Kathryn Rost, PhD

WICHE Center for Rural Mental Health Research

Phone: 850.645.7367
E-mail: Kathryn.rost@med.fsu.edu

Completed Projects

Community-Level Risk Factors for Depression Hospitalizations, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
In this exploratory analysis, we examined the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.

Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
This project will explore whether rural populations achieve outcomes with depression treatment quality intervention comparable to their urban counterparts, and whether any outcome differences are explained by treatment mediators (e.g., evidence-based care) or psychosocial mediators (e.g., stressful life events and social support). Findings from this study can be used to refine interventions before they are disseminated to rural delivery systems.

Distance Learning in Depression for Rural Primary Care Providers, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Mental health, Technology
This project will develop effective distance learning methods to train rural PCPs in integrated care models for depression using computer based training as an approach to improving mental health outcomes in rural areas.

Informing Primary Care Depression Intervention: A Comparison of Hospitalization Rates in Depressed Rural and Urban Patients , Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topics: Mental health, Physicians
The goal in this research was to examine whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling).

Preventing Hospitalization in Depressed Rural Patients, Lead researcher
Research center: WICHE Center for Rural Mental Health Research
Funder: Office of Rural Health Policy (ORHP)
Topic: Mental health
This project will explore whether depressed rural patients are more likely than their urban counterparts to be hospitalized for depression and other health reasons over the course of two years; explore whether any current rural-urban hospitalization differences are reduced in models which control for previous intensive outpatient specialty care utilization; and explore rural-urban differences in the prevalence and consequences of administrative constraints on intensive outpatient specialty care use.

Publications

• Community-Level Risk Factors for Depression Hospitalizations
  Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topics: Mental health, Rural statistics and demographics
  Report Number: Working Paper
  Date: 09 / 2005
  Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
• Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
  Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topics: Mental health, Rural statistics and demographics
  Date: 09 / 2005
  Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
• Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 09 / 2005
  Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
• Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Citation: Journal of Rural Health, 22(4), 343-350
  Date: 2006
  Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
• Identifying Community-Level Predictors of Depression Hospitalizations
  Author(s): John C. Fortney, T. Rushton, S. Wood, Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 09 / 2005
  This investigation demonstrated that: (1) rural counties have lower rates of depression-related hospitalization than urban counties, (2) rurality fails to predict depression-related hospitalization in models that control for community-level demographic, economic and health system risk factors, (3) community-level risk factors explain a respectable ~30% of the variance in depression-related hospitalization rates, and (4) while these risk factors identify high risk areas in the 10 states we studied, they cannot be used to identify high risk areas in other states. Full report available on request. Executive summary available online.
• One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention
  Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Citation: Psychological Medicine, 35(6), 839-854
  Date: 2005
  Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
• Preventing Hospitalization in Depressed Rural Patients
  Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Date: 09 / 2005
  The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request.
• Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
  Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson
  Research center: WICHE Center for Rural Mental Health Research
  Topic: Mental health
  Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773
  Date: 2006
  Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.