Impact of improved depression treatment in primary care on daily functioning and disability.
BACKGROUND
Few data are available regarding the impact of improved depression treatment on daily functioning and disability.


METHODS
In two studies of more intensive depression treatment in primary care, patients initiating antidepressant treatment were randomly assigned to either usual care or to a collaborative management programme including patient education, on-site mental health treatment, adjustment of antidepressant medication, behavioural activation and monitoring of medication adherence. Assessments at baseline as well as 4 and 7 months included several measures of impairment, daily functioning and disability: self-rated overall health, number of bodily pains, number of somatization symptoms, changes in work due to health, reduction in leisure activities due to health, number of disability days and number of restricted activity days.


RESULTS
Average data from the 4- and 7-month assessments in both studies, intervention patients reported fewer somatic symptoms (OR 0.68, 95% CI 0.46, 0.99) and more favourable overall health (OR 0.50, 95% CI 0.28, 0.91). While intervention patients fared better on other measures of functional impairment and disability, none of these differences reached statistical significance.


CONCLUSIONS
More effective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant intervention effect on other disability measures may reflect the brief treatment and follow-up period and the influence of other individual and environmental factors on disability.
Simon
G E
GE
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA.
Katon
W
W
Rutter
C
C
VonKorff
M
M
Lin
E
E
Robinson
P
P
Bush
T
T
Walker
E A
EA
Ludman
E
E
Russo
J
J
D000041:Absenteeism; D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010555:Personality Inventory; D011320:Primary Health Care; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D000928:Antidepressive Agents