Nathalie Moise1, Louise Falzon2, Megan Obi3, Siqin Ye2, Sapana Patel4,5, Christopher Gonzalez6, Kelsey Bryant6, Ian M Kronish2. 1. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA. nm2562@cumc.columbia.edu. 2. Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA. 3. Case Western Reserve University, Cleveland, OH, USA. 4. The New York State Psychiatric Institute, Research Foundation for Mental Hygiene, New York, NY, 10032, USA. 5. Department of Psychiatry, Columbia University, College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY, 10032, USA. 6. New York Presbyterian Hospital, New York, NY, USA.
Abstract
INTRODUCTION: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence. RESULTS: Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation). DISCUSSION: Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, our review highlights the need for further rigorous research in this area.
INTRODUCTION: Nearly 50% of depressed primary care patients referred to mental health services do not initiate mental health treatment. The most promising interventions for increasing depression treatment initiation in primary care settings remain unclear. METHODS: We performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation. Two authors independently selected, extracted data, and rated risk of bias from included studies. Eligible studies used a randomized or pre-post design and assessed depression treatment initiation (i.e., ≥ 1 mental health visit or antidepressant fill) among adults, the majority of whom met criteria for depression. Interventions were classified as simple or complex and sub-classified into intervention strategies that were graded for strength of evidence. RESULTS: Of 9516 articles identified, we included 14 unique studies representing 16 (4 simple and 12 complex) interventions and 8 treatment initiation strategies. We found low to moderate strength of evidence for collaborative/integrated care (3 studies), treatment preference matching (2 studies), and case management (2 studies) strategies. However, there was insufficient evidence to determine the benefit of cultural tailoring (2 studies), motivation (alone, with reminders or with cultural tailoring (5 studies)), education (1 study), and shared decision-making strategies (1 study). Overall, we found moderate strength of evidence for complex interventions (8 of 12 complex interventions demonstrated statistically significant effects on treatment initiation). DISCUSSION: Collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressedpatients to treatment, our review highlights the need for further rigorous research in this area.
Authors: D E Bush; R C Ziegelstein; M Tayback; D Richter; S Stevens; H Zahalsky; J A Fauerbach Journal: Am J Cardiol Date: 2001-08-15 Impact factor: 2.778
Authors: Janine Graf; Christoph Lauber; Carlos Nordt; Peter Rüesch; Peter C Meyer; Wulf Rössler Journal: J Nerv Ment Dis Date: 2004-08 Impact factor: 2.254
Authors: Jane W Njeru; Ramona S DeJesus; Jennifer St Sauver; Lila J Rutten; Debra J Jacobson; Patrick Wilson; Mark L Wieland Journal: Int J Ment Health Syst Date: 2016-02-29