PurposeTo systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.MethodMedline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxie

http://www.medical-mastermind-community.com/uploads/63-Systematic_Review_of_Depression_Anxiety_and.9.pdf

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students.

The efficacy of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screener for clinical depression was examined in a sample of 1,005 community-residing adults (age range = 50-96). Presence of a depressive disorder was determined by diagnostic interview. Analyses revealed that neither age, gender, cognitive impairment, functional impairment, physical disease, nor social desirability had a significant negative effect on the psychometric properties or screening efficacy of the CES-D. These results indicate that there was no significant degradation in the ability of the CES-D to screen for depression among community-residing elderly adults. This conclusion must be tempered by the fact that the sample did not include participants with the more disabling forms of cognitive or functional impairment and physical illness.

Center for Epidemiologic Studies Depression Scale (CES-D) As a Screening Instrument for Depression Among Community-Residing Older Adults

ContextCare of patients with depression in managed primary care settings often
fails to meet guideline standards, but the long-term impact of quality improvement
(QI) programs for depression care in such settings is unknown.ObjectiveTo determine if QI programs in managed care practices for depressed
primary care patients improve quality of care, health outcomes, and employment.DesignRandomized controlled trial initiated from June 1996 to March 1997.SettingForty-six primary care clinics in 6 US managed care organizations.ParticipantsOf 27,332 consecutively screened patients, 1356 with current depressive
symptoms and either 12-month, lifetime, or no depressive disorder were enrolled.InterventionsMatched clinics were randomized to usual care (mailing of practice guidelines)
or to 1 of 2 QI programs that involved institutional commitment to QI, training
local experts and nurse specialists to provide clinician and patient education,
identification of a pool of potentially depressed patients, and either nurses
for medication follow-up or access to trained psychotherapists.Main Outcome MeasuresProcess of care (use of antidepressant medication, mental health specialty
counseling visits, medical visits for mental health problems, any medical
visits), health outcomes (probable depression and health-related quality of
life [HRQOL]), and employment at baseline and at 6- and 12-month follow-up.ResultsPatients in QI (n = 913) and control (n = 443) clinics did not differ
significantly at baseline in service use, HRQOL, or employment after nonresponse
weighting. At 6 months, 50.9% of QI patients and 39.7% of controls had counseling
or used antidepressant medication at an appropriate dosage (P<.001), with a similar pattern at 12 months (59.2% vs 50.1%; P = .006). There were no differences in probability of
having any medical visit at any point (each P≥.21).
At 6 months, 47.5% of QI patients and 36.6% of controls had a medical visit
for mental health problems (P = .001), and QI patients
were more likely to see a mental health specialist at 6 months (39.8% vs 27.2%; P<.001) and at 12 months (29.1% vs 22.7%; P = .03). At 6 months, 39.9% of QI patients and 49.9% of controls still
met criteria for probable depressive disorder (P
= .001), with a similar pattern at 12 months (41.6% vs 51.2%; P = .005). Initially employed QI patients were more likely to be working
at 12 months relative to controls (P = .05).ConclusionsWhen these managed primary care practices implemented QI programs that
improve opportunities for depression treatment without mandating it, quality
of care, mental health outcomes, and retention of employment of depressed
patients improved over a year, while medical visits did not increase overall.

https://jamanetwork.com/journals/jama/articlepdf/192281/JOC90425.pdf

Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial.

Background Patients with congestive heart failure (CHF) may have a high prevalence of depression, which may increase the risk of adverse outcomes. Objective To determine the prevalence and relationship of depression to outcomes of patients hospitalized with CHF. Methods We screened patients aged 18 years or older having New York Heart Association class II or greater CHF, an ejection fraction of 35% or less, or both, admitted between March 1, 1997, and June 30, 1998, to the cardiology service of one hospital. Patients with a Beck Depression Inventory score of 10 or higher underwent a modified National Institute of Mental Health Diagnostic Interview Schedule to identify major depressive disorder. Primary care providers coordinated standard treatment for CHF and other medical and psychiatric disorders. We assessed all-cause mortality and readmission (rehospitalization) rates 3 months and 1 year after depression assessment. Logistic regression analyses were used to evaluate the independent prognostic value of depression after adjustment for clinical risk factors. Results Of 374 patients screened, 35.3% had a Beck Depression Inventory score of 10 or higher and 13.9% had major depressive disorder. Overall mortality was 7.9% at 3 months and 16.2% at 1 year. Major depression was associated with increased mortality at 3 months (odds ratio, 2.5 vs no depression; P = .08) and at 1 year (odds ratio, 2.23; P = .04) and readmission at 3 months (odds ratio, 1.90; P = .04) and at 1 year (odds ratio, 3.07; P = .005). These increased risks were independent of age, New York Heart Association class, baseline ejection fraction, and ischemic etiology of CHF. Conclusions Major depression is common in patients hospitalized with CHF and is independently associated with a poor prognosis.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/751538/ioi00610.pdf

Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure

Objective. —To examine whether depressive symptoms in older adults contribute to increased cost of general medical services. Design. —A 4-year prospective cohort study. Setting. —Four primary care clinics of a large staff-model health maintenance organization (HMO) in Seattle, Wash. Patients. —A total of 5012 Medicare enrollees older than 65 years were invited to participate in the study; 2558 subjects (51%) were successfully enrolled. Nonparticipants were somewhat older and had a higher level of chronic medical illness. Main Outcome Measures. —Depressive symptoms as measured by the Center for Epidemiological Studies Depression scale, which was administered as part of a mail survey at baseline, at 2 years, and at 4 years; and total cost of medical services from the perspective of the HMO. Data were obtained from the cost accounting system of the HMO. Results. —In this cohort of older adults, depressive symptoms were common, persistent, and associated with a significant increase in the cost of general medical services. This increase was seen for every component of health care costs and was not accounted for by an increase in specialty mental health care. The increase in health care costs remained significant after adjusting for differences in age, sex, and chronic medical illness. Conclusions. —Depressive symptoms in older adults are associated with a significant increase in the cost of medical services, even after adjusting for the severity of chronic medical illness.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=416420&pdfFileName=jama_277_20_032.pdf

Depressive Symptoms and the Cost of Health Services in HMO Patients Aged 65 Years and Older: A 4-Year Prospective Study

The present study was undertaken to examine the utility of the Center for Epidemiological Studies-Depression (CES-D) scale and the Beck Depression Inventory (BDI) as screening instruments for primary care clinic patients. We examined: 1) patients' willingness to complete the scales; 2) the level of agreement between the screening instruments and DSM-III diagnosis of Major Depressive Episode, based on the NIMH Diagnostic Interview Schedule (DIS); 3) the effect on detection rates of raising the cut-off score for each depression screen; and 4) the factor structure of the CES-D in our primary care sample versus findings from general population studies. The CES-D and BDI performed comparably as depression screening instruments. Both produced too many false positives when standard (low) cut-off scores were applied. However, when straight cut-off scores were used, results suggested that either the CES-D or BDI might assist physicians in reliably detecting depressed patients, without an overload of false positives. Comparison of our findings with those from other studies suggest that depression screening instruments may be particularly helpful with older primary care patients. The CES-D factor analysis highlights the need to look more closely at the relevance of positive affect to the detection, diagnosis, and treatment of depressive disorders in primary care practices.

Screening for depression in primary care clinics: the CES-D and the BDI.

The Acquired Immune Deficiency Syndrome (AIDS) is both an infectious disease and one of immunologic aberration. While it is a “new” disease and one that has defied attempts to date to discover either a cure or a vaccine, our knowledge about both infectious and immunologically mediated diseases should be applicable to the AIDS problem. Further, the complexity of interacting variables in the pathogenesis of immune deficiency and consequent vulnerability to a variety of infections strongly suggests that AIDS is multifactoral’ and understandable from a biopsychosociul perspective.* Because AIDS is a disease of immune dysfunction, one that manifests itself by infection and/or neoplasia, and one that critically involves the central nervous system,’ AIDS is particularly amenable to a psychoneuroimmunologic a p p r ~ a c h . ~ Our current research is focused on long-term survivors of AIDS. While the prevalent belief among the general public, persons with AIDS, and even the professional community is that AIDS is invariably fatal, there is a small but growing number of individuals who are alive and well 3, 4, and even 5 years after an AIDS diagnosis. Such individuals may be compared against the average life expectancy for AIDS patients, which may range from 18 months to as little as 2 months, depending on which of its many forms the disease takes. Pneumocystis carinii pneumonia (PCP), which accounted for 60% of all AIDS patients a t the time of our study, is responsible for more AIDS deaths than any other infection. About 35% of AIDS patients have

An intensive psychoimmunologic study of long-surviving persons with AIDS. Pilot work, background studies, hypotheses, and methods.

A survey of knowledge, beliefs and attitudes about AIDS was administered simultaneously in San Francisco, New York and London to a total of 399 persons. The aim was to investigate how such knowledge and attitudes may he influenced by social and cultural contexts, as well as by disease epidemiology. Across all samples of the general public (excluding risk group members) in the three cities, general fear of AIDS and anti-gay attitudes were significantly negatively correlated with knowledge about AIDS. In the London sample, general fear of AIDS and anti-gay attitudes were significantly and positively associated with both sexual and general health behavior change. Only sexual behavior change, however, was significantly correlated with general fear of AIDS and anti-gay variables for the New York sample. Neither of these variables was significantly associated with behavior change of any kind in the San Francisco sample. We accounted for these inter-city differences by proposing a four-stage model of pu...

A three city comparison of the public's knowledge and attitudes about AIDS

Part 1 Historical and conceptual contexts of depression in primary care populations: depression screening in primary care - clinical needs and research challenges, C.Clifford Attkisson and Jane Zich screening procedures in primary care - history and uses, Paul S.Frame is screening for depression worthwhile in primary care? screening criteria and the current states of depression research, Douglas B.Kamerow issues of criterion validity for screening measures for depressive disorders in primary care, James Barrett caseness criteria for major depression - the primary care clinician and the psychiatric epidemiologist, Wayne Katon and Michael von Korff. Part 2 Depression screening procedures - methodological considerations and empirical findings: depression screening instruments - history and issues, Jane M.Murphy statistical design of screening procedures, Patrick E.Shrout use of a two-stage procedure to identify depression - the medical outcomes study, M.Audrey Burnam and Kenneth B.Wells studies in the screening and feedback of depression and anxiety in primary care outpatients populations, Joel Yager and Lawrence S.Linn the use of psychiatric screening scales to detect depression in primary care patients, Richard L.Hough, John A.Landverk and Gerald F.Jacobson screening for depression in general medical care, William W.K.Zung, Kathryn Magruder-Habib, and John R.Feussner methodological issues associated with the use of depression screening scales in primary care settings, Paul D.Cleary. Part 3 Special population issues in screening for depression: special population issues in screening for depression, Robert E.Roberts depressive symptomatology in older American indians with chronic disease - some psychometric considerations, Anne E.Baron, Spero M.Manson, Lynn M.Ackerson and Douglas L.Brenneman depression prevention research - the need for screening scales that truly predict, Jeanne Miranda, Ricardo F.Munoz and Martha Shumway screening for depression in primary care - a clinician's perspective, John Matthew. Part 4 Conclusion, guidelines, and recommendations for clinical applications and future research: screening for depression in primary care - guidelines for future practice and research, Herbert C.Schulberg.

Depression in primary care : screening and detection

Patterson and Reid's formulation of coercive versus reciprocal control offers a theoretical model for understanding both parasuicide and nontherapeutic exchanges between treatment staff and repeat suicide attempters. An interpersonal treatment program, derived from the Patterson and Reid formulation, which has been consistently associated with positive changes in the course of hospitalization for moderate-risk inpatients, is outlined, followed by a case illustration and discussion of the treatment strategy. The article stresses the importance of targeting the interpersonal environment as well as parasuicidal acts in the treatment program for repeat suicide attempters.

Jane M. Zich

Papers

Screening for depression in primary care clinics: the CES-D and the BDI.

An intensive psychoimmunologic study of long-surviving persons with AIDS. Pilot work, background studies, hypotheses, and methods.

A three city comparison of the public's knowledge and attitudes about AIDS

Depression in primary care : screening and detection

A reciprocal control approach to the treatment of repeated parasuicide.