Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Finding Solutions To Institutional Corruption: Lessons From Cognitive Dissonance Theory, Lisa Cosgrove, Robert Whitaker

Counseling and School Psychology Faculty Publication Series

The American Psychiatric Association and academic psychiatry in the United States have two conflicts of interest that may affect their assessment of psychiatric drugs and their development of diagnostic and clinical care guidelines: payments from pharmaceutical companies and guild interests. Until recently, the proposed solution to industry-academic relationships has been transparency. However, cognitive dissonance research reveals that disclosure is not a solution because cognitive biases are commonplace and difficult to eradicate. Indeed, bias is most often manifest in subtle ways unbeknownst to the researcher or clinician, and thus is usually implicit and unintentional. Also, recent studies suggest that disclosure of …

Diagnostic Interaction: First-Person Patient Narratives On Hacking's Looping Effects And The Normative Status Of Psychiatric Nosology, Corinne Jager

Honors College Theses

What is the interaction between a psychiatric patient and their diagnosis? How do they respond to being classified? A number of philosophical theories attempt to explain the interaction between the diagnosed patient and their classification. Ian Hacking develops an account of interaction which holds that objects of human science classification are influenced by the awareness of the classification in a way that changes both the classification and its object. Hacking thinks that psychiatric patients are “interactive kinds” whose awareness of their classification causes changes in the individuals' experience of themselves, and thus changes in their classification. Hacking claims that these …

The Impact Of Exercise On Suicide Risk: Examining Pathways Through Depression, Ptsd, And Sleep In An Inpatient Sample Of Veterans, Collin L. Davidson, Kimberly A. Babson, Marcel O. Bonn-Miller, Tasha Souter, Steven D. Vannoy

Steven D Vannoy

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this associ- ation, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was …

Hopelessness And Suicidal Ideation In Iraq And Afghanistan War Veterans Reporting Subthreshold And Threshold Posttraumatic Stress Disorder, Matthew Jakupcak, Katherine D. Hoerster, Alethea Varra, Steven D. Vannoy, Bradford Felker, Stephen Hunt

Steven D Vannoy

Abstract: We examined hopelessness and suicidal ideation in association with subthreshold and threshold posttraumatic stress disorder (PTSD) in a sample of Iraq and Afghanistan War Veterans (U.S., N 􏰀 275) assessed within a specialty VA postdeployment health clinic. Veterans completed paper-and-pencil questionnaires at intake. The military version of the PTSD Checklist was used to determine PTSD levels (No PTSD; subthreshold PTSD; PTSD), and endorsement of hopelessness or suicidal ideation were used as markers of elevated suicide risk. Veterans were also asked if they received mental health treatment in the prior 6 months. Veterans reporting subthreshold PTSD were 3 times more …

Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy

Counseling and School Psychology Faculty Publication Series

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions …

Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove

Counseling and School Psychology Faculty Publication Series

Clinicians practicing today need to be aware of the ways in which the current industry-dominated climate may undermine the integrity of the scientific process and, thus, may compromise patient care. In the mental health field, corporate sponsorship bias can affect psychiatric taxonomy and clinical Practice Guidelines (CPG). Financial conflicts of interest (FCOI) can occur when there are financial associations between researchers, authors, or panel members developing psychiatric diagnostic and treatment guidelines, and the pharmaceutical industry, or when randomized clinical trials (RCTs) are industry funded. Therefore, clinicians need to be especially vigilant about the informed consent process when patients are prescribed …

Models Of Care For Treating Late-Life Depression In Primary Care, Steven D. Vannoy, Diane Powers, JüRgen UnüTzer

Steven D Vannoy

No abstract provided.

The Relationship Between Suicide Ideation And Late-Life Depression, Steven D. Vannoy, Paul Duberstein, Kelly Cukrowicz, Elizabeth Lin, Ming-Yu Fan, Ju ̈Rgen Unu ̈Tzer

Steven D Vannoy

Objective: To describe the course of suicide ideation (SI) in primary-care based late-life depression treatment, identify predictors of SI, characterize the dynamic relationship between depression and SI, and test the hypothesis that collaborative care decreases the likelihood of reporting SI by decreasing the severity of depressive symptoms. Methods: This was a secondary analysis of a randomized controlled trial comparing collaborative care to usual care for late-life depression. Participants were 1,801 adults age 60 and older from eight diverse primary-care systems. Depression was measured using the Hopkins Symptoms Checklist (HSCL-20). SI was operation- alized using one item from the HSCL-20. Predictors …