Blog | Monday, November 11, 2013

QD: News Every Day--Depression interventions may increase treatment, but not outcomes

Use of a tailored interactive computer program for depression immediately prior to a primary care visit resulted in the increased of recommended prescriptions or mental health referrals compared with a control group, a study found.

Researchers randomized adults treated by 135 primary care clinicians with and without depression defined by Patient Health Questionnaire-9 (PHQ-9) score from June 2010 through March 2012 at 7 sites in California. They treated patients with either a depression engagement video targeted to sex and income levelsthat was designed to encourage patient participation in depression-related discussion and care, or an interactive multimedia computer program that was tailored to individual patient characteristics and was intended to improve initial depression care without increasing unnecessary antidepressant prescribing. A control group received a sleep hygiene video.

The video was designed to enhance depression recognition and care-seeking by educating patients about depression, emphasizing the importance of disclosing relevant symptoms and suggesting ways to start a conversation with their primary care physician. The computer program provided patients with feedback tailored to their level of depression symptoms as determined on the PHQ-9, the visit agenda, the reasons for depression, treatment preferences, ability to communicate with health care professionals, and depression stigma.

Results appeared online Nov. 5 at JAMA, The Journal of the American Medical Association.

Of the 925 eligible patients, 867 were included in the primary analysis (depressed, 559; nondepressed, 308). For depressed patients, primary outcomes included superiority assessment of the composite measure of patient-reported antidepressant drug recommendation, mental health referral, or both. For nondepressed patients, the primary outcome was noninferiority assessment of clinician- and patient-reported antidepressant drug recommendations.

Among depressed patients, rates of achieving the primary outcome were 17.5% for the video, 26% for the computer program, and 16.3% for the control group (video vs control, 1.1; 95% CI, −6.7 to 8.9; P=0.79; computer program vs control, 9.9; 95% CI, 1.6 to 18.2; P=0.02). There were no effects on PHQ-8 measured depression score at the 12-week follow-up: video vs control, −0.2; 95% CI, −1.2 to 0.8; computer program vs control, 0.9; 95% CI, −0.1 to 1.9.

Among nondepressed patients, clinician-reported antidepressant prescribing in the two treatment groups was noninferior to control (mean percentage point difference: video vs control, −2.2; 90% CI, −8.0 to 3.49; P=.0499 for noninferiority; computer program vs control, −3.3; 90% CI, −9.1 to 2.4; P=0.02 for noninferiority).

Researchers noted that the tailored computer program had no effect on 12-week, clinically meaningful outcomes.

First author Richard L. Kravitz, MD, FACP, and colleagues wrote, “Translating improvements in initial depression process of care into better clinical outcomes may require reinforcement, clinician support, or systems improvement and additional research examining the effect of combined interventions is warranted.”