Susan M. Paddock

Impact of Teen Depression on Academic, Social, and Physical Functioning

OBJECTIVE: This study aimed to determine the impact of teen depression on peer, family, school, and physical functioning and the burden on parents. METHODS: Patients participated in a longitudinal study of teens with and without probable depression, drawn from 11 primary care offices in Los Angeles, California, and Washington, DC. A total of 4856 teens completed full screening assessments; 4713 were eligible for the study, and 187 (4.0%) met the criteria for probable depression and were invited to participate, as were teens who were not depressed. A total of 184 baseline assessments for teens with probable depression and 184 for nondepressed teens were completed, as were 339 (90%) parent interviews. Follow-up interviews were conducted with 328 teens (89%) and 302 parents (82%). Measures included teen reports of peer and parent support, 2 measures of school functioning, grades, physical health, and days of impairment. Parent reports included peer, school, and family functioning and subjective and objective burdens on parents. RESULTS: Teens with depression and their parents reported more impairment in all areas, compared with teens without depression at baseline, and reported more coexisting emotional and behavioral problems. Both depression and coexisting problems were related to impairment. There was a lasting impact of depressive symptoms on most measures of peer, family, and school functioning 6 months later, but controlling for coexisting baseline emotional and behavioral problems attenuated this relationship for some measures. CONCLUSION: Improvements in teen depression might have benefits that extend beyond clinical symptoms, improving peer, family, and school functioning over time.

Identification of and guidance for problem drinking by general medical providers: results from a national survey.

Background:Heavy alcohol use is associated with health costs and medical problems. There has been a growing consensus that primary care patients should be screened for alcohol problems. Objectives:We examined rates at which patients were asked about alcohol or drug use and problems, extending research in this area by using a standardized problem drinking instrument with a large national sample, examining community level variables, and assessing the extent to which patients who were identified received follow-up. Subjects:A subsample of 7371 persons from the 1998 Healthcare for Communities survey who reported visiting a general medical provider (GMP) in the past year. Measures:Participants completed questionnaires on demographics, mental and physical health, alcohol, drug use and problems, enrollment in a managed health care plan, whether their medical provider asked about alcohol or drug use, and whether they received advice, counseling, or referral. Results:Being asked about alcohol and drug use was associated with being male, young, highly educated, more health problems, mental health diagnosis, and being classified as a problem drinker. Only 48% of problem drinkers received any follow-up, with most being told to “stop drinking” by their GMP. Conclusions:Few people are queried about alcohol or drug use when they visit a GMP. When problem use is identified, most patients do not receive appropriate follow-up and aftercare. The quality of primary care could improve if GMPs were educated about providing brief advice/counseling and were given information concerning resources in their community to make appropriate referrals for patients.

Prevalence and Characteristics of Clients with Co-Occurring Disorders in Outpatient Substance Abuse Treatment

This article reports on the prevalence of probable mental health disorders among clients entering outpatient substance abuse treatment, their clinical characteristics, and past access to substance abuse and mental health care. Four hundred fifteen individuals (74% of those eligible) entering three publicly funded outpatient substance abuse treatment facilities in Los Angeles County were screened for a probable mental health disorder. Of the 210 with a positive screener (just over 50% of those screened), 195 (93%) were interviewed. Depression and anxiety were the most common disorders, and more than a third had two or more probable disorders. Close to 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. Our results indicate high rates of co‐occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access.

The Getting To Outcomes Demonstration and Evaluation: An Illustration of the Prevention Support System

Communities are increasingly being required by state and federal funders to achieve outcomes and be accountable, yet are often not provided the guidance or the tools needed to successfully meet this challenge. To improve the likelihood of achieving positive outcomes, the Getting To Outcomes (GTO) intervention (manual, training, technical assistance) is designed to provide the necessary guidance and tools, tailored to community needs, in order to build individual capacity and program performance. GTO is an example of a Prevention Support System intervention, which as conceptualized by the Interactive Systems Framework, plays a key role in bridging the gap between prevention science (Prevention Synthesis and Translation System) and prevention practice (Prevention Delivery System). We evaluated the impact of GTO on individual capacity and program performance using survey- and interview-based methods. We tracked the implementation of GTO and gathered user feedback about its utility and acceptability. The evaluation of GTO suggests that it can build individual capacity and program performance and as such demonstrates that the Prevention Support System can successfully fulfill its intended role. Lessons learned from the implementation of GTO relevant to illuminating the framework are discussed.

Rates and types of events reported to established incident reporting systems in two US hospitals

Background: US hospitals have had voluntary incident reporting systems for many years, but the effectiveness of these systems is unknown. To facilitate substantial improvements in patient safety, the systems should capture incidents reflecting the spectrum of adverse events that are known to occur in hospitals. Objective: To characterise the incidents from established voluntary hospital reporting systems. Design: Observational study examining about 1000 reports of hospitalised patients at each of two hospitals. Patients and setting: 16 575 randomly selected patients from an academic and a community hospital in the US in 2001. Main outcome measures: Rates of incidents reported per hospitalised patient and characteristics of reported incidents. Results: 9% of patients had at least one reported incident; 17 incidents were reported per 1000 patient-days in hospital. Nurses filed 89% of reports, physicians 1.9% and other providers 8.9%. The most common types were medication incidents (29%), falls (14%), operative incidents (15%) and miscellaneous incidents (16%); 59% seemed preventable and preventability was not clear for 32%. Among the potentially preventable incidents, 43% involved nurses, 16% physicians and 19% other types of providers. Qualitative examination of reports indicated that very few involved prescribing errors or high-risk procedures. Conclusions: Hospital reporting systems receive many reports, but capture a spectrum of incidents that differs from the adverse events known to occur in hospitals, thereby substantially underdetecting physician incidents, particularly those involving operations, high-risk procedures and prescribing errors. Increasing the reporting of physician incidents will be essential to enhance the effectiveness of hospital reporting systems; therefore, barriers to reporting such incidents must be minimised.

Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events

BackgroundPatients in intensive care units (ICUs) frequently experience adverse drug events involving intravenous medications (IV-ADEs), which are often preventable.ObjectivesTo determine how frequently preventable IV-ADEs in ICUs match the safety features of a programmable infusion pump with safety software (“smart pump”) and to suggest potential improvements in smart-pump design.DesignUsing retrospective medical-record review, we examined preventable IV-ADEs in ICUs before and after 2 hospitals replaced conventional pumps with smart pumps. The smart pumps alerted users when programmed to deliver duplicate infusions or continuous-infusion doses outside hospital-defined ranges.Participants4,604 critically ill adults at 1 academic and 1 nonacademic hospital.MeasurementsPreventable IV-ADEs matching smart-pump features and errors involved in preventable IV-ADEs.ResultsOf 100 preventable IV-ADEs identified, 4 involved errors matching smart-pump features. Two occurred before and 2 after smart-pump implementation. Overall, 29% of preventable IV-ADEs involved overdoses; 37%, failures to monitor for potential problems; and 45%, failures to intervene when problems appeared. Error descriptions suggested that expanding smart pumps’ capabilities might enable them to prevent more IV-ADEs.ConclusionThe smart pumps we evaluated are unlikely to reduce preventable IV-ADEs in ICUs because they address only 4% of them. Expanding smart-pump capabilities might prevent more IV-ADEs.

Perceived Barriers to Treatment for Adolescent Depression

Background and Objective:Adolescent depression is common, disabling, and is associated with academic, social, behavioral, and health consequences. Despite the availability of evidence-based depression care, few teens receive it, even when recognized by primary care clinicians. Perceived barriers such as teen worry about what others think or parent concerns about cost and access to care may contribute to low rates of care. We sought to better understand perceived barriers and their impact on service use. Design:After completing an eligibility and diagnostic telephone interview, all depressed teens and a matched sample of nondepressed teens recruited from 7 primary care practices were enrolled and completed telephone interviews at baseline and 6 months (August 2005–September 2006). Participants:Three hundred sixty-eight adolescent patients aged 13 to 17 (184 depressed and 184 nondepressed) and 338 of their parents. Measures:Perceived barriers to depression care and use of services for depression (psychotherapy and antidepressant medication). Results:Teens with depression were significantly more likely to perceive barriers to care compared with nondepressed teens. Parents were less likely to report barriers than their teens; perceived stigma and concern about family member response were among the significant teen barriers. Teen perceived barriers scores were negatively associated with any use of antidepressants (P < 0.01), use of antidepressants for at least 1 month (P < 0.001), and any psychotherapy or antidepressant use (P < 0.05) at 6 months. Conclusions:To improve treatment for adolescent depression, interventions should address both teen and parent perceived barriers and primary care clinicians should elicit information from both adolescents and their parents.

An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment.

CONTEXT Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment. OBJECTIVE The Building Recovery by Improving Goals, Habits, and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment with residential treatment plus group cognitive behavioral therapy for depression delivered by substance abuse treatment counselors. We hypothesized that intervention clients would have improved depression and substance use outcomes compared with those of clients receiving usual care. DESIGN A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which 4 sites were assigned to alternate between the intervention and usual care conditions every 4 months for 2½ years. SETTING Four treatment programs in Los Angeles County. PARTICIPANTS We screened 1262 clients for persistent depressive symptoms (Beck Depression Inventory-II score >17). We assigned 299 clients to receive either usual care (n = 159) or usual care plus the intervention (n = 140). Follow-up rates at 3 and 6 months after the baseline interview were 88.1% and 86.2%, respectively, for usual care and 85.7% and 85.0%, respectively, for the intervention group. INTERVENTION Sixteen 2-hour group sessions of cognitive behavioral therapy for depression. MAIN OUTCOME MEASURES Change in depression symptoms, mental health functioning, and days of alcohol and problem substance use. RESULTS Intervention clients reported significantly fewer depressive symptoms (P < .001 at 3 and 6 months) and had improved mental health functioning (P < .001 at 3 months and P < .01 at 6 months). At 6 months, intervention clients reported fewer drinking days (P < .05) and fewer days of problem substance use (P < .05) on days available. CONCLUSIONS Providing group cognitive behavioral therapy for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01191788.

What we can—and cannot—expect from school-based drug prevention

School-based drug prevention is a central component of drug control strategies. This paper assesses quantitatively its contributions in the United States from a social policy perspective. The social benefits per participant stemming from reduced drug use ( approximately

Costs of Intravenous Adverse Drug Events in Academic and Nonacademic Intensive Care Units

840 from tobacco, alcohol, cocaine and marijuana) appear to exceed the economic costs of running the programs ( approximately