Seasonal affective disorder may be a significant issue in Lewiston, ME due to it\u27s latitude. In addition, lack of transportation and poverty are also issues in this community. This project attempts to address treatment and increase awareness of SAD in Lewiston.https://scholarworks.uvm.edu/fmclerk/1257/thumbnail.jp

Deeb, Ashley L

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University of VermontScholarWorks @ UVMFamily Medicine Clerkship Student Projects Larner College of Medicine2017SAD Management in Lewiston, MEAshley L. DeebUniversity of VermontFollow this and additional works at: https://scholarworks.uvm.edu/fmclerkPart of the Medical Education Commons, and the Primary Care CommonsThis Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion inFamily Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contactdonna.omalley@uvm.edu.Recommended CitationDeeb, Ashley L., "SAD Management in Lewiston, ME" (2017). Family Medicine Clerkship Student Projects. 231.https://scholarworks.uvm.edu/fmclerk/231Ashley Deeb, MSIIIDecember 2016-January 2017Mentor: Bethany Picker MDSeasonal Affective Disorder Management in Lewiston, ME1› Seasonal Affective Disorder (SAD) is a mental illness which involves major depressive episodes that occur and remit during certain seasons of the year. Most commonly, patients experience episodes in the winter months and remission during the spring and summer.1› In North America, SAD prevalence tends to increase with latitude2› It is estimated that 10-20% of recurrent depression cases occur seasonally.3› The total population for Lewiston and Auburn, ME is 59,211. Approximately 27% of these individuals have experienced depression.4 Therefore, an estimated 15,986 individuals in the Lewiston/Auburn area may have experienced SAD or seasonal mood change.› Access to behavioral and mental health care remains in the top 5 health challenges in Androscoggin county along with poverty, transportation, and housing stability.4› There are currently no statistics on SAD in Lewiston; therefore, there may be a subset of individuals who suffer from depression which are actually suffering from SAD and are not receiving appropriate care due to poverty, lack of transportation, and misdiagnosis.The Problem2› There are currently no estimates of the financial impact of SAD in the US› To attempt to give an idea of the cost of SAD, it is estimated that depression costs the US $44 billion per year in lost productive time ($31 billion per year more than non-depressed counterparts) .5› Once again, it is estimated that 10-20% of cases of recurrent depression occur seasonally.3› Additionally, in Lewiston approximately 14.1% of adults note that they have lost 14 or more days due to poor mental health.4The Cost of SAD3› C. Todd Kitchens, DO- Family Medicine Attending at CMMC- Noted that while he does see and treat some patients with a formal SAD diagnosis, he also sees a larger population which fall on a spectrum of mood changes linked to the change in seasons for which a handout with resources would also be helpful.- Some of the barriers to treatment in the Lewiston community include poor access to unfiltered full spectrum light, financial barriers, and being surrounded by an environment which is not conducive to healthy living.- Many of the interventions and treatments he recommends to patients (such as sleep inventories, lifestyle modifications, more time outside exposed to unfiltered light, etc) also serve as preventative measures and would be helpful to include on the handout.Views on SAD in the Community4› [Name Withheld]- Social Worker in the Lewiston Community- Some of the barriers to treatment in the Lewiston community are financial barriers, lack of transportation, inclement weather, and lack of knowledge of resources.-In addition, they feel that there is a stigma associated with mental health; especially in the immigrant population, which may prevent patients from seeking help or resources.-They agreed that an informational handout on SAD and some resources available would be helpful as there may be a lack of knowledge in the community about SAD and nonpharmacological interventions available to patients.Views on SAD in the Community Cont. 5› There may be a population of SAD sufferers in Lewiston, ME who don’t realize that they have SAD rather than depression or are otherwise combatting seasonal mood changes.› In addition, access to mental health services and other resources in general is very difficult due to poverty, lack of transportation, lack of knowledge of resources available, etc.› Therefore, I propose to create an informational handout on the symptoms of SAD which also includes some local resources and suggestions for combatting certain symptoms in the winter as a way of not only informing patients but also offering easily accessible “fixes” and preventative measures.› This handout will be included in patient exam rooms at the Family Medicine Residency (FMR) clinic as there is often ample time between when a patient is roomed and when the provider enters the exam room where a patient may read handouts.Intervention6Results78Results Cont.› The effectiveness of the informational handout may be measured in the future via a survey administered to patients and providers.› The survey administered to patients may include questions such as “Did you read the SAD handout?”, “Did you find the handout helpful?”, “Have you discussed SAD with your provider during this visit or in prior visits?”› The survey administered to providers may include questions regarding whether or not SAD or seasonal symptoms were discussed during the visit and if they have seen an increase in patients inquiring about SAD or seasonal mood changes.› One of the limitations of this handout is that the suggestions and resources listed may not be helpful for everyone with SAD.› In addition, posting the handout in exam rooms at the FMR clinic only reaches a fraction of the desired population as not everyone utilizes the FMR clinic for healthcare and not everyone has a healthcare provider.› While addressing current symptoms and attempting to prevent those symptoms is helpful, a project which focuses on community and early prevention would ultimately be more sustainable and effective.Effectiveness and Limitations9› There are currently no statistics on the prevalence of seasonal affective disorder in the Lewiston, ME community. It would be an interesting project to investigate how common the disorder actually is in this population.› It would also be useful to investigate how accessible light boxes are to this population and whether or not a program which provides cheap or free light boxes could be established.› Another future project could focus on creating community programs (such as healthy cooking classes) which would strengthen the sense of community and resilience of community members.› It was brought to my attention that there is a need for proper organization of handouts and resources in the patient rooms and waiting room. A future project may investigate an effective and sustainable way to present resources and information to patients at the clinic in order to increase patient education and effectiveness of brochures or bulletins presented there.Recommendations for Future Projects101. Rosenthal NE, Sack DA, Gillin JC, et al. Seasonal affective disorder. A description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41:72–80.2. Mersch P, Middendorp H, Bouhuys A, et al. Seasonal affective disorder and latitude: A review of the literature. J Affect Disord. 1999;53:35–48.3. Magnusson A. An overview of epidemiological studies on seasonal affective disorder. ActaPsychiatr Scand. 2000;101:176–84.4. Maine Shared Health Needs Assessment and Planning Process. (2015). Retrieved December 30, 2016, from http://www.maine.gov/dhhs/mecdc/phdata/SHNAPP/data.shtml5. Stewart WF, Ricci JA, Chee E, et al. Cost of lost productive work time among US workers with depression. JAMA. 2003; 289(23):3135-3144.References1112 INTERVIEW CONSENT FORM SAD Management in Lewiston Ashley Deeb 1/9/17   Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website.  Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work.   The interviewer affirms that he/she has explained the nature and purpose of this project.  The interviewee affirms that he/she has consented to this interview.   Yes __√__   Name: _C. Todd Kitchens__________________________________________  Name: _________________________________________________________      

SAD Management in Lewiston, ME

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SAD Management in Lewiston, ME

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