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12. Individual and neighborhood characteristics as predictors of depression symptom response

Author

Panaite, Vanessa, Bowersox, Nicholas W., Zivin, Kara, Ganoczy, Dara, Kim, Hyungjin Myra, and Pfeiffer, Paul N.

Subjects
Evaluation, Research, Prognosis, Depression (Mood disorder) -- Prognosis -- Research, Medical records, Poverty -- Michigan -- Florida, Medical research, Post-traumatic stress disorder -- Prognosis -- Research, Electronic records, Health surveys
Abstract

1 | INTRODUCTION The extent to which effective treatments for depression achieve their intended symptom improvement outcomes (i.e, the quality of care) can vary substantially across treatment settings. (1) However, [...], Objective: Assess whether neighborhood characteristics predict patient-reported outcomes for depression. Data Sources: VA electronic medical record data and U.S. census data. Study Design: Retrospective longitudinal cohort. Data Extraction Methods: Neighborhood and individual characteristics of patients (N = 4,269) with a unipolar depressive disorder diagnosis and an initial Patient Health Questionnaire (PHQ-9) score [greater than or equal to]10 were used to predict 50 percent improvement in 4-8-month PHQ-9 scores. Principal Findings: The proportion of a patient&apos;s neighborhood living in poverty (OR = 0.98; 95% CI: 0.97-.1.00; P = 0.03) was associated with lower likelihood of depression symptom improvement in addition to whether the patient was black (OR = 0.76; 95% CI:0.61-0.96; P = 0.02) had PTSD (OR = 0.59; 95% CI:0.50-0.69; P < 0.001) or had any service-connected disability (OR = 0.73; 95% CI:0.61-0.87; P < 0.001). Conclusions: Neighborhood poverty should be considered along with patient characteristics when determining likelihood of depression improvement. KEYWORDS administrative, depression, improvement, neighborhood, Veterans

Published
2019
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34. Effects of Pair Concordance on Engagement in a Mutual Dyadic Peer Support Intervention for Depression

Author

Bowersox, Nicholas W., Ganoczy, Dara, Pfeiffer, Paul N., Walters, Heather, Kim, H. Myra, and Valenstein, Marcia

Abstract

ABSTRACT:Objective: Peer matching may be important for effective peer support. However, there has been limited investigation into peer matching on peer support participation. Method: 200 patients receiving outpatient depression treatment at a Veterans Affairs medical center were provided with training on how to function as a peer, a peer support manual, and access to a toll-free telephone platform to connect with their partners during the 6-month study. Dyads' contact status (1+ call during 24-week study), number of calls, and average call length were tracked. Measures of concordance were created for dyad characteristics (age, race, baseline depression severity, social support, PTSD status, medical morbidity). Results: Non-White/non-White dyads were less likely to have contact than White/White dyads (OR = .04, 95% CI [.02, .30]). Increased calls were associated with older average dyad age (p &lt; .01) and larger age difference (p &lt; .01). Shorter call length was associated with White/non-White matching and low/high depression matching. Limitations: Small sample size may have restricted power to detect relationships between dyad characteristics and intervention participation. Conclusions: Some peer dyad combinations may result in reduced engagement in mutual peer support interventions. Dyads containing partners with more severe depression may benefit from additional support to bolster participation.

Published
2018

48. Leading from the Middle: Replication of a Re-Engagement Programfor Veterans with Mental Disorders Lost to Follow-Up Care.

Author

Goodrich, David E., Bowersox, Nicholas W., Abraham, Kristen M., Burk, Jeffrey P., Visnic, Stephanie, Zongshan Lai, and Kilbourne, Amy M.

Subjects
*MENTAL illness treatment, *PSYCHOLOGY of veterans, *ENGAGEMENT (Philosophy), *HEALTH status indicators, *EARLY death, *EVIDENCE-based medicine
Abstract

Objectives. Persons with mental disorders experience functional impairments and premature mortality. Limited continuity of care may contribute to disparities in this group. We describe the replication of an evidence-based outreach program (Re-Engage) to reconnect Veterans with mental disorders into care who have dropped out of services. Methods. Using the Enhanced Replicating Effective Programs framework, population-based registries were used to identify Veterans lost-to-care, and providers used this information to determine Veteran disposition and need for care. Providers recorded Veteran preferences, health status, and care utilization, and formative process data was collected to document implementation efforts. Results. Among Veterans who dropped out of care (n = 126), the mean age was 49 years, 10% were women, and 29% were African-American. Providers determined that 39% of Veterans identified for re-engagement were deceased, hospitalized, or ineligible for care. Of the remaining 68 Veterans, outreach efforts resulted in contact with 20, with 7 returning to care. Providers averaged 14.2 hours over 4 months conducting re-engagement services and reported that gaining facility leadership support and having service agreements for referrals were essential for program implementation. Conclusions. Population-level, panel management strategies to re-engage Veterans with mental disorders are potentially feasible if practices are identified to facilitate national rollout. [ABSTRACT FROM AUTHOR]

Published
2012
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49. Depression care following psychiatric hospitalization in the Veterans Health Administration.

Author

Pfeiffer PN, Ganoczy D, Bowersox NW, McCarthy JF, Blow FC, and Valenstein M

Subjects
Adult, Age Factors, Aged, Aged, 80 and over, Depression drug therapy, Depression psychology, Evidence-Based Medicine, Female, Health Services Accessibility, Hospitalization statistics & numerical data, Humans, Inpatients statistics & numerical data, Length of Stay, Logistic Models, Male, Middle Aged, Psychotherapy, Quality Indicators, Health Care, Retrospective Studies, United States, United States Department of Veterans Affairs, Antidepressive Agents therapeutic use, Depression therapy, Hospitals, Veterans statistics & numerical data
Abstract

Objectives: To assess quality of depression care during the high-risk period following a psychiatric hospitalization., Study Design: Retrospective administrative data analysis., Methods: Using Veterans Health Administration (VHA) administrative data, we assessed mental health follow-up within 7 and 30 days of psychiatric hospitalizations for major depression from 2004 to 2008. Adequate antidepressant medication coverage and number of psychotherapy visits were assessed within 90 days of discharge. Multivariable logistic regression was used to identify patient demographic and clinical characteristics associated with each quality indicator., Results: Of the 45,587 patients discharged from a psychiatric inpatient stay with a diagnosis of major depressive disorder, 39.4% and 75.8% received an outpatient visit within 7 and 30 days of discharge, respectively; 58.7% of patients received adequate antidepressant coverage (72 of 90 days) and 12.9% received adequate psychotherapy encounters (8 visits). Receipt of outpatient mental health visits and of adequate psychotherapy were less likely among patients who were male, aged >35 or <65 years, had >3 major general medical comorbidities, lived >30 miles from a VHA clinic, or whose hospital length of stay was <7 days. Patients with comorbid substance use disorders were less likely to receive adequate antidepressant treatment., Conclusions: To optimize evidence-based depression care after a psychiatric hospitalization, health systems might increase receipt of psychotherapy by considering potential barriers related to age, medical condition, and distance. Patients with comorbid substance use disorders or their providers may need additional services to support antidepressant treatment.

Published
2011

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