CoChat
Sign Up
Cited by 332Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Randomized Trial of a Depression Management Program in High Utilizers of Medical Care

Katzelnick, D. J.·2000·Archives of Family Medicine
DOI 10.1001/archfami.9.4.345
Open this paper in CoChat — free account

Abstract

BACKGROUND: High utilizers of nonpsychiatric health care services have disproportionally high rates of undiagnosed or undertreated depression. OBJECTIVE: To determine the impact of offering a systematic primary care-based depression treatment program to depressed "high utilizers" not in active treatment. DESIGN: Randomized clinical trial. SETTING: One hundred sixty-three primary care practices in 3 health maintenance organizations located in different geographic regions of the United States. PATIENTS: A group of 1465 health maintenance organization members were identified as depressed high utilizers using a 2-stage telephone screening process. Eligibility criteria were met by 410 patients and 407 agreed to enroll: 218 in the depression management program (DMP) practices and 189 in the usual care (UC) group. INTERVENTION: The DMP included patient education materials, physician education programs, telephone-based treatment coordination, and antidepressant pharmacotherapy initiated and managed by patients' primary care physicians. MAIN OUTCOME MEASURES: Depression severity was measured using the Hamilton Depression Rating Scale (Ham-D) and functional status using the Medical Outcomes Study 20-item short form (SF-20) subscales. Outpatient visit and hospitalization rates were measured using the health plan's encounter data. RESULTS: Based on an intent-to-treat analysis, at least 3 antidepressant prescriptions were filled in the first 6 months by 151 (69.3%) of 218 of DMP patients vs 35 (18.5%) of 189 in UC (P < .001). Improvements in Ham-D scores were significantly greater in the intervention group at 6 weeks (P = .04), 3 months (P = .02), 6 months (P < .001), and 12 months (P < .001). At 12 months, DMP intervention patients were more improved than UC patients on the mental health, social functioning, and general health perceptions scales of the SF-20 (P < .05 for all). CONCLUSION: In depressed high utilizers not already in active treatment, a systematic primary care-based treatment program can substantially increase adequate antidepressant treatment, decrease depression severity, and improve general health status compared with usual care.

Integrity signals

Registry

Crossref · 10.1001/archfami.9.4.345

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Katzelnick, D. J.
Corresponding author
Katzelnick, D. J.
Venue
Archives of Family Medicine
Publisher
CLOCKSS Archive
Published
2000-04-01
Volume
9
Issue
4
Pages
345-351
ISSN
1063-3987 (ISSN-L)
DOI
10.1001/archfami.9.4.345
OpenAlex
W2134690592
Cited by
331
References
42
Citations by year
2025: 1 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 1 · 2019: 3 · 2018: 6 · 2017: 2 · 2016: 5 · 2015: 4 · 2014: 6 · 2013: 13 · 2012: 9
FWCI
50.82
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Family Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
high utilizers, depression treatment, antidepressant prescribing, primary care, health maintenance organizations, telephone screening, depression severity, functional status, health care utilization
MeSH terms
Antidepressive Agents, Depressive Disorder, Family Practice, Female, Health Maintenance Organizations, Health Services, Humans, Male, Mass Screening, Middle Aged, Patient Education as Topic, Primary Health Care, Psychiatric Status Rating Scales, Sertraline

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review