Collaborative treatment may improve depression outcomes

Women who are treated for depression at an ob/gyn clinic with a collaborative care approach may have improved outcomes, according to a recent study in Obstetrics & Gynecology.

Researchers at the University of Washington performed a two-site, randomized controlled trial, which included screen-positive women (Patient Health Questionnaire-9, with a score of at least 10) who had met criteria for major depression, dysthymia, or both.  Participants were an average of 39 years old; 44% were not white; and 56% suffered from posttraumatic stress disorder. They were randomized to either receive collaborative depression management (n = 102) or usual care (n = 103) for 12 months. Outcomes at 6, 12, and 18 months were compared.

The primary outcome was change from baseline to 12 months in depressive symptoms and functional status. Quality of care, treatment satisfaction, global improvement, and at least a 50% decrease and remission in depressive symptoms were the secondary outcomes.

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Intervention patients had greater improvement in depressive symptoms at 12 months (P <.001) and 18 months (P =.004), when compared to those in the usual care arm. When compared with the usual care group, the intervention group also had improved functioning over the course of 18 months (P<.5) and were more likely to see at least a 50% decrease in depressive symptoms at 12 months (relative risk [RR] 1.74, 95% confidence interval [CI] 1.11 – 2.73). Exposure to collaborative care was also associated with a greater likelihood of at least 4 specialty mental health visits (6-month RR 2.70, 95% CI 1.73-4.20; 12-month RR 2.53, 95% CI 1.63-3.94), receipt of an adequate dose of antidepressant (6-month RR 1.64, 95% CI 1.03-2.60; 12-month RR 1.71, 95% CI 1.08-2.73), and greater satisfaction with care (6-month RR 1.70, 95% CI 1.19-2.44; 12-month RR 2.26, 95% CI 1.52-3.36).

The researchers concluded that collaborative care adapted to the women’s health settings can improve depressive and functional outcomes, as well as quality of depression care. In a press release for the study, one of the study leads, Susan Reed, MD, MPH, said, “We anticipate fewer women will go to emergency rooms for acute care problems related to mental health, and more women will be able to rejoin the workforce.”

Related Story: Nearly 1 in 4 Women Depressed at 1 Year Postpartum

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