PDF(Pubmed)
Abstract：
BACKGROUND: Depression is prevalent among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Veterans, yet rates of Veteran mental health care utilization remain modest. The current study examined: factors in electronic health records (EHR) associated with lack of treatment initiation and treatment delay; the accuracy of regression and machine learning models to predict initiation of treatment.
METHODS: We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis.
RESULTS: 108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586-0.602; machine learning F-measure = 0.46).
CONCLUSIONS: Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.
METHODS: We obtained data from the VA Corporate Data Warehouse (CDW). EHR data were extracted for 127,423 Veterans who deployed to Iraq/Afghanistan after 9/11 with a positive depression screen and a first depression diagnosis between 2001 and 2021. We also obtained 12-month pre-diagnosis and post-diagnosis patient data. Retrospective cohort analysis was employed to test if predictors can reliably differentiate patients who initiated, delayed, or received no mental health treatment associated with their depression diagnosis.
RESULTS: 108,457 Veterans with depression, initiated depression-related care (55,492 Veterans delayed treatment beyond one month). Those who were male, without VA disability benefits, with a mild depression diagnosis, and had a history of psychotherapy were less likely to initiate treatment. Among those who initiated care, those with single and mild depression episodes at baseline, with either PTSD or who lacked comorbidities were more likely to delay treatment for depression. A history of mental health treatment, of an anxiety disorder, and a positive depression screen were each related to faster treatment initiation. Classification of patients was modest (ROC AUC = 0.59 95%CI = 0.586-0.602; machine learning F-measure = 0.46).
CONCLUSIONS: Having VA disability benefits was the strongest predictor of treatment initiation after a depression diagnosis and a history of mental health treatment was the strongest predictor of delayed initiation of treatment. The complexity of the relationship between VA benefits and history of mental health care with treatment initiation after a depression diagnosis is further discussed. Modest classification accuracy with currently known predictors suggests the need to identify additional predictors of successful depression management.
摘要：
背景：抑郁症在持久自由行动和伊拉克自由行动（OEF/OIF）退伍军人中普遍存在，然而，退伍军人精神卫生保健的使用率仍然很低。当前的研究检查了：电子健康记录（EHR）中与缺乏治疗开始和治疗延迟相关的因素；回归和机器学习模型预测治疗开始的准确性。
方法：我们从VA公司数据仓库（CDW）获得了数据。提取了127,423名退伍军人的EHR数据，这些退伍军人在9/11之后部署到伊拉克/阿富汗，并在2001年至2021年之间进行了阳性抑郁症筛查和首次抑郁症诊断。我们还获得了12个月的诊断前和诊断后患者数据。采用回顾性队列分析来测试预测因子是否可以可靠地区分开始的患者，延迟,或者没有接受与抑郁症诊断相关的心理健康治疗。
结果：108,457名抑郁症退伍军人，开始与抑郁症相关的护理（55,492名退伍军人延迟治疗超过一个月）。那些男性，没有退伍军人残疾福利，诊断为轻度抑郁症,有心理治疗史的患者开始治疗的可能性较小。在那些发起护理的人中，那些在基线时有单一和轻度抑郁发作的人，患有PTSD或缺乏合并症的患者更有可能延迟抑郁症的治疗。心理健康治疗史，焦虑症，阳性抑郁筛查均与更快的治疗开始相关。患者的分类是适度的(ROCAUC=0.5995CI=0.586-0.602;机器学习F测量=0.46)。
结论：有VA残疾获益是抑郁症诊断后开始治疗的最强预测因子，有精神健康治疗史是延迟开始治疗的最强预测因子。进一步讨论了VA益处与精神健康护理史与抑郁症诊断后开始治疗之间关系的复杂性。目前已知预测因子的适度分类准确性表明，需要确定成功抑郁症管理的其他预测因子。
方法：我们从VA公司数据仓库（CDW）获得了数据。提取了127,423名退伍军人的EHR数据，这些退伍军人在9/11之后部署到伊拉克/阿富汗，并在2001年至2021年之间进行了阳性抑郁症筛查和首次抑郁症诊断。我们还获得了12个月的诊断前和诊断后患者数据。采用回顾性队列分析来测试预测因子是否可以可靠地区分开始的患者，延迟,或者没有接受与抑郁症诊断相关的心理健康治疗。
结果：108,457名抑郁症退伍军人，开始与抑郁症相关的护理（55,492名退伍军人延迟治疗超过一个月）。那些男性，没有退伍军人残疾福利，诊断为轻度抑郁症,有心理治疗史的患者开始治疗的可能性较小。在那些发起护理的人中，那些在基线时有单一和轻度抑郁发作的人，患有PTSD或缺乏合并症的患者更有可能延迟抑郁症的治疗。心理健康治疗史，焦虑症，阳性抑郁筛查均与更快的治疗开始相关。患者的分类是适度的(ROCAUC=0.5995CI=0.586-0.602;机器学习F测量=0.46)。
结论：有VA残疾获益是抑郁症诊断后开始治疗的最强预测因子，有精神健康治疗史是延迟开始治疗的最强预测因子。进一步讨论了VA益处与精神健康护理史与抑郁症诊断后开始治疗之间关系的复杂性。目前已知预测因子的适度分类准确性表明，需要确定成功抑郁症管理的其他预测因子。
