Systematic review of multifaceted interventions to improve depression care

John W. Williams, Martha Gerrity, Tracey Holsinger, Steven Dobscha, Bradley Gaynes, Allen Dietrich

Research output: Contribution to journalArticle

196 Citations (Scopus)

Abstract

Objective: Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. Method: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. Results: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4% median absolute increase in patients with 50% improvement in symptoms; range, 8.3-46%). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. Conclusion: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.

Original languageEnglish (US)
Pages (from-to)91-116
Number of pages26
JournalGeneral Hospital Psychiatry
Volume29
Issue number2
DOIs
StatePublished - Mar 2007

Fingerprint

Depression
Primary Health Care
Registries
Bibliography
Patient Education
Self Care
Telephone
Mental Health
Language
Therapeutics
Randomized Controlled Trials
Research Personnel
Delivery of Health Care

Keywords

  • Care management
  • Depressive disorder
  • Literature synthesis

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)
  • Psychiatry and Mental health

Cite this

Systematic review of multifaceted interventions to improve depression care. / Williams, John W.; Gerrity, Martha; Holsinger, Tracey; Dobscha, Steven; Gaynes, Bradley; Dietrich, Allen.

In: General Hospital Psychiatry, Vol. 29, No. 2, 03.2007, p. 91-116.

Research output: Contribution to journalArticle

Williams, John W. ; Gerrity, Martha ; Holsinger, Tracey ; Dobscha, Steven ; Gaynes, Bradley ; Dietrich, Allen. / Systematic review of multifaceted interventions to improve depression care. In: General Hospital Psychiatry. 2007 ; Vol. 29, No. 2. pp. 91-116.
@article{9f74023324d442f09cace5ce3a93e1b3,
title = "Systematic review of multifaceted interventions to improve depression care",
abstract = "Objective: Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. Method: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. Results: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4{\%} median absolute increase in patients with 50{\%} improvement in symptoms; range, 8.3-46{\%}). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. Conclusion: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.",
keywords = "Care management, Depressive disorder, Literature synthesis",
author = "Williams, {John W.} and Martha Gerrity and Tracey Holsinger and Steven Dobscha and Bradley Gaynes and Allen Dietrich",
year = "2007",
month = "3",
doi = "10.1016/j.genhosppsych.2006.12.003",
language = "English (US)",
volume = "29",
pages = "91--116",
journal = "General Hospital Psychiatry",
issn = "0163-8343",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Systematic review of multifaceted interventions to improve depression care

AU - Williams, John W.

AU - Gerrity, Martha

AU - Holsinger, Tracey

AU - Dobscha, Steven

AU - Gaynes, Bradley

AU - Dietrich, Allen

PY - 2007/3

Y1 - 2007/3

N2 - Objective: Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. Method: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. Results: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4% median absolute increase in patients with 50% improvement in symptoms; range, 8.3-46%). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. Conclusion: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.

AB - Objective: Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. Method: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. Results: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4% median absolute increase in patients with 50% improvement in symptoms; range, 8.3-46%). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. Conclusion: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.

KW - Care management

KW - Depressive disorder

KW - Literature synthesis

UR - http://www.scopus.com/inward/record.url?scp=33847299529&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33847299529&partnerID=8YFLogxK

U2 - 10.1016/j.genhosppsych.2006.12.003

DO - 10.1016/j.genhosppsych.2006.12.003

M3 - Article

C2 - 17336659

AN - SCOPUS:33847299529

VL - 29

SP - 91

EP - 116

JO - General Hospital Psychiatry

JF - General Hospital Psychiatry

SN - 0163-8343

IS - 2

ER -