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A Pilot Study of Telephone Care Management and Structured Disease Self-Management Groups for Chronic Depression

OBJECTIVE: The authors developed, implemented, and pilot-tested intervention programs to provide effective care for chronic or recurrent depression. METHODS: A total of 104 patients with chronic or recurrent depression were randomly assigned to one of four groups: continued usual behavioral health care, usual care plus telephone monitoring and care management by a care manager, usual care plus care management plus a peer-led chronic-disease self-management group program, or usual care plus care management plus a professionally led depression psychotherapy group. Outcomes in intent-to-treat analyses were assessed at three, six, nine, and 12 months and included treatment participation rates, Hopkins Symptom Checklist depression scale scores, major depression (Structured Clinical Interview for DSM-IV), Patient-Rated Global Improvement ratings, treatment satisfaction, and adequacy of medication. RESULTS: Participation in care management was high in the three intervention groups. Close to 60% of participants invited to both group interventions attended at least an initial meeting, but a greater number assigned to the care management plus the professionally led group continued participation through the 12-month period. The sample was too small to reliably detect small or moderate differences in clinical outcomes, but various measures consistently favored the care management plus professionally led group. CONCLUSIONS: It is feasible to direct additional intervention services to patients with persistent or recurring depression. A larger trial of organized self-management support for chronic depression will be necessary for a definitive evaluation of program effectiveness.

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August 2007: This Month's Highlights
Psychiatr Serv 2007 58: 1031. [Full Text] [PDF]

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