Factors associated with response and remission from depression at 6-months of treatment in a retrospective cohort treated within an integrated care program

Abstract

Background Depression causes significant morbidity, which impacts mental health, overall general health outcomes, everyday functioning and quality of life. This study aims to contribute to knowledge in the field through enhanced understanding of factors that influence depression response and remission, with consideration for design of treatment services to optimize depression outcomes within integrated care programs. Methods Using routine behavioral health screening and electronic health record data, we identified a retrospective cohort consisting of 615 adult patients receiving depression treatment within an integrated care program. Cohort member Patient Health Questionnaire (PHQ-9) data was analyzed for the 6 months following initiation of treatment. Multinomial regression models were estimated to identify factors associated with depression treatment response (PHQ-9 < 10) and remission (PHQ-9 < 5). Results At 6 months, 47% of patients demonstrated treatment response and 16% demonstrated remission. Baseline trauma symptoms and suicidal ideation were significantly associated with decreased odds of achieving remission (Odds Ratio (95% CI) [OR] = 0.45 (0.23, 0.88) and OR = 0.49 (0.29, 0.82), respectively). In fully adjusted models, baseline suicidal ideation remained significant (OR = 0.53 (0.31, 0.89)) and some evidence of an association persisted for baseline trauma symptoms (OR = 0.51 (0.25, 1.01)). Conclusions After controlling for baseline depression symptoms, the presence of suicidal ideation is associated with reduced likelihood of remission. Increased understanding of factors associated with depression treatment outcomes may be employed to help guide the delivery and design of clinical services. Alongside routine screening for co-morbid anxiety, suicidal ideation and traumatic stress should be assessed and considered when designing depression treatment services.

Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis

“…Yu et al (59) showed that cognitive decline and mobility problems in older adults predicted emergency department visits and that mobility problems predicted poorer quality of life. In addition, depression in older adults can lead to significant morbidity, which can affect physical and mental health, overall health outcomes, daily functioning and quality of life (60). However, only five studies (25, [38][39][40]48) recruited psychologists to form multidisciplinary teams and did not specifically provide care services for psychological problems in older adults, instead recommending comprehensive initial assessment using standardized rating scales, follow-up monitoring, the provision of care manager-led psychological support techniques (61,62), and the development of goal plans to improve physical and mental health and mobility-related health problems.…”

Cuidándome: A trauma-informed and cultural adaptation of a chronic disease self-management program for Latina immigrant survivors with a history of adverse childhood experiences and depression or anxiety symptoms.

“…2023; Jeffrey et al, 2021). This negative relationship between ACEs and mental health remains even after accounting for social determinants of health such as socioeconomic status (Wooldridge et al, 2023).…”

“…Furthermore, depression experienced by ACE survivors differs from those who have not experienced abuse. ACEs are associated with more episodes of depression, greater chronicity, and less symptom reduction in response to treatment (Giampetruzzi et al, 2023; Jeffrey et al, 2021). This negative relationship between ACEs and mental health remains even after accounting for social determinants of health such as socioeconomic status (Wooldridge et al, 2023).…”