Integrated Care: Treatment Initiation Following Positive Depression Screens
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Integrated Care: Treatment Initiation Following Positive Depression Screens Benjamin R. Szymanski, MPH1, Kipling M. Bohnert, PhD2,3, Kara Zivin, PhD2,3, and John F. McCarthy, PhD2,3 1
Department of Chronic Disease Epidemiology, Yale School of Public Heath, New Haven, CT, USA; 2Serious Mental Illness Treatment Resource and Evaluation Center, Department of Veterans Affairs, Ann Arbor, MI, USA; 3Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
BACKGROUND: Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care. OBJECTIVE: To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration. DESIGN: Retrospective cohort study. SUBJECTS: Thirty-six thousand, two hundred and sixty-three PC patients with positive depression screens between October 1, 2009 and September 30, 2010. MAIN MEASURES: Subjects were assessed for depression diagnosis and initiation of antidepressants or psychotherapy on the screening day, within 12 weeks, and within 6 months. Among individuals with PC encounters on the screening day, setting of services received that day was categorized as PC only, PC-MHI, or Specialty Mental Health (SMH). Using multivariable generalized estimating equations (GEE) logistic regression, we assessed likelihood of treatment initiation, adjusting for demographic and clinical measures, including depression screening score. KEY RESULTS: Patients who received same-day PCMHI services were more likely to initiate psychotherapy (OR: 8.16; 95 % CI: 6.54–10.17) and antidepressant medications (OR: 2.33, 95 % CI: 2.10–2.58) within 12 weeks than were those who received only PC services on the screening day. CONCLUSIONS: Receipt of same-day PC-MHI may facilitate timely receipt of depression treatment.
KEY WORDS: depression screening; integrated care; veterans. J Gen Intern Med 28(3):346–52 DOI: 10.1007/s11606-012-2218-y © Society of General Internal Medicine 2012
Electronic supplementary material The online version of this article (doi:10.1007/s11606-012-2218-y) contains supplementary material, which is available to authorized users. Received February 2, 2012 Revised July 11, 2012 Accepted August 8, 2012 Published online November 13, 2012
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INTRODUCTION
Ensuring timely delivery of appropriate treatment for individuals with depressive symptoms is an important health policy objective. Depression is the third leading cause of disability worldwide, and the leading cause in middle and high income countries.1 In the United States, over 32 million adults have experienced major depressive disorder in their lives,2 and annual economic costs exceed $80 billion.3 Depression is associated with increased mortality, including cardiovascular4 and suicide mortality.5 In the past decade, there have been focused concerns regarding depression treatment among Veterans, as highlighted in the Comprehensive Veterans H
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