BACKGROUND: Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care. OBJECTIVE: Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressed patients receiving primary care at Infectious Disease or General Medicine clinics. DESIGN: Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients. PARTICIPANTS AND MEASURES: The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used. KEY RESULTS: Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infected patients (0.5 days; 95% CI = 0.5, 6, p = 0.04). Compared to mildly-moderately depressed uninfected patients, severely depressed HIV-infected patients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI = 1.07, 2.60), whereas mildly-moderately depressed HIV-infected patients (adjusted HR 1.10, 95% CI = 0.79, 1.52) and severely depressed uninfected patients (adjusted HR 0.93, 95% CI = 0.60, 1.44) were not. CONCLUSIONS: In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infected patients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.
BACKGROUND: Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care. OBJECTIVE: Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressedpatients receiving primary care at Infectious Disease or General Medicine clinics. DESIGN: Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients. PARTICIPANTS AND MEASURES: The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used. KEY RESULTS: Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infectedpatients (0.5 days; 95% CI = 0.5, 6, p = 0.04). Compared to mildly-moderately depressed uninfectedpatients, severely depressed HIV-infectedpatients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI = 1.07, 2.60), whereas mildly-moderately depressed HIV-infectedpatients (adjusted HR 1.10, 95% CI = 0.79, 1.52) and severely depressed uninfectedpatients (adjusted HR 0.93, 95% CI = 0.60, 1.44) were not. CONCLUSIONS: In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infectedpatients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.
Authors: Shawn L Fultz; Joseph L Goulet; Sharon Weissman; David Rimland; David Leaf; Cynthia Gibert; Maria C Rodriguez-Barradas; Amy C Justice Journal: Clin Infect Dis Date: 2005-07-22 Impact factor: 9.079
Authors: Amy C Justice; Elizabeth Dombrowski; Joseph Conigliaro; Shawn L Fultz; Deborah Gibson; Tamra Madenwald; Joseph Goulet; Michael Simberkoff; Adeel A Butt; David Rimland; Maria C Rodriguez-Barradas; Cynthia L Gibert; Kris Ann K Oursler; Sheldon Brown; David A Leaf; Matthew B Goetz; Kendall Bryant Journal: Med Care Date: 2006-08 Impact factor: 2.983
Authors: Mehri S McKellar; Maragatha N Kuchibhatla; Kris Ann K Oursler; Stephen Crystal; Kathleen M Akgün; Kristina Crothers; Cynthia L Gibert; Karen Nieves-Lugo; Julie Womack; Janet P Tate; Gerda G Fillenbaum Journal: AIDS Res Hum Retroviruses Date: 2019-06-18 Impact factor: 2.205
Authors: Joseph L Goulet; Cynthia Brandt; Stephen Crystal; David A Fiellin; Cynthia Gibert; Adam J Gordon; Robert D Kerns; Stephen Maisto; Amy C Justice Journal: Med Care Date: 2013-03 Impact factor: 2.983