Evaluation of an Integrated Behavioral Health Care Clinical Service Line for Depression: A Quality Improvement...

In this naturalistic study, the authors examined clinical outcomes among patients treated for new episodes of depression in an integrated multisite outpatient behavioral health care model. Psychotherapy, medication management (MM), and transcranial magnetic stimulation (TMS) were provided at each clinic location.

Utilization rates, treatment adherence, and outcomes were measured with the Patient Health Questionnaire and Generalized Anxiety Disorder scales and evaluated over 6 months for 2,160 patients (mean age=37.4 years, 63% female) treated between January 2022 and January 2024. Chi-square, Fisher's exact, and Kruskal-Wallis tests as well as analysis of variance were used for descriptive statistics. Kaplan-Meier, mixed modeling for repeated measures, and multivariable Cox proportional hazards regression analyses were used to evaluate outcomes, temporal trends, and associations with treatment modalities and adjusted for potential confounders.

Most patients received MM+psychotherapy (44%), followed by MM only (24%), psychotherapy only (13%), TMS+MM+psychotherapy (10%), TMS+MM (4%), TMS+psychotherapy (3%), and TMS only (2%). Depression severity was associated with the number of treatments, and treatment utilization and adherence levels were high. Clinical improvement and response were observed among 76% and 58% of patients, respectively. TMS and a higher number of treatment modalities were associated with greater clinical improvement.

The integrated behavioral health care service delivery model studied was associated with high rates of treatment utilization and adherence and meaningful clinical outcomes among adult patients with depression. Although only limited causal inferences can be made, this evaluation provides support for a service model of colocated evidence-based treatments to optimize engagement in care, clinician collaboration, and clinical outcomes.