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October 1996

A Multifaceted Intervention to Improve Treatment of Depression in Primary Care

Author Affiliations

From the Departments of Psychiatry and Behavioral Sciences (Drs Katon and Walker), University of Washington Medical School, and the Center for Health Studies (Drs Robinson, Von Korff, Lin, Bush, Ludman, and Simon), Group Health Cooperative of Puget Sound, Seattle.

Arch Gen Psychiatry. 1996;53(10):924-932. doi:10.1001/archpsyc.1996.01830100072009

Background:  This research study evaluates the effectiveness of a multifaceted intervention program to improve the management of depression in primary care.

Methods:  One hundred fifty-three primary care patients with current depression were entered into a randomized controlled trial. Intervention patients received a structured depression treatment program in the primary care setting that included both behavioral treatment to increase use of adaptive coping strategies and counseling to improve medication adherence. Control patients received "usual" care by their primary care physicians. Outcome measures included adherence to antidepressant medication, satisfaction with care of depression and with antidepressant treatment, and reduction of depressive symptoms over time.

Results:  At 4-month follow-up, significantly more intervention patients with major and minor depression than usual care patients adhered to antidepressant medication and rated the quality of care they received for depression as good to excellent. Intervention patients with major depression demonstrated a significantly greater decrease in depression severity over time compared with usual care patients on all 4 outcome analyses. Intervention patients with minor depression were found to have a significant decrease over time in depression severity on only 1 of 4 study outcome analyses compared with usual care patients.

Conclusion:  A multifaceted primary care intervention improved adherence to antidepressant regimens and satisfaction with care in patients with major and minor depression. The intervention consistently resulted in more favorable depression outcomes among patients with major depression, while outcome effects were ambiguous among patients with minor depression.