Depression Treatment Program Research Articles

The Protective Role of Optimism and Self-esteem on Depressive Symptom Pathways Among Canadian Aboriginal Youth

Aboriginal youth are at disproportionate risk for depression and substance use problems. Increasingly, developmental theories have shifted from focusing on vulnerabilities to protective factors for adolescent depression. In particular, theories emphasizing protective factors are relevant when understanding the mental health of Aboriginal youth. However, it is unclear which factors protect against depressive symptomatology among Aboriginal adolescents to promote optimal development. Using multilevel growth curve modeling, the present study had three main objectives. First, we aimed to model the developmental trajectory of depressive symptoms using a sample of off-reserve Aboriginal youth from a national Canadian dataset (ages 12-23). Second, we sought to examine the relationship between alcohol use behaviors, self-esteem, optimism, and the trajectories of depressive symptoms. Lastly, we investigated whether self-esteem and optimism mediated the relationship between alcohol use and depressive symptoms. Gender differences were also examined within each of the study objectives. A sample of off-reserve Aboriginal youth (N = 283; 48.3% male) was selected from cycles 4-7 of the National Longitudinal Survey of Children and Youth. Heavy drinking was a risk factor for depressive symptoms, while self-esteem and optimism were key protective factors for depressive symptoms among early adolescent Aboriginal youth. Further, the developmental trajectory of depressive symptoms among Canadian Aboriginal youth differed for boys and girls once accounting for risk and protective factors. Thus, it is valuable to integrate the protective role of self-esteem and optimism into developmental theories of depression and mental health intervention programs for early adolescent Aboriginal youth.

Affect and eating behavior in obese adults with and without elevated depression symptoms

Although there is a modest relation between obesity and depression, mechanisms that contribute to this co-occurrence are unclear. This study examined mood and eating behavior among obese adults with and without elevated depression symptoms. Obese adults (N = 50) were subtyped according to a Beck Depression Inventory (BDI) cutoff of 14, indicating "probable depression." Participants with (BDI ≥ 14; n = 15) and without (BDI < 14; n = 35) elevated depression symptoms were compared on affect- and eating-related variables measured via questionnaire and ecological momentary assessment (EMA) using ANCOVA and mixed model regression. After adjusting for group differences in body mass index (BMI; p = .03), participants with elevated depression symptoms reported greater emotional eating via self-report questionnaire [F(1,50) = 4.3; p = .04], as well as more frequent binge eating (Wald χ(2) = 13.8; p < .001) and higher daily negative affect (Wald χ(2) = 7.7; p = .005) on EMA recordings. Emotional eating mediated the relationship between depression status and BMI (indirect effect estimate = 3.79; 95% CI = 1.02-7.46). Emotional eating and binge eating were more commonly reported by obese adults with elevated depression symptoms compared to those without and may occur against a general backdrop of overall low mood. Intervention and prevention programs for obesity and/or depression should address disordered eating to prevent or minimize adverse health consequences.

Examining Relationships Between Body Dissatisfaction, Maladaptive Perfectionism, and Postpartum Depression Symptoms

To explore body dissatisfaction and maladaptive perfectionism as risk factors for postpartum depression symptomatology. Prospective, cohort design. Urban and suburban hospital-based obstetrician and midwifery offices. Forty-six (46) adult ethnically diverse pregnant women with gestational age greater than or equal to 28weeks. Body dissatisfaction and maladaptive perfectionism were assessed in the offices of health care providers during the third trimester of pregnancy. Postpartum depression symptomatology was assessed at least 2months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) via postal mail or e-mail. Body dissatisfaction predicted postpartum depression symptoms, even after controlling for previously established risk factors. No main effect emerged between maladaptive perfectionism and postpartum depression symptoms. Body dissatisfaction in the third trimester of pregnancy serves as a risk factor for postpartum depression. Therefore, assessment of body image during the third trimester of pregnancy may help health care providers identify women at risk of postpartum depression. Body dissatisfaction also may be an important target for postpartum depression prevention and treatment programs.

Depressive Symptoms in Women With Physical Disabilities: Identifying Correlates to Inform Practice

ObjectiveTo examine correlates of depressive symptomatology in a sample of women with diverse physical disabilities to inform practice of modifiable risk factors that warrant attention and intervention. DesignInterview survey. SettingOutpatient chronic care clinics. ParticipantsRacially and ethnically diverse women (N=415) aged 18 to 64 years living with physical disabilities. InterventionsNot applicable. Main Outcome MeasureCenter for Epidemiologic Studies Depression Scale. ResultsDepressive symptoms were high with more than half the women exceeding an established cutoff for clinically significant depressive symptomatology. In hierarchical multiple regression analyses, demographic, disability, and health variables explained significant variance in depressive symptoms; however, modifiable variables (pain interference, social support, abuse) contributed significantly to depression scores over and above demographic, disability, and health variables. Analyses examining predictors of depression classification revealed similar findings. ConclusionsDepression is a significant problem for many women with physical disabilities. Modifiable contributors to depressive symptoms may provide intervention opportunities for researchers and clinicians. Clinicians need to attend closely to pain, particularly perceptions of pain interference; social support and social isolation; and abuse among women with physical disabilities. It may be valuable to include pain self-management, social networking and social skill development, and safety and abuse prevention training when designing depression intervention programs for this population.

Depression treatment preferences of older white and Mexican origin men

ObjectiveAmong older white and Mexican origin male primary care patients, we examined preferences for features of depression care programs that would encourage depressed older men to enter and remain in treatment. MethodSixty-three (45 white, 18 Mexican origin) older men were recruited in six primary care clinics. All had clinical depression in the past year and/or were receiving depression treatment. Participants completed a conjoint analysis preference survey regarding depression treatments, providers and treatment enhancements. ResultsThe data suggest that white men preferred medication over counseling [odds ratio (OR): 1.64 95% confidence interval (CI): 1.12–2.41], while Mexican origin men preferred counseling (OR: medication over counseling: 0.28, 95% CI: 0.12–0.66). Both white and Mexican origin men preferred treatment that included family involvement (vs. none) (white: OR: 1.60, 95% CI 1.12–2.30; Mexican origin: OR: 3.31 95% CI 1.44–7.62) and treatment for insomnia (vs. treatment for alcohol use) (white: OR: 1.72, 95% CI 1.01–2.91; Mexican origin: OR: 3.93 95% CI 1.35–11.42). White men also preferred treatment by telephone (OR: 1.80, 95% CI 1.12–2.87). ConclusionsFindings could inform development of patient-centered depression treatment programs for older men and suggest strategies, such as attention to sleep problems, which providers may employ to tailor treatment to preferences of older men.

How to Identify Students for School‐Based Depression Intervention: Can School Record Review Be Substituted for Universal Depression Screening?

ProblemEarly identification and intervention are critical for reducing the adverse effects of depression on academic and occupational performance. Cost‐effective approaches are needed for identifying adolescents at high depression risk. This study evaluated the utility of school record review versus universal school‐based depression screening for determining eligibility for an indicated depression intervention program implemented in the middle school setting.MethodsAlgorithms derived from grades, attendance, suspensions, and basic demographic information were evaluated with regard to their ability to predict students' depression screening scores.FindingsThe school information‐based algorithms proved poor proxies for individual students' depression screening results. However, school records showed promise for identifying low, medium, and high‐yield subgroups on the basis of which efficient screening targeting decisions could be made.ConclusionsStudy results will help to guide school nurses who coordinate indicated depression intervention programs in school settings as they evaluate options of approaches for determining which students are eligible for participation.

Efficacy of a systematic depression management program in high utilizers of primary care: a randomized trial

BackgroundApproximately 25% of so-called high utilizers of medical care are estimated to suffer from depression. A large proportion of these individuals remain undiagnosed and untreated. This study aims to examine the effects of a systematic screening and collaborative treatment program on depression severity in small primary care practices of the German outpatient health care system.MethodHigh utilizers of primary care who screened positive for depressive symptoms on the Brief Psychiatric Health Questionnaire (B-PHQ) were further diagnosed using the DIA-X, a standardized diagnostic interview, performed by trained and supervised interviewers. Patients with major depression were randomized (cluster randomization by practice) to (a) a six-month treatment program of pharmacotherapy, standardized patient and provider education, and physician and patient counseling or (b) six months of usual medical care. All subjects were followed for a 12-month observation period using the 17-item Hamilton Depression Rating scale (HAMD-17) rated by the treating physicians and the B-PHQ-9 rated by the patients.ResultsA total of 63 high utilizer patients were included in the trial (17 male, 46 female), 19 randomized to intervention, 44 to usual care. The mean age was 49.7 (SD 13.8). Most patients had one or more somatic co-morbidities. There was no significant difference in response (defined as a decrease in the HAMD-17 sum score of at least 50%) after six months of treatment (50% vs. 42%, p = 0.961, all analyses adjusted for age) and after 12 months of treatment (83% vs. 54%, p = 0.282) between groups. Using patient self-rating assessments with the B-PHQ-9 questionnaire the intervention was superior to treatment as usual at six months (83% vs. 16%, p = 0.000).There was no significant difference in HAMD-17 depression severity at six months between the groups (10.5 (SD 7.6) vs. 12.3 (SD 7.8), p = 0.718), but a trend at 12 months (4.7 (SD 8.0) vs. 11.2 (SD 7.4), p = 0.083). Again, using B-PHQ-9 sum scores depression severity was significantly lower in the intervention group than in the treatment as usual group after six months (6.4 (SD 5.2) vs. 11.5 (SD 5.8), p = 0.020), but not at 12 months (7.9 (SD 8.7) vs. 9.0 (SD 5.2), p = 0.858).ConclusionA systematic collaborating treatment program for depression in high utilizers in primary care showed superiority to treatment as usual only in terms of patients´ self-assessment but not according to physicians´ assessment. The advance of the intervention group at 6 months was lost after 12 months of follow-up. Overall, positive results from similar trials in the US health care systems could not be confirmed in a German primary care setting.

Lessons from scaling up a depression treatment program in primary care in Chile

In Chile, the National Depression Detection and Treatment Program (Programa Nacional de Diagnóstico y Tratamiento de la Depresión, PNDTD) in primary care is a rare example of an evidence-based mental health program that was scaled up to the national level in a low- or middle-income country. This retrospective qualitative study aimed to better understand how policymakers made the decision to scale up mental health services to the national level, and to explore the elements, contexts, and processes that facilitated the decision to implement and sustain PNDTD. In-depth semistructured interviews with six key informants selected through intentional sampling were conducted in August-December 2008. Interviewees were senior officers at the Ministry of Health who were directly involved in the decision to scale up the program. Results yielded four elements pivotal to the decisionmaking process: scientific evidence, teamwork and leadership, strategic alliances, and program institutionalization. Each element contributed to building consensus, securing funding, attracting resources, and gaining lasting support from policymakers. Additionally, a review of available documentation led the authors to consider sociopolitical context and use of the media to be important factors. While research evidence for the effectiveness of mental health services in the primary care setting continues to accumulate, low- and middle-income countries should get started on the lengthy process of scaling up by incorporating the elements that led to decisionmaking and implementation of the PNDTD in Chile.

THE MORE IT IS NEEDED, THE LESS IT IS WANTED: ATTITUDES TOWARD FACE-TO-FACE INTERVENTION AMONG DEPRESSED PATIENTS UNDERGOING ONLINE TREATMENT

Many individuals suffering from depression do not actively seek treatment. Self-help strategies represent low-threshold treatment options that are particularly relevant for milder cases. The present study addressed two important issues: (1) we examined depressed individuals' motives and attitudes that may represent barriers to face-to-face treatment; (2) we examined if the participation in an online treatment program facilitates or compromises their willingness to undergo face-to-face treatment. We recruited 210 participants with depression for a trial on the efficacy of an online treatment program for depression. Participants were randomly allocated either to a self-help treatment (Deprexis) or to a wait-list control group. All participants filled out a newly developed 42-item questionnaire called Psychotherapy Expectations, Concerns, and Hopes Inventory (PECHI). The scale measures attitudes toward face-to-face treatment and was administered at baseline and 8 weeks later. Principal component analysis of the PECHI revealed five dimensions: hope for symptomatic improvement, fear of poor alliance with the therapist, skill acquisition, skepticism and resentment of psychotherapy, and self-stigma. Attitudes toward treatment were stable over time and neither modulated by group status nor by self-reported or objective symptom decline. Correlation analyses revealed that current levels of depression and well-being were potent predictors of attitudes toward treatment, suggesting that when the patient feels more depressed, doubts about the effectiveness of therapy emerge more strongly. To conclude, results suggest that Deprexis neither promotes nor reduces negative attitudes toward psychotherapy, nor does it increase barriers to enter face-to-face treatments. An alarming paradox emerged: when a depressed person is in greatest need of help, motivation to seek face-to-face treatment is lowest.

Childbearing depression and childhood aggression: literature review.

Childbearing depression (CBD) and childhood aggression are serious and international problems that encumber public health. Although maternal depression has received much attention in the literature in the last three decades, clinically it remains underdiagnosed and undertreated, especially during pregnancy. As a result, many mothers and families are left to suffer its long-lasting physical and psychosocial effects. This article's aim is to review the current literature on whether CBD increases the likelihood of childhood aggression in children ages 6 years and younger. Using keywords, an electronic search was performed using Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and PubMed databases. Search limits included the following: 2000-2010, English, peer-review, human, All Child: 0-18. From more than 2,000 search results, 13 articles were reviewed based on relevance to article's inquiry and sample size greater than 50. In all, the articles agreed that depression in women increases the likelihood of early childhood aggression by causing negative parenting behaviors. However, this finding is tempered by a number of weaknesses in the quality of articles reviewed and by the complexity of the topic. More research is needed to determine the etiology and interplay of mediating factors between CBD and childhood aggression. This could inform the study and implementation of effective and early prevention, screening, and treatment measures and programs for maternal depression and childhood aggression.

Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression: Randomized Controlled Trial

BackgroundThe stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression.ObjectivesWe tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms.MethodsWe recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs).ResultsOf the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (–6.366 to –0.029). The proportion of the maximum possible indirect effect estimated was κ2 =.54 (95% CI .426–.640).ConclusionsThis study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor.Trial RegistrationClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k)

Assessing the effect of Measurement-Based Care depression treatment on HIV medication adherence and health outcomes: Rationale and design of the SLAM DUNC Study

Depression affects 20–30% of people living with HIV/AIDS (PLWHA) in the U.S. and predicts greater sexual risk behaviors, lower antiretroviral (ARV) medication adherence, and worse clinical outcomes. Yet little experimental evidence addresses the critical clinical question of whether depression treatment improves ARV adherence and clinical outcomes in PLWHA with depression. The Strategies to Link Antidepressant and Antiretroviral Management at Duke, UAB, and UNC (SLAM DUNC) Study is a randomized clinical effectiveness trial funded by the National Institute for Mental Health. The objective of SLAM DUNC is to test whether a depression treatment program integrated into routine HIV clinical care affects ARV adherence. PLWHA with depression (n=390) are randomized to enhanced usual care or a depression treatment model called Measurement-Based Care (MBC). MBC deploys a clinically supervised Depression Care Manager (DCM) to provide evidence-based antidepressant treatment recommendations to a non-psychiatric prescribing provider, guided by systematic and ongoing measures of depressive symptoms and side effects. MBC has limited time requirements and the DCM role can be effectively filled by a range of personnel given appropriate training and supervision, enhancing replicability. In SLAM DUNC, MBC is integrated into HIV care to support HIV providers in antidepressant prescription and management. The primary endpoint is ARV adherence measured by unannounced telephone-based pill counts at 6months with follow-up to 12months and secondary endpoints including viral load, health care utilization, and depressive severity. Important outcomes of this study will be evidence of the effectiveness of MBC in treating depression in PLWHA and improving HIV-related outcomes.

News from the CDC: translating epilepsy self-management research to practice

Epilepsy, which affects about two million persons in the USA, is characterized by recurrent, unprovoked seizures [1]. Many with the condition face significant challenges related to managing treatment, symptoms, disability, lifestyle limitations, depression, and stigma. The Centers for Disease Control and Prevention’s (CDC) Epilepsy Program supports activities related to epidemiologic and prevention research, improving care, combating stigma, promoting patient self-management, increasing public awareness and knowledge, and strengthening partnerships. In 2002, promising research on epilepsy self-management began to emerge from CDC’s Prevention Research Centers, which led to the development of the Managing Epilepsy Well (MEW) Network (http://www.sph.emory.edu/ManagingEpilepsyWell/) [2]. Since 2007, the MEW Network has successfully developed and evaluated several theory-based interventions through telehealth and traditional formats [3]. MEW programs currently available to the public include Epilepsy Awareness Support and Education (WebEase), an on-line self-management program, Using Practice and Learning to Increase Favorable Thoughts (UPLIFT), a telehealth depression treatment program, and Program to Encourage Active Rewarding Lives (PEARLS), a collaborative care home-based depression treatment intervention [3].

Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan

The aim of the present study was to investigate the differences in the prevalence of and risk factors for elderly depression between urban and rural areas in Japan and to further understanding of the features of elderly depression. A multistage, random sampling procedure and mailing method were used in urban and rural areas in Kumamoto Prefecture. A total of 2,152 participants aged 65 years and older were evaluated for depression using the Geriatric Depression Scale (GDS). Factors associated with depression were also examined. In order to assess the relationship between risk factors and subjective happiness, the Philadelphia Geriatric Center Morale Scale (PGC-MS) was used. Depressive symptoms were associated with living alone, being unemployed, chronic illness, sleep disturbance, suicidal ideation, financial strain, and poor social support; the risk factors for elderly depression were almost the same in the two areas. Although three factors (financial strain, work status, and PGC-MS) were significantly associated with depression in both areas on logistic regression analysis, sleep disturbance was significant only for the urban area, and poor social support was significant only for the rural area. Although factors related to depression did not differ markedly between urban and rural elderly people, some risk factors differed between the two areas. Effective intervention programs for elderly depression should pay more attention to regional differences.

Effects of Depression and Anxiety Improvement on Adherence to Medication and Health Behaviors in Recently Hospitalized Cardiac Patients

Impaired adherence to medications and health behaviors may mediate the connection between psychiatric symptoms and mortality in cardiac patients. This study assessed the association between improvements in depression/anxiety and self-reported adherence to health behaviors in depressed cardiac patients in the 6 months after cardiac hospitalization. Data were analyzed from depressed patients on inpatient cardiac units who were hospitalized for acute coronary syndrome, heart failure, or arrhythmia and enrolled in a randomized trial of collaborative care depression management (n = 134 in primary analysis). Measurements of depression (Patient Health Questionnaire-9), anxiety (Hospital Anxiety and Depression Scale, Anxiety subscale), and adherence to secondary prevention behaviors (Medical Outcomes Study-Specific Adherence Scale items) were obtained at baseline, 6 weeks 12 weeks, and 6 months. The association between improvement in depression/anxiety and adherence was assessed by linear regression after accounting for the effects of multiple relevant covariates. At all time points improvement in the Patient Health Questionnaire-9 was significantly and independently associated with self-reported adherence to medications and secondary prevention behaviors. In contrast, improvement in the Hospital Anxiety and Depression Scale, Anxiety subscale was associated with improved adherence only at 6 weeks. In conclusion, in a cohort of depressed cardiac patients, improvement in depression was consistently and independently associated with superior self-reported adherence to medications and secondary prevention behaviors across a 6-month span, whereas improvement in anxiety was not.

Postpartum Depression and Parental Self-Efficacy

This study compared postpartum depression and parental self-efficacy between married immigrant women from Vietnam and native Korean mothers. The participants were 72 native Korean mothers and 69 immigrant Vietnamese mothers living in a suburban city in South Korea. The instruments used were the Edinburgh Postnatal Depression Scale and the Parent Expectation Survey. There were statistically significant differences in age, education, employment, income, husband's age, and family structure between the two groups. Immigrant Vietnamese mothers experienced higher levels of postpartum depression (t = -3.466, p = .001) and had lower parental self-efficacy (t = 5.607, p < .001) than native Korea mothers. Postpartum depression was negatively correlated with parental self-efficacy in native Korean mothers (r = -.349, p = .003), but there was no significant correlation in the immigrant Vietnamese mothers (r = .011, p = .936). The mothers' country of origin, whether immigrant or Korean, was a significant factor in postpartum depression (β = .338, p = .040; R (2) = .091). The mothers' country of origin had no effect on parental self-efficacy (p = .957). Instead, significant differences were found for the age, education level, and family structure of the participant (R (2) = .036). The results of this study demonstrated that postpartum depression was more prevalent among married immigrant women from Vietnam than among native Korean mothers. Accordingly, a postpartum depression intervention program for married immigrant women should be developed and implemented.

Influence of Personal Characteristics, Childhood abuse and Stressful Experience on Suicidal Ideation in Middle School Students

Purpose: The purpose of this study is to investigate the factors influencing suicidal ideation in middle school students. Methods: Suicidal Ideation Questionnaire (SIQ) results, personal characteristics, child abuse experiences, and stress were obtained from a sample of 657 middle school students from 3 conveniently selected schools in S city. Results: Suicidal ideation of participants was positively correlated with child abuse experience, stress, psychosomatic symptoms, antisocial personality and depressive tendencies, whereas sociability and self-esteem were negatively correlated with suicidal ideation. Significant factors influencing suicidal ideation included an antisocial personality tendency, stress related to the family environment, mental abuse, gender (female), depressive trend, running away from home, sociability, and stress related to academic performance. These factors explained 39.9% of the variance. Conclusion: These results suggest that earlier screening and intervention programs for depression and stress in middle school students will be helpful in reducing suicidal ideation. Further studies are needed in which other strategies that could prevent suicidal ideation in middle school students are examined.

Effects of a School-based Intervention Program for Middle School Adolescent Girls with Depression: As Part of the School Health Services

The purpose of this study was to evaluate the effects of a school-based intervention program for middle school adolescent girls with depression. The study was a pretest-posttest repeated-measure design with a nonequivalent control group. Fifty eight students with depressive symptoms were recruited from two middle schools in Seoul, Korea. The data were collected from the intervention (n=30) and the comparison group (n=28). The research instrument was Reynolds Adolescent Depression Scale. The intervention group greatly improved from baseline to 10 weeks and then saw a slight positive change between 10 and 13 weeks. The results of this research show that depression intervention programs are effective for young female adolescents. Thus the investigation has important school-based treatment implications, and should be integrated into school curricula by school health nurses for early intervention of depressive symptoms in middle school adolescent girls.

The Reach of Depression Screening Preceding Treatment: Are There Patterns of Patients' Self-Selection?

This study evaluated the reach of depression screening followed by treatment programs for subsyndromal depression and explored demographic and clinical characteristics of patients who were reached versus those who were not. A two-item Patient Health Questionnaire-Depression was sent to 4196 type 2 diabetic patients. Positively screened patients were interviewed to assess the severity of depression, and those with subclinical symptoms were invited to treatment groups. The reach of screening procedure was evaluated by the total response rate, proportion of positive depression screenings, and proportion of eligible patients entering treatment programs. Predictors of responsiveness to screening and of participation in treatment were determined using logistic regression. Of the 34% of patients who returned the questionnaire (n = 1442), 40% reported depressive symptoms and a need for professional help (n = 581). Age (OR = 1.06, 95% CI = 1.05–1.08), BMI (OR = 1.02, 95% CI = 1.00–1.04), HbA1C (OR = .92, 95% CI = .86–.99), and LDL-cholesterol (OR = .90, 95% CI = .81–1.00) correlated with response to screening. Willingness to accept treatment was predicted by professional status (OR = 3.24, 95% CI = 1.53–6.87), education (OR = 1.21, 95% CI = 1.05–1.38), and BMI (OR = .91, 95% CI = .85–.98). Older patients with better diabetes control were more likely to be reached by postal screening for depressive symptoms. Professionally inactive, better-educated persons and those with lower BMI were more likely to participate in the intervention for subsyndromal depression.

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment

Implementation Research: Reducing the Research-to-Practice Gap in Depression Treatment