Original Articles

Journal of General Internal Medicine

, Volume 18, Issue 1, pp 9-16

First online:

Effectiveness of collaborative care depression treatment in veterans’ affairs primary care

  • Susan C. HedrickAffiliated withthe Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care Systemthe Department of Health Services, University of Washington Email author 
  • , Edmund F. ChaneyAffiliated withMental Health Service, the VA Puget Sound Health Care Systemthe Department of Psychiatry and Behavioral Sciences, University of Washington
  • , Bradford FelkerAffiliated withMental Health Service, the VA Puget Sound Health Care Systemthe Department of Psychiatry and Behavioral Sciences, University of Washington
  • , Chuan-Fen LiuAffiliated withthe Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care Systemthe Department of Health Services, University of Washington
  • , Nicole HasenbergAffiliated withthe Department of Health Services, University of Washington
  • , Patrick HeagertyAffiliated withthe Department of Biostatistics, University of Washington
  • , Jan BuchananAffiliated withSocial Work, VA Puget Sound and the School of Social Work, University of Washington
  • , Rocco BagalaAffiliated withSocial Work, VA Puget Sound and the School of Social Work, University of Washington
  • , Diane GreenbergAffiliated withMental Health Service, the VA Puget Sound Health Care Systemthe Department of Psychiatry and Behavioral Sciences, University of Washington
    • , Grady PadenAffiliated withMedical Service, VA Puget Sound and the Department of Medicine, University of Washington
    • , Stephan D. FihnAffiliated withthe Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care Systemthe Department of Health Services, University of WashingtonMedical Service, VA Puget Sound and the Department of Medicine, University of Washington
    • , Wayne KatonAffiliated withthe Department of Psychiatry and Behavioral Sciences, University of Washington

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic.

DESIGN: Patients were randomly assigned to treatment model by clinic firm.

SETTING: VA primary care clinic.

PARTICIPANTS: One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia.

MEASUREMENTS: Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale.

MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months.

CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

Key words

depressive disorder primary health care veterans