A pilot study of telephone care management and structured disease self-management groups for chronic depression.
OBJECTIVE
The authors developed, implemented, and pilot-tested intervention programs to provide effective care for chronic or recurrent depression.


METHODS
A total of 104 patients with chronic or recurrent depression were randomly assigned to one of four groups: continued usual behavioral health care, usual care plus telephone monitoring and care management by a care manager, usual care plus care management plus a peer-led chronic-disease self-management group program, or usual care plus care management plus a professionally led depression psychotherapy group. Outcomes in intent-to-treat analyses were assessed at three, six, nine, and 12 months and included treatment participation rates, Hopkins Symptom Checklist depression scale scores, major depression (Structured Clinical Interview for DSM-IV), Patient-Rated Global Improvement ratings, treatment satisfaction, and adequacy of medication.


RESULTS
Participation in care management was high in the three intervention groups. Close to 60% of participants invited to both group interventions attended at least an initial meeting, but a greater number assigned to the care management plus the professionally led group continued participation through the 12-month period. The sample was too small to reliably detect small or moderate differences in clinical outcomes, but various measures consistently favored the care management plus professionally led group.


CONCLUSIONS
It is feasible to direct additional intervention services to patients with persistent or recurring depression. A larger trial of organized self-management support for chronic depression will be necessary for a definitive evaluation of program effectiveness.
Ludman
Evette J
EJ
Group Health Center for Health Studies, 1730 Minor Avenue, Seattle, WA 98101, USA. ludman.e@ghc.org
Simon
Gregory E
GE
Grothaus
Louis C
LC
Luce
Casey
C
Markley
David K
DK
Schaefer
Judith
J
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006266:Health Education; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010346:Patient Care Management; D017060:Patient Satisfaction; D010865:Pilot Projects; D011615:Psychotherapy, Group; D012008:Recurrence; D012657:Self-Help Groups; D013689:Telephone; D016896:Treatment Outcome; D014861:Washington
D000928:Antidepressive Agents