Devon K Check1, Marilyn L Kwan2, Neetu Chawla3, Stacie B Dusetzina4, Emily Valice2, Isaac J Ergas2, Janise M Roh2, Tatjana Kolevska5, Donald L Rosenstein6, Lawrence H Kushi2. 1. Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: devon.check@duke.edu. 2. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. 3. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA. 4. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 5. Kaiser Permanente Northern California Vallejo Medical Center, Vallejo, California, USA. 6. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract
CONTEXT: Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival. OBJECTIVE: Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics. METHODS: This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription). RESULTS: Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88). CONCLUSION: Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.
CONTEXT: Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival. OBJECTIVE: Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics. METHODS: This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription). RESULTS: Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88). CONCLUSION: Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.
Authors: Devon K Check; Neetu Chawla; Marilyn L Kwan; Laura Pinheiro; Janise M Roh; Isaac J Ergas; Anita L Stewart; Tatjana Kolevska; Christine Ambrosone; Lawrence H Kushi Journal: Breast Cancer Res Treat Date: 2018-04-05 Impact factor: 4.872
Authors: Beth Waitzfelder; Christine Stewart; Karen J Coleman; Rebecca Rossom; Brian K Ahmedani; Arne Beck; John E Zeber; Yihe G Daida; Connie Trinacty; Samuel Hubley; Gregory E Simon Journal: J Gen Intern Med Date: 2018-02-08 Impact factor: 5.128
Authors: Marilyn L Kwan; Christine B Ambrosone; Marion M Lee; Janice Barlow; Sarah E Krathwohl; Isaac Joshua Ergas; Christine H Ashley; Julie R Bittner; Jeanne Darbinian; Keren Stronach; Bette J Caan; Warren Davis; Susan E Kutner; Charles P Quesenberry; Carol P Somkin; Barbara Sternfeld; John K Wiencke; Shichun Zheng; Lawrence H Kushi Journal: Cancer Causes Control Date: 2008-05-14 Impact factor: 2.506
Authors: Jane Walker; Christian Holm Hansen; Paul Martin; Stefan Symeonides; Ravi Ramessur; Gordon Murray; Michael Sharpe Journal: Lancet Psychiatry Date: 2014-08-28 Impact factor: 27.083