Disease management for depression in an MS clinic.
OBJECTIVE
Evidence-based treatments for depression in multiple sclerosis (MS) are available, but their implementation can be challenging. We explored the feasibility and effectiveness of implementing a disease management program for depression in an MS clinic.


METHODS
A non-randomized "before-after" design was used. The University of Calgary MS Clinic performs routine screening for depression using the Center for Epidemiologic Studies Depression Rating Scale (CES-D). During a six month baseline period, the screen results were not systematically acted upon. During a subsequent nine-month study period, a case manager was routinely notified of positive screens. These patients were offered disease management. Major depression was assessed six months later with a blind administration of the Mini Neuropsychiatric Interview (MINI). Quality of life (EQ-5D) and functional status (WHO DAS II) were also measured.


RESULTS
Eighty-three patients were enrolled in the study; 54 were in the disease management group and 29 received treatment as usual. There was a lower frequency of major depression in the intervention group six months post-screening. No differences in quality of life or functional status were seen.


CONCLUSIONS
Disease management approaches for depression were developed in primary care environments and have been adapted for geriatric and diabetic populations. These strategies may require modification for application in MS clinics. While an intervention for depression was effective in those who received it, its impact on the targeted clinical population was reduced by lower than expected rates of participation and higher than expected rates of treatment at baseline.
Patten
Scott B
SB
Department of Community Health Sciences, University of Calgary, AB, Canada. patten@ucalgary.ca
Newman
Stephen
S
Becker
Melodie
M
Riddell
Catherine
C
Metz
Luanne
L
D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000416:Alberta; D000928:Antidepressive Agents / Q000627:therapeutic use; D001294:Attitude to Health; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D010555:Personality Inventory; D011446:Prospective Studies; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012017:Referral and Consultation; D012959:Socioeconomic Factors
D000928:Antidepressive Agents