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 OJD  Vol.4 No.2 , May 2015
Association of Comorbidity with Depression Treatment Adequacy among Privately Insured Patients Initiating Depression Treatment
Abstract: This study examined the association among comorbidity, type of depression treatment, and depression treatment adequacy among privately insured depression patients using claims data from 165,569 employees. Individuals newly diagnosed with depression (n = 2364) were identified using ICD-9 diagnosis codes. Logistic regression models were used to determine if certain medical and psychiatric comorbidities were associated with depression treatment type (medication only, psychotherapy only, or combined treatment) and treatment adequacy. Approximately half of the sample (56.7%) received medication only, 26.8% received psychotherapy and medication, and 16.5% received psychotherapy only. The medication only group had the highest rate (50.2%) of receiving minimally adequate treatment, while those who received the combined treatment had the lowest rate (21.0%). Patients with comorbid anxiety disorders were significantly more likely to receive combined treatment or psychotherapy alone. Those who had comorbid musculoskeletal pain were significantly more likely to receive combined treatment. After controlling for treatment type, patients with comorbid diabetes and asthma had higher rates of receiving adequate treatment than patients with other comorbid conditions. There is a continous need for practice-system level interventions to improve the proportion of privately insured patients with new depressive episodes who receive adequate depression treatment.
Cite this paper: Rhee, Y. , Gustafson, M. , Ziffra, M. , Mohr, D. , Jordan, N. , (2015) Association of Comorbidity with Depression Treatment Adequacy among Privately Insured Patients Initiating Depression Treatment. Open Journal of Depression, 4, 13-23. doi: 10.4236/ojd.2015.42002.
References

[1]   Akincigil, A., Bowblis, J. R., Levin, C., Walkup, J. T., Jan, S., & Crystal, S. (2007). Adherence to Antidepressant Treatment among Privately Insured Patients Diagnosed With Depression. Medical Care, 45, 363-369.
http://dx.doi.org/10.1097/01.mlr.0000254574.23418.f6

[2]   Alegria, M., Chatterji, P., Wells, K., Cao, Z., Chen, C. N., Takeuchi, D., & Meng, X. L. (2008). Disparity in Depression Treatment among Racial and Ethnic Minority Populations in the United States. Psychiatric Services, 59, 1264-1272.
http://dx.doi.org/10.1176/ps.2008.59.11.1264

[3]   American Psychiatric Association (2000). American Psychiatric Association Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Journal of Psychiatry, 157, 1-45.

[4]   American Psychiatric Association (2010). Practice Guideline for the Treatment of Patients with Major Depressive Disorder (3rd ed.). Arlington,VA: American Psychiatric Association.

[5]   Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., & Rush, A. J. (2007). Dropouts versus Completers among Chronically Depressed Outpatients. Journal of Affective Disorders, 97, 197-202.
http://dx.doi.org/10.1016/j.jad.2006.06.017

[6]   Busch, S. H., Leslie, D., & Rosenheck, R. (2004). Measuring Quality of Pharmacotherapy for Depression in a National Health Care System. Medical Care, 42, 532-542.
http://dx.doi.org/10.1097/01.mlr.0000128000.96869.1e

[7]   Ciechanowski, P. S., Katon, W. J., & Russo, J. E. (2000). Depression and Diabetes: Impact of Depressive Symptoms on Adherence, Function, and Costs. Archives of Internal Medicine, 160, 3278-3285.
http://dx.doi.org/10.1001/archinte.160.21.3278

[8]   Davis, L., Uezato, A., Newell, J. M., & Frazier, E. (2008). Major Depression and Comorbid Substance Use Disorders. Current Opinion in Psychiatry, 21, 14-18.
http://dx.doi.org/10.1097/YCO.0b013e3282f32408

[9]   DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression Is a Risk Factor for Noncompliance with Medical Treatment: Meta-Analysis of the Effects of Anxiety and Depression on Patient Adherence. Archives of Internal Medicine, 160, 2101-2107.
http://dx.doi.org/10.1001/archinte.160.14.2101

[10]   du Fort, G., Newman, S. C., Boothroyd, L. J., & Bland, R. C. (1999). Treatment Seeking for Depression: Role of Depressive Symptoms and Comorbid Psychiatric Diagnoses. Journal of Affective Disorders, 52, 31-40.
http://dx.doi.org/10.1016/S0165-0327(98)00052-4

[11]   Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of Mental Health Treatment: Patterns and Predictors among Epidemiological Survey Respondents in the United States and Ontario. The American Journal of Psychiatry, 159, 845-851.
http://dx.doi.org/10.1176/appi.ajp.159.5.845

[12]   Ettner, S. L., Azocar, F., Branstrom, R. B., Meredith, L. S., Zhang, L., & Ong, M. K. (2010). Association of General Medical and Psychiatric Comorbidities with Receipt of Guideline-Concordant Care for Depression. Psychiatric Services, 61, 1255-1259.
http://dx.doi.org/10.1176/ps.2010.61.12.1255

[13]   Evans, D. L., & Charney, D. S. (2003). Mood Disorders and Medical Illness: A Major Public Health Problem. Biological Psychiatry, 54, 177-180.
http://dx.doi.org/10.1016/S0006-3223(03)00639-5

[14]   Fava, M., Rush, A. J., Alpert, J. E., Balasubramani, G. K., Wisniewski, S. R., Carmin, C. N., Howland, R. et al. (2008). Difference in Treatment Outcome in Outpatients with Anxious versus Nonanxious Depression: A STAR*D Report. The American Journal of Psychiatry, 165, 342-351.
http://dx.doi.org/10.1176/appi.ajp.2007.06111868

[15]   Gill, J. M., Chen, Y. X., & Lieberman, M. I. (2008). Management of Depression in Ambulatory Care for Patients with Medical Co-Morbidities: A Study from a National Electronic Health Record (EHR) Network. International Journal of Psychiatry in Medicine, 38, 203-215.
http://dx.doi.org/10.2190/PM.38.2.g

[16]   Gonzalez, S., Safren, S. A., Delahanty, L. M., Cagliero, E., Wexler, D. J., Meigs, J. B. et al. (2008). Symptoms of Depression Prospectively Predict Poorer Self-Care in Patients with Type 2 Diabetes. Diabetic Medicine, 25, 1102-1107.
http://dx.doi.org/10.1111/j.1464-5491.2008.02535.x

[17]   Hampton-Robb, S., Qualls, R. C., & Compton, W. C. (2003). Predicting First-Session Attendance: The Influence of Referral Source and Client Income. Psychotherapy Research, 13, 223-233.

[18]   Harman, J. S., Edlund, M. J., & Fortney, J. C. (2004). Disparities in the Adequacy of Depression Treatment in the United States. Psychiatric Services, 55, 1379-1385.
http://dx.doi.org/10.1176/appi.ps.55.12.1379

[19]   Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of Major Depressive Disorder: Results from the National Epidemiologic Survey on Alcoholism and Related Conditions. JAMA Psychiatry, 62, 1097-1106.
http://dx.doi.org/10.1001/archpsyc.62.10.1097

[20]   Hepner, K. A., Rowe, M., Rost, K., Hickey, S. C., Sherbourne, C. D., Ford, D. E., Meredith, L. S., & Rubenstein, L. V. (2007). The Effect of Adherence to Practice Guidelines on Depression Outcomes. Annals of Internal Medicine, 147, 320-329.
http://dx.doi.org/10.7326/0003-4819-147-5-200709040-00007

[21]   Howland, R. H., John Rush, A., Wisniewski, S. R., Trivedi, M. H., Warden, D., Fava, M., Berman, S. R. et al. (2009). Concurrent Anxiety and Substance Use Disorders among Outpatients with Major Depression: Clinical Features and Effect on Treatment Outcome. Drug and Alcohol Dependence, 99, 248-260.
http://dx.doi.org/10.1016/j.drugalcdep.2008.08.010

[22]   Jordan, N., Lee, T. A., Valenstein, M., & Weiss, K. B. (2007). Effect of Care Setting on Evidence-Based Depression Treatment for Veterans with COPD and Comorbid Depression. Journal of General Internal Medicine, 22, 1447-1452.
http://dx.doi.org/10.1007/s11606-007-0328-8

[23]   Katon, W. J. (2003). Clinical and Health Services Relationships between Major Depression, Depressive Symptoms, and General Medical Illness. Biological Psychiatry, 54, 216-226.
http://dx.doi.org/10.1016/S0006-3223(03)00273-7

[24]   Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Wang, P. S. et al. (2003). The Epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289, 3095- 3105.
http://dx.doi.org/10.1001/jama.289.23.3095

[25]   Kessler, R. C., Greenberg, P. E., Mickelson, K. D., Meneades, L. M., & Wang, P. S. (2001). The Effects of Chronic Medical Conditions on Work Loss and Work Cutback. Journal of Occupational and Environmental Medicine, 43, 218-225.
http://dx.doi.org/10.1097/00043764-200103000-00009

[26]   Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2008). The Prevalence and Correlates of Workplace Depression in the National Comorbidity Survey Replication. Journal of Occupational and Environmental Medicine, 50, 381-390.
http://dx.doi.org/10.1097/JOM.0b013e31816ba9b8

[27]   Ki, M., Paik, J. W., Choi, K. S., Ryu, S. H., Han, C., Lee, K., Ham, B. J., Chang, H. S., Won, E. S., Jun, T. Y., & Lee, M. S. (2014). Delays in Depression Treatment among Korean Population. Asia-Pacific Psychiatry, 6, 414-424.
http://dx.doi.org/10.1111/appy.12140

[28]   Klinkman, M. S. (1997). Competing Demands in Psychosocial Care: A Model for the Identification and Treatment of Depressive Disorders in Primary Care. General Hospital Psychiatry, 19, 98-111.
http://dx.doi.org/10.1016/S0163-8343(96)00145-4

[29]   Kurdyak, P. A., & Gnam, W. H. (2004). Medication Management of Depression: The Impact of Comorbid Chronic Medical Conditions. Journal of Psychosomatic Research, 57, 565-571.
http://dx.doi.org/10.1016/j.jpsychores.2004.04.367

[30]   Lagerveld, S. E., Bultmann, U., Franche, R. L., Dijk, F. J., Vlasveld, M. C., Feltz-Cornelis, C. M., Klink, J. J. et al. (2010). Factors Associated with Work Participation and Work Functioning in Depressed Workers: A Systematic Review. Journal of Occupational Rehabilitation, 20, 275-292.
http://dx.doi.org/10.1007/s10926-009-9224-x

[31]   Machado, M., Iskedjian, M., Ruiz, I., & Einarson, T. R. (2006). Remission, Dropouts, and Adverse Drug Reaction Rates in Major Depressive Disorder: A Meta-Analysis of Head-to-Head Trials. Current Medical Research & Opinion, 22, 1825- 1837.
http://dx.doi.org/10.1185/030079906X132415

[32]   Manchikanti, L., Giordano, J., Boswell, M., Fellows, B., Manchukonda, R., & Pampati, V. (2007). Psychological Factors as Predictors of Opioid Abuse and Illicit Drug Use in Chronic Pain Patients. Journal of Opioid Management, 3, 89-100.

[33]   Mohr, D. C., Hart, S. L., Howard, I., Julian, L., Vella, L., Catledge, C., & Feldman, M. D. (2006). Barriers to Psychotherapy among Depressed and Nondepressed Primary Care Patients. Annals of Behavioral Medicine, 32, 254-258.
http://dx.doi.org/10.1207/s15324796abm3203_12

[34]   Mulder, R. T. (2002). Personality Pathology and Treatment Outcome in Major Depression: A Review. The American Journal of Psychiatry, 159, 359-371.
http://dx.doi.org/10.1176/appi.ajp.159.3.359

[35]   National Committee for Quality Assurance (2007). HEDIS 2008 Technical Specifications. City name: National Committee for Quality Assurance.

[36]   Olfson, M., Marcus, S. C., Tedeschi, M., & Wan, G. J. (2006). Continuity of Antidepressant Treatment for Adults with Depression in the United States. The American Journal of Psychiatry, 163, 101-108.
http://dx.doi.org/10.1176/appi.ajp.163.1.101

[37]   Olfson, M., Mojtabai, R., Sampson, N. A., Hwang, I., Druss, B., Wang, P. S., Kessler, R. C. et al. (2009). Dropout from Outpatient Mental Health Care in the United States. Psychiatric Services, 60, 898-907.
http://dx.doi.org/10.1176/ps.2009.60.7.898

[38]   Pampallona, S., Bollini, P., Tibaldi, G., Kupelnick, B., & Munizza, C. (2004). Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review. JAMA Psychiatry, 61, 714-719.
http://dx.doi.org/10.1001/archpsyc.61.7.714

[39]   Rhee, Y., Taitel, M. S., Walker, D. R., & Lau, D. T. (2007). Narcotic Drug Use among Patients with Lower Back Pain in Employer Health Plans: A Retrospective Analysis of Risk Factors and Health Care Services. Clinical Therapeutics, 29, 2603-2612.
http://dx.doi.org/10.1016/j.clinthera.2007.12.006

[40]   Rost, K., Nutting, P., Smith, J., Coyne, J. C., Cooper-Patrick, L., & Rubenstein, L. (2000). The Role of Competing Demands in the Treatment Provided Primary Care Patients with Major Depression. Archives of Family Medicine, 9, 150-154.
http://dx.doi.org/10.1001/archfami.9.2.150

[41]   Simon, G. E. (2003). Social and Economic Burden of Mood Disorders. Biological Psychiatry, 54, 208-215.
http://dx.doi.org/10.1016/S0006-3223(03)00420-7

[42]   Stewart, W. F., Ricci, J. A., Chee, E., Hahn, S. R., & Morganstein, D. (2003). Cost of Lost Productive Work Time among US Workers with Depression. JAMA, 289, 3135-3144.
http://dx.doi.org/10.1001/jama.289.23.3135

[43]   Stranges, E., Yu, J., Kassed, C., Mark, T., Coffey, R., Houchens, R., Marder, W. (2009). Diagnosed Depression Associated with Higher Risk of Physical Comorbidities. Ann Arbor, MI: Truven Health Analytics.

[44]   Sung, H. N., Chae, H. S., Kim, E. S., & Kim, J. S. (2014). Diabetes and Depressive Symptoms in Korean Women: The Fifth Korean National Health and Nutrition Examination Survey (2010-2011). Korean Journal of Family Medicine, 35, 127-135.
http://dx.doi.org/10.4082/kjfm.2014.35.3.127

[45]   Tai-Seale, M., Croghan, T. W., & Obenchain, R. (2000). Determinants of Antidepressant Treatment Compliance: Implications for Policy. Medical Care Research and Review, 57, 491-512.
http://dx.doi.org/10.1177/107755870005700405

[46]   Vowles, K. E., & McCracken, L. M. (2008). Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process. Journal of Consulting and Clinical Psychology, 76, 397-407.
http://dx.doi.org/10.1037/0022-006X.76.3.397

[47]   Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-Month Use of Mental Health Services in the United States: Results from the National Comorbidity Survey Replication. JAMA Psychiatry, 62, 629-640.
http://dx.doi.org/10.1001/archpsyc.62.6.629

[48]   Warden, D., Rush, A. J., Carmody, T. J., Kashner, T. M., Biggs, M. M., Crismon, M. L., & Trivedi, M. H. (2009). Predictors of Attrition during One Year of Depression Treatment: A Roadmap to Personalized Intervention. Journal of Psychiatric Practice, 15, 113-124.
http://dx.doi.org/10.1097/01.pra.0000348364.88676.83

[49]   Warden, D., Trivedi, M. H., Wisniewski, S. R., Davis, L., Nierenberg, A. A., Gaynes, B. N., Howland, R. et al. (2007). Predictors of Attrition during Initial (Citalopram) Treatment for Depression: A STAR*D Report. The American Journal of Psychiatry, 164, 1189-1197.
http://dx.doi.org/10.1176/appi.ajp.2007.06071225

[50]   Weilburg, J. B., O’Leary, K. M., Meigs, J. B., Hennen, J., & Stafford, R. S. (2003). Evaluation of the Adequacy of Outpatient Antidepressant Treatment. Psychiatric Services, 54, 1233-1239.
http://dx.doi.org/10.1176/appi.ps.54.9.1233

[51]   Young, A. S., Klap, R., Sherbourne, C. D., & Wells, K. B. (2001). The Quality of Care for Depressive and Anxiety Disorders in the United States. JAMA Psychiatry, 58, 55-61.
http://dx.doi.org/10.1001/archpsyc.58.1.55

 
 
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