Capsule Commentary on Waitzfelder et al., Treatment Initiation for New Episodes of Depression in Primary Care Settings Hale Thompson, PhD Department of Psychiatry , Rush University Medical Center, Chicago, IL, USA. J Gen Intern Med 33(8):1385 generate innovative therapies, social supports, and structural DOI: 10.1007/s11606-018-4319-8 change that mitigate disparities. © Society of General Internal Medicine 2018 The Affordable Care and Health Information Technology for Economic and Clinical Health Acts ushered in the capacity to implement population mental health strategies. The insur- ance mandate, mental health parity, and widespread uptake of electronic health records have expanded access to mental he study by Waitzfelder and colleagues provides a unique health care. With only 36% of newly diagnosed patients opting opportunity to examine factors associated with initiation 1 for treatment, we need to understand how best to utilize these of depression treatment in primary care settings across five infrastructures not only for research, but also for interventions large integrated health systems in five states. Leveraging that will systematically reduce the prevalence of depression electronic health record data, the findings mostly confirm and benefit the general population. documented mental health disparities. The odds of engaging in treatment decreased with age and income and for persons of color, who were also more likely than white patients to choose Corresponding Author: Hale Thompson, PhD; Department of psychotherapy over antidepressant medication. Notably, the Psychiatry Rush University Medical Center, Chicago, IL, USA (e-mail: Hale.Thompson@rush.edu). odds of initiating treatment were higher for patients who were screened with the Patient Health Questionnaire (PHQ)-9 than Compliance with Ethical Standards: for those who were not. In his seminal work, Rose’s Strategy of Preventive Medi- Conflict of Interest: The author has no conflicts of interest with this cine, Sir Geoffrey Rose makes the case for the prevention article. paradox when faced with relatively common conditions like depression. This concept suggests that to achieve the greatest health benefits for the overall population, each participating REFERENCES individual derives only a small benefit from an intervention. 1. Waitzfelder B, Stewart C, Coleman K, et al. Treatment initiation for new Building upon the findings of Waitzfelder and colleagues in episodes of depression in primary care settings. J Gen Intern Med. 2018. https://doi.org/10.1007/s11606-017-4297-2. the context of this paradox, medical and epidemiological 2. Akincigil A, Matthews E. National rates and patterns of depression research ought to prioritize studies on the effectiveness of screening in primary care: results from 2012 and 2013. Psychiatry Serv. 2017;(In Advance):1-7. https://doi.org/10.1176/appi.ps.201600096. population-level interventions. Evidence-based collaborative 3. Rose G. Rose’s Strategy of Preventive Medicine. Second. Oxford: Oxford care models employ a systematic use of the PHQ-9 for screen- University Press; 2008. ing alongside focused case management, antidepressant med- 4. Thota AB, Sipe TA, Byard GJ, et al. Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide Systematic ication management, and cognitive behavioral skills- Review and Meta-Analysis. Am J Prev Med. 2012;42(5):525-538. https:// 4,5 building; implementation science could aid in identifying doi.org/10.1016/j.amepre.2012.01.019. 5. Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and those mechanisms that help reduce disparities across race, anxiety problems. Cochrane database Syst Rev. 2012;10(10):CD006525. class, age, and gender. Qualitative inquiries with patients https://doi.org/10.1002/14651858.CD006525.pub2. who are diagnosed with depression but forgo treatment may Published online May 31, 2018
Journal of General Internal Medicine – Springer Journals
Published: May 31, 2018
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