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BACKGROUND/RATIONALE:
Chronic conditions tend to occur in clusters. Comorbidity - the occurrence of more than one disorder concurrently (i.e., clusters) - is highly prevalent. It is also well established that psychiatric disorders such as depression tend to co-occur with chronic general medical illnesses. Chronic physical and mental illnesses may be especially important among women veterans because of high prevalence of these conditions among women. However, research on women veterans with chronic conditions has been scarce.
OBJECTIVE(S):
The primary objective of the proposed project is to document the care patterns of veteran women with comorbid chronic physical and major mental illness using longitudinal data for the years between 1999 and 2005. The proposed project would build on our prior work on women veterans and the interaction between physical and mental illness in the general population. The important objectives are: Objective 1. For women VHA users with cardiovascular conditions (CVC), determine whether comorbid major depression (MDD) is associated with failure to receive guideline concordant CVC process of care measures (lipid tests and in the case of women with diabetes HbA1c testing and eye-exams). Examine the association between MDD and intermediate outcomes (lipemic and blood pressure control, and for women with diabetes glycemic control) after controlling for patient, clinician and practice system factors. Objective 2. Among veteran women with CVC and MDD, examine the association between individual and health system factors and pharmaco- and psycho-therapy using multivariate models with covariates described in the Figure 1. Objective 3. Among women with CVC and MDD, examine the association between treatment for MDD and process of care measures ((lipid tests and in the case of women with diabetes HbA1c testing and eye-exam) after controlling for patient, clinician and practice system factors. Examine the association between treatment for MDD and intermediate outcomes (lipemic and blood pressure control, and for women with diabetes glycemic control) after controlling for patient, clinician and practice system factors. Objective 4. Among VHA users with chronic physical and mental illness, explore gender disparities in the association between mental health treatment and chronic physical illness care.
METHODS:
Administrative data to study veteran clinic users will use merged patient treatment files from the VHA and claims from Medicare for the years from 1999 through 2005. Cardiovascular conditions and major depression will be identified with already validated algorithms. To accomplish the objectives of the study, we will use multivariable and robust regression techniques to control for correlated data due to clustering and repeated observations.
FINDINGS/RESULTS:
Using diagnostic codes, a majority of women were identified with diabetes, heart disease and hypertension (CVC) within 12 months of observation period (Shen et al., 2008). Among women with CVC, restricting depression diagnostic codes to major depression (296.2 and 296.3) excluded majority of women. Therefore care must be taken in defining major depression (Shen et al., 2008). In general major depression identified with a wider net of diagnostic codes did not affect cardiovascular care (lipid (LDL-C) testing and control) among veteran women with CVC (Rajan et al., 2007). However, incident depression was associated with poor lipid control (Tiwari et al., 2008). Among women with diabetes, over a two year period, 45% of women had serious mental illness including major depression; substance use disorders were high among those with serious mental illness suggesting that further research is needed on the level of integration of mental and physical illness care among veteran women with diabetes (Banerjea et al., 2007).
IMPACT:
The more we understand the interrelatedness of chronic and mental conditions in women veterans who use the VA system or dually utilize VA and Medicare, the better can we develop quality treatment programs for women with complex chronic conditions with better care coordination among physicians across the VA systems. This has long term implications for all women veterans with complexities, including those who do not use the VA system extensively.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Mental Illness, Special (Underserved, High Risk) Populations
DRE:
Treatment, Quality of Care
Keywords:
Cardiovasc’r disease, Depression, Outcomes
MeSH Terms:
none
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