Six-month longitudinal patterns of mental health treatment utilization by older adults with depressive symptoms.
ABSTRACT Aims of the study were to describe behavioral health treatment utilization patterns of community-dwelling older adults with depressive symptoms over a six-month period and to identify factors associated with treatment use, guided by a theoretical model emphasizing the dynamic nature of treatment use patterns over time and social context.
A total of 144 participants ≥65 years old with depressive symptoms completed an in-person baseline interview and six monthly telephone follow-up interviews. Outcomes at each follow-up included the use of antidepressants or counseling. Covariates included personal and social context variables.
Approximately half of the participants (N=70, 48%) received no formal treatment (antidepressant prescription or counseling). Treatment use or nonuse did not change for most participants. More participants with severe symptoms received antidepressants (25%-37%) than did those with milder symptoms (10%-14%), although more participants in the latter group started (milder, 62%,versus severe, 49%) and stopped (milder, 77%, versus severe, 26%) antidepressant treatment at least once. Fewer individuals received counseling overall, with no clear patterns by symptom severity. In multivariate longitudinal analyses, treatment use at follow-up was independently associated with younger age, current major depressive episode, baseline use of antidepressant, intention to begin a new treatment at baseline, and receipt of advice to seek treatment.
Over a six-month period, most older adults with depressive symptoms in this study continued their use or nonuse of mental health treatment. Demographic, need, attitudinal, and social variables were related to treatment use over time. Addressing intentions and providing advice may facilitate treatment seeking.
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ABSTRACT: Among lung cancer patients, depression has been associated with increased mortality, although the mechanisms are unknown. We evaluated the association of depression with mortality and receipt of cancer therapies among depressed veterans with lung cancer. A retrospective, cohort study of lung cancer patients in the Veterans Affairs-Northwest Health Network from 1995 to 2010. Depression was defined by ICD-9 coding within 24 months before lung cancer diagnosis. Multivariable Cox proportional analysis and logistic regression were used. In total, 3869 lung cancer patients were evaluated; 14% had a diagnosis of depression. A diagnosis of depression was associated with increased mortality among all stage lung cancer patients (hazard ratio = 1.14, 95% confidence interval: 1.03-1.27, P = 0.01). Among early-stage (I and II) non-small cell lung cancer (NSCLC) patients, the hazard ratio was 1.37 (95% confidence interval: 1.12-1.68, P = 0.003). There was no association of depression diagnosis with surgery (odds ratio = 0.83, 95% confidence interval: 0.56-1.22, P = 0.34) among early-stage NSCLC patients. A depression diagnosis was not associated with mortality (hazard ratio = 1.02, 95% confidence interval: 0.89-1.16, P = 0.78) or chemotherapy (odds ratio = 1.07, 95% confidence interval: 0.83-1.39, P = 0.59) or radiation (odds ratio = 1.04, 95% confidence interval: 0.81-1.34, P = 0.75) receipt among advanced-stage (III and IV) NSCLC patients. Increased utilisation of health services for depression was associated with increased mortality among depressed patients. Depression is associated with increased mortality in lung cancer patients and this association is higher among those with increased measures of depression care utilisation. Differences in lung cancer treatment receipt are probably not responsible for the observed mortality differences between depressed and non-depressed patients. Clinicians should recognise the significant effect of depression on lung cancer survival.Clinical Oncology 09/2013; DOI:10.1016/j.clon.2013.09.001 · 2.83 Impact Factor
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ABSTRACT: OBJECTIVE: This study examined previous mental health service use among low-income homebound middle-aged and older adults who participated in a study testing the feasibility and efficacy of telehealth problem-solving therapy for depression. METHOD: The sample consisted of 188 homebound adults aged 50 years or older. Data on mental health service use were collected at baseline. We used multivariable logistic regression analysis to examine correlates of different types of outpatient service use within the preceding 12 months. RESULTS: Of the subjects, 56% reported mental health service use. Of the users, 80% had made at least one primary care mental health visit, 21% had visited a psychiatrist, and 25% had received counseling. Higher depressive symptom severity scores were positively associated with a psychiatrist visit only. DISCUSSION: The need to improve low-income homebound older adults' access to psychotherapy was clearly evident.Journal of Aging and Health 04/2013; 25(4). DOI:10.1177/0898264313484059 · 1.56 Impact Factor
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ABSTRACT: The present study investigated the temporal association between life event stressors relevant to older adults and depressive symptoms using a micro-longitudinal design (i.e., monthly increments over a six-month period). Existing research on stress and depressive symptoms has not examined this association over shorter time periods (e.g., monthly), over multiple time increments, or within-persons. An in-person initial interview was followed by six monthly interviews conducted by telephone. Community. Data were drawn from a study of 144 community-dwelling older adults with depressive symptoms. Stressful life events were measured using the Geriatric Life Events Scale (GALES), and depressive symptoms were assessed with the Short - Geriatric Depression Scale (S-GDS). Using multilevel modeling, 31% of the S-GDS' and 39% of the GALES' overall variance was due to within-person variability. Females and persons with worse health reported more depressive symptoms. Stressful life events predicted concurrent depressive symptoms, but not depressive symptoms one month later. The lack of a time-lagged relationship suggests that older adults with depressive symptoms may recover more quickly from life stressors than previously thought, although additional research using varying time frames is needed to pinpoint the timing of this recovery as well as to identify older adults at risk of long-term effects of life stressors.The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 07/2013; 22(11). DOI:10.1016/j.jagp.2013.02.008 · 3.52 Impact Factor