Care managers were psychotherapists

Subjects and clinicians had treatment choice of medications (QI-meds), psychotherapy (QI-therapy), or both (QI-both)

For QI-meds, care managers followed guideline-based algorithms

For QI-therapy, care managers provided weekly sessions of manualized CBT (group or individual)

Statistically significant difference of intervention compared to control at 6 months for the following outcomes:

  • depressive symptoms (CESD = 19.0 vs 21.4; p = 0.02)

  • quality of life scores (SF-12-MCS = 44.6 versus 42.8; p = 0.03)

Nonsignificant improvements seen in greater decrease of suicide attempts among intervention subjects versus controls (14.2% to 6.4% versus 11.6% to 9.5%)

Greater emphasis placed on psychotherapy, particularly in intervention group

Unclear as to what interface was between primary care physicians and care managers

Degree of improvement consistent with previous studies among adults and elderly conducted by same research group (Partners in Care)

Centrally located care managers contacted subjects after 1 week and monthly thereafter to assess response, promote adherence, and endorse self-help practices

Providers were contacted with treatment updates and recommendations

Psychiatrists supervised care managers on weekly basis via telephone

Statistically significant difference of intervention compared to control in depressive symptoms, remission rates, and at least one follow-up visit at 3 and 6 months

Not significantly different on antidepressant adherence and specialty counseling

Subsequent analysis demonstrated that high fidelity with chronic care model associated with better outcomes (e.g., education of subjects, regular contact with care managers, interface with mental health)

Intervention group received psychoeducation (hour-long session weekly × 8 weeks), adherence monitoring and advice from “nonprofessional” care managers

Providers for intervention subjects received training in pharmacotherapy (5 hours) plus weekly supervision by research psychiatrist

Statistically significant difference of intervention compared to control in depressive symptoms (EPDS), social function, and vitality (SF-36) at 3 months

Increase in antidepressant adherence

Psychoeducation attendance very low (2.7 visits of 8 possible)

Authors attribute failure to sustain response due to decrease medication adherence over time (68% relapse rate if medication discontinued during first 3 months versus 26% relapse if medication continued)

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