Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care.

OBJECTIVES

To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care.

DESIGN

Randomised controlled trial.

SETTING

Twelve primary care practices across the United States.

PARTICIPANTS

211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated.

INTERVENTION

Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months.

MAIN OUTCOME MEASURES

Patients' report of remission and functioning.

RESULTS

Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms.

CONCLUSIONS

Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.