Motivational interviewing improves depression outcome in primary care: A cluster randomized trial.
OBJECTIVE
To examine the effects of Motivational Interviewing (MI) conducted by primary care providers on rates of improvement over time for depressive symptoms and remission among low-income patients with newly diagnosed Major Depressive Disorder.


METHODS
Ten care teams were randomized to MI with standard management of depression (MI-SMD; 4 teams, 10 providers, 88 patients) or SMD alone (6 teams, 16 providers, 80 patients). Patients were assessed at 6, 12 and 36 weeks with the Patient Health Questionnaire-9 (PHQ-9). Treatment receipt was ascertained through patient inquiry and electronic records. Audio-recorded index encounters were evaluated for mediators of improved depressive symptoms (providers' MI ability and patient language favoring participating in treatment or other depression related mood-improving behaviors).


RESULTS
In Intention-To-Treat analyses, MI-SMD was associated with a more favorable trajectory of PHQ-9 depressive symptom scores than SMD alone (randomization group × time interaction estimate = 0.13, p = .018). At 36 weeks, MI-SMD was associated with improved depressive symptoms (Cohen's d = 0.41, 95% CI [0.11, 0.72]) and remission rate (Success Rate Difference = 14.53 [1.79, 27.26]) relative to SMD alone. MI-SMD was not associated with a significant group x time interaction for remission, or with increased receipt of antidepressant medication or specialty mental health counseling. The providers' ability to direct clinical discussions toward treating depression, and the patients' language favoring engagement in mood-improving behaviors, mediated the effects of MI-SMD on depressive symptoms (ps < .05).


CONCLUSIONS
Training providers to frame discussions about depression using MI may improve upon standard management for depression. (PsycINFO Database Record
Department of Community Health Services, Denver Health.
Robert D
0000-0001-5748-9503
RD
Keeley
Department of Internal Medicine, University of Colorado-Denver.
David S
DS
Brody
Department of Pediatrics, University of Kansas.
Matthew
M
Engel
Department of Psychology, Fort Lewis College.
Brian L
BL
Burke
Department of Community Health Services, Denver Health.
Kimberly
K
Nordstrom
Department of Public Health Sciences, New Mexico State University-Las Cruces.
Ernesto
E
Moralez
Department of Family Medicine, University of Colorado-Denver.
L Miriam
LM
Dickinson
Caroline
C
Emsermann
D000328:Adult; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*