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Who benefits from more structured depression treatment?
Terry Bush1, Carolyn Rutter, Greg Simon
1Center for Health Studies, Group Health Cooperative, Seattle, Washington, WA 98101-144, USA. bush.t@ghc.org
International Journal of Psychiatry in Medicine
|January 26, 2005
Summary
Collaborative Care interventions are effective for depression. However, predicting who benefits most is difficult; routine outcome monitoring is recommended for optimal treatment response in patients with depression.
Area of Science:
- Psychiatry
- Primary Care Medicine
- Health Services Research
Background:
- Major depression is a leading cause of disability worldwide.
- Effective treatments exist, but predicting individual response remains challenging.
- Collaborative Care models show promise in improving depression outcomes.
Purpose of the Study:
- To identify general prognostic factors for poor outcomes in depression.
- To determine factors associated with differential treatment effects of Collaborative Care.
- To evaluate the robustness of Collaborative Care across diverse patient groups.
Main Methods:
- Analysis of data from two randomized controlled trials of Collaborative Care for major depression.
- Inclusion of adult primary care patients initiating antidepressant treatment.
- Definition of treatment response as a 50% or greater reduction in depression symptoms at four months.
Main Results:
- High neuroticism and a history of recurrent depression or dysthymia predicted poorer outcomes.
- Commonly cited predictors (age, gender, severity, comorbidities) did not predict differential treatment effects.
- Collaborative Care demonstrated robust effects across various at-risk populations.
Conclusions:
- Predicting individual benefit from Collaborative Care at diagnosis is not currently feasible.
- Routine monitoring of treatment outcomes is essential for optimizing depression care.
- Collaborative Care's effectiveness is consistent across diverse patient subgroups.