title: Implementing collaborative primary care for depression and posttraumatic stress disorder: design and sample for a randomized trial in the U.S. military health system.
abstract: BACKGROUND
  War-related trauma, posttraumatic stress disorder (PTSD), depression and suicide are common in US military members. Often, those affected do not seek treatment due to stigma and barriers to care. When care is sought, it often fails to meet quality standards. A randomized trial is assessing whether collaborative primary care improves quality and outcomes of PTSD and depression care in the US military health system.
  
  
  OBJECTIVE
  The aim of this study is to describe the design and sample for a randomized effectiveness trial of collaborative care for PTSD and depression in military members attending primary care.
  
  
  METHODS
  The STEPS-UP Trial (STepped Enhancement of PTSD Services Using Primary Care) is a 6 installation (18 clinic) randomized effectiveness trial in the US military health system. Study rationale, design, enrollment and sample characteristics are summarized.
  
  
  RESULTS
  Military members attending primary care with suspected PTSD, depression or both were referred to care management and recruited for the trial (2592), and 1041 gave permission to contact for research participation. Of those, 666 (64%) met eligibility criteria, completed baseline assessments, and were randomized to 12 months of usual collaborative primary care versus STEPS-UP collaborative care. Implementation was locally managed for usual collaborative care and centrally managed for STEPS-UP. Research reassessments occurred at 3-, 6-, and 12-months. Baseline characteristics were similar across the two intervention groups.
  
  
  CONCLUSIONS
  STEPS-UP will be the first large scale randomized effectiveness trial completed in the US military health system, assessing how an implementation model affects collaborative care impact on mental health outcomes. It promises lessons for health system change.
authors.affiliation: RAND Corporation, Washington, DC, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Engel
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Bray
authors.affiliation: RAND Corporation, Washington, DC, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Jaycox
authors.affiliation: Deployment Health Clinical Center, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Freed
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
authors.forename: Doug
authors.initials: D
authors.lastname: Zatzick
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Lane
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Brambilla
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Rae Olmsted
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Russ
authors.initials: R
authors.lastname: Vandermaas-Peeler
authors.affiliation: VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Litz
authors.affiliation: RAND Corporation, Washington, DC, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Tanielian
authors.affiliation: Deployment Health Clinical Center, Bethesda, MD, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Belsher
authors.affiliation: Deployment Health Clinical Center, Bethesda, MD, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Evatt
authors.affiliation: Deployment Health Clinical Center, Bethesda, MD, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Novak
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000293:Adolescent; D000328:Adult; D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D008889:Military Personnel; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration; D012107:Research Design; D012648:Self Care; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014481:United States; D055815:Young Adult
keywords: Collaborative care; Depression; Implementation; Military; PTSD; Primary care