The Influence of Comorbid Chronic Medical Conditions on the Adequacy of Depression Care for Older Americans

Harman, Jeffrey S.; Edlund, Mark J.; Fortney, John C.; Kallas, Henrique

doi:10.1111/j.1532-5415.2005.00511.x

Cited by 69 publications

(51 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, if GM physicians do experience more "competing demands" on their limited time and resources than SMH providers do, this may decrease their ability to adequately treat psychiatric illnesses [23,24]. (Although note that some researchers have not found that comorbid medical illness reduces adequacy of treatment of mental illness [25]. )…”

Section: Nih Public Accessmentioning

confidence: 99%

Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication

Uebelacker

Wang

Berglund

et al. 2006

General Hospital Psychiatry

View full text Add to dashboard Cite

Objective-General medical (GM) treatments for mental health disorders are less likely to be adequate than specialty mental health (SMH) treatments. We explored whether differences in clinical characteristics of patients treated in each sector (GM-only or SMH-only) or in both sectors (GM + SMH) may help to explain this finding.Method-We analyzed data from the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of 5692 English-speaking adult household residents that was carried out in 2001-03. The NCS-R used a fully-structured diagnostic interview to assess DSM-IV disorders, including mood, anxiety, impulse-control, and substance use disorders. We classified disorders in terms of a three-category severity gradient (serious, moderate, mild) based on information about clinically significant distress and role impairment. We collected self-report data on chronic physical conditions, socio-demographics, and type of treatment received for emotional and substance use problems in the 12 months before the interview.Results-Patients who received GM+SMH treatment had more severe mental disorders and a higher prevalence of mood and anxiety disorders than patients who received treatment in only one of the two sectors. Patients seen in the GM-only and GM+SMH had more chronic physical conditions than patients seen in SMH-only. Conclusions-Patient characteristics may partially explain the lower intensity and adequacy of GM treatment. Keywords health services research; National Comorbidity Survey ReplicationMany people in the U.S. rely upon the general medical (GM) sector to receive care for their mental disorders. In the Epidemiologic Catchment Area (ECA) study conducted in the 1980s, Corresponding author and reprints: LA Uebelacker, PhD., Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. Voice: ; Email: E-mail: Lisa_Uebelacker@brown.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Although widely used, GM treatments tend to consist of fewer visits and lower rates of adequacy than SMH treatments [4][5][6]. Reasons for this lower intensity and quality of GM vs. SMH sector treatments are unclear. Earlier studies found that primary care physicians' abilities to correctly diagnose and treat mental disorders were lower than for mental health specialists [7][8][9]. In the last decade, such findings led to the development of brief screening tools for use in GM settings as well as numerous educational and training initiatives for primary care physicians [10]. However, in spite of these efforts to improve physician recognition, ed...

show abstract

Section: Nih Public Accessmentioning

confidence: 99%

Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication

Uebelacker

Wang

Berglund

et al. 2006

General Hospital Psychiatry

View full text Add to dashboard Cite

show abstract

“…Canadians with depression who had chronic medical disorders were more likely to receive guideline-concordant pharmacotherapy [10]. Among elderly Americans with depression, those with hypertension or diabetes (but not heart disease or arthritis) were more likely to get guideline-concordant care [11]. Other studies have not found statistically significant adjusted associations of medical comorbidity with quality of depression treatment [1, 4, 6, 12, 13].…”

Section: Introductionmentioning

confidence: 99%

“…Self-reported diagnoses are less sensitive than claims diagnoses [17]. Other limitations of these studies included small sample size [4], exclusion of non-elderly [11], use of a non-U.S. sample [10], inclusion of few medical conditions [11, 12], and the inability to establish the relative timing of diagnoses vs. treatment, allowing the possibility that the medical condition developed after the depression was treated [1, 5, 10, 11, 13]. Some studies did not examine guideline-concordance, e.g., due to lack of data on antidepressant duration or dosage [1, 10-13].…”

Section: Introductionmentioning

confidence: 99%

Association of General Medical and Psychiatric Comorbidities With Receipt of Guideline-Concordant Care for Depression

Ettner

Azocar²,

Branstrom³

et al. 2010

Psychiatric Services

View full text Add to dashboard Cite

Objective The objective is to describe the effect of medical and psychiatric comorbidities on receipt of guideline-concordant depression care. Methods 2003-6 pharmacy, medical and behavioral claims and enrollment data from OptumHealth were linked for 1,835 adults with a new depression diagnosis or antidepressant fill. Multiple logistic regression was used to estimate the association of comorbidities with receipt of guideline-concordant pharmacotherapy, psychotherapy, and any therapy. Results Respectively 11%, 23% and 33% of study patients received guideline-concordant psychotherapy, pharmacotherapy and any therapy. Having a psychiatric but no medical comorbidity was associated with higher rates of guideline-concordant psychotherapy and overall guideline concordance; the converse was true for having a medical but no psychiatric comorbidity. Associations of comorbidities were with the probability of receiving any therapy, not improved guideline-concordance among patients already receiving therapy. Conclusions Patients with medical comorbidities may not receive psychotherapy referrals, perhaps due to well-established relationships with their primary care providers.

show abstract

“…In Brazil, this prevalence may be as high as 12% (Valentini et al, 2004). Depression affects individuals of all ages, with a 290 prevalence of about 5% in children and adolescents, reaching as high as 15% among individuals over 65 years of age, with a higher prevalence among middle-aged women (Vasa, Carlino, Pine, 2006;Harman et al, 2005;Ohayon, 2007).…”

Section: Introductionmentioning

confidence: 99%

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Hurtado

Magalhães

Ribeiro

et al. 2010

Braz. J. Pharm. Sci.

View full text Add to dashboard Cite

Selecting the most suitable drug for the treatment of depression has clinical and economic implications, since both safety and cost of antidepressants (AD) vary among therapeutic subgroups. This study aimed to evaluate the prescription of antidepressants for users of the pharmacy for civil servants of PBH (FARMASERV) in 2005. Univariate, bivariate and multivariate analyzes using logistic regression were performed. Of the total prescriptions analyzed (652), the majority were for women (81.7%) and individuals aged between 19 and 59 years (81.7%). The variables independently associated with the selection of AD were gender, age and the specialty of the prescriber. Women and young adults were more likely to be prescribed an SSRI compared to their congeners, with statistically significant differences. Psychiatrists were more likely to prescribe an SSRI than neurologists or general physicians. The determinant factors for selecting antidepressants may aid the planning of interventions aimed at patients and prescribers which can enable rationalization of the use of antidepressants.Uniterms: Antidepressants/rational use. Depression/ treatment . Medicines/rational use.A seleção adequada do medicamento para o tratamento da depressão tem implicações clínicas e econômicas, visto que a segurança e o custo dos antidepressivos (AD) variam entre as subclasses terapêuticas. Esse estudo avaliou prescrições de AD dispensadas em 2005 para usuários da Farmácia da Clínica dos Servidores da PBH (FARMASERV). Foram realizadas análises univariada, bivariada e multivariada dos dados, utilizando-se regressão logística. Do total de prescrições (652), a maioria era para mulheres (81,7%) e para indivíduos com idade entre 19 e 59 anos (81,7%). As variáveis independentemente associadas à seleção de AD foram gênero, faixa etária e especialidade do prescritor. Mulheres e adultos jovens têm maior chance de receber prescrição de ISRS, em comparação aos seus congêneres, sendo as diferenças estatisticamente significativas. A chance dos psiquiatras prescreverem ISRS é maior do que neurologistas e clínicos gerais. Os fatores determinantes da seleção do antidepressivo podem subsidiar o planejamento de intervenções dirigidas aos pacientes e prescritores de forma a permitir a racionalização de sua utilização.Unitermos: Antidepressivos/uso racional. Depressão/terapia. Medicamentos/uso racional.

show abstract

The Influence of Comorbid Chronic Medical Conditions on the Adequacy of Depression Care for Older Americans

Cited by 69 publications

References 22 publications

Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication

Clinical differences among patients treated for mental health problems in general medical and specialty mental health settings in the National Comorbidity Survey Replication

Association of General Medical and Psychiatric Comorbidities With Receipt of Guideline-Concordant Care for Depression

Factors associated to antidepressant prescription for civil servants of Belo Horizonte, MG

Contact Info

Product

Resources

About