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The impact of nonclinical factors on care use for patients with depression: a STAR*D report.

Publication ,  Journal Article
Kashner, TM; Trivedi, MH; Wicker, A; Fava, M; Wisniewski, SR; Rush, AJ
Published in: Cns Neurosci Ther
2009

INTRODUCTION: This article presents baseline findings that describe how nonclinical factors were associated with patient use of psychiatric and general medical care and how those relationships changed after patients enrolled in the 41-site Sequenced Treatment Alternatives to Relieve Depression study (STAR*D). AIMS: STAR*D offered adult outpatients with major depression diligently delivered, measurement-based care. To achieve full remission within a tolerable medication dose, recommendations for treatment based on routine symptom and side-effect measurements were discussed with patients by clinical research coordinators and offered to clinicians who could flexibly tailor that guidance to accommodate individual patient needs. Medications were provided gratis. Pre- and post-enrollment data came from provider records and from patient face-to-face, telephone, and computer-assisted surveys. Two-part nested mixed models assessed patient likelihood and volume of mental and general medical care services. RESULTS: Prior to enrollment, predisposing (gender, race, education, and care attitude), affordability (private insurance), and clinical factors (depressive symptoms and mental and physical functioning) were found to be important drivers of patient use of psychiatric and general medical care. After STAR*D enrollment, however, predisposing factors were less important drivers of psychiatric service use but remained important drivers of general medical care. CONCLUSIONS: Data suggest diligent, measurement-based mental health programs may reduce race, gender, and education disparities in the use of needed mental health care.

Duke Scholars

Published In

Cns Neurosci Ther

DOI

EISSN

1755-5949

Publication Date

2009

Volume

15

Issue

4

Start / End Page

320 / 332

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surveys and Questionnaires
  • Socioeconomic Factors
  • Psychiatric Status Rating Scales
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Health Services Accessibility
 

Citation

APA
Chicago
ICMJE
MLA
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Kashner, T. M., Trivedi, M. H., Wicker, A., Fava, M., Wisniewski, S. R., & Rush, A. J. (2009). The impact of nonclinical factors on care use for patients with depression: a STAR*D report. Cns Neurosci Ther, 15(4), 320–332. https://doi.org/10.1111/j.1755-5949.2009.00091.x
Kashner, T Michael, Madhukar H. Trivedi, Annie Wicker, Maurizio Fava, Stephen R. Wisniewski, and A John Rush. “The impact of nonclinical factors on care use for patients with depression: a STAR*D report.Cns Neurosci Ther 15, no. 4 (2009): 320–32. https://doi.org/10.1111/j.1755-5949.2009.00091.x.
Kashner TM, Trivedi MH, Wicker A, Fava M, Wisniewski SR, Rush AJ. The impact of nonclinical factors on care use for patients with depression: a STAR*D report. Cns Neurosci Ther. 2009;15(4):320–32.
Kashner, T. Michael, et al. “The impact of nonclinical factors on care use for patients with depression: a STAR*D report.Cns Neurosci Ther, vol. 15, no. 4, 2009, pp. 320–32. Pubmed, doi:10.1111/j.1755-5949.2009.00091.x.
Kashner TM, Trivedi MH, Wicker A, Fava M, Wisniewski SR, Rush AJ. The impact of nonclinical factors on care use for patients with depression: a STAR*D report. Cns Neurosci Ther. 2009;15(4):320–332.
Journal cover image

Published In

Cns Neurosci Ther

DOI

EISSN

1755-5949

Publication Date

2009

Volume

15

Issue

4

Start / End Page

320 / 332

Location

England

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Surveys and Questionnaires
  • Socioeconomic Factors
  • Psychiatric Status Rating Scales
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Health Services Accessibility