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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3023 — Getting to Treatment for Depression: The Role of Veterans' Illness Perceptions

Elwy AR (Bedford COE), Dell NS (Bedford COE), Zhao S (Bedford COE), Glickman M (Bedford COE), Bokhour BG (Bedford COE), Pirraglia PA (Providence VA Medical Center), Coldwell CM (Bedford VA Medical Center), Ngo TA (Bedford VA Medical Center), Vielhauer MJ (VA Boston Healthcare System), Eisen SV (Bedford COE)

We undertook a longitudinal study of veterans’ perceptions of depression and its treatment at the beginning of a depression episode in order to determine whether or not illness perceptions predict treatment engagement.

Veterans at three VA medical centers with a new episode of depression, defined as a positive primary care screening on the PHQ-2 or PHQ-9 in primary care in those who had not received a depression diagnosis or prescription for an antidepressant in the past 12 months, were identified through electronic medical records and sent a questionnaire assessing their demographics and illness perceptions. We used the Illness Perception Questionnaire-Revised, adapted for depression, to assess identity, cause, consequences, timeline, cure/control, coherence, and emotional representations. We conducted chart reviews to determine who received treatment for depression three months after a positive screen, and categorized veterans into one of four treatment groups: 1) Received guideline-concordant treatment for depression; 2) Received treatment for depression, but not guideline-concordant; 3) Received mental health treatment, but not for depression; and 4) Did not receive any treatment. Logistic regression models were used to predict veterans' treatment.

Of 142 veterans (age range 22-89) in our study, 40 (28%) had received depression treatment that met guidelines, 27 (19%) had received some depression treatment but it was not guideline-concordant, 9 (6%) had received treatment for another mental health disorder such as anxiety or PTSD, and 66 (47%) had not received any treatment.

Veterans who perceived that depression treatment would not control their depression, and older veterans ( > 60 years), were less likely to receive any mental health treatment compared to younger veterans and those who perceived treatment as helpful (OR = 0.46, 95% CI 0.27-0.79, p < .01). Veterans’ perceptions about the ability to control depression through medical treatment, and older veterans, were less likely to receive any treatment for depression in this study.

Patient-aligned care teams need to elicit veterans’ perceptions of depression treatment to understand what veterans are thinking about treatment and to address any concerns they may have about its effectiveness. Interventions assessing illness perceptions of treatment control may encourage more veterans to obtain timely and appropriate depression care.

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