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How quality improvement interventions for depression affect stigma concerns over time: a nine-year follow-up study.

ABSTRACT: OBJECTIVE:This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care. METHODS:Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in regard to friends, health insurance, and employers. RESULTS:Individuals in QI-therapy were significantly less likely than those in usual care and QI-meds to report concerns about friends learning about a history of depression (odds ratio [OR]=.66 and .65, respectively), and those in QI-meds were more likely than those in QI-therapy and usual care to have concerns about getting insurance (OR=1.42 and 1.68, respectively). CONCLUSIONS:Quality improvement programs for depression can raise or lower stigma concerns, depending on program design and resources for specific treatments.

SUBMITTER: Klap R

PROVIDER: S-EPMC3668788 | biostudies-literature | 2009 Feb

REPOSITORIES: biostudies-literature

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How quality improvement interventions for depression affect stigma concerns over time: a nine-year follow-up study.

Klap Ruth R Tang Lingqi L Schell Terry T Duan Naihua N Wells Kenneth K Miranda Jeanne J Sherbourne Cathy C

Psychiatric services (Washington, D.C.) 20090201 2

<h4>Objective</h4>This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care.<h4>Methods</h4>Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in r ...[more]

PMID: 19176423

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Project description:BackgroundThe association between macronutrient consumption and the risk of type 2 diabetes (T2D) remains equivocal. Here, we investigated whether the quantity and quality of macronutrient intake are associated with T2D incidence in a West Asian population.MethodsT2D-free adults (n = 2457, mean age 38.5 ± 13.6 years, 54.2% women) who participated in the third examination cycle (2005-2008) of the Tehran Lipid and Glucose Study were followed for a median of 8.6 years. We estimated the macronutrient quality index (MQI), its individual sub-indices (carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate protein quality index (HPPQI)), as well as the macronutrient quantity. The risk of T2D in relation to macronutrient quantity, quality, and their combined effects was examined using Cox proportional hazard models adjusted for known risk factors for T2D.ResultsDuring the study follow-up, 257 incident cases of T2D were documented. Individuals in the highest tertiles of MQI and CQI had a 27% (HR = 0.73, 95% CI = 0.54, 0.98) and 29% (HR = 0.71, 95% CI = 0.51-0.99) lower T2D risk than those in the lowest tertiles. The T2D incidence was 35% lower in the middle HPPQI tertile than in the lowest (HR = 0.65, 95% CI = 0.47, 0.89). The multivariable adjusted model showed that individuals in the middle and highest tertiles of carbohydrate intake had 32% (HR = 0.68, 95% CI = 0.49-0.95) and 26% (HR = 0.74, 95% CI = 0.55-1.00) lower risks of T2D than individuals in the lowest tertile. A high-quantity, high-quality carbohydrate diet (≥ 58.5% of energy from carbohydrate with a CQI ≥ 13) and a low-glycemic index (GI), high-fiber diet (GI < 55 and fiber ≥ 25 g/d) were related to a reduced risk of T2D by 34% (HR = 0.66, 95% CI = 0.47, 0.93) and 42% (HR = 0.58, 95% CI = 0.38, 0.90), respectively.ConclusionA diet with a higher carbohydrate quality may be associated with a lower T2D incidence, particularly when the carbohydrate quantity is also high.

Dataset Information

How quality improvement interventions for depression affect stigma concerns over time: a nine-year follow-up study.

Publications

How quality improvement interventions for depression affect stigma concerns over time: a nine-year follow-up study.

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