Hannah N Ziobrowski1, Lucinda B Leung2, Robert M Bossarte3, Corey Bryant4, Janelle N Keusch4, Howard Liu5, Victor Puac-Polanco6, Wilfred R Pigeon7, David W Oslin8, Edward P Post9, Alan M Zaslavsky10, Jose R Zubizarreta11, Ronald C Kessler12. 1. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA. 2. Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA. 3. Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA; Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA. 4. Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, USA. 5. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA. 6. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. 7. Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA. 8. VISN 4 Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 9. Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, USA; Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 10. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Statistics, Harvard University, Cambridge, MA, USA. 11. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Statistics, Harvard University, Cambridge, MA, USA; Department of Biostatistics, Harvard University, Cambridge, MA, USA. 12. Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA. Electronic address: kessler@hcp.med.harvard.edu.
Abstract
BACKGROUND: Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates. METHODS: 2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments. RESULTS: Nearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities. LIMITATIONS: The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities. CONCLUSIONS: Although positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.
BACKGROUND:Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates. METHODS: 2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments. RESULTS: Nearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities. LIMITATIONS: The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities. CONCLUSIONS: Although positive screens for psychiatric comorbidity are pervasive among depressed VHApatients, depression severity accounts for most of the associations of these comorbidities with role impairments.
Authors: Hannah N Ziobrowski; Ruifeng Cui; Eric L Ross; Howard Liu; Victor Puac-Polanco; Brett Turner; Lucinda B Leung; Robert M Bossarte; Corey Bryant; Wilfred R Pigeon; David W Oslin; Edward P Post; Alan M Zaslavsky; Jose R Zubizarreta; Andrew A Nierenberg; Alex Luedtke; Chris J Kennedy; Ronald C Kessler Journal: Psychol Med Date: 2022-02-11 Impact factor: 10.592
Authors: Lucinda B Leung; Karen Chu; Danielle Rose; Susan Stockdale; Edward P Post; Kenneth B Wells; Lisa V Rubenstein Journal: JAMA Netw Open Date: 2022-03-01