Characteristics of Depressed Patients Treated in Rural Areas of Chile

Ariel Castro-Lara, Viviana Guajardo, Rosemarie Fritsch, Ruben Alvarado, Graciela Rojas

1Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile 2Psychiatry Department, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile.
1Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile 2School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Clinical Hospital, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Investigations Support Office, Clinical Hospital, Universidad de Chile, Santiago, Chile.
School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile.

DOI: 10.4236/psych.2013.411A003                

Abstract

Objective: To describe a group of depressed patients that participated in a clinical intervention to improve depression treatment in rural areas. Materials and Methods: It is a clinical intervention for depressed patients from 15 rural hospitals. The principal outcome is depressive symptomatology measured with the Beck Depression Inventory (BDI), and the secondary outcome is quality of life. The intervention consists of a collaborative program between primary care teams and specialized teams, with support from an electronic platform and a call center. Results: 254 subjects—13.8% men and 86.2% women—were recruited, with an age range between 18 and 65 years. The majority had a stable partner and attended high school. Homemakers made up 47.4% of the sample, and 38.7% were employed. The average BDI score was 29.8 (s. d. = 9.2). There was a history of previous depressive episodes in 42.9% of the cases, 37.4% presented severe suicide risk, and 59.1% had a comorbid anxiety disorder. Conclusion: It is a clinical sample of patients with severe depressive symptoms who are treated by primary care physicians in rural zones. The sample had comorbid anxiety and poor quality of life associated with their mental illness.

Keywords

Depression; Mental Health; Rural Health

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Alvarado, R., & Rojas, G. (2011). The national programme for the diagnosis and treatment of depression in primary care: An evaluation necessary. Revista Médica de Chile, 139, 592-599. http://dx.doi.org/10.4067/S0034-98872011000500005 [Google Scholar] [CrossRef]
[2]	Alvarado, R., Vega, J., Sanhueza, G., & Munoz, M. G. (2005). Program Evaluation for the detection, diagnosis and comprehensive treatment of depression in primary care in Chile. Revista Panamericana de Salud Pública, 18, 278-286.
[3]	Beck, A. T., Steer, R. A., & Carbin, M. G. (1998). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100. http://dx.doi.org/10.1016/0272-7358(88)90050-5 [Google Scholar] [CrossRef]
[4]	Escobar, C., & Rojas, G. (2010). Suicidal behavior observed in hospitalizations Frutillar. Hospital’s revision 2008-2009. Revista de Psiquiatría Clínica, 48, 7-14.
[5]	Florenzano, R., Acuna, J., Fullerton, C., & Castro, C. (1998). Comparative study of the frequency and features of emotional disturbances in patients in primary care clinics. Revista Médica de Chile, 126, 397-405.
[6]	Fortney, J., Pyne, J., Edlund, M., Williams, D., Robinson, D., Mittal, D., & Henderson, K. (2007). A randomized trial of telemedicine-based collaborative care for depression. Journal of General Internal Medicine, 22, 1086-1093. http://dx.doi.org/10.1007/s11606-007-0201-9 [Google Scholar] [CrossRef] [PubMed]
[7]	Friedman, B., Conwell, Y., & Delavan, R. L. (2007). Correlates of late-life major depression: A comparison of urban and rural primary care patients. The American Journal of Geriatric Psychiatry, 15, 28-41. http://dx.doi.org/10.1097/01.JGP.0000224732.74767.ad [Google Scholar] [CrossRef]
[8]	Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314-2321. http://dx.doi.org/10.1001/archinte.166.21.2314 [Google Scholar] [CrossRef] [PubMed]
[9]	Gómez Gómez, E. (2002). Gender, equity and access to health services: An empirical approach. Revista Panamericana de Salud Pública, 11, 327-334.
[10]	Inostroza, M. (2006). Health status survey 2004-2005 Isapres’s population. www. superintendenciadesalud
[11]	Kohn, R., Levav, I., de Almeida, J. M., Vicente, B., Andrade, L., Caraveo-Anduaga, J. J., Saraceno, B., et al. (2005). Mental disorders in Latin America and the Caribbean: A public health priority. Revista Panamericana de Salud Pública, 18, 229-240. http://dx.doi.org/10.1590/S1020-49892005000900002 [Google Scholar] [CrossRef]
[12]	Luo, W., & Wang, F. (2003). Measures of spatial accessibility to health care in a GIS environment: Synthesis and a case study in the Chicago region. Environment and Planning B, 30, 865-884. http://dx.doi.org/10.1068/b29120 [Google Scholar] [CrossRef] [PubMed]
[13]	Mendonza-Sassi, R., & Béria, J. U. (2001). Use of health services: A systematic review of factors related. Cuadernos Médico Sociales, 81, 43-60.
[14]	Ministry of Health (2009). Clinic guide treatment of people with depression. Santiago: Ministry of Health.
[15]	Ministry of Health (2012). Department of health statistics and information. http://www.deis.cl/
[16]	Moyano Díaz, E., & Barría, R. (2006). Suicide and Gross Domestic Product (GDP) in Chile: Towards a model predictive quality of life. Revista Latinoamericana de Psicología, 38, 343-359.
[17]	Murray, C. J. L., & Lopez, A. D. (1997). Alternative projections of mortality and disability by cause 1900-2020: Global burden of disease study. The Lancet, 349, 1498-1504. http://dx.doi.org/10.1016/S0140-6736(96)07492-2 [Google Scholar] [CrossRef]
[18]	Murray, C. J. L., & Lopez, A. D. (1996). The global burden of disease. Cambridge, MA: Harvard School of Public Health on behalf of the World Bank.
[19]	Patel, V., Araya, R., De Lima, M., Ludermir, A., & Todd, C. (1999). Women, poverty and common mental disorders in four restructuring societies. Social Science & Medicine, 49, 1461-1471. http://dx.doi.org/10.1016/S0277-9536(99)00208-7 [Google Scholar] [CrossRef]
[20]	Rojas, G., Araya, R., & Fritsch, R. (2000). Mental health, psychosocial and primary health care. Acta Psiquiátrica y Psicológica de América Latina, 46, 119-126.
[21]	Rojas, G., Fritsch, R., Solis, J., Jadresic, E., Castillo, C., Gonzalez, M., Araya, R., et al. (2007). Treatment of postnatal depression in low-income mothers in primary care clinics in Santiago, Chile: A randomized controlled trial. The Lancet, 370, 1629-1637. http://dx.doi.org/10.1016/S0140-6736(07)61685-7 [Google Scholar] [CrossRef]
[22]	Rojas, G., Araya, R., & Lewis, G. (2005). Comparing sex inequalities in common affective disorders across countries: Great Britain and Chile. Social Science & Medicine, 60, 1693-1703. http://dx.doi.org/10.1016/j.socscimed.2004.08.030 [Google Scholar] [CrossRef] [PubMed]
[23]	Rosenberg, M. W. (1998). Medical or health geography? Populations, peoples and places. International Journal of Population Geography, 4, 211-226. http://dx.doi.org/10.1002/(SICI)1099-1220(199809)4:3<211::AID-IJPG83>3.0.CO;2-O [Google Scholar] [CrossRef]
[24]	Sartorius, N., üstün, T. B., Costa e Silva, J. A., Goldberg, D., Lecrubier, V., Ormel, J., Von Korff, M., & Wittchen, H. U. (1993). An international study of psychological problems in primary care. Preliminary Report from the WHO Collaborative Project on “Psychological Problems in General Health Care”. Archives of General Psychiatry, 50, 819-824. http://dx.doi.org/10.1001/archpsyc.1993.01820220075008 [Google Scholar] [CrossRef] [PubMed]
[25]	Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Dunbar, G. C., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.
[26]	Tomas Baader, M., Patricia Behne, H., José Luis Molina, F., Lorena Gacitúa, C., Lisette Yánez, M., Edmundo Urra, P., & Rocío Millán, A. (2011). Are you changing the prevalence of suicides and their characteristics in the Chilean population? Analysis of suicide rates and their sociodemographic characteristics occurred in the province of Valdivia, Los Ríos Region today, between 1996-2008. Revista Chilena de Neuro-Psiquiatría, 49, 2.
[27]	Van Orden, M., Hoffman, T., Haffmans, J., Spinhoven, P., & Hoencamp, E. (2009). Collaborative mental health care versus care as usual in a primary care setting: A randomized controlled trial. Psychiatric Services, 60, 74-79. http://dx.doi.org/10.1176/appi.ps.60.1.74 [Google Scholar] [CrossRef]
[28]	Ware, J. E., Kosinski, M., & Keller, S. D. (1994). SF-36 physical and mental summary scales: A user’s manual. Boston, MA: The Health Institute.