The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64878

Roger Boothroyd, PhD¹, Katherine A. Best, MSW, MPH¹, Julienne Giard, MSW², Paul Stiles², and Janet Suleski, MSW². (1) Louis de la Parte Florida Mental Health Institute, University of South Florida, 13301 North Bruce B. Downs Blvd, Tampa, FL 33612, 813-974-1915, boothroyd@fmhi.usf.edu, (2) Florida Mental Health Institute / Mental Health Law & Policy, University of South Florida, 13301 Bruce B. Downs Blvd, Tampa, FL 33612

Introduction. Depression is a leading cause of disability and burden of disease (WHO, 2001) with economic costs exceeding $63 billion/year in the US (DHHS, 1999). The challenges of treating depression among the poor are compounded by broader social needs. This study examined the prevalence of depression and other problems among enrollees in an Indigent Health Plan.

Methods. Questionnaires were mailed to a stratified (gender, race, age, provider) random sample of enrollees using a five wave mailing procedure. Questionnaires contained measures of health (SF-12), mental health (PHQ-9), substance use (CAGE & DAST-10), and social needs (self-developed). Established criterion scores identified enrollees with clinically significant problems and a post-stratification weighting method adjusted for response bias.

Results. The adjusted response rate was 51% (n=1,443). Clinical levels of depression were present in 28.6% of respondents (CI95 = ± 2.6%). Depressed respondents were significantly more likely to have alcohol problems (OR=1.7), drug problems (OR=2.6), and poorer health (SF-12 Mean=32.7) compared to non-depressed respondents (Mean=43.1). Multiple social needs were associated with depression. Depressed respondents averaged 7.8 needs compared to 3.6 among non-depressed respondents. Odds ratios indicate an increased likelihood to lack food (OR=2.5), shelter (OR=3.1), money (OR=3.2), have legal (OR=2.8), and family problems (OR=2.8).

Implication. High rates co-occurring social needs among clinically depressed persons reflect the need for comprehensive, coordinated care that simply dispensing medications will not address. A disease management approach to depression is but the tip of the iceberg in alleviating these problems among the poor.

Learning Objectives:

• Participants will become aware of the multiplicity of social problems associated with the treatment of depression among the poor and will recognize the need for comprehensive treatment approaches to assist in both meeting these individuals' basic as well as mental health needs.

Keywords: Depression, Treatment System

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.