This proposal studies factors associated with physician decisions regarding results from an intervention program including a physician workshop, screening scale for depression, and its impact on patients' overall medical care utilization, health status, and satisfaction with treatment. A randomized clinical trial design with 12 months follow-up will be used. Specifically, the study will examine those factors which facilitate physicians to diagnose, treat or refer patients with depressive disorders. These include not only such factors as training in recognizing and treating depression but also use of psychiatric consultation, and the effect of discussing mental disorders on the physician-patient relationship. Patient factors include overall health status, the existence of physical diseases that require treatment, and patient resistance to psychiatric diagnosis and treatment. Approximately 1,200 consecutive patients in the General Medical Clinic of the Duke affiliated Durham VA Medical Center will be screened for depression. Patients screened positively using both the Self-rating Depression Scale and the depression portion of the NIMH Diagnostic Interview Schedule will be randomly assigned to the experimental group (primary physician informed of screening results) or control group (physician not-informed), and patients followed for 12 months from study entry. During this time, both their outpatient and inpatient medical charts will be reviewed to determie all diagnoses, treatment, diagnostic procedures, clinical evaluations of health status, and medical care utilization. Also, patients will be interviewed quarterly to determine their perceived health status, satisfaction with medical care received, changes in depressive symptomatology and any other outside VA sources of health used. Data on the informed and not-informed groups will be compared to evaluate factors associated with the physician's diagnosis and treatment of depression, and subsequent effect on the patient's health status and medical care utilization.
| Zung, W W; Magruder-Habib, K; Velez, R et al. (1990) The comorbidity of anxiety and depression in general medical patients: a longitudinal study. J Clin Psychiatry 51 Suppl:77-80;discussion 81 |
| Magruder-Habib, K; Zung, W W; Feussner, J R (1990) Improving physicians' recognition and treatment of depression in general medical care. Results from a randomized clinical trial. Med Care 28:239-50 |
| Magruder-Habib, K; Zung, W W; Feussner, J R et al. (1989) Management of general medical patients with symptoms of depression. Gen Hosp Psychiatry 11:201-7;discussion 216-21 |
