Collaborative care for depression symptoms in an outpatient cardiology setting: A randomized clinical trial.
BACKGROUND
Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC).


METHODS
Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6months.


RESULTS
There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p=.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p=0.34) after 6months, or in the number of hospitalizations after 12months (p=0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p=0.03).


CONCLUSIONS
This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed.
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: carneyr@bmc.wustl.edu.
Robert M
RM
Carney
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Kenneth E
KE
Freedland
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Brian C
BC
Steinmeyer
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
Eugene H
EH
Rubin
Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Gregory
G
Ewald
D000368:Aged; D000553:Ambulatory Care; D002309:Cardiology / Q000379:methods*; D000071959:Case Managers; D003299:Cooperative Behavior; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy*; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D016896:Treatment Outcome
Collaborative care; Depression; Outpatient cardiology