Nathan D Shippee1, Brooke H Rosen2, Kurt B Angstman3, Manuel E Fuentes4, Ramona S DeJesus5, Steven M Bruce3, Mark D Williams6. 1. Division of Health Policy and Management, University of Minnesota, 420 Delaware St. SE, D375 Mayo MMC 729, Minneapolis, MN 55455. Electronic address: nshippee@umn.edu. 2. Mayo Medical School, Mayo Clinic. 3. Department of Family Medicine, Mayo Clinic. 4. Department of Psychiatry, Clinica Alemana/Universidad del Desarrollo, Santiago, Chile. 5. Department of Primary Care Internal Medicine, Mayo Clinic. 6. Department of Psychiatry and Psychology, Mayo Clinic.
Abstract
OBJECTIVE: Within a practice-based collaborative care program for depression, we examined associations between positive baseline screens for comorbid mental and behavioral health problems, depression remission and utilization after 1 year. METHODS: This observational study of 1507 depressed adults examined baseline screens for hazardous drinking (Alcohol Use Disorders Identification Test score ≥ 8), severe anxiety (Generalized Anxiety Disorder 7-item score ≥ 15) and bipolar disorder [Mood Disorders Questionnaire (MDQ) positive screen]; 6-month depression remission; primary care, psychiatric, emergency department (ED) and inpatient visits 1 year postbaseline; and multiple covariates. Analyses included logistic and zero-inflated negative binomial regression. RESULTS: At unadjusted baseline, 60.7% had no positive screens beyond depression, 31.5% had one (mostly severe anxiety), 6.6% had two and 1.2% had all three. In multivariate models, positive screens reduced odds of remission versus no positive screens [e.g., one screen odds ratio (OR) = 0.608, p = .000; all three OR = 0.152, p = .018]. Screening positive for severe anxiety predicted more postbaseline visits of all types; severe anxiety plus hazardous drinking predicted greater primary care, ED and inpatient; severe anxiety plus MDQ and the combination of all three positive screens both predicted greater psychiatric visits (all p < .05). Regression-adjusted utilization patterns varied across combinations of positive screens. CONCLUSIONS: Positive screens predicted lower remission. Severe anxiety and its combinations with other positive screens were common and generally predicted greater utilization. Practices may benefit from assessing collaborative care patients presenting with these screening patterns to determine resource allocation.
OBJECTIVE: Within a practice-based collaborative care program for depression, we examined associations between positive baseline screens for comorbid mental and behavioral health problems, depression remission and utilization after 1 year. METHODS: This observational study of 1507 depressed adults examined baseline screens for hazardous drinking (Alcohol Use Disorders Identification Test score ≥ 8), severe anxiety (Generalized Anxiety Disorder 7-item score ≥ 15) and bipolar disorder [Mood Disorders Questionnaire (MDQ) positive screen]; 6-month depression remission; primary care, psychiatric, emergency department (ED) and inpatient visits 1 year postbaseline; and multiple covariates. Analyses included logistic and zero-inflated negative binomial regression. RESULTS: At unadjusted baseline, 60.7% had no positive screens beyond depression, 31.5% had one (mostly severe anxiety), 6.6% had two and 1.2% had all three. In multivariate models, positive screens reduced odds of remission versus no positive screens [e.g., one screen odds ratio (OR) = 0.608, p = .000; all three OR = 0.152, p = .018]. Screening positive for severe anxiety predicted more postbaseline visits of all types; severe anxiety plus hazardous drinking predicted greater primary care, ED and inpatient; severe anxiety plus MDQ and the combination of all three positive screens both predicted greater psychiatric visits (all p < .05). Regression-adjusted utilization patterns varied across combinations of positive screens. CONCLUSIONS: Positive screens predicted lower remission. Severe anxiety and its combinations with other positive screens were common and generally predicted greater utilization. Practices may benefit from assessing collaborative care patients presenting with these screening patterns to determine resource allocation.
Authors: R C Kessler; N A Sampson; P Berglund; M J Gruber; A Al-Hamzawi; L Andrade; B Bunting; K Demyttenaere; S Florescu; G de Girolamo; O Gureje; Y He; C Hu; Y Huang; E Karam; V Kovess-Masfety; S Lee; D Levinson; M E Medina Mora; J Moskalewicz; Y Nakamura; F Navarro-Mateu; M A Oakley Browne; M Piazza; J Posada-Villa; T Slade; M Ten Have; Y Torres; G Vilagut; M Xavier; Z Zarkov; V Shahly; M A Wilcox Journal: Epidemiol Psychiatr Sci Date: 2015-02-27 Impact factor: 6.892