Use In Treatment Of Depression Research Articles

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

To address problems with low rates of detection and treatment of depression of pregnant and postpartum women, many advocate depression screening in obstetrical settings. This study evaluated the Healthy Start depression initiative to assess whether it resulted in diminished rates of depressive symptoms and increased rates of detection, referral, and treatment among pregnant and postpartum women. Three cohorts were used to examine the program impact: a pre-Healthy Start depression initiative cohort, a post-Healthy Start depression initiative cohort that was enrolled in New Haven Healthy Start, and a post-Healthy Start depression initiative cohort not enrolled in the New Haven program. Participants included 1,336 pregnant and postpartum women receiving obstetrical care at publicly funded health care clinics. Measures included the Primary Care Evaluation of Mental Disorders Brief Patient Health Questionnaire; the PTSD Symptom Scale; a five-item modification of the Conflict Tactics Scale; and questions regarding alcohol, illicit substances, and general medical and obstetrical history. The Healthy Start depression initiative changed neither levels of depressive symptoms nor use of depression treatment in unselected populations. The initiative may have decreased the rate of referral for depression in the cohort under study. Universal screening and support for treatment referral by paraprofessionals did not reduce the overall rates of depressive symptoms of perinatal women who received care at publicly funded obstetrical clinics. Future work on depression screening should consider strategies to engage women who are more severely affected by a depressive disorder in behavioral health treatment.

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Depression Screening of Perinatal Women: An Evaluation of the Healthy Start Depression Initiative

Preferences and Perceived Barriers to Treatment for Depression during the Perinatal Period

Little is understood about why few women during the perinatal period will use depression treatment. In particular, beliefs and barriers related to depression treatment use have not been studied. In this study, African American and white pregnant women (n = 108) who screened > or =10 on the Edinburgh Postnatal Depression Scale (EPDS) were asked about recent formal and informal treatment use in prenatal care settings. Confidence in the helpfulness of treatment, providers, and settings and perceived barriers to treatment were assessed and compared between African American and white women. Pregnant women overall reported low rates of formal treatment use but frequently sought help from informal sources, such as friends, family, and printed materials. All women expressed greatest confidence in psychosocial treatments and lowest confidence in antidepressants. African American women reported less confidence in advice from family and friends and in antidepressants than did white women. Women expressed greatest confidence in treatments delivered by mental health professionals and religious leaders. African American women sought help more frequently and had significantly more confidence in religious leaders as treatment deliverers than white women. Women had greatest confidence in treatments delivered in professional and home settings, with African American women expressing greater confidence in religious settings than white women. All women reported greatest concern with structural barriers, compared with attitudinal and knowledge barriers. Understanding patterns of treatment use, beliefs, and barriers to depression treatment provides important information for tailoring and improving appropriate use of mental health treatment in women during the perinatal period.

Kinetic and Thermodynamic Assessment of Binding of Serotonin Transporter Inhibitors

Several serotonin reuptake inhibitors are in clinical use for treatment of depression and anxiety disorders. However, to date, reported pharmacological differentiation of these ligands has focused mainly on their equilibrium binding affinities for the serotonin transporter. This study takes a new look at antidepressant binding modes using radioligand binding assays with [(3)H]S-citalopram to determine equilibrium and kinetic rate constants across multiple temperatures. The observed dissociation rate constants at 26 degrees C fall into a narrow range for all molecules. Conversely, association rate constants generally decreased with increasing equilibrium binding affinities. Consistent with this, the measured activation energy for S-citalopram association was relatively large (19.5 kcal . mol(-1)), suggesting conformational change upon ligand binding. For most of the drugs, including citalopram, the enthalpy (DeltaH(O)) and entropy (-TDeltaS(O)) contributions to reaction energetics were determined by van't Hoff analyses to be roughly equivalent (25-75% DeltaG(O)) and to correlate (positively for enthalpy) with the polar surface area of the drug. However, the binding of the drug fluvoxamine was predominantly entropically driven. When these data are considered in the context of the physicochemical properties of these ligands, two distinct binding modes can be proposed. The citalopram-type binding mode probably uses a polar binding pocket that allows charged or polar interactions between ligand and receptor with comparatively small loss in enthalpy due to dehydration. The fluvoxamine-type binding mode is fueled by energy released upon burying hydrophobic ligand moieties into a binding pocket that is flexible enough to suffer minimal loss in entropy from conformational constraint.

Service Use and Outcomes Among Elderly Persons With Low Incomes Being Treated for Depression

Older adults with low incomes rarely use mental health care, and untreated depression is a serious problem in this population. This study examined whether a collaborative care model for depression in primary care would increase use of depression treatment and treatment outcomes for low-income elderly adults as well as for higher-income older adults. A multisite randomized clinical trial that included 1,801 adults aged 60 years and older who were diagnosed as having depression compared collaborative care for depression with treatment as usual in primary care. Participants were divided into groups by income definitions on the basis of criteria used by the U.S. Census Bureau and the U.S. Department of Housing and Urban Development (HUD). A total of 315 participants (18%) were living below the poverty level by the U.S. Census criteria, 261 (15%) were living below 30% of the area median income (AMI) (HUD criteria) but above poverty, 438 (24%) were living between 30% and 50% of the AMI, 327 (18%) were living between 50% and 80% of the AMI, and 460 (26%) were not poor. The income groups were compared on service use, satisfaction, depression severity, and physical health at baseline and at three, six, and 12 months after being randomly assigned to collaborative care or usual care. The benefits for low-income older adults were similar to those for middle- and higher-income older adults. At 12 months, intervention patients in all economic brackets had significantly greater rates of depression care for both antidepressant medication and psychotherapy, greater satisfaction, lower depression severity, and less health-related functional impairment than usual care participants. Lower-income older adults can experience benefits from collaborative management of depression in primary care similar to those of higher-income older adults, although they may require up to a year to reap physical health benefits.

The Impact of a Brief Obstetrics Clinic-Based Intervention on Treatment Use for Perinatal Depression

The purpose of this study was to examine the association of prenatal depression screening and obstetrics clinician notification procedures with depression treatment use through 6 weeks postpartum. An initial sample of 1298 women was screened for depression as part of routine clinical care at their first prenatal care appointment using the Edinburgh Postnatal Depression Scale (EPDS) at a university hospital obstetrics clinic in the United States. Women with an EPDS > 10 who agreed to participate in this longitudinal study completed assessments of depression and treatment use throughout pregnancy and through 6 weeks postpartum. Following screening and prior to their second prenatal visit, all women scoring > or = 10 on the EPDS received nurse-delivered depression feedback and referral, and all treating physicians were notified of the elevated EPDS status (i.e., > or = 10) of their patients. The majority (65%) of pregnant women with current major depressive disorder (MDD) were not receiving any depression treatment throughout the study period. Overall, women with EDPS > or = 10 who reported that their physician discussed depression with them (67%) were significantly more likely to seek treatment (compared with those who did not report physician discussion of depression with them) by the 1 month prenatal follow-up but not by the 6 weeks postpartum follow-up. Initial depression severity and treatment use prior to screening were the strongest predictors of subsequent depression treatment use. Depression screening combined with systematic clinician follow-up showed a modest short-term impact on depression treatment use for perinatal depression but did not affect depression outcomes. Most women with MDD were not engaged in treatment throughout the follow-up period despite the interventions. More intensive and repeated monitoring might enhance the effect of clinician interventions to improve treatment use.

Depression treatment and satisfaction in a multicultural sample of type 1 and type 2 diabetic patients.

To assess rates of depressive symptoms, depression treatment, and satisfaction in a multicultural sample of individuals with type 1 and type 2 diabetes. This study was conducted with a cross-sectional community-based survey design. The sample (n = 221) was predominantly female (60.3%), had type 2 diabetes (75%), and was middle class with a mean (+/-SD) age of 54 +/- 12 years. A total of 53% were white. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD) (mean 16.4 +/- 11.3). Using conservative thresholds (CESD score > or =22), 25.3% of participants reported clinically significant depression. Rates of depression did not differ by ethnic group or diabetes type. The majority (76%) of depressed participants reported treatment (52% antidepressants, 63% mental health providers, 19% alternative healers, and 15% herbal remedies). African Americans were less likely to report any depression treatment, to receive antidepressant medications, or receive treatment from a mental health professional compared with whites. Participants with high depressive symptoms reported general satisfaction with depression treatment experiences. High rates of depressive symptoms were observed across ethnic groups, yet significant differences in use of depression treatment existed across ethnic groups. Those seeking depression treatment reported satisfaction with a variety of depression treatment modalities. Increased depression screening and treatment may be beneficial for ethnically diverse patients with type 1 and type 2 diabetes.

Hispanic Ethnicity, Language, and Depression: Physician-Patient Communication and Patient Use of Alternative Treatments

To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression. This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as "distressed." Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report. Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for depression. Over 40% of patients spent time talking with their physicians at their current visit about what was making them depressed and 34% received counseling about depression. Hispanic ethnicity and language were not significantly related to physician communication with patients about how to overcome depression. Thirty-six percent of patients reported talking with a minister or other religious person about feelings of depression or sadness. Seventeen percent of patients had used herbal remedies or non-prescription medications and 5% had seen a curandero for feelings of depression or sadness. Hispanic ethnicity and language were not significantly related to patient use of alternative treatments for depression. Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression. Physicians should make sure to ask patients about all of the types of things they are doing to help overcome their depression.

Sudden gains in cognitive behavioral treatment for depression: when do they occur and do they matter?

Despite the use of efficacious treatments for depression, individuals differ in both the degree to which they recover and the rate at which recovery occurs. Tang and colleagues found that depressed patients who had sudden improvements in their symptomatology not only maintained these gains, but also enjoyed more improvement and higher rates of recovery than those without sudden gains (J. Consulting Clin. Psychol. 67(6) (1999) 894; J. Consulting Clin. Psychol. 70(2) (2002) 444). Our study examined the role of sudden gains in a cognitive-behavioral group treatment for depression. Results indicated that 41.9% of patients experienced sudden gains. Furthermore, sudden gains occurring in the first third of treatment appear to have special importance. Participants enjoying early sudden gains had significantly larger changes in depressive symptom scores over the course of treatment than those without sudden gains and were marginally more likely to be treatment responders compared to those without early sudden gains. In contrast to Tang and DeRubeis (J. Consulting Clin. Psychol. 67(6) (1999) 894), however, sudden gains were not associated with cognitive changes.

Cost of lost productive work time among US workers with depression.

Evidence consistently indicates that depression has adversely affected work productivity. Estimates of the cost impact in lost labor time in the US workforce, however, are scarce and dated. To estimate the impact of depression on labor costs (ie, work absence and reduced performance while at work) in the US workforce. All employed individuals who participated in the American Productivity Audit (conducted August 1, 2001-July 31, 2002) between May 20 and July 11, 2002, were eligible for the Depressive Disorders Study. Those who responded affirmatively to 2 depression-screening questions (n = 692), as well as a 1:4 stratified random sample of those responding in the negative (n = 435), were recruited for and completed a supplemental interview using the Primary Care Evaluation of Mental Disorders Mood Module for depression, the Somatic Symptom Inventory, and a medical and treatment history for depression. Excess lost productive time (LPT) costs from depression were derived as the difference in LPT among individuals with depression minus the expected LPT in the absence of depression projected to the US workforce. Estimated LPT and associated labor costs (work absence and reduced performance while at work) due to depression. Workers with depression reported significantly more total health-related LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk, respectively). Eighty-one percent of the LPT costs are explained by reduced performance while at work. Major depression accounts for 48% of the LPT among those with depression, again with a majority of the cost explained by reduced performance while at work. Self-reported use of antidepressants in the previous 12 months among those with depression was low (<33%) and the mean reported treatment effectiveness was only moderate. Extrapolation of these survey results and self-reported annual incomes to the population of US workers suggests that US workers with depression employed in the previous week cost employers an estimated 44 billion dollars per year in LPT, an excess of 31 billion dollars per year compared with peers without depression. This estimate does not include labor costs associated with short- and long-term disability. A majority of the LPT costs that employers face from employee depression is invisible and explained by reduced performance while at work. Use of treatments for depression appears to be relatively low. The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.