Prevalence of Anxiety, Depression, and Substance Use Disorders in an Urban General Medicine Practice

Olfson, Mark; Shea, Steven; Feder, Adriana; Fuentes, Milton A.; Nomura, Yoko; Gameroff, Marc J.; Weissman, Myrna M.

doi:10.1001/archfami.9.9.876

Cited by 241 publications

(159 citation statements)

References 39 publications

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“…Our estimates even surpassed depression rates among outpatient medical samples, which generally fall around 17% to 24% and are widely recognized to be much higher than community rates. [16][17][18] Nevertheless, screening positive for depression is not equivalent to being diagnosed with a major depressive episode. Even screening instruments with laudable test characteristics such as the HANDS, which has a sensitivity of 95% and a specificity of 94% for detecting a DSM-IV-diagnosed major depressive episode, 12 can yield high false positives.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Boudreaux¹,

Cagande²,

Kilgannon³

et al. 2006

Prim. Care Companion CNS Disord.

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Objective:To determine prevalence and predictors of depression among emergency department (ED) patients.Method: For 1 week in November 2003, consecutive adult patients presenting to an urban ED from 8:00 a.m. to midnight were screened for a DSM-IV major depressive episode using the Harvard Department of Psychiatry National Depression Screening Day Scale. Patients who were severely ill or who had altered mental status were excluded. Demographic factors, psychiatric history, and brief medical history also were assessed.Results: Of 182 patients enrolled, 57 (32%, 95% CI = 25 to 39) screened positive for depression, which was much greater than general community estimates (6.6%, p < .0001). Depression was more likely (p < .001) in patients with a psychiatric history (61% vs. 22%), substance abuse history (65% vs. 30%), or a suicide attempt (67% vs. 30%). Eleven percent (95% CI = 7 to 17) of subjects endorsed suicidal ideation at least "some of the time."Limitations: This sample underrepresented severely ill, acutely distressed, or cognitively disabled patients. The most likely effect of these exclusion criteria was to yield an underestimate of depression. Also, the ED was located in a northeastern, urban city, which may not represent the rest of the country. Finally, we used a screening instrument without established operating characteristics within the ED setting.Conclusion: Although findings suggest that depression is common, it is often ignored in the ED setting. Recent efforts to increase awareness of depression in outpatient medical settings may be warranted in EDs as well.(Prim Care Companion J Clin Psychiatry 2006;8:66-70)

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Section: Discussionmentioning

confidence: 99%

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

Boudreaux¹,

Cagande²,

Kilgannon³

et al. 2006

Prim. Care Companion CNS Disord.

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“…4,5 PTSD is consistently associated with increased health care utilization, medical morbidity, and health-compromising behaviors such as tobacco and alcohol abuse. 6 The high prevalence and negative health effects of PTSD have led to increased screening efforts for the disorder in Department of Veterans Affairs (VA) and Department of Defense (DoD) clinics.…”

Section: T He Prevalence Of Posttraumatic Stress Disorder (Ptsd) Inmentioning

confidence: 99%

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

et al. 2016

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BACKGROUND: Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE: The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGN: We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTS: A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURES: The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

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“…Thus, the racial/ethnic classification was validated using data collected as part of a distinct study having self-reported racial/ethnic data in 1007 patients followed in one of our clinical sites. 55,56 Using the self-reported data as the gold standard, the sensitivity of the CIS database was 67% for Hispanics and 72% for African Americans, and the specificity was 94% for both Hispanics and African Americans. This misclassification would have resulted in an underrepresentation of the proportion of minority women included in the analysis and biased the results toward the null.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram

Press

Carrasquillo

Sciacca³

et al. 2008

Journal of Women's Health

140

111

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Background: Although non-Hispanic white women have an increased risk of developing breast cancer, the disease-specific survival is lower for African American and Hispanic women. Little is known about disparities in follow-up after an abnormal mammogram. The goal of this study was to investigate potential disparities in follow-up after an abnormal mammogram. Methods: A retrospective cohort study of 6722 women with an abnormal mammogram and documented follow-up from January 2000 through December 2002 was performed at an academic medical center in New York City. The outcome was the number of days between the abnormal mammogram and follow-up imaging or biopsy. Cox proportional hazards models were used to assess the effect of race/ethnicity and other potential covariates. Results: The median number of days to diagnostic follow-up after an abnormal mammogram was greater for African American (20 days) and Hispanic (21 days) women compared with non-Hispanic white (14 days) women (p Ͻ 0.001). Racial/ethnic disparities remained significant in a multivariable model controlling for age, Breast Imaging Reporting and Data System (BIRADS) category, insurance status, provider practice location, and median household income. Conclusions: After an abnormal mammogram, African American and Hispanic women had longer times to diagnostic follow-up compared with non-Hispanic white women. Future efforts will focus on identifying the barriers to follow-up so that effective interventions may be implemented.

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Prevalence of Anxiety, Depression, and Substance Use Disorders in an Urban General Medicine Practice

Cited by 241 publications

References 39 publications

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

A Prospective Study of Depression Among Adult Patients in an Urban Emergency Department

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram

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