title: Improving care for depression in obstetrics and gynecology: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate an evidence-based collaborative depression care intervention adapted to obstetrics and gynecology clinics compared with usual care.
  
  
  METHODS
  A two-site, randomized controlled trial included screen-positive women (Patient Health Questionnaire-9 score of at least 10) who met criteria for major depression, dysthymia, or both (Mini-International Neuropsychiatric Interview). Women were randomized to 12 months of collaborative depression management or usual care; 6-month, 12-month, and 18-month outcomes were compared. The primary outcomes were change from baseline to 12 months in depression symptoms and functional status. Secondary outcomes included at least 50% decrease and remission in depressive symptoms, global improvement, treatment satisfaction, and quality of care.
  
  
  RESULTS
  Participants were, on average, 39 years old, 44% were nonwhite, and 56% had posttraumatic stress disorder. Intervention (n=102) compared with usual care (n=103) patients had greater improvement in depressive symptoms at 12 months (P<.001) and 18 months (P=.004). The intervention group compared with usual care group had improved functioning over the course of 18 months (P<.05), were more likely to have at least 50% decrease in depressive symptoms at 12 months (relative risk [RR] 1.74, 95% confidence interval [CI] 1.11-2.73), greater likelihood of at least four specialty mental health visits (6-month RR 2.70, 95% CI 1.73-4.20; 12-month RR 2.53, 95% CI 1.63-3.94), adequate dose of antidepressant (6-month RR 1.64, 95% CI 1.03-2.60; 12-month RR 1.71, 95% CI 1.08-2.73), and greater satisfaction with care (6-month RR 1.70, 95% CI 1.19-2.44; 12-month RR 2.26, 95% CI 1.52-3.36).
  
  
  CONCLUSIONS
  Collaborative depression care adapted to women's health settings improved depressive and functional outcomes and quality of depression care.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT01096316.
  
  
  METHODS
  I.
authors.affiliation: Departments of Obstetrics and Gynecology, Psychiatry, and Psychiatry and Behavioral Sciences at Harborview Medical Center and University of Washington Medical Center, University of Washington School of Medicine; and Group Health Research Institute, Seattle, Washington.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Melville
authors.forename: Susan D
authors.initials: SD
authors.lastname: Reed
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Croicu
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Anna
authors.initials: A
authors.lastname: LaRocco-Cockburn
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D003866:Depressive Disorder / Q000628:therapy*; D019263:Dysthymic Disorder / Q000628:therapy; D005260:Female; D006176:Gynecology; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D017060:Patient Satisfaction; D011787:Quality of Health Care; D016896:Treatment Outcome