Evidence map›Paper›PMID 34004405›Full record

ArticleJournal of affective disorders2021

Comorbid mental disorders, depression symptom severity, and role impairment among Veterans initiating depression treatment through the Veterans Health Administration.

Hannah N Ziobrowski, Lucinda B Leung, Robert M Bossarte, Corey Bryant, Janelle N Keusch, Howard Liu, Victor Puac-Polanco, Wilfred R Pigeon, David W Oslin, Edward P Post and 3 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of affective disorders, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
2.0field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 14 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 7 institutions in 1 country.

Hannah N ZiobrowskiDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA.
Lucinda B LeungCenter for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
Robert M BossarteDepartment of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA; Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.
Corey BryantCenter for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, USA.
Janelle N KeuschCenter for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, USA.
Howard LiuDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.
Victor Puac-PolancoDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
Wilfred R PigeonCenter of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
David W OslinVISN 4 Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Edward P PostCenter for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, USA; Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Alan M ZaslavskyDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Statistics, Harvard University, Cambridge, MA, USA.
Jose R ZubizarretaDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA; Department of Statistics, Harvard University, Cambridge, MA, USA; Department of Biostatistics, Harvard University, Cambridge, MA, USA.
Ronald C KesslerDepartment of Health Care Policy, Harvard Medical School, 180 Longwood Ave, 02115 Boston, MA, USA. Electronic address: kessler@hcp.med.harvard.edu.
Harvard University · USVA Center for Clinical Management Research · USPhiladelphia VA Medical Center · USUniversity of California, Los Angeles · USUniversity of Michigan · USUniversity of Rochester Medical Center · USWest Virginia University · US

Funding

Leveraging EHR data to evaluate key treatment decisions to prevent suicide-related behaviorsR01MH121478 · NIMH · HARVARD MEDICAL SCHOOL · PI KESSLER, RONALD C · 2020 to 2023
$3.1M
Improving Depression Management in Primary CareIK2HX002867 · VA · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · PI LEUNG, LUCINDA B · 2020 to 2025
–
HSRD VA IK2 HX002867NIMH NIH HHS R01 MH121478
6 · The paper itself

Abstract

backgroundPsychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates.

methods2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments.

resultsNearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities. LIMITATIONS: The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities.

conclusionsAlthough positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.

Indexed as

Mental DisordersStress Disorders, Post-TraumaticVeteransComorbidityCross-Sectional StudiesDepressionHumansVeterans HealthComorbidityDepressionDepression symptom severityFunctioningRole impairmentVeteransVeterans Health Administration

Identifiers

PMID34004405
PMCPMC8508583
OpenAlexW3159380864

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.