IAC 07-087
Help-Seeking Depression in VHA Primary Care Patients
Rani Elwy, PhD MSc BA VA Bedford HealthCare System, Bedford, MA Bedford, MA Funding Period: March 2009 - February 2011 Portfolio Assignment: Mental and Behavioral Health |
BACKGROUND/RATIONALE:
VHA mandates annual screening for depression for all Veterans in primary care. However, even after a positive screen for depression, patients may delay seeking treatment for many years, despite the fact that effective treatment is available which can substantially improve their clinical outcomes and quality of life. Therefore, it is highly beneficial to understand the individual factors that account for delays in getting treatment for depression. OBJECTIVE(S): We aimed to longitudinally examine Veterans' illness perceptions of depression and its treatment at the beginning of a depression episode to determine whether or not illness perceptions predict treatment engagement. We also tested Leventhal's self-regulation model of illness behavior as a potential model of help-seeking behavior among Veterans with depression. Our main study hypothesis was: Veterans who perceive depression as a health threat (e.g., more severe symptoms, relating to cause and controllability) will be more likely to receive guideline-concordant depression treatment three months after a positive depression screen than Veterans who do not perceive depression as a health threat. METHODS: Veterans who received a positive PHQ-2 screen in primary care at three VA medical centers, and who had not received a diagnosis of depression nor a prescription for any anti-depressant in the previous 12 months (as determined by chart review) were eligible for the study. Eligible Veterans were mailed a questionnaire assessing illness perceptions of depression, as measured by the Illness Perception Questionnaire-Revised (IPQ-R) adapted for depression, and past treatment for depression. A subsequent chart review was conducted to document whether these Veterans received HEDIS guideline-concordant depression treatment three months later. We used fixed effects Glimmix models to predict the probability of receiving guideline-concordant depression treatment, with specific IPQ-R and interaction items selected from logistic stepwise regression models. We also explored the social and contextual factors surrounding decisions to seek or not seek treatment for depression through semi-structured interviews with a sub-sample of participants who did or did not receive depression treatment. FINDINGS/RESULTS: Of the 271 Veterans who participated, 92 (34%) received guideline-concordant depression treatment three months following a positive screen. Conducting chart reviews until six months post positive-screen did not change this proportion. Veterans who reported more severe symptoms (OR=4.65), and those who believed they could control their depression (OR=2.95) were more likely to receive guideline-concordant treatment at three months post-positive screen. Those who believed that nothing could control depression (OR=2.43) or who attributed the cause of depression to stress (OR=1.65) or feelings of grief or loss (OR=1.30) were less likely to receive guideline-concordant treatment. However, among Veterans who had not received any treatment in the past five years, the probability of receiving guideline-concordant treatment was higher among those who believed that stress (OR=2.34) and their own risky behaviors (OR=3.31) caused their depression, and the probability of receiving guideline-concordant treatment was lower among those who thought that their symptoms would last a short time (OR=3.81). Grounded thematic analyses of 23 interviews indicated that illness perception constructs (such as consequences, controllability, severity of symptoms and cause) were discussed by Veterans as serving as barriers or facilitators to seeking treatment for depression. IMPACT: Veterans in this study who perceived their depression symptoms as significant threats to their health were more likely to seek treatment. Many veterans are not receiving high quality depression treatment following a positive screen in primary care. Discussing potential causes of symptoms, the ability of treatment to control these symptoms, and how long symptoms may last are important areas for providers to focus on in order to encourage greater uptake of depression treatment in primary care. External Links for this ProjectDimensions for VADimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.Learn more about Dimensions for VA. VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Mental, Cognitive and Behavioral Disorders, Health Systems Science
DRE: Prevention, Prognosis Keywords: Depression, Primary care MeSH Terms: none |