treatment for depression as a gateway for assessment and treatment of other co-morbidities jose m....

Treatment for Depression as a Gateway for Assessment and

Treatment of Other Co-Morbidities

Jose M. Pena , MDRandal M. Graf, PhDM. Scott Tims, MS

“I have no actual or potential conflict of interest in relation to

this educational activity or presentation”

Surveys

• American College Health Association - National College Health Assessment (ACHA)

• National Survey of Counseling Center Directors (Gallagher, RP)

• Mental Health Care in the College Community, (ed. Kay J and Schwartz V)

• College Student Mental Health : Effective Services and Strategies Across Campus (ed. Benton A and Benton L)

Increase in Number and Severity of Mental Health Problems

• Anxiety 13%• Anorexia 2%• Bulimia 2%• Depression 18%– Considered Suicide (1yr.) 9 %– Attempted Suicide (Life) 1%– On Psych Medication 36%

ACHA, 2008; Kay 2010

Increased Need for Services

• Directors of Health Services – 93% report increase in # of students on meds.– 95% report greater acuity• Staff burnout• Service shortages during peak times

– 67% report increase in crisis counseling– 60% increased demand w/o increased resources

Gallagher 2008

On-Line Mental Health Self-Assessment Survey

• Demographic Information• Six Domains– Depression (DEP, n=230)– Bipolar (BP, n=88)– Alcohol Use (AU, n=32)– Eating Dis. (ED, n=58)– Generalized Anxiety (GAD, n=102)– Posttraumatic Stress (PTSD, n=26)

• Likelihood of problem • Received Treatment

Demographic Information Across All Groups

• Caucasian (62-77%)• Female (74-91%)• Undergraduates (59-75%)

Within Group: Very likely to have the identified problem

• Depression (89%)• Bipolar Dis. (34%)• Alcohol Use (91%)• Eating Dis. (66%)• Generalized Anxiety Dis. ( 96%)• PTSD (100%)

Within Group Treatment Seeking (vs. Likelihood)

• Depression 27% (vs. 89%)• Bipolar Disorder 2% (vs. 34%)• Alcohol Use 3% (vs. 91%)• Eating Dis. 19% (vs. 66%) • Generalized Anxiety 19% (vs. 96%)• PTSD 12% (vs. 100%)• Low utilization Across Groups

Within Group Treatment Seeking for Depression > Other

• Bipolar Dis. P< .0001• Alcohol Use P< .0027• Eating Dis. P< .0086• PTSD P< .0522• Generalized Anxiety P< .2407• Treatment seeking for depression much more

likely than for other problems, with trends in same direction

Limitations

• Demographic : predominantly Caucasian, Female, undergrad.

• Self-selection • Small sample size

Discussion

• All groups: Low treatment utilization • Treated Depression highest at only 27%• Increased Demand vs. Resources– ?? Tip of the Iceberg

Treatment Seeking for Depression

• Co-Morbidity– Bipolar Dis.– Alcohol Use – PTSD– ED– GAD

Treatment Seeking

• Recall: PTSD• Disclosure : PTSD, ED, Alcohol (SA) • Denial: Alcohol (SA), ED, Bipolar• Distress– Bipolar I : 32% Dep : 15% Mania/Cycling– Bipolar II : 50% Dep; 4% Hypo/Cycling

• Age/Onset: DSM/Bipolar? • Stigma: GAD weakest trend

Judd LL et al ArchGenPsych 2002

Importance of Effective Screening and Diagnosis

• Subjective Chief complaint vs. Co-Morbidity• Mental health and Non-mental health settings • Anti-depressant Rx• PHQ

Recommendations

Prevention/Screening • M. Scott Tims, MS

Clinical Care/Programs • Randall M. Graf, PhD