Characteristics of Persons with Major Depressive Disorder Receiving Integrated Primary and Behavioral Health Care Services: Interrelationships Among Psychosocial Characteristics, Cardiometabolic Indicators, and Health Status

Background: Major depressive disorder (MDD) is a leading cause of disability in the U.S. Persons with MDD typically are diagnosed with chronic comorbid cardiometabolic conditions (e.g., hypertension, obesity). Treatment that integrates both primary and behavioral healthcare (PBHC) services reduces healthcare costs and negative health outcomes.  However, no research has examined empirically-relevant factors that influence the health status of persons with MDD in integrated PBHC programs.  The current study examined interrelationships among health status, health data, and psychosocial characteristics.

 Methods:  The present study used existing data collected from the health records of 1,270 persons with SMI receiving integrated PBHC services at 3 community-based clinics. The subsample of clients with MDD from the original study comprised the sample for the current study (N=410, 32.2%).  Social support was measured with the 4-item Social Connectedness Subscale of the Mental Health Statistics Improvement Program (SCS-MHSIP).  Psychological distress was assessed with the K6, and daily functioning was measured with the 8-item Perception of Functioning (PF) subscale of the MHSIP.  Health indicator data measured systolic and diastolic blood pressure (BP), body mass index (BMI), blood glucose, and blood lipids, including high-density-lipoproteins (HDL), low-density-lipoproteins (LDL), triglycerides (TRI), and lipid total.  Health status was self-assessed with one MHSIP item asking participants to rate their overall health.  First, bivariate analyses were conducted to examine zero-order correlations between major variables of interest. Ordinary least squares (OLS) regression was employed using a forced entry method to examine the predictive ability of significant correlates on participants’ overall health status.

 Results:  The sample consisted of primarily middle-aged (M=45.6,SD=11.2) females (75.5%). African Americans (51.2%) and Whites (48.8%) were proportionately represented. Overall mean scores on the SCS-MHSIP and the PF-MHSIP were 14.7 (SD=2.9) and 21.8 (SD=4.67), respectively, indicating moderate levels of social support and daily functioning. The mean K6 score was 12.5 (SD=6.1), indicating moderate levels of psychological distress. The mean systolic BP score was 133.4 (SD=20.5), which exceeded the clinical cutoff; and the mean diastolic BP score was 81.2 (SD=12.6), just below the cutoff. The mean BMI score was 32.6 (SD=9.7), which corresponds to the low range of obesity. Mean blood glucose was above normal, at 112.4 (SD=60.9) and all lipoprotein levels were within range: Lipid HDL=50.2(SD=17.6), lipid LDL=120.7(SD=43.9), lipid TRI=148.9(SD=176.5), and lipid total=196.0(SD=44.8). The overall mean health status score was 2.2 (SD=0.9,Range=1-5), indicating that participants perceived their overall health as below average. The following significant predictors of health status were included in the OLS regression model: diastolic BP (r=-.10), blood glucose (r=-.13), social support (r=.18), psychological distress (r=-.32), and daily functioning (r=.32). The inclusion of all predictor variables  explained approximately 15% of the variance in health status (R=.38,R Square=.15). The model was significant, at F(5,330) = 11.6,p<.001. Among correlates, blood glucose (beta=-14, p<.01), psychological distress (beta=-.16, p<.05), and daily functioning (beta=.22, p<.01) were significant predictors of current health status.  

Implications: Results are consistent with those of the original study showing that physical and social determinants are associated with self-assessed health among persons with SMI. Research with clients with MDD is needed to identify additional relevant predictors of overall health.