Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial.
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.
Araya
Ricardo
R
Division of Psychiatry, University of Bristol, Bristol, UK. r.araya@bris.ac.uk
Rojas
Graciela
G
Fritsch
Rosemarie
R
Gaete
Jorge
J
Rojas
Maritza
M
Simon
Greg
G
Peters
Tim J
TJ
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