Tuesday, September 9, 2014

Collaborative Care for Depression in Ob-Gyn Patients Appears to Especially Help Disadvantaged, Study Suggests

Collaborative depression care adapted to obstetrics-gynecology settings appears to have a greater impact on depression outcomes for socially disadvantaged women with no insurance or with public coverage compared with women with commercial insurance, according to “A Randomized Trial of Collaborative Depression Care in Obstetrics and Gynecology Clinics: Socioeconomic Disadvantage and Treatment Response,” in AJP in Advance.

In the study, 205 women who screened positive for depression with a score of at least 10 on the Patient Health Questionnaire–9 and met criteria for major depression or dysthymia were randomized to a 12-month intervention program or to usual care, with blinded assessments at 6, 12, and 18 months. A total of 120 patients had no insurance or relied on public coverage ,and 85 had commercial insurance.

The collaborative care model included an initial engagement session with the care manager, choice of psychotherapy or medication, help for uninsured patients with charity care for medications and use of social workers as care managers to help alleviate barriers to care.

Compared with patients with commercial insurance, those with no insurance or with public coverage had greater recovery from depression symptoms with collaborative care than with usual care over the 18-month follow-up period.

Senior author Wayne Katon, M.D., (pictured above) told Psychiatric News the study is one of the first to show the benefits of collaborative care for disadvantaged patients. “Contrary to some studies which suggest that depression in socially disadvantaged women is difficult to treat due to the many social stressors these women experience, the current study in two university affiliated Ob-Gyn clinics actually showed that collaborative care was associated with a greater degree of recovery from depression compared to usual care in women with either no insurance or publically funded insurance compared to women with commercial insurance,” he said.


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