Diagnosing and treating depression and anxiety in patients with cardiovascular disorders and diabetes mellitus in primary healthcare: is training of physicians enough for improvement?

INTRODUCTION. Common mental disorders - anxiety and depression - are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. OBJECTIVE. To explore whether the rates of referrals to psychiatrist and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in the primary healthcare facility after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS. Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n = 400). The educational programme for PCPhs on diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n = 178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment, according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS. The proportions of patients with borderline abnormal and abnormal HADS scores ( 7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases it was indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral. CONCLUSIONS. Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

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The relationship between older cancer survivors’ reports of depression, anxiety and pain to health providers’ findings and mortality

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8597 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8597-8597

Author(s):

P. H. Seo ◽

R. Sloane ◽

S. S. Ingram ◽

D. Misra ◽

E. C. Clipp ◽

...

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Karnofsky Performance Status ◽

Depression Scale ◽

Primary Care Providers ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Health Providers ◽

Care Providers ◽

Pain Anxiety

8597 Background: Older cancer survivors may experience psychological distress due to their cancer experience and aging health. This study aimed to compare primary care and specialty providers’ inquiries of pain, depression and anxiety to older cancer survivors’ questionnaire responses. Methods: 153 patients seen in oncology clinics at the Veterans Affairs Medical Center (Durham, NC) from November 1999 until April 2000 completed the Hospital Anxiety and Depression Scale and a pain thermometer questionnaire. Blinded chart review examined health provider inquiries of pain, anxiety and depression. Cox proportional hazards survival analyses were performed on subjective pain, anxiety and depression with comorbidities and Karnofsky performance status (KPS) added in controlled models. Results: Patients were on average aged 68, had 5.4 comorbidities, 87.4% KPS, and were 3.1 years from a cancer diagnosis. Health providers missed 17 of 94 patients with significant levels of self-reported pain (sensitivity 0.82). Although 28 (20.6%) and 33 (25.8%) patients screened positively for depression and anxiety respectively, providers asked 7 patients about anxiety (sensitivity 0.15) and 16 patients about depression (sensitivity 0.25). The overall three year mortality was 37.9%. Pain was not associated with mortality. Patients screening for depression [HR 2.03 (95% CI: 1.03, 4.01)] and anxiety [HR 2.02 (95% CI: 1.01, 4.04)] had lower 3 year survival. KPS and comorbidities diminished these effects. Conclusions: In older cancer survivors, anxiety and depression may have an association with mortality. To improve detection, oncology and primary care providers should routinely inquire about mood and aim to intervene with pharmacologic or supportive treatments. No significant financial relationships to disclose.

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The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

Current issues in pharmacy and medicine science and practice ◽

10.14739/2409-2932.2021.3.241818 ◽

2021 ◽

Vol 14 (3) ◽

pp. 369-373

Author(s):

O. H. Aleksieiev ◽

V. V. Taranov ◽

V. P. Petrykhin

Keyword(s):

Primary Care ◽

Medical Care ◽

Primary Healthcare ◽

Rural Areas ◽

Rural Population ◽

Healthcare Facility ◽

Service Area ◽

Healthcare Facilities ◽

Care Facilities

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.

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Depression and Anxiety Screens as Simultaneous Predictors of 10-Year Incidence of Diabetes Mellitus in Older Adults in Primary Care

Journal of the American Geriatrics Society ◽

10.1111/jgs.14454 ◽

2016 ◽

Vol 65 (2) ◽

pp. 294-300 ◽

Cited By ~ 5

Author(s):

Tasneem Khambaty ◽

Christopher M. Callahan ◽

Anthony J. Perkins ◽

Jesse C. Stewart

Keyword(s):

Diabetes Mellitus ◽

Older Adults ◽

Primary Care ◽

Depression And Anxiety

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Disease management for co-morbid depression and anxiety in diabetes mellitus: design of a randomised controlled trial in primary care

BMC Family Practice ◽

10.1186/1471-2296-12-139 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 9

Author(s):

Corinne H Stoop ◽

Viola RM Spek ◽

Victor JM Pop ◽

François Pouwer

Keyword(s):

Diabetes Mellitus ◽

Primary Care ◽

Randomised Controlled Trial ◽

Disease Management ◽

Controlled Trial ◽

Depression And Anxiety ◽

Randomised Controlled

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Psychiatric comorbidity in African patients with epilepsy – Experience from Sierra Leone

International Journal of Epilepsy ◽

10.1016/j.ijep.2016.12.002 ◽

2017 ◽

Vol 04 (01) ◽

pp. 026-030 ◽

Cited By ~ 3

Author(s):

Tenema M’bayo ◽

Michal Tomek ◽

Clifford Kamara ◽

Durodami Lisk

Keyword(s):

Sierra Leone ◽

Primary Healthcare ◽

Psychiatric Comorbidity ◽

Sub Saharan Africa ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Depression And Anxiety ◽

Screening Programs ◽

Sub Saharan ◽

The Impact

Abstract Objective Epilepsy is associated with a significant burden of psychiatric comorbidity, including depression and anxiety disorders. However, paucity of data exists regarding the impact of epilepsy on mental health of patients in the setting of sub-Saharan Africa, where these comorbidities are under-recognized and under-treated. We carried out a cross-sectional descriptive study to investigate the prevalence and determinants of depression and anxiety among people with epilepsy in Sierra Leone. Method A screening tool previously validated in the primary healthcare setting in Zambia was administered to adult patients in our epilepsy clinics in Freetown and Kenema, Sierra Leone. In addition, various socio-demographic and clinical characteristics were recorded for each patient. Results A total of 142 patients were included. The mean screening score was 16.3 out of 40, with 39 (27.5%) patients scoring above the diagnostic cut-off point for anxiety and/or depression. Variables showing a significant association with the presence of psychiatric comorbidity included female gender (p = 0.015), seizure frequency of >2 per month (p = 0.001), and self-reporting of sedation and/or dizziness as side effects of anti-epileptic medications (p = 0.006). Conclusion Symptoms of anxiety and depression are common in epilepsy patients in Sierra Leone. Given the significant negative impacts of such comorbidity on those affected, primary healthcare workers in sub-Saharan countries should be trained to inquire about anxiety and depression symptoms in epilepsy patients, and implementation of screening programs should be considered.

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What Can Happen When Postpartum Anxiety Progresses to Psychosis? A Case Study

Case Reports in Psychiatry ◽

10.1155/2018/8262043 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Vesna Pirec

Keyword(s):

Case Report ◽

Psychiatric Hospitalization ◽

Anxiety And Depression ◽

Psychiatric History ◽

Depression And Anxiety ◽

Postpartum Anxiety ◽

Psychopharmacological Treatment ◽

Social Rehabilitation ◽

Long Course

This case report describes a primipara without documented psychiatric history prior to complicated delivery. Onset of severe insomnia and anxiety was right after childbirth but not treated. Obsessive thinking pattern became more prominent. The patient became depressed and sought psychiatric help four months after delivery. Insomnia was then treated pharmacologically. Anxiety and depression persisted, suicidal ideation emerged, and the patient became confused, indecisive, overwhelmed, and delusional regarding her child’s health. Medications for depression and anxiety were started six months postpartum yet were ineffective. The patient’s obsessions gradually became fully psychotic and she committed an altruistic infanticide eight months postpartum. Psychiatric hospitalization occurred, followed by a long course of mental, physical, legal, and social rehabilitation. She was minimally responsive to psychopharmacological treatment, which appeared to be partly related to her hormonal dysregulation. Several months into the treatment she gradually started improving and returned to baseline two years later. The Illinois court found the patient not guilty to murder by reason of Insanity.

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Study on the Prevalence of Depression and Anxiety among Diabetes Mellitus patients in Tertiary Care Hospital- A Prospective Cross-sectional Study.

Asian Journal of Pharmaceutical Research and Development ◽

10.22270/ajprd.v8i2.658 ◽

2020 ◽

Vol 8 (2) ◽

pp. 26-32

Author(s):

Pem Tamang

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Low Income ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Diabetic Patients ◽

Depression And Anxiety ◽

Sectional Study ◽

Cross Sectional ◽

Prevalence Of Depression

Background: Diabetes mellitus is one of the most predominant, chronic disease afflicting globally with its amplifying burden. The association of diabetes with psychological disorders exists with depression and anxiety being the most common, often remains undiagnosed or unidentified eventually leading to a decline in functional abilities and self-care, worsening the health profile of the patients and contributing to both morbidity and mortality. This study explores the association of psychiatric problems with diabetes mellitus and their related risk factors. Objectives: To investigate the association and the prevalence of psychiatric disorders (depression and anxiety) among diabetic patients and access their associated risk factors. Methods: A prospective cross-sectional study was conducted for six months in 105 diabetic patients from the outpatient department. Hospital Anxiety and Depression Scale (HADS) was used to evaluate the symptoms of anxiety and depression. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Overall 53(50.5%) were observed with the symptoms of anxiety while 45(42.9%) with symptoms of depression respectively. The prevalence of marked anxiety and depression was observed higher in a female. Anxiety and depression were also common among participants with moderate social support. Anxiety and depression were greater among patient who were illiterate (OR=1.50, 95% CI 0.92-5.38), unemployed (OR=7.50, 95% CI 1.29-43.61) with low income (PR=3.09 95% CI 0.92-10.36) and who were retired (OR=6.00, 95% CI 0.81-44.35).Conclusion: The result showed a high prevalence of depression and anxiety among female than in the male. Most of the patients developed moderate or severe anxiety and depression. Various factors such as low income, age, low education, unemployed, uncontrolled diabetes were associated with anxiety and depression. Awareness programs and health education should be conducted. Counseling and appropriate medication should be initiated to reduce future complications. Key words:

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Community residents’ preferences for chronic disease management in Primary Care Facilities in China: a stated preference survey

Archives of Public Health ◽

10.1186/s13690-021-00728-8 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Xianglin Li ◽

Mingzhu Jiang ◽

Yingying Peng ◽

Xiao Shen ◽

Erping Jia ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Chronic Diseases ◽

Primary Healthcare ◽

Chronic Disease Management ◽

Healthcare Services ◽

Modern Medicine ◽

Policy Makers ◽

Care Facilities

Abstract Background Although Chinese government has dedicated the past decades to treating chronic diseases by primary healthcare system, many more residents are apt to choose higher-tier facilities to treat minor chronic diseases. Understanding residents’ preferences for chronic disease management in primary care facilities can bridge the gap between residents’ choices and policy implementation. This study aims to elicit residents’ preferences for chronic disease management in primary care facilities in the hypothetical minor chronic disease scenario. Methods Six hundred eighty residents were administered a discrete choice experiment that elicited preferences for chronic disease management in primary care facilities. Services attributes were service mode, treatment measure, out-of-pocket expenditure (OOP), traveling time to healthcare facility and title of physician. Mixed logit models were used to estimate stated preferences and willingness to pay for attributes. WTP confidence intervals were estimated by the delta method. Results A total of 94.44% of the completed questionnaires were valid (680 of 720 respondents). The participants preferred chronic disease management service with modern medicine, traveling time ≤ 30mins, and less OOP expenditure. Compared with Traditional Chinese Medicine (TCM), residents prefer modern medicine, willing to pay 155.53 CNY ($21.97) to change from TCM to modern medicine. Compensation about 86.02 CNY ($12.15) was needed to enable residents to change the choice of the nearer primary care facility to a further one. Integrated medicine in community clinics by experts was residents’ most preferred scenario while TCM in the tertiary hospital was their least preferred one. Conclusion In order to increase the utilization of primary healthcare services in chronic diseases management, policy makers need to concern more about the services of medical treatment type, price and convenience. Therefore, we advise policy makers to provide nearer primary healthcare services for residents especially for residents in surrounding areas. Furthermore, balancing the resource allocation between Traditional Chinese Medicine and modern medicine is worthy of consideration.

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