Rates Of Depression Diagnoses Research Articles

Conflict-Related Breakdowns in Routine Medical Care - Longitudinal Outcomes for Civilians with Pre-Existing Cognitive Impairment.

Individuals with dementia face increased vulnerability during crises like armed conflicts. However, little is known about how conflicts affect dementia care delivery and patients' health. We conducted a longitudinal cohort study using medical record data. The study included 23,733 adults aged≥65 years with a diagnosis of dementia and 249,749 matched adults without dementia. Data were collected at baseline (March-October 2023), and two follow-up timepoints (December 2023 and February 2024), bracketing an armed conflict between Israel and Palestinian militant groups that began on October 7, 2023. We compared changes over time in clinical characteristics, medication use, healthcare utilization, costs between groups. Dementia prevalence was stable, but psychotropic medication use declined more sharply in those with dementia. Rates of depression diagnoses fell, and obesity rose in both groups. Healthcare utilization decreased substantially post-conflict, with fewer outpatient visits, hospitalizations, and emergency visits. Cost divergence between groups also increased over time. Machine learning identified shifting clusters of service users from high to mainly low users' post-conflict. The conflict severely disrupted routine dementia care and altered health behaviors. Flexible service delivery and access promotion strategies are needed to support vulnerable populations like people with dementia during crises.

Racial Disparities in Diagnosis and Treatment of Depression Associated with Androgen Deprivation Therapy for Prostate Cancer

To analyze potential racial disparities in the diagnosis and management of depression associated with androgen deprivation therapy. TriNetX health record network was queried for prostate cancer patients treated with androgen deprivation therapy from 2003-2023. Differences in rates of depression diagnosis and treatment were compared between White and Black patients. Means, odds ratios, and t tests were calculated in univariate analysis with 95% confidence intervals (CI). Data were queried from 93 health care organizations to yield 78,313 prostate cancer patients treated with androgen deprivation therapy. Patients on androgen deprivation therapy had 60% greater odds of developing depression vs other patients [9% vs 6%; odds ratio (OR) 1.6; 95% CI (1.5-1.7); P <.0001]. Of those with depression secondary to androgen deprivation therapy, only 35% were treated with antidepressants. After starting androgen deprivation therapy, White patients had 30% greater odds of being diagnosed with depression, compared to Black patients [10% vs 8%; OR 1.3; 95% CI (1.2-1.4);P <.001]. White patients also had higher odds of being treated with a first line antidepressant than Black patients [56% vs 48%; OR 1.4, 95% CI (1.2-1.6),P <.001]. This analysis confirms a significant association between androgen deprivation therapy and the development of clinical depression, and highlights its medical undertreatment. Importantly, our findings also indicate significant racial disparities in the identification and treatment of depression. Routine screening initiatives that account for social determinants of health may alleviate this disparity. Limitations of this study include retrospective design and lack of data describing severity of depression, which might correlate with need for medication.

Prevalence of depression among caregivers based on the condition and relationship of care recipient

BackgroundCaregiver distress is the strain experienced by individuals providing care for people with chronic conditions which limit their self-sufficiency for tasks of daily living. Over 1 in 5 Americans are caregivers–a number expected to increase with an aging population. MethodsWe performed a cross-sectional analysis using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Centers for Disease Control and Prevention (CDC) to determine rates of depressive disorders among caregivers and associations between demographic and relational aspects of the care recipient. ResultsThe included sample size for analysis was 32,676, representing 17,274,935 US caregivers. We found that caregivers who were female, American Indian/Alaskan Native, race-not-listed, earning less than $15,000 a year, or did not complete high school, had higher rates of depression diagnosis. The rates of depression were higher among caregivers if the recipient had a mental or chronic respiratory condition, or if the recipient was their live-in partner. Rates of depression were lower for caregivers of their mother-in-law or spouse. LimitationsResults were based on self-reported survey data, which are susceptible to social desirability bias. Diagnoses of depression may also be over or under reported across several demographic variables, which may confound results. ConclusionOur findings add to previous research showing that specific groups of caregivers are at higher risk for caregiver stress. Future qualitative research may elucidate underlying causes of depression among caregivers. Analysis into the risk factors for depression among caregivers is vital in providing effective therapeutic options for the caregiver.

P119 Co-morbid insomnia is associated with worse health, and lower CPAP recommendation rates and nightly use in people with sleep apnoea

Abstract Introduction Co-morbid insomnia and sleep apnoea (COMISA) is associated with poor health and reduced adherence to continuous positive airway pressure (CPAP) therapy in sleep clinic samples. However, health and treatment correlates of COMISA in community-based samples of obstructive sleep apnoea (OSA) are poorly described. Methods Australian adults previously diagnosed with OSA were surveyed online. COMISA was defined as co-morbid OSA and nocturnal insomnia symptoms (difficulties falling asleep, maintaining sleep, and/or early morning awakenings at least a few nights a week over the past month). Logistic regression and ANCOVAs determined associations of COMISA with medical conditions and general health, controlling for age, gender, and body mass index. Treatment recommendation rates and average nightly use were compared between those with COMISA versus OSA-alone. Results Among 412 participants (54.6% male, mean age 58.5 [SD=13.9] years), 74.8% had COMISA. Compared to OSA-alone, COMISA was associated with higher rates of fair/poor general health (60.4% versus 46.6%, p=0.010), lower EQ-5D overall health (mean difference 7.55 [SD=2.73], p=0.010), and greater rates of depression diagnoses (56.3% versus 28.0%, p&amp;lt;0.001), which persisted after adjustment for covariates. People with COMISA reported lower rates of CPAP therapy recommendation (82.8%, versus 95.2%, p=0.002), and nightly use (mean difference 0.54 [SD=0.13] hours/night, p&amp;lt;0.001), and greater rates of upper-airway surgery recommendations (14%, versus 2.9%, p=0.002) and completion (13%, versus 1.9%, p=0.001). Conclusions COMISA was associated with worse health, depression, lower CPAP recommendations and use, and greater upper-airway surgery compared to those with OSA-alone.

Self-Stigma and Its Relationship With Rates of Depression Diagnosis

Background: Self-stigma about suicide might impede people seeking help from mental health professionals. There is little research about self-stigma expressed by suicide decedents. Aims: We aimed to explore (a) self-stigma about suicide through examination of suicide notes; and (b) whether the expression of self-stigma was associated with the formal diagnoses of depression. Method: Data were extracted from notes left by people who died by suicide in two major Chinese cities (Shanghai, 2004-2017; Wuhan, 2005-2019). Note content was examined and self-stigma items were coded. Demographics associated with self-stigma were reported. Rates of depression were compared between note-leavers who expressed self-stigma, and those who did not. Results: Notes were left by 567 suicide decedents (representing about 19% all suicides). Approximately 25% notes contained at least one self-stigma item. Older people made fewer self-stigma references, as did people from Wuhan. Depression was not associated with self-stigma. Limitations: Not all people dying from suicide leave notes, and suicide notes variably report self-stigma, thus self-stigma about suicide may be underestimated. Conclusion: Self-stigma items varied across regions and age groups, but not with depression. Therefore, self-stigma expressed by suicide decedents may not reflect help-seeking behaviours from professional mental health services.

Objective and subjective childhood socioeconomic disadvantage and incident depression in adulthood: a longitudinal analysis in the Sister Study.

Understanding of the role of objective versus subjective childhood socioeconomic disadvantage (SD) in depression onset in adulthood among women, independent of later life SD, and across birth cohorts, is limited. We examined the association between objective (i.e., household education level) and subjective (i.e., rank of family income and report of not enough food to eat) SD during childhood and diagnosis of clinical depression after age 30 among 47,055 women in the Sister Study. We used Cox proportional hazard models adjusting for women's race/ethnicity, childhood household composition, mother's age at her birth adulthood educational attainment, and calendar year of birth. Analyses were repeated stratified by 10-year birth group. A total of 8036 (17.1%) women were diagnosed with clinical depression over a mean follow-up of 24.0 (± 9.9) years. Those reporting being poor (versus well-off) or not having enough food to eat in childhood had a 1.28 (95% confidence interval (CI) 1.13, 1.44) and 1.30 (95% CI 1.21, 1.41) times higher rate of depression diagnosis, respectively, with consistent associations observed across birth year groups. An inverse association between low household education level and incident depression was observed at baseline (i.e., age 30) becoming positive over time in the total sample but only among women born between 1935-1954 in analyses stratified by 10-year birth group. Our findings suggest that subjective SD in childhood is a largely consistent predictor of depression onset among women in adulthood whereas the effects of household education level in childhood may vary across women born into different birth cohorts, and for some, across the lifecourse.

CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors.

Depression in post-treatment cancer survivors is common and can impair quality of life. CanDirect is a novel, telephone-delivered depression self-care intervention for cancer survivors. We conducted a randomized controlled superiority trial to compare CanDirect with usual care (UC) in this population. Participants completing cancer treatment within the past 10 years who had mild-moderate depressive symptoms with or without major depression were recruited from clinical and community settings in Quebec and Ontario. Permuted block random assignment allocated participants to CanDirect plus UC or to UC alone. Assessments of depression severity (Center for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes health-related quality of life (Short Form Survey-12 mental and physical component summaries), anxiety symptoms (Hospital Anxiety and Depression Scale), activation (Patient Activation Measure), depression diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV), and health services (self-report) were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting. Participants recruited between September 2016 and October 2018 were randomly assigned to CanDirect (n = 121) or UC (n = 124). Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months. CanDirect participants reported less severe depressive symptoms on the CES-D than UC participants at 6 months, adjusted effect size (ES) 0.61 (95% CI, 0.33 to 0.88). CanDirect participants also had significantly greater quality of life, lower anxiety, more activation, and lower rates of depression diagnoses, compared with UC. Exploratory analysis suggested that sex was a modifier of the primary outcome (interaction term P value = .03); the intervention was less effective in men (ES, 0.12; 95% CI, -0.45 to 0.69). The findings suggest that CanDirect is an effective method of managing mild-moderate depression symptoms in cancer survivors.

239 Delivery length of stay and hospitalization costs in women with depression: a retrospective cohort

Perinatal depression is common, and the rate of depression diagnosis recorded at delivery has been increasing. Depression has been associated with increased length of stay (LOS) and hospital costs in patients with other comorbid conditions. Our objective is to assess delivery LOS and hospital costs in women with depression. We performed a retrospective cohort study using the National Inpatient Sample comparing delivery hospitalizations of women with and without a history of depression in 2012-2016. Ectopic pregnancies, spontaneous and elective abortions were excluded. International Classification of Disease 9th and 10th edition diagnosis and procedure codes were used to identify our cohort and outcomes. The primary outcomes were maternal LOS and total cost of delivery hospitalization. Secondary outcomes included maternal comorbidities, delivery morbidities, and hospital characteristics. Univariate analyses were performed for all primary and secondary outcomes, and multivariate regression was performed for LOS, non-home discharge, and total cost of delivery hospitalization, controlling for confounding variables. 3,531,288 admissions met inclusion criteria, 50,865 (1.4%) of whom had documented depression. There was no significant difference in LOS in women with depression (p=0.16). Women with depression had a higher total hospital cost ($4,194 (2,986-6,042) vs $3,810 (2,731 – 5,413), p<0.001), and were more likely to have a non-home discharge (p<0.001) compared to women without depression. In multivariate regression, depression was associated with increased risk of LOS >3 days (aOR 1.04/95% CI 1.04-1.04), non-home discharge (aOR 1.78/95% CI 1.69-1.88), and total hospital cost >$4,000 (aOR 1.04/95% CI 1.03-1.05). After controlling for pre-existing conditions, mode of delivery, and hospital characteristics, depression was associated with statistically significantly increased length of hospital stay, non-home discharge, and greater total hospital costs, though these differences were small and not likely clinically significant.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System: A Cohort Study.

Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes. To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment. Retrospective pre-post study. Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded. Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016. Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment. Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01). Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.

Stigma and help-seeking behaviours of men with depression: a literature review

In the UK, more women are being treated for depression than men, yet men are up to three times more likely to die by suicide. It has been suggested that stigma has a role in the lower rate of depression diagnosis in men and may reduce the likelihood of them engaging in help-seeking behaviours.This article discusses a literature review of the available evidence on the help-seeking behaviours of men with depression. The Cumulative Index to Nursing and Allied Health Literature, PsycARTICLES, PsycINFO and Medline databases were searched, and a total of 18 articles were included in the review. Following analysis, two themes emerged: social stigma and self-stigma, both of which were found to affect help-seeking behaviours. Therefore, it is important for healthcare professionals to consider the factors that can influence stigma and help-seeking behaviour, and for mental health services to be accessible and appealing to men with depression.

The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use

ObjectiveAssess the influence of healthcare utilization on previously reported associations between contraception initiation, diagnosis of depression, and dispensing of antidepressant medications. Study designRetrospective cohort analysis of insurance records from 272,693 women ages 12–34 years old enrolled in the United States Military Healthcare System in September 2014 and followed for 12 months. We compared outcomes of women who initiated hormonal contraception with all women eligible for care and then with women who accessed care during the study month using Kaplan-Meier and Cox proportional hazards analyses. ResultsWomen age 12–34 who initiated hormonal contraception experienced a higher risk of depression diagnosis and antidepressant use when compared to all enrolled women but not when compared to women who accessed care. Among those who accessed care, some progestins (i.e., levonorgestrel, Hazard Ratio (HR) = 1.46, and norelgestromin, HR = 1.93) were associated with an increased rate of depression diagnosis but not antidepressant use; norethindrone (HR = 0.21) was associated with a decreased rate of depression diagnosis. ConclusionWhen compared to women utilizing their health insurance, associations between initiating hormonal contraception and depression diagnosis and antidepressant use decreased or disappeared. This suggests that healthcare utilization may have confounded previous reports of an association between hormonal contraception use and depression and antidepressant use.

An Exploratory Analysis of Self-Reported Protective Factors against Self-Harm in an Enrolled Veteran General Mental Health Population.

The purpose of this study is to characterize self-reported protective factors against suicide or self-harm within free-response comments from a harm-risk screening. Veterans enrolled in Department of Veterans Affairs mental health care were administered a self-harm and suicide screening as part of the baseline assessment in an ongoing implementation trial. Veterans indicated if they had thoughts of harming themselves and if so, what kept them from acting on them. Responses were coded based on established Centers for Disease Control protective factor categories. Descriptive analyses of demographic factors (such as age, gender, and race), clinical factors, and quality of life measures were conducted across groups depending on levels of self-harm risk. Of 593 Veterans, 57 (10%) screened positive for active thoughts of self-harm or suicide. Those with thoughts of self-harm had lower quality of life scores and higher rates of depression diagnoses. Of those individuals, 41 (72%) reported protective factors including Personal Resources (17%), Community Resources or Relationships (68%), and Other including pets and hobbies (15%). Those with stated protective factors had higher rates of employment and lower rates of PTSD diagnoses. This is one of the first open-response studies of harm-risk protective factors, allowing for a patient-centered approach that prioritizes the individual's voice and values. New protective factors emerged through the open-response format, indicating important factors that kept Veterans safe from self-harm or suicide such as pets and hobbies. Increasing focus on strengths and positive aspects of Veterans' lives that serve as protective factors may ultimately improve mental health treatment and prevention of suicide and self-harm.

Duration of maternal mental health-related outcomes after an infant’s death: A retrospective matched-cohort study using linkable administrative data

IntroductionMothers have increased mental illness such as anxiety and depression after the death of a child.&#x0D; Objectives and ApproachThe mental health of all mothers who experience the death of an infant (&lt; 1 years old) in Manitoba, Canada between April 1, 1999, and March 31, 2011 (n = 534) is examined in the four years leading up to, and the four years following, the death of their child to determine how long increased levels of mental-health realted outcomes remain elevated after the death of an infant. Mental&#x0D; health-related outcomes of these mothers are compared with a matched (3:1) cohort of mothers who did not experience the death of a child (n = 1,602).&#x0D; ResultsCompared with mothers who did not experience the death of a child, mothers experiencing this event had higher rates of anxiety diagnoses and psychotropic prescriptions starting 6 months before the death. Elevated rates of anxiety continued for the first year and elevated rates of psychotropic prescriptions continued for six months after the death of the child. Mothers who experienced the death of a child had higher rates of depression diagnoses in the year after the death. Relative rates (RR) of depression (RR = 4.94), anxiety (RR = 2.21), and psychotropic medication use (RR = 3.18) were highest in the six months after the child’s death.&#x0D; Conclusion/ImplicationsElevated rates of depression, anxiety, and psychotropic medication use after the death of a child end within one year of the child’s death.

A comparison of psychological well-being and quality of life between spouse and non-spouse caregivers in patients with head and neck cancer: a 6-month follow-up study.

ObjectiveThe caregivers of patients with head and neck cancer (HNC) may suffer from impaired psychological well-being and a decreased quality of life (QOL) related to the chronic burden of caring for patients’ physical conditions and their mood changes. In this study, we aimed to compare the psychological well-being and QOL between spouse caregivers and non-spouse caregivers of patients with HNC over a 6-month follow-up period.Patients and methodsThis study was conducted using a prospective design with consecutive sampling. We recruited study subjects from the outpatient combined treatment clinic of HNC at a medical center in Southern Taiwan. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition was carried out by a trained senior psychiatrist to diagnose caregivers. Furthermore, one research assistant collected the caregivers’ demographic characteristics, clinical data, and clinical rating scales, including the Short Form 36 (SF-36) Health Survey, Hospital Anxiety and Depression Scale (HADS), and Family Appearance, Pulse, Grimace, Activity, and Respiration index at the patients’ pretreatment, as well as their 3- and 6-month follow-up appointments.ResultsOf the 143 subjects that successfully completed the study, two-thirds of caregivers were spouses. During the 6-month follow-up period, spouse caregivers demonstrated significantly higher rates of depression diagnosis (p=0.032), higher scores in the depression subscale of HADS (HADS-D) (p=0.010), and lower SF-36 mental component summary (MCS) scores (p=0.007) than non-spouse caregivers. Furthermore, during those 6 months, HADS-D (p=0.007) and the anxiety subscale of HADS scores (p<0.001) significantly decreased, while SF-36 MCS scores significantly increased (p=0.015).ConclusionThe mental health of spouse caregivers of HNC patients was more severely affected than that of non-spouse caregivers during the observed 6-month follow-up period. Therefore, clinicians need to pay more attention to caregivers’ psychological distress during patient care, especially for spouse caregivers.

Duration of maternal mental health-related outcomes after an infant's death: A retrospective matched cohort study using linkable administrative data.

Mothers have increased mental illness such as anxiety and depression after the death of a child. We examine the duration of this worsening of mental health. The mental health of all mothers who experience the death of an infant (<1 years old) in Manitoba, Canada between April 1, 1999 and March 31, 2011 (n=534) is examined in the 4 years leading up to, and the 4 years following, the death of their child. Mental health-related outcomes of these mothers are compared with a matched (3:1) cohort of mothers who did not experience the death of a child (n=1,602). Three mental health-related outcomes are examined: depression diagnoses, anxiety diagnoses, and use of psychotropic medications. Compared with mothers who did not experience the death of a child, mothers experiencing this event had higher rates of anxiety diagnoses and psychotropic prescriptions starting 6 months before the death. Elevated rates of anxiety continued for the first year and elevated rates of psychotropic prescriptions continued for 6 months after the death of the child. Mothers who experienced the death of a child had higher rates of depression diagnoses in the year after the death. Relative rates (RR) of depression (RR=4.94), anxiety (RR=2.21), and psychotropic medication use (RR=3.18) were highest in the 6 months after the child's death. Elevated rates of depression, anxiety, and psychotropic medication use after the death of a child end within 1 year of the child's death.

Educational level influenced the gold standard diagnosis of late-life depression in the GreatAGE study

IntroductionThe validity of the 30-item Geriatric Depression Scale (GDS-30) in detecting late-life depression (LLD) requires a certain level of cognitive functioning. Further research is needed in population-based setting on other socio-demographic and cognitive variables that could potentially influence the accuracy of clinician rated depression.ObjectiveTo compare the diagnostic accuracy of two instruments used to assess depressive disorders [(GDS-30) and the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] among three groups with different levels of cognitive functioning (normal, Mild Cognitive Impairment – MCI, Subjective Memory Complain – SMC) in a random sampling of the general population 65+ years.MethodsThe sample, collected in a population-based study (GreatAGE Study) among the older residents of Castellana Grotte, South-East Italy, included 844 subjects (54.50% males). A standardized neuropsychological battery was used to assess MCI, SMC and depressive symptoms (GDS-30). Depressive syndromes were diagnosed through the SCID IV-TR. Socio-demographic and cognitive variables were taken into account in influencing SCID performance.ResultsAccording to the SCID, the rate of depressive disorders was 12.56%. At the optimal cut-off score (≥ 4), GDS-30 had 65.1% sensitivity and 68.4% specificity in diagnosing depressive symptoms. Using a more conservative cut-off (≥ 10), the GDS-30 specificity reached 91.1% while sensitivity dropped to 37,7%. The three cognitive subgroups did not differ in the rate of depression diagnosis. Educational level is the only variable associated to the SCID diagnostic performance (P = 0.015).ConclusionsAt the optimal cut-off, GDS-30 identified lower levels of screening accuracy for subjects with normal cognition rather than for SMC (AUC 0.792 vs. 0.692); educational attainment possibly may modulate diagnostic clinician performance.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Increase in depression diagnoses and prescribed antidepressants among young girls. A national cohort study 2000–2013

Aims: To analyse trends in depression diagnoses and antidepressant use according to age and gender.Methods: Nationwide cohort study including all women and men of 10–49 years living in Denmark during 2000–2013. The Psychiatric Registry and Prescription Registry provided data on depression diagnoses and antidepressant medication, respectively. Incidence rates as well as 1-year prevalence rates were calculated.Results: The incidence and 1-year prevalence rates of depression diagnoses increased during 2000–2013. The women/men rates were 2.0 for both 1-year prevalence of depressions diagnoses and antidepressant use. For adolescent girls, the absolute increase was 3 per 1000 for depression diagnoses and 8 per 1000 for first use of antidepressants, compared to boys who had an increase of 1.1 and 3 per 1000, respectively. Before puberty, boys and girls had almost the same incidence rates of both depression diagnoses and antidepressant use throughout the period. After puberty, girls had significantly higher incidence rates than boys, and experienced during the study period a steeper increase than boys. According to age, the girls/boys incidence rate ratio of a depression diagnosis increased from 0.8 in the 10–11 year age group to 2.7 at age 12–19 years and hereafter decreased with increasing age to 1.5 at age 45–49.Conclusions: Depression diagnosed and first use of antidepressants increased more for girls of 12–19 years than for boys during 2000–2013, and the incidences were similar for girls and boys before puberty, but higher after puberty for girls.

A Statewide Effort to Implement Collaborative Care for Depression: Reach and Impact for All Patients With Depression.

Little is known about the reach and impact of collaborative care for depression outside of clinical trials. The objective of this study was to examine the effect of a collaborative care intervention for depression on the rates of depression diagnosis, use of specific depression codes, and treatment intensification. Evaluation of a staggered, multiple baseline implementation initiative. Patients receiving depression care in primary care clinics throughout Minnesota from February 2008 through March 2011. Data regarding depression diagnosis rates and codes, and measures of antidepressant intensification were provided by health insurers. Depression Improvement Across Minnesota: Offering a New Direction (DIAMOND) affected neither rates of depression recognition nor use of depression diagnostic codes, and the overall reach of DIAMOND was disappointingly small. Patients in DIAMOND had more episodes of treatment intensification than non-DIAMOND patients, but we were unable to account for depression severity in our analysis. DIAMOND did not affect depression recognition or diagnostic coding, but may have affected treatment intensification. Our results suggest that even strongly evidence-based interventions may have little contamination effects on patients not enrolled in the new care model.

When depression is diagnosed, older adults are as likely as younger adults to be prescribed pharmacotherapy and psychotherapy.

This study examined age group differences in the rates of depression diagnosis and treatment using a national probability sample. Using data from the 2012 National Ambulatory Medical Care Survey (n=62,723 visits by patients aged 18+ years), we used bivariate and multivariable binary logistic regression analyses to test age group differences in antidepressant medication (ADM) and psychotherapy prescribed/ordered or provided at visits during which depression was diagnosed. Visits by older adults were less likely to result in a depression diagnosis than visits by younger individuals: 2.46% and 1.80% in the 65-74 and 75+ age groups, compared to 4.06%, 4.24% and 4.12% in the 18-29, 30-49 and 50-64 age groups, respectively. Of all visits involving diagnosed depression, 65.88% included prescribing/ordering or providing ADM and 19.01% included psychotherapy ordering or providing, without significant age group difference. Prescribing/ordering or providing ADM occurs frequently during visits to physicians regardless of specialty, while psychotherapy was ordered or provided mostly during visits to psychiatrists. During ambulatory care visits in which depression was diagnosed, older adults were as likely as younger adults to be prescribed/provided treatment; however, in more than 30% of visits by depressed older adults neither ADM nor psychotherapy was prescribed.

Early Efforts By Medicare Accountable Care Organizations Have Limited Effect On Mental Illness Care And Management

People with mental illness use more health care and have worse outcomes than those without such illnesses. In response to incentives to reduce spending, accountable care organizations (ACOs) may therefore attempt to improve their management of mental illness. We examined changes in mental health spending, utilization, and quality measures associated with ACO contracts in the Medicare Shared Savings Program and Pioneer model for beneficiaries with mental illness, using Medicare claims for the period 2008-13 and difference-in-differences comparisons with local non-ACO providers. Pioneer contracts were associated with lower spending on mental health admissions in the first year of the contract, an effect that was attenuated in the second year. Otherwise, ACO contracts were associated with no changes in mental health spending or readmissions, outpatient follow-up after mental health admissions, rates of depression diagnosis, or mental health status. These results suggest that ACOs have not yet focused on mental illness or have been largely unsuccessful in early efforts to improve their management of it.