Literature Collection

2781

Depression in primary care: challenges & controversies

Type: Journal Article

Authors: A. Avasthi, A. Ghosh

Year: 2014

Publication Place: India

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2782

Depression in primary care: current and future challenges

Type: Journal Article

Authors: M. A. Craven, R. Bland

Year: 2013

Publication Place: Canada

Abstract: OBJECTIVES: To describe the current state of knowledge about detection and treatment of major depressive disorder (MDD) by family physicians (FPs), and to identify gaps in practice and current and future challenges. METHODS: We reviewed the recent literature on MDD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or International Classification of Diseases, Revision 10) in primary care, with an emphasis on systematic reviews and meta-analyses addressing prevalence, the impact of an aging population and of chronic disease on MDD rates in primary care, detection and treatment rates by FPs, adequacy of treatment, and interventions that could improve recognition and treatment. RESULTS: About 10% of primary care patients are likely to meet criteria for MDD. The number of cases will increase as the baby boomer cohort ages and as the prevalence of chronic disease increases. The bidirectional relation between MDD and chronic disease is now firmly established. Detection and treatment rates in primary care remain low. Treatment quality is frequently inadequate in terms of follow-up and monitoring. Formal case management and collaborative care interventions are likely to provide some benefits. CONCLUSIONS: Low detection rates and low treatment rates need to be addressed. Planned reassessment may improve detection rates when the FP is uncertain whether MDD is present, but further research is needed to determine why FPs frequently do not initiate treatment, even when MDD is detected. A caring, attentive FP who monitors depressed patients is likely to have considerable placebo effect. Greater focus on integrated, concurrent treatment for MDD and chronic physical diseases in the middle-aged and elderly is also required.; Publisher: Abstract available from the publisher.

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2783

Depression in primary care: learning lessons in a national quality improvement program

Type: Journal Article

Authors: H. A. Pincus, C. Pechura, D. Keyser, J. Bachman, J. K. Houtsinger

Year: 2006

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2784

Depression in primary care: Strategies for a psychiatry-scarce environment

Type: Journal Article

Authors: A. R. Alson, D. M. Robinson, D. Ivanova, J. Azer, M. Moreno, M. L. Turk, A. Nitturkar, K. S. Blackman

Year: 2016

Publication Place: United States

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2785

Depression in primary health care: From evidence to policy

Type: Journal Article

Authors: K. M. Griffiths, H. Christensen

Year: 2008

Publication Place: Australia

Abstract: OBJECTIVE: To consider the implications for mental health policy of a recent synthesis of the literature on the effectiveness of different service delivery models for depression in primary care. METHODS: A discussion based on the results of several systematic reviews of primary care models for depression management. Primary care was defined broadly within a prevention, early-intervention, treatment and recovery/support framework, and incorporated both community and general practice settings. RESULTS: There were promising effective models for depression interventions both in the broader community and in general practice settings. CONCLUSIONS: There is a need to support evidence-based models for depression care, including innovative new technologies for facilitating consumer self-management of depression. The ability of practitioner training and guideline implementation to improve consumer outcomes for depression is limited. Policies and incentives are required to facilitate the reorganisation of general practice and, in particular, the implementation of care management as well as enhanced care and guided self-help in these settings.

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2786

Depression is under-recognised in the sport setting: time for primary care sports medicine to be proactive and screen widely for depression symptoms

Type: Journal Article

Authors: T. Trojian

Year: 2016

Publication Place: England

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2787

Depression management interests among Alaska Native and American Indian adults in primary care

Type: Journal Article

Authors: J. P. Avey, L. G. Dirks, D. A. Dillard, S. M. Manson, M. Merrick, J. J. Smith, G. C. Prickette, S. Tetpon, D. Galbreath, B. Triplett, R. F. Robinson

Year: 2018

Publication Place: Netherlands

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2788

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination

Type: Journal Article

Authors: D. Goedde, A. Zidack, Y. H. Li, D. Arkava, E. Mullette, Y. Mullowney, J. M. Brant

Year: 2021

Abstract:

BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.

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2789

Depression Outcomes in Adults Attending Family Practice Were Not Improved by Screening, Stepped-Care, or Online CBT during a 12-Week Study when Compared to Controls in a Randomized Trial

Type: Journal Article

Authors: P. H. Silverstone, K. Rittenbach, V . Y. Suen, A. Moretzsohn, I. Cribben, M. Bercov, A. Allen, C. Pryce, D. M. Hamza, M. Trew

Year: 2017

Publication Place: Switzerland

Abstract: There is uncertainty regarding possible benefits of screening for depression in family practice, as well as the most effective treatment approach when depression is identified. Here, we examined whether screening patients for depression in primary care, and then treating them with different modalities, was better than treatment-as-usual (TAU) alone. Screening was carried out for depression using the 9-item Patient Health Questionnaire (PHQ-9), with a score of >/=10 indicating significant depressive symptoms. PHQ-9 scores were given to family physicians prior to patients being seen (except for the Control group). Patients (n = 1,489) were randomized to one of four groups. Group #1 were controls (n = 432) in which PHQ-9 was administered, but results were not shared. Group #2 was screening followed by TAU (n = 426). Group #3 was screening followed by both TAU and the opportunity to use an online cognitive behavioral therapy (CBT) treatment program (n = 440). Group #4 utilized an evidence-based Stepped-care pathway for depression (n = 191, note that this was not available at all clinics). Of the study sample 889 (60%) completed a second PHQ-9 rating at 12 weeks. There were no statistically significant differences in baseline PHQ-9 scores between these groups. Compared to baseline, mean PHQ-9 scores decreased significantly in the depressed patients over 12 weeks, but there were no statistically significant differences between any groups at 12 weeks. Thus, for those who were depressed at baseline Control group (Group #1) scores decreased from 15.3 +/- 4.2 to 4.0 +/- 2.6 (p < 0.001), Screening group (Group #2) scores decreased from 15.5 +/- 3.9 to 4.6 +/- 3.0 (p < 0.001), Online CBT group (Group #3) scores decreased from 15.4 +/- 3.8 to 3.4 +/- 2.7 (p < 0.01), and the Stepped-care pathway group (Group #4) scores decreased from 15.3 +/- 3.6 to 5.4 +/- 2.8 (p < 0.05). In conclusion, these findings from this controlled randomized study do not suggest that using depression screening tools in family practice improves outcomes. They also suggest that much of the depression seen in primary care spontaneously resolves and do not support suggestions that more complex treatment programs or pathways improve depression outcomes in primary care. Replication studies are required due to study limitations.

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2790

Depression Program in Primary Health Care: The Chilean Experience

Type: Journal Article

Authors: Ruben Alvarado, Graciela Rojas, Alberto Minoletti, Francisca Alvarado, Carlos Dominguez

Year: 2012

Publication Place: United States

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2791

Depression Screening Among African American Adults in the Primary Care Setting

Type: Journal Article

Year: 2019

Publication Place: United States

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2792

Depression screening and management among adolescents in primary care: factors associated with best practice

Type: Journal Article

Authors: L. A. Taliaferro, J. Hetler, G. Edwall, C. Wright, A. R. Edwards, I. W. Borowsky

Year: 2013

Publication Place: United States

Abstract: OBJECTIVE: To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients' depressive symptoms, and using best practice when managing depressed adolescents. METHODS: Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. RESULTS: The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. CONCLUSIONS: Enhancing clinicians' competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care.

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2793

Depression screening in a VA primary care clinic

Type: Journal Article

Authors: R. D. Kirkcaldy, L. L. Tynes

Year: 2006

Publication Place: United States

Abstract: In 1998 the U.S. Department of Veterans Affairs (VA) mandated annual depression screening at all VA primary care clinics. The VA Medical Center, New Orleans, implemented a four-item screening tool. The authors report on an evaluation of the screening program. Of 1,100 patients visiting the clinic during a one-month period, 1,068 (97 percent) were screened at that visit or at some point in the previous 12 months. Of the 70 patients who screened positive for depression, 50 (71 percent) were offered at least one treatment modality or psychiatric referral. The findings establish benchmarks for screening administration and for follow-through on positive screens. The authors describe features of the electronic medical record that contributed to the successful implementation of this best practice.

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2794

Depression screening in adolescents in the United States: a national study of ambulatory office-based practice

Type: Journal Article

Authors: I. S. Zenlea, C. E. Milliren, L. Mednick, E. T. Rhodes

Year: 2014

Publication Place: United States

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2795

Depression Treatment by Bedford East Community Mental Health Team: An audit to assess how many patients in a Bedfordshire Community Mental Health Team might safely be transferred to Primary Care

Type: Journal Article

Authors: S. Butler, K. Klepacka, M. Agius, R. Zaman

Year: 2010

Publication Place: Croatia

Abstract: INTRODUCTION: Recently there has been pressure on Secondary Psychiatric services to discharge patients back into Primary care. This project is to show what depression treatments are used by Bedford East Community Mental Health Team (BECMHT) and therefore identify whether some of these patients could be appropriately managed in Primary care. SUBJECTS AND METHOD: We identified, using an anonymised database, patients being treated with different anti-depressant regimens in BECMHT. We compared these treatments with the steps described in NICE Guidelines, and other evidence based treatment modalities which we found on literature search. Based on this data, we attempted to predict which patients it might be safe to discharge to primary care for ongoing treatment. RESULTS: Many different combinations of medications were found. Many patients had other intercurrent mental health diagnoses. DISCUSSION: There are many possible evidence based treatments for depression which can be employed once those listed by NICE are exhausted. We review all of these. Some patients are, accordingly, on combinations of medication as augmentation strategies.It is responsible to only discharge patients into Primary care when their symptoms are controlled. CONCLUSION: We identified groups of patients who might be transferred back to primary care for maintenance treatment, provided that shared care protocols are in Place, and there is easy access to secondary care services should the need arise.

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2796

Depression treatment preferences in older primary care patients

Type: Journal Article

Authors: A. M. Gum, P. A. Arean, E. Hunkeler, L. Tang, W. Katon, P. Hitchcock, D. C. Steffens, J. Dickens, J. Unutzer

Year: 2006

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2797

Depression treatment preferences of older white and Mexican origin men

Type: Journal Article

Authors: Dwight Johnson, C. Apesoa-Varano, J. Hay, J. Unutzer, L. Hinton

Year: 2013

Publication Place: United States

Abstract: OBJECTIVE: Among 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. METHOD: Sixty-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. RESULTS: The 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). CONCLUSIONS: Findings 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.

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2798

Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos

Type: Journal Article

Authors: E. Horevitz, K. C. Organista, P. A. Arean

Year: 2015

Abstract: OBJECTIVE: Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral). METHODS: The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients. RESULTS: English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment. CONCLUSIONS: Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.

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2799

Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment

Type: Journal Article

Authors: B. Lowe, R. L. Spitzer, J. B. Williams, M. Mussell, D. Schellberg, K. Kroenke

Year: 2008

Publication Place: United States

Abstract: OBJECTIVE: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. METHOD: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. RESULTS: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. CONCLUSIONS: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.

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2800

Depression, anxiety, and posttraumatic stress as predictors of immune functioning: differences between youth with behaviorally and perinatally acquired HIV

Type: Journal Article

Authors: Courtney Lynn, Tiffany Chenneville, Kathy Bradley-Klug, Audra St John Walsh, Robert F. Dedrick, Carina A. Rodriguez

Year: 2019

Publication Place: Abingdon

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