The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes

Swenson, Sara; Rose, Monica; Vittinghoff, Eric; Stewart, Anita L.; Schillinger, Dean

doi:10.1097/mlr.0b013e31816080e9

Cited by 51 publications

(43 citation statements)

References 46 publications

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“…Our findings using objective measures of patient–provider communication do not strongly support studies using self-reported measures showing a link between depression and lower-quality patient–provider communication (Schenker et al, 2009; Swenson et al, 2008). However, to our knowledge, this is the first study to evaluate the effect of depressive symptoms on objective measures of patient–provider communication, which may have contributed to results that differ from previous studies evaluating subjective measures of communication alone.…”

Section: Discussioncontrasting

confidence: 99%

“…Not only are increased depressive symptoms associated with poor HIV patient outcomes (Leserman, 2008) but also based on evidence from other patient populations, depressive symptoms may also have a detrimental effect on patient–provider communication. In type II diabetes, patients with severe depressive symptoms report experiencing more verbal dominance and less patient activation and rapport building with their primary care provider than patients without depression (Swenson, Rose, Vittinghoff, Stewart, & Schillinger, 2008). Also, depressed patients with coronary artery disease were more likely to report that their provider was unresponsive to their medical treatment preferences (Schenker, Stewart, Na, & Whooley, 2009).…”

Section: Introductionmentioning

confidence: 99%

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The impact of depressive symptoms on patient–provider communication in HIV care

et al. 2013

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Persons with HIV who develop depression have worse medical adherence and outcomes. Poor patient–provider communication may play a role in these outcomes. This cross-sectional study evaluated the influence of patient depression on the quality of patient–provider communication. Patient–provider visits (n = 406) at four HIV care sites were audio-recorded and coded with the Roter Interaction Analysis System (RIAS). Negative binomial and linear regressions using generalized estimating equations tested the association of depressive symptoms, as measured by the Center for Epidemiology Studies Depression scale (CES-D), with RIAS measures and postvisit patient-rated quality of care and provider-reported regard for his or her patient. The patients, averaged 45 years of age (range = 20–77), were predominately male (n = 286, 68.5%), of black race (n = 250, 60%), and on antiretroviral medications (n = 334, 80%). Women had greater mean CES-D depression scores (12.0) than men (10.6; p = 0.03). There were no age, race, or education differences in depression scores. Visits with patients reporting severe depressive symptoms compared to those reporting none/mild depressive symptoms were longer and speech speed was slower. Patients with severe depressive symptoms did more emotional rapport building but less social rapport building, and their providers did more data gathering/counseling (ps < 0.05). In postvisit questionnaires, providers reported lower levels of positive regard for, and rated more negatively patients reporting more depressive symptoms (p < 0.01). In turn, patients reporting more depressive symptoms felt less respected and were less likely to report that their provider knows them as a person than none/mild depressive symptoms patients (ps < 0.05). Greater psychosocial needs of patients presenting with depressive symptoms and limited time/resources to address these needs may partially contribute to providers’ negative attitudes regarding their patients with depressive symptoms. These negative attitudes may ultimately serve to adversely impact patient–provider communication and quality of HIV care.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of depressive symptoms on patient–provider communication in HIV care

et al. 2013

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“…In a retrospective analysis of data collected from 1599 patients attending 43 Scottish general practices, higher scores on the six Nottingham Health Profile dimensions of distress were significantly associated with more negative responses to questionnaire items on the doctorpatient relationship (Hopton et al, 1993). A range of other studies suggest that more negative assessments of healthcare are made by people with greater psychological distress (Bui, Ostor, Kuo, Freeman, & Goodwin, 2005;Goldzweig et al, 2010;O'Malley et al, 2005;Schenker, Stewart, Na, & Whooley, 2009;Swenson, Rose, Vittinghoff, Stewart, & Schillinger, 2008).…”

Section: Introductionmentioning

confidence: 94%

Primary care experience of people with long-standing psychological problems: Evidence from a national survey in England

Abel¹,

Mavaddat²,

Elliott³

et al. 2011

International Review of Psychiatry

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People with psychological problems face important challenges in obtaining high quality healthcare. We review evidence on the experience of primary care by people with mental health problems, including reasons why their care may be reported as worse than other groups. In the 2009 English GP Patient Survey, 5.7% of 2,163,456 respondents reported that they had a long-standing psychological or emotional condition. In an unadjusted regression model, respondents with long-standing emotional or psychological conditions rated their experiences worse than people without such problems, with scores which were up to 3 percentage points lower on individual survey items. However, after controlling for age, gender, ethnicity, deprivation and self-reported general health, people with long-standing psychological or emotional problems had slightly higher scores on 16 out of the 18 survey items, though with the equivalent of less than 2 percentage points difference for most items. Part of the reason for the difference between the adjusted and unadjusted models was the high prevalence of self-reported 'fair' or 'poor' general health among people who reported psychological problems. Overall, the results suggest that people with long-standing psychological and emotional conditions have similar experiences of English primary care compared to the rest of the population.

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“…Our findings underscore the need for physicians to improve health communication with their patients regarding depression management. 33,34 Team-based approaches, such as collaborative depression care that provides educational materials regarding depression diagnosis, treatment, psychoeducation, and support by care managers, have been shown to significantly increase antidepressant adherence in patients with comorbid depression and diabetes, and improve disease control for both conditions. 32,35 Such interventions may succeed in part by empowering patients to become more engaged in their depression management and communicate more effectively with their providers when they are experiencing medication side effects.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)

et al. 2013

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Validated three-item self-report scale measured health literacy. Discrete indices of adherence based on pharmacy dispensing data according to validated methods: primary non-adherence (medication never dispensed); early non-persistence (dispensed once, never refilled); non-persistence at 180 and 365 days; and new prescription medication gap (NPMG; proportion of time that the person is without medication during 12 months after the prescription date). KEY RESULTS: Seventy-two percent of patients were classified as having health literacy limitations. After adjusting for sociodemographic and clinical covariates, patients with health literacy limitations had significantly poorer adherence compared to patients with no limitations, whether measured as early non-persistence (46 % versus 38 %, p < 0.05), non-persistence at 180 days (55 % versus 46 %, p<0.05), or NPMG (41 % versus 36%, p<0.01). There were no significant associations with primary adherence or non-persistence at 365 days. CONCLUSIONS: Poorer antidepressant adherence among adults with diabetes and health literacy limitations may jeopardize the continuation and maintenance phases of depression pharmacotherapy. Findings underscore the importance of national efforts to address health literacy, simplify health communications regarding treatment options, improve public understanding of depression treatment, and monitor antidepressant adherence.

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The Influence of Depressive Symptoms on Clinician–Patient Communication Among Patients With Type 2 Diabetes

Cited by 51 publications

References 46 publications

The impact of depressive symptoms on patient–provider communication in HIV care

The impact of depressive symptoms on patient–provider communication in HIV care

Primary care experience of people with long-standing psychological problems: Evidence from a national survey in England

Health Literacy and Antidepressant Medication Adherence Among Adults with Diabetes: The Diabetes Study of Northern California (DISTANCE)

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