Double Trouble: Does Co-Morbid Chronic Somatic Illness Increase Risk for Recurrence in Depression? a Systematic Review.

Double trouble: does co-morbid chronic somatic illness increase risk for recurrence in depression? A systematic review.

PLoS One. 2013; 8(3): e57510
Kok GD, Bockting CL, Burger H, Hannig W, Pijnenborg GH, Cuijpers P, Hollon SD

To perform a systematic review, and if possible a meta-analysis, to establish whether depressed patients with co-morbid chronic somatic illnesses are a high risk “double trouble” group for depressive recurrence.The databases PubMed, EMbase and PsycINFO were systematically searched until the 4 of December 2012 by using MeSH and free text terms. Additionally, reference lists of retrieved publications and treatment guidelines were reviewed, and experts were consulted. Inclusion criteria were: depression had to be measured at least twice during the study with qualified instruments and the chronic somatic illness had to be assessed by self-report or by a medical professional. Information on depressive recurrence was extracted and additionally risk ratios of recurrence were calculated.The search generated four articles that fulfilled our inclusion criteria. These studies showed no differences in recurrence over one- two- three- and 6.5 years of follow-up for a total of 2010 depressed patients of which 694 patients with a co-morbid chronic somatic illness versus 1316 patients without (Study 1: RR?=?0.49, 95% CI, 0.17-1.41 at one year follow-up and RR?=?1.37, 95% CI, 0.78-2.41 at two year follow-up; Study 2: RR?=?0.94, 95% CI, 0.65-1.36 at two year follow-up; Study 3: RR?=?1.15, 95% CI, 0.40-3.27 at one year follow-up; RR?=?1.07, 95% CI, 0.48-2.42 at two year follow-up and RR?=?0.99, 95% CI,0.55-1.77 at 6.5 years follow-up; Study 4: RR?=?1.16, 95% CI, 0.86-1.57 at three year follow-up).We found no association between a heightened risk for depressive recurrence and co-morbid chronic somatic illnesses. There is a need for more longitudinal studies to justify the current specific treatment advice such as long-term pharmacological maintenance treatment for this presumed “double trouble” group. HubMed – depression

Depression and risk of mortality in people with diabetes mellitus: a systematic review and meta-analysis.

PLoS One. 2013; 8(3): e57058
van Dooren FE, Nefs G, Schram MT, Verhey FR, Denollet J, Pouwer F

To examine the association between depression and all-cause and cardiovascular mortality in people with diabetes by systematically reviewing the literature and carrying out a meta-analysis of relevant longitudinal studies.PUBMED and PSYCINFO were searched for articles assessing mortality risk associated with depression in diabetes up until August 16, 2012. The pooled hazard ratios were calculated using random-effects models.Sixteen studies met the inclusion criteria, which were pooled in an overall all-cause mortality estimate, and five in a cardiovascular mortality estimate. After adjustment for demographic variables and micro- and macrovascular complications, depression was associated with an increased risk of all-cause mortality (HR?=?1.46, 95% CI?=?1.29-1.66), and cardiovascular mortality (HR?=?1.39, 95% CI?=?1.11-1.73). Heterogeneity across studies was high for all-cause mortality and relatively low for cardiovascular mortality, with an I-squared of respectively 78.6% and 39.6%. Subgroup analyses showed that the association between depression and mortality not significantly change when excluding three articles presenting odds ratios, yet this decreased heterogeneity substantially (HR?=?1.49, 95% CI?=?1.39-1.61, I-squared?=?15.1%). A comparison between type 1 and type 2 diabetes could not be undertaken, as only one study reported on type 1 diabetes specifically.Depression is associated with an almost 1.5-fold increased risk of mortality in people with diabetes. Research should focus on both cardiovascular and non-cardiovascular causes of death associated with depression, and determine the underlying behavioral and physiological mechanisms that may explain this association. HubMed – depression

The eCHAT Program to Facilitate Healthy Changes in New Zealand Primary Care.

J Am Board Fam Med. 2013 Mar; 26(2): 177-82
Goodyear-Smith F, Warren J, Elley CR

This article describes eCHAT (electronic case-finding and help assessment tool), designed to improve health and well-being through systematic screening and intervention for modifiable lifestyle and mental health issues in primary care populations and monitoring to inform continuous quality improvement. eCHAT allows patients to identify unhealthy behaviors (risky substance use, gambling, being subject to abuse, physical inactivity) and negative mood states (depression, anxiety, anger) with which they would like help before a visit using an iPad in the waiting room or via the Internet in the community. Family physicians access summarized results, including scores and interpretations of screening tests at the point of care. eCHAT stimulates conversations between patients and clinicians about life changes they might make, encouraging active participation in decision making and engagement in self-management. Stepped-care clinical decision support tools offer interventions through self-management options to primary care interventions through to secondary care referral. As well as systematically screening and intervening in individual practice populations, anonymous collated and encrypted data also can be used to measure the mental health and lifestyle risk factors and interventions provided at practice network, regional, and national levels to monitor system and organizational performance improvements, identify regional and national variations, benchmark service delivery, and support quality improvement. HubMed – depression

Validation of the Diagnostic Algorithms for 5 Chronic Conditions in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN): A Kingston Practice-based Research Network (PBRN) Report.

J Am Board Fam Med. 2013 Mar; 26(2): 159-67
Kadhim-Saleh A, Green M, Williamson T, Hunter D, Birtwhistle R

Objective: The objective of this study was to assess the validity of electronic medical records-based diagnostic algorithms for 5 chronic conditions.A retrospective validation study using primary chart abstraction. A standardized abstraction form was developed to ascertain diagnoses of diabetes, hypertension, osteoarthritis, chronic obstructive pulmonary disease, and depression. Information about billing, laboratory tests, notes, specialist and hospital reports, and physiologic data was collected. An age-stratified random sample of 350 patient charts was selected from Kingston, Ontario, Canada. Approximately 90% of those charts were allocated to people aged ?60 years.Three hundred thirteen patient records were included in the study. Patients’ mean age was 68 years and 52% were women. High interrater reliability was indicated by 92% complete agreement and a ? statistic of 89.3%. The sensitivities of algorithms were 100% (diabetes), 83% (hypertension), 45% (osteoarthritis), 41% (chronic obstructive pulmonary disease), and 39% (depression). The lowest specificity was 97%, for depression. The positive predictive value ranged from 79% (depression) to 100%, and the negative predictive value ranged from 68% (osteoarthritis) to 100%.The diagnostic algorithms for diabetes and hypertension demonstrate adequate accuracy, thus allowing their use for research and policy-making purposes. The algorithms for the other 3 conditions require further refinement to attain better sensitivities. HubMed – depression