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February 21, 2017

When and How to Treat Subthreshold Depression

Author Affiliations
  • 1VA Health Services Research and Development Service Center for Health Communication and Information, Regenstrief Institute, Indianapolis, Indiana
  • 2Indiana University School of Medicine, Indianapolis
JAMA. 2017;317(7):702-704. doi:10.1001/jama.2017.0233

Depressive disorders are present in about 10% of primary care patients and account for more years lived with disability than any single disease.1,2 Nearly three-quarters of all outpatient visits for depression are to primary care clinicians rather than to mental health specialists.3 Collaborative care is a therapeutic intervention in which behavioral health is integrated into primary care, most commonly using a nurse care manager to monitor depressive symptoms in depressed patients and adjust treatment under the supervision of a psychiatrist. Many of the nurse contacts are conducted by telephone, thereby increasing the efficiency of collaborative care. Although collaborative care has been demonstrated to improve depression in more than 80 randomized clinical trials,4,5 most trials have targeted major depression.