The effects of primary care depression treatment on patients' clinical status and employment | Knowledge Translation for Employment Research Center

Authors:	Schonebaum, A., Boyd, J., & Dudek, K.
Year Published	2002
Publication	Health Services Research
Volume	37
Number	5
Pages	1145-1158
Publisher	John Wiley & Sons, Inc.
Background	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.
Purpose	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.
Setting	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.
Sample	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.
Data Collection	Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.
Control	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.
Findings	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.
Conclusions	Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.
URL	http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464020/
Disabilities	Emotional disturbance
Populations	Hispanic or Latino \| Black / African American \| White / Caucasian
Outcomes	Employment acquisition
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2002

Publication

Health Services Research

Volume

37

Number

5

Pages

1145-1158

Publisher

John Wiley & Sons, Inc.

Background

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.

Purpose

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.

Setting

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.

Sample

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.

Data Collection

Patient-reported clinical status, employment, health care use, and personal characteristics; health care use and costs from claims data.

Control

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.

Findings

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.

Conclusions

Appropriate treatment for depression provided in community-based primary care substantially improves clinical and quality of life outcomes and employment.

URL

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464020/

Disabilities

Emotional disturbance

Populations

Hispanic or Latino | Black / African American | White / Caucasian

Outcomes

Employment acquisition

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes