TITLE

Time to depression treatment in primary care among HIV-infected and uninfected veterans

AUTHOR(S)
Hooshyar, Dina; Goulet, Joseph; Chwastiak, Lydia; Crystal, Steven; Gibert, Cynthia; Mattocks, Kristin; Rimland, David; Rodriguez-Barradas, Maria; Justice, Amy C.; VACS Project Team
PUB. DATE
July 2010
SOURCE
JGIM: Journal of General Internal Medicine;Jul2010, Vol. 25 Issue 7, p656
SOURCE TYPE
Academic Journal
DOC. TYPE
journal article
ABSTRACT
Background: Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care.Objective: Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressed patients receiving primary care at Infectious Disease or General Medicine clinics.Design: Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients.Participants and Measures: The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used.Key Results: Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infected patients (0.5 days; 95% CI = 0.5, 6, p = 0.04). Compared to mildly-moderately depressed uninfected patients, severely depressed HIV-infected patients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI = 1.07, 2.60), whereas mildly-moderately depressed HIV-infected patients (adjusted HR 1.10, 95% CI = 0.79, 1.52) and severely depressed uninfected patients (adjusted HR 0.93, 95% CI = 0.60, 1.44) were not.Conclusions: In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infected patients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.
ACCESSION #
51242440

 

Related Articles

  • Effects of drug abuse and mental disorders on use and type of antiretroviral therapy in HIV-infected persons. Turner, Barbara J.; Fleishman, John A.; Wenger, Neil; London, Andrew S.; Burnam, M. Audrey; Shapiro, Martin F.; Bing, Eric G.; Stein, Michael D.; Longshore, Douglas; Bozzette, Samuel A.; Turner, B J; Fleishman, J A; Wenger, N; London, A S; Burnam, M A; Shapiro, M F; Bing, E G; Stein, M D; Longshore, D; Bozzette, S A // JGIM: Journal of General Internal Medicine;Sep2001, Vol. 16 Issue 9, p625 

    Objective: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use.Design: Prospective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in...

  • The course of depressive illness in general practice. Limosin, Frédéric; Loze, Jean-Yves; Zylberman-Bouhassira, Myriam; Schmidt, Mark E.; Perrin, Eléna; Rouillon, Frédéric; Limosin, Frédéric; Perrin, Eléna; Rouillon, Frédéric // Canadian Journal of Psychiatry;Feb2004, Vol. 49 Issue 2, p119 

    Objective: Depression is reported to be common in primary care settings and to have a high likelihood of relapse during the 4- to 6-month period following initial symptomatic improvement. However, most prospective studies of long-term treatment of depression have been conducted with...

  • HIV treatment adherence and unprotected sex practices in people receiving antiretroviral therapy. Kalichman, S.C.; Rompa, D. // Sexually Transmitted Infections;Feb2003, Vol. 79 Issue 1, p59 

    Background: Poor HIV treatment adherence can result in the development of drug resistant strains of HIV and HIV positive people may transmit drug resistant virus to their sex partners.Objective: To examine the association between HIV treatment adherence and sexual risk...

  • Prevalence of practice system tools for improving depression care among primary care clinics: the DIAMOND initiative. Margolis, Karen L.; Solberg, Leif I.; Crain, A. Lauren; Whitebird, Robin R.; Ohnsorg, Kristin A.; Jaeckels, Nancy; Oftedahl, Gary; Glasgow, Russell E. // JGIM: Journal of General Internal Medicine;Sep2011, Vol. 26 Issue 9, p999 

    Background: Practice system tools improve chronic disease care, but are generally lacking for the care of depression in most primary care settings.Objective: To describe the frequency of various depression-related practice system tools among Minnesota primary care...

  • Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? Beach, Mary Catherine; Keruly, Jeanne; Moore, Richard D. // JGIM: Journal of General Internal Medicine;Jun2006, Vol. 21 Issue 6, p661 

    PURPOSE: Patient-centeredness, originally defined as understanding each patient as a unique person, is widely considered the standard for high-quality interpersonal care. The purpose of our study was to examine the association between patient perception of being ‘known as a person’...

  • Longitudinal Characterization of Depression and Mood States Beginning in Primary HIV Infection. Gold, Jessica; Grill, Marie; Peterson, Julia; Pilcher, Christopher; Lee, Evelyn; Hecht, Frederick; Fuchs, Dietmar; Yiannoutsos, Constantin; Price, Richard; Robertson, Kevin; Spudich, Serena // AIDS & Behavior;Jun2014, Vol. 18 Issue 6, p1124 

    The article discusses a study which assessed the characteristics of depression and mood states starting in primary HIV infection. Topics covered include the use of the Beck Depression Inventory (BDI) and Profile of Mood States (POMS) and the prevalence of depression over the course of HIV...

  • Depressive symptoms and perceived doctor-patient communication in the Heart and Soul study. Schenker, Yael; Stewart, Anita; Na, Beeya; Whooley, Mary A. // JGIM: Journal of General Internal Medicine;May2009, Vol. 24 Issue 5, p550 

    Background: Doctor-patient communication is an important marker of health-care quality. Little is known about the extent to which medical comorbidities, disease severity and depressive symptoms influence perceptions of doctor-patient communication in patients with chronic...

  • How important is intrinsic spirituality in depression care? A comparison of white and African-American primary care patients. Cooper, Lisa A.; Brown, Charlotte; Thi Vu, Hong; Ford, Daniel E.; Powe, Neil R.; Cooper, L A; Brown, C; Vu, H T; Ford, D E; Powe, N R // JGIM: Journal of General Internal Medicine;Sep2001, Vol. 16 Issue 9, p634 

    We used a cross-sectional survey to compare the views of African-American and white adult primary care patients (N = 76) regarding the importance of various aspects of depression care. Patients were asked to rate the importance of 126 aspects of depression care (derived from attitudinal domains...

  • Optimizing detection of major depression among patients with coronary artery disease using the patient health questionnaire: data from the heart and soul study. Thombs, Brett D.; Ziegelstein, Roy C.; Whooley, Mary A. // JGIM: Journal of General Internal Medicine;Dec2008, Vol. 23 Issue 12, p2014 

    Background: Clinical guidelines recommend depression screening in patients with coronary artery disease (CAD), but how to accomplish this is unclear.Objective: We evaluated the test characteristics of the two-item Patient Health Questionnaire (PHQ-2), the nine-item...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics