Adequate Treatment Of Depression Research Articles

A Collaborative Care Depression Management Program for Cardiac Inpatients: Depression Characteristics and In-Hospital Outcomes

Depression in cardiac patients is common, under-recognized, and independently associated with mortality. Our objectives in this initial report from a 6-month longitudinal trial were to determine whether a collaborative care program improves rates of depression treatment by discharge among patients hospitalized with acute cardiovascular disease, and to assess key clinical characteristics of depression in this cohort. This was a prospective, randomized trial comparing collaborative care and usual care interventions for depressed cardiac patients who were admitted to cardiac units in an urban academic medical center. For collaborative care subjects, the care manager performed a multi-component depression intervention in the hospital that included patient education and treatment coordination; usual care subjects' inpatient providers were informed of the depression diagnosis. The mean Patient Health Questionnaire-9 for subjects (N = 175) was 17.6 (SD 3.5; range 11-26), consistent with moderate-severe depression. The majority of subjects had depression for over one month (n = 134; 76.6%) and a prior depressive episode (n = 124; 70.8%); nearly one-half (n = 75; 42.9%) had thoughts that life was not worth living in the preceding 2 weeks. Collaborative care subjects were far more likely to receive adequate depression treatment by discharge (71.9% collaborative care vs. 9.5% usual care; p < 0.001). Depression identified by systematic screening in hospitalized cardiac patients appears was prolonged, and of substantial severity. A collaborative care depression management model appears to vastly increase rates of appropriate treatment by discharge.

Approaching the Treatment of Depression in Elderly Cancer Patients

Cancer elevates the risk for developing depression. Among patients, untreated depression predicts a poorer quality of life, higher medical care costs and excess cancer mortality. Psychosocial care is now considered to be a standard component of quality cancer care. However, there is a limited evidence base and few guidelines for screening and treating depression in elderly cancer patients. In oncology settings, rates of adequate treatment for depression in elderly patients remain strikingly low. Novel approaches are needed to increase access to care, particularly among those with advanced disease.

Predictors of adequate depression treatment among Medicaid-enrolled adults.

To determine whether Medicaid-enrolled depressed adults receive adequate treatment for depression and to identify the characteristics of those receiving inadequate treatment. Claims data from a Medicaid-enrolled population in a large mid-Atlantic state between July 2006 and January 2008. We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period (N=1,098). Many depressed adults received either minimally adequate psychotherapy or pharmacotherapy. Black individuals and individuals who began their depression treatment episode with an inpatient psychiatric stay for depression were markedly less likely to receive minimally adequate psychotherapy and more likely to receive inadequate treatment. Racial minorities and individuals discharged from inpatient treatment for depression are at risk for receiving inadequate depression treatment.

Erratum to: Access to Adequate Outpatient Depression Care for Mothers in the USA: A Nationally Representative Population-Based Study

Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996–2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, and adequate). Multivariate regression was used to model the odds of receiving some or adequate treatment, compared to none. Results indicated that only 34.8% of mothers in the USA with depression received adequate treatment. Mothers not in the paid workforce and those with health insurance were more likely to receive treatment, while minority mothers and those with less education were less likely to receive treatment. Understanding disparities in receipt of adequate treatment is critical to designing effective interventions, reducing treatment inequities, and ultimately improving the mental health and health of mothers and their families.

Access to adequate outpatient depression care for mothers in the USA: a nationally representative population-based study.

Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996-2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, and adequate). Multivariate regression was used to model the odds of receiving some or adequate treatment, compared to none. Results indicated that only 34.8% of mothers in the USA with depression received adequate treatment. Mothers not in the paid workforce and those with health insurance were more likely to receive treatment, while minority mothers and those with less education were less likely to receive treatment. Understanding disparities in receipt of adequate treatment is critical to designing effective interventions, reducing treatment inequities, and ultimately improving the mental health and health of mothers and their families.

Management of depression in the last month of life

In clinical practice, assessment and adequate treatment of depression in the last month of life remain a difficult task. Although assessment instruments and criteria for depression are available for use in the palliative care population, few have been applied for the last weeks of life. The same is true for clinical management including antidepressants. Assessment aids such as Hospital Anxiety and Depression Scale or Hamilton Depression Rating Scale are available and validated for the last days or weeks of life, but its clinical impact remains unclear. The wish to die may symbolize more the acceptance that life comes to an end instead of reflecting a depressive or anxiety disorder. Communication about concrete preparation for death, life completion discussions, expressing religious struggle and giving back a sense of coherence seem to be promising non-pharmacological strategies and may lead to improved social function and better management of physical symptoms. Good news for researchers comes from a recent study highlighting the fact that psychosocial research seems to be of more potential benefit than burden for the patient. No recent literature can be found on the pharmacological management of depression in the last weeks of life. Few studies demonstrate the usefulness of concrete end of life preparation discussions that underpins the importance and impact of best carer-patient relationship during this last phase of life. A Cochrane protocol on antidepressants in severely physically ill patients has been undertaken recently to highlight this important clinical question, but results may reflect the lack of studies focusing on the last weeks or days of life.

Facteurs associés à l’adéquation des traitements de l’épisode dépressif majeur en France

Level of treatment inadequacy amongst people suffering from a major depressive episode (MDE) remains an important issue in the literature. Moreover, from a public health perspective, it's important to know how this situation can be improved. The objective of this study was to identify which factors are associated with adequate treatment for depression in France. A More specific objective was to investigate if being adequately treated is associated with the type of health care professionals consulted and, furthermore, to test the specific effect of providers taking sociodemographic and clinical variables into account. This study was carried out from the data of the Health Barometer 2005, a random survey on various health topics. Thirty thousand five hundred and fourteen individuals from 12 to 75 years old were interviewed by telephone from October 2004 to February 2005. Depressive disorders were assessed by a standardized tool (CIDI-SF) according to the classification of the DSM-IV (16,883 individuals had answered the questions of mental health: 60% of the individuals aged 15 or older). Levels of treatment adequacy are higher for women, more severe disorders, and for people living in Paris or Central Eastern regions. They are lower for students. Significant differences were found between types of professionals and levels of treatment adequacy. They are higher for psychiatrists than for psychologists and psychotherapists and higher than for general practitioners. Lowest levels of adequate treatment were found for depressed people who used services without considering this recourse being for "mental health reasons". There are also some significant differences in sociodemographic and clinical patient characteristics between health care professionals. The population of depressed people consulting without "mental health reasons" is older and less educated. The population of depressed people consulting a psychiatrist suffers from more severe disorders and is more educated than those consulting a general practitioner. The population of depressed people consulting a psychologist or a psychotherapist is younger and more educated. Taking sociodemographic and clinical variables into account, the probability of receiving an adequate treatment increases when using specialized care only, or conjointly with the primary care sector. To be retired and to be yet another "inactive" is associated with better treatment adequacy, as is living in Mediterranean, Paris or Central Eastern regions. Severe MDE also increases the probability of being adequately treated. Levels of treatment adequacy differ between health professionals, even when sociodemographic characteristics of their patients and the severity of their disorders are controlled; specialized care, in particular when associated with primary care use of services, is correlated with the highest rates of adequate treatments, and should therefore be recommended. Geographical areas are associated with adequation of treatments, but not with use of healthcare systems. This suggests that disparities in the organization of the healthcare systems and in the collaboration between professional might exist in the different areas.

Trends in Antidepressant Utilization From 2001 to 2004

This study investigated whether the trend of increasing rates of antidepressant use in the 1990s continued into 2000-2004. Antidepressant treatment rates were examined by age group and by the class of antidepressant in order to identify whether any observed trends were being driven by a particular age group of patients or class of medication. Secondary analysis was performed on data from the 2000-2004 Medical Panel Expenditure Surveys, a nationally representative survey of U.S. households, to examine trends in antidepressant use by age group and medication class in the total sample (N=166,435). Trends in the rates of antidepressant use among individuals with self-reported depression (N=10,959) and self-reported anxiety disorders without comorbid depression (N=6,899) were also examined. Antidepressant use increased among all Americans, from 6.6% in 2000 to 8.1% in 2004 (p<.001). Rates of antidepressant use by individuals with anxiety disorders without comorbid depression increased from 30.8% in 2000 to 39.0% in 2002, before declining to 33.2% in 2004. However, antidepressant use decreased among individuals with self-reported depression, from 63.1% in 2000 to 56.7% in 2004 (p<.001). This downward trend in antidepressant use was largely driven by a decrease in use of selective serotonin reuptake inhibitors, especially among children and middle-aged adults with depression. Rates of adequate antidepressant treatment (defined as receiving at least four antidepressant prescriptions at the minimum adequate daily dosage) peaked in 2002 (36.9%), and there was a significant decline by 2004 (31.7%) (p=.003). After years of increased use of antidepressant therapy to treat depression, a trend reversal in the beginning of the 21st century was observed, including decreasing rates of adequate antidepressant treatment. This downward trend preceded the black-box warnings included on antidepressant labels beginning in 2004.

Patterns of Mild Cognitive Impairment After Treatment of Depression in the Elderly

Late-life depression (LLD) is associated with persistent cognitive impairment in a subset of individuals. The purpose of this study was to 1) examine the frequency and characteristics of cognitive diagnoses (Mild Cognitive Impairment [MCI], dementia) among remitted elderly depressed subjects and 2) to compare the prevalence rate and correlates of cognitive diagnoses with those of comparison subjects. Crosssectional. Outpatient geriatric mental health clinic. The authors examined cognitive diagnoses among 109 subjects age 65 and older, after depression treatment response and 65 never-depressed, age- and education-equated comparison subjects. Cognitive diagnoses were independently established by the University of Pittsburgh's Alzheimer's Disease Research Center. Bivariate and multivariate analyses were conducted to examine the role of specific risk factors for cognitive diagnosis among depressed subjects. Relative to comparison subjects, nearly twice as many depressed subjects were diagnosed with MCI or dementia (48% versus 28%). Of the 109 depressed subjects, 38% were diagnosed with MCI (63% amnestic, 37% nonamnestic). The majority of amnestic MCI subjects (85%) had the multiple domain subtype. Age, but not age of onset or lifetime depression duration, predicted cognitive diagnosis. Despite adequate depression treatment response, 48% of remitted depressed subjects had a cognitive diagnosis. Of the 38% diagnosed with MCI, there was high representation among both the amnestic and the nonamnestic subtypes, suggesting heterogeneity in cognitive course and outcomes in LLD.

Disparities in Depression Care: Implications for Population-Based Surveys

Back to table of contents Previous article Next article LetterFull AccessLetterBrason Lee M.S.W., M.S.Brason Lee M.S.W., M.S.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2009.60.2.268AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Disparities in Depression Care: Implications for Population-Based SurveysTo the Editor: I applaud the work of Alegría and colleagues described in their article, "Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States," in the November 2008 issue ( 1 ). In examining whether individuals who could benefit from depression treatment received no treatment or inadequate treatment, these investigators touched on an important policy issue that warrants further discussion. Namely, given the lack of population-based studies that take an expanded look at issues related to depression, what are some of the lessons that health professionals in the policy and research arena can learn from their findings? In terms of population health, one lesson is that we may need to broaden the focus from using a single indicator to using multiple indicators to improve the detection of the need for mental health care and the assessment of the quality of mental health care. The Behavioral Risk Factor Surveillance System (BRFSS), conducted by the Centers for Disease Control and Prevention, is arguably the largest annual telephone health survey in the world. The BRFSS contains one general item related to the number of days in which the respondents rated their mental health as not good. In addition, eight items related to the severity of depressive symptoms are included in a list of optional questions, which means that states can elect not to include these items in their surveys. Although the eight optional questions measure some of the aspects of global functioning that are addressed in most depression scales, none of the BRFSS questions specifically ask for information related to the number of days in which respondents felt totally unable to carry out daily activities. In the study by Alegría and colleagues this variable was associated with the strongest likelihood of receipt of depression treatment and of receipt of adequate depression treatment. The strength of this association was second only to that of insurance type. In addition, none of the BRFSS questions attempt to look at the frequency or quality of depression treatment. Our awareness of mental health care disparities is not new. The continued call by the Healthy People 2010 initiative to reduce racial and ethnic disparities in mental health care requires us to seriously reevaluate how we approach the identification of mental health care need in a racially and ethnically diverse society and how we measure the quality of that care as a way to engage and retain people in treatment. In a society that is increasingly more diverse, health policy makers and researchers must recognize the need to be sensitive and flexible in the use of language that is understandable to patients ( 2 ) and that recognizes how the expression of depression and depressive symptoms may be culturally shaped ( 3 ). Mr. Lee is an independent researcher who is also affiliated with the California Department of Public Health, Sacramento. The views expressed are those of the author and may not necessarily represent the policies of the California Department of Public Health.

Treatment of depression in a low-income primary care setting with colocated mental health care.

In order to characterize depression treatment-as-usual in a large primary care practice in the United States with colocated mental health care, and to examine predictors of receiving any treatment and receiving adequate treatment, primary care patients were systematically approached in waiting rooms. Those with a minimum level of depression symptoms (n = 91) were asked to participate in a study in which they completed assessments of mental health service use, depression symptoms, and related problems. Results suggested that most patients with elevated depressive symptoms were receiving some type of mental health care, indicating they had been identified as depressed. However, only half were receiving "minimally adequate care." Minority patients were less likely to receive any care. Patients who were more depressed, demonstrated poorer problem-solving ability, and had poorer physical health were more likely to receive any treatment and to receive minimally adequate treatment for depression. These results suggest that, even in the context of colocated mental health care, there is still room for improving treatment of depressed patients.

Prevalence of Depression Diagnoses and Use of Antidepressant Medications by Veterans with Spinal Cord Injury

The objectives of this study were to examine the prevalence of depression diagnoses among veterans with spinal cord injuries and disabilities (SCI&D) for a 3-yr period, and to characterize patterns of antidepressant medication use in this population. This study was a retrospective analysis of clinical and administrative data. The sample consisted of 3678 veterans with SCI&D who had received any health care at a Department of Veterans Affairs facility between fiscal years 1999 and 2001, a depression diagnosis, and complete data. Logistic regression analysis was used to examine associations between patient characteristics, antidepressant types, and prescription patterns. Approximately 22% of veterans with SCI&D received a diagnosis of depression during at least one encounter with a healthcare provider. Of those diagnosed, 72% received antidepressant prescriptions. However, a large percentage (67%) did not continue antidepressant use for 6 mos. Patients started on a selective serotonin reuptake inhibitor were more likely to have at least 6 mos of continuous use than patients started on other, newer antidepressants. Many veterans with SCI&D may not be receiving adequate treatment for depression. Veterans with SCI&D should be aggressively screened and treated for depression, and further research is necessary to determine which treatments for depression are most effective for persons with SCI&D.

Depression and ischemic heart disease: what have we learned from clinical trials?

Discuss the interplay of depression and ischemic heart disease. Studies demonstrate high prevalence of depression and its negative impact among patients with ischemic heart disease. Results extend previous findings among men, demonstrating a significant increase in mortality and cardiovascular events among depressed women. Sertraline, citalopram and mitrazapine have been shown to be safe and well tolerated in patients with ischemic heart disease. Sertraline and citalopram have demonstrated efficacy for treating depression in such patients. Mirtazapine did not have significant efficacy on post-myocardial infarction depression. Cognitive-behavioral therapy and interpersonal therapy have not been found to have a significant treatment effect. Treating depression may have an impact on cardiovascular morbidity and mortality, but this has not yet been adequately studied. Studies to date lack sufficient statistical power to fully examine the impact of interventions for depression on cardiovascular outcomes. Cardiologists encounter depression among 25-30% of their patients with ischemic heart disease. Depression is an independent risk factor for poor prognosis among ischemic heart disease patients, at a level comparable to several conventional cardiac risk factors. Adequate treatment of depression may improve the poor prognosis of depressed patients with ischemic heart disease.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Health‐related quality of life in sporadic adult‐onset ataxia

Despite progressive disability in sporadic adult-onset ataxia (SAOA), little is known about patients' assessment of their ataxic disorder and its impact on health-related quality of life (Hr-QoL). This study investigated Hr-QoL by means of the following self-administered scales: Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory (BDI), and the Medical Outcome Study Short Form (SF-36). Twenty-two unselected ataxia patients were included. Sleep-related complaints were found in 9 (41%) of 22 and symptoms of depression in 6 (38%) of 16 patients. Compared to a large german control group, SAOA patients had lower scores in all SF-36 dimensions except for bodily pain. The greatest impairment was found in the domain physical functioning, followed by the domains social functioning and role limitations (emotional problems). There was a significant negative correlation of all nonmotor SF-36 dimensions with the BDI score. Walking aid dependency was significantly correlated with poorer health status perception in several motor and nonmotor domains. In addition, impaired sleep quality was correlated with an impaired general health perception and with bodily pain. The study demonstrates a great impact of SAOA on Hr-QoL. Adequate treatment of depression, motor disability, and impaired sleep quality is essential to improve Hr-QoL in ataxic patients.

Depressionsbehandlung - was brauchen Frauen?/ Treatment of depression: what do women need?

To answer the question of adequate treatment of depression in women from a scientific point of view, it is necessary to investigate the aetiology of depressive disorders as they relate to bio-genetic, mental and social factors. For a comprehensive understanding of depressive disorders in women three factors are analysed: (1) the severity of a depression, (2) the phenomenological description, and (3) the factors of the development of depression in the female life cycle. Different treatment strategies for women can be developed on the basis of these phenomenological and psychodynamic considerations. A case study of a female patient suffering from depressive adjustment disorder who had a background history of sexual reproductive problems is presented to demonstrate characteristic factors in women which may serve as indicators for psychoanalytic focal psychotherapy. In our opinion, psychoanalytic theory in its complexity, working with unconscious phantasies, fears concerning body integrity and relationships to others, is the most appropriate method to determine specific factors behind the pathogenesis and the persistence of depressive disorders in women.

The Influence of Comorbid Chronic Medical Conditions on the Adequacy of Depression Care for Older Americans

To assess the effect of the co-occurrence of four common chronic medical conditions (hypertension, diabetes mellitus, arthritis, heart disease) on the probability of receiving adequate depression treatment. Retrospective analysis of the 2000 and 2001 Medical Expenditure Panel Surveys (MEPS). Households in the United States. MEPS respondents aged 65 and older with self-reported depression (N=498). Adequate depression treatment is defined as receiving eight psychotherapy sessions or filling at least four antidepressant prescriptions at a minimally adequate dosage. Comorbid diabetes mellitus, hypertension, heart disease, and arthritis in older persons with depression were identified from patient self-report. An estimated 34% (95% confidence interval=28-39%) of older persons with self-reported depression received an adequate course of depression treatment during a calendar year. Having hypertension or diabetes mellitus was associated with significantly greater odds of receiving adequate depression care (hypertension odds ratio (OR)=1.81, P=.02; diabetes mellitus OR=1.77, P=.03). Having heart disease or arthritis was not significantly associated with the odds of receiving adequate depression care. Some chronic medical conditions are associated with a greater likelihood of receiving adequate depression care; comorbid medical conditions do not result in lower quality of depression treatment in older persons. The high prevalence rates of comorbid depression and low rates of adequate depression care in elderly persons with chronic illnesses point to the importance of improving primary care depression treatment or enhancing specialty mental health referral.

Improving Depression Care for Older, Minority Patients in Primary Care

Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes. A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care. Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10). Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.

First admissions for depression: is the `no-treatment interval' a critical predictor of time to remission?

Background: This study aimed to replicate findings that length of episode prior to adequate antidepressant treatment (the `no-treatment interval') and premorbid neuroticism predict time to remission from the institution of adequate treatment for depression. Methods: Eighty-three inpatients meeting ICD-10 criteria for a depressive illness were entered into an 18-month prospective follow-up study of illness course. Subjects were assessed using the Schedules for Clinical Assessment in Neuropsychiatry, Maudsley Personality Inventory (MPI) and the Hamilton Rating Scale for Depression (HRSD). Remission was defined as an HRSD score of <8 for 2 consecutive weeks. Results Twenty-two patients (27%) remained depressed 12 months after the onset of adequate treatment. Significantly longer times to remission were predicted by a longer no-treatment interval and higher premorbid neuroticism scores. Limitations: Adequate antidepressant treatment was commenced prior to admission in half the cases, requiring a retrospective assessment of illness course prior to study entry. Twenty-four patients (29%) had not remitted at the time of completion of the MPI. Conclusions: These results replicate previous findings identifying a longer time to treatment and higher neuroticism scores as predictors of chronicity in depression.

Treatment of mental disorders in seven physicians committing suicide.

Through psychological autopsy seven cases of physician suicide were studied. All seven victims received a diagnosis of current mood disorder, two of them bipolar disorder. Five had suffered a disabling physical condition. None of the victims had had adequate treatment with antidepressant or mood-stabilizing drugs, nor had they been in psychotherapy. Current adequate treatment for depression seems to be as rare among physician victims as among suicides with major depressive disorders in the population.