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Journal ArticleDOI

Depressive symptom burden as a barrier to screening for breast and cervical cancers.

01 Jul 2004-Journal of Womens Health (Mary Ann Liebert, Inc. 2 Madison Avenue Larchmont, NY 10538 USA)-Vol. 13, Iss: 6, pp 731-738
TL;DR: The presence of a high depressive symptom burden is a modest independent risk factor for lack of subsequent mammography and Pap smear testing, and ensuring that depressed patients receive regular cancer screening services is important.
Abstract: Background: Depression has been associated with lower cancer screening rates in some studies. We examined whether a higher depressive symptom burden presented a barrier to subsequent mammography an...
Citations
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Journal ArticleDOI
TL;DR: Patients highly connected to a specific physician would be more likely to receive care consistent with guidelines, according to common performance measures and the association of connectedness with the performance of commonly used measures of health care quality was investigated.
Abstract: Persistent deficiencies exist in the quality of health care in the United States (1– 4). Because primary care physicians are the first source of health care for most patients to receive preventive and chronic illness care, efforts to measure and improve quality of care have often focused on these physicians (5–7). In practice, however, many patients receive episodic care from different physicians (8 –12). Patients without a regular source of care are less likely to receive care consistent with guidelines (13–20). Continuity of care is a shared responsibility between physicians and patients. Even if physicians or practices treated all patients similarly, patients vary in their ability and willingness to adhere to recommendations. Performance measures originally designed for use in large populations are increasingly used to assess the quality of practices and individual physicians. One concern with this approach is that physicians who care for patients who are less willing or able to adhere to recommendations will seem to perform less well. To investigate this possibility, we developed the concept of physician–patient connectedness. We use the term connectedness to describe the closeness of the relationship between a patient and an individual physician on the basis of a model predicting how likely a physician is to identify a patient as “my patient.” We hypothesized that patients highly connected to a specific physician would be more likely to receive care consistent with guidelines, according to common performance measures. We further hypothesized that differences in connectedness may contribute to health care disparities to the extent that connectedness is correlated with race or ethnicity and insurance status. We investigated these hypotheses in a network of primary care physicians affiliated with a large teaching hospital. We used a previously developed and validated algorithm (21, 22) to determine the connectedness of more than 150 000 patients with a specific physician. The algorithm used the designated primary care physician field from the practice registration system along with patient age, time since most recent visit, and in-state residence. We then examined variation in the proportion of connected patients among practices and the association of connectedness with the performance of commonly used measures of health care quality.

175 citations

Journal ArticleDOI
TL;DR: Maintaining regular cervical cancer screenings was significantly associated with having health insurance, normal body mass index (BMI), smoking status (nonsmoker), mood, and being knowledgeable about cervical cancer screening and human papillomavirus (HPV) infection.
Abstract: Background: Although it is widely accepted that Papanicolaou (Pap) screening can reduce cervical cancer mortality, many women still do not maintain regular cervical cancer screenings. Objective: To describe the prevalence of cervical cancer screening and the demographic, behavioral, psychological, and cancer-related knowledge factors associated with adherence to U.S. Preventive Services Task Force (USPSTF) cervical cancer screening guidelines among women in the United States. Methods: Data for women aged 25–64 were obtained from the National Cancer Institute's (NCI) 2005 Health Information National Trends Survey (HINTS). Women were considered adherent to screening guidelines if they had two consecutive, on-schedule screenings and planned to have another within the next 3 years. The sample comprised 2070 women. Results: Ninety-eight percent of women reported ever having a Pap smear, 90% reported having had a recent Pap smear (within 3 years), and 84% were adherent to USPSTF screening guidelines. M...

151 citations

Journal ArticleDOI
TL;DR: Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.
Abstract: Okoro CA, Strine TW, Eke PI, Dhingra SS, Balluz LS. The association between depression and anxiety and use of oral health services and tooth loss. Community Dent Oral Epidemiol 2012; 40: 134–144. © 2011 John Wiley & Sons A/S Abstract – Objective: The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss. Methods: Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI). Results: The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1–5 missing teeth, 9.7% (SE, 0.2%) for 6–31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1–5, 6–31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1–5 teeth removed, 6–31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14–1.59; AOR = 1.83; 95% CI = 1.51–2.22; and AOR = 1.44; 95% CI = 1.11–1.86, respectively). The adjusted odds of being in the 1–5 teeth removed and 6–31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders. Conclusions: Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.

146 citations


Additional excerpts

  • ...persons with depressive disorders (13, 14)....

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Journal ArticleDOI
TL;DR: There is strong evidence to suggest that the quality of preventive and screening services received by patients with mental illness is often lower, but occasionally superior to that received by individuals who have no comparable mental disorder.

108 citations


Cites background or methods from "Depressive symptom burden as a barr..."

  • ...[34] used the CES-D, a validated scale to assess depression....

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  • ...Nine studies showed decreased screening in the mentally ill group [28,31–34,40,41,43,48]....

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  • ...Looking at the study populations, eight focused on depression and/or anxiety [31–38]....

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  • ...In the SWAN study of the menopause, the authors found no significant relationship between depressive score and rates of cervical screening [34]....

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  • ...97) [34]....

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Journal ArticleDOI
TL;DR: Clarifying multiple symptom concepts in the symptoms experience, determining appropriate measurement methodologies for the concepts, and identifying appropriate strategies will lessen the burden of symptoms and contribute to improved quality of life and better patient outcomes.
Abstract: Purpose/objectives To analyze the concept of symptom burden and discuss implications for symptom research and symptom management. Data sources MEDLINE, CINAHL, PsycINFO, Cochrane Reviews, and published literature. Data synthesis Through Rodgers's evolutionary method of concept analysis, attributes of symptom burden were identified as dynamic, multidimensional, quantifiable, subjective, and physiologic. The major antecedent was multiple symptoms related to worsening disease status. Consequences of symptom burden included decreased survival, poor prognosis, delay or termination of treatment, increased hospitalizations and medical costs, decreased functional status, and lowered self-reported quality of life. Symptom burden is defined as the subjective, quantifiable prevalence, frequency, and severity of symptoms placing a physiologic burden on patients and producing multiple negative, physical, and emotional patient responses. Conclusions Symptom burden is an important concept in the symptoms experience, separate from symptom distress and other related terms. The continued differentiation of symptom concepts is important for sound methodologic research and meaningful interventions that affect and improve patient experiences. Implications for nursing Clarifying multiple symptom concepts in the symptoms experience, determining appropriate measurement methodologies for the concepts, and identifying appropriate strategies will lessen the burden of symptoms and contribute to improved quality of life and better patient outcomes.

100 citations

References
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Journal ArticleDOI
TL;DR: The CES-D scale as discussed by the authors is a short self-report scale designed to measure depressive symptomatology in the general population, which has been used in household interview surveys and in psychiatric settings.
Abstract: The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.

48,339 citations

Journal ArticleDOI
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.

39,961 citations

Journal ArticleDOI
TL;DR: Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.
Abstract: Background: Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients’ treatment noncompliance with their anxiety and depression.

3,882 citations

Journal ArticleDOI
TL;DR: The probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.
Abstract: Histories of depression-related symptoms were obtained from 3845 randomly selected adult residents of Kansas City, Missouri, and Washington County, Maryland. Depressed persons were slightly more common in Kansas City than in Washington County but within the latter area no urban–rural differences were observed. More depressed persons were found among blacks than among whites. Slightly more white females than males were depressed; no significant differences were found between black females and males. After adjustment for the effects of other independent variables, the probability of having symptoms of depression was highest among persons who were young adults, unmarried, not employed outside the home, poorly paid, and not well educated.

712 citations

Journal ArticleDOI
TL;DR: In this paper, the authors used the Structured Clinical Interview for the Diagnostic and statistical Manual of Mental Disorders, Third Edition, Revised, to establish "gold standard" diagnoses including major and minor depressive disorders.
Abstract: Background: Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument might aid in the recognition of depression. However, available findings from younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffered substantial methodological limitations. Methods: One hundred thirty patients 60 years or older attending 3 primary care internists' practices participated in the study. Two screening scales were used: the Center for Epidemiologic Studies—Depression Scale (CES-D) and the Geriatric Depression Scale (GDS). The Structured Clinical Interview for the Diagnostic and statistical Manual of Mental Disorders, Third Edition, Revised , was used to establish "gold standard" diagnoses including major and minor depressive disorders. Receiver operating curve analysis was used to determine each scale's operating characteristics. Results: Both the CES-D and the GDS had excellent properties in screening for major depression. The optimum cutoff point for the CES-D was 21, yielding a sensitivity of 92% and a specificity of 87%. The optimum cutoff point for the GDS was 10, yielding a sensitivity of 100% and a specificity of 84%. A shorter version of the GDS had a sensitivity of 92% and a specificity of 81% using a cutoff point of 5. All scales lost accuracy when used to detect minor depression or the presence of any depressive diagnosis. Conclusions: The CES-D and the GDS have excellent properties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease administration, primary care clinicians should consider its routine use in their practices. Arch Intern Med. 1997;157:449-454

587 citations