Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D
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Background Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown. Objective To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial. Design Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system. Participants A total of 2,876 previously established outpatients in primary (n = 1091) or specialty (n = 1785) with nonpsychotic depression who had at least 1 post-baseline measure. Measurements and main results Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR(16)]); response (QIDS-SR(16)); time to first remission (QIDS-SR(16)). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p = .40) and by QIDS-SR(16) (32.5% PC vs 33.1% SC, p = .78) and response rates by QIDS-SR(16) (45.7% PC vs 47.6% SC, p = .33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p = .12) and to response (5.5 weeks PC vs 5.4 weeks SC, p = .97) did not differ by setting. Conclusions Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.
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Pharmacotherapeutic treatment, primarily antidepressants, can take 6 to 8 weeks or more to become effective.
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- Authors
- Gaynes, B. N., Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Balasubramani, G. K., McGrath, P. J., Thase, M. E., Klinkman, M., Nierenberg, A. A., Yates, W. R., & Fava, M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- The University of Texas Southwestern Medical Center (US)
- University of Pittsburgh (US)
- New York State Psychiatric Institute (US)
- University of Pennsylvania (US)
- University of Michigan (US)
- Harvard University (US)
- University of Oklahoma (US)
- Corresponding author
- Gaynes, Bradley N.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2008-02-05
- Volume
- 23
- Issue
- 5
- Pages
- 551-560
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2324144
- OpenAlex
- W2050866278
- Cited by
- 97
- References
- 67
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 8 · 2018: 4 · 2017: 3 · 2016: 6 · 2015: 3 · 2014: 6 · 2013: 8 · 2012: 9
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- University of Texas Southwestern Medical Center
- National Institutes of Health (n01mh90003-26-0-0, N01MH90003)
- National Institute of Mental Health (N01‐MH‐90003, N01 MH090003, NIMH K23, K23 MH01951-03, K23MH001951)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- major depressive disorder, primary care, specialist care, measurement-based care, citalopram, STAR*D, outpatients, remission, treatment response, antidepressant treatment, comparison of care settings
- MeSH terms
- Adult, Antidepressive Agents, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Medicine, Mental Health Services, Middle Aged, Outpatients, Primary Health Care, Psychology, Specialization, Citalopram, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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