This study compares the effectiveness of two established treatments for major depression, anti-depressant medication and short-term cognitive behavioral therapy in public sector gynecology patients. They study these women because depression is most common among young women and among those who frequently use medical services. Young women who are frequent users of medical services are often seen by gynecologists rather than primary care setting. In their pilot study of 205 public sector gynecology patients, 21 percent met criteria for major depression, yet only 19 percent of those who are depressed had obtained treatment. This study will determine the effectiveness of two established treatments for depression for young African American, Latina, and White women seen in Prince George's county , Maryland public sector gynecology clinics. We will determine the rates of psychiatric disorders, as well as physical and sexual assault, among a sample of 3,886 women being screened for the study. In addition, they will determine the relationship of depression, history of physical assault, and history of sexual assault on use of medical services by these young women. A total of 450 women (150 each African-American, Latina and White) who meet DSM-IV criteria for major depression will be randomly assigned to pharmaco-therapy, cognitive behavioral group therapy, or gynecological care as usual. Evaluations will occur at intake, post- treatment, and 6 months follow-up. The hypothesize that those receiving pharmacotherapy or group therapy will report less depressive symptomalogy and improved functional status following treatment as compared with the care as usual women. They will examine the impact of treatments on subsequent medical utilization. In addition, they will determine whether history of assault impacts on depression treatment outcomes. Finally. they will examine the cost-effectiveness of the two treatments, with outcomes including both depressive symptomalogy and functional status.
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