RESUMO
OBJECTIVE: Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. METHODS: A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. RESULTS: Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (p<.001 for all). Intervention patients also had significantly improved quality-of-care indicators, including the proportion of patients receiving either psychotherapy or antidepressant medication (77% versus 21%, p<.001). CONCLUSIONS: Collaborative care for depression can greatly improve care and outcomes in public-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.
Assuntos
Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Hispânico ou Latino , Avaliação de Resultados em Cuidados de Saúde , Atenção Primária à Saúde , Melhoria de Qualidade , Assistentes Sociais , Adulto , Transtorno Depressivo/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/classificação , Satisfação Pessoal , Pobreza , Setor Público , Qualidade de VidaRESUMO
BACKGROUND: Collaborative care and care management are cornerstones of Primary Care-Mental Health Integration (PC-MHI) and have been shown to reduce depressive symptoms. Historically, the standard of Veterans Affairs (VA) collaborative care was referring patients with posttraumatic stress disorder (PTSD) to specialty care. Although referral to evidence-based specialty care is ideal, many veterans with PTSD do not receive such care. To address this issue and reduce barriers to care, VA currently recommends veterans with PTSD be offered treatment within PC-MHI as an alternative. The current project outlines a pilot implementation of an established telephone-based collaborative care model-Translating Initiatives for Depression into Effective Solutions (TIDES)-adapted for Iraq/Afghanistan War veterans with PTSD symptoms (TIDES/PTSD) seen in a postdeployment primary care clinic. MATERIALS AND METHODS: Structured medical record extraction and qualitative data collection procedures were used to evaluate acceptability, feasibility, and outcomes. RESULTS: Most participants (n=17) were male (94.1%) and white (70.6%). Average age was 31.2 (standard deviation=6.4) years. TIDES/PTSD was successfully implemented within PC-MHI and was acceptable to patients and staff. Additionally, the total number of care manager calls was positively correlated with number of psychiatry visits (r=0.63, p<0.05) and amount of reduction in PTSD symptoms (r=0.66, p<0.05). Overall, participants in the pilot reported a significant reduction in PTSD symptoms over the course of the treatment (t=2.87, p=0.01). CONCLUSIONS: TIDES can be successfully adapted and implemented for use among Iraq/Afghanistan veterans with PTSD. Further work is needed to test the effectiveness and implementation of this model in other sites and among veterans of other eras.
Assuntos
Atenção Primária à Saúde/organização & administração , Consulta Remota/organização & administração , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos , Adulto , Campanha Afegã de 2001- , Antipsicóticos/uso terapêutico , Comportamento Cooperativo , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Guerra do Iraque 2003-2011 , Masculino , Educação de Pacientes como Assunto , Satisfação do Paciente , Autocuidado , Telefone , Estados UnidosRESUMO
OBJECTIVE: The aim of this study is to describe the roles of family members in older men's depression treatment from the perspectives of older men and primary care physicians (PCPs). METHODS: Cross-sectional, descriptive qualitative study conducted from 2008-2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California's Central Valley. Participants in this study were the following: (1) 77 age ≥ 60, noninstitutionalized men with a 1-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and (2) a convenience sample of 15 PCPs from the same recruitment sites. Semi-structured and in-depth qualitative interviews were conducted and audiotaped then transcribed and analyzed thematically. RESULTS: Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment-impeding roles of family included triggering or worsening men's depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. CONCLUSIONS: Families play important roles in older men's depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support.
Assuntos
Atitude do Pessoal de Saúde , Transtorno Depressivo/terapia , Família , Apoio Social , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Pesquisa Qualitativa , Adulto JovemRESUMO
OBJECTIVE: Among older white and Mexican origin male primary care patients, we examined preferences for features of depression care programs that would encourage depressed older men to enter and remain in treatment. METHOD: Sixty-three (45 white, 18 Mexican origin) older men were recruited in six primary care clinics. All had clinical depression in the past year and/or were receiving depression treatment. Participants completed a conjoint analysis preference survey regarding depression treatments, providers and treatment enhancements. RESULTS: The data suggest that white men preferred medication over counseling [odds ratio (OR): 1.64 95% confidence interval (CI): 1.12-2.41], while Mexican origin men preferred counseling (OR: medication over counseling: 0.28, 95% CI: 0.12-0.66). Both white and Mexican origin men preferred treatment that included family involvement (vs. none) (white: OR: 1.60, 95% CI 1.12-2.30; Mexican origin: OR: 3.31 95% CI 1.44-7.62) and treatment for insomnia (vs. treatment for alcohol use) (white: OR: 1.72, 95% CI 1.01-2.91; Mexican origin: OR: 3.93 95% CI 1.35-11.42). White men also preferred treatment by telephone (OR: 1.80, 95% CI 1.12-2.87). CONCLUSIONS: Findings could inform development of patient-centered depression treatment programs for older men and suggest strategies, such as attention to sleep problems, which providers may employ to tailor treatment to preferences of older men.
Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/terapia , Americanos Mexicanos/psicologia , Preferência do Paciente/etnologia , Psicoterapia , População Branca/psicologia , Idoso , Transtorno Depressivo/psicologia , Família , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Preferência do Paciente/psicologia , Assistência Centrada no Paciente/métodos , Atenção Primária à Saúde/métodos , Distúrbios do Início e da Manutenção do Sono/psicologia , Distúrbios do Início e da Manutenção do Sono/terapia , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
OBJECTIVES: This study aims (i) to compare depression frequency and self-reported depression treatment in Mexican-origin and white men; (ii) to examine ethnic differences in self-reported prior depression diagnosis and types of treatment; and (iii) to determine whether Mexican-origin men (both English and Spanish language preferring) are less likely than white men to report receiving depression treatment after controlling for potential confounders. METHODS: This is a cross-sectional, observational study of Mexican-origin and white men (60 years old and over) presenting for primary care visits at six outpatient clinics in California's Central Valley. Clinical depression was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), module for past-year major depression and questions for chronic depression. Past year, self-reported prior depression diagnosis and treatment (i.e., medication, psychotherapy, mental health referral) were assessed through a structured questionnaire. RESULTS: The frequency of past-year clinical depression was similar for both ethnic groups, yet Mexican-origin men were significantly less likely than whites to report receiving a prior diagnosis of depression or prior depression treatment. Compared with whites, the odds of untreated depression in Mexican-origin men was 4.35 (95% CI 1.35-14.08) for those interviewed in English and 10.40 (95% CI 2.11-51.25) for those interviewed in Spanish. For both ethnic groups, the majority (i.e., approximately two-thirds) of men receiving depression treatment also met criteria for past-year clinical depression. CONCLUSIONS: Mexican-origin older men in primary care suffer from significant gaps in depression care (i.e., diagnosis and treatment) compared with whites. Delivering effective depression treatment (i.e., so that depression remits) remains elusive for both ethnic groups.
Assuntos
Atenção à Saúde/normas , Transtorno Depressivo/terapia , Idoso , California/epidemiologia , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings. METHODS: A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data. RESULTS: In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over the six-month follow-up period compared with patients who received enhanced usual care (ß=-.41, t=-2.36, df=219, p=.018, for the SCL; and ß=-3.51, t=-2.49, df=221, p=.013, for the PHQ-9). A greater proportion of patients in the CBT group than in the group that received enhanced usual care achieved treatment response at three months (p=.017), as indicated by a 50% improvement in SCL depression score or a score <.75, and reported high satisfaction with treatment (p=.013). CONCLUSIONS: Although limited by small sample size, pilot results suggest culturally tailored, telephone-based CBT has the potential to enhance access to psychotherapy in an underserved Latino population with little access to mental health services.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/terapia , Hispânico ou Latino/psicologia , Telemedicina , Adulto , Feminino , Humanos , Entrevista Psicológica , Masculino , Satisfação do Paciente , Projetos Piloto , Escalas de Graduação Psiquiátrica , População Rural , Telemedicina/métodos , Telefone , Resultado do Tratamento , WashingtonRESUMO
OBJECTIVE: This study assessed treatment preferences among low-income Latino patients in public-sector primary care clinics and examined whether a collaborative care intervention that included patient education and allowed patients to choose between medication, therapy, or both would increase the likelihood that patients received preferred treatment. METHODS: A total of 339 Latino patients with probable depressive disorders were recruited; participants completed a baseline conjoint analysis preference survey and were randomly assigned to receive the intervention or enhanced usual care. At 16 weeks, a patient survey assessed depression treatment received during the study period. Logistic regression models were constructed to estimate treatment preferences, examine patient characteristics associated with treatment preferences, and examine patient characteristics associated with a match between stated preference and actual treatment received. RESULTS: The conjoint analysis preference survey showed that patients preferred counseling or counseling plus medication over antidepressant medication alone and that they preferred treatment in primary care over specialty mental health care, but they showed no significant preference for individual versus group treatment. Patients also indicated that individual education sessions, telephone sessions, transportation assistance, and family involvement were barrier reduction strategies that would enhance their likelihood of accepting treatment. Compared with patients assigned to usual care, those in the intervention group were 21 times as likely to receive preferred treatment. Among all participants, women, unemployed persons, those who spoke English, and those referred by providers were more likely to receive preferred treatment. CONCLUSIONS: Collaborative care interventions that include psychotherapy can increase the likelihood that Latino patients receive preferred care; however, special efforts may be needed to address preferences of working persons, men, and Spanish-speaking patients.
Assuntos
Prestação Integrada de Cuidados de Saúde , Transtorno Depressivo/terapia , Hispânico ou Latino , Preferência do Paciente , Antidepressivos/uso terapêutico , Aconselhamento , Prestação Integrada de Cuidados de Saúde/organização & administração , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/etnologia , Feminino , Pesquisas sobre Atenção à Saúde , Hispânico ou Latino/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/etnologia , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Pobreza/psicologia , Fatores SocioeconômicosRESUMO
Case reports of mothball ingestion have shown that paradichlorobenzene, the organic compound found in mothballs, can induce multiple organ effects, including encephalopathy. Psychiatrists are often involved in these cases due to presumed depression. Diagnosis is frequently delayed and/or inaccurate due to the inability to obtain a full history. A delay in diagnosis may result in an inappropriate treatment plan. We present a case involving a woman who ingested mothballs due to Pica emphasizing the importance and challenges of getting a thorough history. Barriers include cultural differences, shame and obtaining collateral information.
Assuntos
Clorobenzenos/intoxicação , Depressão/diagnóstico , Encefalite/induzido quimicamente , Inseticidas/efeitos adversos , Anamnese , Adulto , Clorobenzenos/administração & dosagem , Diagnóstico Diferencial , Ingestão de Alimentos , Encefalite/diagnóstico , Feminino , Humanos , Inseticidas/administração & dosagem , PicaRESUMO
This study examined the psychometric properties of the Revised Illness Perception Questionnaire adapted for a clinical sample of low-income Latinos suffering from depression. Participants (N = 339) were recruited from public primary care centers. Their average age was 49.73 years and the majority was foreign born females of either Mexican or Central American descent. Confirmatory factor analysis was used to test the factor structure of this measure. Construct and discriminant validity and internal consistency were evaluated. After the elimination of three items because of low factor loadings (< .40) and the specification of seven error covariances, a revised model composed of 24 items had adequate goodness-of-fit indices and factor loadings, supporting construct validity. Each of the subscales reported satisfactory internal consistency. Intercorrelations between the 5 illness perception factors provided initial support for the discriminant validity of these factors in the context of depression. The establishment of the psychometric properties of this adapted measure will pave the way for future studies examining the role illness perceptions play in the help seeking and management of depression among Latinos.
Assuntos
Atitude Frente a Saúde/etnologia , Depressão/diagnóstico , Depressão/etnologia , Hispânico ou Latino/psicologia , Hispânico ou Latino/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Depressão/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Projetos Piloto , Reprodutibilidade dos TestesRESUMO
PURPOSE: To determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia. PATIENTS AND METHODS: Study patients included 472 low-income, predominantly female Hispanic patients with cancer age >or= 18 years with major depression (49%), dysthymia (5%), or both (46%). Patients were randomly assigned to intervention (n = 242) or enhanced usual care (EUC; n = 230). Intervention patients had access for up to 12 months to a depression clinical specialist (supervised by a psychiatrist) who offered education, structured psychotherapy, and maintenance/relapse prevention support. The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication. RESULTS: At 12 months, 63% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 (PHQ-9) depression scale compared with 50% of EUC patients (odds ratio [OR] = 1.98; 95% CI, 1.16 to 3.38; P = .01). Improvement was also found for 5-point decrease in PHQ-9 score among 72.2% of intervention patients compared with 59.7% of EUC patients (OR = 1.99; 95% CI, 1.14 to 3.50; P = .02). Intervention patients also experienced greater rates of depression treatment (72.3% v 10.4% of EUC patients; P < .0001) and significantly better quality-of-life outcomes, including social/family (adjusted mean difference between groups, 2.7; 95% CI, 1.22 to 4.17; P < .001), emotional (adjusted mean difference, 1.29; 95% CI, 0.26 to 2.22; P = .01), functional (adjusted mean difference, 1.34; 95% CI, 0.08 to 2.59; P = .04), and physical well-being (adjusted mean difference, 2.79; 95% CI, 0.49 to 5.1; P = .02). CONCLUSION: ADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms, improvement in quality of life, and lower pain levels compared with EUC for patients with depressive disorders in a low-income, predominantly Hispanic population in public sector oncology clinics.
Assuntos
Transtorno Depressivo Maior/terapia , Serviços de Saúde Mental/organização & administração , Neoplasias/complicações , Assistência Centrada no Paciente/métodos , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/etnologia , Transtorno Depressivo Maior/etiologia , Transtorno Distímico/etnologia , Transtorno Distímico/etiologia , Transtorno Distímico/terapia , Estudos de Viabilidade , Feminino , Seguimentos , Hispânico ou Latino , Humanos , Los Angeles/epidemiologia , Masculino , Educação de Pacientes como Assunto , Satisfação do Paciente , Assistência Centrada no Paciente/organização & administração , Psicoterapia , Qualidade de Vida , Distribuição por Sexo , Fatores Socioeconômicos , Resultado do TratamentoRESUMO
OBJECTIVE: This article describes the randomized clinical trial methodology for a population-based study of oncology patients receiving cancer care in a public sector medical center. The primary goal is to test the effectiveness of socioculturally tailored collaborative care intervention in improving depression and quality of life outcomes among low-income ethnic minority patients with major depression and cancer. METHODS: The Patient Health Questionnaire (PHQ-9) depression scale was used to identify patients meeting criteria for major depression (one cardinal depression symptom plus a PHQ-9 score of > or =10). Study-eligible patients were >/=90 days from cancer diagnosis who were receiving acute cancer treatment or follow-up care in oncology clinics. Patients with advanced disease limiting life expectancy to <6 months, acutely suicidal or on antipsychotic medication were excluded. Allowing for attrition due to death or loss to follow-up, the study was powered at the 80% level to detect a 20% difference between study arms in the proportion of patients with >/=50% reduction in PHQ-9 symptoms at 12 months. RESULTS: Of 2330 patients screened, 23.2% met criteria. An 82.4% enrollment rate resulted in 446 primarily women being recruited and randomized to intervention or usual care. CONCLUSION: The study applies methods used in primary care depression trials with adaptations for oncology care clinics and for low-income minority patients.
Assuntos
Depressão/psicologia , Depressão/terapia , Neoplasias/psicologia , Centros Médicos Acadêmicos , Idoso , Algoritmos , Depressão/complicações , Depressão/etnologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/etnologia , Pobreza , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Projetos de PesquisaRESUMO
OBJECTIVES: Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. METHODS: Secondary data were analyzed from Partners in Care, which examined dissemination of best practices for depression in primary care. Primary care clinicians' decisions regarding watchful waiting were examined by using the baseline survey data from Partners in Care completed by clinicians and patients from February 1996 to March 1997. Participants were 167 primary care clinicians from 46 practices of seven managed care organizations across the United States and their 1,187 patients with depression. Primary care clinicians' proclivity for watchful waiting was examined by using a brief scenario describing a patient with major depressive disorder. RESULTS: Thirty-four clinicians (20 percent) reported a strong proclivity to use watchful waiting for the patient in the scenario. The proclivity was significantly associated with clinicians' reports of the proportion of their actual patients with whom they used this approach. Clinicians were significantly more likely to choose watchful waiting for their actual patients if they had more psychotherapy knowledge (p=.035) or perceived that the need to treat the patient's medical illness was more important than the need to treat his or her mental illness (p=.046) and were less likely to choose a watchful waiting approach if they perceived the lack of availability of mental health professionals as a barrier (p=.050). CONCLUSIONS: Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.
Assuntos
Atitude Frente a Saúde , Comportamento de Escolha , Transtorno Depressivo Maior/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Satisfação do Paciente , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Demografia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Mental/provisão & distribuição , Observação , Índice de Gravidade de Doença , Estados UnidosRESUMO
OBJECTIVE: This study examined the impact of patient characteristics and source of care on differences between whites and Latinos in use and quality of depression treatment in managed primary care settings. METHODS: Data were examined for 1,175 patients (398 Latinos and 777 whites) in 46 managed primary care practices who screened positive for probable depressive disorder. Patient baseline assessments were used to compile sociodemographic and clinical characteristics and to derive variables for receipt of any depression care and depression care that met minimum guidelines (antidepressant use or specialty counseling) in the past six months. Clinics were classified by the percentage of their patient population that consisted of Latinos to determine whether patients in highly Latino clinics reported lower rates of care. Predictors of use and quality of depression care were examined by using logistic regression. RESULTS: Rates of receipt of any depression care and guideline-level depression care were low, and Latinos were less than half as likely as whites to receive such care, even after the analyses controlled for independent predictors (that is, younger age, higher educational level, current unemployment, more comorbid medical illness, and a diagnosis of a depressive or anxiety disorder). The likelihood of receiving any care or care that met guidelines did not significantly vary according to whether clinics served a low, moderate, or high percentage of Latinos. CONCLUSIONS: Disparities in depression care for Latinos were not attributable to sociodemographic and clinical characteristics, and they were not attributable to receiving care in clinics that served ethnically similar or dissimilar clientele. These findings suggest that other patient or provider factors may be responsible.
Assuntos
Transtorno Depressivo/etnologia , Transtorno Depressivo/terapia , Hispânico ou Latino/psicologia , Grupos Minoritários/psicologia , Atenção Primária à Saúde/normas , Adulto , Antidepressivos/uso terapêutico , Fidelidade a Diretrizes , Acessibilidade aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Gestão da Qualidade Total/métodos , Estados Unidos , População Branca/psicologiaAssuntos
Medicina Baseada em Evidências , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Transtornos Mentais/economia , Psicotrópicos/efeitos adversos , Psicotrópicos/economia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Viés de Seleção , Resultado do Tratamento , Estados UnidosRESUMO
In a pilot study, 55 low-income Latina patients with breast or cervical cancer and comorbid depression were randomly assigned to receive collaborative care as part of the Multifaceted Oncology Depression Program or usual care. Relative to patients in the usual care condition, patients receiving collaborative care were more likely to show>or=50% improvement in depressive symptoms as measured by the Personal Health Questionnaire (OR=4.51, 95% CI=1.07-18.93). Patients in the collaborative care program were also more likely to show improvement in emotional well-being (increase of 2.15) as measured by the Functional Assessment of Cancer Therapy Scale than were those receiving usual care (decrease of 0.50) (group difference=2.65, 95% CI: 0.18-5.12). Despite health system, provider, and patient barriers to care, these initial results suggest that patients in public sector oncology clinics can benefit from onsite depression treatment.
Assuntos
Carcinoma/epidemiologia , Comportamento Cooperativo , Depressão/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Hispânico ou Latino , Neoplasias do Colo do Útero/epidemiologia , Comorbidade , Depressão/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Psicoterapia , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
PURPOSE: To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecologic cancer, receipt of antidepressant medications or counseling services, and correlates of depression. PATIENTS AND METHODS: Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (stage 0 to III) or gynecologic cancer (International Federation of Gynecology and Obstetrics stage 0 to IIIB). A diagnostic depression screen and baseline questionnaire were administered before or during active treatment or during active follow-up. Self-report data were collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care. RESULTS: Twenty-four percent of women reported moderate to severe levels of depressive disorder (30% of breast cancer patients and 17% of gynecologic cancer patients). Only 12% of women meeting criteria for major depression reported currently receiving medications for depression, and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage nor treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social and family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression. CONCLUSION: Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecologic cancer is prevalent and is correlated with pain, anxiety, and health-related quality of life. Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation, and treatment in this population.
Assuntos
Antidepressivos/uso terapêutico , Neoplasias da Mama/complicações , Neoplasias da Mama/psicologia , Depressão/epidemiologia , Depressão/terapia , Neoplasias dos Genitais Femininos/complicações , Neoplasias dos Genitais Femininos/psicologia , Adulto , Administração de Caso , Aconselhamento , Depressão/diagnóstico , Etnicidade , Feminino , Humanos , Pessoa de Meia-Idade , Grupos Minoritários , Pobreza , Prevalência , Índice de Gravidade de Doença , População UrbanaRESUMO
The authors examined the feasibility of conjoint analysis for measuring the depression treatment preferences of low-income, low-literacy Latino primary care patients. Forty-two patients with depression (58 percent of those eligible for the study) completed a survey about preferences for treatment and strategies to reduce barriers to care. They preferred combined counseling and medication to either approach alone and preferred individual over group treatment but did not show a significant preference for treatment setting. The odds of treatment acceptance were increased by the availability of telephone appointments, bus passes, and help with making appointments. Although further validation is required, conjoint analysis appears to be feasible for assessing preferences regarding depression treatment in this underserved population.
Assuntos
Comportamento de Escolha , Depressão/tratamento farmacológico , Depressão/psicologia , Comportamentos Relacionados com a Saúde , Hispânico ou Latino/psicologia , Adolescente , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fatores SocioeconômicosAssuntos
Medicina Baseada em Evidências , Mau Uso de Serviços de Saúde , Transtornos do Humor/tratamento farmacológico , Antidepressivos Tricíclicos/farmacologia , Antidepressivos Tricíclicos/uso terapêutico , Fidelidade a Diretrizes , Humanos , Lítio/farmacologia , Lítio/uso terapêutico , Inibidores da Monoaminoxidase/farmacologia , Inibidores da Monoaminoxidase/uso terapêutico , Guias de Prática Clínica como Assunto , Sociedades MédicasRESUMO
In this study, we sought to establish whether there was an association between adult attachment style and number of medically unexplained physical symptoms in patients with hepatitis C. Thirty-two patients with hepatitis C were assessed with regard to attachment style classification, number of lifetime medically unexplained symptoms, lifetime psychiatric diagnoses, medical comorbidity, disease severity, use of interferon, and demographic characteristics. Analysis of covariance was used to compare the four attachment groups on number of lifetime medically unexplained symptoms, and Pearson correlations were used to assess the association of continuous ratings of attachment style with lifetime medically unexplained symptoms. Number of lifetime medically unexplained symptoms varied significantly as a function of attachment style group, with patients with fearful attachment reporting significantly more medically unexplained symptoms than patients with secure attachment (P < 0.01). Number of lifetime medically unexplained symptoms was positively correlated with continuous ratings of fearful attachment (r = 0.53, P < 0.01) and preoccupied attachment (r = 0.46, P < 0.01). Implications for treatment are discussed.