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Cited by 47Treatment of Major DepressionMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Characteristics, treatment patterns, and outcomes of persistent depression despite treatment in primary care

Sherbourne, Cathy, Schoenbaum, Michael, Wells, Kenneth B, Croghan, Thomas W·2004·General Hospital Psychiatry
DOI 10.1016/j.genhosppsych.2003.08.009
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Abstract

We examine the sociodemographic and clinical characteristics of depressed primary care patients who receive at least minimal standards of evidence-based treatment, comparing those who remain depressed with those who recover; and their subsequent treatment patterns and other outcomes. We used observational data from a subset of 542 treated patients participating in a group-level randomized controlled trial of quality improvement interventions for depression conducted in six managed care organizations. Nonresponse to treatment was defined as having at least minimally appropriate treatment for at least two of three 6-month periods but continuing to have probable depression. Our definitions of depression and appropriate treatment are broader than those used in clinical trials, but relevant to primary care settings. Many of the factors predictive of treatment resistance in clinical trials predict nonresponse to guideline concordant care among diverse primary care, depressed patients. The main unique predictors of nonresponse to treatment include a clinical factor (suicide ideation) requiring clinician assessment and intervention, a social/economic factor (unemployment) usually not addressed by medical interventions, and medication nonadherence. Nonresponders used more adjunctive therapies and combination medications, suggesting clinicians and patients were searching for solutions. High rates of service use and poor outcomes emphasize the urgency of new research to find solutions for these patients.

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Authors
Sherbourne, C., Schoenbaum, M., Wells, K. B., & Croghan, T. W.
Affiliations
RAND Corporation (US)
Corresponding author
Sherbourne, Cathy
ORCID
Wells, Kenneth B
Venue
General Hospital Psychiatry
Publisher
Elsevier BV
Published
2004-03
Volume
26
Issue
2
Pages
106-114
ISSN
0163-8343 (ISSN-L)
DOI
10.1016/j.genhosppsych.2003.08.009
OpenAlex
W1972430434
Cited by
47
References
56
Citations by year
2022: 1 · 2021: 1 · 2019: 2 · 2018: 2 · 2017: 5 · 2016: 1 · 2014: 2 · 2013: 5 · 2012: 6
FWCI
2.72
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • General Hospital Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01HS08349)
  • National Institute of Mental Health (P50-MH54623, P50MH054623)
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
dysthymia, treatment-resistant depression, primary care, guideline-concordant care, suicidal ideation, unemployment, medication non-adherence, adjunctive therapy, service utilization, quality improvement intervention, managed care
MeSH terms
Depression, Humans, Practice Patterns, Physicians', United States, Multivariate Analysis, Treatment Outcome

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