Trends in the diagnosis of diseases of despair in the United States, 2009–2018: a retrospective cohort study

Brignone, Emily; George, Daniel R.; Sinoway, Lawrence I.; Katz, Curren; Sauder, Charity L.; Murray, Andrea; Gladden, R. Matthew; Kraschnewski, Jennifer L.

doi:10.1136/bmjopen-2020-037679

Cited by 40 publications

(49 citation statements)

References 34 publications

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“… 17 Given that being uninsured or underinsured appears to place vulnerable populations at greater risk for financial and mental distress, health care systems may need to go beyond improving clinical processes and codesign primary, secondary, and tertiary interventions to address underlying factors associated with despair and precarity. 47 Such interventions may require community partners not typically included in conventional health services (eg, community health workers and social workers). Building and evaluating effective organizational partnerships and best practices in integrated care of at-risk patients would be valuable.…”

Section: Discussionmentioning

confidence: 99%

“…Building and evaluating effective organizational partnerships and best practices in integrated care of at-risk patients would be valuable. 47 …”

Section: Discussionmentioning

confidence: 99%

“…Our team previously examined rates of clinically documented diseases of despair (DoD) patterns (ie, comorbidities associated with despair, including suicidal ideation, substance use disorders, and sequela) from 2009 to 2018 and also observed increases across age, gender, and geography (rural or urban). 47 To better conceptualize this understudied phenomenon, it is necessary to understand what is happening on the ground in communities with increasing despair-related deaths and comorbidities. 17 However, to our knowledge, no studies have qualitatively examined high-risk locales to assess community perceptions of DoD to generate hypotheses about causation and potential intervention strategies.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities

et al. 2021

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IMPORTANCE Diseases of despair (ie, mortality or morbidity from suicidality, drug abuse, and alcoholism) were first characterized as increasing in rural White working-class populations in midlife with low educational attainment and associated with long-term economic decline. Excess mortality now appears to be associated with working-class citizens across demographic and geographic boundaries, but no known qualitative studies have engaged residents of rural and urban locales with high prevalence of diseases of despair to learn their perspectives. OBJECTIVETo explore perceptions about despair-related illness and potential intervention strategies among diverse community members residing in discrete rural and urban hotspots. DESIGN, SETTING, AND PARTICIPANTSIn this qualitative study, high-prevalence hotspots for diseases of despair were identified from health insurance claims data in Central Pennsylvania. Four focus groups were conducted with 60 community members in organizations and coalitions from 3 census block group hotspot clusters in the health system between September 2019 and January 2020. Focus groups explored awareness and beliefs about causation and potential intervention strategies. MAIN OUTCOMES AND MEASURESA descriptive phenomenological approach was applied to thematic analysis, and a preliminary conceptual model was constructed to describe how various factors may be associated with perpetuating despair and with public health. RESULTSIn total, 60 adult community members participated in 4 focus groups (44 women, 16 men; 40 White non-Hispanic, 17 Black, and 3 Hispanic/Latino members). Three focus groups with 43 members were held in rural areas with high prevalence of diseases of despair, and 1 focus group with 17 members in a high-prevalence urban area. Four themes emerged with respect to awareness and believed causation of despair-related illness, and participants identified common associated factors, including financial distress, lack of critical infrastructure and social services, deteriorating sense of community, and family fragmentation. Intervention strategies focused around 2 themes: (1) building resilience to despair through better community and organizational coordination and peer support at the local level and (2) encouraging broader state investments in social services and infrastructure to mitigate despair-related illness. CONCLUSIONS AND RELEVANCEIn this qualitative study, rural and urban community members identified common factors associated with diseases of despair, highlighting the association between long-term political and economic decline and public health and a need for both community-and state-level solutions to address despair. Health care systems participating in addressing community (continued) Key Points Question What do people living in communities with high prevalence of diseases of despair (suicidality, drug abuse, and alcoholism) believe is driving the crisis, and what are their potential solutions? Findings In this qualitative study, 60 participants from 3 communities identif...

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Section: Discussionmentioning

confidence: 99%

“…Building and evaluating effective organizational partnerships and best practices in integrated care of at-risk patients would be valuable. 47 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities

et al. 2021

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“…Healthcare claims and pharmacy claims data were obtained from Highmark Health, a non-profit healthcare organization. 19 The data include Blue Cross Blue Shield (BCBS) members with commercial (large group, small group, and participants who acquired individual or small group insurance through Affordable Care Act Marketplace) or Medicare Advantage insurance.…”

Section: Participantsmentioning

confidence: 99%

Association of depression screening with diagnostic and treatment-related outcomes among youth

Riehm

Brignone²,

Stuart

et al. 2021

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Background and ObjectivesThe goals of depression screening, which is universally recommended in primary care settings in the U.S., are to identify adolescents with depression and connect them to treatment. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental health care over time.MethodsThis longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one routine well-visit between 2014 and 2017. Using propensity score matching, we compared adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Diagnostic and treatment-related outcomes were examined over 6-month follow-up and included depression diagnoses, mood-related diagnoses, antidepressant prescriptions, any mental health-related prescriptions, and psychotherapy. We also examined heterogeneity of associations by sex.ResultsCompared to adolescents who were not screened for depression, adolescents screened for depression were 30% more likely to be diagnosed with depression (RR=1.30, 95% CI=1.11-1.52) and 17% more likely to receive a mood-related diagnosis (RR=1.17, 95% CI=1.08-1.27), but were not more likely to be treated with an antidepressant prescription (RR=1.11, 95% CI=0.82-1.51), any mental health prescription (RR=1.15, 95% CI=0.87-1.53), or psychotherapy (RR=1.13, 95% CI=0.98-1.31). In general, associations were stronger among females.ConclusionsAdolescents who were screened for depression during a well-visit were more likely to receive a diagnosis of depression or a mood-related disorder in the six months following screening. Future research should explore methods for increasing access to treatment and treatment uptake following screening.Clinical Trial Registration (if any)N/ATable of Contents SummaryInsurance claims data were used to explore associations between depression screening during routine well-visits and depression diagnoses, psychiatric prescriptions, and psychotherapy among adolescents.What’s Known on This SubjectDepression screening is increasingly viewed as a key strategy for addressing depression among adolescents. To inform clinical guidelines, the United States Preventive Services Task Force has called for research to examine the diagnostic and treatment-related outcomes of depression screening.What This Study AddsIn a sample of 57,732 adolescents, adolescents who were screened for depression during a well-visit were more likely to receive a depression or mood-related diagnosis over 6-month follow-up, but were not more likely to be treated with medication or psychotherapy.

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Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

et al. 2021

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IMPORTANCE Firearms are the most common method of suicide, one of the "diseases of despair" driving increased mortality in the US over the past decade. However, routine standardized questions about firearm access are uncommon, particularly among adult populations, who are more often asked at the discretion of health care clinicians. Because standard questions are rare, patterns of patient-reported access are unknown. OBJECTIVE To evaluate whether and how patients self-report firearm access information on a routine mental health monitoring questionnaire and additionally to examine sociodemographic and clinical associations of reported access. DESIGN, SETTING, AND PARTICIPANTSCross-sectional study of patients receiving care for mental health and/or substance use in primary care or outpatient mental health specialty clinics of Kaiser Permanente Washington, an integrated health insurance provider and care delivery system. MAIN OUTCOMES AND MEASURESElectronic health records were used to identify patients who completed a standardized self-reported mental health monitoring questionnaire after a single question about firearm access was added from January 1, 2016, through December 31, 2019. Primary analyses evaluated response (answered vs not answered) and reported access (yes vs no) among those who answered, separately for patients seen in primary care and mental health. These analyses also evaluated associations between patient characteristics and reported firearm access. Data analysis took place from February 2020 through May 2021.RESULTS Among patients (n = 128 802) who completed a mental health monitoring questionnaire during the study period, 74.4% (n = 95 875) saw a primary care clinician and 39.3% (n = 50 631) saw a mental health specialty clinician. The primary care and mental health samples were predominantly female (63.1% and 64.9%, respectively) and White (75.7% and 77.0%), with a mean age of 42.8 and 51.1 years. In primary care, 83.4% of patients answered the question about firearm access, and 20.9% of patients who responded to the firearm question reported having access. In mental health, 91.8% of patients answered the question, and 15.3% reported having access. CONCLUSIONS AND RELEVANCEIn this cross-sectional study of adult patients receiving care for mental health and substance use, most patients answered a question about firearm access on a standardized mental health questionnaire. These findings provide a critical foundation to help advance understanding of the utility of standardized firearm access assessment and to inform development of practice guidelines and recommendations. Responses to standard firearm access questions used in combination with dialogue and decision-making resources about firearm access and storage may improve suicide prevention practices and outcomes.

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Trends in the diagnosis of diseases of despair in the United States, 2009–2018: a retrospective cohort study

Cited by 40 publications

References 34 publications

Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities

Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities

Association of depression screening with diagnostic and treatment-related outcomes among youth

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

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