Time to depression treatment in primary care among HIV-infected and uninfected veterans.
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.
Hooshyar
Dina
D
Yale University School of Medicine, New Haven, CT, USA.
Goulet
Joseph
J
Chwastiak
Lydia
L
Crystal
Steven
S
Gibert
Cynthia
C
Mattocks
Kristin
K
Rimland
David
D
Rodriguez-Barradas
Maria
M
Justice
Amy C
AC
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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