Rezaeizadeh Afsaneh, Sanchez Katherine, Zolfaghari Kiumars, Madia Nancy D
Department of Psychiatry, UT Southwestern Medical Center, United States.
School of Social Work, University of Texas at Arlington, United States.
Int J Clin Health Psychol. 2021 Sep-Dec;21(3):100241. doi: 10.1016/j.ijchp.2021.100241. Epub 2021 Apr 10.
Uninsured populations have poor treatment engagement and are less likely to receive evidence-based interventions for depression. The objective of the current study was to retrospectively examine depression screening, diagnosis, and treatment patterns among uninsured patients in primary care. Study sample included all patients ( = 11,803) seen in nine community-based clinics. Key variables included depression screener and/or a depression diagnosis, anti-depressant initiation, behavioral health visits, and patient follow up measures. Treatment patterns from the subsample of patients diagnosed with depression were analyzed by collecting the number of behavioral health visits and antidepressant use six months (180 days) following the diagnosis. Utilization of the depression screening tool was high (67%, = 7,935) and 24% ( = 2,789) of the patients had a diagnosis of depression, however, more than half of the patients with a depression diagnosis did not have a recorded treatment plan ( = 1,474). The odds of anti-depressant use and behavioral visits for Hispanic patients were significantly greater than for Non-Hispanic patients. Universal screening with brief measures in primary care is improving, however, guideline-concordant depression treatment remains elusive for uninsured populations.
未参保人群的治疗参与度较低,且不太可能接受基于证据的抑郁症干预措施。本研究的目的是回顾性研究初级保健中未参保患者的抑郁症筛查、诊断和治疗模式。研究样本包括在九家社区诊所就诊的所有患者(n = 11,803)。关键变量包括抑郁症筛查和/或抑郁症诊断、抗抑郁药起始治疗、行为健康就诊以及患者随访措施。通过收集诊断后六个月(180天)的行为健康就诊次数和抗抑郁药使用情况,对诊断为抑郁症的患者子样本的治疗模式进行了分析。抑郁症筛查工具的使用率很高(67%,n = 7,935),24%(n = 2,789)的患者被诊断为抑郁症,然而,超过一半的抑郁症诊断患者没有记录在案的治疗计划(n = 1,474)。西班牙裔患者使用抗抑郁药和进行行为就诊的几率显著高于非西班牙裔患者。初级保健中采用简短措施进行普遍筛查的情况正在改善,然而,对于未参保人群来说,符合指南的抑郁症治疗仍然难以实现。