Research selection bias and the prevalence of depressive disorders in psychiatric facilities.

Applied a statistical technique to correct for selection bias in estimating the prevalence of depressive disorders in community mental health centers (CMHCs). Approximately 243 Ss completed the screening instruments at 2 CMHCs. Results indicate that the prevalence of depression in total CMHC populations may approach 44% rather than the 25% derived from a censored sample. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice Guidelines

The Depression Guideline Panel of the Agency for Health Care Policy and Research in 1993 published recommendations for treating major depression in primary care practice that were often based on studies of tertiary care psychiatric patients. We reviewed reports of randomized controlled trials in primary care settings published between 1992 and 1998. This evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings. In most cases, the choice between these treatments should depend on patient preference. Studies to date suggest that improving treatment of depression in primary care requires properly organized treatment programs, regular patient follow-up, monitoring of treatment adherence, and a prominent role for the mental health specialist as educator, consultant, and clinician for the more severely ill. Future research should focus on how guidelines are best implemented in routine practice, since conventional dissemination strategies have little impact.     

Challenge of human service programs for psychologists.

The rationale for, and the manner in which, mental health services are provided in 1971 differs significantly from the patterns of a decade ago. The perspective and activities have expanded from the isolated clinic to the more encompassing community mental health program. During the 1970's psychologists will be challenged to evolve the scope even further by designing far-flung human service systems which seek to provide comprehensive and coordinated assistance to clients. 4 prominent alternative program structures are arising at the community level: information and referral centers, diagnostic centers, multiservice centers, and human services networks. It is predicted that psychologists may well be required to redesign their (a) practice, by developing job roles in nonpsychiatric settings; (b) research, by increased use of the ecological model for the resolution of pressing social problems; and (c) training, by expanded use of multidisciplinary settings offering broadly defined rather than narrowly circumscribed work experiences. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical practice guidelines for managing major depression in primary care practice: Implications for psychologists.

Clinical practice guidelines are being developed by professional and governmental bodies to improve the quality of health care. The guidelines developed by the US Public Health Service Agency for Health Care Policy and Research seek to improve the primary care physician's ability to diagnose and treat major depression. Clinical, educational, and research implications for psychologists are considered in light of how the recommended guidelines potentially will influence the nature and quality of care provided for mood disorders by generalist physicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Academia and the training of human service delivery program evaluators.

Many think the demand for high-quality evaluation personnel has reached the point where universities should consider the development of program evaluation curricula. Although much of this article focuses on the training of evaluators for the mental health service delivery system, the suggestions made are applicable to the training of evaluation specialists who will function in a variety of public and private human service settings. Among the several issues considered are the body of knowledge to be taught in program evaluation curricula, the specific concepts and skills needed by the evaluator to function effectively, and whether training should be structured as an interdepartmental or intradepartmental specialty. (19 ref) (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)     

Federal mental health policymaking: An assessment of deinstitutionalization.

Argues that significant advances in psychopharmacology and psychology have occurred in the last 3 decades and that the technologies of treating serious mental disorders have improved accordingly. The authors describe the emerging issues of efficacious and cost-effective applications of these technologies to an increasingly complex system of needs and populations, their potential role in public policy, and their relationship to recent federal policy decisions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of psychosocial treatments in primary care. A review of randomized clinical trials

A prevailing complaint among individuals with sensorineural hearing loss (SNHL) is difficulty understanding speech, particularly under adverse listening conditions. The present investigation compared the speech-recognition abilities of listeners with mild to moderate degrees of SNHL to normal-hearing individuals with simulated hearing impairments, accomplished using spectrally shaped masking noise. Speech-perception ability was assessed using the predictability-high sentences from the Speech Perception in Noise test. Results revealed significant differences between groups in sentential-recognition ability, with the hearing-impaired subjects performing poorer than the masked-normal listeners. These findings suggest the presence of a secondary distortion degrading sentential-recognition ability in the hearing impaired, implications of these data will be discussed concerning the mechanism(s) responsible for speech perception in the hearing impaired.     

Assessment depression in primary care practice with the Beck Depression Inventory and the Hamilton Rating Scale for Depression.

Individuals suffering from depression seek help as frequently in the primary care setting as in psychiatric facilities. As primary care physicians increasingly provide such treatments, they will need to assess a patient's clinical status before, during, and after treatment. The authors evaluated the concordance and factor structures of 2 widely used depression inventories, the Beck Depression Inventory and the Hamilton Rating Scale for Depression, in a sample of primary care patients participating in a randomized, control trial of treatments for major depression. The 2 scales were significantly correlated and assessed similar rates of improvement at multiple assessment points. Factor analyses indicated that despite their equivalent assessment of severity of depression, the 2 instruments emphasize different dimensions of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating depressed primary care patients improves their physical, mental, and social functioning

BACKGROUND: This study describes the functioning of primary care patients with major depressive disorder, the relationship of medical comorbidity to functional status, and the effects of depression-specific treatment on functional status after 8 months. METHODS: Patients were randomized to a protocol intervention (nortriptyline hydrochloride or interpersonal psychotherapy) or to usual care with the patient's physician in a clinical trial of primary care treatments of depression. Their functional status was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Global Assessment Scale. Medical comorbidity was assessed with the Duke Severity of Illness Checklist. The Hamilton Rating Scale for Depression and Beck Depression Inventory were used to measure depressive severity. Assessments were conducted at baseline and at 1, 2, 4, and 8 months after randomization. RESULTS: At baseline, patients reported substantial impairments in the functional domains as assessed by the SF-36 and Global Assessment Scale. Severity of general medical illness and depression were not correlated. Greater medical comorbidity was associated with diminished physical, but not psychological, functioning. Mean scores on SF-36 scales and the Global Assessment Scale improved significantly during the 8 months of follow-up. Patients assigned to protocol treatments showed greater improvement, compared with those assigned to usual care, on the SF-36 mental summary scale and most individual scales but not on the SF-36 physical summary scale. However, patients who completed protocol treatment also experienced significant improvement on the physical summary scale. Medical comorbidity was only a weak predictor of outcome. CONCLUSIONS: Primary care patients with major depressive disorder report substantial impairments in physical, psychological, and social functioning on initial assessment. Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months. Functional impairments improve with time, but standardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician's usual care.