The interdependence of behavioral and somatic health: implications for conceptualizing health and measuring treatment outcomes

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Abstract

Purpose

The interdependence of behavioral and somatic aspects of various health conditions warrants greater emphasis on an integrated care approach.

Theory

We propose that integrated approaches to health and wellness require comprehensive and empirically-valid outcome measures to assess quality of care.

Method

We discuss the transition from independent to integrated treatment approaches and provide examples of new systems for integrated assessment of treatment outcome.

Results

Evidence suggests that support for an independent treatment approach is waning and momentum is building towards more integrated care. In addition, research evidence suggests integrated care improves health outcomes, and both physicians and patients have favorable impressions of integrated care.

Conclusions

As treatment goals in the integrated perspective expand to take into account the intimate relationships among mental illness, overall health, and quality of life, clinicians need to develop outcome measures that are similarly comprehensive.

Discussion

Increased recognition, by researchers, providers, and insurers, of the interdependence between behavioral and physical health holds great promise for innovative treatments that could significantly improve patients' lives.

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Most cited references 72

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The prevalence of comorbid depression in adults with diabetes: a meta-analysis.

Judy Anderson, P Lustman, Melvin E. Clouse … (2001)

To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.

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Depression and poor glycemic control: a meta-analytic review of the literature.

P Lustman, Paul Carney, Melvin E. Clouse … (2000)

Depression is common among patients with diabetes, but its relationship to glycemic control has not been systematically reviewed. Our objective was to determine whether depression is associated with poor glycemic control. Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, calculate effect sizes (ESs), and statistically analyze the collective data. A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13-0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than self-report questionnaires were used to assess depression (ES 0.28 vs. 0.15). Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the long-term course of diabetes.

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Toward a syndrome model of addiction: multiple expressions, common etiology.

Howard J Shaffer, Debi A LaPlante, Richard A LaBrie … (2015)

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Author and article information

Contributors

: Role: EdD,

Harvard Medical School, Division on Addictions, 101 Station Landing, 2nd floor, Medford, MA 02155, USA

: Role: PhD,

Harvard Medical School, Division on Addictions, 101 Station Landing, 2nd floor, Medford, MA 02155, USA

: Role: MPH,

Cambridge Health Alliance, Division on Addictions, 101 Station Landing, Second Floor, Medford, MA 02155, USA

: Role: PhD, MBA,

Corporate Clinical Department, ValueOptions, 240 Corporate Blvd, Norfolk, VA 23502, USA

: Role: PhD,

Research and Outcomes Department, ValueOptions, 7286 Southampton Lane, West Chester, OH 45069, USA

: Role: MD,

Medical Affairs Department, Massachusetts Behavioral Health Partnership, ValueOptions, 150 Federal Street, Boston, MA 02110, USA

: Role: PhD,

Research and Outcomes Department, ValueOptions, Inc., 520 Pleasant Valley Road, Trafford, PA 1508, USA

: Role: PhD,

Harvard Graduate School of Education, 8 Story Street, 5th Floor, Cambridge, MA 02138, USA

: Role: PhD, CAS,

Harvard Medical School, Division on Addictions, 101 Station Landing, 2nd floor, Medford, MA 02155, USA

Journal

Journal ID (nlm-ta): Int J Integr Care

Journal ID (publisher-id): IJIC

Title: International Journal of Integrated Care

Publisher: Igitur, Utrecht Publishing & Archiving (Utrecht, The Netherlands )

ISSN (Electronic): 1568-4156

Publication date Collection: Apr-Jun 2007

Publication date (Electronic): 16 May 2007

Volume: 7

Electronic Location Identifier: e10

Affiliations