Depression Disease Management Research Articles

The Relationship Between Risk of Depression Levels And Disease Management Individuals With Chronic Diseases and Affecting Factors

Amaç: Araştırma, Aile Sağlığı Merkezine başvuran kronik hastalığı olan bireylerin depresyon riski ile hastalık öz yönetimi arasındaki ilişkiyi ve etkileyen faktörleri değerlendirmek amacıyla yapılmıştır. Yöntem: Tanımlayıcı-ilişki arayıcı nitelikte olan bu çalışmanın örneklemini, Ocak-Mart 2020 tarihleri arasında Aile Sağlığı Merkezine başvuran 418 kronik hastalığı olan bireyler oluşturmaktadır. Veriler “Kişisel Bilgi Formu”, “Beck Depresyon Envanteri (BDE)” ve “Kronik Hastalıklarda Öz Bakım Yönetimi Ölçeği” (SCMP-G) aracılığıyla toplanmıştır. Bulgular: Çalışmaya katılanların yaş ortalaması 62,1±5,73 olup %56,7’sinin kadın, %81,9’unun evli, %96,1’inin çocuğunun olduğu, %23,4’ünün ilkokul mezunu,%60,5’inin çalışmadığı tespit edilmiştir. Katılımcıların depresyon düzeyleri değerlendirildiğinde %16,5’inin minimal düzeyde depresyona, %12,7’sinin hafif düzeyde depresyona, %66,5’inin orta düzeyde depresyona ve %4,3’ünün ise şiddetli düzeyde depresyona sahip olduğu görülmüştür. BDE toplam puan ortalaması 18,56±6,82 olarak saptanmıştır. SCMP-G’nin toplam puan ortalaması 107,38±8,48, öz koruma alt boyutu için toplam puan ortalaması 61,21±8,48, sosyal koruma alt boyutu için toplam puan ortalaması 46,17±8,48bulunmuştur.İleri yaşta olanların, bekâr olanların, çalışmayanların, gelir durumu kötü olanların, depresyon riski yüksek bulunmuştur. İleri yaşta olanların, kadınların, bekâr olanların, gelir durumu çok iyi olanların SCMP-G puanları yüksektir (p<0,05).BDE ile SCMP-G arasında negatif yönlü orta düzeyde bir ilişki tespit edilmiştir (p=0,000). Sonuç: Kronik hastalığa sahip bireylerin depresyon riski orta; öz bakım yönetimleri iyi düzeyde değerlendirilmiştir. Bireylerde yaş, medeni durum, çalışma durumu, gelir durumu depresyon riski düzeylerini; yaş, cinsiyet, medeni durum, gelir durumu da öz bakım yönetimini olumsuz etkilemektedir. Bireylerin depresyon düzeyleri arttıkça öz bakım yönetimlerinin azaldığı saptanmıştır.

What YouTube narratives reveal about online support, counseling entrance, and how Black Americans manage depression symptomatology

ABSTRACT This manuscript explores the depression disease management of Black Americans (N = 50) who post their experiences on YouTube. The narratives garnered five themes: (1) personal and national histories as a barrier to treatment and contributor to depression, (2) utilizing the social network as informal counseling and as the catalyst for formal counseling, (3) long-term undiagnosed depression management and mismanagement, (4) advocating to destigmatize and treat depression, and (5) positive experiences initiating and engaging in treatment. Novel findings include how participants discuss narratives in third person, the importance of the Youtube community, and advocacy to destigmatize and treat depression.

Personality in multiple sclerosis (MS): impact on health, psychological well-being, coping, and overall quality of life

Personality has long been considered a factor that can account for differences in health, well-being, and overall quality of life (QOL). A ‘Distressed or Type D Personality’ has been studied in medical populations as a predictor of several outcomes. The purpose of the present investigation was to determine the presence of Type D Personality in multiple sclerosis (MS) and its role on disease symptoms, disease management, health-related behaviors, coping, psychological well-being, and overall QOL and functioning. Two hundred and thirty (230) individuals with MS completed a survey assessing personality, disease symptoms, disease management, coping, self-efficacy, locus of control (LOC), psychological well-being, and QOL. Thirty-seven (16%) individuals were found to be ‘Type D+.’ Such individuals reported greater fatigue, pain, depression, and anxiety and worse disease management and adherence. They also reported engaging in maladaptive means of coping. Compared to ‘Type D−’ they reported lower self-efficacy, LOC, QOL and greater perceived stress. Finally, ‘Type D+’ individuals were more likely to be considering leaving the workforce. Findings suggest that ‘Type D’ Personality is associated with various negative outcomes in MS. Consideration of the routine assessment of personality in MS seems warranted and may better inform interventions and ward off poor outcomes.

Internet-Delivered Disease Management for Recurrent Depression: A Multicenter Randomized Controlled Trial

Background: Strategies to improve the life of patients suffering from recurrent major depression have a high relevance. This study examined the efficacy of 2 Internet-delivered augmentation strategies that aim to prolong symptom-free intervals. Methods: Efficacy was tested in a 3-arm, multicenter, open-label, evaluator-blind, randomized controlled trial. Upon discharge from inpatient mental health care, 232 adults with 3 or more major depressive episodes were randomized to 1 of 2 intervention groups (SUMMIT or SUMMIT-PERSON) or to treatment as usual (TAU) alone. Over 12 months, participants in both intervention arms received, in addition to TAU, intense monitoring via e-mail or a smartphone, including signaling of upcoming crises, assistance with personal crisis management, and facilitation of early intervention. SUMMIT-PERSON additionally offered regular expert chats. The primary outcome was ‘well weeks', i.e. weeks with at most mild symptoms assessed by the Longitudinal Interval Follow-Up Evaluation, during 24 months after the index treatment. Results: SUMMIT compared to TAU reduced the time with an unwell status (OR 0.48; 95% CI 0.23-0.98) through faster transitions from unwell to well (OR 1.44; 95% CI 0.83-2.50) and slower transitions from well to unwell (OR 0.69; 95% CI 0.44-1.09). Contrary to the hypothesis, SUMMIT-PERSON was not superior to either SUMMIT (OR 0.77; 95% CI 0.38-1.56) or TAU (OR 0.62; 95% CI 0.31-1.24). The efficacy of SUMMIT was strongest 8 months after the intervention. Conclusions: The fully automated Internet-delivered augmentation strategy SUMMIT has the potential to improve TAU by reducing the lifelong burden of patients with recurrent depression. The fact that the effects wear off suggests a time-unlimited extension.

Dose–response effects for depression and Schizophrenia management on hospital utilization in Illinois Medicaid: a multivariate regression analysis

BackgroundThe prevalence of schizophrenia and depression in the United States is far higher among Medicaid recipients than in the general population. Individuals suffering from mental illness, including schizophrenia and depression, also have higher rates of emergency department utilization, which is costly and may not generate the positive health outcomes desired. Disease management programs strive to help individuals suffering from chronic illnesses better manage their condition(s) and seek health care in the appropriate settings. The objective of this manuscript is to estimate a dose–response impact on hospital inpatient and emergency room utilizations for any reason by Medicaid recipients with depression or schizophrenia who received disease management contacts.MethodsMultivariate regression analysis of panel data taken from administrative claims was conducted to test the hypothesis that increased contacts lower the likelihood of all-cause inpatient admissions and emergency room visits. Subjects included 6,274 members of Illinois’ non-institutionalized Medicaid-only aged, blind or disabled population diagnosed with depression or schizophrenia. The statistical measure is the odds ratio. The odds ratio association is between the monthly utilization indicators and the number of contacts (doses) a member had for each particular disease management intervention.ResultsHigher numbers of intervention contacts for Medicaid recipients diagnosed with depression or schizophrenia were associated with statistically significant reductions in all-cause inpatient admissions and emergency room utilizations.ConclusionsThere is a high correlation between depression and schizophrenia disease management contacts and lowered all-cause hospital inpatient and emergency room utilizations.

Disease management for co-morbid depression and anxiety in diabetes mellitus: design of a randomised controlled trial in primary care

BackgroundDepression and anxiety are common co-morbid health problems in patients with type 2 diabetes. Both depression and anxiety are associated with poor glycaemic control and increased risk of poor vascular outcomes and higher mortality rates. Results of previous studies have shown that in clinical practice, treatment of depression and anxiety is far from optimal as these symptoms are frequently overlooked and undertreated.Methods/DesignThis randomised controlled trial will examine the effectiveness of a disease management programme treating symptoms of depression and anxiety in primary care patients with Type 2 diabetes. Patients will be randomized on patient level in 1:1 ratio. Random block sizes of 2 and 4 are used. The disease management programme consists of screening, stepped treatment and monitoring of symptoms (n = 80). This will be compared to care as usual (n = 80).DiscussionThe disease management model for co-morbid depression and anxiety in primary care patients with diabetes is expected to result in reduced symptoms of depression and anxiety, improved quality of life, reduced diabetes specific distress and improved glyceamic control, compared to care as usual.Trial RegistrationDutch Trial Register NTR2626

Chronic Disease Management for Depression in US Medical Practices

Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients. The Depression in Primary Care (DPC) intervention was introduced in 5 primary care practices in the University of Michigan Health System, with 5 matched practices selected as control sites. Clinicians were free to refer none, some, or all of their depressed patients at their discretion. Core clinical outcomes of remission and serial change in Patient Health Questionnaire (PHQ-8) scores for 728 DPC enrollees observed for up to 18 months after enrollment were compared with those for 78 patients receiving usual care who completed mailed questionnaires at baseline, 6, 12, and 18 months. DPC enrollees had sustained improvement in remission rates and reduced-function days over the full 18 months. Mean change in the PHQ-8 score over each 6-month interval was more favorable for DPC enrollees than for usual care patients, and the proportion of DPC enrollees in remission was higher at 6 months (43.4% vs 33.3%; P = .11), 12 months (52.0% vs 33.9%; P = .012), and 18 months (49.2% vs 27.3%; P = .004). Multivariate analysis controlling for age, sex, ethnicity, baseline severity, and comorbid medical illness confirmed that DPC enrollees had significantly more reduction in depressive symptom burden over 18 months. The DPC intervention produced sustained improvement in clinical outcomes over 18 months in a cohort of chronically depressed patients with persistent symptoms despite active treatment.

Stakeholder Benefit from Depression Disease Management: Differences by Rurality?

Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. This paper investigates whether two proposed stakeholders (health plans and employer purchasers) economically benefit from depression care management (reduced outpatient utilization and work costs, respectively) in two delivery systems (rural and urban). This study examined the main and differential effects of depression care management on outpatient utilization and work costs over 24 months in a preplanned secondary analysis of 479 depressed patients from rural and urban primary care practices in a randomized controlled trial. Over 24 months, the intervention did not significantly reduce outpatient utilization costs in the entire cohort (-$191, 95% confidence interval (CI)=-$2,083 to $1,647), but it did decrease work costs (-$1,970, 95% CI=-$3,934 to -$92). While not statistically significant, rural-urban differences in work costs were in the same direction, while rural-urban differences in utilization costs differed in direction. These findings provide preliminary evidence that employers who elect to cover depression care management costs should receive comparable economic benefits in the rural and urban employees they insure. Given the limited sample size, further research may be needed to determine whether health plans who elect to cover depression care management costs will receive comparable economic benefits in the rural and urban enrollees they insure.

Course and outcome of depressive disorders in primary care: a prospective 18-month study

Depressive disorders are known to often be chronic and recurrent both in the general population and in psychiatric settings. However, despite its importance for public health and services, the outcome of depression in primary care is not well known. In The Vantaa Primary Care Depression Study (PC-VDS), 1111 consecutive primary-care patients were screened for depression with the Prime-MD screen, and 137 diagnosed with DSM-IV depressive disorders by interviewing with the Structured Clinical Interview for DSM-IV (SCID)-I/P and SCID-II. This cohort was prospectively followed-up at 3, 6 and 18 months. Altogether 123 patients (90%) completed the 18-month follow-up, including 79 with major depressive disorder (MDD) and 44 with subsyndromal disorders. Duration of the index episode and the timing of relapses/recurrences were examined using a life-chart. Of the patients with MDD, only a quarter [25% (20/79)] achieved and remained in full remission, while another quarter [25% (20/79)] persisted in major depressive episode for 18 months. The remaining 49% (39/79) suffered from residual symptoms or recurrences. In Cox regression models, time to remission and recurrences were robustly predicted by severity of depression, and less consistently by co-morbid substance-use disorder, chronic medical illness or cluster C personality disorder. Of the subsyndromal patients, 25% (11/44) proceeded to MDD. This prospective medium-term study verified the high rate of recurrences and chronicity of depression also in primary care. Severity of depressive symptoms and co-morbidity are important predictors of outcome. Development of chronic disease management for depression is warranted in primary care.

Effectiveness of a Depression Disease Management Program in Improving Depression and Work Function—A Pilot Study

We examined whether there were differences in depression and work function outcomes among primary care and specialty mental health patients treated by the Michigan Depression Outreach and Collaborative Care (M-DOCC), a depression care management program, developed by the University of Michigan Depression Center. In addition, we examined the relationship between depressive symptoms and workplace functioning among M-DOCC enrollees over time. We used mixed model and logistic regression analyses. Despite baseline differences in patient characteristics between primary care and specialty care patients, the location of treatment setting was not a significant predictor of depression or work function outcomes over time among patients enrolled in a depression care management program. Patients in both treatment settings showed significant decreases in depressive and functional impairment over time, with improvements in these symptoms occurring concurrently. Patients with greater case severity were less likely to demonstrate depression and work function improvements over time, and more severe side effects were associated with fewer depression symptom improvements over time. Both depression and work function outcomes improved over time among patients enrolled in a depression care management program, and this improvement did not differ based on whether a patient was treated in a primary or specialty care setting.

Health plans' disease management programs: extending across the medical and behavioral health spectrum?

Although the disease management industry has expanded rapidly, there is little nationally representative data regarding medical and behavioral health disease management programs at the health plan level. National estimates from a survey of private health plans indicate that 90% of health plan products offered disease management for general medical conditions such as diabetes but only 37% had depression programs. The frequency of specific depression disease management activities varied widely. Program adoption was significantly related to product type and behavioral health contracting. In health plans, disease management has penetrated more slowly into behavioral health and depression program characteristics are highly variable.

Improving Medication Management of Depression in Health Plans

Improving Medication Management of Depression in Health Plans

An evidence-based review updating the various treatment and management approaches to serotonin reuptake inhibitor-associated sexual dysfunction

Although most patients (80-90%) will respond to the first or second antidepressant prescribed, major depression disease management outcomes data are poor. Serotonin reuptake inhibitor (SRI) antidepressant-associated sexual dysfunction, which is reported to occur in 40-70% of patients on these agents, is a major factor for treatment noncompliance, treatment failure and costly disease management outcomes. Up to 90% of patients with treatment-emergent sexual dysfunction will discontinue their prescribed medication prematurely. Despite several thousand published reports on treatment modalities based on heuristic post hoc hypotheses of central serotonin inhibition and those involving agonist, antagonist, partial agonist, switching, augmentation and waiting management approaches, no evidence-based data are available to support those treatment modalities, leaving patients exposed to random pharmacology. The emergence of new approaches based on novel signaling to treat sexual dysfunction, which demonstrate efficacy for selective type 5 phosphodiesterase inhibitor treatment of SRI antidepressant-associated sexual dysfunction, offers an opportunity for an evidence-based re-evaluation of the comparative effectiveness of various management approaches to SRI antidepressant-associated sexual dysfunction.

Disease Management for Depression in an Ms Clinic

Evidence-based treatments for depression in multiple sclerosis (MS) are available, but their implementation can be challenging. We explored the feasibility and effectiveness of implementing a disease management program for depression in an MS clinic. A non-randomized "before-after" design was used. The University of Calgary MS Clinic performs routine screening for depression using the Center for Epidemiologic Studies Depression Rating Scale (CES-D). During a six month baseline period, the screen results were not systematically acted upon. During a subsequent nine-month study period, a case manager was routinely notified of positive screens. These patients were offered disease management. Major depression was assessed six months later with a blind administration of the Mini Neuropsychiatric Interview (MINI). Quality of life (EQ-5D) and functional status (WHO DAS II) were also measured. Eighty-three patients were enrolled in the study; 54 were in the disease management group and 29 received treatment as usual. There was a lower frequency of major depression in the intervention group six months post-screening. No differences in quality of life or functional status were seen. Disease management approaches for depression were developed in primary care environments and have been adapted for geriatric and diabetic populations. These strategies may require modification for application in MS clinics. While an intervention for depression was effective in those who received it, its impact on the targeted clinical population was reduced by lower than expected rates of participation and higher than expected rates of treatment at baseline.

A System-Based Approach to Depression Management in Primary Care Using the Patient Health Questionnaire-9

Primary care physicians are more likely to see patients with depression than with any other disorder except hypertension, and its management poses a challenge to busy primary care practices. The Patient Health Questionnaire-9, a simple self-administered tool of proven validity and reliability, is a commonly used screening instrument for depression in primary care practice. This review article provides a system-based approach to depression management using the Patient Health Questionnaire-9 to guide clinicians in the identification and treatment of depression and its follow-up care.

Chronic Disease Management for Depression in Primary Care: A Summary of the Current Literature and Implications for Practice

To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada. We reviewed all RCTs conducted between 1992 and 2006, including other reviews and analyses of pooled data. Using various search terms, we searched PsycINFO, Cinahl (1982 to May 2005), MEDLINE (1995 to 2005), EMBASE, The Cochrane Library, and PubMed. There is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care. Most studies have demonstrated improved outcomes in terms of symptom reduction, relapse prevention, functioning in the community, adherence to treatment, community and workplace involvement, and satisfaction with care received. Primary care practices need to examine how they can incorporate different concepts and models for managing depression. Components to consider include case registries, care managers or coordinators, treatment algorithms, follow-up and monitoring after a treated episode, care and relapse prevention plans, visits by psychiatrists, and training and ongoing education for all providers.

Double-Disease Management or One Care Manager for Two Chronic Conditions: Pilot Feasibility Study of Nurse Telephonic Disease Management for Depression and Congestive Heart Failure

This study assessed the feasibility of a telephonic nurse double-disease management program (DDMP) for patients with depression and congestive heart failure. Thirty-five patients with depression and congestive heart failure were entered into a novel DDMP modeled after Wagner's chronic illness care model and implemented as part of a 13-month Breakthrough Series Collaborative administered by the Institute of Healthcare Improvement. Twenty-four patients remained in the program long enough to complete at least one follow-up assessment (ie, 6 weeks or longer). Patients were entered into the program based on depression severity scores from either the interactive voice response (IVR) version of the Hospital Anxiety and Depression Scale (HADS) or the self-administered (or telephonic) Patient Health Questionnaire (PHQ). Because use of the IVR version of the HADS was eliminated after several weeks into the program (because of poor patient acceptance), 19 patients had both entry and follow-up scores on the same instrument (PHQ). Depression "response" was defined as a 50% improvement in PHQ score. Mixed models regression was used to test the statistical significance of change in PHQ scores over time. Patient and clinician reports were obtained to evaluate program acceptability and satisfaction. Eighty-two percent of patients (n = 11) with Major Depressive Disorder (MDD) responded, and 75% of patients (n = 8) with "other depression" (PHQ score < 10) responded. Mean change in PHQ scores for the sample as a whole improved significantly over the 24 weeks of the program (p < 0.0003), as well as for those with major depression and other depression considered separately (p < 0.01 for both). In some patients who refused medication, depression seemed to respond to self-management support interventions of the care manager. Based on patient acceptance and clinicians' reports, the program appeared feasible and possibly effective. DDMP appears feasible and possibly effective. Future clinical trials are warranted.

Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients

Federally qualified health centers across the country are adopting depression disease management programs following federally mandated training; however, little is known about the relative effectiveness of depression disease management in rural versus urban patient populations. To explore whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). A preplanned secondary analysis was conducted in a consecutively sampled cohort of 479 depressed primary care patients recruited from 12 practices in 10 states across the country participating in the Quality Enhancement for Strategic Teaming study. Depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients. Depression disease management appears to improve clinical outcomes in urban but not rural patients. Because these programs compete for scarce resources, health care organizations interested in delivering depression disease management to rural populations need to advocate for programs whose clinical effectiveness has been demonstrated for rural residents.

Effectiveness of Disease Management Programs in Depression: A Systematic Review

The authors systematically evaluated the published evidence to assess the effectiveness of disease management programs in depression. English-language articles on depression were identified through a MEDLINE search for the period from January 1987 to June 2001. Two reviewers evaluated 16,952 published titles, identified 24 depression disease management programs that met explicit inclusion criteria, and extracted data on study characteristics, interventions used, and outcome measures. Pooled effect sizes were calculated by using a random-effects model. Pooled results for disease management program effects on symptoms of depression showed statistically significant improvements (effect size=0.33, N=24). Programs also had statistically significant effects on patients' satisfaction with treatment (effect size=0.51, N=6), patients' compliance with the recommended treatment regimen (effect size=0.36, N=7), and adequacy of prescribed treatment (effect size=0.44, N=11). One program with an explicit screening component showed significant improvement in the rate of detection of depression by primary care physicians (effect size=0.66); two other programs lacking a screening component showed small nonsignificant improvements in the detection rate (effect size=0.18). Disease management programs increased health care utilization (effect size=-0.10, N=8), treatment costs (effect size=-1.03, N=3), and hospitalization (effect size=-0.20, N=2). Disease management appears to improve the detection and care of patients with depression. Further research is needed to assess the cost-effectiveness of disease management in depression, and consideration should be given to more widespread implementation of these programs.