scholarly journals RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints

2005 ◽  
Vol 3 (1) ◽  
pp. 15-22 ◽  
Author(s):  
L. M. Dickinson
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Care Manager

Symptom dimensions of major depression in a large community-based cohort

2021 ◽  
pp. 1-8
Author(s):  
Michael Wainberg ◽  
Peter Zhukovsky ◽  
Sean L. Hill ◽  
Daniel Felsky ◽  
Aristotle Voineskos ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Risk Scores ◽  
Polygenic Risk Score ◽  
Psychiatric Diagnoses ◽  
Uk Biobank ◽  
Community Based ◽  
Symptom Dimensions ◽  
Polygenic Risk ◽  
Large Community

Abstract Background Our understanding of major depression is complicated by substantial heterogeneity in disease presentation, which can be disentangled by data-driven analyses of depressive symptom dimensions. We aimed to determine the clinical portrait of such symptom dimensions among individuals in the community. Methods This cross-sectional study consisted of 25 261 self-reported White UK Biobank participants with major depression. Nine questions from the UK Biobank Mental Health Questionnaire encompassing depressive symptoms were decomposed into underlying factors or ‘symptom dimensions’ via factor analysis, which were then tested for association with psychiatric diagnoses and polygenic risk scores for major depressive disorder (MDD), bipolar disorder and schizophrenia. Replication was performed among 655 self-reported non-White participants, across sexes, and among 7190 individuals with an ICD-10 code for MDD from linked inpatient or primary care records. Results Four broad symptom dimensions were identified, encompassing negative cognition, functional impairment, insomnia and atypical symptoms. These dimensions replicated across ancestries, sexes and individuals with inpatient or primary care MDD diagnoses, and were also consistent among 43 090 self-reported White participants with undiagnosed self-reported depression. Every dimension was associated with increased risk of nearly every psychiatric diagnosis and polygenic risk score. However, while certain psychiatric diagnoses were disproportionately associated with specific symptom dimensions, the three polygenic risk scores did not show the same specificity of associations. Conclusions An analysis of questionnaire data from a large community-based cohort reveals four replicable symptom dimensions of depression with distinct clinical, but not genetic, correlates.

scholarly journals Implementation of a care manager organisation and its association with antidepressant medication patterns: a register-based study of primary care centres in Sweden

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044959
Author(s):  
Christine Sandheimer ◽  
Cecilia Björkelund ◽  
Gunnel Hensing ◽  
Kirsten Mehlig ◽  
Tove Hedenrud
Keyword(s):  
Primary Care ◽  
Treatment Guidelines ◽  
Common Mental Disorders ◽  
Common Mental Disorder ◽  
Antidepressant Medication ◽  
Linear Mixed Effects ◽  
Care Manager ◽  
Defined Daily Doses ◽  
Number Of Patients ◽  
Mental Disorder Diagnosis

ObjectiveTo evaluate the implementation of a care manager organisation for common mental disorders and its association with antidepressant medication patterns on primary care centre (PCC) level, compared with PCCs without this organisation. Moreover, to determine whether a care manager organisation is associated with antidepressant medication patterns that is more in accordance with treatment guidelines.DesignRegister-based study on PCC level.SettingPrimary care in Region Västra Götaland, Sweden.ParticipantsAll PCCs in the region. PCCs were analysed in three subgroups: PCCs with a care manager organisation during 2015 and 2016 (n=68), PCCs without the organisation (n=92) and PCCs that shifted to a care manager organisation during 2016 (n=42).Outcome measuresProportion of inadequate medication users, defined as number of patients >18 years with a common mental disorder diagnosis receiving care at a PCC in the region during the study period and dispensed 1–179 defined daily doses (DDD) of antidepressants of total patients with at least 1 DDD. The outcome was analysed through generalised linear regression and a linear mixed-effects model.ResultsOverall, all PCCs had about 30%–34% of inadequate medication users. PCCs with a care manager organisation had significantly lower proportion of inadequate medication users in 2016 compared with PCCs without (−6.4%, p=0.02). These differences were explained by higher proportions in privately run PCCs. PCCs that shifted to a care manager organisation had a significant decrease in inadequate medication users over time (p=0.01).ConclusionsPublic PCCs had a more consistent antidepressant medication pattern compared with private PCCs that gained more by introducing a care manager organisation. It was possible to document a significant decrease in inadequate medication users, notwithstanding that PCCs in the region followed the guidelines to a comparatively high extent regardless of present care manager organisation.

scholarly journals Cost-effectiveness of Treatments for Major Depression in Primary Care Practice

1998 ◽  
Vol 55 (7) ◽  
pp. 645 ◽  
Author(s):  
Judith R. Lave ◽  
Richard G. Frank ◽  
Herbert C. Schulberg ◽  
Mark S. Kamlet
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Major Depression ◽  
Primary Care Practice ◽  
Care Practice

scholarly journals Antidepressant Prescribing in Primary Care to Older Adults Without Major Depression

2017 ◽  
Vol 68 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Donovan T. Maust ◽  
Jo Anne Sirey ◽  
Helen C. Kales
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Major Depression

scholarly journals Quality of life, diagnosis, and treatment of patients with major depression: a prospective cohort study in primary care

2011 ◽  
Vol 33 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Ana Flávia Barros da Silva Lima ◽  
Marcelo Pio de Almeida Fleck
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cohort Study ◽  
Major Depression ◽  
Antidepressant Treatment ◽  
Epidemiologic Studies ◽  
World Health ◽  
World Health Organization Quality

OBJECTIVE: To describe the demographic and clinical characteristics, adequacy of antidepressant treatment, and changes in quality of life of patients with major depression receiving follow-up care from primary care centers. METHOD: A cohort study was performed in which major depression patients were followed-up over a nine-month period. Several evaluation instruments were used, including the World Health Organization Quality of Life and the Quality of Life-Depression, Centers for Epidemiologic Studies-Depression questionnaires. RESULTS: The sample comprised 179 individuals, mostly female (73%), with a mean age of 38 years and mean education of 9 years. At the end of the follow-up period, 42% of the individuals still presented with major depression, 25% had complete symptom remission, and only 9% were properly treated with antidepressants. In relation to quality of life, there were significant differences especially between baseline and after nine months in almost all measures. CONCLUSION: This study demonstrated that depressive symptoms are poorly recognized and that treatment is often inadequate for patients followed-up in primary care units in the south of Brazil. Most of the patients continued to have symptoms of depression over the nine-month period which were associated with impaired quality of life.

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