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The Evidence Speaks

The Evidence Speaks (October 2020)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Vigo D
, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, et al. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorderPsychol Med. 2020 Oct 20 epub ahead of print.

Major depressive disorder (MDD) carries the largest disease burden of all mental health disorders. While it is known that there are shortfalls in MDD treatment quality and quantity, specific gaps in pharmacotherapy and psychotherapy are less understood. A new study, led by CHÉOS Scientist Dr. Daniel Vigo, analyzes the coverage of pharmacotherapy and psychotherapy (combined and separately) for MDD. The goal was to identify actionable bottlenecks in effective coverage, which was defined as an “adequate combination of (and adherence with) psychotherapy and pharmacotherapy delivered by an adequate provider in adequate amounts.” A total of 17 surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. These surveys contain the largest cross-sectional database on MDD treatment. The researchers determined that only one in ten people living with MDD received effective coverage. The bottlenecks in coverage appeared to be underutilization of psychotherapy and psychopharmacology, inadequate physician monitoring, and inadequate drug type. The results from this study highlight potential ways in which quality of care and effective coverage could be improved, in line with the United Nations’ Sustainable Development Goals of achieving universal health coverage inclusive of mental health. The researchers conclude that the identified bottlenecks could be addressed by innovations like telehealth training and supervision, and community resources to deliver pharmacotherapy and psychotherapy.

Hosseini Z, Veenstra G, Khan NA, Conklin AI. Social connections and hypertension in women and men: a population-based cross-sectional study of the Canadian Longitudinal Study on AgingJ Hypertens. 2020 Oct 22 epub ahead of print.

Hypertension is a well-known risk factor for cardiovascular diseases (CVD) and is more common among women than men at older ages. The associations between social ties and hypertension are poorly understood, and studies from a sex and gender perspective are rare. To address this gap, CHÉOS Scientists Drs. Nadia Khan and Annalijn Conklin collaborated with colleagues from UBC and the University of Saskatchewan to investigate the types of social ties that affect hypertension most among older women and men in Canada, and whether different types interact to have a combined effect. Using Canadian Longitudinal Study on Aging cohort data, the team analyzed 28,238 people aged 45–85 years. They assessed four types of social ties – marital status, living arrangement, social network size, and social participation – alone and in combination to determine the effect on blood pressure and hypertension. They also examined gender differences. The study found that being non-partnered, participating in two or fewer social activities per month, or having a small network size was associated with a higher risk of hypertension in women. For men, living alone was associated with lower risk of hypertension. Increased social participation mitigated the adverse associations between non-partnership and blood pressure, especially among women. Overall, this study demonstrates that a number of types of social ties, plus specific combinations of them, are associated with hypertension; an effect appearing more pronounced in women. The results add to the literature on this topic and could be used to help inform clinical and public health strategies to reduce CVD burden.

Williams-Yuen J, Minaker G, Buxton J, Gadermann A, Palepu A. ‘You’re not just a medical professional’: Exploring paramedic experiences of overdose response within Vancouver’s downtown eastsidePLoS One. 2020 Sep 28;15(9):e0239559.

B.C. represents just 13 per cent of the Canadian population, yet it accounts for approximately one third of overdose deaths. Paramedics, who already exhibit higher rates of post-traumatic stress disorder than the general population, are directly impacted by the overdose crisis and the resulting increased workload. While studies have looked into health care worker experiences of treating overdose, there is yet to be a focus on paramedic perspectives specifically. A new study, conducted by a team from UBC including CHÉOS Scientists Drs. Anne Gadermann and Anita Palepu, sought to explore and describe the ways in which paramedics experience overdose response in Vancouver, B.C. The researchers conducted interviews with ten paramedics who were stationed in the city’s Downtown Eastside, which experiences the highest levels of overdose events and deaths in the province. The results indicate that paramedic clinical roles are not seen as significant causes of emotional stress. Instead, distress was associated with negative interactions and broader feelings of helplessness. Other challenges noted by the respondents were encountering repeat patients and patients who refuse transport. The paramedics questioned did share some positive experiences, such as encounters with patients who were open to receiving treatment for addiction. They also expressed the ability to find purpose and empathy in circumstances that are largely represented as triggering hopelessness. Overall, this research shed light on paramedic-specific perspectives on responding to the overdose crisis. Future studies should continue to explore this topic, with a particular focus on how empathy and compassion may relate to paramedics’ resilience.