly younger (p<0.0001), more likely to be unemployed (p=0.04), had more pregnancy associated depressive symptoms (p<0.0001) and psychosocial stress (p<0.0001), were more likely to be smokers (p<0.0001), were more likely to be taking antidepressants (ADs) during pregnancy (p=0.002), were less likely to drink any alcohol during pregnancy (p=0.02), and were more likely to have prepregnancy medical illnesses, including diabetes (p=0.02) and neurologic conditions (p=0.02). CONCLUSION Specific sociodemographic and clinical risk factors for PPD were identified that could help physicians target depression case finding for pregnant women.
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Affiliation(s)
- Wayne Katon
- 1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington
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Bauer AM, Parker MM, Schillinger D, Katon W, Adler N, Adams AS, Moffet HH, Karter AJ. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE). J Gen Intern Med 2014; 29:1139-47. [PMID: 24706097 PMCID: PMC4099457 DOI: 10.1007/s11606-014-2845-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression and adherence to antidepressant treatment are important clinical concerns in diabetes care. While patient-provider communication patterns have been associated with adherence for cardiometabolic medications, it is unknown whether interpersonal aspects of care impact antidepressant medication adherence. OBJECTIVE To determine whether shared decision-making, patient-provider trust, or communication are associated with early stage and ongoing antidepressant adherence. DESIGN Observational new prescription cohort study. SETTING Kaiser Permanente Northern California. PATIENTS One thousand five hundred twenty-three adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010. MEASUREMENTS Exposures included items based on the Trust in Physicians and Interpersonal Processes of Care instruments and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) communication scale. Measures of adherence were estimated using validated methods with physician prescribing and pharmacy dispensing data: primary non-adherence (medication never dispensed), early non-persistence (dispensed once, never refilled), and new prescription medication gap (NPMG; proportion of time without medication during 12 months after initial prescription). RESULTS After adjusting for potential confounders, patients' perceived lack of shared decision-making was significantly associated with primary non-adherence (RR = 2.42, p < 0.05), early non-persistence (RR = 1.34, p < 0.01) and NPMG (estimated 5% greater gap in medication supply, p < 0.01). Less trust in provider was significantly associated with early non-persistence (RRs 1.22-1.25, ps < 0.05) and NPMG (estimated NPMG differences 5-8%, ps < 0.01). LIMITATIONS All patients were insured and had consistent access to and quality of care. CONCLUSIONS Patients' perceptions of their relationships with providers, including lack of shared decision-making or trust, demonstrated strong associations with antidepressant non-adherence. Further research should explore whether interventions for healthcare providers and systems that foster shared decision-making and trust might also improve medication adherence.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, USA,
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Cerimele JM, Chan YF, Chwastiak LA, Avery M, Katon W, Unützer J. Bipolar disorder in primary care: clinical characteristics of 740 primary care patients with bipolar disorder. Psychiatr Serv 2014; 65:1041-6. [PMID: 24733084 PMCID: PMC4119512 DOI: 10.1176/appi.ps.201300374] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to describe the characteristics of primary care patients with bipolar disorder enrolled in a statewide mental health integration program (MHIP). METHODS With the Composite International Diagnostic Interview (Version 3.0) and clinician diagnosis, 740 primary care patients with bipolar disorder were identified in Washington State between January 2008 and December 2011. Clinical rating scales were administered to patients at the time of enrollment and during treatment. Quality-of-care outcomes were obtained from a systematic review of the patient disease registry and compared with a previous study of patients with depressive symptoms in an MHIP. Descriptive analysis techniques were used to describe patients' clinical characteristics. RESULTS Primary care patients with bipolar disorder had high symptom severity on depression and anxiety measures: Patient Health Questionaire-9 (mean±SD score of 18.1±5.9 out of 27) and the seven-item Generalized Anxiety Disorder scale (15.7±4.7 out of 21). Psychosocial problems were common, with approximately 53% reporting concerns about housing, 15% reporting homelessness, and 22% reporting lack of a support person. Only 26% of patients were referred to specialty mental health treatment. Patients with bipolar disorder had a greater amount of contact with clinicians during treatment compared with patients with depressive symptoms from a prior study. CONCLUSIONS Primary care patients with bipolar disorder enrolled in MHIP had severe depression, symptoms of comorbid psychiatric illnesses, and multiple psychosocial problems. Patients with bipolar disorder received more intensive care compared with patients with depressive symptoms from a prior study. Referral to a community mental health center occurred infrequently even though most patients had persistent symptoms.
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Raney L, Pollack D, Parks J, Katon W. The American Psychiatric Association response to the "joint principles: integrating behavioral health care into the patient-centered medical home". Fam Syst Health 2014; 32:147-148. [PMID: 24955687 DOI: 10.1037/fsh0000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011). The American Psychiatric Association Workgroup on Integrated Care supports the recommendations made in these Joint Principles and recognizes the significant benefit of treating behavioral and general medical conditions concurrently. The workgroup offers comments on this effort as it pertains to health care in general and psychiatric practice.
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Affiliation(s)
| | - David Pollack
- Department of Psychiatry, Oregon Health & Science University
| | - Joe Parks
- Missouri Department of Social Services
| | - Wayne Katon
- Division of Health Services and Psychiatric Epidemiology, Department of Psychiatry, University of Washington Medical School
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Abstract
People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.
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Affiliation(s)
- Erik R Vanderlip
- Departments of Family Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Huang H, Gören JL, Chan YF, Katon W, Russo J, Hogan D, Unützer J. Pharmacologic management of bipolar disorder in a Medicare Advantage population. Psychosomatics 2014; 55:572-7. [PMID: 25016355 DOI: 10.1016/j.psym.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to examine patterns of pharmacotherapy for beneficiaries in a high-risk Medicare Advantage program who were diagnosed with bipolar disorder. METHODS This was a cross-sectional study of 2338 Medicare Advantage beneficiaries diagnosed with bipolar disorder. Pharmacotherapy treatment was assessed via receipt of (1) a mood stabilizer or antipsychotic or both (i.e., guideline concordant bipolar care) and (2) unopposed antidepressant (i.e., without prescription of a mood stabilizer or an antipsychotic). Logistic regression was used to examine correlates of bipolar disorder care. RESULTS Among those younger than 65 years of age (n = 1395), 54% received guideline concordant therapy and 29% received unopposed antidepressant therapy. Among those 65 years and older (n = 943), 40% received guideline concordant therapy and 33% received unopposed antidepressant therapy. CONCLUSION Overall, about half of beneficiaries in this Medicare Advantage plan received guideline concordant pharmacotherapy for bipolar disorder, while approximately one-third received an unopposed antidepressant prescription. Antipsychotic medications accounted for most of the monotherapy observed. This study identifies opportunities for further improvements in the pharmacotherapy of bipolar disorder in high-risk Medicare patients.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA (H.H.).
| | - Jessica L Gören
- Pharmacy Practice/Clinical Pharmacy/Psychiatry, University of RI/CHA/Harvard, Somerville, MA (J.L.G.)
| | - Ya-Fen Chan
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | - Wayne Katon
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
| | | | - Jürgen Unützer
- Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA (J.R., W.K., Y.-F.C., J.U.)
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Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry 2014; 36:296-301. [PMID: 24417955 PMCID: PMC4517666 DOI: 10.1016/j.genhosppsych.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate determinants of mental health service use among depressed adolescents. METHOD We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use. RESULTS Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77-16.35), parental history of depression/anxiety (OR 4.12, CI 1.36-12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use. CONCLUSION Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.
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Affiliation(s)
- David J. Breland
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Elizabeth McCauley
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Carol Rockhill
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences; UW School of Medicine
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
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Huang H, Coleman S, Bridge JA, Yonkers K, Katon W. A meta-analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight. Gen Hosp Psychiatry 2014; 36:13-8. [PMID: 24094568 PMCID: PMC3877723 DOI: 10.1016/j.genhosppsych.2013.08.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/11/2013] [Accepted: 08/24/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To examine the relationship between antidepressant use in pregnancy and low birth weight (LBW) and preterm birth (PTB). DATA SOURCES AND STUDY SELECTION We searched English and non-English language articles via PubMed, CINAHL and PsychINFO (from their start dates through December 1st, 2012). We used the following keywords and their combinations: antidepressant, selective serotonin reuptake inhibitor (SSRI), pregnancy, antenatal, prenatal, birthweight, birth weight, preterm, prematurity, gestational age, fetal growth restriction, intrauterine growth restriction, and small-for-gestational age. Published studies were considered eligible if they examined exposure to antidepressant medication use during pregnancy and reported data on at least one birth outcome of interest: PTB (<37 weeks gestation) or LBW (<2500 g). Of the 222 reviewed studies, 28 published studies met the selection criteria. DATA EXTRACTION Two authors independently extracted study characteristics from eligible studies. RESULTS Using random-effects models, antidepressant use in pregnancy was significantly associated with LBW (RR: 1.44, 95% confidence interval (CI): 1.21-1.70) and PTB (RR: 1.69, 95% CI: 1.52-1.88). Studies varied widely in design, populations, control groups and methods. There was a high level of heterogeneity as measured by I2 statistics for both outcomes examined. The relationship between antidepressant exposure in pregnancy and adverse birth outcomes did not differ significantly when taking into account drug type (SSRI vs. other or mixed) or study design (prospective vs. retrospective). There was a significant association between antidepressant exposure and PTB for different types of control status used (depressed, mixed or nondepressed). CONCLUSIONS Antidepressant use during pregnancy significantly increases the risk for LBW and PTB.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
| | - Shane Coleman
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
| | - Jeffrey A. Bridge
- Department of Pediatrics and The Research Institute at Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Kimberly Yonkers
- PMS and Perinatal Psychiatric Research Program, Yale University, New Haven, CT
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
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Rosenberg D, Lin E, Peterson D, Ludman E, Von Korff M, Katon W. Integrated medical care management and behavioral risk factor reduction for multicondition patients: behavioral outcomes of the TEAMcare trial. Gen Hosp Psychiatry 2014; 36:129-34. [PMID: 24333157 PMCID: PMC4301679 DOI: 10.1016/j.genhosppsych.2013.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of the study was to compare behavioral outcomes (physical activity, sedentary behavior, smoking cessation, diet) between the intervention and usual care conditions from the TEAMcare trial. METHODS TEAMcare was a randomized trial among 214 adults with depression and poorly controlled diabetes and/or coronary heart disease that promoted health behavior change and pharmacotherapy to improve health. Behavioral outcomes were measured with the International Physical Activity Questionnaire (physical activity, sitting time) and the Summary of Diabetes Self-Care Activities Measure (smoking, diet, exercise). Poisson regression models among completers (N=185) were conducted adjusting for age, education, smoking status and depression. RESULTS Intervention participants had more days/week following a healthy eating plan [relative rate=1.2, 95% confidence interval (CI)=1.1-1.4] and more days of participation in 30 min of physical activity (relative rate=1.2, 95% CI=1.1-2.0) compared to usual care. Intervention participants were more likely to meet physical activity guidelines (7.5% increase) compared to usual care (12% decrease; P=.053). CONCLUSION Diet and activity generally improved for those receiving the intervention, while there were no differences in some aspects of diet (fruit and vegetable and high-fat food intake), smoking status and sitting time between conditions in the TEAMcare trial.
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Affiliation(s)
- Dori Rosenberg
- Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA.
| | - Elizabeth Lin
- Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA
| | - Do Peterson
- Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA
| | - Evette Ludman
- Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA
| | - Michael Von Korff
- Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA 98101, USA
| | - Wayne Katon
- Group Health Research Institute, University of Washington School of Medicine, Box 356560, Seattle, WA 98195-6560
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Lin EHB, Von Korff M, Peterson D, Ludman EJ, Ciechanowski P, Katon W. Population targeting and durability of multimorbidity collaborative care management. Am J Manag Care 2014; 20:887-95. [PMID: 25495109 PMCID: PMC4301683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES A patient-centered collaborative care program for depression and uncontrolled diabetes and/or coronary heart disease (CHD) demonstrated improved clinical outcomes relative to usual care. We report clinically stratified analyses of patient outcomes to inform the duration and targeting of care management services for complex patients with multimorbidity. METHODS A 12-month randomized controlled trial of a multimorbidity collaborative care program followed patients at 6, 12, 18, and 24 months for diabetes (glycated hemoglobin [A1C]), blood pressure (systolic; SBP), low-density lipoprotein (LDL) cholesterol, and depression (Symptoms Check List-20 score). Depressed patients with less favorable medical control (Patient Health Questionnaire-9 score > 10, A1C > 8.0 %, SBP > 140 mm Hg, and LDL cholesterol > 120 mg/dL) were compared with depressed patients with more favorable medical control to describe differential intervention benefits over time. RESULTS In contrast to patients with more favorable baseline control, patients with depression and unfavorable control of A1C, SBP, and LDL at baseline showed improved outcomes as early as the 6-month follow-up assessment. Clinical benefits in the intervention group were largely sustained over the 24-month follow-up, except for some deterioration of glycemic control in intervention patients and trends toward improvement among controls over time. Among patients with depression and more favorable medical control at baseline, there were minimal between-group differences in medical disease outcomes. CONCLUSIONS Clinical benefits of a multimorbidity collaborative care management program occurred early, and were only found among patients with poor control of baseline diabetes and CHD risk factors. Targeting may maximize reach and improve affordability of complex care management.
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LaRocco-Cockburn A, Reed SD, Melville J, Croicu C, Russo JE, Inspektor M, Edmondson E, Katon W. Corrigendum to “Improving depression treatment for women: Integrating a collaborative care depression intervention into OB-GYN care” [Contemp. Clin. Trials 36 (2013) 362–370]. Contemp Clin Trials 2014. [DOI: 10.1016/j.cct.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yu MK, Katon W, Young BA. Diabetes self-care, major depression, and chronic kidney disease in an outpatient diabetic population. Nephron Clin Pract 2013; 124:106-12. [PMID: 24192760 DOI: 10.1159/000355551] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/23/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND/AIMS The associations between major depression and chronic kidney disease (CKD) in patients with diabetes are incompletely characterized. Depressed patients with diabetes are known to have worse diabetes self-care, but it is not known whether this mediates the association between depression and CKD in this population. METHODS We conducted a cross-sectional study of the associations between major depressive symptoms and CKD in the Pathways Study (n = 4,082), an observational cohort of ambulatory diabetic patients from a managed care setting. Depression status was ascertained using the Patient Health Questionnaire-9 (PHQ-9). Stepwise logistic regression models examined the associations between depression and impaired estimated glomerular filtration rate (<60 ml/min/1.73 m(2)) or microalbuminuria, after adjustment for demographics, CKD risk factors, and diabetes self-care variables. RESULTS Clinically significant depression symptoms (PHQ-9 ≥10) were associated with a greater risk of microalbuminuria after adjustment for demographic variables (OR 1.54, 95% CI 1.21-1.95) and traditional CKD risk factors (OR 1.36, 95% CI 1.04-1.77); this association persisted after additional adjustment for diabetes self-care (OR 1.34, 95% CI 1.02-1.75). Depression was not associated with impaired estimated glomerular filtration rate in any of the models. CONCLUSION In this cohort of diabetic subjects, clinically significant depression symptoms were associated with microalbuminuria, which could not be entirely explained by differences in diabetes self-care.
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Affiliation(s)
- Margaret K Yu
- Division of Nephrology, University of Washington, Seattle, Wash., USA
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Tabb KM, Gavin AR, Guo Y, Huang H, Debiec K, Katon W. Views and experiences of suicidal ideation during pregnancy and the postpartum: findings from interviews with maternal care clinic patients. Women Health 2013; 53:519-35. [PMID: 23879461 DOI: 10.1080/03630242.2013.804024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Perinatal suicidality (i.e., thoughts of death, suicide attempts, or self-harm during the period immediately before and up to 12 months after the birth of a child) is a significant public health concern. Few investigations have examined the patients' own views and experiences of maternal suicidal ideation. METHODS Between April and October 2010, researchers identified 14 patient participants at a single university-based medical center for a follow-up, semi-structured interview if they screened positive for suicidal ideation on the Patient Health Questionnaire-9 (PHQ-9) short form. In-depth interviews followed a semi-structured interview guide. Researchers transcribed all interviews verbatim and analyzed transcripts using thematic network analysis. RESULTS Participants described the experience of suicidality during pregnancy as related to somatic symptoms, past diagnoses, infanticide, family psychiatric history (e.g., completed suicides and family member attempts), and pregnancy complications. The network of themes included the perinatal experience, patient descriptions of changes in mood symptoms, illustrations of situational coping, and reported mental health service use. IMPLICATIONS The interview themes suggested that in this small sample, pregnancy represented a critical time period to screen for suicide and to establish treatment for the mothers in the study. These findings may assist health care professionals in the development of interventions designed to identify, assess, and prevent suicidality among perinatal women.
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Affiliation(s)
- Karen M Tabb
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Bauer AM, Schillinger D, Parker MM, Katon W, Adler N, Adams AS, Moffet HH, Karter AJ. Health literacy and antidepressant medication adherence among adults with diabetes: the diabetes study of Northern California (DISTANCE). J Gen Intern Med 2013; 28:1181-7. [PMID: 23512335 PMCID: PMC3744297 DOI: 10.1007/s11606-013-2402-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/28/2013] [Accepted: 02/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have reported that health literacy limitations are associated with poorer disease control for chronic conditions, but have not evaluated potential associations with medication adherence. OBJECTIVE To determine whether health literacy limitations are associated with poorer antidepressant medication adherence. DESIGN Observational new prescription cohort follow-up study. PARTICIPANTS Adults with type 2 diabetes who completed a survey in 2006 and received a new antidepressant prescription during 2006-2010 (N = 1,366) at Kaiser Permanente Northern California. MAIN MEASURES Validated three-item self-report scale measured health literacy. Discrete indices of adherence based on pharmacy dispensing data according to validated methods: primary non-adherence (medication never dispensed); early non-persistence (dispensed once, never refilled); non-persistence at 180 and 365 days; and new prescription medication gap (NPMG; proportion of time that the person is without medication during 12 months after the prescription date). KEY RESULTS Seventy-two percent of patients were classified as having health literacy limitations. After adjusting for sociodemographic and clinical covariates, patients with health literacy limitations had significantly poorer adherence compared to patients with no limitations, whether measured as early non-persistence (46 % versus 38 %, p < 0.05), non-persistence at 180 days (55 % versus 46 %, p < 0.05), or NPMG (41 % versus 36%, p < 0.01). There were no significant associations with primary adherence or non-persistence at 365 days. CONCLUSIONS Poorer antidepressant adherence among adults with diabetes and health literacy limitations may jeopardize the continuation and maintenance phases of depression pharmacotherapy. Findings underscore the importance of national efforts to address health literacy, simplify health communications regarding treatment options, improve public understanding of depression treatment, and monitor antidepressant adherence.
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Affiliation(s)
- Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
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Russo J, Katon W, Zatzick D. The development of a population-based automated screening procedure for PTSD in acutely injured hospitalized trauma survivors. Gen Hosp Psychiatry 2013; 35:485-91. [PMID: 23806535 PMCID: PMC3784242 DOI: 10.1016/j.genhosppsych.2013.04.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 04/26/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This investigation aimed to advance posttraumatic stress disorder (PTSD) risk prediction among hospitalized injury survivors by developing a population-based automated screening tool derived from data elements available in the electronic medical record (EMR). METHOD Potential EMR-derived PTSD risk factors with the greatest predictive utilities were identified for 878 randomly selected injured trauma survivors. Risk factors were assessed using logistic regression, sensitivity, specificity, predictive values and receiver operator characteristic (ROC) curve analyses. RESULTS Ten EMR data elements contributed to the optimal PTSD risk prediction model including International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) PTSD diagnosis, other ICD-9-CM psychiatric diagnosis, other ICD-9-CM substance use diagnosis or positive blood alcohol on admission, tobacco use, female gender, non-White ethnicity, uninsured, public or veteran insurance status, E-code identified intentional injury, intensive care unit admission and EMR documentation of any prior trauma center visits. The 10-item automated screen demonstrated good area under the ROC curve (0.72), sensitivity (0.71) and specificity (0.66). CONCLUSIONS Automated EMR screening can be used to efficiently and accurately triage injury survivors at risk for the development of PTSD. Automated EMR procedures could be combined with stepped care protocols to optimize the sustainable implementation of PTSD screening and intervention at trauma centers nationwide.
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Affiliation(s)
- Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA 98104
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LaRocco-Cockburn A, Reed SD, Melville J, Croicu C, Russo JE, Inspektor M, Edmondson E, Katon W. Improving depression treatment for women: integrating a collaborative care depression intervention into OB-GYN care. Contemp Clin Trials 2013; 36:362-70. [PMID: 23939510 DOI: 10.1016/j.cct.2013.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/27/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Women have higher rates of depression and often experience depression symptoms during critical reproductive periods, including adolescence, pregnancy, postpartum, and menopause. Collaborative care intervention models for mood disorders in patients receiving care in an OB-GYN clinic setting have not been evaluated. Study design and methodology for a randomized controlled trial of collaborative care depression management versus usual care in OB-GYN clinics and the details of the adapted collaborative care intervention and model implementation are described in this paper. METHODS Women over age 18 years with clinically significant symptoms of depression, as measured by a Patient Health Questionnaire-9 (PHQ-9) score ≥10 and a clinical diagnosis of major depression or dysthymia, were randomized to the study intervention or to usual care and were followed for 18 months. The primary outcome assessed was change over time in the SCL-20 depression scale between baseline and 12 months. BASELINE RESULTS Two hundred five women were randomized: 57% white, 20% African American, 9% Asian or Pacific Islander, 7% Hispanic, and 6% Native American. Mean age was 39 years. 4.6% were pregnant and 7.5% were within 12 months postpartum. The majority were single (52%), and 95% had at least the equivalent of a high school diploma. Almost all patients met DSM IV criteria for major depression (99%) and approximately 33% met criteria for dysthymia. CONCLUSIONS An OB-GYN collaborative care team, including a social worker, a psychiatrist, and an OB-GYN physician, who met weekly and used an electronic tracking system for patients was the essential element of the proposed depression care treatment model described here. Further study of models that improve quality of depression care that are adapted to the unique OB-GYN setting is needed.
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Affiliation(s)
- Anna LaRocco-Cockburn
- Department of Obstetrics and Gynecology, University of Washington Medical School, Seattle, WA, USA.
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Huang H, Chan YF, Bauer AM, Suzuki J, Katon W, Russo J, Hogan D, Unützer J. Specialty behavioral health service use among chronically ill medicare advantage patients with substance use problems. Psychosomatics 2013; 54:546-51. [PMID: 23932530 DOI: 10.1016/j.psym.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study examines the use of substance abuse and mental health services among older adults with substance use disorders. METHODS Participants were members of Humana Cares, a subsidiary of Humana, Inc., a care management program for chronically ill Medicare Advantage members, between 2008 and 2010. All adults aged 65 and older with a substance use disorder identified with International Classification of Diseases-9 codes were included. We compared utilization of substance abuse and mental health services among participants with no psychiatric comorbidity (n = 585), with comorbid depression (n = 605), and with comorbid severe and persistent mental illness (severe and persistent mental illness, n = 95). RESULTS Twenty-eight percent utilized substance abuse services and 36% utilized mental health services. After adjusting for covariates, comorbid depression (odds ratio = 4.27, 95% confidence interval: 3.22-5.65) and severe and persistent mental illness (odds ratio = 10.75, 95% confidence interval: 5.22-20.13) were independently associated with specialty service use (either substance abuse or mental health services). CONCLUSION Although few chronically ill older adults with substance use disorders in this Medicare Advantage program received any specialty substance abuse or mental health services, utilization was higher among those who had concurrent psychiatric disorders.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA.
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Kessler RC, Calabrese JR, Farley PA, Gruber MJ, Jewell MA, Katon W, Keck PE, Nierenberg AA, Sampson NA, Shear MK, Shillington AC, Stein MB, Thase ME, Wittchen HU. Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders. Psychol Med 2013; 43:1625-1637. [PMID: 23075829 DOI: 10.1017/s0033291712002334] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. METHOD Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. RESULTS Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses. CONCLUSIONS CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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Rockhill CM, Katon W, Richards J, McCauley E, McCarty CA, Myaing MT, Zhou C, Richardson LP. What clinical differences distinguish depressed teens with and without comorbid externalizing problems? Gen Hosp Psychiatry 2013; 35:444-7. [PMID: 23648192 PMCID: PMC3692614 DOI: 10.1016/j.genhosppsych.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study examined differences in co-occurring symptoms, psychosocial correlates, health care utilization and functional impairment in youth who screened positive for depression, stratified by whether or not they also self-reported externalizing problems. METHODS The AdoleSCent Health Study examined a random sample of youth ages 13-17 enrolled in a health care system. A total of 2291 youth (60.7% of the eligible sample) completed a brief depression screen: the two-item Patient Health Questionnaire. The current analyses focus on a subset of youth (n=113) who had a follow-up interview and screened positive for possible depression on the Patient Health Questionnaire 9 using a cutoff score of 11 or higher [1]. Youth were categorized as having externalizing behavior if their score was ≥ 7 on the Pediatric Symptom Checklist (PSC) externalizing scale [2,3]. χ(2) tests and Wilcoxon rank sum tests were used to compare groups. RESULTS Differences between groups included that youth with depression and externalizing symptoms had a higher rate of obesity and had higher self-reported functional impairment than youth with depression symptoms alone. CONCLUSIONS Adding screening for externalizing problems to existing recommendations for depression screening may help primary care providers to identify a high-risk depressed group of youth for referral to mental health services.
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Affiliation(s)
- Carol M Rockhill
- Department of Psychiatry, University of Washington, Seattle Children's Hospital, Seattle, WA 98195, USA.
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Dickens C, Katon W, Blakemore A, Khara A, Tomenson B, Woodcock A, Fryer A, Guthrie E. Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression. Respir Med 2013; 108:426-37. [PMID: 23806286 DOI: 10.1016/j.rmed.2013.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
CONTEXT Chronic obstructive pulmonary disease is common and accounts for considerable healthcare expenditure. A large proportion of this healthcare expenditure is attributable to the use of expensive urgent healthcare. The characteristics of interventions that reduce the use of urgent healthcare remain unclear. OBJECTIVE To examine the characteristics of complex interventions intended to reduce the use of urgent and unscheduled healthcare among people with COPD. DATA SOURCES Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to 25th January 2013 were conducted. These were supplemented by hand-searching bibliographies and citation tracing identified reviews and eligible studies. STUDY SELECTION Studies were eligible for inclusion if they: i) included adults with chronic obstructive pulmonary disease, ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. DATA EXTRACTION Data on the subjects recruited, trial methods used, the characteristics of complex interventions and the effects of the intervention on urgent healthcare utilisation were extracted from eligible studies. RESULTS 32 independent studies were identified. Pooled effects indicated that interventions were associated with a 32% reduction in the use of urgent healthcare (OR = 0.68, 95% CI = 0.57, 0.80). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.66, 95% CI = 0.55, 0.81), Exercise (OR = 0.60, 95% CI = 0.48, 0.76) and relaxation therapy (OR = 0.48, 95% CI = 0.33, 0.70). CONCLUSIONS Use of urgent healthcare in patients with COPD was significantly reduced by complex interventions. Complex interventions among people with COPD may reduce the use of urgent care, particularly those including education, exercise and relaxation.
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Affiliation(s)
- Chris Dickens
- Institute of Health Service Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), Universities of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter EX2 4SG, UK
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA
| | - Amy Blakemore
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Centre for Primary Care, Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK.
| | - Angee Khara
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Barbara Tomenson
- Biostatistics Unit, Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Ashley Woodcock
- Institute of Inflammation and Repair, University of Manchester, 2nd Floor Education and Research Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Anna Fryer
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Else Guthrie
- Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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40
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Coleman SM, Katon W, Lin E, Von Korff M. Depression and death in diabetes; 10-year follow-up of all-cause and cause-specific mortality in a diabetic cohort. Psychosomatics 2013; 54:428-36. [PMID: 23756124 DOI: 10.1016/j.psym.2013.02.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/14/2013] [Accepted: 02/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND When depression co-occurs with type 2 diabetes, adverse bidirectional interactions increase the burden of both illnesses. In addition to affecting patient's health, functioning, and quality of life, this relationship also results in increased mortality compared with those with depression or diabetes alone. OBJECTIVE The purpose of this study was to examine the relationship between depression and all-cause as well as cause-specific mortality in patients with type 2 diabetes by extending findings from our 5-year mortality study. Specifically, we re-examined the risk of depression and all-cause, cardiovascular, cancer, and non-cardiovascular, non-cancer related deaths. METHOD We used an ICD-10 algorithm combined with death certificate data to classify mortality types among type 2 diabetic patients who participated in the Pathways Epidemiologic Study. Cox proportional hazard modeling was used to examine the relationships between depression status and mortality over a 10-year period. RESULTS We found a significant positive relationship between depression and all-cause as well as non-cardiovascular, non-cancer mortality in this sample (n = 4128). Cardiovascular mortality failed to reach significance in fully adjusted models and, in contrast to the 5-year data, no trend or significant relationship was observed between depression status and cancer related deaths. CONCLUSIONS Our study confirmed a significant positive relationship between depression and mortality in patients with type 2 diabetes. Major depression demonstrated a stronger relationship than did minor depression, and among cause-specific groups, non-cardiovascular, non-cancer death types demonstrated the largest magnitude of association with depression status.
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Affiliation(s)
- Shane M Coleman
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
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Kohen R, Myaing MT, Richards J, Zhou C, McCauley EA, Katon W, Richardson LP. Depression persistence and serotonin transporter genotype in adolescents under usual care conditions. J Child Adolesc Psychopharmacol 2013; 23:290-4. [PMID: 23647137 PMCID: PMC3657280 DOI: 10.1089/cap.2011.0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Polymorphisms of the serotonin transporter (SERT) gene have been shown to influence the risk for depression. The goal of this study was to investigate a possible effect of SERT polymorphisms on severity and course of depression symptoms in a community sample of adolescents. METHODS Community-dwelling adolescents (n=192) ages 13-17 years, who were at risk for depression, were followed for a period of 6 months. Subjects donated a saliva sample for genotyping of the 5-HTTLPR and STin2 VNTR polymorphisms of SERT. RESULTS We found no associations between SERT genotype and severity of depressive symptoms at baseline. Depression symptom severity markedly decreased over time. For 5-HTTLPR, we observed a significant interaction between time and genotype, indicating the possibility that heterozygote genotype carriers (s/l) might experience a greater reduction in depression symptoms over time compared with adolescents with the 5-HTTLPR l/l genotype. CONCLUSIONS Our study shows that for most community-dwelling adolescents, depressive symptoms decrease over time. A possible interaction effect of time and SERT genotype will require confirmation in larger studies.
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Affiliation(s)
- Ruth Kohen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Mon T. Myaing
- Seattle Children's Research Institute, Seattle, Washington
| | - Julie Richards
- Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth A. McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Group Health Research Institute, Seattle, Washington
| | - Laura P. Richardson
- Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Group Health Research Institute, Seattle, Washington
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Huang H, Russo J, Bauer AM, Chan YF, Katon W, Hogan D, Unützer J. Depression care and treatment in a chronically ill Medicare population. Gen Hosp Psychiatry 2013; 35:382-6. [PMID: 23557895 PMCID: PMC3692601 DOI: 10.1016/j.genhosppsych.2013.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 02/18/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study is to examine depression care among chronically ill Medicare Advantage beneficiaries. METHODS This study includes 5898 Medicare Advantage members with a depression diagnosis enrolled between 2008 and 2010 in a care management program. Two depression care indicators were created: (a) any depression care (≥ 1 antidepressant prescription or ≥ 1 specialty mental health visit) and (b) among those receiving any depression care, those receiving an antidepressant prescription for ≥ 90 days or ≥ 2 specialty visits. Multivariable analysis using logistic regression was used to examine correlates of depression care. RESULTS Among those <65 years old, 72% received any depression care with 75% receiving ≥ 90 days of an antidepressant and/or ≥ 2 specialty visits. Among ≥ 65 years old, 65% received any depression care with 67% receiving ≥ 90 days of an antidepressant and/or ≥ 2 specialty visits. For both age groups, female gender, medical comorbidities and dual eligibility were positively associated with an antidepressant prescription. In the older group, female gender was positively associated with at least a 90-day supply of an antidepressant prescription, while substance use disorders were negatively associated with receiving a minimum of 90 days of an antidepressant. Regional differences and certain psychiatric comorbidities were also associated with receiving depression care. CONCLUSION Two thirds of the depressed patients in this Medicare Advantage population received depression care. Further studies are needed to examine the effects of quality improvement efforts in the context of care management programs for chronically ill older adults.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA.
| | - Joan Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
| | - Amy M. Bauer
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
| | - Ya-Fen Chan
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
| | | | - Jürgen Unützer
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA
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Richardson LP, McCauley E, McCarty CA, Grossman DC, Myaing M, Zhou C, Richards J, Rockhill C, Katon W. Predictors of persistence after a positive depression screen among adolescents. Pediatrics 2012; 130:e1541-8. [PMID: 23166342 PMCID: PMC3507250 DOI: 10.1542/peds.2012-0450] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth. METHODS We conducted a cohort study of 444 youth (aged 13-17 years) from a large health care delivery system. Youth with depressive symptoms, based on a 2-item depression screen, were oversampled for the baseline interview. Baseline assessments included the Patient Health Questionnaire 9-item (PHQ-9) depression screen as well as clinical factors that were hypothesized to influence depression persistence (family history of depression, functional impairment, perceived social support, anxiety symptoms, externalizing symptoms, and medical comorbidity). Logistic regression analysis was used to examine factors associated with the persistence of depression at 6 months postbaseline. RESULTS Of 113 youth with a positive baseline screen (PHQ-9 ≥11), 47% and 35% continued to be positive at 6-week and 6-month follow-up, respectively. After controlling for treatment status, only 2 factors were significantly associated with depression persistence at 6 months: baseline depressive symptom score and continuing to have a positive screen at 6 weeks. For each 1-point increase on the PHQ-9 score at baseline, youth had a 16% increased odds of continuing to be depressed at 6 months (odds ratio: 1.16, 95% confidence interval: 1.01-1.34). Youth who continued to screen positive 6 weeks later had almost 3 times the odds of being depressed at 6 months (odds ratio: 2.89, 95% confidence interval: 1.09-7.61). CONCLUSIONS Depressive symptom severity at presentation and continued symptoms at 6 weeks postscreening are the strongest predictors of depression persistence. Patients with high depressive symptom scores and continued symptoms at 6 weeks should receive active treatment.
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Affiliation(s)
- Laura P. Richardson
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington;,Group Health Research Institute, Seattle, Washington; and
| | - Elizabeth McCauley
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Carolyn A. McCarty
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - David C. Grossman
- Group Health Research Institute, Seattle, Washington; and,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Mon Myaing
- Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Chuan Zhou
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Julie Richards
- Group Health Research Institute, Seattle, Washington; and
| | - Carol Rockhill
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Wayne Katon
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Dickens C, Katon W, Blakemore A, Khara A, McGowan L, Tomenson B, Jackson J, Walker L, Guthrie E. Does depression predict the use of urgent and unscheduled care by people with long term conditions? A systematic review with meta-analysis. J Psychosom Res 2012; 73:334-42. [PMID: 23062805 DOI: 10.1016/j.jpsychores.2012.08.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/04/2012] [Accepted: 08/27/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND Factors that drive the use of urgent healthcare among people with chronic physical illness (i.e. long term conditions-LTCs) are poorly understood. We conducted a systematic review with meta analysis to examine the strength of association between depression and subsequent use of urgent healthcare among people with LTCs. METHODS Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library 2011 were conducted, supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts about relevant studies. Studies were eligible for inclusion if they: i)used prospective cohort design, ii)included patients with diabetes, asthma, chronic obstructive pulmonary disease or coronary heart disease, iii)used a standardised measure of depression, and iv)assessed urgent healthcare utilisation prospectively. Data on the subjects recruited, methods used and the association between depression and subsequent urgent healthcare utilisation were extracted from eligible studies. Odds ratios (ORs) were calculated for each study and pooled using random effects models. RESULTS 16 independent studies were identified. Pooled effects indicated that depression was associated with a 49% increase in the odds of urgent healthcare utilisation (OR=1.49, p<.0005). This effect was not significantly affected by publication bias or inclusion of studies of low quality. Effects were much smaller and non-significant among the 3 studies that controlled for other covariates, including severity of illness (OR=1.13, p=.31). CONCLUSIONS Depression was associated with increased urgent healthcare use, but not in the minority of studies that controlled for other covariates. This possibly suggests confounding, but the severity measures may themselves have been influenced by depression.
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Affiliation(s)
- Chris Dickens
- Mental Health Research Group, Peninsula College of Medicine and Dentistry, University of Exeter, UK.
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Katon W, Guico-Pabia CJ. Improving quality of depression care using organized systems of care: a review of the literature. Prim Care Companion CNS Disord 2012; 13:10r01019blu. [PMID: 21731829 DOI: 10.4088/pcc.10r01019blu] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/19/2010] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish the need for a chronic disease management strategy for major depressive disorder (MDD), discuss the challenges involved in implementing guideline-level treatment for MDD, and provide examples of successful implementation of collaborative care programs. DATA SOURCES A systematic literature search of MEDLINE and the US National Library of Medicine was performed. STUDY SELECTION We reviewed clinical studies evaluating the effectiveness of collaborative care interventions for the treatment of depression in the primary care setting using the keywords collaborative care, depression, and MDD. This review includes 45 articles relevant to MDD and collaborative care published through May 2010 and excludes all non-English-language articles. RESULTS Collaborative care interventions include a greater role for nonmedical specialists and a supervising psychiatrist with the major goal of improving quality of depression care in primary care systems. Collaborative care programs restructure clinical practice to include a patient care strategy with specific goals and an implementation plan, support for self-management training, sustained patient follow-up, and decision support for medication changes. Key components associated with the most effective collaborative care programs were improvement in antidepressant adherence, use of depression case managers, and regular case load supervision by a psychiatrist. Across studies, primary care patients randomized to collaborative care interventions experienced enhanced treatment outcomes compared with those randomized to usual care, with overall outcome differences approaching 30%. CONCLUSIONS Collaborative care interventions may help to achieve successful, guideline-level treatment outcomes for primary care patients with MDD. Potential benefits of collaborative care strategies include reduced financial burden of illness, increased treatment adherence, and long-term improvement in depression symptoms and functional outcomes.
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Affiliation(s)
- Wayne Katon
- University of Washington Medical School, Seattle, WA, USA.
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Huang H, Chan YF, Katon W, Tabb K, Sieu N, Bauer AM, Wasse JK, Unützer J. Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups. Fam Pract 2012; 29:394-400. [PMID: 22090192 PMCID: PMC3408881 DOI: 10.1093/fampra/cmr108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED PURPOSE. To examine variations in depression care and outcomes among high-risk pregnant and parenting women from different racial/ethnic groups served in community health centres. METHODS As part of a collaborative care programme that provides depression treatment in primary care clinics for high-risk mothers, 661 women with probable depression (Patient Health Questionnaire-9 ≥ 10), who self-reported race/ethnicity as Latina (n = 393), White (n = 126), Black (n = 75) or Asian (n = 67), were included in the study. Primary outcomes include quality of depression care and improvement in depression. A Cox proportional hazard model adjusting for sociodemographic and clinical characteristics was used to examine time to treatment response. RESULTS We observed significant differences in both depression processes and outcomes across ethnic groups. After adjusting for other variables, Blacks were found to be significantly less likely to improve than Latinas [hazard ratio (HR): 0.53, 95% confidence interval (CI): 0.44-0.65]. Other factors significantly associated with depression improvement were pregnancy (HR: 1.52, 95% CI: 1.27-1.82), number of clinic visits (HR: 1.26, 95% CI: 1.17-1.36) and phone contacts (HR: 1.45, 95% CI: 1.32-1.60) by the care manager in the first month of treatment. After controlling for depression severity, having suicidal thoughts at baseline was significantly associated with a decreased likelihood of depression improvement (HR: 0.75, 95% CI: 0.67-0.83). CONCLUSIONS In this racially and ethnically diverse sample of pregnant and parenting women treated for depression in primary care, the intensity of care management was positively associated with improved depression. There was also appreciable variation in depression outcomes between Latina and Black patients.
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Affiliation(s)
- Hsiang Huang
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical School, Seattle, WA 98195-6560, USA.
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Grote NK, Spieker SJ, Lohr MJ, Geibel SL, Swartz HA, Frank E, Houck PR, Katon W. Impact of childhood trauma on the outcomes of a perinatal depression trial. Depress Anxiety 2012; 29:563-73. [PMID: 22447637 PMCID: PMC3554235 DOI: 10.1002/da.21929] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure. METHODS Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included ≥ 18 years, >12 on the Edinburgh Postnatal Depression Scale, 10-32 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems. RESULTS Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure. CONCLUSIONS Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.
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Affiliation(s)
- Nancy K. Grote
- School of Social Work, University of Washington, Seattle, WA,Correspondence to: Nancy K. Grote, School of Social Work, University of Washington, Campus Box 354900, 4101 15th Ave. East, Seattle, WA 98105.
| | | | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle, WA
| | - Sharon L. Geibel
- Office of Child Development, University of Pittsburgh, Pittsburgh, PA
| | - Holly A. Swartz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Patricia R. Houck
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Katon W, Russo J, Lin EHB, Schmittdiel J, Ciechanowski P, Ludman E, Peterson D, Young B, Von Korff M. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. ACTA ACUST UNITED AC 2012; 69:506-14. [PMID: 22566583 DOI: 10.1001/archgenpsychiatry.2011.1548] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Patients with depression and poorly controlled diabetes mellitus, coronary heart disease (CHD), or both have higher medical complication rates and higher health care costs, suggesting that more effective care management of psychiatric and medical disease control might also reduce medical service use and enhance quality of life. OBJECTIVE To evaluate the cost-effectiveness of a multicondition collaborative treatment program (TEAMcare) compared with usual primary care (UC) in outpatients with depression and poorly controlled diabetes or CHD. DESIGN Randomized controlled trial of a systematic care management program aimed at improving depression scores and hemoglobin A(1c) (HbA(1c)), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL-C) levels. SETTING Fourteen primary care clinics of an integrated health care system. PATIENTS Population-based screening identified 214 adults with depressive disorder and poorly controlled diabetes or CHD. INTERVENTION Physician-supervised nurses collaborated with primary care physicians to provide treatment of multiple disease risk factors. MAIN OUTCOME MEASURES Blinded assessments evaluated depressive symptoms, SBP, and HbA(1c) at baseline and at 6, 12, 18, and 24 months. Fasting LDL-C concentration was assessed at baseline and at 12 and 24 months. Health plan accounting records were used to assess medical service costs. Quality-adjusted life-years (QALYs) were assessed using a previously developed regression model based on intervention vs UC differences in HbA(1c), LDL-C, and SBP levels over 24 months. RESULTS Over 24 months, compared with UC controls, intervention patients had a mean of 114 (95% CI, 79 to 149) additional depression-free days and an estimated 0.335 (95% CI, -0.18 to 0.85) additional QALYs. Intervention patients also had lower mean outpatient health costs of $594 per patient (95% CI, -$3241 to $2053) relative to UC patients. CONCLUSIONS For adults with depression and poorly controlled diabetes, CHD, or both, a systematic intervention program aimed at improving depression scores and HbA(1c), SBP, and LDL-C levels seemed to be a high-value program that for no or modest additional cost markedly improved QALYs. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00468676
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
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Richardson LP, Russo JE, Katon W, McCarty CA, DeVries A, Edlund MJ, Martin BC, Sullivan M. Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain. J Adolesc Health 2012; 50:553-8. [PMID: 22626480 PMCID: PMC3368381 DOI: 10.1016/j.jadohealth.2011.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults presenting with common chronic pain complaints (back pain, neck pain, headache, and arthritis/joint pain). METHODS Using claims data from January 1, 2001 to June 30, 2008, we conducted a longitudinal analysis of opioid use patterns among 13-24-year-old subjects presenting with a new episode of chronic pain. Long-term opioid use was defined as receiving >90 days of opioids within a 6-month period with no gap of >30 days in use of opioids in the 18 months after the first qualifying pain diagnosis. Mental health disorders were identified from claims in the 6 months before the first qualifying pain diagnosis. RESULTS Fifty-nine thousand seventy-seven youth met criteria for a new episode of chronic pain. Among these youth, 321 (.5%) met criteria for long-term opioid use, and 16,172 (27.4%) had some opioid use. After controlling for demographic and clinical factors, youth with preexisting mental health diagnoses had a 2.4-fold increased risk of subsequently receiving long-term opioids versus no opioids (odds ratio = 2.36, 95% confidence interval = 1.73-3.23) and a 1.8-fold increased likelihood of receiving long-term opioids versus some opioids (odds ratio = 1.83, 95% confidence interval = 1.34-2.50). CONCLUSIONS Mental health disorders are associated with increased risk for long-term opioid use among adolescents and emerging young adults. Further study is warranted to examine risks and benefits of long-term opioid use in this population.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | | | - Mark J. Edlund
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mark Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, 98195-6560, USA.
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