Stepped Collaborative Care for Primary Care Patients With Persistent Symptoms of Depression

Abstract

OVER THE LAST decade, multiple studies have shown that there is a high prevalence of major depression in primary care (6%-10%).^1,2 There has been substantial evidence demonstrating that depression is associated with multiple unexplained medical symptoms,³ impairment in functioning and quality of life,^2,4 and high medical costs.^5,6 There is also accumulating evidence that more intensive, organized treatment that integrates mental health practitioners into primary care improves outcomes of depressed patients.^7-9 However, changes brought on by health system reform have tended to decrease the availability of specialty mental health care to primary care patients.¹⁰ These opposing trends make it imperative that scarce specialty resources are used when and where they are most needed. This study tests a population-based collaborative care model that attempts to use specialty resources in the most efficient way to reduce the burden of depression.