PRIME-MD and rural primary care: Detecting depression in a low-income rural population.

An efficient method for screening depression in primary care may ultimately facilitate referrals to and collaboration with psychologists. The current study extends previous research on the validity of the Mood Module of the Primary Care Evaluation of Mental Disorders (PRIME-MD; R. L. Spitzer et al, 1995) and used nurses as administrators in two rural public health units. Participants were 136 predominantly female (59% Caucasian, 38% African American) primary care patients. Results indicated that 40% were classified as depressed. Depressed participants reported significantly worse mental and physical functioning, even after controlling for age, severity of illness, and tobacco use. Routine screenings for mood disorders in rural primary care could serve as a means of facilitating collaboration between primary care physicians and psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and primary health care for children.

There is an emerging consensus among those responsible for primary health care to children that such care should not only include medical concerns but also should assist parents with common problems of development and behavior. Psychologists are increasingly included among the personnel of medical groups that provide primary care to children. A model for this relatively new type of practice is described. Such pediatric primary-care settings also offer new research opportunities for psychologists. An important public policy issue concerns how comprehensive primary health care, including psychological services, can be made accessible to all children, and how research to evaluate such services and improve their efficacy can be encouraged. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening older adults for depression in primary care settings.

Primary care is a logical environment for depression recognition in older adults. Most older adults are diagnosed and treated for depression by primary care providers. Recognition systems for depression in this setting are particularly needed because the prevalence of depression in older primary care patients may range from 7% to 36%, depending on the instrument and diagnostic criteria used. Implementing systematic detection systems in primary care settings has proven difficult. In one study, only one third of all physicians surveyed used any formal screening tool. Though a number of barriers to recognition of depression have been identified, the authors focus their discussion in this article on two, time and patient factors, and review two screening instruments, the Geriatric Depression Scale--Short Form and the Center for Epidemiologic Studies Depression Scale, that may be able to address these factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latex allergy: a growing problem in health care

Incidence of latex allergy appears to be growing among health-care professionals. More research is required into prevalence and prevention strategies. Nurses should minimize their risk of sensitisation by wearing latex gloves only when necessary. Employers and the DoH need to take steps to minimise the problem.     

Problem-solving treatment and coping styles in primary care for minor depression.

Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Late-life suicide and depression in the primary care setting

Late-life depression and suicidal behavior in the primary care setting is a significant public health concern. The prevalence of depression in this population is substantial, yet rates of detection and treatment are far from adequate. Untreated depression has significant consequences with regard to morbidity and mortality. Although suicide is a relatively low-base-rate behavior, a substantial proportion of late-life suicides have contact with their primary care provider prior to their death; thus this offers an avenue for suicide prevention. There is a growing knowledge base concerning what constitutes barriers to the recognition and treatment of late-life depression as well as what constitutes useful screening tools and treatments for the depressed elderly. Important new findings with regard to the functional effects of subsyndromal depression, possible subtypes of late-life depression, the clinical utility of SSRIs and psychotherapeutic interventions, and innovative and collaborative models of care hold promise for advancing the science and practice of treating late-life depression.     

Neuroticism and extraversion as predictors of health outcomes in depressed primary care patients

A case with an alpha-fetoprotein (AFP)-producing carcinoma originating from the rectum is described. A 71-year-old male patient, who underwent a rectectomy for rectal carcinoma, developed space occupying lesions in the liver and a remarkable AFP elevation (220,000 ng/ml) in the 6th month postoperatively, and then expired one year later. Histologically, the rectal carcinoma consisted of well-differentiated adenocarcinomas, and contiguous cancerous cells proliferating in either a medullary or trabecular pattern. In the "trabecular" areas, localization of AFP was confirmed immunohistochemically. Results of concanavalin A or lens culinaris agglutinin affinity chromatography demonstrated that it was between a hepatic type and a yolk sac type, and was considered to be an intestinal type. This could have been an AFP-producing rectal carcinoma, in which the patient experienced liver metastasis at a relatively early postoperative period and died. This shows that AFP-producing rectal carcinomas are highly malignant, biologically, similar to AFP-producing gastric cancers.     

Anxiety, information, interpersonal impacts, and adjustment to a stressful health care situation.

40 adult patients scheduled for dental extraction surgery were given either specific or general preparatory information, and this information was presented in either a personalized or relatively impersonal fashion using nonverbal cues. Changes in state anxiety over the course of the experiment were accounted for by individual differences in the Dental Anxiety Scale. The most important determinant of adjustment during surgery was the congruence between specificity of information received and individual differences in preference for information. The finding that high levels of presurgery anxiety are associated with poor adjustment is discussed in terms of I. L. Janis's (1958) model of stress. Ss' perceptions of information-giver hostility and dominance were also significantly (inversely) related to adjustment; the differential impact of informational and interpersonal variables is discussed in terms of moderating characteristics of health care settings. (44 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Response styles among patients with minor depression and dysthymia in primary care.

Ruminative responses to depression have predicted duration and severity of depressive symptoms. The authors examined how response styles change over the course of treatment for depression and as a function of type of treatment. They also examined the ability of response styles to predict treatment outcome and status at follow-up. Primary care patients (n=96) with dysthymia or minor depression were randomly assigned to problem-solving therapy, paroxetine, or placebo. Patients' depressive symptoms and rumination, but not distraction, decreased over time. Pretreatment rumination and distraction were associated with more depressive symptoms at the conclusion of treatment; the latter finding was not consistent with the response style theory of depression. Results are discussed in terms of their implications for this theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The severity of major depression and choice of treatment in primary care practice.

The Agency for Health Care Policy and Research Depression Guideline Panel recommended pharmacotherapy as the 1st-line treatment for more severely depressed primary care patients, but research supporting its recommendation has not been conducted with this population. A post hoc analysis was conducted, therefore, with data gathered in a randomized controlled trial about the relationship between initial level of depressive severity and functional ability, treatment with nortriptyline hydrochloride (NT) or interpersonal psychotherapy (IPT), and clinical course over 8 months among primary care patients experiencing major depression. Treatment type was unrelated to clinical course among more severely depressed patients (baseline 17-item Hamilton Rating Scale for Depression [HRSD] score ≥20). However, less severely depressed patients (baseline 17-item HRSD score ≤19) who were prescribed NT improved significantly more rapidly during the initial 3 months of treatment than patients provided with IPT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in satisfaction with primary care physicians in a managed care health plan

This study examines whether the formation of satisfaction with primary care physicians in a managed health care plan differs for men and women. Findings indicate that there are significant differences in the formation of satisfaction. For both men and women, the probability that an individual is satisfied is influenced by the type of plan enrolled in, number of problems experienced and beliefs about the quality of and access to benefits. Income and additional insurance coverage affects the probability of satisfaction for women only. Simulation analysis shows how satisfaction changes as individual characteristics and experience with managed care change.     

Risk factors for depression in primary care. Findings of the TADEP project

Lead stable isotope ratio (IR) analysis by inductively coupled plasma mass spectrometry was used to examine the relationship between sources of Pb in 22 dust wipe samples collected from 10 homes in Jersey City, NJ. Common lead sources examined included interior lead-based paints, exterior soils and street dusts, and indoor air. High correlations between IRs of wipe samples and both street dusts and exterior soils indicated these two exterior sources were indistinguishable. They were treated as a single exterior source in a source apportionment using IR matching and a simple mixing model. The upper-bound estimate of the contribution of interior lead-based paints to 10 floor- and eight sill-wipe samples was 56% and 50%, respectively. It was not possible to apportion sources in four of the 22 samples because wipe sample IRs were outside the range of measured sources. Examination of means obscures the variability in the data, however, as eight of the 18 apportioned samples matched interior or exterior source media. In most cases, however, sources from outside the home contribute as much Pb to house dust wipe samples as interior lead-based paints.     

A paradigm shift in the scope of practice for health psychologists: Training health psychologists to be primary care case managers.

Innovative programs in the Department of Defense have challenged health psychologists to broaden their scope of practice. To this end, health psychologists at Tripler Army Medical Center independently admit and discharge patients and serve as primary care managers during hospitalization and follow-up aftercare. A conceptual overview of the Tripler health psychology training philosophy and how the training model has guided Army health psychology in managing, rather than simply consulting, on the care of patients will be offered. Practical considerations and a training curriculum are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)