Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.2 Depression
A.2 Depression
Pages 205-228
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From page 205... ...
In the form of either depressive symptoms or actual depressive disorder, it impairs physical, cognitive, social, and occupational functioning to an extent comparable to chronic illnesses such as diabetes and coronary heart disease (Wells et al., 1989)
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. Recurrence of depression, incomplete recovery between episodes, and previous suicide attempts are associated with increased risk for future depressive disorder (Depression Guideline Panel, 1993a)
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. The underdiagnosis and undertreatment of depression in primary care settings has led to the development of a set of clinical practice guidelines (Depression Guideline Panel, 1993a,b)
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Proportion of the adult population (18 years of age and older) with current depressive symptoms meeting diagnostic criteria (DSM-IV)
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This indicator could help identify groups in the population that might be at increased risk for depression. It would not provide a strict measure of symptom levels or diagnosable depression comparable to those based on more detailed screening and diagnostic assessments, but it would be easier to obtain at the community level.
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Indicators might include the following: 1. Proportion of the adult population experiencing two or more depressive symptoms who also report limitations in physical activity, role function (work, school, or home)
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A state-level data system such as this has the advantage of being able to identify hospital care provided outside a specific community. Numbers of hospital discharges are likely to be influenced by a variety of factors unrelated to the prevalence of depressive disorders, such as availability of hospital beds and insurance coverage for hospital care.
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Communities cannot expect to eliminate many of these risk factors, but they can respond through various channels in ways that reduce their impact. Health departments, health plans, social service agencies, schools, nursing homes, and employers, among others, might be expected to facilitate access to services intended to resolve problems or moderate their impact.
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2. Proportion of the adult population meeting diagnostic criteria for depressive disorder who have sought treatment.
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For the elderly, the need may be for programs that address social isolation or that monitor symptom levels in nursing home residents. Programs for children of depressed parents offered by social service agencies, or perhaps by health plans, respond to current cases of depression and are an effort to reduce the risk of future depression.
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5. Proportion of employed persons with access to employee assistance programs.
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Features of the physical environment can also be risk factors for depression. Seasonal affective disorder, for example, typically recurs with the shorter periods of daylight in fall and winter and is seen more often among persons living further north (Depression Guideline Panel, 1993a)
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Comprehensive community-level data are not likely to be readily available, but several separate sources can be tapped. Some of these include hospital discharge data, health plan data systems, and the state mental health agency client data system.
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Accreditation standards are also being proposed for behavioral health care provided by MCOs and by managed behavioral health organizations (NCQA, 1996; IOM, 1997)
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4. Proportion of managed care organizations or managed behavioral health organizations serving the community that are accredited by a nationally recognized organization (e.g., the National Committee for Quality Assurance [NCQA]
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reporting 14 or more days, during the past 30 days, of feeling sad, blue, or depressed. This indicator is an assessment of the extent of at least minimal depressive symptoms in the community; it does not, however, apply formal diagnostic criteria.
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Data would probably have to be collected through periodic surveys. In terms of accountability, this indicator would address the role that many sectors of the community (e.g., health care providers, employers, schools, nursing homes, social service agencies, criminal justice agencies)
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Employee assistance programs (EAPs) are a resource for work site interventions that might address risks for depression (e.g., stress reduction)
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9. Proportion of managed care organizations or managed behavioral health organizations serving the community that are accredited by a nationally recognized organization (e.g., NCQA under its proposed Behavioral Health Accreditation program)
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the proposed set of indicators with others that are appropriate for local circumstances. REFERENCES AMBHA and NASMHPD (American Managed Behavioral Healthcare Association and National Association of State Mental Health Program Directors)
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1996. NCQA Issues First National Accreditation Standards for Managed Behavioral Health Organizations.
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U.S. Preventive Services Task Force.
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institutions thoughts of suicide during Community organizations past 12 months Special health risk groups General public Health and Reduce functional Proportion of adults meeting Community Health care providers Function, impairment criteria for depressive disorder survey Health care plans Well-Being from depression who are not receiving treatment Local health agencies Business and industry Reduce adverse Number (or rate) of suicides Death Education agencies and outcomes of depression certificates institutions Community organizations Special health risk groups Disease, patient organizations General public Social Improve access Proportion of employed Employers Local health agencies Environment to services persons with access to Business and industry employee assistance programs Community organizations Special health risk groups 227 continued on next page
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From page 228... ...
TABLE A.2-1 Continued 228 Field Model Domain Construct Sample Indicators Data Sources Stakeholders Reduce financial Proportion of employees with Employers, Health care plans barriers to treatment insurance coverage for mental insurance Local government health services for themselves; licensing Business and industry for their families authority General public Health Care Ensure that the health Proportion of patients Patient records; Health care providers care system is following receiving ambulatory claims files Health care plans appropriate treatment follow-up within 30 days after Special health risk groups practices discharge for hospitalization General public for depression Proportion of depressed Patient records; Health care providers patients prescribed anti- prescription Health care plans depressant medications who services; claims Special health risk groups receive prescriptions for files General public therapeutically effective doses Proportion of MCOs or Behavioral Health care plans managed behavioral health health care Business and industry organizations that are providers; Special health risk groups accredited by a nationally accrediting General public recognized organization organizations NOTE: BRFSS, Behavioral Risk Factor Surveillance System; MCO, managed care organization; YRBSS, Youth Risk Behavior Surveillance System.
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