National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 172 Research Studies DisplayedIsbell LM, Graber ML, Rovenpor DR
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
The purpose of this randomized experiment study was to investigate the influence of comorbid depression on diagnostic accuracy. The researchers utilized an interactive vignette that described a patient with a complex presentation of pernicious anemia. Fifty-nine physician participants were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. The study found that the patient with comorbid depression was less likeable than the control patient. Accuracy of diagnosis was lower in the depression condition compared to the control condition, but this difference was not statistically significant. Accuracy was lower in the depression condition (vs. control) when physicians ordered less tests, but there was no variation for physicians who ordered more tests.
AHRQ-funded; HS025752.
Citation: Isbell LM, Graber ML, Rovenpor DR .
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
Diagnosis 2023 Aug; 10(3):257-66. doi: 10.1515/dx-2020-0106..
Keywords: Depression, Behavioral Health
Acolin J, Cadigan JM, Fleming CB
Trajectory of depressive symptoms in the context of romantic relationship breakup: characterizing the “natural course” of response and recovery in young adults.
This study’s objective was to characterize the trajectory of depressive symptoms before, during, and after relationship breakup in young adults and to examine subjective appraisal and sense of control. The authors used the PHQ-2 survey to screen for depressive symptoms. In their sample of participants reporting a single breakup during the 2-year study period (N = 156), breakup was associated with a temporary increase in depressive symptoms that returned to pre-breakup levels within 3 months. They observed increased symptoms among negatively appraised, but not positive or neutral, events. The lower the sense of control, the more depressive symptoms were demonstrated at all time points.
AHRQ-funded; HS013853.
Citation: Acolin J, Cadigan JM, Fleming CB .
Trajectory of depressive symptoms in the context of romantic relationship breakup: characterizing the “natural course” of response and recovery in young adults.
Emerging Adulthood 2023 Oct; 11(5):1211-22. doi: 10.1177/21676968231184922..
Keywords: Depression, Young Adults, Behavioral Health
Lewis A, Howland RE, Horwitz LI
Medicaid value-based payments and health care use for patients with mental illness.
This retrospective cohort study’s objective was to investigate if New York State's Medicaid value-based payment reform was associated with improved utilization patterns for patients with mental illness (major depression disorder, bipolar disorder, and/or schizophrenia). The cohort included Medicaid 306,290 individuals with depression (67.4% female; mean age, 38.6 years), 85,105 patients with bipolar disorder (59.6% female; mean age, 38.0 years), and 71,299 patients with schizophrenia (45.1% female mean age, 40.3 years). After adjustment, the analysis estimated a statistically significant, positive association between value-based payments and behavioral health visits for patients with depression (0.91 visits) and bipolar disorder (1.01 visits). There were no statistically significant changes to primary care visits for patients with depression and bipolar disorder, but value-based payments were associated with reductions in primary care visits for patients with schizophrenia (-1.31 visits). In every diagnostic population, value-based payment was associated with significant reductions in mental health emergency department visits (population with depression: -0.01 visits; population with bipolar disorder: -0.02 visits; population with schizophrenia: -0.04 visits).
AHRQ-funded; HS026980; HS026120.
Citation: Lewis A, Howland RE, Horwitz LI .
Medicaid value-based payments and health care use for patients with mental illness.
JAMA Health Forum 2023 Sep; 4(9):e233197. doi: 10.1001/jamahealthforum.2023.3197..
Keywords: Medicaid, Behavioral Health, Payment, Depression
Titus AR, Mezuk B, Hirschtick JL
Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.
Researchers examined the intersection of demographic, economic, and illness-related predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan. Data were taken from a population-based survey of Michigan adults who experienced a COVID-19 diagnosis prior to August 2020. Results indicated that relative risks for experiencing poor mental health outcomes varied by race/ethnicity, sex, age, and income. Symptom severity was associated with a higher burden of comorbid depressive/anxiety symptoms. "Long COVID" was associated with all outcomes. The researchers concluded that because of overlapping risk factors, integrated approaches to treating depressive/anxiety symptoms among COVID-19 survivors is warranted.
AHRQ-funded; HS026120.
Citation: Titus AR, Mezuk B, Hirschtick JL .
Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.
Soc Psychiatry Psychiatr Epidemiol 2023 Jul; 58(7):1099-108. doi: 10.1007/s00127-023-02453-9..
Keywords: COVID-19, Depression, Anxiety, Behavioral Health
O'Connor EA, Perdue LA, Coppola EL
Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force.
The objectives of this article were to review the benefits and harms of depression and suicide risk screening and treatment and the accuracy of instruments to detect these conditions in primary care patients. Evidence gathered from the literature search supported screening for depression in primary care settings, including during pregnancy and postpartum. The authors noted, however, that there were numerous important gaps in the evidence for suicide risk screening.
AHRQ-funded; 290201500011I; 75Q80120D00004.
Citation: O'Connor EA, Perdue LA, Coppola EL .
Depression and suicide risk screening: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Jun 20; 329(23):2068-85. doi: 10.1001/jama.2023.7787..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Depression, Behavioral Health, Evidence-Based Practice, Guidelines, Risk
Steiger KG, Boehmer KR, Klanderman MC
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
The objective of this study was to create a model based on patients' characteristics that predicted the number of burdens reported using the ICAN Discussion Aid, in order to target use of this tool to the patients most likely to benefit. Participants were 635 adult patients who completed the ICAN Aid at a Scottsdale, Arizona, family medicine clinic; patient characteristics were gathered from their health records. The results showed that the number of burdens a patient will report on the ICAN Aid can be approximated based on certain patient characteristics. Adults with major depression, a BMI of 26 or greater, and those of a younger age may have greater reported burdens on ICAN. The authors noted that these finding will need to be validated in independent samples.
AHRQ-funded; HS026379; HS026379.
Citation: Steiger KG, Boehmer KR, Klanderman MC .
Who is most burdened in health care? An analysis of responses to the ICAN Discussion Aid.
J Am Board Fam Med 2023 Apr 3;36(2):277-88. doi: 10.3122/jabfm.2022.220251R1.
Keywords: Depression, Behavioral Health
Franco MI, Staab EM, Zhu M
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
Utilizing patient portals in a population health framework for depression screening presents a potentially effective method for proactively engaging and identifying individuals with depression. The purpose of this study was to evaluate the efficacy of a population health-based depression screening compared to in-clinic screening alone in detecting patients with depression. A practical clinical trial conducted at an urban, academic, tertiary care center's adult internal medicine outpatient clinic included a total of 2713 eligible adult patients due for depression screening with active portal accounts. Patients with known depression or bipolar disorder, and those who had been screened within the previous year were excluded. Participants were randomly allocated to receive either usual care (n = 1372) or population health care (n = 1341). In the usual care group, medical assistants screened patients during clinic visits. In the population health care group, patients were sent portal-based letters inviting them to complete an online screener, irrespective of appointment status. The Computerized Adaptive Test for Mental Health (CAT-MH™) was used for both in-clinic and portal-based screenings. The study found that the population health care group displayed a higher depression screening rate compared to the usual care group (43% (n = 578) vs. 33% (n = 459), p < 0.0001). Additionally, the rate of positive screens was greater in the population health care group than in the usual care group (10% (n = 58) vs. 4% (n = 17), p < 0.001).
AHRQ-funded; HS26151
Citation: Franco MI, Staab EM, Zhu M .
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
J Gen Intern Med 2023 Mar;38(4):857-64. doi: 10.1007/s11606-022-07779-9.
Keywords: Depression, Behavioral Health, Screening, Health Information Technology (HIT)
Steenland MW, Trivedi AN
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
This study examined the association of Medicaid expansion in Arkansas with postpartum antidepressant prescription fills and antidepressant continuation and supply during the first 6 months postpartum. This cohort study used data comparing persons with Medicaid and commercially financed childbirth using Arkansas' All-Payer Claims Database (2013-2016). A total of 60,990 births were included, with 72% of births paid for by Medicaid and 28% paid by a commercial payer. Before expansion, 4.2% of people with a Medicaid-paid birth filled an antidepressant prescription in the later postpartum period. Medicaid expansion was associated with a 4.6 percentage point increase in the likelihood, or a relative change of 110%, in this outcome. Among people with early postpartum depression, Medicaid expansion increased the continuity of antidepressant treatment by 20.5 percentage points and the number of days with antidepressant supply in the later postpartum period by 14.1 days.
AHRQ-funded; HS027464.
Citation: Steenland MW, Trivedi AN .
Association of Medicaid expansion with postpartum depression treatment in Arkansas.
JAMA Health Forum 2023 Feb; 4(2):e225603. doi: 10.1001/jamahealthforum.2022.5603..
Keywords: Depression, Behavioral Health, Medicaid, Maternal Care, Women, Access to Care
Crits-Christoph P, Gallop R, Duong L
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Keywords: Depression, Behavioral Health, Research Methodologies
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
Optional keywords: mental psychotherapy
Summary
The purpose of this study was to investigate the optimal statistical model for analyzing time effects in psychotherapy randomized trials, specifically when the primary outcome involves repeated assessments of depression symptoms. The researchers utilized data from three studies comparing psychotherapy treatments for major depressive disorder. Self-report ratings were used in Study 1 (N=237) and Study 2 (N=100), while clinician ratings were utilized in Study 3 (N=120). Depression symptoms were assessed at every session in Studies 1 and 2 and monthly in Study 3. Time patterns examined included linear, quadratic, cubic, logarithmic transformation of time, piecewise linear, and unstructured models. The researchers found that in Study 1, a logarithmic-linear model demonstrated the best fit. Study 2 found that all models had negligible support compared to the unstructured model, which was the best fitting. In Study 3, although the cubic model displayed the best fit, it was not significantly superior to the log-linear or unstructured model. The study concluded that when evaluating repeated measures of depression symptoms as the primary outcome, trials should consistently compare various time models, including an unstructured model.
AHRQ-funded; HS018440
Citation: Crits-Christoph P, Gallop R, Duong L .
Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time.
Psychother Res 2023 Feb;33(2):158-72. doi: 10.1080/10503307.2022.2073289.
Keywords: Depression, Behavioral Health, Research Methodologies
Moise N, Paniagua-Avila A, Barbecho JM
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
This study used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. The goal is to optimize depression treatment in primary care clinics using the Transform DepCare shared decision-making and psychoeducation patient tool. The authors applied the Behaviour Change Wheel to their prior mixed methods to identify key sustainability behaviors and determinants of sustainability. The authors enlisted 22 national and local stakeholders to operationalize and adapt a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. They identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. They determined that a waiting room that delivered DepCare, the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key improvements would include expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).
AHRQ-funded; HS025198.
Citation: Moise N, Paniagua-Avila A, Barbecho JM .
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
Implement Sci Commun 2023 Jan 25; 4(1):10. doi: 10.1186/s43058-022-00383-2..
Keywords: Depression, Primary Care, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
McQuillan J, Andersen JA, Berdahl TA
AHRQ Author: Berdahl TA
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
The objective of this study was to examine associations between changes in Rheumatoid Arthritis symptoms and depressive symptoms and to test if these associations differed by education, or gender, or race/ethnicity. Data was taken from the National Rheumatoid Arthritis Study, 1988-98. The results indicated that people with Rheumatoid Arthritis experienced increases in depressive symptoms as well as pain, functional disability, and household work disability over the study period. There was no difference noted in the rate of change in depressive symptoms by education, gender, nor race/ethnicity, but the association of functional disability with depressive symptoms was stronger for men than women. The researchers concluded that it is important to monitor and treat both mental and physical health symptoms, and that future research should focus on the collection of data that reflects the educational, gender, and racial/ethnic diversity of people with Rheumatoid Arthritis.
AHRQ-authored.
Citation: McQuillan J, Andersen JA, Berdahl TA .
Associations of rheumatoid arthritis and depressive symptoms over time: are there differences by education, race/ethnicity, and gender?
Arthritis Care Res 2022 Dec;74(12):2050-58. doi: 10.1002/acr.24730..
Keywords: Arthritis, Depression, Behavioral Health, Racial and Ethnic Minorities, Sex Factors, Chronic Conditions
Ortiz D, Perkins AJ, Fuchita M
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
The purpose of this retrospective post-hoc analysis study was to evaluate variations in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Data from the Trauma Medical Home, a multicenter randomized controlled trial was used for analysis. The study found that almost 50% of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9, and 41% of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at the baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) were more likely to have experienced at least mild depression at the time of hospital discharge after traumatic injury.
AHRQ-funded; HS026390.
Citation: Ortiz D, Perkins AJ, Fuchita M .
Pre-existing anxiety and depression in injured older adults: an under-recognized comorbidity with major health implications.
Ann Surg Open 2022 Dec; 3(4):e217. doi: 10.1097/as9.0000000000000217..
Keywords: Elderly, Anxiety, Depression, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Injuries and Wounds
Viswanathan M, Wallace IF, Cook Middleton J
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors sought to review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force. They found indirect evidence that suggested some screening instruments were reasonably accurate for detecting depression. Further, psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.
AHRQ-funded; 290201500011I.
Citation: Viswanathan M, Wallace IF, Cook Middleton J .
Screening for depression and suicide risk in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Oct 18;328(15):1543-56. doi: 10.1001/jama.2022.16310..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Depression, Behavioral Health, Screening, Primary Care, Guidelines, Evidence-Based Practice, Prevention
Brodney S, Valentine KD, Vo HA
Measuring shared decision making in younger and older adults with depression.
This study compared shared decision making (SDM) of younger (18-39 years) and older (40-75 years) patients for starting or stopping depression treatment. A panel of 494 respondents completed one of two versions of the SDM Process scale that differed in wording of pros and cons items, and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider, or together). SDM Process scores were higher for younger respondents than older respondents. Higher scores were also associated with no decisional conflict and less decision regret.
AHRQ-funded; HS025718.
Citation: Brodney S, Valentine KD, Vo HA .
Measuring shared decision making in younger and older adults with depression.
Int J Qual Health Care 2022 Oct 12;34(4):mzac076. doi: 10.1093/intqhc/mzac076..
Keywords: Shared Decision Making, Depression, Behavioral Health
Richmond J, Sanderson M, Shrubsole MJ
Psychosocial impact of COVID-19 among adults in the southeastern United States.
The authors investigated factors associated with depressive and anxiety symptoms during the COVID-19 pandemic. Using data from the Southern Community Cohort Study (SCCS), their results overall suggested that individuals in fair/poor health, living alone, and/or experiencing decreased physical activity and vegetable/fruit consumption have higher risk of depressive and anxiety symptoms. They recommended clinical and public health interventions to support individuals experiencing depression and anxiety during the COVID-19 pandemic.
AHRQ-funded; HS026122.
Citation: Richmond J, Sanderson M, Shrubsole MJ .
Psychosocial impact of COVID-19 among adults in the southeastern United States.
Prev Med 2022 Oct;163:107191. doi: 10.1016/j.ypmed.2022.107191..
Keywords: COVID-19, Anxiety, Depression, Behavioral Health, Public Health
Ivlev I, Beil TL, Haynes JS
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
This rapid evidence review was conducted to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. An extensive literature review was done through December 6, 2021 for controlled trials conducted in settings highly applicable to the US. Additionally, the authors searched relevant systematic reviews for eligible studies. They identified 12 trials that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to other therapies in improving depression symptoms immediately, but not at a longer follow-up. There did not appear to be an increased risk for suicidal attempts or ideation with dCBT, however the number of events was very small. Potential barriers to implementing and maintaining dCBT included challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. No data on harms or unintended negative consequences were reported in the included studies.
AHRQ-funded; HS026370.
Citation: Ivlev I, Beil TL, Haynes JS .
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
J Adolesc Health 2022 Jul;71(1):14-19. doi: 10.1016/j.jadohealth.2022.01.220..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
King C, Goldstein E, Crits-Christoph P
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
The purpose of this study was to: examine the comorbidities of mental health issues and a medical condition in a community mental health setting with a primarily Medicare and Medicaid population; describe the range of comorbid medical conditions in this setting; and explore the association between medical conditions on the alliance, attrition from services and outcome. The researchers accessed patient charts and conducted structured clinical interviews to collect medical diagnoses from 353 participants who had previously had a baseline evaluation as a participant in a study of therapies for major depressive disorder. The researchers reported that a high percentage of patients in the study experienced a comorbid medical condition. There were no significant correlations between the number of medical conditions and treatment outcome or early attrition from treatment. Further analyses revealed that the presence of a nervous system disorder was correlated with poorer treatment outcomes. The researchers concluded that patients undergoing treatment for major depressive disorder may benefit from simultaneously attending to the impact of medical conditions on physical functioning.
AHRQ-funded; HS018440.
Citation: King C, Goldstein E, Crits-Christoph P .
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
Psychotherapy 2022 Jun;59(2):199-208. doi: 10.1037/pst0000380..
Keywords: Depression, Behavioral Health, Community-Based Practice
Mitchell SE, Reichert M, Howard JM
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
The purpose of this randomized controlled trial study was to assess whether post-discharge depression treatment will benefit hospitalized patients by reducing readmissions. Participants included hospitalized patients with a patient health questionnaire-9 score of 10 or higher. The researchers delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention. The study found that at 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission or reutilization. The intention-to-treat analysis also showed no differences at 90 days in readmission or reutilization. In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions. The study concluded that unplanned hospital use can be decreased with post-discharge treatment of depression and support for care transition.
AHRQ-funded; HS019700.
Citation: Mitchell SE, Reichert M, Howard JM .
Reducing readmission of hospitalized patients with depressive symptoms: a randomized trial.
Ann Fam Med 2022 May-Jun;20(3):246-54. doi: 10.1370/afm.2801..
Keywords: Depression, Behavioral Health, Hospital Readmissions, Hospital Discharge, Transitions of Care
Khodneva Y, Goyal P, Levitan EB
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
The purpose of this study was to determine whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). The study found that over a median of 9.2 years of follow-up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age-adjusted HF hospitalization incidence rates per 1000 person-years were 4.9 for participants with depressive symptoms compared with 3.2 for participants without depressive symptoms. For overall HF, the elevated risk lessened after controlling for covariates. Among those without baseline CHD, when HFpEF was evaluated separately, after controlling for all covariates, depressive symptoms were related with incident hospitalization. In contrast, depressive symptoms were not related with incident HFrEF hospitalizations. The researchers concluded that among individuals without CHD at baseline, depressive symptoms were related with incident hospitalization for HFpEF, but not for those with baseline CHD or HFrEF.
AHRQ-funded; HS013852.
Citation: Khodneva Y, Goyal P, Levitan EB .
Depressive symptoms and incident hospitalization for heart failure: findings From the REGARDS Study.
J Am Heart Assoc 2022 Apr 5;11(7):e022818. doi: 10.1161/jaha.121.022818..
Keywords: Depression, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk
Morden E, Byron S, Roth L
Health plans struggle to report on depression quality measures that require clinical data.
This study examined challenges and opportunities for reporting 5 HEDIS measures which used electronic clinical data to assess adolescent and perinatal depression care quality. Two learning collaboratives were convened with 10 health plans from 5 states. The authors conducted analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. The challenges most reported included: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices.
AHRQ-funded; HS025296.
Citation: Morden E, Byron S, Roth L .
Health plans struggle to report on depression quality measures that require clinical data.
Acad Pediatr 2022 Apr;22(3s):S133-s39. doi: 10.1016/j.acap.2021.09.022..
Keywords: Children/Adolescents, Depression, Behavioral Health, Quality Indicators (QIs), Quality Measures, Quality of Care
Crockett KB, Borgatti A, Tan F
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
This study examined the role that weight discrimination and race is associated with pre-treatment depressive symptoms. A cohort of Black and White adults were enrolled in a 16-week obesity intervention treatment (N = 271; mean BMI = 35.7 kg/m2); 59% Black; 92% women). They reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Their weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. Participants with a history of weight discrimination scored 2.4 points higher on the CES-D and lost 2% less weight relative to those without weight discrimination. Race modified the association between weight discrimination and treatment session attendance, such that Black participants attended fewer sessions if they had prior experience of weight discrimination. However, this association was not true among White individuals.
AHRQ-funded; HS013852.
Citation: Crockett KB, Borgatti A, Tan F .
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
Int J Behav Med 2022 Apr;29(2):152-59. doi: 10.1007/s12529-021-10009-x..
Keywords: Obesity, Obesity: Weight Management, Behavioral Health, Racial and Ethnic Minorities, Depression
Wright JH, Owen J, Eells TD
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. The purpose of this study was to evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.
AHRQ-funded; HS024047.
Citation: Wright JH, Owen J, Eells TD .
Effect of computer-assisted cognitive behavior therapy vs usual care on depression among adults in primary care: a randomized clinical trial.
JAMA Netw Open 2022 Feb;5(2):e2146716. doi: 10.1001/jamanetworkopen.2021.46716..
Keywords: Depression, Behavioral Health, Primary Care, Treatments, Comparative Effectiveness
Tuteja S, Salloum RG, Elchynski AL
Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide antidepressant therapy.
This paper looked at how sites implement or plan implementation of pharmacogenetic (PGx) testing to guide antidepressant therapy. The authors administered two surveys at 17 sites that had implemented or were in the process of implementing PGx testing for antidepressants. The first survey (Survey 1) collected data on the process and logistics of testing, and the second survey (Survey 2) asked sites to rank the importance of Consolidated Framework for Implementation Research (CFIR) constructs using best-worst scaling choice experiments. Four of the sites were still in the planning stage, 13 offered testing in the outpatient setting, and nine in both outpatient/inpatient settings. PGx tests were mainly ordered by psychiatrists (92%) and primary care (69%) providers. Justification for antidepressants selected for PGx guidance was based on Clinical Pharmacogenetics Implementation Consortium guidelines (94%) and US Food and Drug Administration (FDA; 75.6%) guidance. Both institutional and commercial laboratories were used for testing. Sites were consistent in ranking Consolidated Framework for Implementation Research (CFIR) constructs and identified patient needs/resources, leadership engagement, intervention knowledge/beliefs, evidence strength and quality, and the identification of champions as most important for implementation. Key drivers for implementation were similar across sites and may help guide other institutions interested in providing PGx-guided pharmacotherapy for antidepressant management.
AHRQ-funded; HS026379.
Citation: Tuteja S, Salloum RG, Elchynski AL .
Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide antidepressant therapy.
Clin Transl Sci 2022 Feb; 15(2):371-83. doi: 10.1111/cts.13154..
Keywords: Medication, Depression, Behavioral Health, Genetics
Sun N, Hua CL, Qiu X
Urban and rural differences in trajectories of depressive symptoms in later life in the United States.
This research had two primary goals: to examine the relationship between urban residence and trajectories of depressive symptoms and to investigate whether this relationship differs by social isolation and loneliness. The investigators conducted latent growth curve analysis to predict both baseline and trajectories of depression based on urban or rural residency. Findings of this study served to better understand how social and geographic contexts shaped long-term well-being of older adults.
AHRQ-funded; HS000011.
Citation: Sun N, Hua CL, Qiu X .
Urban and rural differences in trajectories of depressive symptoms in later life in the United States.
J Appl Gerontol 2022 Jan;41(1):148-57. doi: 10.1177/0733464820972527..
Keywords: Elderly, Rural Health, Depression, Behavioral Health