New Diagnosis Of Depression Research Articles

Generalized anxiety disorder screening scores are associated with greater treatment need among Veterans with depression

Comorbid anxiety and depression predict a poorer prognosis than either disorder occurring alone. It is unclear whether self-reported anxiety symptom scores identify patients with depression in need of more intensive mental health services. This study evaluated how anxiety symptoms predicted treatment receipt and outcomes among patients with new depression diagnoses in the Veterans Health Administration (VHA). Electronic medical record data from 128,917 VHA patients (71.6% assessed for anxiety, n = 92,237) with new diagnoses of depression were analyzed to examine how Generalized Anxiety Disorder-7 (GAD-7) scores predicted psychotropic medication prescriptions, psychotherapy receipt, acute care service utilization, and follow-up depression symptoms. Patients who reported severe symptoms of anxiety were significantly more likely to receive adequate acute phase and continuation phase antidepressant treatment, daytime anxiolytics/sedatives, nighttime sedative/hypnotics, and endorse more severe depression symptoms and suicidal ideation at follow-up. Patients who reported severe symptoms of anxiety at baseline were less likely to initiate psychotherapy. The GAD-7 may help identify depressed patients who have more severe disease burden and require additional mental health services.

Impact of COVID-19 pandemic on depression incidence and healthcare service use among patients with depression: an interrupted time-series analysis from a 9-year population-based study

BackgroundMost studies on the impact of the COVID-19 pandemic on depression burden focused on the earlier pandemic phase specific to lockdowns, but the longer-term impact of the pandemic is less well-studied. In this population-based cohort study, we examined the short-term and long-term impacts of COVID-19 on depression incidence and healthcare service use among patients with depression.MethodsUsing the territory-wide electronic medical records in Hong Kong, we identified all patients aged ≥ 10 years with new diagnoses of depression from 2014 to 2022. We performed an interrupted time-series (ITS) analysis to examine changes in incidence of medically attended depression before and during the pandemic. We then divided all patients into nine cohorts based on year of depression incidence and studied their initial and ongoing service use patterns until the end of 2022. We applied generalized linear modeling to compare the rates of healthcare service use in the year of diagnosis between patients newly diagnosed before and during the pandemic. A separate ITS analysis explored the pandemic impact on the ongoing service use among prevalent patients with depression.ResultsWe found an immediate increase in depression incidence (RR = 1.21, 95% CI: 1.10–1.33, p < 0.001) in the population after the pandemic began with non-significant slope change, suggesting a sustained effect until the end of 2022. Subgroup analysis showed that the increases in incidence were significant among adults and the older population, but not adolescents. Depression patients newly diagnosed during the pandemic used 11% fewer resources than the pre-pandemic patients in the first diagnosis year. Pre-existing depression patients also had an immediate decrease of 16% in overall all-cause service use since the pandemic, with a positive slope change indicating a gradual rebound over a 3-year period.ConclusionsDuring the pandemic, service provision for depression was suboptimal in the face of increased demand generated by the increasing depression incidence during the COVID-19 pandemic. Our findings indicate the need to improve mental health resource planning preparedness for future public health crises.

New onset postoperative depression after major surgery: an analysis from a national claims database

BackgroundPostoperative depression is not well characterised. We investigated the incidence of postoperative depression with the hypothesis that after controlling for confounders, new onset depression would vary significantly by surgical type. MethodsWe conducted a retrospective cohort study using the Optum Clinformatics Datamart. The primary outcome was new onset postoperative depression, defined by a new diagnosis of depression or new prescription for an antidepressant in the year after surgery using International Classification of Diseases (ICD) 9/10 codes and drug names. Adjustment for preoperative comorbidities and predictors of depression was with multivariable Cox regression and propensity score matching. Sensitivity analyses defining new onset depression as both a new diagnosis of depression and a new prescription for an antidepressant, or either outcome separately, were conducted. ResultsData from 132 390 cardiac surgery, 12 538 thoracotomy, 32 630 video-assisted thoracoscopic surgery (VATS), 96 750 hip fracture surgery, 157 484 hip replacement, and 347 878 laparoscopic cholecystectomy patients from January 2004 to June 2021 were analysed. The incidence of new onset postoperative depression was 18.8% for hip fracture surgery, 16.1% for thoracotomy, 12.6% for cardiac surgery, 12.4% for VATS, 8.6% for laparoscopic cholecystectomy, and 6.8% for hip replacement. After multivariable adjustment, hip fracture surgery patients were most likely to develop new onset postoperative depression (hazard ratio [95% confidence interval]) 1.56 [1.45–1.68]), followed by thoracotomy (1.12 [1.03–1.22]), cardiac surgery (1.09 [1.04–1.12]), VATS (0.95 [0.90–1.00]), and hip replacement (0.55 [0.52–0.57]) compared with patients undergoing laparoscopic cholecystectomy (hazard ratio=1). Results from propensity score matched analyses and sensitivity analyses were similar. ConclusionsThe risk of postoperative depression differs by surgical type after controlling for preoperative characteristics.

New Caregiver Diagnoses of Severe Depression and Child Asthma Controller Medication Adherence.

Children with asthma who have depressed caregivers are known to be less adherent to medication regimes. However, it is less clear how adherence responds to a caregiver's new diagnosis of severe depression or whether there is a similar relationship with other serious caregiver diagnoses. The hypothesis is that adherence worsens both with new diagnoses of depression and possibly with new diagnoses of other serious conditions. This study follows a cohort of 341,444 continuously insured children with asthma before and after a caregiver's new diagnosis of severe depression or another serious health condition. The effect of a new depression diagnosis on a child's medication adherence is compared to the effect of new diagnoses of other common caregiver chronic conditions including diabetes, cancer, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease. Results show that children's medication adherence declines following a caregiver's new diagnosis of severe depression, but that it also declines following a caregiver's new diagnosis of diabetes. There is no association with new diagnoses of the other caregiver chronic conditions examined. Children whose caregivers have a new diagnosis of depression or diabetes may be at increased risk of deterioration in their medication adherence. These caregivers may benefit from additional support and follow-up. The relationship between caregivers' health and children's medication adherence is complex and deserves further study.

Relationship between Diabetic Retinopathy Disease Severity, Anxiety, and Depression

Purpose: Determine the relationship between nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), anxiety, and depression. Materials and Methods: This retrospective case-control study identified patients 18 years or older seen by the University of North Carolina Ophthalmology department between July 2008-July 2018 diagnosed with anxiety, depression, NPDR, and PDR. Odds ratios (OR) were calculated separately for the severity of diabetic retinopathy (DR) and anxiety or depression. Results: Among the 47,740 study subjects, 27,893 (58%) were female, 3,239 (6.8%) had NPDR and 1,430 (3.0%) had PDR. The incidence of anxiety after DR was 1.5%, and the incidence of depression after DR was 2.4%. NPDR (0.997; 0.896-1.110; p&lt;0.001) conveyed no change in odds, while PDR (0.869; 0.756-0.998; p&lt;0.001) demonstrated a reduction in odds for a subsequent diagnosis of anxiety. Compared to other 18-34 year old patients with less severe or no disease, 18-34 year old patients with NPDR (2.801; 1.450-5.408; p=0.003) and PDR (2.999; 1.499-6.001; p=0.004) exhibited an increased odds for subsequent anxiety. NPDR (1.473; 1.342-1.617; p&lt;0.001) and PDR (1.232; 1.092-1.389; p&lt;0.001) demonstrated an increased odds for subsequent diagnosis of depression. When stratifying by age, 18-34 year old patients again had the highest increase in odds for subsequent diagnosis of depression (NPDR 3.452; 1.774-6.719; p&lt;0.001 and PDR 4.382; 2.232-8.603; p&lt;0.001). Conclusions: Patients with DR have an increased risk for a new diagnosis of depression, and DR severity has a positive linear relationship with the diagnosis of depression. Age likely plays a prominent role in risk stratification for a new diagnosis of anxiety in patients with DR.

Racial-Ethnic Differences in Treatment Initiation for New Diagnoses of Perinatal Depression.

The adverse consequences of untreated perinatal depression highlight the need to identify populations to target in order to increase treatment rates. The authors sought to evaluate treatment initiation for a new diagnosis of depression during pregnancy or postpartum and to describe racial-ethnic differences in initiation and type (psychotherapy, antidepressants) of treatment in a large health care system with universal perinatal depression screening. This retrospective cohort study included women who delivered a live birth in the Kaiser Permanente Northern California system between October 2012 and May 2017. Black, Latina, Asian, and White women ages ≥15 years were eligible. New depression diagnoses were defined by using ICD-9 and ICD-10 codes from electronic health records. Treatment initiation was defined as receiving at least one antidepressant medication dispensation or psychotherapy visit up to 90 days after the diagnosis. Modified Poisson regression was used to estimate the risk for initiating treatment and the type of treatment initiated. In total, 13,637 women with a new depression diagnosis (prenatal: N=7,041, 51.6%; postpartum: N=6,596, 48.4%) were identified. Of the pregnant women, 31.4% initiated treatment, and of the postpartum women, 73.1% initiated treatment. Latina and Asian women were less likely than White women to initiate treatment postpartum. During pregnancy and postpartum, non-White women were more likely to initiate psychotherapy. White women were more likely to initiate antidepressant medication during pregnancy and postpartum or a combination of antidepressant medication and psychotherapy during the postpartum period. Research is warranted to identify patient-, provider-, and system-level barriers that contribute to racial-ethnic disparities in perinatal mental health care.

The effect of initial antidepressant type on treatment adherence in outpatients with new onset depression

BackgroundContinuous use of antidepressants can relieve depressive symptoms and prevent recurrence in people with depression; however, many studies have reported low drug compliance rates. This study aimed to investigate the relationship between the type of initial antidepressants and treatment adherence in outpatients with new onset depression. MethodsThis was a retrospective cohort study using National Health Insurance claim data for services provided in 2012. We examined data from 142,336 individuals aged 18 years or older, who were continuously enrolled in treatment after a new episode of depression, and had initiated antidepressant treatment. A new diagnosis of depression, is defined as a first reported diagnosis of depression in the preceding five years. Adherence was operationally defined as the antidepressant being dispensed to the patient at least 80% of the time during the first three- and six-month treatment periods. To investigate the relationship between the initial type of antidepressants and treatment adherence, we estimated adjusted odds ratios and 95% confidence intervals using logistic regression analysis, adjusting for socio-demographic and health care utilization characteristics. ResultsA statistically significant association was found between initial antidepressant type and adherence in the first three- and six-month treatment periods for employed and self-employed patients newly diagnosed with major depression. In addition, patients with starting prescriptions for tricyclic antidepressants had significantly lower adherence compared to selective serotonin reuptake inhibitors. LimitationsThis study used national insurance data; therefore, only variables on the claim form were available, and psychological and environmental factors were not considered. ConclusionsThis was the first study to demonstrate the relationship between initial antidepressant type and treatment adherence among Korean outpatients with new onset depression.

Depression, Anxiety, and Patterns of Mental Health Care Among Men With Prostate Cancer Receiving Androgen Deprivation Therapy.

Androgen deprivation therapy (ADT) use is associated with an increased risk of developing depression and anxiety. Little is known about how the mental health of these men is treated. We identified men with prostate cancer who received ADT between 2001 and 2015 using Optum's de-identified Clinformatics Data Mart Database. We determined the incidence of depression or anxiety diagnoses, mental health treatments, and the specialty of providers initiating psychotropic medications, after the start of ADT. Outcomes were compared with those of men with prostate cancer not receiving ADT and men without prostate cancer. Of 37388 men with prostate cancer treated with ADT, 3964 (10.6%) received a new diagnosis of depression or anxiety. Of those 3964 men, 1892 (47.7%) did not receive a documented treatment, 10 (0.3%) received psychotherapy, 1321 (33.3%) a selective serotonin reuptake inhibitor, and 744 (18.8%) a benzodiazepine. The median time from initiation of ADT to a depression or anxiety diagnosis was 9.3 months. Primary care physicians were the most common prescribers of psychotropic medications (72.2%). The proportion of men not receiving mental health treatments of interest (47.7%) was similar compared to men without prostate cancer (49.1%), but statistically significantly lower compared to men with prostate cancer not receiving ADT (52.7%). In men with prostate cancer receiving ADT with a new diagnosis of depression or anxiety, nearly half are not receiving mental health care while one in five is introduced to a benzodiazepine. Further investigation toward improving the mental health care for men on ADT is needed.

Incidence of depression and antidepressant prescription in patients with COPD: A large UK population-based cohort study

BackgroundDepression is frequently reported in patients with Chronic Obstructive Pulmonary Disease (COPD). However, there is little information available on the incidence of depression following a COPD diagnosis. ObjectiveTo determine the incidence of a new diagnosis of depression or antidepressant prescription in people with and without a COPD diagnosis. MethodsA matched cohort study was conducted using The Health Improvement Network database. Patients with confirmed COPD diagnosis were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of depression and antidepressant prescription. Results44,362 patients with COPD and 124,140 subjects without COPD were included. The incidence rate of depression per 1000 person-years following COPD diagnosis was greater (11.4; 95% CI: 10.9–11.8) compared to subjects without COPD (5.7; 95% CI: 5.5–5.8) (p < 0.001). Patients with COPD were 42% more likely to have an incident depression (adjusted hazard ratio [aHR]: 1.42; 95% CI: 1.32–1.53; p < 0.001), and 40% more likely to be prescribed an antidepressant (aHR: 1.40; 95% CI: 1.35–1.45; p < 0.001). The incidence to either depression or antidepressant prescription was also greater for patients with COPD (aHR: 1.41; 95% CI: 1.36–1.46; p < 0.001). Patients with COPD and worse breathlessness had a higher risk of incident depression compared to patients with less breathlessness. ConclusionHealthcare providers managing patients with COPD should be alert to the existence of depression and aware of its symptoms and consequences.

Behavioral Health Diagnoses and Health Care Use Before and During the COVID-19 Pandemic.

Emerging evidence has suggested a population-wide worsening of psychiatric symptoms during the COVID-19 pandemic, particularly among individuals with preexisting mental health conditions. The authors investigated whether reported behavioral health problems are being identified and treated. This observational cohort study retrospectively compared Medicaid data of patients from the first year of the pandemic (2020) in the United States (N=1,589,111 patients) with the corresponding data from the year before (2019; N=1,715,872 patients). Outcome measures included several behavioral health diagnoses and health care utilization. During the pandemic period examined, the numbers of patients served, adults receiving a new diagnosis of anxiety, and children receiving a new diagnosis of depression all increased. Across all age groups, nonbehavioral health emergency department visits significantly decreased. These findings support reports of increases in psychiatric morbidity but do not provide evidence for increased demand for health care services.

Longitudinal impact of bladder cancer diagnosis on common psychiatric disorders.

BackgroundThe presence of psychiatric disorders in patients with cancer is associated with increased morbidity and poorer outcomes. We sought to determine the impact of a new bladder cancer diagnosis on the incidence of depression and anxiety.MethodsWe used a database of billing claims (MarketScan®) to identify patients newly diagnosed with bladder cancer between 2009 and 2018. Patients with preexisting psychiatric disorders or use of anxiolytics/antidepressants were excluded. We matched cases to patients without a bladder cancer or psychiatric diagnosis. Our primary outcome was a new diagnosis of depression, anxiety, or use of anxiolytics/antidepressants. Other exposures of interest included gender and treatment received. We used multivariable regression to estimate odds ratios for these exposures.ResultsWe identified 65,846 cases with a new diagnosis of bladder cancer (31,367 privately insured; 34,479 Medicare‐eligible). Compared to controls, bladder cancer patients were more likely to develop new‐onset depression/anxiety at 6 months (privately insured: 6.9% vs. 3.4%, p < 0.001; Medicare‐eligible: 5.7% vs. 3.4%, p < 0.001) and 36 months (privately insured: 19.2% vs. 13.5%, p < 0.001; Medicare‐eligible: 19.3% vs. 16.0%, p < 0.001). Women (vs. men, privately insured: OR 1.65, 95%CI 1.53–1.78; Medicare‐eligible: OR 1.63, 95%CI 1.50–1.76) and those receiving cystectomy and chemotherapy (vs. no treatment, privately insured: OR 4.94, 95%CI 4.13–5.90; Medicare‐eligible: OR 2.35, 95%CI 1.88–2.94) were more likely to develop significant depression/anxiety.ConclusionA new diagnosis of bladder cancer was associated with increased burden of significant depression/anxiety compared with matched controls. Women and patients receiving more radical treatments had higher rates of depression and anxiety.

Achalasia is associated with a higher incidence of depression in outpatients in Germany.

Background and aimAchalasia represents a chronic motility disorder of the esophagus featuring an impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. By causing dysphagia, regurgitation, aspiration and chest pain, achalasia might tremendously affect life quality of patients. However, the impact of achalasia on the development of mood disorders including depression has largely remained unclear. The aim of this study was to evaluate the incidence of depression in achalasia patients.MethodsWe analyzed a large primary care cohort database in Germany capturing data from 7.49 million patients.ResultsA total of n = 1,057 patients with achalasia diagnosed between January 2005 and December 2018 were matched to a cohort of n = 3,171 patients without achalasia controlling for age, sex, physician, index year, and the Charlson comorbidity index. Interestingly, while the frequency of depression prior to the diagnosis of achalasia was comparable in both groups, new diagnoses of depression were significantly higher within one year after the diagnosis of achalasia compared to the control group, suggesting a direct and previously unrecognized association between achalasia and depression.ConclusionOur data suggest that the clinical management of patients with achalasia should include a careful and structured work-up for mood disorders in order to improve long-term quality of life in these patients.

Risk of incident dementia in late-life depression treated with antidepressants: A nationwide population cohort study

Antidepressants are frequently used to treat depression in patients with dementia. In addition, late-life depression is associated with the incidence of subsequent cognitive impairment or dementia. However, the association between exposure to antidepressants in late-life depression and the development of incident dementia remains understudied. Through a population-based retrospective cohort design, data were extracted from the Taiwan National Health Insurance Research Dataset of medical claims registered from 1998-2013. We collected data of individuals who had received a new diagnosis of depression between 2000 and 2007. We excluded those who received a diagnosis of depression and were given antidepressants before 2000 and those younger than 60 years. The primary outcome was the occurrence of incident dementia. The time from the prescription of antidepressants or the diagnosis of depression until the outcome or the end of 2013 was calculated as the time to event. A total of 563,918 cases were included and were divided into either antidepressant users or antidepressant nonusers. Cox proportional hazards models were used to calculate the hazard ratio and 95% confidence interval. Exposure to antidepressants did not increase the risk of dementia in patients with late-life depression at either a low exposure dosage (hazard ratio: 1.06, 95% confidence interval: 0.91-1.23) or a high exposure dosage (hazard ratio: 1.07, 95% confidence interval: 0.95-1.20). To confirm the validity of our results, we performed a sensitivity analysis and subgroup analysis, and the post-hoc results were consistent with the main results. Antidepressants did not increase the risk of incident dementia in patients with late-life depression.

Cataract and the increased risk of depression in general population: a 16-year nationwide population-based longitudinal study

Cataract is the primary cause of visual impairment and can be corrected by cataract surgery. We investigated the impact of cataract on the risk of depression along with the benefits of cataract surgery. Patients newly diagnosed with cataract by ophthalmologists between 2001 and 2015 were identified from the National Health Insurance Research Database (NHIRD) in Taiwan. Non-cataract individuals were recruited by 1:1 matching for age, sex and index year. After propensity score matching, 233,258 patients in total were included in our study: 116,629 in each of the cataract and non-cataract cohorts. The primary outcome was the new diagnosis of depression by psychiatrists. In a mean follow-up period of 7.8 years, cataract was significantly associated with increased risk of developing depression (adjusted hazard ratio [aHR] = 1.78, 95% confidence interval [CI] 1.70–1.87, p < 0.001). We further divided the cataract cohort into surgery and non-surgery groups. Notably, cataract surgery group was associated with a decreased risk of depression compared with non-surgery patients (aHR = 0.75, 95% CI 0.71–0.79, p < 0.001). Our results emphasise the importance of regular screening for depression among cataract patients and the beneficial effect of cataract surgery in reducing the risk of depression.

Depression, anxiety, and patterns of mental health care among men with prostate cancer on androgen deprivation therapy (ADT).

12100 Background: ADT is associated with an increased risk of depression and anxiety, raising the concern that a substantial portion of men with prostate cancer need mental health care. We sought to investigate the development of depression or anxiety and subsequent patterns of mental health care in men with prostate cancer on ADT. Methods: Clinformatics DataMart, a claims database of commercially insured patients, was used to identify men with prostate cancer who received ADT between 2001-2015 and had continuous enrollment for 1 year before and 2 years after starting ADT. We determined the rate of incident diagnoses of depression or anxiety and the incident use of mental health treatments - psychotherapy and psychiatric medications (≥ 5 day supply) - after the start of ADT. Results: Among 37,388 men in the final analytic cohort, 11.3% (n=4239, 95% confidence interval (CI) 11.0-11.6%) received new diagnoses of depression or anxiety: 5.8% depression (95% CI, 5.5-6.0%), 3.7% anxiety (95% CI 3.5-3.9%), and 1.8% both (95% CI, 1.7-1.9%). Those who received a diagnosis of depression or anxiety were more likely to be white (68% v. 64%, p&lt;0.01); no differences were noted in age, education, or household income. Among those with a new diagnosis of depression or anxiety, 0.07% received psychotherapy (95% CI, 0.02-0.23%), 34.9% a selective serotonin reuptake inhibitor (95% CI, 33.5-36.4%), 11.6% a serotonin norepinephrine reuptake inhibitor (95% CI, 10.7-12.6%), and 19.9% a benzodiazepine (95% CI, 18.7-21.1%). Conclusions: Among men with prostate cancer receiving ADT, more than 1 in 10 received a new diagnosis of depression or anxiety. Of those, 1 in 5 were introduced to a benzodiazepine, a drug class with risks of dependence, cognitive impairment, falls, and fractures, whereas receipt of psychotherapy was rare. Further investigation into how to improve the mental health care of men on ADT is needed. [Table: see text]

PMU127 DIABETES, HYPERTENSION, AND STATIN MEDICATION ADHERENCE AND DEPRESSION

Several survey studies found that patients with depression had high risk of being non-adherent to medication therapies for other chronic conditions. A previous research suggested that antidepressants had positive impact on glycemic control for diabetes patients possibly related to improved medication adherence after relief of depressive symptoms. We used real-world claims data to examine the association of depression with adherence to three therapeutic classes (3TC): oral diabetes, hypertension and statin medications. This retrospective cohort study used IBM MarketScan® database. Adults 18-64 years old, who initiated their therapy in 2015, continued taking the 3TC medications and continuously enrolled in 2016 and 2017, were included. The study group patients started anti-depression medications or had depression diagnosis in 2015, while the control group did not. Patients with new diagnosis of depression after 2015 were excluded. Medication adherence were measured using proportion of days covered (PDC) defined by CMS. The adjusted odds ratio (OR) of being non-adherent (PDC<80%) were calculated for 2016 and 2017 after controlling for age, gender, employee classification and status, and geographic location. About 1/3 patients filling 3TC medications also filled anti-depression medications. The study group (n=652,005) had significantly greater odds of being non-adherent to their established therapies than the control group (n=1,201,656) in 2016: diabetes OR =1.03 (95% CI 1.01-1.05); hypertension OR=1.32 (95% CI 1.30-1.34); and statin OR=1.32 (95% CI 1.30-1.34). The odds of being non-adherent became more substantial in 2017: diabetes OR=1.07 (95% CI 1.06-1.09); hypertension OR=1.55 (95% CI 1.53-1.57); and statin OR=1.52 (95% CI 1.49-1.54). Depression has negative impact on medication adherence to treat three chronic conditions, especially for statin and hypertension. To achieve better health outcomes, healthcare providers including clinics and pharmacies should manage depression in conjunction with other chronic conditions.

Improving Access to Psychological Therapies for older adults: auditing management of newly diagnosed mild and moderate depression in six general practices within the Birmingham and Solihull CCG

BackgroundThe first-line treatments for mild–moderate and moderate–severe depression according to the National Institute for Health and Care Excellence clinical guidelines for the management of depression in adults are psychological therapies...

P008 EVALUTING THE EFFECTIVENESS OF TRANSITION OF CARE FOR PEDIATRIC INFLAMMATORY BOWEL DISEASE PATIENTS USING A STANDARDIZED TRANSITION PROCESS

Abstract Significance The incidence of inflammatory bowel disease (IBD) is rising around the globe. As pediatric IBD patients approach adulthood, they are in jeopardy of a lapse in care. We developed a standardized a health maintenance transition visit (HMV) to supplement standard medical care visits (SMV) to prepare patients for transition. Our aim was to assess the effectiveness of the structured HMV using the Transition Readiness Assessment Questionnaire (TRAQ) to predict readiness at time of transfer to an adult gastroenterologist. Methods A retrospective chart review was conducted including demographics and clinical data from HMV visits and pediatric or adult SMV visits. Clinical variables included scheduling, providers, TRAQs, Patient Health Questionnaire-9 (PHQ9), health maintenance goals, and disease status. The effectiveness of the HMV was accessed by attendance, PHQ9 screening, adherence to health recommendations, and TRAQ scores. Results 140 patients completed at least one HMV. The patient cohort was 80% white and 59% male. Mean age was 18 ± 2 years old at the time of their first HMV. The majority of patients had a primary IBD diagnosis of Crohn’s disease (75%), followed by ulcerative colitis (21%), and unclassified IBD (4%). Most patients had inactive disease (68%) around the time of the first HMV, while a minority had mild (20%) or moderate (12%) disease activity based on PGA. The average TRAQ score at the first HMV visit was 66 ± 17. Patients who completed at least 1 prior HMV (n=8) scored significantly higher on the TRAQ when transferring to the adult care compared to patients (n=29) who were transferred at their first HMV visit (92 vs 83, p&amp;lt;0.05). Of the 56 patients who completed the PHQ9 depression screen, 22 had a positive screen. Of the patients with no prior diagnosis of depression, 36% had a positive screen with the severity of depression ranging from mild to severe. Across all visits, 45 patients were transferred into adult care following a HMV. Conclusions This study demonstrated that a structured HMV prior to transfer may increase transition readiness as assessed by the TRAQ. In addition, new diagnosis of depression was made in a significant portion of patients screened, emphasizing the importance of regular screening for psychological issues. Future studies are needed to validate these findings and potentially move towards a standard template for transition readiness in pediatric IBD patients.

Nursing Home Star Ratings and New Onset of Depression in Long-Stay Nursing Home Residents

ObjectivesTo examine the association between nursing home (NH) quality and new onset of depression and severity of depressive symptoms in a national cohort of long-stay NH residents in the United States. DesignCohort study. Setting and participants129,837 long-stay residents without indicators of depression admitted to 13,921 NHs. MethodsNH quality was measured by Nursing Home Compare star ratings (overall, health inspection, staffing, quality measures) closest to admission. Study outcomes at 90 days from the Minimum Data Set 3.0 included depression diagnosis and severity of depressive symptoms (minimal; mild; moderate; moderately severe/severe). Symptoms were measured by resident self-report Patient Health Questionnaire (PHQ-9) or a staff-report observational version (PHQ-9-OV). Logistic and multinomial logistic models with generalized estimating equations were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsAt 90 days postadmission, 14.1% of residents had a new diagnosis of depression, and odds did not differ across star ratings. Nearly 90% of these residents had minimal depressive symptoms, with only 8.5% reporting mild symptoms and 2.6% with moderate to severe symptoms. Using minimal depressive symptoms as the reference, residents in NHs with 5-star overall ratings were 12% less likely than those in 3-star NHs to experience mild (95% CI: 0.81-0.96) and 31% less likely to experience moderate symptoms (95% CI: 0.58-0.82). In NHs with 1-star staffing compared to 3-star, residents had 37% higher odds of moderate symptoms (95% CI: 1.14-1.64) and 57% higher odds of moderately severe to severe depressive symptoms (95% CI: 1.17-2.12). The odds of any above-minimal depressive symptoms decreased as quality measure ratings increased. Conclusions/ImplicationsLower NH quality ratings were associated with more severe depressive symptoms. Further investigation is warranted to identify potential mechanisms for a targeted intervention to improve quality and provide more equitable care.

2287-PUB: Association of Depression Treatment and Glycemic Control in Adults with Diabetes

Patients with diabetes and comorbid depression have an increased risk of complications. In a repeated panel cross-sectional study, we investigated the effect of depression care on glycemic control for adults with diabetes. Local health plan provided secondary data (N=29,227) that contained depression information and overall health risk calculated by Johns Hopkins ACG software using diagnosis code, visits, and medication claims. This data was matched with A1c, demographics, and neighborhood characteristics. Study outcome is A1c change. Predictor of interest is depression treatment: (1) no depression in either year, (2) new onset is not treated in prior year but treated in sequential year, (3) past is treated in one year and none in sequential year, and (4) persistent is received treatment in both years. Covariates are age, sex, health risk, insurance types, and neighborhood characteristics. The analysis is a multiple linear regression model using a difference-in-differences framework. Adjusting for covariates, new onset of depression treatment was associated with better diabetes control, A1c decreased by 0.072 (p=0.025), compared to no depression. Compared to no depression, past depression treatment was associated with lower diabetes control, A1c increased by 0.071 (p=0.007). Persistent depression treatment had A1c change not different from no depression group (p=0.731). Among patients with diabetes, past depression treatment appeared to have poorer glycemic control compared with those not depressed. New onset of depression treatment appeared to improve glycemic control. New diagnosis of depression increased patient contact with provider. A decline in diabetes control among patients received depression treatment in the past, may be related to a change in contact with provider. Future studies could investigate whether patient visit with providers was affected by a change in depression and examine if A1c testing rate correlates with health service utilization. Disclosure H.N. Fu: None. A.M. Raiter: None. C. Carlin: None. K.A. Peterson: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)