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Treatment for Depression as a Gateway for Assessment and
Treatment of Other Co-Morbidities
Jose M. Pena , MDRandal M. Graf, PhDM. Scott Tims, MS
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“I have no actual or potential conflict of interest in relation to
this educational activity or presentation”
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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)
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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
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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
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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
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Demographic Information Across All Groups
• Caucasian (62-77%)• Female (74-91%)• Undergraduates (59-75%)
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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%)
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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
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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
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Limitations
• Demographic : predominantly Caucasian, Female, undergrad.
• Self-selection • Small sample size
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Discussion
• All groups: Low treatment utilization • Treated Depression highest at only 27%• Increased Demand vs. Resources– ?? Tip of the Iceberg
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Treatment Seeking for Depression
• Co-Morbidity– Bipolar Dis.– Alcohol Use – PTSD– ED– GAD
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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
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Importance of Effective Screening and Diagnosis
• Subjective Chief complaint vs. Co-Morbidity• Mental health and Non-mental health settings • Anti-depressant Rx• PHQ
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Recommendations
Prevention/Screening • M. Scott Tims, MS
Clinical Care/Programs • Randall M. Graf, PhD