In a collaborative effort between a managed behavioral health organization, a health maintenance organization, and a state employer, this pilot study tested the value of mailing a depression education flyer to primary care patients who were recently prescribed antidepressant medications and an informational letter to their physician. The intervention, designed to improve use of behavioral healthcare services and antidepressant medication adherence, had a moderate impact on consistency of antidepressant medication use and on use of psychotherapy in combination with antidepressant medications. Additionally, intervention patients on combination treatment were more likely to stay on antidepressant medications into the continuation phase of treatment.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Copies of the Depression Information Flyer are available from the first author upon request.
Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association. 2003;289(23):3095–3105.
Thase ME. Effectiveness of antidepressants: comparative remission rates. Journal of Clinical Psychiatry. 2003;64(Suppl 2):3–7.
Westen D, Morrison K. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consulting Clinical Psychology. 2001;69(6):875–899.
Casacalenda N, Perry JC, Looper K. Remission in major depressive disorder: a comparison of pharmacotherapy, psychotherapy, and control conditions. American Journal of Psychiatry. 2002;159(8):1354–1360.
Thase ME, Greenhouse JB, Frank E, et al. Treatment of major depression with psychotherapy or psychotherapy–pharmacotherapy combinations. Archives of General Psychiatry. 1997;54(11):1009–1015.
Burnand Y, Andreoli A, Kolatte E, et al. Psychodynamic psychotherapy and clomipramine in the treatment of major depression. Psychiatric Services. 2002;53(5):585–590.
Pampallona S, Bollini P, Tibaldi G, et al. Combined pharmacotherapy and psychological treatment for depression: a systematic review. Archives of General Psychiatry. 2004;61(7):714–749.
Dobrez DG, Melfi CA, Croghan TW, et al. Antidepressant treatment for depression: total charges and therapy duration. Journal of Mental Health Policy and Economics. 2000;3(4):187–197.
de Jonghe F, Kool S, van Aalst G, et al. Combining psychotherapy and antidepressants in the treatment of depression. Journal of Affective Disorders. 2001;64(2–3):217–229.
Thase ME, Howland RH. Refractory depression: relevance of psychosocial factors and therapies. Psychiatric Annals. 1994;24:232–240.
Fava GA, Grandi S, Zielezny M, et al. Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. American Journal of Psychiatry. 1994;151(9):1295–1299.
Fava GA, Savron G, Grandi S, et al. Cognitive–behavioral management of drug-resistant major depressive disorder. Journal of Clinical Psychiatry. 1997;58:278–282.
Kocsis JH, Rush AJ, Markowitz JC, et al. Continuation treatment of chronic depression: A comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and their combination. Psychopharmacology Bulletin. 2003;37(4):73–87.
Fava GA, Rafanelli C, Grandi S, et al. Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. American Journal of Psychiatry. 1998;155:1443–1445.
Hollon SD, DeRubeis RJ, Shelton RC, et al. Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry. 2005;62(4):417–422.
Katz SJ, Kessler RC, Lin E, et al. Medication management of depression in the United States and Ontario. Journal of General Internal Medicine. 1998;13(2):77–85.
Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine. 2005;352(24):2515–2523.
Dwight-Johnson M, Sherbourne CD, Liao D, et al. Treatment preferences among depressed primary care patients. Journal of General Internal Medicine. 2000;15(8):527–534.
Davidson JR, Meltzer-Brody SE. The underrecognition and undertreatment of depression: what is the breadth and depth of the problem? Journal of Clinical Psychiatry. 1999;60(Suppl 7):4–9.
Simon GE, VonKorff M, Rutter C, et al. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. British Medical Journal. 2000;320(7234):550–554.
Robinson WD, Geske JA, Prest LA, et al. Depression treatment in primary care 2005. Journal of the American Board of Family Practice. 2005;18(2):79–86.
Way K, Young CH, Opland E. Antidepressant utilization patterns in a national managed care organization. Drug Benefit Trends. 1999;11(9):6–11.
Schoenbaum M, Unutzer J, Wetzel J, et al. Reasons for use and early discontinuation of antidepressant medication: a pilot study. Paper presented at: Academy Health Meeting June 27, 2003.
Lin EH, Von Korff M, Katon W, et al. The role of the primary care physician in patients' adherence to antidepressant therapy. Medical Care. 1995;33(1):67–74.
Whooley MA, Simon GE. Managing depression in medical outpatients. New England Journal of Medicine. 2000;343(26):1942–1950.
Solberg LI, Trangle MA, Wineman AP. Follow-up and follow-through of depressed patients in primary care: the critical missing components of quality care. Journal of the American Board of Family Practice. 2005;18(6):520–527.
Keller MB. The long-term treatment of depression. Journal of Clinical Psychiatry. 1999;60(Suppl 17):41–45.
Nierenberg, AA. Management of patients on antidepressant therapy. Journal of Clinical Psychiatry Monograph. 1999;17:22–25.
Mundt J, Clarke G, Burroughs D, et al. Effectiveness of antidepressant pharmacotherapy: the impact of medication compliance and patient education. Depression and Anxiety. 2001;13:1–10.
Ruoff G. A method that dramatically improves patient adherence to depression treatment. Journal of Family Practice. 2005;54(10):846–852.
Rost K, Nutting P, Smith J, et al. The role of competing demands in the treatment provided primary care patients with major depression. Archives of Family Medicine. 2000;9(2):150–154.
Von Korff M, Unutzer J, Katon W, Wells K. Improving care for depression in organized health care systems. Journal of Family Practice. 2001;50(6):530–531.
National Center for Health Statistics. Health, United States 2004 With Chartbook on Trends in the Health of Americans. Hyattsville, Maryland, 2004.
Greenberg PE, Kessler RC, Birnbaum HG, et al. The economic burden of depression in the United States: how did it change between 1990 and 2000? Journal of Clinical Psychiatry. 2003;64(12):1465–1475.
Stewart WF, Ricci JA, Chee E, Morganstein D, et al. Lost productive time and cost due to common pain conditions in the US workforce. Journal of the American Medical Association. 2003;290(18):2443–2454.
The authors would like to acknowledge our collaborating partners Mark D. Aldrich from UBH and Scott Solsman, who at the time of the study was employed by the Benefits Administration Services Office for the State of Ohio. Both of them were essential in the design and implementation of this study. We would also like to thank Joyce McCulloch and Dr. Robert Fusco of UBH for their helpful comments on the manuscript.
This study was conducted at United Behavioral Health (UBH), 425 Market Street, 27th Floor, San Francisco, CA 94105, USA.
Rober B. Branstrom, PhD, United Behavioral Health, Behavioral Health Sciences, 425 Market Street, 27th Floor, San Francisco, CA 94105, USA.
About this article
Cite this article
Azocar, F., Branstrom, R.B. Use of Depression Education Materials to Improve Treatment Compliance of Primary Care Patients. JBHSR 33, 347–353 (2006). https://doi.org/10.1007/s11414-006-9030-6
- Behavioral Health
- Antidepressant Medication
- Primary Care Patient
- Behavioral Health Service
- Continuation Phase