We propose a randomized trial of a multi-component intervention program to improve detection and management of depression among women in primary care. This study will be conducted in 3 public primary care clinics in deprived areas of Santiago, Chile. Using a two-stage screening process consecutive female attenders with current depressive disorders will be identified and invited to participate. Baseline assessment will include: symptom severity, diagnostic status, treatment history, medical and psychiatric co- morbidity and substance use, and functional status and disability. Consenting patients will be randomly assigned to usual care or to a comprehensive program with intensity of treatment adjusted according to symptom severity. For all patients in the intervention group the program will include a brief structured group program emphasizing education, behavioural activation and problem solving. Patients with more severe depression at the initial assessment will also be referred to the primary care physician to be evaluated for medication. All patients will be contacted for a formal assessment of treatment response after six weeks. Those with persistent depression will be referred to the primary care physician for evaluation. This evaluation will focus on initiating pharmacotherapy (for those not already receiving medication) or adjustments in existing pharmacotherapy. All patients, usual care and intervention, will complete blinded follow-up assessments at 1, 3 and 6 months after randomization. The assessments will include measurements of: symptom severity, functional status and disability, and health care utilization. These data will be used to answer the following questions: 1) Is delivery of organized depression treatment feasible in deprived public-sector primary care clinics? 2) Does the intervention program improve the clinical and functional outcome compared to usual care? 3) What are the incremental cost and cost-effectiveness of the intervention program compared to care as usual?
| Araya, Ricardo; Flynn, Terry; Rojas, Graciela et al. (2006) Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile. Am J Psychiatry 163:1379-87 |
