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Biomedical subjects

Wayne Katon

Publications and source records attributed to Wayne Katon.

At least 55 records · Page 3Linked to original sources
PubMed2003

Health care costs associated with posttraumatic stress disorder symptoms in women.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a prevalent disorder that has been associated with elevated rates of medically unexplained physical symptoms, significant functional impairment, and high health care use. However, little is known about actual health care costs associated with PTSD. METHODS: We administered the PTSD Checklist (PCL) to 1225 female members of a metropolitan health maintenance organization and validated the instrument using a structured PTSD interview in a subset of 268 women. Participants were classified into 3 groups by PCL score: low (<30), moderate (30-44), and high (> or =45). By using the cost accounting system of the health maintenance organization, we examined differences between the groups with respect to total and component health care costs, controlling for chronic medical illness and other forms of psychological distress. RESULTS: The total unadjusted mean +/- SD annual health care costs were 3060 US dollars +/- 6381 US dollars (median, 1283 US dollars) for the high PCL score group, 1779 US dollars +/- 3008 US dollars (median, 829 US dollars) for the moderate PCL score group, and 1646 US dollars +/- 5156 US dollars (median, 609 US dollars) for the low PCL score group. After adjusting for depression, chronic medical disease, and demographic factors, women with high PCL scores had a significantly greater odds of having nonzero health care costs compared with women with low PCL scores (odds ratio, 13.14; 95% confidence interval, 1.70-101.19). Compared with women in the low PCL score group, those in the moderate PCL score group had, on average, a 38% increase in adjusted total annual median costs, and those in the high PCL score group had a 104% increase. CONCLUSIONS: Women with PTSD symptoms in this study had significantly higher total and component health care costs, even after controlling for depression, chronic medical illness, and demographic differences. These findings are similar to those found in studies of costs related to major depression and suggest that instituting health services interventions to improve recognition and treatment of PTSD in primary and specialty care clinics may be a cost-effective approach for lowering the prevalence of this disorder.

Adolescent↗
PubMed2003

Depression screening attitudes and practices among obstetrician-gynecologists.

OBJECTIVE: To assess obstetrician-gynecologists' attitudes and practices related to depression screening. METHOD: A total of 282 obstetrician-gynecologists completed a 36-question mail survey that assessed attitudes regarding depression screening, training to treat depression, psychosocial concern, professional influence, and ease of screening. RESULT: Depression screening (employed regardless of signs or symptoms) was reported by 44% of physicians. Positive attitudes toward depression screening, high psychosocial concern, high ease of screening, and adequate training to treat depression were significant independent predictors of depression screening practices. CONCLUSION: The majority of obstetrician-gynecologists are concerned about depression, believe depression screening is effective, and perform some degree of depression screening with their patients. However, they perceive depression screening as difficult to carry out in everyday practice, and some question whether screening improves outcomes.

Attitude of Health Personnel↗
PubMed2003

Impacting late life depression: integrating a depression intervention into primary care.

groups and semi-structured individual interviews with all Depression Clinical Specialists (DCSs) working with Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment), a study testing a collaborative care intervention for late life depression, to examine integration of the intervention model into primary care. DCSs described key intervention components, including supervision from a psychiatrist and a liaison primary care provider, weekly team meetings, computerized patient tracking, and outcomes assessment tools as effective in supporting patient care. DCSs discussed details of protocols, training, environmental set-up, and interpersonal factors that seemed to facilitate integration. DCSs also identified research-related factors that may need to be preserved in the real world. Basic elements of the IMPACT model seem to support integration of late life depression care into primary care. Research-related components may need modification for dissemination.

Aging↗
PubMed2003

Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care.

OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. DESIGN: Patients were randomly assigned to treatment model by clinic firm. SETTING: VA primary care clinic. PARTICIPANTS: One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. MEASUREMENTS: Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale. MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

Adult↗
PubMed2003

Depression treatment in a sample of 1,801 depressed older adults in primary care.

OBJECTIVES: To examine rates and predictors of lifetime and recent depression treatment in a sample of 1,801 depressed older primary care patients DESIGN: Cross sectional survey data collected from 1999 to 2001 as part of a treatment effectiveness trial. SETTING: Eighteen primary care clinics belonging to eight organizations in five states. PARTICIPANTS: One thousand eight hundred one clinic users aged 60 and older who met diagnostic criteria for major depression or dysthymia. MEASUREMENTS: Lifetime depression treatment was defined as ever having received a prescription medication, counseling, or psychotherapy for depression. Potentially effective recent depression treatment was defined as 2 or more months of antidepressant medications or four or more sessions of counseling or psychotherapy for depression in the past 3 months. RESULTS: The mean age +/- standard deviation was 71.2 +/- 7.5; 65% of subjects were women. Twenty-three percent of the sample came from ethnic minority groups (12% were African American, 8% were Latino, and 3% belonged to other ethnic minorities). The median household income was $23,000. Most study participants (83%) reported depressive symptoms for 2 or more years, and most (71%) reported two or more prior depressive episodes. About 65% reported any lifetime depression treatment, and 46% reported some depression treatment in the past 3 months, although only 29% reported potentially effective recent depression treatment. Most of the treatment provided consisted of antidepressant medications, with newer antidepressants such as selective serotonin reuptake inhibitors constituting the majority (78%) of antidepressants used. Most participants indicated a preference for counseling or psychotherapy over antidepressant medications, but only 8% had received such treatment in the past 3 months, and only 1% reported four or more sessions of counseling. Men, African Americans, Latinos, those without two or more prior episodes of depression, and those who preferred counseling to antidepressant medications reported significantly lower rates of depression care. CONCLUSION: The findings suggest that there is considerable opportunity to improve care for older adults with depression. Particular efforts should be focused on improving access to depression care for older men, African Americans, Latinos, and patients who prefer treatments other than antidepressants.

Aged↗
PubMed2003

Managed care, access to specialists, and outcomes among primary care patients with pain.

OBJECTIVE: To determine whether managed care controls were associated with reduced access to specialists and worse outcomes among primary care patients with pain. DATA SOURCES/STUDY SETTING: Patient, physician, and office manager questionnaires collected in the Seattle area in 1996-1997, plus data abstracted from patient records and health plans. STUDY DESIGN: A prospective cohort study of 2,275 adult patients with common pain problems recruited in the offices of 261 primary care physicians in Seattle. DATA COLLECTION: Patients completed a waiting room questionnaire and follow-up surveys at the end of the first and sixth months to measure access to specialists and outcomes. Intensity of managed care controls measured by plan managed care index and benefit/cost-sharing indexes, office managed care index, physician compensation, financial incentives, and use of clinical guidelines. PRINCIPAL FINDINGS: A financial withhold for referral was associated with a lower likelihood of referral to a physician specialist, a greater likelihood of seeing a specialist without referral, and a lower patient rating of care from the primary physician. Otherwise, patients in more managed offices and with greater out-of-network plan benefits had greater access to specialists. Patients with more versus less managed care had similar health outcomes, but patients in more managed offices had lower ratings of care provided by their primary physicians. CONCLUSIONS: Increased managed care controls were generally not associated with reduced access to specialists and worse health outcomes for primary care patients with pain, but patients in more managed offices had lower ratings of care provided by their primary physicians.

Adult↗
PubMed2003

Moving treatment research from clinical trials to the real world.

Recently the National Institutes of Health has been emphasizing research that takes findings generated by clinical research and translates them into treatments for patients who are seen in day-to-day nonresearch settings. This translational process requires a series of steps in which elements of both efficacy and effectiveness research are combined into successively more complex designs. However, there has been little discussion of exactly how to develop and operationalize these designs. This article describes an approach to the development of these hybrid designs. Their operationalization is illustrated by using the design of an ongoing effectiveness treatment study of panic disorder in primary care. Experts in both efficacy and effectiveness research collaborated to address the methodologic and data collection issues that need to be considered in designing a first-generation effectiveness study. Elements of the overall study design, setting or service delivery context, inclusion and exclusion criteria, recruitment and screening, assessment tools, and intervention modification are discussed to illustrate the thinking behind and rationale for decisions about these different design components. Although the series of decisions for this study were partly influenced by considerations specific to the diagnosis of panic disorder and the context of the primary care setting, the general stepwise approach to designing treatment interventions using an effectiveness model is relevant for the development of similar designs for other mental disorders and other settings.

Clinical Trials as Topic↗
PubMed2003

Cost-effectiveness of collaborative care for depression in a primary care veteran population.

OBJECTIVE: This study examined the incremental cost-effectiveness of a collaborative care intervention for depression compared with consult-liaison care. METHODS: A total of 354 patients in a Department of Veterans Affairs (VA) primary care clinic who met the criteria for major depression or dysthymia were randomly assigned to one of the two care models. Under the collaborative care model, a mental health team provided a treatment plan to primary care providers, telephoned patients to encourage adherence, reviewed treatment results, and suggested modifications. Outcomes were assessed at three and nine months by telephone interviews. Health care use and costs were also assessed. RESULTS: A significantly greater number of collaborative care patients were treated for depression and given prescriptions for antidepressants. The collaborative care patients experienced an average of 14.6 additional depression-free days over the nine months. The mean incremental cost of the intervention per patient was $237 US dollars for depression treatment and $519 US dollars for total outpatient costs. A majority of the additional expenditures were accounted for by the intervention. The incremental cost-effectiveness ratio was $24 US dollars per depression-free day for depression treatment costs and $33 US dollars for total outpatient cost. CONCLUSIONS: Better coordination and communication under collaborative care was associated with a greater number of patients being treated for depression and with moderate increases in days free of depression and in treatment cost. Additional resources are needed for effective collaborative care models for depression treatment in primary care.

Cost-Benefit Analysis↗
PubMed2003

Identifying Depressed Patients With a High Risk of Comorbid Anxiety in Primary Care.

BACKGROUND: Depressive and anxiety disorders are highly prevalent in the primary care setting. There is evidence that patients with depression and comorbid anxiety are more severely impaired than patients with depression alone and require aggressive mental health treatment. The goal of this study was to assess the impact of comorbid anxiety in a primary care population of depressed patients. METHOD: 342 subjects diagnosed with a DSM-IV-defined major depressive episode, dysthymia, or both were asked 2 questions about the presence of comorbid anxiety symptoms (history of panic attacks and/or flashbacks). Patient groups included depression only (N = 119), depression and panic attacks (N = 51), depression and flashbacks (N = 97), and depression and both panic attacks and flashbacks (N = 75). Groups were compared on demographics, mental health histories, and health-related quality-of-life variables. Data were gathered from January 1998 to March 1999. RESULTS: Those patients with depression, panic attacks, and flashback symptoms as compared with those with depression alone were more likely to be younger, unmarried, and female. The group with depression, panic attacks, and flashbacks was also more likely to have more depressive symptoms, more impaired health status, worse disability, and a more complicated and persistent history of mental illness. Regression analysis revealed that the greatest impact on disability, presence of depressive symptoms, and mental health outcomes was associated with panic attacks. CONCLUSION: By asking 2 questions about comorbid anxiety symptoms, primary care providers evaluating depressed patients may be able to identify a group of significantly impaired patients at high risk of anxiety disorders who might benefit from collaboration with or referral to a mental health specialist.

Journal Article↗
PubMed2002

Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial.

CONTEXT: Few depressed older adults receive effective treatment in primary care settings. OBJECTIVE: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. DESIGN: Randomized controlled trial with recruitment from July 1999 to August 2001. SETTING: Eighteen primary care clinics from 8 health care organizations in 5 states. PARTICIPANTS: A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depression, Problem Solving Treatment in Primary Care. MAIN OUTCOME MEASURES: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. RESULTS: At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. CONCLUSION: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

Aged↗
PubMed2002

Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery.

OBJECTIVE: We examined the associations between psychiatric and substance use diagnoses and low birth weight (LBW), very low birth weight (VLBW), and preterm delivery among all women delivering in California hospitals during 1995. METHODS: This population-based retrospective cohort analysis used linked hospital discharge and birth certificate data for 521,490 deliveries. Logistic regression analyses were conducted to assess the associations between maternal psychiatric and substance use hospital discharge diagnoses and LBW, VLBW, and preterm delivery while controlling for maternal demographic and medical characteristics. RESULTS: Women with psychiatric diagnoses had a significantly higher risk of LBW (adjusted odds ratio [OR] 2.0; 95% confidence interval [CI] 1.7, 2.3), VLBW (OR 2.9; 95% CI 2.1, 3.9), and preterm delivery (OR 1.6; 95% CI 1.4, 1.9) compared with women without those diagnoses. Substance use diagnoses were also associated with higher risk of LBW (OR 3.7; 95% CI 3.4, 4.0), VLBW (OR 2.8; 95% CI 2.3, 3.3), and preterm delivery (OR 2.4; 95% CI 2.3, 2.6). CONCLUSION: Maternal psychiatric and substance use diagnoses were independently associated with low birth weight and preterm delivery in the population of women delivering in California in 1995. Identifying pregnant women with current psychiatric disorders and increased monitoring for preterm and low birth weight delivery among this population may be indicated.

Adolescent↗
PubMed2002

Response styles among patients with minor depression and dysthymia in primary care.

Ruminative responses to depression have predicted duration and severity of depressive symptoms. The authors examined how response styles change over the course of treatment for depression and as a function of type of treatment. They also examined the ability of response styles to predict treatment outcome and status at follow-up. Primary care patients (n = 96) with dysthymia or minor depression were randomly assigned to problem-solving therapy, paroxetine, or placebo. Patients' depressive symptoms and rumination, but not distraction, decreased over time. Pretreatment rumination and distraction were associated with more depressive symptoms at the conclusion of treatment; the latter finding was not consistent with the response style theory of depression. Results are discussed in terms of their implications for this theory.

Adolescent↗
PubMed2002

Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms.

OBJECTIVE: To determine whether managed care is associated with reduced access to mental health specialists and worse outcomes among primary care patients with depressive symptoms. DESIGN: Prospective cohort study. SETTING: Offices of 261 primary physicians in private practice in Seattle. PATIENTS: Patients (N = 17,187) were screened in waiting rooms, enrolling 1,336 adults with depressive symptoms. Patients (n = 942) completed follow-up surveys at 1, 3, and 6 months. MEASUREMENTS AND RESULTS: For each patient, the intensity of managed care was measured by the managedness of the patient's health plan, plan benefit indexes, presence or absence of a mental health carve-out, intensity of managed care in the patient's primary care office, physician financial incentives, and whether the physician read or used depression guidelines. Access measures were referral and actually seeing a mental health specialist. Outcomes were the Symptom Checklist for Depression, restricted activity days, and patient rating of care from primary physician. Approximately 23% of patients were referred to mental health specialists, and 38% saw a mental health specialist with or without referral. Managed care generally was not associated with a reduced likelihood of referral or seeing a mental health specialist. Patients in more-managed plans were less likely to be referred to a psychiatrist. Among low-income patients, a physician financial withhold for referral was associated with fewer mental health referrals. A physician productivity bonus was associated with greater access to mental health specialists. Depressive symptom and restricted activity day outcomes in more-managed health plans and offices were similar to or better than less-managed settings. Patients in more-managed offices had lower ratings of care from their primary physicians. CONCLUSIONS: The intensity of managed care was generally not associated with access to mental health specialists. The small number of managed care strategies associated with reduced access were offset by other strategies associated with increased access. Consequently, no adverse health outcomes were detected, but lower patient ratings of care provided by their primary physicians were found.

Adolescent↗
PubMed2002

Long-term effects of a collaborative care intervention in persistently depressed primary care patients.

OBJECTIVE: A previous study described the effect of a collaborative care intervention on improving adherence to antidepressant medications and depressive and functional outcomes of patients with persistent depressive symptoms 8 weeks after the primary care physician initiated treatment. This paper examined the 28-month effect of this intervention on adherence, depressive symptoms, functioning, and health care costs. DESIGN: Randomized trial of stepped collaborative care intervention versus usual care. SETTING: HMO in Seattle, Wash. PATIENTS: Patients with major depression were stratified into severe and moderate depression groups prior to randomization. INTERVENTIONS: A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician. MEASURES AND MAIN RESULTS: The collaborative care intervention was associated with continued improvement in depressive symptoms at 28 months in patients in the moderate-severity group (F1,87 = 8.65; P =.004), but not in patients in the high-severity group (F1,51 = 0.02; P =.88) Improvements in the intervention group in antidepressant adherence were found to occur for the first 6 months (chi2(1) = 8.23; P <.01) and second 6-month period (chi2(1) = 5.98; P <.05) after randomization in the high-severity group and for 6 months after randomization in the moderate-severity group(chi2(1) = 6.10; P <.05). There were no significant differences in total ambulatory costs between intervention and control patients over the 28-month period (F1,180 = 0.77; P =.40). CONCLUSIONS: A collaborative care intervention was associated with sustained improvement in depressive outcomes without additional health care costs in approximately two thirds of primary care patients with persistent depressive symptoms.

Adult↗
PubMed2002

Prevalence of comorbid psychiatric illness and its impact on symptom perception, quality of life, and functional status in women with urinary incontinence.

OBJECTIVE: The purpose of this study was to determine the prevalence and impact of major depression and panic disorder in women with urinary incontinence. STUDY DESIGN: Participants were 218 consecutive women with urinary incontinence over a 14-month period. Major depression and panic disorder diagnoses, symptom perception, incontinence-specific quality of life, functional status, and urinary incontinence type were assessed. RESULTS: The overall prevalence of major depression and panic disorder was 16% and 7%, respectively. In a comparison to patients with stress urinary incontinence, the odds of having major depression were 9.2 for patients with urge and 13.5 for patients with mixed urinary incontinence. Although clinically similar to patients who did not have depression, patients with depression rated their urinary incontinence as significantly more severe and had greater quality of life and functional status impairment. CONCLUSION: Current major depression and panic disorder are highly prevalent in women with urinary incontinence. Patients with urge and mixed urinary incontinence are significantly more likely to have coexistent psychiatric illness. Comorbid major depression significantly impacts a patient's urinary incontinence symptom reporting, incontinence-specific quality of life, and functional status.

Comorbidity↗
PubMed2002

Predicting posttraumatic distress in hospitalized trauma survivors with acute injuries.

OBJECTIVE: Each year approximately 2.5 million Americans are hospitalized after sustaining traumatic physical injuries. Few investigations have comprehensively screened for posttraumatic symptomatic distress or identified predictors of posttraumatic stress disorder (PTSD) in representative samples of surgical inpatients. METHOD: The subjects were 101 randomly selected survivors of motor vehicle crashes or assaults who were interviewed while hospitalized and 1, 4, and 12 months after injury. In the surgical ward, inpatients were screened for PTSD, depressive, and dissociative symptoms, for prior trauma, for pre-event functioning, and for alcohol and drug intoxication. Patient demographic and injury characteristics were also recorded. Random coefficient regression models were used to assess the association between these clinical, injury, and demographic characteristics and PTSD symptom levels over the year after the injury. RESULTS: Of the 101 surgical inpatients, 73% screened positive for high levels of symptomatic distress and/or substance intoxication. At 1, 4, and 12 months after the injury, 30%-40% reported symptoms consistent with a diagnosis of PTSD. High ward PTSD symptom levels were the strongest and most parsimonious predictor of persistent symptoms over the course of the year. Greater prior trauma, stimulant intoxication, and female gender were also associated with higher symptom levels. Increasing injury severity, however, was not associated with higher PTSD symptom levels. CONCLUSIONS: Clinical and demographic characteristics readily identifiable at the time of surgical inpatient hospitalization predict PTSD symptoms over the year after injury. Effectiveness trials that test screening and intervention procedures for at-risk inpatients should be developed.

Accidents, Traffic↗
PubMedDate not supplied

Depression and diabetes symptom burden.

OBJECTIVE: To examine the relationship among patient-reported diabetes symptoms, severity of depressive illness and objective measures of diabetes control and severity among a population-based sample of patients with diabetes. METHODS: A mailed survey was sent to all patients with diabetes from nine primary care clinics of a Health Maintenance Organization. The Patient Health Questionnaire (PHQ-9) was used to diagnose major depression, the Self-Completion Patient Outcome instrument assessed diabetes symptoms and automated medical record data were used to measure diabetes treatment intensity, HbA(1c) levels, diabetes complications and medical comorbidity. Analysis of covariance (ANCOVA) was used to determine if the number of diabetes symptoms was related to having major depression and to number of depressive symptoms. Logistic regression analyses determined the relative strengths of the associations between each individual diabetic symptom and presence of major depression, HbA(1c) levels above 8.0% and two or more diabetes complications. RESULTS: Among 4168 patients with diabetes, those with major depression (N=487) reported significantly more diabetes symptoms (mean=4.40) than participants without depression (mean=2.46) after adjusting for demographic characteristics, objective measures of diabetes severity and medical comorbidity [F(1,4029)=339.31, P<.0001]. The overall number of diabetes symptoms was related to the number of depressive symptoms (from 0 to 9) endorsed by participants [F(9,4021)=110.05, P<.0001]. Logistic regression analyses found that depression was significantly related to each of the 10 diabetes symptoms (all P<.001). CONCLUSIONS: The depression-diabetes symptom association is stronger than the association of diabetes symptoms with measures of glycemic control and diabetes complications.

Aged↗