Time to depression treatment in primary care among HIV-infected and uninfected veterans

Dina Hooshyar, Joseph Goulet, Lydia Chwastiak, Steven Crystal, Cynthia Gibert, Kristin Mattocks, David Rimland, Maria Rodriguez-Barradas, Amy C. Justice

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

BACKGROUND: Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care. OBJECTIVE: Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressed patients receiving primary care at Infectious Disease or General Medicine clinics. DESIGN: Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients. PARTICIPANTS AND MEASURES: The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used. KEY RESULTS: Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infected patients (0.5 days; 95% CI∈=∈0.5, 6, p∈=∈0.04). Compared to mildly-moderately depressed uninfected patients, severely depressed HIV-infected patients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI∈=∈1.07, 2.60), whereas mildly-moderately depressed HIV-infected patients (adjusted HR 1.10, 95% CI∈=∈0.79, 1.52) and severely depressed uninfected patients (adjusted HR 0.93, 95% CI∈=∈0.60, 1.44) were not. CONCLUSIONS: In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infected patients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.

Original languageEnglish (US)
Pages (from-to)656-662
Number of pages7
JournalJournal of general internal medicine
Volume25
Issue number7
DOIs
StatePublished - Jul 2010

Keywords

  • AIDS
  • HIV
  • antidepressant drugs
  • major depression
  • psychotherapy

ASJC Scopus subject areas

  • Internal Medicine

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