Organized Care for Depression Improves Outcomes and Reduces Costs

STUDY

Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, Ciechanowski P, Ludman EJ, Young BA: Cost-effectiveness of systematic depression treatment among people with diabetes mellitus.

SUMMARY

Design. A randomized controlled trial and economic analysis.

Subjects. Three hundred twenty-nine patients with diabetes and a current depressive disorder.

Methods. Researchers identified from computer records 9,063 patients with diabetes from nine primary care clinics affiliated with Group Health Cooperative and mailed them a survey that included the nine-item Patient Health Questionnaire (PHQ-9), a well-validated depression screening instrument. Those scoring 10 or more on the PHQ-9 on two separate occasions and who were found to have moderate or greater symptoms with the Hopkins Symptom Check List (SCL) were invited to an in-person baseline visit. Three hundred twenty-nine patients attended and were randomized to a nurse-delivered multi-component depression management program or usual care.

The program used a stepped-care approach with incorporation of patient preferences for treatment (antidepressant medication, structured psychotherapy, or both). Follow-up was delivered with a combination of in-person and phone-based visits. Outcomes were measured by blinded telephone-based assessments at 3, 6, 12, and 24 months. The main …