title: Time to depression treatment in primary care among HIV-infected and uninfected veterans.
abstract: BACKGROUND
  Multiple factors, including patient characteristics, competing demands, and clinic type, impact delivery of depression treatment in primary care.
  
  
  OBJECTIVE
  Assess whether depression severity and HIV serostatus have a differential effect on time to depression treatment among depressed patients receiving primary care at Infectious Disease or General Medicine clinics.
  
  
  METHODS
  Multicenter prospective cohort, (Veterans Aging Cohort Study), comparing HIV-infected to uninfected patients.
  
  
  METHODS
  The total cohort consisted of 3,239 HIV-infected and 3,227 uninfected patients. Study inclusion criteria were untreated depressive symptoms, based on a Patient Health Questionnaire (PHQ-9) score of greater than 9, and no antidepressants or mental health visits in the 90 days prior to PHQ-9 assessment. Treatment was defined as antidepressant receipt or mental health visit within 90 days following PHQ-9 assessment. Depression severity based on PHQ-9 scores was defined as mild-moderate (greater than 9 to 19) and severe (20 or greater). Kaplan-Meier curves were used to estimate time to treatment by depression severity and HIV serostatus. Cox proportional hazards methods adjusted for covariates were used.
  
  
  RESULTS
  Overall, 718 (11%) of the cohort met inclusion criteria, 258 (36%) of whom received treatment. Median time to treatment was 7 days [95% confidence interval (CI) = 4, 13] and was shortest for severely depressed HIV-infected patients (0.5 days; 95% CI = 0.5, 6, p = 0.04). Compared to mildly-moderately depressed uninfected patients, severely depressed HIV-infected patients were significantly more likely to receive treatment [adjusted hazard ratio (HR) 1.67, 95% CI = 1.07, 2.60), whereas mildly-moderately depressed HIV-infected patients (adjusted HR 1.10, 95% CI = 0.79, 1.52) and severely depressed uninfected patients (adjusted HR 0.93, 95% CI = 0.60, 1.44) were not.
  
  
  CONCLUSIONS
  In this large cohort, time to primary care treatment of depression was shortest among severely depressed HIV-infected patients. Regardless of HIV serostatus, if depression was not treated on the assessment day, then it was unlikely to be treated within a 90-day period, leading to the majority of depression being untreated.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Dina
authors.initials: D
authors.lastname: Hooshyar
authors.forename: Joseph
authors.initials: J
authors.lastname: Goulet
authors.forename: Lydia
authors.initials: L
authors.lastname: Chwastiak
authors.forename: Steven
authors.initials: S
authors.lastname: Crystal
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Kristin
authors.initials: K
authors.lastname: Mattocks
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
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