Duncan G. Campbell

Depression Diagnosis and Antidepressant Treatment among Depressed VA Primary Care Patients

This study examined the extent to which 3559 VA primary care patients with depression symptomatology received depression diagnoses and/or antidepressant prescriptions. Symptomatology was classified as mild (13%), moderate (42%) or severe (45%) based on SCL-20 scores. Diagnosis and treatment was related to depression severity and other patient characteristics. Overall, 44% were neither diagnosed nor treated. Only 22% of those neither diagnosed nor treated for depression received treatment for other psychopathology. Depression treatment performance measures dependent on diagnoses and antidepressant prescriptions from administrative databases exclude undiagnosed patients with significant, treatable, symptomatology.

Complementary and alternative medicine use in veterans with multiple sclerosis: Prevalence and demographic associations

The present study explored complementary and alternative medicine (CAM) use in veterans with multiple sclerosis (MS). We administered self-report questionnaires to 451 veterans who received healthcare from Veterans Health Administration facilities. CAM use among veterans with MS was widespread; 37% of respondents reported current or past use. Roughly 33% of CAM users reported using multiple interventions, and 40% of respondents desired interventions that they were not already using. Logistic regression suggested that CAM use was more likely among participants with graduate-level education, poor self-reported health over the past year, and a progressive relapsing MS subtype. Participants who used traditional medical services were also more likely to use CAM, which suggests that CAM services are used in addition to, as opposed to in place of, traditional services. As others have proposed, these results suggest that care providers who work with persons with MS would be well served to understand, routinely screen for, and make use of CAM when appropriate.

Prevalence and correlates of smoking status among veterans affairs primary care patients with probable major depressive disorder.

In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics associated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.8%. Relative to nonsmokers with probable major depression, bivariate comparisons revealed that current smokers had higher depression severity, drank more heavily, and were more likely to have comorbid PTSD. Smokers with probable major depression were also more likely than nonsmokers with probable major depression to have missed a health care appointment and to have missed medication doses in the previous 5months. Smokers were more amenable than non-smokers to depression treatment and diagnosis, and they reported more frequent visits to a mental health specialist and less social support. Alcohol abuse and low levels of social support were significant concurrent predictors of smoking status in controlled multivariable logistic regression. In conclusion, smoking prevalence was high among primary care patients with probable major depression, and these smokers reported a range of psychiatric and psychosocial characteristics with potential to complicate systems-level smoking cessation interventions.

The Environmental Rating Scale (ERS) : A measure of the quality of the residential environment for adults with autism

This study used classical test theory to assess the psychometric properties of the Environmental Rating Scale (ERS), a measure specifically designed to assess the treatment programs in residential settings that serve individuals with autism. Results of the confirmatory factor analysis support the presence of a single factor represented by the total score. The reliability of the measure was demonstrated by assessments of the internal consistency, stability, and interrater reliability. Preliminary analysis of the validity of the ERS indicates that this measure discriminates between treatment settings designed specifically for individuals with autism and those designed for other populations of developmentally handicapped clients and family homes. The ERS was also significantly positively correlated with a measure of the caregivers knowledge about autism and a visitors global impression of the desirability of the setting as a place to live.

Sociotropy and Autonomy: Preliminary Evidence for Construct Validity Using TAT Narratives

In this investigation, we evaluated the construct validity of sociotropy and autonomy as assessed by the revised Personal Style Inventory (PSI; Robins et al., 1994). Stories given to 6 cards of the Thematic Apperception Test (Murray, 1943) were coded for need for Achievement (McClelland, Atkinson, Clark, & Lowell, 1953) and need for Affiliation (Heyns, Veroff, & Atkinson, 1958). These scores were correlated with PSI Sociotropy and Autonomy, along with their component subscales. The construct validity of Sociotropy, Autonomy, and 5 of 6 component subscales were supported as hypothesized. Consistent with past research, there was no support for the construct validity of the Perfectionism/Self-Criticism subscale of Autonomy. In addition, separate analyses by gender suggested that the construct validity of sociotropy may be greater for women than for men. The results represent an important finding in that nonquestionnaire measures of interpersonal and achievement-related concerns were found to support the validity of the PSI, a need identified by the questionnaires authors.

Stigma Predicts Treatment Preferences and Care Engagement Among Veterans Affairs Primary Care Patients with Depression

BackgroundWhereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed.PurposeThis study tests whether stigma, defined as depression label avoidance, predicted patients’ preferences for depression treatment providers, patients’ prospective engagement in depression care, and care quality.MethodsWe conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression.ResultsRelative to low-stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care.ConclusionsHigh stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement.

Relationships between mood and employment over time among depressed VA primary care patients

OBJECTIVE Associations between depression, productivity and work loss have been reported, yet few studies have examined relationships between longitudinal depression status and employment continuity. We assessed these relationships among Veterans of conventional working ages. METHODS We used longitudinal survey data from Veterans receiving primary care in 1 of 10 Veterans Health Administration primary care practices in five states. Our sample included 516 participants with nine-item Patient Health Questionnaire (PHQ-9) scores indicating probable major depression (PHQ-9≥10) at baseline and who completed either the 7-month follow-up survey or follow-up surveys at both 7 and 18 months postbaseline. We examined relationships between depression persistence and employment status using multinomial logistic regression models. RESULTS Although general employment rates remained stable (21%-23%), improved depression status was associated with an increased likelihood of becoming employed over 7 months among those who were both depressed and nonemployed at baseline. Improvements in depression status starting at 7 months and continuing through 18 months were associated with remaining employed over the 18-month period, relative to those who were depressed throughout the same time frame. CONCLUSIONS Given the pressing need to prevent socioeconomic deterioration in the increasing population of conventional working-aged Operation Enduring Freedom and Operation Iraqi Freedom Veterans, further attention to the depression/employment relationship is urgently needed.

Mood Management Intervention for College Smokers with Elevated Depressive Symptoms: A Pilot Study

Abstract Objective: This pilot study examined smoking reduction and cessation among college smokers with elevated depressive symptomatology participating in a group-based behavioral counseling, mood management, and motivational enhancement combined intervention (CBT). Participants and Methods: Fifty-eight smokers (smoked 6 days in the past 30) were randomized to 6 sessions of CBT (n = 29) or a nutrition-focused attention-matched control group (CG; n = 29). Results: Relative to CG participants, significantly more CBT participants reduced smoking intensity by 50% (χ2[1, N = 58] = 4.86, p = .028) at end of treatment. Although CBT participants maintained smoking reductions at 3- and 6-month follow-up, group differences were no longer significant. No group differences in cessation emerged. Finally, participants in both groups evidenced increased motivation to reduce smoking at end of treatment (F[1, 44] = 11.717, p = .001, ηp 2 = .207). Conclusions: Findings demonstrate the utility of this intervention for smoking reduction and maintenance of reductions over time among a population of college students with elevated depressive symptomatology.

Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.

Sociotropy and autonomy: an examination of interpersonal and work adjustment.

One-hundred and sixty-five undergraduate students completed measures of sociotropy, autonomy, and adjustment. Autonomy was associated with poor social adjustment but was not associated with work role adjustment. Sociotropy failed to evidence a significant relation with work role or social adjustment. In past research, autonomy has primarily been theorized to contribute to depression when achievement needs are not met. Our results raise the possibility that autonomy may be linked to depression through the pathway of low social support and interpersonal difficulties. In addition, the results suggest that sociotropic individuals may not have objectively poor social adjustment despite their concerns regarding this area. Likewise, autonomous individuals may not have better or worse work adjustment despite their efforts to achieve.