A randomized controlled trial of a close monitoring program for minor depression and distress.
BACKGROUND
Minor depression is almost twice as common in primary care (PC) as major depression. Despite the high prevalence, few evidence-based algorithms exist for managing patients with minor depression or patients presenting solely with distress.


OBJECTIVE
The aim of this study was to test the effectiveness of a telephone-based close monitoring program to manage PC patients with minor depression or distress.


METHODS
Subjects were randomly assigned to either the control arm (usual care; UC) or the intervention arm (close monitoring; CM). We hypothesized that those randomized to CM would exhibit less depression and be less likely to have symptoms progress to the point of meeting diagnostic criteria.


METHODS
Overall, 223 PC subjects with minor depression or distress consented to participation in this trial.


METHODS
At baseline, subjects completed a telephone-based evaluation comprised of validated diagnostic assessments of depression and other MH disorders. Outcomes were assessed at six months utilizing this same battery. Chart reviews were conducted to track care received, such as prescribed antidepressants and MH and primary care visits.


RESULTS
Subjects in the CM arm exhibited fewer psychiatric diagnoses than those in the UC arm (chi(2) = 4.04, 1 df, p = 0.04). In addition, the intervention group showed improved overall physical health (SF-12 PCS scores) (M = 45.1, SD = 11.8 versus M = 41.5, SD = 12.4) (chi(2) = 5.90, 1 df, p = .02).


CONCLUSIONS
Those randomized to CM exhibited less MH problems at the conclusion of the trial, indicating that the close monitoring program is effective, feasible and valuable. The findings of this study will allow us to enhance clinical care and support the integration of mental health services and primary care.
Ross
Jennifer T
JT
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA.
TenHave
Thomas
T
Eakin
April C
AC
Difilippo
Suzanne
S
Oslin
David W
DW
D000328:Adult; D000368:Aged; D003863:Depression / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome