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Depression module

Depression module. Integrating Population Health Inquiry Transforms (IPHIT) Family Medicine Northeast Education Afternoon January 21, 2014,. IPHIT Education M odules - topics. 8 rotating modules (four/year ) maternal/child health depression obesity cardiovascular disease and diabetes

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Depression module

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  1. Depression module Integrating Population Health Inquiry Transforms (IPHIT) Family Medicine Northeast Education Afternoon January 21, 2014,

  2. IPHIT Education Modules - topics • 8 rotating modules (four/year) • maternal/child health • depression • obesity • cardiovascular disease and diabetes • prevention/wellness • chronic pain • asthma/COPD • tobacco/AODA

  3. Do you remember this slide? Notheast Education Afternoon October 23, 2013

  4. Top diagnoses at UW-Madison Family Medicine Residency clinics

  5. Morbidity • According to the WHO (2004) • depression is the 3rd most important cause of disease burden worldwide • 8th most important in low-income countries • 1st most important in middle- and high-income countries • Estimated that by the year 2020 • depression will be the 2nd leading cause of disability worldwide, trailing only ischemic heart disease • Mental health disorders are the leading cause of disability in the US and Canada • leading to more the 25% of all years of life lost to disability and premature mortality

  6. 15 leading causes of death in the US 2010 • Diseases of heart (heart disease) • Malignant neoplasms (cancer) • Chronic lower respiratory diseases • Cerebrovascular diseases (stroke) • Accidents (unintentional injuries) • Alzheimer’s disease • Diabetes mellitus (diabetes) • Nephritis, nephrotic syndrome and nephrosis (kidney disease) • Influenza and pneumonia • Intentional self-harm (suicide) • Septicemia • Chronic liver disease and cirrhosis • Essential hypertension and hypertensive renal dis­ ease (hypertension) • Parkinson’s disease • Pneumonitis due to solids and liquids

  7. Healthy People 2020 Sample national targets

  8. HealthyPeople.gov • Mental Health and Mental Disorders (MHMD)

  9. HealthyPeople.gov

  10. National data A bird’s eye view

  11. Prevalence of Current Depression* Among Persons Aged ≥12 Years, by Age Group and Sex — United States 2007–2010National Health and Nutrition Examination Survey Lifetime prevalence of depression is 16.5% 12 month prevalence of severe depression is 2% * Current depression was determined based on responses to the Patient Health Questionnaire, which asks about symptoms of depression during the preceding 2 weeks. Depression was defined by a score of ≥10 out of a possible total score of 27. † 95% confidence interval

  12. 1 in 10 Americans over age 12 takes an antidepressant

  13. Suicide rates by race/ethnicity

  14. Suicide Rates Rise Sharply in U.S.By Tara Parker-PopesPublished: May 2, 2013 • From 1999 to 2010, the age-adjusted suicide rate for adults aged 35–64 years in the United States increased significantly by 28.4%, from 13.7 per 100,000 population to 17.6 (p<0.001). More people now die of suicide than in car accidents, according to the Center for Disease …In 2010 there were 33,687 death from motor vehicle crashes and 38,364 suicides.

  15. Wisconsin data

  16. Depression is even more prevalent in Wisconsin • 8.4% of Wisconsin adults experienced major depression in 2009 • 15th highest rate of depression in the US

  17. In 2006… Among those ages 18-40 years, suicide was the second most common cause of death, following unintentional injuries. Each suicide death was estimated to affect the life of six other people. This means nearly 4,000 Wisconsin residents were affected by a loved one’s suicide. There were 5,277 hospitalizations and 4,143 emergency department visits due to self-harm. Many who make suicide attempts never seek professional care immediately after the attempt. These hospitalizations and emergency department visits resulted in over $64 million dollars in hospital charges. Forty-five percent of suicides were by firearm.

  18. Suicide trends in WI

  19. DANE County

  20. Suicide in Dane County

  21. Healthydane.org

  22. Healthydane.org Gender Race/Ethnicity

  23. Northeast data

  24. Patients with a depression diagnosis Depression is significantly more prevalent at Wingra and Northeast.

  25. Adjusted for age, gender, race/ethnicity, payer category and language

  26. Northeast patients

  27. Northeast patients

  28. Utilization of health care services * Last 3 years

  29. Comorbidities

  30. PHQ 9 data for the DFM

  31. Missing information • We do not have suicide data • Think about PHQ documentation

  32. Disparities data

  33. Depression disparities • Sex • the prevalence of depression is about 2x higher in females than in males • Race • Native Americans are about twice as likely as white to experience depression in their lifetime • the lifetime incidence of depression is about 18% for whites and about 10% for blacks • however, the chronicity and functional impairment is greater for blacks compared with whites • Age • in community surveys, adults 65 and older have a lower prevalence of depression compared with younger adults • however, older adults with a greater burden of medical illness have a depression prevalence similar to younger adults • LGBTQ • 2.5 times more likely to carry a mental health disorder than heterosexuals • Those rejected from their families were 8.4 times more likely to attempt suicide and have 5.9 times more likely to be depressed

  34. Root causes Including some social determinants

  35. Risk factors for depression • individual risk factors • genetics • female sex • early puberty • substance abuse • family • parental depression • poor parenting • parent-child conflict • parental abuse • marital conflict or divorce • single-parent household (for girls only)

  36. Risk factors for depression • school and peers • poor grades • peer rejection • stressful life events • entering new social context with decrease in social support • neighborhood and community • low socio-economic status • stressful community events

  37. population-level interventions depression

  38. Interventions to prevent depression? • What do we mean by prevention, anyway? • Gerald Caplan “Principles of Preventive Psychiatry” – 1964 • primary prevention • secondary prevention • tertiary prevention • Robert Gordon – 1983 • universal prevention • offered to the full population, likely to provide benefit to all • targeted prevention • targeted to subpopulations identified to be at elevated risk • indicated prevention • indicated for specific individuals who are identified as having particular vulnerability based on individual assessment but who are currently asymptomatic*

  39. further reading • IOM report 2009 - Preventing Mental, Emotional, and Behavioral Disorders Among Young People - Progress and Possibilities • http://books.nap.edu/openbook.php?record_id=12480 • stats on US depression • http://www.nimh.nih.gov/statistics/1mdd_adult.shtml • paper on youth prevention from UW Extension • http://www1.cyfernet.org/prog/teen/94-youthfut9.html • Healthiest Wisconsin progress report 2009 • http://publichealthcouncil.dhs.wi.gov/shp/mentalreport09.pdf • Healthy Wisconsin 2020 mental health summary • http://www.dhs.wisconsin.gov/hw2020/pdf/mentalhealth.pdf • Dane Co health report 2013 • http://www.publichealthmdc.com/documents/HealthDC-2013status.pdf

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