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Treatment for Depression as a Gateway for Assessment and Treatment of Other Co-Morbidities

Treatment for Depression as a Gateway for Assessment and Treatment of Other Co-Morbidities. Jose M. Pena , MD Randal M. Graf, PhD M. Scott Tims, MS. “I have no actual or potential conflict of interest in relation to this educational activity or presentation”. Surveys.

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Treatment for Depression as a Gateway for Assessment and Treatment of Other Co-Morbidities

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  1. Treatment for Depression as a Gateway for Assessment and Treatment of Other Co-Morbidities Jose M. Pena , MD Randal M. Graf, PhD M. Scott Tims, MS

  2. “I have no actual or potential conflict of interest in relation to this educational activity or presentation”

  3. 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)

  4. 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

  5. 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

  6. 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

  7. Demographic Information Across All Groups • Caucasian (62-77%) • Female (74-91%) • Undergraduates (59-75%)

  8. 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%)

  9. 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

  10. 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

  11. Limitations • Demographic : predominantly Caucasian, Female, undergrad. • Self-selection • Small sample size

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

  13. Treatment Seeking for Depression • Co-Morbidity • Bipolar Dis. • Alcohol Use • PTSD • ED • GAD

  14. 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

  15. Importance of Effective Screening and Diagnosis • Subjective Chief complaint vs. Co-Morbidity • Mental health and Non-mental health settings • Anti-depressant Rx • PHQ

  16. Recommendations Prevention/Screening Clinical Care/Programs Randall M. Graf, PhD • M. Scott Tims, MS

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