Felker BL (VA Puget Sound Healthcare System)
Bonner LM (Northwest Center for Outcomes Research in Older Adults)
Liu CF (Northwest Center for Outcomes Research in Older Adults)
Chaney EF (Northwest Center for Outcomes Research in Older Adults)
Rubenstein LV (Center for the Study of Healthcare Provider Behavior)
Chan D (Northwest Center for Outcomes Research in Older Adults)
Campbell DG (Northwest Center for Outcomes Research in Older Adults)
Implementing a Collaborative Work Group to address barriers related to effective collaboration between primary care and mental health providers helped improve medication adherence, appointment keeping, and more uniform depression treatment policies.
WAVES is a site-randomized evaluation of the implementation of TIDES, a collaborative care depression quality improvement intervention. TIDES was implemented in 7 VA primary care clinics in three VISNs. WAVES participants were evaluated for depression symptomatology using the nine-item Patient Health Questionnaire (PHQ-9). Participants who were positive (PHQ-9 > 10) and who consented to join the study were evaluated for comorbid PTSD with the current VA/DOD screening questions. This study compared demographics (age, gender, marital status, race, education), perceived health, medical co-morbidity (Seattle Index of Comorbidity, SIC), social support, and satisfaction with care between participants with depression symptoms only (n=319) and those with depression and PTSD symptoms (n=358).
In bivariate comparisons, participants with depression and co-morbid PTSD had more severe depression (PHQ-9=16.64 vs. 14.60, p<.001), were younger (57 years vs. 65, p<.001) and more educated (chi-square=18.57, p<.001), and had fewer medical problems (SIC=6.49 vs. 7.85, p<.001), lower tangible social support (2.35 vs. 2.02, p<.001) and lower emotional support (2.56 vs. 2.22, p<.001), and less satisfaction with mental health care (p<.05). To test whether findings were a function of demographic differences, we used regression models and found that controlling for patient demographics, patients with PTSD had a significantly higher PHQ-9 score (p<.001), while the differences in SIC, social support, and satisfaction with care were no longer significant.
In this large VA primary care cohort, approximately half of depressed patients screened positive for PTSD. Those with co-morbid depression and PTSD had worse depression.
When evaluating VA primary care patients for depression, it is important to screen for co-morbid PTSD. Careful assessment of patient’s support systems and interventions to increase these support systems may be helpful for some patients with depression and PTSD depending on demographic characteristics.