PubMed Health⌕ Search

Biomedical subjects

Wayne Katon

Publications and source records attributed to Wayne Katon.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

The detection and treatment of posttraumatic distress and substance intoxication in the acute care inpatient setting.

Each year, approximately 2.5 million Americans require inpatient admissions after sustaining traumatic physical injuries. Few investigations have assessed the routine detection and treatment of acute care inpatients with high levels of posttraumatic distress. A representative sample of 101 hospitalized patients with acute injuries was screened for posttraumatic stress disorder (PTSD) and depressive symptoms, as well as substance intoxication. Patients' medical records were reviewed for documentation of psychiatric symptoms and diagnoses and the initiation of early evaluation and treatment. High levels of PTSD and/or depressive symptoms were present in over 50% of patients. Although providers frequently noted symptomatic distress, few symptomatic patients received formal diagnoses, evaluations or treatment. Patients who had positive substance toxicology screens on admission infrequently received in-depth evaluation or treatment. A substantial number of injured trauma survivors have high levels of symptomatic distress that are inconsistently evaluated and treated in the acute care medical setting. Mental health interventions appear to be feasibly and effectively delivered from trauma centers. Therefore, ongoing investigation and policy initiatives informing the detection and treatment of patients with psychiatric disturbances in acute care could substantially enhance the quality of mental health care for injured survivors of individual and mass trauma.

Acute Disease↗
PubMedDate not supplied

Medical illness and response to treatment in primary care panic disorder.

OBJECTIVE: Although studies have suggested that comorbid medical illness can affect the outcome of patients with depression, little is known about whether medical illness comorbidity affects treatment outcome in patients with anxiety. METHOD: Primary care patients with panic disorder (n=232), participating in a randomized collaborative care intervention of CBT and pharmacology, were divided into those above (n=125) and below (n=107) the median for burden of chronic medical illness and assessed at 3, 6, 9 and 12 months. RESULTS: Subjects with a greater burden of medical illness were more psychiatrically ill at baseline, with greater anxiety symptom severity, greater disability and more psychiatric comorbidity. The intervention produced significant and similar increases in amount of evidence-based care, and reductions in clinical symptoms and disability that were comparable in the more and less medically ill groups. CONCLUSIONS: The comparable response of individuals with more severe medical illness suggests that CBT and pharmacotherapy for panic disorder work equally well regardless of medical illness comorbidity. However, the more severe psychiatric illness both at baseline and follow-up in these same individuals suggest that treatment programs may need to be extended in time to optimize treatment outcome.

Adolescent↗
PubMedDate not supplied

Physicians' satisfaction with a collaborative disease management program for late-life depression in primary care.

OBJECTIVE: This study describes physicians' satisfaction with care for patients with depression before and after the implementation of a primary care-based collaborative care program. METHOD: Project Improving Mood, Promoting Access to Collaborative Treatment for late-life depression (IMPACT) is a multisite, randomized controlled trial comparing a primary care-based collaborative disease management program for late-life depression with care as usual. A total of 450 primary care physicians at 18 participating clinics participated in a satisfaction survey before and 12 months after IMPACT initiation. The preintervention survey focused on physicians' satisfaction with current mental health resources and ability to provide depression care. The postintervention survey repeated these and added questions about physician's experience with the IMPACT collaborative care model. RESULTS: Before intervention, about half (54%) of the participating physicians were satisfied with resources to treat patients with depression. After intervention, more than 90% reported the intervention as helpful in treating patients with depression and 82% felt that the intervention improved patients' clinical outcomes. Participating physicians identified proactive patient follow-up and patient education as the most helpful components of the IMPACT model. CONCLUSIONS: Physicians perceived a substantial need for improving depression treatment in primary care. They were very satisfied with the IMPACT collaborative care model for treating depressed older adults and felt that similar care management models would also be helpful for treating other chronic medical illnesses.

Attitude of Health Personnel↗
PubMedDate not supplied

Where is the patient? The association of psychosocial factors and missed primary care appointments in patients with diabetes.

OBJECTIVE: Missed appointments are associated with poorer health outcomes. We predicted that compared to secure attachment style, fearful and dismissing attachment styles would be associated with greater number of missed primary care visits in patients with diabetes. METHODS: In patients with diabetes from nine health maintenance organization primary care clinics, we collected data on attachment style and major depression status, and determined the number of missed primary care appointments from automated data. We used Poisson and logistic regression analyses to determine if attachment style was associated with the number of missed primary care same day appointments, scheduled office visits and scheduled preventive care visits, after adjusting for demographics, clinical characteristics, appointment frequency and clustering by clinic. We included major depression as a potential effect modifier. RESULTS: Among 3,923 patients with diabetes, prevalence rates of attachment styles were 43.9% for secure, 35.8% for dismissing, 8.1% for preoccupied and 12.2% for fearful attachment style. Major depression was present in 12.4% of patients. Among patients without major depression, there were more missed scheduled office visits (RR=1.46, 95% CI=1.18-1.81) among those with dismissing compared to secure attachment style. The likelihood of having missed same day appointments was lower for those with fearful attachment style relative to those with secure attachment style in nondepressed patients compared to patients with fearful and secure attachment style with major depression (P < .01). CONCLUSIONS: Attachment styles characterized by low levels of collaboration are associated with more missed primary care appointments compared to secure attachment style in patients with diabetes. These associations are moderated by depression status.

Adult↗
PubMedDate not supplied

Panic episodes among patients with diabetes.

OBJECTIVE: The objective of this study was to examine the prevalence of panic episodes in persons with diabetes and the demographic, behavioral and clinical characteristics associated with panic symptoms in persons with diabetes. METHOD: A survey mailed to 4385 patients with diabetes assessed recent experiences of panic episodes, depression, diabetes symptoms, quality of life, disability, smoking status and body mass index. Automated medical record data were used to measure diabetes treatment, hemoglobin A1c (Hb(A1c)) levels, diabetes complications and medical comorbidity. RESULTS: One hundred ninety-three (4.4%) participants reported recent panic episodes, among whom 54.5% also met criteria for major depression. After accounting for the effects of depression, panic episodes were associated with higher Hb(A1c) values, increased diabetic complications and symptoms, greater disability and lower self-rated health and functioning. CONCLUSION: Panic is strongly associated with decrements in disease status and functioning. Since panic is often comorbid with depression, efforts to address psychological disorders among persons with diabetes may need to pay increased attention to anxiety and mood disorders.

Anxiety Disorders↗
PubMedDate not supplied

Arthritis pain and disability: response to collaborative depression care.

OBJECTIVE: Collaborative care for depression decreases arthritis pain and disability among older adults, above and beyond mood improvement. This study investigates whether depression management is effective for improving arthritis outcomes across a range of pain severity and activity interference. METHODS: A multi-site randomized-controlled trial (Improving Mood, Providing Access to Collaborative Treatment - IMPACT) identified 1001 participants with both depression and arthritis (mostly osteoarthritis). Depression care managers provided 12 months of systematic depression care [antidepressant pharmacotherapy, and/or problem-solving treatment (PST)] for intervention participants in primary care settings. Control patients received care as usual. Baseline and 12-month interviews assessed arthritis pain severity and activity interference as well as depression, analgesic use, overall functional impairment and coexisting medical conditions. RESULTS: Baseline pain severity showed significant interactions with the intervention on 12-month pain severity (t=2.28, df=68, P=.03) and disability outcomes (t=2.03, df=177, P=.04). Interaction effects of the intervention with baseline activity interference on 12-month pain severity showed a similar trend, but were not statistically significant (t=1.87, df=944, P=.06). CONCLUSIONS: Systematic depression management was more effective than usual care in decreasing pain severity among arthritis patients with lower initial pain severity, but did not have greater benefits than usual care on pain among patients with higher initial pain severity.

Aged↗
PubMedDate not supplied

Predictors of nonresponse to treatment in primary care patients with dysthymia.

Dysthymia is one of the most prevalent problems in primary care, especially in the elderly. In this study, we evaluated the demographic and clinical predictors of nonresponse to treatment in primary care patients with dysthymia. The study sample consisted of 338 primary care patients meeting DSMIII-R criteria for dysthymia from 4 diverse geographic sites in a randomized controlled 11-week trial of paroxetine, problem-solving therapy or placebo. Patients who attended at least 4 treatment sessions were used in the analysis. A score of less than 7 on the Hamilton was defined as a positive response to treatment. By Week 11, 52.2% of patients had a positive response to treatment. Patients with lower levels of education (odds ratio 0.44, 95% CI 0.23, 0.86), higher scores on the personality dimension of neuroticism (odds ratio 0.58, 95% CI 0.36, 0.92) and those with more severe medical illness (odds ratio 0.97, 95% CI 0.95, 0.99) were less likely to recover with either active or placebo treatments. Elderly women (>60 years of age; odds ratio 0.19, 95% CI 0.05, 0.66) were also less likely to respond to all treatments; however, females had a significantly higher response to placebo treatment compared to males. The factors associated with lack of response to treatment included lower-levels of education, high neuroticism, more severe medical illness and being an older female. This analysis is based on patients agreeing to participate in a randomized controlled trial, limiting representativeness of the sample, however, the demographic and clinical characteristics are common in elderly depressed primary care patients, and may signal the need for increased mental health specialty consultation.

Aged↗
PubMedDate not supplied

Correlates of remission in primary care patients treated for minor depression.

As minor depression is perhaps the most common form of mood disorder seen in primary care, we sought to explore the effects of both pharmacologic and psychosocial interventions for primary care patients with this condition. Three hundred and eighteen primary care patients meeting criteria for minor depression (defined as endorsing 3 or 4 of the nine DSM-IV symptoms of major depression, at least one of which was either depressed mood or anhedonia, for a period of at least four weeks, and scoring > or = 10 on the Hamilton Rating Scale for Depression) from 4 diverse geographic sites were enrolled in a randomized controlled 11 week trial of paroxetine, problem-solving therapy or placebo. Patients who attended at least 4 treatment sessions and who received a Hamilton score by an independent rater at either 6 or 11 weeks were used in the analysis (77% of enrolled patients). A score of < or = 6 on the Hamilton was defined as a positive response to treatment. Fifty four percent of patients met our criteria for remission (HRS-D < or = 6) by week 11, with no difference among treatments. Patients who were women, younger, of European descent, homemakers or retired persons (as opposed to unemployed) and who had lower baseline severity of depression were more likely to remit across all treatment conditions. Although explicitly addressed in the data analysis, differences in outcomes across the four sites of the investigations limit our confidence in the generalizabilty of our findings. In addition, patients with lower levels of educational attainment had a higher dropout rate, suggesting further caution about the generalizability of the findings. Defining remission in this categorical way, we found no differences among the interventions studied, but did find that outcome was related to demographic and clinical characteristics of the patients. While it is difficult to know why female patients were more likely to remit, this may be a function of the association in our subject populations between male gender and the likelihood (approximately .46) of being a patient in the VA system. The remaining variables associated with higher probability of remission appear to reflect social advantage and lower severity or complexity of illness.

Adult↗
PubMedDate not supplied

Case review vs. usual care in primary care patients with depression: a pilot study.

This paper reports on the results of a pilot study comparing the efficacy of an experimental case review program between psychiatrists and primary care physicians (PCPs) with PCPs' usual care on the outcome of depressive disorders at 1-year. The secondary aim of the paper is to identify correlates of remission of depressive disorders at the 1-year follow-up. The experimental case review program consisted of 12 biweekly meetings of primary care physicians with a psychiatrist. Meetings lasted two hours and were based on review of cases identified at the interview as suffering from full-blown or subthreshold conditions. Subjects were assessed at baseline, 3 months and 1 year. The baseline assessment included the Composite International Diagnostic Interview, the Hamilton Depression (HDRS) and Anxiety (HARS) Rating Scales, the Medical Outcomes Study SF-36 and some forms to collect life events, major difficulties, social support, and ongoing treatments. At 3 months patients received by mail the General Health Questionnaire (GHQ-12) and at one year the baseline clinical assessment was replicated. Assessments were conducted on eighty cases with major, minor or subsyndromal depression (SSD). The experimental case review program was similar in efficacy to usual care, with an average reduction of 5.5 points on the HAMD. Significant reduction in the severity of depression was associated with a limited number of baseline characteristics, such as being married and having minor depression as compared to major depression and SSD. On the contrary, chronic physical illness at baseline predicted a lower reduction of HAMD scores at one year. While major difficulties and life events during the one-year interval between the two assessments significantly predicted a poorer outcome, social support at home was related to a better outcome. This pilot study indicates that a case review intervention program is not efficacious in a mixed sample of patients with subsyndromal to major depression representative of the current practice of primary case physicians. Still, it might be worthwhile for "difficult" patients selected by the PCPs. In our sample, psychosocial factors seem to be important predictors of outcome. Future trials and large naturalistic studies are needed to address this key point.

Adult↗
PubMedDate not supplied

Treating panic disorder in primary care: a collaborative care intervention.

Efficacy research indicates the success of cognitive behavioral treatment and medication treatment for panic disorder with or without agoraphobia. However, research findings to date possess limited generalizability beyond specialty mental health settings. We present a model for collaborative care treatment for panic disorder in the primary care setting that combines cognitive behavioral therapy and medications, and involves a behavioral health specialist, psychiatrist, and primary care physician. Educational aids that are aimed to educate and activate patients to participate as partners in their care are provided. We outline the ways in which the standard treatment was modified, in light of the nature of the sample and setting, such as fewer sessions and management of comorbidity. Also, we provide evidence for acceptability of this intervention to primary care physicians and patients. This description is intended to lay the groundwork for continued research efforts in the extension of efficacious treatments into primary care settings.

Cooperative Behavior↗
PubMedDate not supplied

Validation of the PTSD checklist in an HMO sample of women.

Although Post-traumatic Stress Disorder (PTSD) is common among patients seeking care at medical clinics, little is known about the performance of screening instruments for this disorder in these settings. Previous studies of acute trauma populations using the PTSD Checklist (PCL) have suggested that scores of 45-50 provide the best discrimination between cases and noncases. We gave the PCL to 1,225 randomly selected women enrolled in an HMO. After interviewing a sample of 261 of these women using a structured, clinician-administered PTSD interview, we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis. The optimum balance of sensitivity and specificity for this population was a score of 30, yielding a sensitivity of.82 and specificity of.76. The positive and negative likelihood ratios for this cut score were 3.40 and 0.24, respectively. By comparison, the use of 45 as a cut score would result in very low sensitivity (.36) in this setting. The lower cut score found in this study may indicate that the use of previously published cut scores of 45-50 may not optimize the function of the PCL as a screening tool outside of acute trauma settings due to an unacceptably high number of false negative cases.

Adolescent↗
PubMedDate not supplied

Improving primary care treatment of depression among patients with diabetes mellitus: the design of the pathways study.

This paper describes the methodology of a population based study of primary care patients with diabetes mellitus enrolled in a health maintenance organization. The first goal was to determine the prevalence and impact of depression in patients with diabetes. The second goal was to randomize approximately 300 patients with diabetes and major depression and/or dysthymia in a trial to test the effectiveness of a collaborative care intervention in improving quality of care and health outcomes among patients with diabetes and depression.

Major Depressive Disorder↗
PubMedDate not supplied

Effect on disability outcomes of a depression relapse prevention program.

OBJECTIVE: This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse. MATERIALS AND METHODS: Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription. Patients responding to initial treatment but at high risk for relapse were randomized to usual care or a relapse prevention intervention (N= 386). The 12-month relapse prevention program included systematic patient education, two psycho-educational visits with a depression prevention specialist, shared decision-making regarding maintenance pharmacotherapy, and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail. Disability outcomes were assessed via blinded telephone assessments at 3, 6, 9, and 12 months using SF-36 and Sheehan Disability scales. RESULTS: Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy. Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period. One of the three disability measures (the SF-36 Social Function scale) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up, whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls. CONCLUSIONS: Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes. Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients, relatively mild levels of depressive symptoms among both intervention and control patients at baseline, the absence of a specific relapse prevention effect of the intervention, and the resultant modest differences in depressive symptoms between intervention and control patients in this trial.

Adult↗
PubMedDate not supplied

Influence of patient attachment style on self-care and outcomes in diabetes.

OBJECTIVE: Difficulties collaborating with providers and important others may adversely influence self-management in patients with diabetes. We predicted that dismissing attachment style, characterized by high interpersonal self-reliance and low trust of others, would be associated with poorer self-management in patients with diabetes. METHODS: A population-based mail survey was sent to all patients with diabetes from nine primary care clinics of a health maintenance organization. We collected data on attachment style, self-care behaviors, the patient provider relationship and depression status and accessed automated diagnostic, pharmacy, and laboratory data to measure diabetes treatment intensity, medical comorbidity, glycosylated hemoglobin levels, and diabetes complications. We used logistic regression to determine whether dismissing attachment style was associated with poorer diabetes self-care behaviors, adherence to medication, smoking status, and higher glycosylated hemoglobin. RESULTS: In 4095 primary care patients with diabetes, prevalence rates for secure, dismissing, preoccupied, and fearful attachment styles were 44.2%, 35.8%, 7.9%, and 12.1%, respectively. When compared with secure attachment style, dismissing attachment style was associated with significantly lower levels of exercise (p =.005), foot care (p <.05), diet (p =.001), and adherence to oral hypoglycemic medications (p <.05), and with higher rates of smoking (p <.05), and these associations were mediated through the patient-provider relationship. Preoccupied attachment style, characterized by overreliance on others, was associated with a significantly lower risk of having glycosylated hemoglobin levels >8%, compared with secure attachment style. CONCLUSION: Attachment style is significantly associated with diabetes self-management and outcomes.

Adult↗
PubMedDate not supplied

Potentially modifiable factors associated with disability among people with diabetes.

OBJECTIVE: This article seeks to identify potentially modifiable factors associated with disability among people with diabetes. STUDY DESIGN AND SETTING: Among people with diabetes (N = 4357) in a large health maintenance organization, disease severity, psychologic and behavioral risk factors for disability were assessed. Disability was evaluated by the WHO Disability Assessment Scale (WHO-DAS-II), the SF-36 Social Functioning scale, and days of reduced household work. RESULTS: Depression was associated with a tenfold increase in elevated WHO-DAS-II and low SF-36 Social Functioning scores, and a fourfold increase in 20+ days of reduced household work. Minor depression and the presence of three or more diabetic complications were associated with approximately a twofold increase in disability risk. Diabetic symptoms, chronic disease comorbidity, and reduced exercise were also associated with disability. CONCLUSION: Among people with diabetes, depression, diabetic complications, and exercise are potentially modifiable factors associated with disability. This suggests that integrated, biopsychosocial approaches may be needed to understand and to ameliorate disability among people with diabetes.

Activities of Daily Living↗
PubMedDate not supplied

Somatic, posttraumatic stress, and depressive symptoms among injured patients treated in trauma surgery.

Few investigations have examined the course of somatic complaints among acutely injured trauma survivors. Posttraumatic stress disorder (PTSD), depressive, and somatic symptoms were assessed in trauma surgery inpatients (N=73) interviewed while hospitalized and again 12 months after their injury. Somatic symptoms occurred frequently and were significantly greater in patients with higher levels of PTSD and depressive symptoms, even after the analyses were adjusted for injury severity and medical comorbidity. These findings, when considered in conjunction with data documenting the heterogeneity of treatment providers visited after traumatic injury, suggest that the development of early screening and intervention procedures should incorporate assessments of physical symptoms.

Acute Disease↗
PubMedDate not supplied

Depression and comorbid illness in elderly primary care patients: impact on multiple domains of health status and well-being.

PURPOSE: Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression. METHODS: We collected cross-sectional data as part of a treatment effectiveness trial that was conducted in 8 diverse health care organizations. Patients aged 60 years and older (N = 1,801) who met diagnostic criteria for major depression or dysthymia participated in a baseline survey. A survey instrument included questions on sociodemographic characteristics, depression severity and chronicity, neuroticism, and the presence of 11 common chronic medical illnesses, as well as questions screening for panic disorder and posttraumatic stress disorder. Measures of 4 general health indicators (physical and mental component scales of the SF-12, Sheehan Disability Index, and global quality of life) were included. We conducted separate mixed-effect regression linear models predicting each of the 4 general health indicators. RESULTS: Depression severity was significantly associated with all 4 indicators of general health after controlling for sociodemographic differences, other psychological dysfunction, and the presence of 11 chronic medical conditions. Although study participants had an average of 3.8 chronic medical illnesses, depression severity made larger independent contributions to 3 of the 4 general health indicators (mental functional status, disability, and quality of life) than the medical comorbidities. CONCLUSIONS: Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities.

Aged↗