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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH051338-09
Application #
6538692
Study Section
Special Emphasis Panel (ZMH1-SRV-C (01))
Program Officer
Gonzales, Junius J
Project Start
1994-06-01
Project End
2004-05-31
Budget Start
2002-06-01
Budget End
2003-05-31
Support Year
9
Fiscal Year
2002
Total Cost
$475,225
Indirect Cost
Name
Center for Health Studies
Department
Type
DUNS #
078198520
City
Seattle
State
WA
Country
United States
Zip Code
98101
Simon, Gregory E; Ludman, Evette J (2013) Should mental health interventions be locally grown or factory-farmed? Am J Psychiatry 170:362-5
Tutty, Steve; Spangler, Diane L; Poppleton, Landon E et al. (2010) Evaluating the effectiveness of cognitive-behavioral teletherapy in depressed adults. Behav Ther 41:229-36
Simon, Gregory E; Ludman, Evette J; Rutter, Carolyn M (2009) Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Arch Gen Psychiatry 66:1081-9
Ludman, Evette J; Simon, Gregory E; Tutty, Steve et al. (2007) A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. J Consult Clin Psychol 75:257-66
Simon, Gregory E; Ludman, Evette J; Operskalski, Belinda H (2006) Randomized trial of a telephone care management program for outpatients starting antidepressant treatment. Psychiatr Serv 57:1441-5
Simon, Gregory E; Savarino, James; Operskalski, Belinda et al. (2006) Suicide risk during antidepressant treatment. Am J Psychiatry 163:41-7
Simon, Gregory E; Ludman, Evette J (2006) Outcome of new benzodiazepine prescriptions to older adults in primary care. Gen Hosp Psychiatry 28:374-8
Simon, Gregory E; Khandker, Rezaul K; Ichikawa, Laura et al. (2006) Recovery from depression predicts lower health services costs. J Clin Psychiatry 67:1226-31
Simon, Gregory E; Von Korff, Michael (2006) Medical co-morbidity and validity of DSM-IV depression criteria. Psychol Med 36:27-36
Tutty, Steve; Ludman, Evette Joy; Simon, Greg (2005) Feasibility and acceptability of a telephone psychotherapy program for depressed adults treated in primary care. Gen Hosp Psychiatry 27:400-10

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