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CDA 10-036 – HSR Study

CDA 10-036
Improving Depression Care Following Psychiatric Hospitalization
Paul N Pfeiffer, MD MS
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: July 2010 - June 2015
Depressive disorders are common among Veterans and are associated with decreased work productivity, disability, poor quality of life, and increased suicide risk. About 10% of depressed Veterans treated in VA outpatient mental health clinics are psychiatrically hospitalized each year. Providing high quality depression care after hospitalization is important because the risks of persistent functional impairment, relapse, and suicide are much higher during this time. This research aims to address this gap in knowledge about the type of care received and identify how care might be improved during this critical juncture.

This project will comprehensively assess the care provided to depressed Veterans following a psychiatric hospitalization and use these findings to develop interventions to enhance mental health servics for this population. The study will incorporate three main goals: 1) to characterize depression care received by Veterans following hospitalization for depression, 2) assess the perceptions and concerns of recently discharged depressed patients to understand barriers to optimal post-hospitalization care, and 3) develop and test the feasibility of a pilot intervention to provide enhanced depression care services for patients following a psychiatric hospitalization.

This first aim of this project is a retrospective cohort study using demographic, clinical, and service utilization data for all depressed VA patients with a psychiatric hospitalization to examine measures of guideline concordant depression care and trends in care following VA quality improvement initiatives. The second aim includes a mailed survey and qualitative data collection from recently discharged patients to assess preferences for services and barriers to effective post-hospitalization care. The third aim is a pilot study of health service intervention that includes automated monitoring and enhanced social support to improve post-hospital care for depression.

Not yet available.

Understanding the quality of depression care and barriers to care after discharge from a psychiatric hospitalization is essential to improving care and outcomes. The findings from the CDA work suggest that timely follow up alone is not enough to improve many care processes. Longer-term support for these high risk depressed VA patients is indicated and study results indicate that individual therapy as well as family and peer support are preferred by patients. Pilot study findings suggest that receiving enhanced support from family members/friends or a VA peer support specialist is associated with high patient satisfaction, although the impact on mental health outcomes and treatment requires futher study. Social support interventions may require additional structure and training for the support person in order to be effective.

External Links for this Project

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Journal Articles

  1. Li Z, Valenstein M, Pfeiffer P, Ganoczy D. A global logrank test for adaptive treatment strategies based on observational studies. Statistics in medicine. 2014 Feb 28; 33(5):760-71. [view]
  2. Valenstein M, Walters H, Pfeiffer PN, Ganoczy D, Miller M, Fiorillo M, Bossarte RM. Acceptability of potential interventions to increase firearm safety among patients in VA mental health treatment. General hospital psychiatry. 2018 Nov 1; 55:77-83. [view]
  3. Zivin K, Ganoczy D, Pfeiffer PN, Miller EM, Valenstein M. Antidepressant adherence after psychiatric hospitalization among VA patients with depression. Administration and policy in mental health. 2009 Nov 1; 36(6):406-15. [view]
  4. Valenstein M, Kim HM, Ganoczy D, Eisenberg D, Pfeiffer PN, Downing K, Hoggatt K, Ilgen M, Austin KL, Zivin K, Blow FC, McCarthy JF. Antidepressant agents and suicide death among US Department of Veterans Affairs patients in depression treatment. Journal of Clinical Psychopharmacology. 2012 Jun 1; 32(3):346-53. [view]
  5. Pfeiffer PN, Szymanski BR, Zivin K, Post EP, Valenstein M, McCarthy JF. Are primary care mental health services associated with differences in specialty mental health clinic use? Psychiatric services (Washington, D.C.). 2011 Apr 1; 62(4):422-5. [view]
  6. Pfeiffer PN, Ganoczy D, Zivin K, Valenstein M. Benzodiazepines and adequacy of initial antidepressant treatment for depression. Journal of Clinical Psychopharmacology. 2011 Jun 1; 31(3):360-4. [view]
  7. Pfeiffer PN, Ganoczy D, Bowersox NW, McCarthy JF, Blow FC, Valenstein M. Depression care following psychiatric hospitalization in the veterans health administration. The American journal of managed care. 2011 Sep 1; 17(9):e358-64. [view]
  8. Pfeiffer PN, King C, Ilgen M, Ganoczy D, Clive R, Garlick J, Abraham K, Kim HM, Vega E, Ahmedani B, Valenstein M. Development and pilot study of a suicide prevention intervention delivered by peer support specialists. Psychological Services. 2019 Aug 1; 16(3):360-371. [view]
  9. Sripada RK, Bohnert KM, Ganoczy D, Pfeiffer PN. Documentation of Evidence-Based Psychotherapy and Care Quality for PTSD in the Department of Veterans Affairs. Administration and policy in mental health. 2018 May 1; 45(3):353-361. [view]
  10. Pfeiffer PN, Valenstein M, Hoggatt KJ, Ganoczy D, Maixner D, Miller EM, Zivin K. Electroconvulsive therapy for major depression within the Veterans Health Administration. Journal of affective disorders. 2011 Apr 1; 130(1-2):21-5. [view]
  11. Li Z, Pfeiffer PN, Hoggatt KJ, Zivin K, Downing K, Ganoczy D, Valenstein M. Emergent anxiety after antidepressant initiation: a retrospective cohort study of Veterans Affairs Health System patients with depression. Clinical therapeutics. 2011 Dec 1; 33(12):1985-1992.e1. [view]
  12. Zivin K, Pfeiffer PN, Bohnert AS, Ganoczy D, Blow FC, Nallamothu BK, Kales HC. Evaluation of the FDA warning against prescribing citalopram at doses exceeding 40 mg. The American journal of psychiatry. 2013 Jun 1; 170(6):642-50. [view]
  13. Pfeiffer PN, Glass J, Austin K, Valenstein M, McCarthy JF, Zivin K. Impact of distance and facility of initial diagnosis on depression treatment. Health services research. 2011 Jun 1; 46(3):768-86. [view]
  14. Sripada RK, Bohnert KM, Ganoczy D, Blow FC, Valenstein M, Pfeiffer PN. Initial group versus individual therapy for posttraumatic stress disorder and subsequent follow-up treatment adequacy. Psychological Services. 2016 Nov 1; 13(4):349-355. [view]
  15. Zivin K, Pfeiffer PN, Szymanski BR, Valenstein M, Post EP, Miller EM, McCarthy JF. Initiation of Primary Care-Mental Health Integration programs in the VA Health System: associations with psychiatric diagnoses in primary care. Medical care. 2010 Sep 1; 48(9):843-51. [view]
  16. Bowersox NW, Bohnert AS, Ganoczy D, Pfeiffer PN. Inpatient psychiatric care experience and its relationship to posthospitalization treatment participation. Psychiatric services (Washington, D.C.). 2013 Jun 1; 64(6):554-62. [view]
  17. Kim HM, Pfeiffer P, Ganoczy D, Valenstein M. Intensity of outpatient monitoring after discharge and psychiatric rehospitalization of veterans with depression. Psychiatric services (Washington, D.C.). 2011 Nov 1; 62(11):1346-52. [view]
  18. Skolarus LE, Piette JD, Pfeiffer PN, Williams LS, Mackey J, Hughes R, Morgenstern LB. Interactive Voice Response-An Innovative Approach to Post-Stroke Depression Self-Management Support. Translational stroke research. 2017 Feb 1; 8(1):77-82. [view]
  19. Pfeiffer PN, Szymanski B, Dhawan N, Difranco D, Valenstein M, Zivin K. Is there an "unhealthy volunteer effect" in mental health outpatient research? Psychiatry Research. 2010 Apr 30; 176(2-3):224-8. [view]
  20. Piette JD, Sussman JB, Pfeiffer PN, Silveira MJ, Singh S, Lavieri MS. Maximizing the value of mobile health monitoring by avoiding redundant patient reports: prediction of depression-related symptoms and adherence problems in automated health assessment services. Journal of medical Internet research. 2013 Jul 5; 15(7):e118. [view]
  21. Pfeiffer PN, Bohnert KM, Zivin K, Yosef M, Valenstein M, Aikens JE, Piette JD. Mobile health monitoring to characterize depression symptom trajectories in primary care. Journal of affective disorders. 2015 Mar 15; 174:281-6. [view]
  22. Pfeiffer PN, Ganoczy D, Zivin K, McCarthy JF, Valenstein M, Blow FC. Outpatient follow-up after psychiatric hospitalization for depression and later readmission and treatment adequacy. Psychiatric services (Washington, D.C.). 2012 Dec 1; 63(12):1239-42. [view]
  23. Pfeiffer PN, Blow AJ, Miller E, Forman J, Dalack GW, Valenstein M. Peers and peer-based interventions in supporting reintegration and mental health among National Guard soldiers: a qualitative study. Military medicine. 2012 Dec 1; 177(12):1471-6. [view]
  24. Pfeiffer PN, Henry J, Ganoczy D, Piette JD. Pilot study of psychotherapeutic text messaging for depression. Journal of telemedicine and telecare. 2017 Aug 1; 23(7):665-672. [view]
  25. Valenstein M, Walters H, Pfeiffer PN, Ganoczy D, Ilgen MA, Miller MJ, Fiorillo M, Bossarte RM. Possession of Household Firearms and Firearm-Related Discussions with Clinicians Among Veterans Receiving VA Mental Health Care. Archives of suicide research : official journal of the International Academy for Suicide Research. 2019 Apr 3; 24(sup1):260-279. [view]
  26. Aikens JE, Trivedi R, Heapy A, Pfeiffer PN, Piette JD. Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression. Journal of general internal medicine. 2015 Jun 1; 30(6):797-803. [view]
  27. Sripada RK, Pfeiffer PN, Rampton J, Ganoczy D, Rauch SA, Polusny MA, Bohnert KM. Predictors of PTSD Symptom Change Among Outpatients in the U.S. Department of Veterans Affairs Health Care System. Journal of traumatic stress. 2017 Feb 1; 30(1):45-53. [view]
  28. Pfeiffer PN, Brandfon S, Garcia E, Duffy S, Ganoczy D, Myra Kim H, Valenstein M. Predictors of suicidal ideation among depressed Veterans and the interpersonal theory of suicide. Journal of affective disorders. 2014 Jan 1; 152-154:277-81. [view]
  29. Pfeiffer PN, Bowersox N, Birgenheir D, Burgess J, Forman J, Valenstein M. Preferences and Barriers to Care Following Psychiatric Hospitalization at Two Veterans Affairs Medical Centers: A Mixed Methods Study. The journal of behavioral health services & research. 2016 Jan 1; 43(1):88-103. [view]
  30. Levine DS, McCarthy JF, Cornwell B, Brockmann L, Pfeiffer PN. Primary Care-Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care. Psychiatric services (Washington, D.C.). 2017 May 1; 68(5):476-481. [view]
  31. Johnson-Lawrence VD, Szymanski BR, Zivin K, McCarthy JF, Valenstein M, Pfeiffer PN. Primary care-mental health integration programs in the veterans affairs health system serve a different patient population than specialty mental health clinics. The primary care companion for CNS disorders. 2012 May 17; 14(3). [view]
  32. Skolarus LE, Lisabeth LD, Burke JF, Levine DA, Morgenstern LB, Williams LS, Pfeiffer PN, Brown DL. Racial and Ethnic Differences in Mental Distress among Stroke Survivors. Ethnicity & disease. 2015 Jan 1; 25(2):138-44. [view]
  33. Buchholz KR, Bohnert KM, Pfeiffer PN, Valenstein M, Ganoczy D, Anderson RE, Sripada RK. Reengagement in PTSD psychotherapy: A case-control study. General hospital psychiatry. 2017 Sep 1; 48:20-24. [view]
  34. Kim HM, Gerlach LB, Yosef M, Stano C, Conroy DA, Valenstein M, Pfeiffer PN, Sales AE, Zivin K. Responsiveness of Veterans Affairs Health Care System to Zolpidem Safety Warnings. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2018 Jul 15; 14(7):1135-1141. [view]
  35. Smith EG, Kim HM, Ganoczy D, Stano C, Pfeiffer PN, Valenstein M. Suicide risk assessment received prior to suicide death by Veterans Health Administration patients with a history of depression. The Journal of clinical psychiatry. 2013 Mar 1; 74(3):226-32. [view]
  36. Bucy RA, Hanisko KA, Kamphuis LA, Nallamothu BK, Iwashyna TJ, Pfeiffer PN. Suicide Risk Management Protocol in Post-Cardiac Arrest Survivors: Development, Feasibility, and Outcomes. Annals of the American Thoracic Society. 2017 Mar 1; 14(3):363-367. [view]
  37. Pfeiffer PN, Kim HM, Ganoczy D, Zivin K, Valenstein M. Treatment-resistant depression and risk of suicide. Suicide & Life-Threatening Behavior. 2013 Aug 1; 43(4):356-65. [view]
  38. Pfeiffer PN, Szymanski BR, Valenstein M, McCarthy JF, Zivin K. Trends in antidepressant prescribing for new episodes of depression and implications for health system quality measures. Medical care. 2012 Jan 1; 50(1):86-90. [view]
  39. Johnson-Lawrence V, Zivin K, Szymanski BR, Pfeiffer PN, McCarthy JF. VA primary care-mental health integration: patient characteristics and receipt of mental health services, 2008-2010. Psychiatric services (Washington, D.C.). 2012 Nov 1; 63(11):1137-41. [view]
Journal Other

  1. Zivin K, Pfeiffer PN, Bohnert AS, Ganoczy D, Blow FC, Nallamothu BK, Kales HC. Safety of high-dosage citalopram. The American journal of psychiatry. 2014 Jan 1; 171(1):20-2. [view]
Conference Presentations

  1. Pfeiffer PN. Challenges in using outcomes to measure depression care quality. Paper presented at: VA Center to Improve Veteran Involvement in Care Seminar Series; 2015 Mar 13; Portland, OR. [view]
  2. Pfeiffer PN. Improving Depression Care Following Psychiatric Hospitalization. Poster session presented at: VA Career Development Award Program Annual Conference; 2012 Jul 1; Washington, DC. [view]
  3. Sripada RK, Bohnert KM, Ganoczy D, Blow FC, Valenstein MT, Pfeiffer PN. Initial Group versus Individual therapy for Posttraumatic Stress Disorder and Subsequent Follow-Up Treatment Adequacy. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA. [view]
  4. Skolarus LE, Pfeiffer PN, Williams LS, Mackey JS, Piette JD, Morgenstern LB. Interactive voice response—a novel approach to post-stroke depression monitoring. Poster session presented at: American Academy of Neurology Annual Meeting; 2015 Apr 18; Washington, DC. [view]
  5. Pfeiffer PN. Meeting the Mental Health Needs of Returning Michigan National Guard Soldiers: Initial findings from Welcome Back Veterans project. Paper presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 27; Baltimore, MD. [view]
  6. Pfeiffer PN. Risk of Incident Diabetes Following Augmentation of Antidepressant Medication with a Second-Generation Antipsychotic for Depression. Poster session presented at: American Psychiatric Association Annual Meeting; 2013 May 21; San Francisco, CA. [view]
  7. Pfeiffer PN, Gancozy D, Zivin K, Valenstein MT. Treatment Resistant Depression and Risk for Psychiatric Hospitalization. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; Washington, DC. [view]
  8. Pfeiffer PN. Trends in Depression Care During the Transition Period Following Psychiatric Hospitalization. Paper presented at: VA Mental Health Annual Conference; 2011 Aug 23; Baltimore, MD. [view]
  9. Valenstein MT, Pfeiffer PN, DesJardin S, Eisenberg D, Hunt J, Kim HM, West B, Clive B, Walters H, Lepkowski J. Veteran College Student's Mental Health A Nationally Representative Sample. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA. [view]
  10. Zivin K, Pfeiffer PN, Ilgen MA, Welsh DE, McCarthy JF, Valenstein MT, Miller EM, Kales HC. Years of potential life lost associated with depression among Veterans. Poster session presented at: American Association for Geriatric Psychiatry Annual Meeting; 2012 Mar 16; Washington, DC. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Prevention
Keywords: none
MeSH Terms: none

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