3 results
19 - Outcome measures for the treatment of depression in primary care
- from Part IV - International approaches to outcome assessment
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- By William E. Narrow, American Psychiatric Institute for Research and Education, USA, Farifteh F. Duffy, American Psychiatric Institute for Research
- Edited by Graham Thornicroft, { Author Role= exceeds the limit of 5 characters including spacing}, Michele Tansella, { Author Role= exceeds the limit of 5 characters including spacing}
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- Book:
- Mental Health Outcome Measures
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 319-345
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- Chapter
- Export citation
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Summary
Major depression is highly prevalent, often chronic or recurrent, and among the most disabling and costly of illnesses, yet its burden is often unrecognised. Historically, the primary care sector of the US health system has played a large role in both the mental and physical healthcare of patients with depression (Regier et al, 1993; Kessler et al, 2003). This role is amplified by the managed care industry, which may emphasise restricted access to specialty care in its efforts to limit costs. This chapter reviews state-of-the-art research on the treatment of depression in primary care, with special attention to the measurement tools used to support outcomes assessment.
Epidemiology, service use and costs of depression in primary care
Prevalence of disorder
In the general population, the 12-month prevalence of major depressive disorder has been estimated at 6.6%, according to the US National Comorbidity Survey Replication (NCS-R; Kessler et al, 2003). About a quarter to a half of patients with depression are treated in primary care (Narrow et al, 1993; Regier et al, 1993; Kessler et al, 2003) and, accordingly, the disorder is highly prevalent in primary care, with a point prevalence estimated at 5–10% (Katon et al, 1992, Simon & Von Korff, 1995) among adults 18 years of age and older.
Disability
According to the World Health Organization Global Burden of Disease Study, unipolar major depressive disorder was the fourth leading cause of worldwide disability for both sexes in the 1990s (Murray & Lopez, 1996a). It is projected that depression will rank as the second largest contributor to the worldwide burden of disease by 2020 (Murray & Lopez, 1996b). The Medical Outcomes Study (MOS) demonstrated that physical functioning and well-being scores on the 36-item Short Form (SF–36) for patients with major depression were comparable, and in some cases significantly worse than scores for patients with other chronic medical conditions. Mental functioning and well-being scores were consistently and significantly worse for the MOS patients with depression than for patients with medical illnesses (Hays et al, 1995). Another longitudinal observational study compared primary care patients with depression during their ‘worst-functioning’ assessment interval with participants who did not have depression (Rost et al, 1998).
19 - Outcome measures for the treatment of depression in primary care
- from Part IV - International approaches to outcome assessment
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- By William E. Narrow, Associate Director of the Division of Research at the American Psychiatric Association and the American Psychiatric Institute for Research and Education, USA, Farifteh F. Duffy, Director of Quality of Care Research at the American Psychiatric Institute for Research and Education, Arlington, Virginia, USA.
- Edited by Graham Thornicroft, Michelle Tansella
-
- Book:
- Mental Health Outcome Measures
- Published online:
- 02 January 2018
- Print publication:
- 01 September 2010, pp 319-345
-
- Chapter
- Export citation
-
Summary
Major depression is highly prevalent, often chronic or recurrent, and among the most disabling and costly of illnesses, yet its burden is often unrecognised. Historically, the primary care sector of the US health system has played a large role in both the mental and physical healthcare of patients with depression (Regier et al, 1993; Kessler et al, 2003). This role is amplified by the managed care industry, which may emphasise restricted access to specialty care in its efforts to limit costs. This chapter reviews state-of-the-art research on the treatment of depression in primary care, with special attention to the measurement tools used to support outcomes assessment.
Epidemiology, service use and costs of depression in primary care
Prevalence of disorder
In the general population, the 12-month prevalence of major depressive disorder has been estimated at 6.6%, according to the US National Comorbidity Survey Replication (NCS-R; Kessler et al, 2003). About a quarter to a half of patients with depression are treated in primary care (Narrow et al, 1993; Regier et al, 1993; Kessler et al, 2003) and, accordingly, the disorder is highly prevalent in primary care, with a point prevalence estimated at 5–10% (Katon et al, 1992, Simon & Von Korff, 1995) among adults 18 years of age and older.
Disability
According to the World Health Organization Global Burden of Disease Study, unipolar major depressive disorder was the fourth leading cause of worldwide disability for both sexes in the 1990s (Murray & Lopez, 1996a). It is projected that depression will rank as the second largest contributor to the worldwide burden of disease by 2020 (Murray & Lopez, 1996b). The Medical Outcomes Study (MOS) demonstrated that physical functioning and well-being scores on the 36-item Short Form (SF–36) for patients with major depression were comparable, and in some cases significantly worse than scores for patients with other chronic medical conditions. Mental functioning and well-being scores were consistently and significantly worse for the MOS patients with depression than for patients with medical illnesses (Hays et al, 1995). Another longitudinal observational study compared primary care patients with depression during their ‘worst-functioning’ assessment interval with participants who did not have depression (Rost et al, 1998).
4 - The epidemiology of mental disorder treatment need: community estimates of ‘medical necessity’
- from Part II - Unmet need: general problems and solutions
- Edited by Gavin Andrews, University of New South Wales, Sydney, Scott Henderson, Australian National University, Canberra
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- Book:
- Unmet Need in Psychiatry
- Published online:
- 21 August 2009
- Print publication:
- 06 January 2000, pp 41-58
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- Chapter
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Summary
This chapter provides a developmental perspective on how the US mental health community has responded to periodic requests to define and quantify the need for mental health services in both public and private insurance sectors. It focuses on a model of epidemiological data that will improve the ability to plan for mental health services. The chapter talks about a research enterprise that is attuned to health policy service delivery innovations, service and economic research parameters, and treatment technologies involving both efficacy and effectiveness outcome measurement. Although most managed care systems have been in the private sector, public sector contracts for Medicaid and Medicare mental health services are growing. To be most effective, the role of epidemiology must be inclusive enough to inform us about the unmet need for treatment in the community. Thus, epidemiology may serve as an integrating discipline for basic science, clinical medicine, public health and health policy.