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      Depression screening and treatment among uninsured populations in Primary Care Translated title: Detección y tratamiento de la depresión en poblaciones sin seguro médico en Atención Primaria


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          Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients ( N = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, n = 7,935) and 24% ( n = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan ( n = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.

          Translated abstract

          Poblaciones sin seguro médico tienen un compromiso deficiente con el tratamiento médico y menos probabilidad de recibir intervenciones basadas en evidencia para la depresión. El objetivo fue examinar retrospectivamente detección, diagnóstico y tratamiento de depresión entre pacientes sin seguro médico en Atención Primaria. Se incluyó a pacientes ( N = 11.803) atendidos en nueve clínicas comunitarias. Las variables fueron detección de depresión y/o diagnóstico de depresión, inicio del consumo de antidepresivos, visitas al proveedor de salud mental y medidas de seguimiento. Los planes de tratamiento de una submuestra de pacientes con depresión se analizaron mediante la recopilación del número de visitas a salud mental y uso de antidepresivos durante seis meses después del diagnóstico. La utilización de la herramienta de detección de depresión fue alta (67%, n = 7.935) y 24% ( n = 2.789) en pacientes diagnosticados de depresión. Más de la mitad de los pacientes no tenían plan de tratamiento registrado ( n = 1.474). Las probabilidades de uso de antidepresivos y visitas a proveedores de salud mental para pacientes hispanos fueron mayores que para pacientes no hispanos. La detección universal con medidas breves en Atención Primaria está mejorando, pero el tratamiento de la depresión sigue siendo difícil de alcanzar para poblaciones sin seguro.

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          Most cited references20

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          The Patient Health Questionnaire-2: validity of a two-item depression screener.

          A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
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            Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review.

            Evidence-based practice involves the consideration of efficacy and effectiveness, clinical expertise, and patient preference in treatment selection. However, patient preference for psychiatric treatment has been understudied. The aim of this meta-analytic review was to provide an estimate of the proportion of patients preferring psychological treatment relative to medication for psychiatric disorders. A literature search was conducted using PubMed, PsycINFO, and the Cochrane Collaboration library through August 2011 for studies written in English that assessed adult patient preferences for the treatment of psychiatric disorders. The following search terms and subject headings were used in combination: patient preference, consumer preference, therapeutics, psychotherapy, drug therapy, mental disorders, depression, anxiety, insomnia, bipolar disorder, schizophrenia, substance-related disorder, eating disorder, and personality disorder. In addition, the reference sections of identified articles were examined to locate any additional articles not captured by this search. Studies that assessed preferred type of treatment and included at least 1 psychological treatment and 1 pharmacologic treatment were included. Of the 644 articles identified, 34 met criteria for inclusion. Authors extracted relevant data including the proportion of participants reporting preference for psychological or pharmacologic treatment. The proportion of adult patients preferring psychological treatment was 0.75 (95% CI, 0.69-0.80), which was significantly higher than equivalent preference (ie, higher than 0.50; P < .001). Sensitivity analyses suggested that younger patients (P = .05) and women (P < .01) were significantly more likely to choose psychological treatment. A preference for psychological treatment was consistently evident in both treatment-seeking and unselected (ie, non-treatment-seeking) samples (P < .001 for both) but was somewhat stronger for unselected samples. Aggregation of patient preferences across diverse settings yielded a significant 3-fold preference for psychological treatment. Given evidence for enhanced outcomes among those receiving their preferred psychiatric treatment and the trends for decreasing utilization of psychotherapy, strategies to maximize the linkage of patients to preferred care are needed. © Copyright 2013 Physicians Postgraduate Press, Inc.
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              Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement.

              Update of the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for depression in adults.

                Author and article information

                Int J Clin Health Psychol
                Int J Clin Health Psychol
                International Journal of Clinical and Health Psychology : IJCHP
                Asociacion Espanola de Psicologia Conductual
                10 April 2021
                Sep-Dec 2021
                10 April 2021
                : 21
                : 3
                [a ]Department of Psychiatry, UT Southwestern Medical Center, United States
                [b ]School of Social Work, University of Texas at Arlington, United States
                [c ]Center for Applied Health Research, Baylor Scott and White Research Institute, United States
                [d ]Health Science Center Permian Basin, Texas Tech University, United States
                Author notes
                [* ]Corresponding author: School of Social Work, 211 South Cooper Street, Arlington, TX, 76019, United States. ksanchez@ 123456uta.edu
                S1697-2600(21)00022-3 100241
                © 2021 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Brief Report

                depression,measurement-based care,health disparities,hispanic,descriptive study,depresión,cuidado basado en medidas,disparidades de salud,hispanos,estudio descriptivo


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