title: Collaborative Care for Depression in Chronic Hepatitis C Clinics.
abstract: Depression is highly prevalent yet underdiagnosed and undertreated among patients with chronic hepatitis C virus (HCV) infection. Collaborative care models have improved depression outcomes in primary care settings, and this study aimed to provide more information on testing such methods in specialty HCV care.
  
  
  
  Hepatitis C Translating Initiatives for Depression Into Effective Solutions (HEPTIDES) was a randomized controlled trial that tested a collaborative depression care model in HCV clinics at four Veterans Affairs facilities. The HEPTIDES intervention consisted of an offsite depression care team (depression care manager, pharmacist, and psychiatrist) that delivered collaborative care. Participant interview data were collected at baseline and at six months. The outcome was depression severity measured with the Hopkins Symptom Checklist (SCL-20) and reported as treatment response (≥50% decrease in SCL-20 item score), remission (mean SCL-20 item score <.5), and depression-free days (DFDs).
  
  
  
  Baseline screening identified 263 HCV-infected patients with depression. In unadjusted analyses, intervention participants' reports trended toward more treatment response (19% versus 13%) and remission (12% versus 6%), but total number of DFDs (50.9) was similar to that of usual care participants (50.7). These trends did not reach statistical significance for the overall sample in the adjusted analyses: response (odds ratio [OR]=2.02, 95% confidence interval [CI]=.98-4.20), remission (OR=2.63, CI=1.00-6.94), and DFDs (β=7.6 days, CI=-.99 to 16.2). However, the intervention was effective in improving all three outcomes for patients who did not meet criteria for remission at baseline (SCL-20 score >.5, N=245).
  
  
  
  Depression collaborative care resulted in modest improvements in HCV patient depression outcomes. Future research should investigate intervention modifications to improve outcomes in specialty HCV clinics.
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Shahriar
authors.initials: S
authors.lastname: Tavakoli-Tabasi
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Susan
authors.initials: S
authors.lastname: Nicholson
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Brian
authors.initials: B
authors.lastname: Dieckgraefe
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Erma
authors.initials: E
authors.lastname: Storay
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bidwell Goetz
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Shubhada
authors.initials: S
authors.lastname: Sansgiry
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Allen
authors.initials: A
authors.lastname: Gifford
authors.affiliation: Dr. Kanwal, Dr. Tavakoli-Tabasi, Ms. Smith, and Dr. Sansgiry are with the Michael E. DeBakey Veterans Affairs (VA) Medical Center, Houston, Texas. Dr. Kanwal is also with the Sections of Gastroenterology and Hepatology and Dr. Tavakoli-Tabasi is also with the Section of Infectious Diseases, Baylor College of Medicine, Houston. Dr. Pyne and Ms. Storay are with Central Arkansas Veterans Healthcare System, where Dr. Pyne is with the Center for Mental Health Outcomes Research and Ms. Storay is with the Section of Hepatology. Dr. Pyne is also with the Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock. Ms. Nicholson and Dr. Dieckgraefe are with the Sections of Gastroenterology and Hepatology, John Cochran VA Medical Center, Saint Louis, Missouri. Dr. Goetz is with the Section of Infectious Diseases, VA Greater Los Angeles Veterans Healthcare System and David Geffen School of Medicine at University of California, Los Angeles, Los Angeles. Dr. Gifford is with the Department of Health Policy and Management and the Department of Medicine, Boston University, Boston. Dr. Asch is with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, and with the Division of General Medical Disciplines, Stanford University, Palo Alto.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*