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Erschienen in: Journal of General Internal Medicine 3/2013

01.03.2013 | Original Research

Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9

verfasst von: Amy M. Bauer, MD MS, Ya-Fen Chan, PhD, Hsiang Huang, MD, MPH, Steven Vannoy, PhD, Jürgen Unützer, MD, MPH, MA

Erschienen in: Journal of General Internal Medicine | Ausgabe 3/2013

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ABSTRACT

BACKGROUND

With increasing emphasis on integrating behavioral health services, primary care providers play an important role in managing patients with suicidal thoughts.

OBJECTIVE

To evaluate whether Patient Health Questionnaire-9 (PHQ-9) Item 9 scores are associated with patient characteristics, management, and depression outcomes in a primary care-based mental health program.

DESIGN

Observational analysis of data collected from a patient registry.

PARTICIPANTS

Eleven thousand fifteen adults enrolled in the Mental Health Integration Program (MHIP).

INTERVENTIONS

MHIP provides integrated mental health services for safety-net populations in over 100 community health centers across Washington State. Key elements of the team-based model include: a disease registry; integrated care management; and organized psychiatric case review.

MAIN MEASURES

The independent variable, suicidal ideation (SI), was assessed by PHQ-9 Item 9. Depression severity was assessed with the PHQ-8. Outcomes included four indicators of depression treatment process (care manager contact, psychiatric case review, psychotropic medications, and specialty mental health referral), and two indicators of depression outcomes (50 % reduction in PHQ-9 score and PHQ-9 score < 10).

KEY RESULTS

SI was common (45.2 %) at baseline, with significantly higher rates among men and patients with greater psychopathology. Few patients with SI (5.4 %) lacked substantial current depressive symptoms. After adjusting for age, gender, and severity of psychopathology, patients with SI received follow-up earlier (care manager contact HR = 1.05, p < 0.001; psychiatric review HR = 1.02, p < 0.05), and were more likely to receive psychotropic medications (OR = 1.11, p = 0.001) and specialty referral (OR = 1.23, p < 0.001), yet were less likely to achieve a PHQ-9 score < 10 (HR = 0.87, p < 0.001).

CONCLUSIONS

Suicidal thoughts are common among safety-net patients referred by primary care providers for behavioral health care. Scores on Item 9 of the PHQ-9 are easily obtainable in primary care, may help providers initiate conversations about suicidality, and serve as useful markers of psychiatric complexity and treatment-resistance. Patients with positive scores should receive timely and comprehensive psychiatric evaluation and follow-up.
Literatur
1.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatr. 2010;32(4):345–59.CrossRef Kroenke K, Spitzer RL, Williams JB, Lowe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatr. 2010;32(4):345–59.CrossRef
2.
Zurück zum Zitat Uebelacker LA, German NM, Gaudiano BA, Miller IW. Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study. Prim Care Companion CNS Disord. 2011;13(1). Uebelacker LA, German NM, Gaudiano BA, Miller IW. Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: a cross-sectional study. Prim Care Companion CNS Disord. 2011;13(1).
3.
Zurück zum Zitat Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909–16.PubMedCrossRef Luoma JB, Martin CE, Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159(6):909–16.PubMedCrossRef
5.
Zurück zum Zitat Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999;56(12):1109–15.PubMedCrossRef Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch Gen Psychiatry. 1999;56(12):1109–15.PubMedCrossRef
6.
Zurück zum Zitat Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273(13):1026–31.PubMedCrossRef Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995;273(13):1026–31.PubMedCrossRef
7.
Zurück zum Zitat Unützer J, Katon W, Callahan C, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836–45.PubMedCrossRef Unützer J, Katon W, Callahan C, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22):2836–45.PubMedCrossRef
8.
Zurück zum Zitat Thielke S, Vannoy S, Unutzer J. Integrating mental health and primary care. Prim Care. 2007;34(3):571–92. vii.PubMedCrossRef Thielke S, Vannoy S, Unutzer J. Integrating mental health and primary care. Prim Care. 2007;34(3):571–92. vii.PubMedCrossRef
9.
Zurück zum Zitat Unützer J, Choi Y, Cook IA, Oishi S. A web-based data management system to improve care for depression in a multicenter clinical trial. Psychiatr Serv. 2002;53(6):671–73. 678.PubMedCrossRef Unützer J, Choi Y, Cook IA, Oishi S. A web-based data management system to improve care for depression in a multicenter clinical trial. Psychiatr Serv. 2002;53(6):671–73. 678.PubMedCrossRef
10.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedCrossRef Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.PubMedCrossRef
11.
Zurück zum Zitat Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004;42(12):1194–201.PubMedCrossRef Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004;42(12):1194–201.PubMedCrossRef
12.
Zurück zum Zitat Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.PubMedCrossRef Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.PubMedCrossRef
13.
Zurück zum Zitat Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–73.PubMedCrossRef Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–73.PubMedCrossRef
14.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.PubMedCrossRef Kroenke K, Spitzer RL, Williams JB. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.PubMedCrossRef
15.
Zurück zum Zitat Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef
16.
Zurück zum Zitat Dennis ML, Chan YF, Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. Am J Addict. 2006;15(Suppl 1):80–91.PubMedCrossRef Dennis ML, Chan YF, Funk RR. Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. Am J Addict. 2006;15(Suppl 1):80–91.PubMedCrossRef
17.
Zurück zum Zitat Gensichen J, Teising A, Konig J, Gerlach FM, Petersen JJ. Predictors of suicidal ideation in depressive primary care patients. J Affect Disord. 2010;125(1–3):124–7.PubMedCrossRef Gensichen J, Teising A, Konig J, Gerlach FM, Petersen JJ. Predictors of suicidal ideation in depressive primary care patients. J Affect Disord. 2010;125(1–3):124–7.PubMedCrossRef
18.
Zurück zum Zitat Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatr. 1997;170:205–28.CrossRef Harris EC, Barraclough B. Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatr. 1997;170:205–28.CrossRef
19.
Zurück zum Zitat Nock MK, Hwang I, Sampson N, et al. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med. 2009;6(8):e1000123.PubMedCrossRef Nock MK, Hwang I, Sampson N, et al. Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med. 2009;6(8):e1000123.PubMedCrossRef
20.
Zurück zum Zitat Unützer J, Chan YF, Hafer E, et al. Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care. Am J Public Health. 2012;102(6):e41–5.PubMedCrossRef Unützer J, Chan YF, Hafer E, et al. Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care. Am J Public Health. 2012;102(6):e41–5.PubMedCrossRef
21.
Zurück zum Zitat Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412–8.PubMedCrossRef Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5(5):412–8.PubMedCrossRef
22.
Zurück zum Zitat Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open. 2011;1(2):e000198.PubMedCrossRef Vannoy SD, Robins LS. Suicide-related discussions with depressed primary care patients in the USA: gender and quality gaps. A mixed methods analysis. BMJ Open. 2011;1(2):e000198.PubMedCrossRef
Metadaten
Titel
Characteristics, Management, and Depression Outcomes of Primary Care Patients Who Endorse Thoughts of Death or Suicide on the PHQ-9
verfasst von
Amy M. Bauer, MD MS
Ya-Fen Chan, PhD
Hsiang Huang, MD, MPH
Steven Vannoy, PhD
Jürgen Unützer, MD, MPH, MA
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 3/2013
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-012-2194-2

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