We propose a randomized trial to evaluate the effectiveness and cost-effectiveness of two innovative telephone-based interventions to improve primary care management of depression: A program of Phone Monitoring and Self-Care including: telephone monitoring (2 contacts during acute-phase treatment), care management (communication and coordination with treating physicians) plus self-care (written psychoeducational materials emphasizing cognitive and behavioral self-management techniques with mailed reminder/self-monitoring materials during maintenance phase). A program of Phone Monitoring and Counseling including: more frequent phone monitoring and care management plus a structured phone counseling program (an 8-session manualized cognitive-behavioral program followed by 4 telephone relapse- prevention sessions. These intervention programs have similar goals and content, but they differ significantly in expected cost and skill level of personnel required. We will evaluate these programs among primary care patients with residual symptoms (SCL Depression score greater than 0.5) 8 weeks after initiation of antidepressant treatment. Eligible and consenting patients will be randomly assigned to either continued Usual Care or one of the two intervention programs. Blinded assessments will examine clinical outcomes (SCL depression score, depression diagnosis by SCID) and functional outcomes (SF-36 Questionnaire and disability/lost productivity) over 18 months. Computerized data systems will be used to assess quality of treatment received (prescriptions filled and visits made) as well as treatment costs. Data analyses will examine: Feasibility and Acceptability of the two intervention programs Short-term long-term effects of each intervention on process of care (depression treatment visits in primary and specialty care, intensity/duration of pharmacotherapy) and patient outcomes (depressive symptoms, functional impairment, disability/lost productivity) Maintenance of intervention effects after withdrawal of intervention services (i.e. 12-18 mos) Incremental cost and cost-effectiveness of each intervention program compared to care as usual.
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