TY - VIDEO
KW - Health care expenditures
KW - Health services utilization
KW - Mental depression
KW - Mental Health
KW - Post traumatic stress disorder
AU - D. Chan
A1 - 
AB - Depressed patients with comorbid posttraumatic stress disorder (PTSD) are often more functionally impaired and more severely mentally ill than patients with depression alone. However, few studies have examined depression and comorbid PTSD in primary care settings. This dissertation describes three studies of depressed Veterans in primary cam clinics across the U.S. Data were drawn from two group-randomized trials of collaborative care depression treatment: a multi-site trial in nine Veterans Affairs (VA) primary care clinics, and a second trial based in the Seattle VA General Internal Medicine clinic. The first, cross-sectional study, found that PTSD screen positive (PTSD+) depressed patients had more frequent mental health, primary care depression, and outpatient visits, and a higher proportion were prescribed antidepressants than PTSD screen negative (PTSD-) patients. PTSD+ patients had correspondingly higher mental health, primary care depression, outpatient, and antidepressant costs. The second study evaluated the effectiveness and cost-effectiveness of collaborative care depression treatment compared to usual care over 9 months. Under collaborative care, a mental health team developed an individualized treatment plan for primary care providers, a social worker telephoned patients to enhance adherence, and suggested treatment modifications. In PTSD+ depressed veterans, there was a trend toward collaborative care improving depression symptoms and functioning but findings were not statistically significant. Collaborative care was associated with more depression-free days and moderately increased treatment costs. The third, pre-post comparison study, assessed whether depression care manager assessment, a crucial component of collaborative care, changed patients' knowledge and attitudes regarding mental health treatment among PTSD+ depressed veterans. The depression care manager assessment was a 45-minute phone intervention monitoring patient symptoms and problem-solving around treatment barriers. We found that this one-time assessment did not lead to greater knowledge, more positive attitudes towards depression treatment or less stigma in PTSD+ depressed veterans. As service members return from war, providers will see more patients with PTSD and depression and can expect increased outpatient and mental health services use and costs. There were some indications from these studies that collaborative care may be an effective treatment approach for depressed patients with PTSD, but more research is needed to confirm these trends.
C4 - This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.
C5 - Financing & Sustainability; Financing & Sustainability; Grey Literature
CY - United States -- Washington
N2 - Depressed patients with comorbid posttraumatic stress disorder (PTSD) are often more functionally impaired and more severely mentally ill than patients with depression alone. However, few studies have examined depression and comorbid PTSD in primary care settings. This dissertation describes three studies of depressed Veterans in primary cam clinics across the U.S. Data were drawn from two group-randomized trials of collaborative care depression treatment: a multi-site trial in nine Veterans Affairs (VA) primary care clinics, and a second trial based in the Seattle VA General Internal Medicine clinic. The first, cross-sectional study, found that PTSD screen positive (PTSD+) depressed patients had more frequent mental health, primary care depression, and outpatient visits, and a higher proportion were prescribed antidepressants than PTSD screen negative (PTSD-) patients. PTSD+ patients had correspondingly higher mental health, primary care depression, outpatient, and antidepressant costs. The second study evaluated the effectiveness and cost-effectiveness of collaborative care depression treatment compared to usual care over 9 months. Under collaborative care, a mental health team developed an individualized treatment plan for primary care providers, a social worker telephoned patients to enhance adherence, and suggested treatment modifications. In PTSD+ depressed veterans, there was a trend toward collaborative care improving depression symptoms and functioning but findings were not statistically significant. Collaborative care was associated with more depression-free days and moderately increased treatment costs. The third, pre-post comparison study, assessed whether depression care manager assessment, a crucial component of collaborative care, changed patients' knowledge and attitudes regarding mental health treatment among PTSD+ depressed veterans. The depression care manager assessment was a 45-minute phone intervention monitoring patient symptoms and problem-solving around treatment barriers. We found that this one-time assessment did not lead to greater knowledge, more positive attitudes towards depression treatment or less stigma in PTSD+ depressed veterans. As service members return from war, providers will see more patients with PTSD and depression and can expect increased outpatient and mental health services use and costs. There were some indications from these studies that collaborative care may be an effective treatment approach for depressed patients with PTSD, but more research is needed to confirm these trends.
PB - University of Washington
PP - United States -- Washington
PY - 2007
SP - 91
EP - 91
EP - 
T1 - Depression and comorbid PTSD in veterans: Evaluation of collaborative care programs and impact on utilization and costs
TI - Depression and comorbid PTSD in veterans: Evaluation of collaborative care programs and impact on utilization and costs
U1 - Financing & Sustainability; Financing & Sustainability; Grey Literature
U4 - This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.
VL - Ph.D.
Y1 - 2007
ER -