Journal of Clinical Psychology in Medical Settings

, Volume 17, Issue 3, pp 258–271

Bibliotherapy as a Treatment for Depression in Primary Care

  • Elizabeth V. Naylor
  • David O. Antonuccio
  • Mark Litt
  • Gary E. Johnson
  • Daniel R. Spogen
  • Richard Williams
  • Catherine McCarthy
  • Marcia M. Lu
  • David C. Fiore
  • Dianne L. Higgins
Article

Abstract

This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were randomly assigned to receive either usual care or a behavioral prescription to read the self-help book, Feeling Good (Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins). The treatment groups did not differ in terms of overall outcome variables. Patients in both treatment groups reported statistically significant decreases in depression symptoms, decreases in dysfunctional attitudes, and increases in quality of life. Although not statistically significant, the mean net medical expenses in the behavioral prescription group were substantially less. This study provided empirical evidence that a behavioral prescription for Feeling Good may be as effective as standard care, which commonly involves an antidepressant prescription.

Keywords

Depression Primary care Bibliotherapy Usual care 

References

  1. Ackerson, J., Scogin, F., McKendree-Smith, N., & Lyman, R. D. (1998). Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. Journal of Consulting and Clinical Psychology, 66, 685–690.CrossRefPubMedGoogle Scholar
  2. Antonuccio, D. O. (2008). Treating depressed children with antidepressants: More harm than benefit? Journal of Clinical Psychology in Medical Settings, 15, 92–97.CrossRefPubMedGoogle Scholar
  3. Antonuccio, D. O., Burns, D. D., & Danton, W. G. (2002). Antidepressants: A triumph of marketing over science? Prevention and Treatment, 5. Available at: http://journals.apa.org/prevention/volume5/pre0050025c.html.
  4. Antonuccio, D. O., Danton, W. G., & DeNelsky, G. (1995). Psychotherapy vs medication for depression: Challenging the conventional wisdom with data. Professional Psychology: Research and Practice, 26, 574–585.CrossRefGoogle Scholar
  5. Antonuccio, D. O., Danton, W. G., DeNelsky, G. Y., Greenberg, R. P., & Gordon, J. S. (1999). Raising questions about antidepressants. Psychotherapy and Psychosomatics, 68, 3–14.CrossRefPubMedGoogle Scholar
  6. Antonuccio, D. O., Thomas, M., & Danton, W. G. (1997). A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (Prozac) in the treatment of depression. Behavior Therapy, 28, 187–210.CrossRefGoogle Scholar
  7. Bahl, S., Cotterchio, M., & Kreiger, N. (2003). Use of antidepressant medications and the possible association with breast cancer risk. Psychotherapy and Psychosomatics, 72, 185–194.CrossRefPubMedGoogle Scholar
  8. Bahrick, A. (2008). Persistence of sexual dysfunction side effects after discontinuation of antidepressant medications: Emerging evidence. Open Psychology Journal, 1, 42–50.CrossRefGoogle Scholar
  9. Baldessarini, R. J. (1995). Risks and implications of interrupting maintenance psychotropic drug therapy. Psychotherapy and Psychosomatics, 63, 137–141.CrossRefPubMedGoogle Scholar
  10. Beck, A. T., Guth, D., Steer, R. A., & Ball, R. (1997). Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Behavior Research and Therapy, 35, 785–791.CrossRefGoogle Scholar
  11. Beck, A. T., Steer, R. A., Ball, R., Ciervo, C. A., & Kabat, M. (1997). Use of Beck Anxiety and Beck Depression Inventories for Primary Care with medical outpatients. Assessment, 4, 211–219.Google Scholar
  12. Beck, A. T., Steer, R. A., & Brown, G. K. (2000). Manual for the Beck Depression Inventory-Fast Screen for medical patients. San Antonio, TX: Psychological Corporation.Google Scholar
  13. Borkovec, T. D. (1990). Control groups and comparison groups in psychotherapy outcome research. National Institute on Drug Abuse: Research Monograph Series, Mono, 140, 50–65.Google Scholar
  14. Borkovec, T. D., & Mathews, A. M. (1988). Treatment of nonphobic anxiety disorders: A comparison of directive, nondirective, cognitive, and coping desensitization therapy. Journal of Consulting and Clinical Psychology, 5, 877–884.CrossRefGoogle Scholar
  15. Bruce, M. L., Ten Have, T. R., Reynolds, C. F., Katz, I. I., Schulberg, H. C., Mulsant, B. H., et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. JAMA, 291, 1081–1091.CrossRefPubMedGoogle Scholar
  16. Brunnaur, A., Laux, G., Geiger, E., Soyka, M., & Moller, H. J. (2006). Antidepressants and driving ability: Results from a clinical study. Journal of Clinical Psychiatry, 67, 1776–1781.CrossRefGoogle Scholar
  17. Bryk, A. S., & Raudenbush, S. W. (1992). Hierarchical linear models: Applications and data analysis methods. Newbury Park, CA: Sage.Google Scholar
  18. Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins.Google Scholar
  19. Chilvers, C., Dewey, M., Fielding, K., Gretton, V., Miller, P., Palmer, B., et al. (2001). Antidepressant drugs and generic counseling for treatment of major depression in primary care: Randomized trial with patient preference arms. BMJ, 322, 772–775.CrossRefPubMedGoogle Scholar
  20. Conte, H. R., Plutchik, R., Wild, K. V., & Karasu, T. B. (1986). Combined psychotherapy and pharmacotherapy for depression: A systematic analysis of the evidence. Archives of General Psychiatry, 43, 471–479.PubMedGoogle Scholar
  21. Cotterchio, M., Kreiger, N., Darlington, G., & Steingart, A. (2000). Antidepressant medication use and breast cancer risk. American Journal of Epidemiology, 151, 951–957.PubMedGoogle Scholar
  22. Coupland, N. J., Bell, C. J., & Potokar, J. P. (1996). Serotonin reuptake inhibitor withdrawal. Journal of Clinical Psychopharmacology, 16, 356–362.CrossRefPubMedGoogle Scholar
  23. Cuijpers, P. (1997). Bibliotherapy in unipolar depression: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 28, 139–147.CrossRefPubMedGoogle Scholar
  24. Cuijpers, P., van Straten, A., Warmerdam, L., & Andersson, G. (2008). Psychological treatment of depression: A meta-analytic database of randomized studies. BMC Psychiatry, 8, 36. doi:10.1186/1471-244X-8-36.
  25. Cummings, N. A., Pallik, H., Dorken, M. S., & Henke, C. J. (2000). Medicaid, managed mental healthcare and medical cost offset. In J. L. Thomas & J. L. Cummings (Eds.), The value of psychological treatment (pp. 324–335). Pheonix, AZ: Zeig, Tucker and Company Inc.Google Scholar
  26. Dalfen, A. K., & Stewart, D. E. (2001). Who develops stable or fatal adverse drug reactions to selective serotonin reuptake inhibitors? Canadian Journal of Psychiatry, 46, 258–262.Google Scholar
  27. de Maat, S. M., Dekker, J., Schoevers, R. A., & de Jonghe, F. (2007). Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis. European Psychiatry, 22, 1–8.PubMedGoogle Scholar
  28. Dean, A. G., Dean, J. A., Coulimbier, D., Brendel, K. A., Smith, D. C., Burton, A. H., et al. (1995). A word processor database and statistics program for public health on IBM-compatible microcomputers (6th ed.). Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  29. DeRubeis, R. J., Gelfand, L. A., Tang, T. Z., & Simons, A. D. (1999). Medications versus cognitive behavior therapy for severely depressed outpatients: Mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156, 1007–1013.PubMedGoogle Scholar
  30. DeRubeis, R. J., Hollon, S. D., Amsterdam, J. D., Shelton, R. C., Young, P. R., Solomon, R. M., et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.CrossRefPubMedGoogle Scholar
  31. Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414–419.CrossRefPubMedGoogle Scholar
  32. Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., et al. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468–477.CrossRefPubMedGoogle Scholar
  33. Donovan, S., Madeley, R., Clayton, A., Beeharry, M., Jones, S., Kirk, C., et al. (2000). Deliberate self-harm and antidepressant drugs: Investigation of a possible link. British Journal of Psychiatry, 177, 551–556.CrossRefPubMedGoogle Scholar
  34. Elkin, I., Shea, M., Watkins, J., & Imber, S. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program’s general effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.PubMedGoogle Scholar
  35. Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: A new measure. Psychopharmacology Bulletin, 29, 321–326.PubMedGoogle Scholar
  36. Fava, G. A. (1995). Holding on: Depression, sensitization by antidepressant drugs, and the prodigal experts. Psychotherapy and Psychosomatics, 64, 57–61.CrossRefPubMedGoogle Scholar
  37. Fava, G. A. (2002). Long-term treatment with antidepressant drugs: The spectacular achievements of propaganda. Psychotherapy and Psychosomatics, 71, 127–132.CrossRefPubMedGoogle Scholar
  38. Fava, M., Graves, L. M., Benazzi, F., Scalia, M. J., Iosifefscu, D. V., Alpert, J. E., et al. (2006). A cross-sectional study of the prevalence of cognitive and physical symptoms during long-term antidepressant treatment. Journal of Clinical Psychiatry, 67, 1754–1759.CrossRefPubMedGoogle Scholar
  39. Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., et al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA, 303, 47–53.CrossRefPubMedGoogle Scholar
  40. Gould, R. A., & Clum, G. A. (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review, 13, 169–189.CrossRefGoogle Scholar
  41. Gregory, R. J., Schwer Canning, S., Lee, T. W., & Wise, J. C. (2004). Cognitive bibliotherapy for depression: A meta-analysis. Professional Psychology: Research and Practice, 35, 275–280.CrossRefGoogle Scholar
  42. Guthrie, E., Moorey, J., Margison, F., Barker, H., Palmer, S., McGrath, G., et al. (1999). Cost-effectiveness of brief psychodynamic-interpersonal therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 519–526.CrossRefPubMedGoogle Scholar
  43. Haaga, D. A., & Stiles, W. B. (2002). Randomized clinical trials in psychotherapy research: Methodology, design, and evaluation. In C. R. Snyder & R. E. Ingram (Eds.), Handbook of psychological change; Psychotherapy processes and practices for the 21st century (pp. 14–39). New York: Wiley.Google Scholar
  44. Halbreich, U., Shen, J., & Panaro, V. (1996). Are chronic psychiatric patients at increased risk for developing breast cancer? American Journal of Psychiatry, 153, 559–560.PubMedGoogle Scholar
  45. Hall, L. H., & Roberston, M. H. (1998). Undergraduate ratings of the acceptability of single and combined treatments for depression: A comparative analysis. Professional Psychology: Research and Practice, 29, 269–272.CrossRefGoogle Scholar
  46. Hammad, T. A., Laughren, T., & Racoosin, J. (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry, 63, 332–339.CrossRefPubMedGoogle Scholar
  47. Haslam, C., Brown, S., Atkinson, S., & Haslam, R. (2004). Patients’ experiences of medication for anxiety and depression: Effects on working life. Family Practice, 21, 204–212.CrossRefPubMedGoogle Scholar
  48. Healy, D. (2002). Conflicting interests in Toronto: Anatomy of a controversy at the interface of academia and industry. Perspectives in Biology and Medicine, 45, 250–263.CrossRefPubMedGoogle Scholar
  49. Hintze, J. (2008). PASS. Kaysville, UT: NCSS LLC.Google Scholar
  50. Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., et al. (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422.CrossRefPubMedGoogle Scholar
  51. Hollon, S. D., Shelton, R. C., & Loosen, P. T. (1991). Cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 59, 88–99.CrossRefPubMedGoogle Scholar
  52. Hunsley, J. (2003). Cost-effectiveness and medical cost offset considerations in psychological service provision. Canadian Psychology, 44, 61–73.Google Scholar
  53. Imel, Z. E., Malterer, M. B., McKay, K. M., & Wampold, B. E. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. Journal of Affective Disorders, 110, 197–206.CrossRefPubMedGoogle Scholar
  54. Jacobson, N. S., & Traux, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefPubMedGoogle Scholar
  55. Jamison, C., & Scogin, F. (1995). Outcome of cognitive bibliotherapy with depressed adults. Journal of Consulting and Clinical Psychology, 63, 644–650.CrossRefPubMedGoogle Scholar
  56. Jorm, A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. British Journal of Psychiatry, 177, 396–401.CrossRefPubMedGoogle Scholar
  57. Khan, A., Warner, H. A., & Brown, W. A. (2000). Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials. Archives of General Psychiatry, 57, 311–330.CrossRefPubMedGoogle Scholar
  58. Lin, E. H. B., Katon, W., Von Korff, M., Tang, L., Williams, J. W., Kroenke, K., et al. (2003). Effect of improving depression care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial. JAMA, 290, 2428–2434.CrossRefPubMedGoogle Scholar
  59. McLeod, C. C., Budd, M. A., & McClelland, D. C. (1997). Treatment of somatization in primary care. General Hospital Psychiatry, 19, 251–258.CrossRefPubMedGoogle Scholar
  60. Mental Health Foundation Report: Exercise therapy? The treatment of mild and moderate depression in primary care. (2006). Retrieved on June 16, 2006 from http://www.psychminded.co.uk/news/news2005/april05/up_and_running.pdf.
  61. Moore, T. J. (2004). Drug safety research: Special report. Medical use of antidepressant drugs in children and adults: 1998–2001. Paper presented at the Feb. 2, 2004 FDA Hearing on the Use of Antidepressants in Children. Retrieved on March 2, 2004 from http://drugsafetyresearch.com/downloads/med_use_antidep.pdf.
  62. Moorman, P. G., Grubber, J. M., Millikan, R. C., & Newman, B. (2003). Antidepressant medications and their association with invasive breast cancer and carcinoma in situ of the breast. Epidemiology, 14, 307–314.CrossRefPubMedGoogle Scholar
  63. Olfson, M., Marcus, S., Druss, B., Elinson, L., Tanielian, T., & Pincus, H. A. (2002). National trends in the outpatient treatment of depression. JAMA, 287, 203–210.CrossRefPubMedGoogle Scholar
  64. Pantalon, M. V., Lubetkin, B. S., & Fishman, S. T. (1995). Use and effectiveness of self-help books in the practice of cognitive and behavioral therapy. Cognitive and Behavioral Practice, 2, 213–228.CrossRefGoogle Scholar
  65. Patten, S. B., Williams, J. V. A., Lavorato, D. H., Brown, L., McLaren, L., & Eliasziw, M. (2009). Major depression, antidepressant medication and the risk of obesity. Psychotherapy and Psychosomatics, 78, 182–186.CrossRefPubMedGoogle Scholar
  66. Paykel, E. S., Hart, D., & Priest, R. G. (1998). Changes in public attitudes to depression during the Defeat Depression Campaign. British Journal of Psychiatry, 173, 519–522.CrossRefPubMedGoogle Scholar
  67. Preda, A., MacLean, R. W., Mazure, C. M., & Bowers, M. B. (2001). Antidepressant-associated mania and psychosis resulting in psychiatric admissions. Journal of Clinical Psychiatry, 62, 30–33.CrossRefPubMedGoogle Scholar
  68. Priest, R. G., Vize, C., Roberts, A., Roberts, M., & Tylee, A. (1996). Lay people’s attitude to treatment of depression: Results of opinion poll for Defeat Depression Campaign just before its launch. BMJ, 313, 858–859.PubMedGoogle Scholar
  69. Raeder, M. B., Bjelland, I., Emil Vollset, S., & Steen, V. M. (2006). Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: The Hordaland Health Study. Journal of Clinical Psychiatry, 67, 1974–1982.CrossRefPubMedGoogle Scholar
  70. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30–49.CrossRefPubMedGoogle Scholar
  71. Rosenbaum, J. F., Fava, M., Hood, S. L., Ashcroft, R. C., & Krebs, W. B. (1998). Selective serotonin reuptake inhibitor discontinuation syndrome: A randomized clinical trial. Biological Psychiatry, 44, 77–87.CrossRefPubMedGoogle Scholar
  72. Scheinthal, S. M., Steer, R. A., Giffin, L., & Beck, A. T. (2001). Evaluating geriatric medical outpatients with the Beck Depression Inventory-FastScreen for Medical Patients. Aging and Mental Health, 5, 143–148.CrossRefPubMedGoogle Scholar
  73. Scogin, F., Hamblin, D., & Beutler, L. (1987). Bibliotherapy for depressed older adults: A self-help alternative. Gerontologist, 27, 383–387.PubMedGoogle Scholar
  74. Scogin, F., Jamison, C., & Davis, N. (1990). A two-year follow-up of the effects of bibliotherapy for depressed older adults. Journal of Consulting and Clinical Psychology, 58, 665–667.CrossRefPubMedGoogle Scholar
  75. Scogin, F., Jamison, C., Floyd, M., & Chaplin, W. (1998). Measuring learning in depression treatment: A cognitive bibliotherapy test. Cognitive Therapy and Research, 22, 475–482.CrossRefGoogle Scholar
  76. Scogin, F., Jamison, C., & Gochneaut, K. (1989). The comparative efficacy of cognitive and behavioral bilbliotherapy for mildly and moderately depressed older adults. Journal of Consulting and Clinical Psychology, 57, 403–407.CrossRefPubMedGoogle Scholar
  77. Sharpe, C. R., Collet, J. P., Belzile, E., Hanley, J. A., & Boivin, J. F. (2002). The effects of tricyclic antidepressants on breast cancer risk. British Journal of Cancer, 85, 92–97.CrossRefGoogle Scholar
  78. Simon, G. E., Manning, W. G., Katzelnick, D. J., Pearson, S. D., Henk, H. J., & Helstad, C. P. (2001). Cost effectiveness of systematic depression treatment for high utilizers of general medical care. Archives of General Psychiatry, 58, 181–187.CrossRefPubMedGoogle Scholar
  79. Singer, J. D., & Willett, J. B. (2003). Analysis of longitudinal data. New York: Oxford University Press.CrossRefGoogle Scholar
  80. Smith, N., Floyd, M., Jamison, C., & Scogin, F. (1997). Three-year follow-up of bibliotherapy for depression. Journal of Consulting and Clinical Psychology, 65, 324–327.CrossRefPubMedGoogle Scholar
  81. Smoller, J. W., Allison, M., Cochrane, B. B., Curb, J. D., Perlis, R. H., Robinson, J. G., et al. (2009). Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study. Archives of Internal Medicine, 169, 2128–2139.CrossRefPubMedGoogle Scholar
  82. SPSS for Windows, Rel. 12.0. (1999). Chicago: SPSS Inc.Google Scholar
  83. SPSS Graduate Pack for Windows, Rel. 15.0. (2006). Chicago: SPSS Inc.Google Scholar
  84. Steer, R. A., Cavalieri, T. A., Leonard, D. M., & Beck, A. T. (1999). Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders. General Hospital Psychiatry, 21, 106–111.CrossRefPubMedGoogle Scholar
  85. Steinbrueck, S. M., Maxwell, S. E., & Howard, G. S. (1983). A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults. Journal of Consulting and Clinical Psychology, 51, 856–863.CrossRefPubMedGoogle Scholar
  86. Storosum, J. G., van Zwieten, B. J., van den Brink, W., Gersons, B. P. R., & Broekmans, A. W. (2001). Suicide risk in placebo-controlled studies of major depression. American Journal of Psychiatry, 158, 1271–1275.CrossRefPubMedGoogle Scholar
  87. Swinburn, B. A., Walter, L. G., Arrol, B., Tilyard, M. W., & Russell, D. G. (1997). Green prescriptions: Attitudes and perceptions of general practitioners towards prescribing exercise. British Journal of General Practice, 47, 567–569.PubMedGoogle Scholar
  88. Swinburn, B. A., Walter, L. G., Arrol, B., Tilyard, M. W., & Russell, D. G. (1998). The green prescription study: A randomized controlled trial of written exercise advice provided by general practitioners. American Journal of Public Health, 88, 288–291.CrossRefPubMedGoogle Scholar
  89. TADS. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression. JAMA, 292, 807–820.CrossRefGoogle Scholar
  90. TADS. (2007). The treatment for adolescents with depression study: Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132–1143.CrossRefGoogle Scholar
  91. Weissman, A. N., & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation.  Paper presented at the Meeting of the American Educational Research Association, Toronto.Google Scholar
  92. Wexler, B. E., & Cicchetti, D. V. (1992). The outpatient treatment of depression: Implications of outcome research for clinical practice. Journal of Nervous and Mental Disease, 180, 277–286.CrossRefPubMedGoogle Scholar
  93. Winter, L. B., Steer, R. A., Jones-Hicks, L., & Beck, A. T. (1999). Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. Journal of Adolescent Health, 24, 389–394.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Elizabeth V. Naylor
    • 1
  • David O. Antonuccio
    • 2
  • Mark Litt
    • 3
  • Gary E. Johnson
    • 1
  • Daniel R. Spogen
    • 1
  • Richard Williams
    • 1
  • Catherine McCarthy
    • 1
  • Marcia M. Lu
    • 1
  • David C. Fiore
    • 1
  • Dianne L. Higgins
    • 4
  1. 1.Department of Family & Community MedicineUniversity of Nevada School of MedicineRenoUSA
  2. 2.Department of Psychiatry and Behavioral SciencesUniversity of Nevada School of MedicineRenoUSA
  3. 3.Division of Behavioral SciencesUniversity of Connecticut Health CenterFarmingtonUSA
  4. 4.Tahoe Forest Multispecialty ClinicsIncline VillageUSA

Personalised recommendations