A multifaceted intervention to improve treatment of depression in primary care

W. Katon, P. Robinson, M. Von Korff, E. Lin, T. Bush, E. Ludman, G. Simon and E. Walker
Department of Psychiatry, University of Washington Medical School, Seattle, USA.

BACKGROUND: This research study evaluates the effectiveness of a multifaceted intervention program to improve the management of depression in primary care. METHODS: One hundred fifty-three primary care patients with current depression were entered into a randomized controlled trial. Intervention patients received a structured depression treatment program in the primary care setting that included both behavioral treatment to increase use of adaptive coping strategies and counseling to improve medication adherence. Control patients received "usual" care by their primary care physicians. Outcome measures included adherence to antidepressant medication, satisfaction with care of depression and with antidepressant treatment, and reduction of depressive symptoms over time. RESULTS: At 4-month follow-up, significantly more intervention patients with major and minor depression than usual care patients adhered to antidepressant medication and rated the quality of care they received for depression as good to excellent. Intervention patients with major depression demonstrated a significantly greater decrease in depression severity over time compared with usual care patients on all 4 outcome analyses. Intervention patients with minor depression were found to have a significant decrease over time in depression severity on only 1 of 4 study outcome analyses compared with usual care patients. CONCLUSION: A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression. The intervention consistently resulted in more favorable depression outcomes among patients with major depression, while outcome effects were ambiguous among patients with minor depression.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Battling depression
Stewart
CMAJ 2008;178:1023-1024.
FULL TEXT  

Best Practices: Integrating Behavioral Health and Primary Care: The Harris County Community Behavioral Health Program
Begley et al.
Psychiatr. Serv. 2008;59:356-358.
ABSTRACT | FULL TEXT  

Collaboration between family physicians and psychologists: What do family physicians know about psychologists' work?
Grenier et al.
cfp 2008;54:232-233.
ABSTRACT | FULL TEXT  

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management
Cheung et al.
Pediatrics 2007;120:e1313-e1326.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder
Wells et al.
Psychiatr. Serv. 2007;58:1269-1278.
ABSTRACT | FULL TEXT  

Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial
Wang et al.
JAMA 2007;298:1401-1411.
ABSTRACT | FULL TEXT  

Service Use and Outcomes Among Elderly Persons With Low Incomes Being Treated for Depression
Arean et al.
Psychiatr. Serv. 2007;58:1057-1064.
ABSTRACT | FULL TEXT  

A Pilot Study of Telephone Care Management and Structured Disease Self-Management Groups for Chronic Depression
Ludman et al.
Psychiatr. Serv. 2007;58:1065-1072.
ABSTRACT | FULL TEXT  

Applying Theory-Driven Approaches to Understanding and Modifying Clinicians' Behavior: What Do We Know?
Perkins et al.
Psychiatr. Serv. 2007;58:342-348.
ABSTRACT | FULL TEXT  

The Costs and Benefits of Enhanced Depression Care to Employers
Wang et al.
Arch Gen Psychiatry 2006;63:1345-1353.
ABSTRACT | FULL TEXT  

Collaborative care for depression in primary care: Making sense of a complex intervention: systematic review and meta-regression
Bower et al.
Br. J. Psychiatry 2006;189:484-493.
ABSTRACT | FULL TEXT  

Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes
Gilbody et al.
Arch Intern Med 2006;166:2314-2321.
ABSTRACT | FULL TEXT  

Depression decision support in primary care: a cluster randomized trial.
Dobscha et al.
ANN INTERN MED 2006;145:477-487.
ABSTRACT | FULL TEXT  

Costs and consequences of enhanced primary care for depression: Systematic review of randomised economic evaluations
GILBODY et al.
Br. J. Psychiatry 2006;189:297-308.
ABSTRACT | FULL TEXT  

A Taxonomy for Disease Management: A Scientific Statement From the American Heart Association Disease Management Taxonomy Writing Group
Krumholz et al.
Circulation 2006;114:1432-1445.
ABSTRACT | FULL TEXT  

Treatment and Adequacy of Treatment of Mental Disorders Among Respondents to the Mexico National Comorbidity Survey
Borges et al.
Am. J. Psychiatry 2006;163:1371-1378.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile
Araya et al.
Am. J. Psychiatry 2006;163:1379-1387.
ABSTRACT | FULL TEXT  

PRISM-E: Comparison of Integrated Care and Enhanced Specialty Referral Models in Depression Outcomes
Krahn et al.
Psychiatr. Serv. 2006;57:946-953.
ABSTRACT | FULL TEXT  

Satisfaction With Mental Health Services in Older Primary Care Patients
Chen et al.
AJGP 2006;14:371-379.
ABSTRACT | FULL TEXT  

Collaborative care for depression
Simon
BMJ 2006;332:249-250.
FULL TEXT  

A Meta-Analysis of Labor Supply Effects of Interventions for Major Depressive Disorder
Timbie et al.
Psychiatr. Serv. 2006;57:212-218.
ABSTRACT | FULL TEXT  

Depression Treatment Preferences in Older Primary Care Patients
Gum et al.
Gerontologist 2006;46:14-22.
ABSTRACT | FULL TEXT  

Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT | FULL TEXT  

Follow-Up and Follow-Through of Depressed Patients in Primary Care: The Critical Missing Components of Quality Care
Solberg et al.
J Am Board Fam Med 2005;18:520-527.
ABSTRACT | FULL TEXT  

Depression and Stages of Huntington's Disease
Paulsen et al.
J. Neuropsychiatry Clin. Neurosi. 2005;17:496-502.
ABSTRACT | FULL TEXT  

Suicide Prevention Strategies: A Systematic Review
Mann et al.
JAMA 2005;294:2064-2074.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Evidence-Based Pharmacotherapy or Cognitive Behavior Therapy Compared With Community Referral for Major Depression in Predominantly Low-Income Minority Women
Revicki et al.
Arch Gen Psychiatry 2005;62:868-875.
ABSTRACT | FULL TEXT  

Hormone Therapy Does Not Affect Depression Severity in Older Women
Goldstein et al.
AJGP 2005;13:616-623.
ABSTRACT | FULL TEXT  

Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?
Wells et al.
Am. J. Psychiatry 2005;162:1149-1157.
ABSTRACT | FULL TEXT  

Clinical Assessment of Axis I Psychiatric Morbidity in Chronic Epilepsy: A Multicenter Investigation
Jones et al.
J. Neuropsychiatry Clin. Neurosi. 2005;17:172-179.
ABSTRACT | FULL TEXT  

Psychologist Prescribing
Katon et al.
Psychiatr. Serv. 2005;56:357-357.
FULL TEXT  

A Randomized Effectiveness Trial of Cognitive-Behavioral Therapy and Medication for Primary Care Panic Disorder
Roy-Byrne et al.
Arch Gen Psychiatry 2005;62:290-298.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Adherence-Enhancing Interventions: A Quality Assessment of the Evidence
Elliott et al.
The Annals of Pharmacotherapy 2005;39:508-515.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis
Rost et al.
Ann Fam Med 2005;3:7-14.
ABSTRACT | FULL TEXT  

Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms
Smith et al.
Psychosom. Med. 2005;67:123-129.
ABSTRACT | FULL TEXT  

Telephone Psychotherapy and Care Management for Depression
Tanvetyanon
JAMA 2004;292:2720-2720.
FULL TEXT  

Patient Safety Forum: Should Psychologists Have Prescribing Authority?
Yates et al.
Psychiatr. Serv. 2004;55:1420-1426.
FULL TEXT  

Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study
Grote et al.
Research on Social Work Practice 2004;14:397-407.
ABSTRACT  

The Burden of Major Depression Avoidable by Longer-term Treatment Strategies
Vos et al.
Arch Gen Psychiatry 2004;61:1097-1103.
ABSTRACT | FULL TEXT  

The Pathways Study: A Randomized Trial of Collaborative Care in Patients With Diabetes and Depression
Katon et al.
Arch Gen Psychiatry 2004;61:1042-1049.
ABSTRACT | FULL TEXT  

Prevalence and Predictors of Depression Treatment in an International Primary Care Study
Simon et al.
Am. J. Psychiatry 2004;161:1626-1634.
ABSTRACT | FULL TEXT  

Telephone Psychotherapy and Telephone Care Management for Primary Care Patients Starting Antidepressant Treatment: A Randomized Controlled Trial
Simon et al.
JAMA 2004;292:935-942.
ABSTRACT | FULL TEXT  

Moving Treatment Research From Clinical Trials to the Real World
Roy-Byrne et al.
Focus 2004;2:410-415.
ABSTRACT | FULL TEXT  

Going to Scale: Re-Engineering Systems for Primary Care Treatment of Depression
Dietrich et al.
Ann Fam Med 2004;2:301-304.
ABSTRACT | FULL TEXT  

Clinical Results for Patients With Major Depressive Disorder in the Texas Medication Algorithm Project
Trivedi et al.
Arch Gen Psychiatry 2004;61:669-680.
ABSTRACT | FULL TEXT  

Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review
Pampallona et al.
Arch Gen Psychiatry 2004;61:714-719.
ABSTRACT | FULL TEXT  

Barriers to the Treatment of Depression in Cancer Patients
Greenberg
J Natl Cancer Inst Monogr 2004;2004:127-135.
ABSTRACT | FULL TEXT  

Implementing the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder Diagnostic Guidelines in Primary Care Settings
Leslie et al.
Pediatrics 2004;114:129-140.
ABSTRACT | FULL TEXT  

Response, Partial Response, and Nonresponse in Primary Care Treatment of Depression
Corey-Lisle et al.
Arch Intern Med 2004;164:1197-1204.
ABSTRACT | FULL TEXT  

Bridging Community Intervention and Mental Health Services Research
Wells et al.
Am. J. Psychiatry 2004;161:955-963.
ABSTRACT | FULL TEXT  

The Partners in Care Approach to Ethics Outcomes in Quality Improvement Programs for Depression
Halpern et al.
Psychiatr. Serv. 2004;55:532-539.
ABSTRACT | FULL TEXT  

Extent and Cost of Informal Caregiving for Older Americans With Symptoms of Depression
Langa et al.
Am. J. Psychiatry 2004;161:857-863.
ABSTRACT | FULL TEXT  

Quality of Care for Medicaid-Covered Youth Treated With Antidepressant Therapy
Richardson et al.
Arch Gen Psychiatry 2004;61:475-480.
ABSTRACT | FULL TEXT  

Preliminary Outcomes From an Integrated Mental Health Primary Care Team
Felker et al.
Psychiatr. Serv. 2004;55:442-444.
ABSTRACT | FULL TEXT  

Five-Year Impact of Quality Improvement for Depression: Results of a Group-Level Randomized Controlled Trial
Wells et al.
Arch Gen Psychiatry 2004;61:378-386.
ABSTRACT | FULL TEXT  

Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial
Bruce et al.
JAMA 2004;291:1081-1091.
ABSTRACT | FULL TEXT  

Impact of Pain on Depression Treatment Response in Primary Care
Bair et al.
Psychosom. Med. 2004;66:17-22.
ABSTRACT | FULL TEXT  

Effectiveness of Disease Management Programs in Depression: A Systematic Review
Badamgarav et al.
Am. J. Psychiatry 2003;160:2080-2090.
ABSTRACT | FULL TEXT  

The Depression Care Manager and Mental Health Specialist as Collaborators Within Primary Care
Oxman et al.
AJGP 2003;11:507-516.
ABSTRACT | FULL TEXT  

Presidential Address: Re-Envisioning a Mental Health System for the United States
Appelbaum
Am. J. Psychiatry 2003;160:1758-1762.
FULL TEXT  

Predictors of Psychiatric Comorbidity in Medical Outpatients
Lowe et al.
Psychosom. Med. 2003;65:764-770.
ABSTRACT | FULL TEXT  

Physician Discontent: Challenges and Opportunities
Mechanic
JAMA 2003;290:941-946.
ABSTRACT | FULL TEXT  

Treating Depression in Predominantly Low-Income Young Minority Women: A Randomized Controlled Trial
Miranda et al.
JAMA 2003;290:57-65.
ABSTRACT | FULL TEXT  

The Epidemiology of Major Depressive Disorder: Results From the National Comorbidity Survey Replication (NCS-R)
Kessler et al.
JAMA 2003;289:3095-3105.
ABSTRACT | FULL TEXT  

Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review
Gilbody et al.
JAMA 2003;289:3145-3151.
ABSTRACT | FULL TEXT  

Aligning Incentives in the Treatment of Depression in Primary Care With Evidence-Based Practice
Frank et al.
Psychiatr. Serv. 2003;54:682-687.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Collaborative Care for Depression in a Primary Care Veteran Population
Liu et al.
Psychiatr. Serv. 2003;54:698-704.
ABSTRACT | FULL TEXT  

Using Qualitative Methods to Distill the Active Ingredients of a Multifaceted Intervention
Levinson Miller et al.
Psychiatr. Serv. 2003;54:568-571.
ABSTRACT | FULL TEXT  

Improving the detection and management of depression in primary care
Gilbody et al.
Qual Saf Health Care 2003;12:149-155.
ABSTRACT | FULL TEXT  

"Usual Care" for Major Depression in the 1990s: Characteristics and Expert-Estimated Outcomes
Horvitz-Lennon et al.
Am. J. Psychiatry 2003;160:720-726.
ABSTRACT | FULL TEXT  

Depressive Disorders: Treatment with Nonpharmacological Alternatives
Zunkel
Complementary Health Practice Review 2003;8:116-127.
ABSTRACT  

Moving Treatment Research From Clinical Trials to the Real World
Roy-Byrne et al.
Psychiatr. Serv. 2003;54:327-332.
ABSTRACT | FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Cost-effectiveness and Cost Offset of a Collaborative Care Intervention for Primary Care Patients With Panic Disorder
Katon et al.
Arch Gen Psychiatry 2002;59:1098-1104.
ABSTRACT | FULL TEXT  

Health Disparities and the Quality of Ambulatory Care
Lurie and Buntin
NEJM 2002;347:1709-1710.
FULL TEXT  

Interventions used in disease management programmes for patients with chronic illness---which ones work? Meta-analysis of published reports
Weingarten et al.
BMJ 2002;325:925-925.
ABSTRACT | FULL TEXT  

Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care
Rost et al.
BMJ 2002;325:934-934.
ABSTRACT | FULL TEXT  

Discontinuation of Use and Switching of Antidepressants: Influence of Patient-Physician Communication
Bull et al.
JAMA 2002;288:1403-1409.
ABSTRACT | FULL TEXT  

Use, Quality, and Outcomes of Care for Mental Health: The Rural Perspective
Rost et al.
Med Care Res Rev 2002;59:231-265.
ABSTRACT  

Patient adherence with antidepressant treatment * Authors' reply
Vergouwen et al.
Br. J. Psychiatry 2002;181 :78-79.
FULL TEXT  

Treatment of Minor Depression
Oxman and Sengupta
AJGP 2002;10:256-264.
ABSTRACT | FULL TEXT  

A Randomised Controlled Trial of an Educational Intervention for Depression among Asian Women in Primary Care in the United Kingdom
Jacob et al.
International Journal of Social Psychiatry 2002;48:139-148.
ABSTRACT  

Dropping Out of Mental Health Treatment: Patterns and Predictors Among Epidemiological Survey Respondents in the United States and Ontario
Edlund et al.
Am. J. Psychiatry 2002;159:845-851.
ABSTRACT | FULL TEXT  

A 75-Year-Old Man With Depression
Kroenke
JAMA 2002;287:1568-1576.
FULL TEXT  

Appropriateness of Prescribing Practices for Serotonergic Antidepressants
Loosbrock et al.
Psychiatr. Serv. 2002;53:179-184.
ABSTRACT | FULL TEXT  

Patient adherence in the treatment of depression
PAMPALLONA et al.
Br. J. Psychiatry 2002;180:104-109.
ABSTRACT | FULL TEXT  

Adequacy of Treatment for Serious Mental Illness in the United States
Wang et al.
Am. J. Public Health 2002;92:92-98.
ABSTRACT | FULL TEXT  

Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care: A Randomized Trial
Kroenke et al.
JAMA 2001;286:2947-2955.
ABSTRACT | FULL TEXT  

Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care
Wells et al.
Am. J. Psychiatry 2001;158:2027-2032.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of a Collaborative Care Program for Primary Care Patients With Persistent Depression
Simon et al.
Am. J. Psychiatry 2001;158:1638-1644.
ABSTRACT | FULL TEXT  

Two-Year Effects of Quality Improvement Programs on Medication Management for Depression
Unutzer et al.
Arch Gen Psychiatry 2001;58:935-942.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Practice-Initiated Quality Improvement for Depression: Results of a Randomized Controlled Trial
Schoenbaum et al.
JAMA 2001;286:1325-1330.
ABSTRACT | FULL TEXT  

Integrated Medical Care for Patients With Serious Psychiatric Illness: A Randomized Trial
Druss et al.
Arch Gen Psychiatry 2001;58:861-868.
ABSTRACT | FULL TEXT  

A Randomized Effectiveness Trial of Collaborative Care for Patients With Panic Disorder in Primary Care
Roy-Byrne et al.
Arch Gen Psychiatry 2001;58:869-876.
ABSTRACT | FULL TEXT  

Long-term Effectiveness of Disseminating Quality Improvement for Depression in Primary Care
Sherbourne et al.
Arch Gen Psychiatry 2001;58:696-703.
ABSTRACT | FULL TEXT  

Depression and Service Utilization in Elderly Primary Care Patients
Luber et al.
AJGP 2001;9:169-176.
ABSTRACT | FULL TEXT  

Suicide in Elders
Conwell and Duberstein
Ann. N. Y. Acad. Sci. 2001;932:132-150.
ABSTRACT | FULL TEXT  

Treatment Process and Outcomes for Managed Care Patients Receiving New Antidepressant Prescriptions From Psychiatrists and Primary Care Physicians
Simon et al.
Arch Gen Psychiatry 2001;58:395-401.
ABSTRACT | FULL TEXT