Evidence-Based Models of Integrated Management of Depression in Primary Care
Section snippets
Primary care research in substance abuse and mental health for the elderly
Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) is a multisite trial comparing service use, outcomes, and costs in integrated versus enhanced referral models of mental health care for older persons with depression, anxiety, or at-risk alcohol consumption. Integrated treatment models have the following features: mental health services are colocated in the primary care setting, with no distinction in terms of signage or clinic names; mental health services are
Improving mood: promoting access to collaborative treatment
Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) is a multisite primary care trial of collaborative [14] and stepped care [16] for late-life depression that integrates brief psychotherapy and medication management [30]. IMPACT draws on earlier studies that focused on adults of all ages and that suggested that the barriers to effective treatment of depression might be more problematic for older adults because of stigma, ageism, and the clinical complexities associated with
Prevention of suicide in primary care elderly: collaborative trial
The Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) is a multisite collaborative study funded by the National Institute of Mental Health in 1998 and conducted by the Late-Life Mood Disorder Intervention Research Centers at the University of Pittsburgh, the University of Pennsylvania, and Cornell University. PROSPECT was designed to assess whether depression treatment in primary care settings can reduce the risk of suicide in elderly patients. The research design of
Re-engineering systems for primary care treatment of depression
In 1995, the John D. and Catherine T. MacArthur Foundation charged leading clinicians and researchers in primary care and mental health to make a national difference in the primary care management of depression. Findings from initial projects [10], [39], [40], [41] and related first- and second-generation clinical trials spawned a three-component clinical model for primary care depression management and a practice change model to support local adoption of the clinical model [42]. Key elements
Care management and the role of the mental health specialist
The preceding overview of state-of-the-art efforts to systematically modify the management of depression in primary care practice highlights the diverse factors affecting the success of these efforts. The three trials comparing system change with usual care included different depression diagnoses and used different outcome time points and different depression measures. Nevertheless, the results were all positive, with effect sizes in the small to medium range. Given the small number of studies
Assessing and managing suicidality
Considering the care manager's role in assessing and treating depression in the primary care sector, can this person also serve as a resource in managing the suicidal ideation and behaviors presented by a subgroup of depressed ambulatory care patients? The significance of this question is highlighted by a growing awareness that the primary care sector potentially can play a crucial role in resolving the public health crisis of suicide [51], [52]. Because approximately 45% of persons who killed
Discussion
The sizeable number of primary care practices, clinicians, and patients that have participated in three generations of health services research on the management of depression is impressive. The most recent generation of this research focuses extensively on the elderly, and its findings deserve the attention of geriatric mental health specialists. The study results published to date suggest that these system changes produce better outcomes than usual care for depression in a wide range of
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Cited by (0)
The authors have not received pharmaceutical industry support. Dr. Oxman received support from the Substance Abuse and Mental Health Services Administration (as co-investigator for PRISM-E), the John D. and Catherine T. MacArthur Foundation (as co-investigator for RESPECT-D), and the John A. Hartford Foundation (as consultant for IMPACT). Dr. Dietrich received support from the John D. and Catherine T. MacArthur Foundation (as principal investigator for RESPECT-D and consultant for IMPACT). Dr. Schulberg received support from the John D. and Catherine T. MacArthur Foundation (as co-investigator for RESPECT-D) and the John A. Hartford Foundation (as consultant for IMPACT).