Does a depression intervention result in improved outcomes for patients presenting with physical symptoms?
Cite this article as: Keeley, R.D., Smith, J.L., Nutting, P.A. et al. J GEN INTERN MED (2004) 19: 615. doi:10.1111/j.1525-1497.2004.30611.x Abstract OBJECTIVE: To investigate the effects of exclusively physical presentation of depression on 1) depression management and outcomes under usual care conditions, and 2) the impact of an intervention to improve management and outcomes. DESIGN AND SETTING: Secondary analysis of a depression intervention trial in 12 community-based primary care practices. PARTICIPANTS: Two hundred adults beginning a new treatment episode for depression. MEASUREMENTS: Presenting complaint and physician depression query at index visit; antidepressant use, completion of adequate antidepressant trial, change in depressive symptoms, and physical and emotional role functioning at 6 months. MAIN RESULTS: Sixty-six percent of depressed patients presented exclusively with physical symptoms. Under usual care conditions, psychological presenters were more likely than physicial presenters to complete an adequate trial of anti-depressant treatment but experienced equivalent improvements in depressive severity and role functioning. In patients presenting exclusively with physicial symptoms, the intervention significantly improved physician query (40.8% vs 18.0%; P=.06), receipt of any antidepressant (63.0% vs 20.1%; P=.001), and an adequate antidepressant trial (34.9% vs 5.9%; P=.004), but did not significantly improve depression severity or role functioning. In patients presenting with psychological symptoms, the intervention significantly improved receipt of any antidepressant (79.9% vs 38.0%; P=.01) and an adequate antidepressant trial (46.0% vs 23.8%; P=.004), and also improved depression severity and physical and emotional role functioning. CONCLUSIONS: Our results suggest that there is a differential intervention effect by presentation style at the index visit. Thus, current interventions should be targeted at psychological presenters and new approaches should be developed for physical presenters. Key words depressive disorder affective symptoms moderator variables somatoform disorders
Portions of this manuscript were presented at the Beyond the Clinic Walls: Expanding Mental Health, Drug, and Alcohol Services Research Outside the Specialty Care System Conference cosponsored by the National Institute of Mental Health, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism, Washington, DC, March 2003.
This manuscript was presented as a distinguished paper at the North American Primary Care Research Group Conference, Banff, Canada, October 26, 2003.
This research was supported by National Institute of Mental Health grant R01 MH54444, Health Resources and Services Administration National Research Service Award 5T32 HP 10006-10, and by a grant from the John D. and Catherine T. MacArthur Foundation. Dr. Rost is also supported by NIMH K02 Independent Scientist Award MH63651.
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