Approaches to Understanding and Addressing Treatment-Resistant Depression: A Scoping Review

Treatment-resistant depression is associated with significant disability and, due to its high prevalence, results in substantive economic and societal burden at a population level. The objective of this study is to synthesize extant literature on approaches currently being applied to understand and address this condition. It is hoped that the findings can be used to inform practitioners and guide future research. A scoping review of the scientific literature was conducted with findings categorized and charted by underlying research paradigm. Currently, the vast majority of research stems from a biological paradigm (81%). Research on treatment-resistant depression would benefit from a broadened field of study. Given that multiple etiological mechanisms likely contribute to treatment-resistant depression and current efforts at prevention and treatment have substantial room for improvement, an expanded research agenda could more effectively address this significant public health issue

Poster Introductions III--Antipsychotic Utilization in British Columbia from 1997 to 2006

This study examined the prevalent use of antipsychotic medication in British Columbia from 1997 to 2006 among individuals aged 20 and above. Utilization data were obtained from BC’s PharmaNet system – a provincially maintained database that contains prescription dispensation records and demographic information for individuals residing in BC. Using the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification, claim records for Antipsychotics, Atypical Antipsychotics, Butyrophenones, Phenotiazines, Thioxanthenes, and Miscellaneous Antipsychotics were identified in the PharmaNet dataset. Individuals who filled at least 1 antipsychotic prescription in a given year were counted as prevalent users. Results were examined across gender and several age groupings. Preliminary analyses of the results provide evidence for increasing prevalent use from 1997 to 2006. Similarly, initial results suggest prevalent use increases with age, with older age groups (75 and above) exhibiting dramatic jumps in utilization. Results will be discussed in light of the various indications for the use of antipsychotic medications and the various health concerns associated with its prolonged use, particularly among the elderly. Joseph H. Puyat is an MSc student in the School of Population and Public Health (SPPH), Faculty of Medicine, University of British Columbia. He was a project manager and researcher at the Center for Applied Research in Mental Health and Addictions (CARMHA), Faculty of Health Sciences, Simon Fraser University where he worked on various projects including the analysis of the BC provincial prescription database to examine the pharmacoepidemiology of psychotropic drugs, and, the development of supported self-management strategies for the treatment of mood disorders. Before joining CARMHA, he conducted studies on aggression and violence among students groups and wrote research reports examining social psychological processes shaping the Filipino youth\u27s self-concept

Selection of Depression Measures for Use among Vietnamese Populations in Primary Care Settings: A Scoping Review

Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. We reviewed the validity of the instruments as reported in the studies and qualitatively assessed cultural validity and acceptability for use in primary care. We found much variation in the methods used to validate the measures, with an emphasis on criterion validity and reliability. Enhanced evaluation of content and construct validity is needed to ensure validity within diverse cultural contexts such as Vietnam. For effective use in primary care, measures must be further evaluated for their brevity and ease of use. To identify appropriate measures for use in primary care in diverse populations, assessment must balance standard validity testing with enhanced testing for appropriateness in terms of culture, language, and gender and for acceptability for use in primary care

Approaches to Understanding and Addressing Treatment-Resistant Depression: A Scoping Review

Treatment-resistant depression is associated with significant disability and, due to its high prevalence, results in substantive economic and societal burden at a population level. The objective of this study is to synthesize extant literature on approaches currently being applied to understand and address this condition. It is hoped that the findings can be used to inform practitioners and guide future research. A scoping review of the scientific literature was conducted with findings categorized and charted by underlying research paradigm. Currently, the vast majority of research stems from a biological paradigm (81%). Research on treatment-resistant depression would benefit from a broadened field of study. Given that multiple etiological mechanisms likely contribute to treatment-resistant depression and current efforts at prevention and treatment have substantial room for improvement, an expanded research agenda could more effectively address this significant public health issue

Access to and waiting time for psychiatrist services in a Canadian urban area:A study in real time

Objective: To obtain improved quality information regarding psychiatrist waiting times by use of a novel methodological approach in which accessibility and wait times are determined by a real-time patient referral procedure. Method: An adult male patient with depression was referred for psychiatric assessment by a family physician. Consecutive calls were made to all registered psychiatrists ( n = 297) in Vancouver. A semistructured call procedure was used to collect information about the psychiatrists' availability for receipt of this and similar referrals, identify factors that affect psychiatrist accessibility, and determine the availability of cognitive-behavioural therapy (CBT). Results: Efforts were made to contact 297 psychiatrists and 230 (77%) were reached successfully. Among the 230 psychiatrists contacted, 160 (70%) indicated that they were unable to accept the referral. Although 70 (30%) indicated that they might be able to consider accepting a referral, 64 (91% of those who would consider accepting the referral) indicated that they would need to review detailed, written referral information and could not provide estimates of the length of wait times if the patient was to be accepted. Only 6 (3% of the 230 psychiatrists contacted) offered immediate appointment times and their wait times ranged from 4 to 55 days. When asked whether they could provide CBT, most (56%) psychiatrists in clinical practice answered maybe. Conclusions: Substantial barriers exist for family physicians attempting to refer patients for psychiatric referral. Consolidated efforts to improve access to psychiatric assessment are needed. </jats:sec

Factors associated with delayed diagnosis of mood and/or anxiety disorders

Introduction: This study examined the association between time to diagnosis and sociodemographic and clinical characteristics, as well as time to diagnosis and physical and mental health status, among Canadian adults with a self-reported mood and/or anxiety disorder diagnosis. Methods: We used data from the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component. The study sample (n=3212) was divided into three time to diagnosis subgroups: long (> 5 years), moderate (1-5 years) and short (< 1 year). We performed descriptive and multinomial multivariate logistic regression analyses. Estimates were weighted to represent the Canadian adult household population living in the 10 provinces with diagnosed mood and/or anxiety disorders. Results: The majority (61.6%) of Canadians with a mood and/or anxiety disorder diagnosis reported having received their diagnosis more than one year after symptom onset (30.0% reported a moderate delay and 31.6% a long delay). Upon controlling for individual characteristics, we found significant associations between a moderate delay and having no or few physical comorbidities; a long delay and older age; and both moderate and long delays and early age of symptom onset. In addition, a long delay was significantly associated with "poor" or "fair" perceived mental health and the greatest number of activity limitations. Conclusion: These findings affirm that a long delay in diagnosis is associated with negative health outcomes among Canadian adults with mood and/or anxiety disorders. Time to diagnosis is particularly suboptimal among older adults and people with early symptom onset. Tailored strategies to facilitate an early diagnosis for those at greatest risk of a delayed diagnosis, especially for those with early symptom onset, are needed

Facteurs associés au diagnostic tardif d'un trouble de l'humeur et/ou d'anxiété

Introduction : Cette étude examine les relations entre le délai écoulé avant l'établissement d'un diagnostic et les caractéristiques sociodémographiques et cliniques, ainsi que les relations entre ce délai de diagnostic et l'état de santé physique et mental des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété. Méthodologie : L'Enquête sur les personnes ayant une maladie chronique au Canada - Composante sur les troubles de l'humeur et d'anxiété de 2014 a été utilisée pour cette étude. L'échantillon de l'étude (n = 3 212) a été divisé en trois sous-groupes en fonction du délai de diagnostic : long (plus de 5 ans), modéré (1 à 5 ans) et court (moins d'un an). Nous avons réalisé des analyses de régression logistique multivariées descriptives et multinomiales. Nous avons pondéré toutes les estimations afin que les données soient représentatives de la population canadienne adulte vivant en logement privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de troubles de l'humeur et/ou d'anxiété. Résultats : La plupart (61,6 %) des adultes canadiens ayant déclaré avoir reçu un diagnostic de trouble de l'humeur et/ou d'anxiété ont dit avoir reçu leur diagnostic plus d'un an après l'apparition des symptômes (délai modéré : 30,0 %; délai long : 31,6 %). Après ajustement des caractéristiques individuelles, nous avons constaté qu'un délai modéré était significativement associé à la présence d'un faible nombre de comorbidités physiques ou d'aucune, qu'un délai long était significativement associé à un âge plus avancé, et qu'un délai long ou modéré étaient significativement associés à l'apparition de symptômes à un jeune âge. Finalement, un délai long était significativement associé à une santé mentale perçue comme « mauvaise » ou « passable » et à un nombre plus élevé de limitations d'activité. Conclusion : Ces résultats confirment qu'un long délai de diagnostic est associé à des résultats de santé négatifs chez les adultes canadiens atteints de trouble de l'humeur et/ou d'anxiété. Le délai de diagnostic est particulièrement sous-optimal chez les adultes plus âgés et les personnes dont les symptômes sont apparus à un jeune âge. La mise en œuvre de stratégies adaptées facilitant l'établissement d'un diagnostic précoce chez les personnes les plus susceptibles d'obtenir un diagnostic tardif, surtout chez celles dont les symptômes sont apparus à un jeune âge, est nécessaire

The Fundamental Association Between Mental Health and Life Satisfaction: Results from Successive Waves of a Canadian National Survey

Background: A self-reported life satisfaction question is routinely used as an indicator of societal well-being. Several studies support that mental illness is an important determinant for life satisfaction and improvement of mental healthcare access therefore could have beneficial effects on a population’s life satisfaction. However, only a few studies report the relationship between subjective mental health and life satisfaction. Subjective mental health is a broader concept than the presence or absence of psychopathology. In this study, we examine the strength of the association between a self-reported mental health question and self-reported life satisfaction, taking into account other relevant factors. Methods: We conducted this analysis using successive waves of the Canadian Community Health Survey (CCHS) collected between 2003 and 2012. Respondents included more than 400,000 participants aged 12 and over. We extracted information on self-reported mental health, socio-demographic and other factors and examined correlation with self-reported life satisfaction using a proportional ordered logistic regression. Results: Life satisfaction was strongly associated with self-reported mental health, even after simultaneously considering factors such as income, general health, and gender. The poor-self-reported mental health group had a particularly low life satisfaction. In the fair-self-reported mental health category, the odds of having a higher life satisfaction were 2.35 (95% CI 2.21 to 2.50) times higher than the odds in the poor category. In contrast, for the “between 60,000 CAD and 79,999 CAD” household income category, the odds of having a higher life satisfaction were only 1.96 (95% CI 1.90 to 2.01) times higher than the odds in the “less than 19,999 CAD” category. Conclusions: Subjective mental health contributes highly to life satisfaction, being more strongly associated than other selected previously known factors. Future studies could be useful to deepen our understanding of the interplay between subjective mental health, mental illness and life satisfaction. This may be beneficial for developing public health policies that optimize mental health promotion, illness prevention and treatment of mental disorders to enhance life satisfaction in the general population