199610 Treatment patterns for incident depression episode among women veterans with or at risk for cardiovascular conditions

Tuesday, November 10, 2009: 1:30 PM

Chan Shen, PhD , Economics, George Washington University, New Brunswick, NJ
Patricia A. Findley, DrPH, MSW , School of Social Work, Rutgers,The State University of New Jersey, New Brunswick, NJ
Ranjana Banerjea, PhD , Center for Healthcare Knowledge Management, Department of Veterans Affairs, NJ Health Care System, East Orange, NJ
Susan Frayne, MD, MPH , Stanford Univeristy School of Medicine, Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA
Leonard Pogach, MD, PhD , Center for Healthcare Knowledge Management, Department of Veterans Affairs, NJ Health Care System, East Orange, NJ
Usha Sambamoorthi, PhD , Department of Psychiatry, University of Massachusetts Medical School, Englishtown, NJ
BACKGROUND: Treatment of depression among individuals with heart disease or diabetes is important because of its beneficial effects in reducing mortality, recurrence of heart disease, and healthcare expenditures. Post-hoc analysis of the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study found an association between reduction in death rates or recurrent MI and antidepressant use.

OBJECTIVE: Examine treatment patterns for incident depression episode among veteran women with or at risk for cardiovascular conditions.

METHODS: Longitudinal data (2002-2003) of merged Veteran Health Administration (VHA) and Medicare data on women veterans with diabetes or heart disease or hypertension (N = 54,166); these conditions and depression were identified using International Classification of Codes, 9th edition, clinical modification codes. Chi-square tests and multinomial logistic regressions were performed to analyze depression treatment patterns.

FINDINGS: Overall, 15% (N = 8,147) of veteran women with Cardiovascular Conditions were diagnosed with a new episode of depression in fiscal year 2003. Of these women 77% received treatment for depression–54% only antidepressants; 4% only psychotherapy; 19% both. After controlling for demographic, socio-economic, and other physical and mental health conditions, African Americans, older women, those with heart disease and serious mental illness were less likely to receive any treatment for depression.

CONCLUSION: Although overall rates of treatment for depression were high among veteran women with chronic physical illnesses, many subgroups of women veterans were vulnerable to not receiving treatment for depression.

IMPLICATION: Further research and targeted interventions are needed to promote treatment for depression and eliminate disparities in treatment for depression.

Learning Objectives:
1. Define incident depression episodes using administrative data; 2. Identify antidepressant use and psychotherapy use using administrative data; 3. Discuss types of treatment for depression among women with cardiovascular conditions; and 4. List subgroup differences in rates of treatment for depression among veteran women with chronic physical illnesses.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the first author of the paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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