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Guideline-Consistent Antidepressant Treatment Patterns Among Veterans With Diabetes and Major Depressive Disorder

Dr. Tiwari, Ms. Rajan, Dr. Pogach, and Dr. Sambamoorthi are affiliated with the Health Services Research and Development Center for Health Care Knowledge and Management, New Jersey Health Care System, Department of Veteran Affairs (VA), East Orange, New Jersey. Dr. Sambamoorthi is also with the Department of Psychiatry, University of Massachusetts Medical School, Worcester. Dr. Miller is with the Center for Health Quality, Outcomes, and Economic Research, VA, Bedford, Massachusetts. Dr. Olfson is with the Department of Psychiatry, Columbia University, New York City. Send correspondence to Dr. Sambamoorthi at the Health Services Research and Development Center for Health Care Knowledge and Management, New Jersey Health Care System, VA, 385 Tremont Ave., Mail Stop 129, East Orange, NJ 07018 (e-mail: usha.sambamoorthi{at}umassmed.edu).

OBJECTIVE: This study estimated guideline-consistent antidepressant treatment of depression among veterans with diabetes and examined its variation by patient-level demographic characteristics, socioeconomic characteristics, access to care, and health status. METHODS: Data were retrospectively analyzed from Veterans Health Administration (VHA) and Medicare claims of VHA clinic users with diabetes and major depressive disorder (N=3,953). Major depression was identified by using ICD-9-CM codes 296.2 and 296.3. Incident episode was identified by using 120-day negative diagnosis and medication history on or before the first depression diagnosis date in fiscal year 1999. Guideline-consistent depression treatment was defined as the receipt of antidepressants for at least 90 days within a period of six months after the onset of depression. Chi square tests and logistic regressions were used to analyze patterns of guideline-consistent antidepressant treatment. RESULTS: Overall, 51% received any antidepressant treatment for diagnosed major depression; among patients using any antidepressants, 62% received guideline-consistent antidepressant treatment. VHA users who received care from a mental health specialist were more likely to have guideline-consistent treatment than those who were not receiving care from a mental health specialist. African Americans, older veterans, and those with substance use disorders were less likely to have guideline-consistent antidepressant treatment. CONCLUSIONS: Guideline-consistent depression care was lower for certain subgroups of individuals. Further research is necessary to evaluate the reasons for this finding, so that targeted care coordination strategies could be developed to improve antidepressant treatment. Increased contact with mental health specialty staff, which is now being implemented in the VHA, may increase antidepressant treatment among VHA users with diabetes and major depression.

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