title: Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial.
abstract: BACKGROUND
  Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile.
  
  
  METHODS
  In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depression were allocated stepped care or usual care. Stepped care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. Data were analysed on an intention-to-treat basis. The primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation.
  
  
  RESULTS
  About 90% of randomised patients completed outcome assessments. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. The adjusted difference in mean HDRS score between the groups was -8.89 (95% CI -11.15 to -6.76; p<0.0001). At 6-months' follow-up, 70% (60-79) of the stepped-care compared with 30% (21-40) of the usual-care group had recovered (HDRS score <8).
  
  
  CONCLUSIONS
  Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme, which is being introduced across Chile. Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression.
authors.affiliation: Division of Psychiatry, University of Bristol, Bristol, UK. r.araya@bris.ac.uk
authors.forename: Ricardo
authors.initials: R
authors.lastname: Araya
authors.forename: Graciela
authors.initials: G
authors.lastname: Rojas
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Fritsch
authors.forename: Jorge
authors.initials: J
authors.lastname: Gaete
authors.forename: Maritza
authors.initials: M
authors.lastname: Rojas
authors.forename: Greg
authors.initials: G
authors.lastname: Simon
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D002677:Chile; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D011203:Poverty; D011614:Psychotherapy, Brief; D011615:Psychotherapy, Group; D011795:Surveys and Questionnaires; D016896:Treatment Outcome