Effectiveness of screening and treatment for depression in ambulatory indigent patients.
OBJECTIVE
To determine the effectiveness of screening and treatment for depression among ambulatory indigent patients visiting resident physicians.


METHODS
Two-group randomized trial (N = 33 intervention, N = 28 usual care) with baseline, 6-month, and 12-month outcome measurements.


METHODS
Internal Medicine Residency Clinic.


METHODS
Clinic patients over 18 years of age who screened positive for depression on the PRIME-MD during a visit to their resident physician. Patients were not receiving treatment nor seeking care for any emotional problems. All patients were either enrolled in Medicaid or had income below the poverty line.


METHODS
Resident physicians were educated to follow AHCPR (AHRQ; Agency for Healthcare Research and Quality) guidelines for diagnosis and treatment of depression in a primary care setting. For the intervention group patients, a screening nurse advised residents regarding the positive screen, handed them a standardized protocol outline, and attempted to arrange behavioral care. The patients in the usual care group were provided the results of the screen by the screening nurse before their visit with the resident, and advised to seek care for their symptoms.


RESULTS
Results for the primary outcome of depression symptoms measured with the Beck Depression Inventory (BDI) demonstrated that intervention was successful in reducing symptoms relative to usual care (difference = -4.9 BDI points, P =.05, 95% confidence interval [CI], -9.8 to -0.005 effect size = -0.41). During the 12-month follow-up, 70% of intervention patients were treated for depression (of these, 91% with antidepressants), while 15% of usual care patients were treated with antidepressants for depression. Another 18% of the usual care group had depression noted, but no treatment was identified. BDI differences between intervention and control groups were similar at the 6- and 12-month measures. Quality of life and costs were also measured, but differences between the groups were not significant in this regard.


CONCLUSIONS
Screening and treatment for depression by resident physicians was successful in reducing symptoms relative to usual care in an indigent population. Almost twice as many intervention patients as usual care controls demonstrated a substantial reduction (10 BDI points) in symptoms related to depression.
Jarjoura
David
D
Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44272-0095, USA. djarj@neoucom.edu
Polen
Ann
A
Baum
Elizabeth
E
Kropp
Denize
D
Hetrick
Suzanne
S
Rutecki
Gregory
G
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008489:Medical Indigency; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011788:Quality of Life
D000928:Antidepressive Agents