Dr. Manson is applying for an RSDA, Level II to enable him to develop and evaluate an innovative program for improving the detection and management of depressive disorders among American Indian primary care patients. The project will be based in an outpatient clinic of the Indian Health Service in Shiprock, New Mexico, on the Navajo Indian Reservation. The evaluation uses a pre- and post-intervention design. All clinic physicians will be trained in the diagnosis and management of major depression. Half of the patients will be screened for major depression and the results provided to the physician before the patient examination; and the other half will be given a screening instrument unrelated to depression. The screening instrument for depression is the Inventory to Diagnose Depression (IDD), a self-report instrument, which will be adapted linguistically for this population. The effectiveness of the physician training will be evaluated by medical record review for examining changes in the management of depression, and by questionnaire for changes in the physicians's knowledge and attitudes. The internal consistency reliability of the screening instrument will be assessed. Its criterion validity will be examined in a sample of 80 patients, in relation to diagnoses based on the Schedule for Affective Disorders and Schizophrenia, Lifetime version (SADS-L). The criterion validity of clinic physicians' diagnoses will also be examined. The research will take place in a primary care clinic serving a population which has unusually great unmet health needs, and the planned model should also be applicable to other primary care clinical settings. Thus, this project involves evaluating a number of questions. In particular, the validity of the screening instrument, the effects of screening for depression in general, physicians' handling of depressed patients, the validity of general physicians' diagnosis of depression, and most centrally the impact of providing general physicians with a training program on the diagnosis and management of depression on their actual treatment and management of this condition.
