Interventions that improve the quality of depression care: where do we go from here?

Harpole, Linda H; Harpole, L H
December 2000
JGIM: Journal of General Internal Medicine;Dec2000, Vol. 15 Issue 12, p894
Academic Journal
In this study, the authors hypothesized that depression severity would predict outcome, and patients were thus stratified by depression severity prior to randomization. As they anticipated, intervention patients in the lower severity group were significantly more likely to improve over time. The more severely depressed group did not experience greater improvement than the usual care group. This was in spite of more intensive pharmacotherapy and appropriate antidepressant dosing. However, these patients were more likely to have comorbid panic disorder, loneliness, and childhood emotional abuse. Interestingly, they were more likely than the control group to improve over the first 3 months of the study, while the active intervention was ongoing. However, the difference in response between the intervention and usual tare groups disappeared at 6 months, when psychiatry visits were no longer occurring. This suggests that more severely depressed patients with other comorbid illness may require more intensive, continued support and psychotherapy, as appropriate medication management alone was not sufficient. This hypothesis needs to be further tested, but implies that more explicit stepped collaborative care algorithms that match intensity and longevity with severity may prove to be the next step in improving the effectiveness and cost-effectiveness of depression therapy.


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