The effects of primary care depression treatment on patients' clinical status and employment
|Authors:||Schonebaum, A., Boyd, J., & Dudek, K.|
|Publication||Health Services Research|
|Publisher||John Wiley & Sons, Inc.|
Effective treatment of depression could thus have major public health benefits. Yet despite availability of efficacious treatments, that is, antidepressant medications and psychotherapies, and of national practice guidelines, rates of appropriate treatment for depression remain low nationally, particularly in primary care where only about a quarter of depressed patients receive appropriate care.
The goal of this study was to evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months.
The study was conducted in six diverse, non academic managed primary care organizations. Forty-six of 48 primary care practices and 181 of 183 clinicians participated. Practices were matched into blocks of three clusters, based on factors that might affect baseline quality of care or intervention response: clinician specialty mix, distribution of patient socioeconomic and demographic characteristics, and presence of onsite mental health clinicians.
Study staff screened 27,332 consecutive patients in participating practices over five to seven months. Patients were eligible if they intended to use the clinic during the next twelve months and screened positive for depression, using items from the World Health Organization's twelve-month Composite International Diagnostic Interview. Patients were positive if they reported at least one week of depression in the last 30 days, plus two weeks or more of depressed mood or loss of interest in pleasurable activities or persistent depression over the year.
Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.
Usual care practices only received written depression treatment guidelines by mail. In all intervention conditions, patients and providers made their own treatment decisions and use of intervention resources was optional.
At six months, patients with appropriate care, compared to those without it, had lower rates of depressive disorder (24 percent versus 70 percent), better mental health-related quality of life, and higher rates of employment (72 percent versus 53 percent), each p<.05.
Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.
|Populations||Hispanic or Latino | Black / African American | White / Caucasian|
|Research Design||Randomized Controlled Trials (RCTs)|