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Time to Depression Treatment in Primary Care Among HIV-infected and Uninfected Veterans

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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.

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Acknowledgements

This work was funded by National Institute on Alcohol and Alcohol Abuse (U01 AA 13566 and U10 AA 13566), National Institute of Aging (K23 AG00826), Robert Wood Johnson Generalist Faculty Scholar Award, an Inter-agency Agreement between NIA, National Institute of Mental Health, and VA HSR&D Research Enhancement Award Program (REAP) PRIME Project (REA 08-266).

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Yale University School of Medicine, New Haven, CT, USA

    Dina Hooshyar MD, MPH, Joseph Goulet PhD, Lydia Chwastiak MD, MPH, Kristin Mattocks PhD & Amy C. Justice MD, PhD

  2. VA Connecticut Healthcare System, Building 35a, Room 2-212, 950 Campbell Avenue, West Haven, CT, 06516, USA

    Dina Hooshyar MD, MPH, Joseph Goulet PhD, Lydia Chwastiak MD, MPH, Kristin Mattocks PhD & Amy C. Justice MD, PhD

  3. The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA

    Steven Crystal PhD

  4. VA Medical Center and George Washington University Medical Center, Washington, DC, USA

    Cynthia Gibert MD

  5. VA Medical Center and Emory University School of Medicine, Atlanta, GA, USA

    David Rimland MD

  6. Michael E. De Bakey VAMC and Baylor College of Medicine, Houston, TX, USA

    Maria Rodriguez-Barradas MD

Authors
  1. Dina Hooshyar MD, MPH
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  2. Joseph Goulet PhD
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  9. Amy C. Justice MD, PhD
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for the VACS Project Team

Corresponding author

Correspondence to Amy C. Justice MD, PhD.

Additional information

The views expressed here are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Funding

National Institute on Alcohol and Alcohol Abuse (U01 AA 13566 and U10 AA 13566), National Institute of Aging (K23 AG00826), Robert Wood Johnson Generalist Faculty Scholar Award, an Inter-agency Agreement between NIA, National Institute of Mental Health, and VA HSR&D Research Enhancement Award Program (REAP) PRIME Project (REA 08-266).

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Hooshyar, D., Goulet, J., Chwastiak, L. et al. Time to Depression Treatment in Primary Care Among HIV-infected and Uninfected Veterans. J GEN INTERN MED 25, 656–662 (2010). https://doi.org/10.1007/s11606-010-1323-z

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  • DOI: https://doi.org/10.1007/s11606-010-1323-z

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