A Randomized Trial of Off-Site Collaborative Care for Depression in Chronic Hepatitis C Virus

To test the effectiveness of a collaborative depression care model in improving depression and hepatitis C virus (HCV) care.

Hepatitis C virus clinic patients who screened positive for depression at four Veterans Affairs Hospitals.

We compared off-site depression collaborative care (delivered by depression care manager, pharmacist, and psychiatrist) with usual care in a randomized trial. Primary depression outcomes were treatment response (≥50 percent decrease in 20-item Hopkins Symptoms Checklist [SCL-20] score), remission (mean SCL-20 score, <0.5), and depression-free days (DFDs). Primary HCV outcome was receipt of HCV treatment.

Patient data were collected by self-report telephone surveys at baseline and 12 months, and from electronic medical records.

Baseline screening identified 292 HCV-infected patients with depression, and 242 patients completed 12-month follow-up (82.9 percent). Intervention participants were more likely to report depression treatment response, remission, and more DFDs than usual care participants. Intervention participants were more likely to receive antiviral treatment; however, the difference was not statistically significant.

Off-site depression collaborative care improved depression outcomes in HCV patients and may serve as a model for collaboration between mental health and specialty physical health providers in other high co-occurring conditions.