Development of a Clinician Report Measure to Assess Psychotherapy for Depression in Usual Care Settings

Although mental health policy initiatives have called for quality improvement in depression care, practical tools to describe the quality of psychotherapy for depression are not available. We developed a clinician-report measure of adherence to three types of psychotherapy for depression—cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. A total of 727 clinicians from a large, national managed behavioral health care organization responded to a mail survey. The measure demonstrated good psychometric properties, including appropriate item-scale correlations, internal consistency reliability, and a three-factor structure. Our results suggest that this questionnaire may be a promising approach to describing psychotherapy for depression in usual care

Development of a Patient-Report Measure of Psychotherapy for Depression

Despite clear indications of need to improve depression treatment, practical tools that efficiently measure psychotherapy are not available. We developed a patient-report measure of psychotherapy for depression that assesses Cognitive Behavioral (CBT), Interpersonal (IPT), and Psychodynamic therapies. 420 patients with depression from a large managed behavioral health care organization completed the measure. The three subscales measuring CBT, IPT, and Psychodynamic Therapy showed good internal consistency, appropriate item-total correlations, and were supported by a 3-factor structure. Our results suggest that a patient questionnaire is a promising approach for assessing psychotherapy in quality improvement interventions

How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study

OBJECTIVE: Although depression is one of the most common problems of medical and psychiatric outpatients, it has not been clear whether the extent of medical comorbidity among depressed patients varies across major types of clinical settings in which depressed patients receive care--especially by type of treating clinician (general medical versus mental health specialty) or type of payment for services (prepaid versus fee-for-service). METHODS: The authors examined these issues using data on 1,152 adult outpatients with current depressive symptoms and a lifetime history of unipolar depressive disorder who received care in one of three health care delivery systems in three U.S. sites. RESULTS: Depressed patients had a similarly high prevalence (64.9%-71.0%) of any of eight common chronic medical conditions whether they were seen in the general medical or specialty mental health sector; however, those visiting medical clinicians had a significantly higher prevalence of the two most common chronic medical conditions, hypertension and arthritis. Among depressed patients with hypertension, those visiting the general medical sector were more likely to be taking antihypertensive medication than were those visiting the mental health specialty sector. Type of payment (prepaid versus fee-for-service) was unrelated to either prevalence or severity of comorbid medical conditions, suggesting that the typical depressed patient in all types of practices studied had medical comorbidity. CONCLUSIONS: These data suggest that clinicians in all health care settings must be prepared to encounter chronic medical conditions and complaints in the depressed patients who visit them

Post-Deployment Stress: What Families Should Know, What Families Can Do

Information is covered for families of veterans returning from deployment in Iraq or Afghanistan about post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other emotional and behavioral problems that veterans may face. Before developing this pamphlet, companion to CP-534-IADIF (Post-Deployment Stress: What You Should Know, What You Can Do), RAND surveyed a couple hundred existing educational materials on these topics. The researchers then coded and classified these materials and reviewed them to identify gaps in information and to isolate the best materials from which to draw upon. Based on these refined materials, the booklet was further improved by feedback from RAND Corporation experts, other military mental health experts, and nine focus groups including service members and their families

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study

We estimated clinicians\u27 awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care

C-C4-03: Teen Tobacco Use and Depression in Primary Care

Background/Aims: Tobacco use is the number one cause of preventable morbidity and death in the nation. Despite the ever growing list of harmful effects associated with smoking, tobacco use is common among children and adolescents and approximately half who try smoking will progress to regular use and dependence. Of concern, the great progress achieved between 1997 and 2003 in reducing teen smoking has stalled with overall rates near 20%. There is only limited evidence of the effectiveness of smoking cessation interventions in teen populations, and the low probability that adolescents will stop smoking on their own highlights the importance of prevention and early detection. Depressive disorders occur in approximately one in five youth by age 18 and are associated with a broad range of negative effects on health, as well as academic and social functioning