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Effectiveness of collaborative care depression treatment in veterans’ affairs primary care

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Abstract

OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic.

DESIGN: Patients were randomly assigned to treatment model by clinic firm.

SETTING: VA primary care clinic.

PARTICIPANTS: One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia.

MEASUREMENTS: Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale.

MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months.

CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

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Author information

Authors and Affiliations

  1. the Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care System, Seattle, Wash

    Susan C. Hedrick PhD, Chuan-Fen Liu PhD & Stephan D. Fihn MD, MPH

  2. Mental Health Service, the VA Puget Sound Health Care System, Seattle, Wash

    Edmund F. Chaney PhD, Bradford Felker MD & Diane Greenberg PhD

  3. the Department of Health Services, University of Washington, Seattle, Wash

    Susan C. Hedrick PhD, Chuan-Fen Liu PhD, Nicole Hasenberg MPH & Stephan D. Fihn MD, MPH

  4. the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Wash

    Edmund F. Chaney PhD, Bradford Felker MD, Diane Greenberg PhD & Wayne Katon MD

  5. the Department of Biostatistics, University of Washington, Seattle, Wash

    Patrick Heagerty PhD

  6. Medical Service, VA Puget Sound and the Department of Medicine, University of Washington, Seattle, Wash

    Grady Paden MD & Stephan D. Fihn MD, MPH

  7. Social Work, VA Puget Sound and the School of Social Work, University of Washington, Seattle, Wash

    Jan Buchanan MSW, MC & Rocco Bagala ACSW

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  1. Susan C. Hedrick PhD
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  2. Edmund F. Chaney PhD
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  12. Wayne Katon MD
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Corresponding author

Correspondence to Susan C. Hedrick PhD.

Additional information

This report presents the findings and conclusions of the authors. It does not necessarily represent those of the VA or HSR&D Service.

The Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service supported this research.

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Hedrick, S.C., Chaney, E.F., Felker, B. et al. Effectiveness of collaborative care depression treatment in veterans’ affairs primary care. J GEN INTERN MED 18, 9–16 (2003). https://doi.org/10.1046/j.1525-1497.2003.11109.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.11109.x

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