Can depression treatment in primary care reduce disability? A stepped care approach.
OBJECTIVE
To assess effects of stepped collaborative care depression intervention on disability.


METHODS
Randomized controlled trial.


METHODS
Four primary care clinics of a large health maintenance organization.


METHODS
Two hundred twenty-eight patients with either 4 or more persistent major depressive symptoms or a score of 1.5 or greater on the Hopkins Symptom Checklist. Depression items were randomized to stepped care intervention or usual care 6 to 8 weeks after initiating antidepressant medication.


METHODS
Augmented treatment of persistently depressed patients by an on-site psychiatrist collaborating with primary care physicians. Treatment included patient education, adjustment of pharmacotherapy, and proactive monitoring of outcomes.


METHODS
Baseline, 1-, 3-, and 6-month assessments of the Sheehan Disability Scale and the social function and role limitation subscales of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).


RESULTS
Patients who received the depression intervention experienced less interference in their family, work, and social activities than patients receiving usual primary care (Sheehan Disability Scale, z = 2.23; P =.025). Patients receiving intervention also reported a trend toward more improvement in SF-36-defined social functioning than patients receiving usual care (z = 1.63, P =.10), but there was no significant difference in role performance (z = 0.07, P =.94).


CONCLUSIONS
Significant disability accompanied depression in this persistently depressed group. The stepped care intervention resulted in small to moderate functional improvements for these primary care patients. Arch Fam Med. 2000;9:1052-1058
Lin
E H
EH
Center for Health Studies, Group Health Cooperative of Puget Sound, Center for Health Studies, Met Park II, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA. lin.e@ghc.org
VonKorff
M
M
Russo
J
J
Katon
W
W
Simon
G E
GE
Unützer
J
J
Bush
T
T
Walker
E
E
Ludman
E
E
D003625:Data Collection; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010348:Patient Care Team; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D011570:Psychiatry; D012017:Referral and Consultation