• Steven K Dobscha, Kathryn Corson, David H Hickam, Nancy A Perrin, Dale F Kraemer, and Martha S Gerrity.
• Portland Veterans Affairs Medical Center, Oregon Health & Science University, and Oregon State University, Portland, Oregon 97207, USA. steven.dobscha@va.gov
• Ann. Intern. Med. 2006 Oct 3;145(7):477-87.

BackgroundIntensive collaborative interventions improve depression outcomes, but the benefit of less intensive interventions is not clear.ObjectiveTo determine whether decision support improves outcomes for patients with depression.DesignClinician-level, cluster randomized, controlled trial.Setting5 primary care clinics of 1 Veterans Affairs medical center.Participants41 primary care clinicians, and 375 patients with depression (Patient Health Questionnaire [PHQ-9] depression scores of 10 to 25 or Hopkins Symptom Checklist-20 [SCL-20] scores > or = 1.0).MeasurementsThe primary outcome was change in depression score (SCL-20) at 6 and 12 months. Secondary outcomes were health-related quality-of-life (36-item Short Form for Veterans [SF-36V] score), patient satisfaction, antidepressant use, and health care utilization.InterventionClinicians received depression education and were randomly assigned to depression decision support or usual care. The depression decision support team, which consisted of a psychiatrist and nurse, provided 1 early patient educational contact and depression monitoring with feedback to clinicians over 12 months.ResultsAlthough SCL-20 depression scores improved in both groups, the intervention had no effect compared with usual care. The difference in slopes comparing intervention and control over 12 months was 0.20 (95% CI, -0.37 to 0.78; P = 0.49), which was neither clinically nor statistically significant. Changes in SF-36V scores also did not differ between groups. At 12 months, intervention patients reported greater satisfaction (P = 0.002) and were more likely to have had at least 1 mental health specialty appointment (41.1% vs. 27.2%; P = 0.025), to have received any antidepressant (79.3% vs. 69.3%; P = 0.041), and to have received antidepressants for 90 days or more (76.2% vs. 61.6%; P = 0.008).LimitationsUsual care clinicians received depression education and had on-site mental health support, which may have mitigated intervention effectiveness.ConclusionsDecision support improved processes of care but not depression outcomes. More intensive care management or specialty treatment may be needed to improve depression outcomes.

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