Primary Care-Mental Health Integration Programs in the Veterans Affairs Health System Serve a Different Patient Population Than Specialty Mental Health Clinics.

Primary care-mental health integration programs in the veterans affairs health system serve a different patient population than specialty mental health clinics.

Filed under: Depression Treatment

Prim Care Companion CNS Disord. 2012; 14(3):
Johnson-Lawrence VD, Szymanski BR, Zivin K, McCarthy JF, Valenstein M, Pfeiffer PN

Objective: To assess whether Primary Care-Mental Health Integration (PC-MHI) programs within the Veterans Affairs (VA) health system provide services to patient subgroups that may be underrepresented in specialty mental health care, including older patients and women, and to explore whether PC-MHI served individuals with less severe mental health disorders compared to specialty mental health clinics.Method: Data were obtained from the VA National Patient Care Database for a random sample of VA patients, and primary care patients with an ICD-9-CM mental health diagnosis (N = 243,806) in 2009 were identified. Demographic and clinical characteristics between patients who received mental health treatment exclusively in a specialty mental health clinic (n = 128,248) or exclusively in a PC-MHI setting (n = 8,485) were then compared. Characteristics of patients who used both types of services were also explored.Results: Compared to patients treated in specialty mental health clinics, PC-MHI service users were more likely to be aged 65 years or older (26.4% vs 17.9%, P < .001) and female (8.6% vs 7.7%, P = .003). PC-MHI patients were more likely than specialty mental health clinic patients to be diagnosed with a depressive disorder other than major depression, an unspecified anxiety disorder, or an adjustment disorder (P < .001) and less likely to be diagnosed with more severe disorders, including bipolar disorder, posttraumatic stress disorder, psychotic disorders, and alcohol or substance dependence (P < .001).Conclusions: Primary Care-Mental Health Integration within the VA health system reaches demographic subgroups that are traditionally less likely to use specialty mental health care. By treating patients with less severe mental health disorders, PC-MHI appears to expand upon, rather than duplicate, specialty care services. HubMed – depression


Effect of comorbid depression on outcomes in diabetes and its relationship to quality of care and patient adherence: a statewide primary care ambulatory research and resources consortium study.

Filed under: Depression Treatment

Prim Care Companion CNS Disord. 2012; 14(3):
Katerndahl D, Calmbach WL, Becho J

Objective: To determine whether current depression was associated with poorer quality of care and poorer patient adherence to treatment regimens and whether current depression was associated with patient diabetes outcomes independent of its relationships to quality of care and patient adherence among patients with diabetes.Method: This study was conducted in the offices of family physicians who belong to the Statewide Primary Care Ambulatory Research and Resources Consortium from March 2006 to March 2011. Seven primary care physicians enrolled 10 to 20 English- or Spanish-speaking patients with diabetes presenting for routine follow-up visits. Subjects included 106 patients who completed a questionnaire documenting their depressive symptoms, compliance with diabetes therapy, diabetes-related quality of life, and patient satisfaction. The physicians completed a 4-item questionnaire concerning whether the patient had depression and any depression treatments that they ordered. All questions were answered either “yes” or “no.” A practice research coordinator evaluated the quality of diabetes care provided and ordered hemoglobin A(1c) (HbA(1c)) testing for the patient.Results: Depression was associated with poorer compliance, quality of care, diabetes-related quality of life, and patient satisfaction; only HbA(1c) levels did not correlate with depression. When adjusting for compliance and quality of care, depression was still associated with poorer quality of life and satisfaction (P ? .001). While physician recognition and treatment of depression were less than optimal, depression severity was a significant predictor of receiving some form of mental health intervention (P ? .05) except for the provision of mental health counseling. Poor diabetes control was associated with the provision of counseling (P ? .10), while poor quality of life was associated with recognition of depression (P ? .10).Conclusion: Depression was independently associated with satisfaction and quality of life but not diabetes control. Although depression severity was an important predictor of depression recognition and treatment, poor quality of life was a predictor of recognition, and poor diabetes control was a predictor of receiving mental health counseling.
HubMed – depression


Efficacy of adjunctive aripiprazole in major depressive disorder: a pooled response quartile analysis and the predictive value of week 2 early response.

Filed under: Depression Treatment

Prim Care Companion CNS Disord. 2012; 14(3):
Casey DE, Laubmeier KK, Marler SV, Forbes RA, Baker RA

Objective: To assess varying levels of response to aripiprazole adjunctive to standard antidepressant therapy (ADT) and the predictive value of an early response for a sustained response.Method: This post hoc analysis of 3 similarly designed randomized, double-blind, placebo-controlled phase 3 studies investigated the efficacy and safety of adjunctive aripiprazole to standard ADT in patients with major depressive disorder (DSM-IV-TR criteria) who had a prior inadequate response to 1-3 ADTs (CN138-139 [September 2004-December 2006], CN138-163 [June 2004-April 2006], and CN138-165 [March 2005-April 2008]). Response levels were defined as percent decreases from baseline in Montgomery-Asberg Depression Rating Scale (MADRS) total score after 6 weeks of treatment, with a ? 25% decrease for minimal, > 25 to < 50% decrease for partial, ? 50% to < 75% decrease for moderate, and ? 75% decrease for a robust response to treatment.Results: More patients receiving adjunctive aripiprazole exhibited a partial (23.9% vs 17.9%, P = .017), moderate (23.1% vs 15.0%, P < .001), and robust response (14.3% vs 7.4%, P < .001) compared with adjunctive placebo. Adjunctive aripiprazole treatment compared with adjunctive placebo treatment was associated with a significantly greater proportion of patients achieving an early response (week 2, ? 50% reduction in MADRS total score, n = 110/539 vs n = 47/525, P < .001, number needed to treat = 9) and an endpoint response (relative risk = 1.7, 95% CI = 1.4-2.0, P < .001, number needed to treat = 7). A univariate logistic regression analysis revealed that an early response was a significant predictor of endpoint remission (P < .001).Conclusions: Aripiprazole augmentation was associated with a significantly greater proportion of patients achieving a partial, moderate, or robust response to treatment compared with ADT alone. Patients showing an early response (week 2) to augmentation maintained their response through endpoint, suggesting that clinicians may make clinically meaningful decisions early during treatment.Trial identifiers: NCT00095823, NCT00095758, and NCT00105196. HubMed – depression



What is TMS? An Interview of Psychiatrist and TMS Expert Dr. Kira Stein – Los Angeles-based Psychiatrist and TMS expert Kira Stein, MD, explains what transcranial magnetic stimulation is and how it works. Interviewed by “Let’s Get Real” host Catherine Whelin Costen. This is not medical advice, but instead is general education about clinical depression and treatment alternatives. If you believe that you are suffering from clinical depression it is important to seek medical care.


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