scholarly journals Remote Collaborative Depression Care Program for Adolescents in Araucan�a Region, Chile: Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Vania Martínez ◽  
Graciela Rojas ◽  
Pablo Martínez ◽  
Pedro Zitko ◽  
Matías Irarrázaval ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Clinical Guidelines ◽  
Intervention Group ◽  
Depression Care ◽  
Primary Care Teams ◽  
Primary Care Clinicians ◽  
Specialized Mental Health

BACKGROUND Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. OBJECTIVE The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. METHODS A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. RESULTS More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). CONCLUSIONS This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. CLINICALTRIAL ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY)

Integrating Clinical Nurse Specialists into the Treatment of Primary Care Patients with Depression

2003 ◽  
Vol 33 (1) ◽  
pp. 17-37 ◽  
Author(s):  
Ralph W. Swindle ◽  
Jaya K. Rao ◽  
Ahdy Helmy ◽  
Laurie Plue ◽  
X. H. Zhou ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Integrated Care ◽  
Medical Center ◽  
Treatment Plan ◽  
Intervention Group ◽  
Nurse Specialist ◽  
Clinical Nurse ◽  
Primary Care Patients

Objective: To examine the effectiveness of integrating generalist and specialist care for veterans with depression. Method: We conducted a randomized trial of patients screening positive for depression at two Veterans Affairs Medical Center general medicine clinic firms. Control firm physicians were notified prior to the encounter when eligible patients had PRIME-MD depression diagnoses. In the intervention firm, a mental health clinical nurse specialist (CNS) was to: design a treatment plan; implement that plan with the primary care physician; and monitor patients via telephone or visits at two weeks, one month and two months. Primary outcomes (depressive symptoms, patient satisfaction with health care) were collected at 3 and 12 months. Results: Of 268 randomized patients, 246 (92%) and 222 (83%) completed 3- and 12-month follow-up interviews. There were no between-group differences in depressive symptoms or satisfaction at 3 or 12 months. The intervention group had greater chart documentation of depression at baseline (63% versus 33%, p = 0.003) and a higher referral rate to mental health services at 3 months (27% versus 9%, p = 0.019). There was no difference in the rate of new prescriptions for, or adequate dosing of, anti-depressant medications. In 40% of patients, CNSs disagreed with the PRIME-MD depression diagnosis, and their rates of watchful waiting were correspondingly high. Conclusions: Implementing an integrated care model did not occur as intended. Experienced CNSs often did not see the need for treatment in many primary care patients identified by the PRIME-MD. Integrating integrated care models in actual practice may prove challenging.

Process mapping appointments to identify improvements in care delivered to patients who screen positive for depression

2016 ◽  
Vol 4 (3) ◽  
pp. 433
Author(s):  
Bo Kim ◽  
Stephanie Rodrigues ◽  
Natalie S Dell ◽  
Rani Elwy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Treatment ◽  
Veterans Health ◽  
Health Administration ◽  
Depression Care ◽  
Positive Screen ◽  
Novel Approach ◽  
Using Data

Rationale, aims and objectives  After screening positive for depression, many patients do not receive effective medication or maintain optimal contact with practitioners.  Our objective was to examine how appointments that patients have after screening positive may affect the delivery of evidence-based and guideline-concordant depression care. Methods  We reviewed treatment records for 271 patients who screened positive for depression in primary care across three United States Veterans Health Administration medical facilities.  For each patient, we mapped the process of appointments that took place following the positive screen, noting the number of appointments, the service line in which each appointment was held, as well as whether guideline-concordant depression care was in turn received over four months. Results  We found that (i) approximately half of the patients who screened positive had no follow-up appointments, (ii) all patients who had two or more follow-up appointments received some – but not necessarily guideline-concordant – mental health treatment, and (iii) there were distinct patterns across the three facilities regarding which service lines’ appointments most often resulted in treatment. Conclusions  Our work offers a novel approach of using data on appointments that patients have after screening positive for depression to shed light on current care practices.  The number of post-screening appointments can be an informative process measure for improving depression care to become more guideline-concordant.  Facilities vary substantially in terms of which service lines they use to attain guideline-concordance, likely due to notable differences in how their primary care, integrated primary care behavioral health, and mental health services are organized.

scholarly journals Mental health specialist video consultations versus treatment-as-usual for patients with depression or anxiety disorders in primary care: A randomized controlled feasibility trial (Preprint)

2020 ◽  
Author(s):  
Justus Tönnies ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Joachim Szecsenyi ◽  
Frank Peters-Klimm ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Anxiety Disorder ◽  
Intervention Group ◽  
Control Group ◽  
Treatment As Usual ◽  
Mental Health Specialist ◽  
Randomized Controlled ◽  
Health Specialist

BACKGROUND Most people suffering from depression and anxiety disorders are solely treated by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in ageing societies and long waiting times on the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in the primary care environment the patient is already familiar with. OBJECTIVE In an individually randomized controlled trial we aimed to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression and/or anxiety disorder. METHODS Participants were recruited by their primary care physicians during regular practice visits. Eligible patients were required to experience at least moderate symptoms of depression and/or anxiety disorder. Patients were randomized in two groups receiving either treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. Video consultations focused on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment and attendance at sessions. Effectiveness outcomes included depression (PHQ-9), anxiety (GAD-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale, SSD-12), recovery (Recovery Assessment Scale, RAS-G), and perception of chronic illness care (Patient Assessment of Chronic Illness Care, PACIC–Short Form) – which were measured at baseline and 16 weeks post-allocation by assessors blinded to group allocation. RESULTS Fifty patients with depression and/or anxiety disorder were randomized, 23 to the intervention group and 27 to the treatment-as-usual group. The recruitment yield (number randomized per number screened) and consent rate (number randomized per number eligible) were 50/73 (68.5%) and 50/58 (86.2%), respectively. Concerning acceptability, 20 (87.0%) of the 23 in the intervention group completed the intervention. Of 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 95.7% and 85.2% for the intervention and the control group, respectively. Change from baseline scores at post-measurement for the “No Domination by Symptoms” domain of recovery (RAS-G) were somewhat higher for the intervention group compared to the control group (Mann-Whitney U-Test: rank-biserial r = 0.19 [-0.09; 0.46], P = .18). We did not detect any notable differences between the intervention group and the control group for the other effectiveness outcomes. We did not observe any serious adverse events related to the trial. CONCLUSIONS The intervention and study procedures are feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate effectiveness in routine care. CLINICALTRIAL German Clinical Trials Register (registration no. DRKS00015812).

How Do Primary Care Clinicians Manage Childhood Mood and Anxiety Syndromes?

2005 ◽  
Vol 35 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Frances J. Wren ◽  
Sarah H. Scholle ◽  
Jungeun Heo ◽  
Diane M. Comer
Keyword(s):  
Mental Health ◽  
United States ◽  
Primary Care ◽  
Puerto Rico ◽  
Care Management ◽  
Psychosocial Problems ◽  
The United States ◽  
Primary Care Clinicians ◽  
Primary Care Management

Objective: To describe how primary care clinicians manage children in whom they diagnose mood or anxiety syndromes. Method: This study is a secondary analysis of data from the multi-site Child Behavior Study (CBS)—a cross-sectional survey of primary care management of psychosocial problems. The management of children in whom clinicians identified mood or anxiety syndromes is described and compared with the management of children in whom they identified other psychosocial problems. Recruitment for the CBS occurred in 206 primary care practices in the United States, Puerto Rico, and Canada from October 1994 through June 1997. Participants were 20,861 consecutively sampled primary care attendees aged 4–15 years and 395 clinicians. Primary outcome measures for this report are rates of referral to specialized mental health care and rates of active primary care management (i.e., scheduling a follow-up appointment and/or providing ongoing counseling and/or psychotropic prescription). Results: Identification of a mood or anxiety syndrome was associated with increased rates of referral to mental health compared with rates for children with other psychosocial problems. There was no effect on the proportion of children counseled during the visit. In fact, unless accompanied by a co-morbid behavioral syndrome, children receiving the diagnosis of a mood or anxiety syndrome were less likely to be offered a scheduled follow-up appointment. Rates of prescription of antidepressants or anti-anxiety agents were higher for mood/anxiety groups but this was still uncommon (6.7%). Conclusions: Active management of childhood mood and anxiety syndromes in primary care was uncommon in the United States, Puerto Rico, and Canada in the mid-1990s.

scholarly journals An mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE Study

2020 ◽  
Author(s):  
Adrian Aguilera ◽  
Caroline A. Figueroa ◽  
Rosa Hernandez-Ramos ◽  
Urmimala Sarkar ◽  
Anupama G Cemballi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Machine Learning ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Ethnic Minority ◽  
Low Income ◽  
Learning Algorithm ◽  
Intervention Group ◽  
Smartphone Application

ABSTRACTIntroductionDepression and diabetes are highly disabling diseases with a high prevalence and high rate of comorbidity, particularly in low-income ethnic minority patients. Though comorbidity increases the risk of adverse outcomes and mortality, most clinical interventions target these diseases separately. Increasing physical activity might be effective to simultaneously lower depressive symptoms and improve glycemic control. Self-management apps are a cost-effective, scalable and easy access treatment to increase physical activity. However, cutting-edge technological applications often do not reach vulnerable populations and are not tailored to an individual’s behavior and characteristics. Tailoring of interventions using machine learning methods likely increases the effectiveness of the intervention.Methods and analysisIn a three-arm randomized controlled trial we will examine the effect of a text-messaging smartphone application to encourage physical activity in low-income ethnic minority patients with comorbid diabetes and depression. The adaptive intervention group receives messages chosen from different messaging banks by a reinforcement learning algorithm. The uniform random intervention group receives the same messages, but chosen from the messaging banks with equal probabilities. The control group receives a weekly mood message. We aim to recruit 276 adults from primary care clinics aged 18 to 75 years who have been diagnosed with current diabetes and show elevated depressive symptoms (PHQ-8 >5). We will compare passively collected daily step counts, self-report PHQ-8 and most recent HbA1c from medical records at baseline and at intervention completion at 6-month follow-up.Ethics and disseminationThe Institutional Review Board at the University of California San Francisco approved this study (IRB: 17-22608). We plan to submit manuscripts describing our User Designed Methods and testing of the adaptive learning algorithm and will submit the results of the trial for publication in peer-reviewed journals and presentations at (inter)-national scientific meetings.Registrationclinicaltrials.gov: NCT03490253; pre-resultsArticle SummaryStrengths and LimitationsNovel approach of targeting diabetes and depressive symptoms using a smartphone applicationAbility to compare adaptive messaging for increasing physical activity to messages delivered with equal probabilitiesTesting of a smartphone application integrated within primary care settings in a low-income vulnerable patient populationLongitudinal design with 6-month follow-up enables assessing intervention effects over timeChallenges of this trial include supporting users in key behavior change in an automated manner with minimal in-person support

scholarly journals Prevalence and Factors Associated With Mental Health Symptoms in Adults Undergoing Covid-19 Testing

2021 ◽  
Vol 12 ◽  
pp. 215013272110271
Author(s):  
Ikponmwosa Osaghae ◽  
Linh K. Nguyen ◽  
Tong Han Chung ◽  
Olivia Moffitt ◽  
Yen-Chi L. Le ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Logistic Regression ◽  
Depressive Symptoms ◽  
Regression Analyses ◽  
Mental Health Symptoms ◽  
Hazardous Alcohol Use ◽  
Health Symptoms ◽  
Hazardous Alcohol

Background and objective: Understanding the mental health impact of the COVID-19 pandemic on persons receiving COVID-19 testing will help guide mental health interventions. We aimed to determine the association between sociodemographic factors and mental health symptoms at 8 weeks (baseline) after a COVID-19 test, and compare prevalence of mental health symptoms at baseline to those at 16-week follow-up. Materials and Methods: Prospective cohort study of adults who received outpatient COVID-19 testing at primary care clinics. Logistic regression analyses were used to assess the association between sociodemographic characteristics and COVID-19 test results with mental health symptoms. Mental health symptoms reported at baseline were compared to symptoms at 16 weeks follow-up using conditional logistic regression analyses. Results: At baseline, a total of 124 (47.51%) participants reported at least mild depressive symptoms, 110 (42.15%) participants endorsed at least mild anxiety symptoms, and 94 participants (35.21%) endorsed hazardous use of alcohol. Females compared to males were at increased risk of at least mild depressive symptoms at baseline (Adjusted Odds Ratio (AOR): 2.08; 95% CI: 1.14-3.79). The odds of at least mild depressive symptoms was significantly lower among those residing in zip codes within the highest quartile compared to lowest quartile of household income (AOR: 0.37; 95% CI: 0.17-0.81). Also, non-Hispanic Whites had significantly higher odds of reporting hazardous alcohol use compared to non-Whites at baseline (AOR: 1.94; 95% CI: 1.05-3.57). The prevalence of mental health symptoms remained elevated after 16 weeks. Conclusion and Relevance: We found a high burden of symptoms of depression and anxiety as well as hazardous alcohol use in a diverse population who received testing for COVID-19 in the primary care setting. Primary care providers need to remain vigilant in screening for symptoms of mental health disorders in patients tested for COVID-19 well after initial testing.

scholarly journals Effects of a psychosocial intervention at one-year follow-up in a PREDIMED-plus sample with obesity and metabolic syndrome

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Núria Mallorquí-Bagué ◽  
María Lozano-Madrid ◽  
Cristina Vintró-Alcaraz ◽  
Laura Forcano ◽  
Andrés Díaz-López ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Depressive Symptoms ◽  
Psychosocial Support ◽  
Food Addiction ◽  
Intervention Group ◽  
Control Group ◽  
Lifestyle Recommendations ◽  
One Year ◽  
Mediational Role

AbstractThis study examines if overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms, and if these variables could be modified after 1 year of a multimodal intervention (diet, physical activity, psychosocial support). 342 adults (55–75 years) with overweight/obesity and metabolic syndrome (MetS) from the PREDIMED-Plus Cognition study were randomized to the intervention or to the control group (lifestyle recommendations). Cognitive and psychopathological assessments were performed at baseline and after 1-year follow-up. At baseline, higher impulsivity was linked to higher food addiction and depressive symptoms, but not to body mass index (BMI). Food addiction not only predicted higher BMI and depressive symptoms, but also achieved a mediational role between impulsivity and BMI/depressive symptoms. After 1 year, patients in both groups reported significant decreases in BMI, food addiction and impulsivity. BMI reduction and impulsivity improvements were higher in the intervention group. Higher BMI decrease was achieved in individuals with lower impulsivity. Higher scores in food addiction were also related to greater post-treatment impulsivity. To conclude, overweight/obesity are related to higher impulsivity, food addiction and depressive symptoms in mid/old age individuals with MetS. Our results also highlight the modifiable nature of the studied variables and the interest of promoting multimodal interventions within this population.

scholarly journals Pathways to Mental Health–Related Treatment Among Caregiving Spouses

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 358-358
Author(s):  
Hyojin Choi ◽  
Kristin Litzelman ◽  
Molly Maher ◽  
Autumn Harnish
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Healthcare ◽  
Health Condition ◽  
Future Research ◽  
Provider Type ◽  
Hospital Emergency Room ◽  
Health Related ◽  
Nationally Representative

Abstract Spouses of cancer survivors are 33% less likely to receive guideline-concordant depression treatment than other married adults. However, depression is only one of many manifestations of psychological distress for caregivers. This exploratory study sought to assess the paths by which caregivers access mental health-related treatment. Using nationally representative data from the Medical Expenditures Panel Survey, we assessed the proportion of caregivers who received a mental health-related prescription or psychotherapy visit across care settings (office based versus outpatient hospital, emergency room, or inpatient visit), provider type (psychiatric, primary care, other specialty, or other), and visit purpose (regular checkup, diagnosis and treatment, follow-up, psychotherapy, other). In addition, we assessed the health condition(s) associated with the treatment. The findings indicate that a plurality of caregivers accessed mental health-related treatment through an office-based visit (90%) with a primary care provider (47%). A minority accessed this care through a psychologist or psychiatrist (11%) or a physician with another specialty (12%) or other provider types. Nearly a third accessed treatment as part of a regular check-up (32%). These patterns did not differ from the general population after controlling for sociodemographic characteristics. Interestingly, mental health-related treatments were associated with a mental health diagnosis in only a minority of caregivers. The findings confirm the importance of regular primary care as a door way to mental healthcare, and highlight the range of potential paths to care. Future research will examine the correlates of accessing care across path types.

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