Improving Primary Care for Depression in Late Life: The Design of a Multicenter Randomized Trial

Unützer, Jürgen; Katon, Wayne; Williams, John W; Callahan, Christopher M.; Harpole, Linda H.; Hunkeler, Enid M.; Hoffing, Marc; Areán, Patricia A.; Hegel, Mark T.; Schoenbaum, Michael; Oishi, Sabine; Langston, Christopher A.

doi:10.1097/00005650-200108000-00005

Cited by 263 publications

(250 citation statements)

References 52 publications

Supporting

Mentioning

248

Contrasting

Unclassified

Order By: Relevance

“…It has been recognised that improving the treatment of common mental health problems is a very complex task which requires changes to the way care is provided, together with additional resources to develop the appropriate systems to enable primary care professionals to deliver high quality care (Gilbody 2003a;Katon 1997;Katon 2001). Four distinct models of quality improvement in common mental health problems have been identified: training primary care staff, consultation-liaison, replacement/referral, and collaborative care (Bower 2005).…”

Section: Description Of the Interventionmentioning

confidence: 99%

“…Case management has been described as a health worker taking responsibility for proactively following up patients, assessing patient adherence to psychological and pharmacological treatments, monitoring patient progress, taking action when treatment is unsuccessful, and delivering psychological support (Von Korff 2001). Case managers work closely with the primary care provider (who retains overall clinical responsibility) and can receive regular supervision from a mental health specialist (Gilbody 2003a;Katon 2001). …”

Section: How the Intervention Might Workmentioning

confidence: 99%

See 1 more Smart Citation

Collaborative care for depression and anxiety problems

Archer

Bower

Gilbody

et al. 2012

Cochrane Database of Systematic Reviews

730

562

View full text Add to dashboard Cite

Section: Description Of the Interventionmentioning

confidence: 99%

Section: How the Intervention Might Workmentioning

confidence: 99%

Collaborative care for depression and anxiety problems

Archer

Bower

Gilbody

et al. 2012

Cochrane Database of Systematic Reviews

730

562

View full text Add to dashboard Cite

“…In terms of substantive findings, clients had a high prevalence of depression, 33 % overall and 35 % in primary care/public health settings with even higher prevalence in other screening locations; by comparison, depression rates in primary care are typically 6-20 %. 7,40,[48][49][50] Thus, clients in safety net populations within under-resourced communities have a high burden of depression meriting evaluation. The clients were primarily African American or Latino and most were uninsured, met federal poverty criteria, or were not employed.…”

Section: Discussionmentioning

confidence: 99%

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

et al. 2013

View full text Add to dashboard Cite

BACKGROUND:As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in underresourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES:Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.KEY WORDS: depression services; community-partnered; participatory research; CPPR; CBPR; community-based; under-resourced. J Gen Intern Med 28(10):1279-87 DOI: 10.1007/s11606-013-2480-7 © Society of General Internal Medicine 2013 BACKGROUND Current healthcare reforms call for expansions of primary care and integrated medical homes for safety-net populations. 1,2 Primary care is a "de facto" mental health setting, 3 where rates of recognition and treatment for depression are lower than in specialty mental health settings. 4 While collaborative care is effective for primary care depressed patients, [5][6][7] little is known about how to conceptualize depression management in neighborhoods with high rates of poverty and ethnic minority representation. 8 Neighborhood poverty is predictive of depression onset, 9 and while prevalence of depressive disorders is similar for Latinos and African Americans relative to non-Hispanic whites, 10,11 African Americans may have greater severity when depressed. 12 Ethnic and socioeconomic disparities in access to and quality of mental health...

show abstract

“…Patients were excluded if they had current alcohol abuse, a history of bipolar disorder or schizophrenia, ongoing treatment by a psychiatrist, severe cognitive impairment, or a high acute risk for suicide. (Unutzer et al, 2001) The Institutional Review Boards from each participating organization and the study coordinating center approved the study procedures and all patients signed informed consents. None of the authors have any financial conflicts of interest that would bias this work.…”

Section: Overviewmentioning

confidence: 99%

“…Details of the independent assessment procedures have been reported elsewhere. (Unutzer et al, 2001) …”

Section: Survey Datamentioning

confidence: 99%

One extra month of depression: the effects of caregiving on depression outcomes in the IMPACT trial

Thompson

Fan

Unützer

et al. 2008

Int J Geriat Psychiatry

Self Cite

View full text Add to dashboard Cite

show abstract

Improving Primary Care for Depression in Late Life: The Design of a Multicenter Randomized Trial

Cited by 263 publications

References 52 publications

Collaborative care for depression and anxiety problems

Collaborative care for depression and anxiety problems

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

One extra month of depression: the effects of caregiving on depression outcomes in the IMPACT trial

Contact Info

Product

Resources

About