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Time to depression treatment in primary care among HIV-infected and uninfected veterans
Women’s Health Research Faculty Publications
  • Dina Hooshyar, Yale University
  • Joseph Goulet, Yale University
  • Lydia Chwastiak, Yale University
  • Steven Crystal, Rutgers University - New Brunswick/Piscataway
  • Cynthia Gibert, George Washington University - School of Medicine and Health Sciences
  • Kristin M Mattocks, University of Massachusetts Medical School Worcester
  • David Rimland, Emory University
  • Maria Rodriguez-Barradas, Baylor College of Medicine
  • Amy C Justice, Yale University
UMMS Affiliation
Department of Quantitative Health Sciences
Document Type
Cohort Studies; Depressive Disorder; Female; HIV Infections; Humans; Male; Middle Aged; Primary Health Care; Prospective Studies; Time Factors; Treatment Outcome; Veterans
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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Citation: 2010 Apr 20. Link to article on publisher's site

At the time of publication, Kristin Mattocks was not yet affiliated with the University of Massachusetts Medical School.

Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Dina Hooshyar, Joseph Goulet, Lydia Chwastiak, Steven Crystal, et al.. "Time to depression treatment in primary care among HIV-infected and uninfected veterans" Vol. 25 Iss. 7 (2010) ISSN: 0884-8734 (Linking)
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