Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2002 Oct 26;325(7370):934.
doi: 10.1136/bmj.325.7370.934.

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

Kathryn Rost  1 , Paul Nutting, Jeffrey L Smith, Carl E Elliott, Miriam Dickinson
Affiliations
Clinical Trial

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

Kathryn Rost et al. BMJ. .

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of patient recruitment and participation
Figure 2
Figure 2
Effect of ongoing intervention in primary care on treatment of patients with depression
Figure 3
Figure 3
Effect of ongoing intervention in primary care on outcomes among patients with depression
See this image and copyright information in PMC

Comment in

References

    1. Andrews G. Should depression be managed as a chronic disease? BMJ. 2001;322:419–421. - PMC - PubMed
    1. Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry. 1998;55:694–700. - PubMed
    1. Wells KB, Burnam A, Rogers W, Hays R, Camp P. The course of depression in adult outpatients: results from the medical outcomes study. Arch Gen Psychiatry. 1992;49:788–794. - PubMed
    1. Rost KM, Zhang M, Fortney J, Smith J, Coyne J, Smith GR., Jr Persistently poor outcomes of undetected major depression in primary care. Gen Hosp Psychiatry. 1998;20:12–20. - PubMed
    1. Lin EHB, Katon WJ, Von Korff M, Russo JE, Simon GE, Bush TM, et al. Relapse of depression in primary care: rate and clinical predictors. Arch Fam Med. 1998;7:443–449. - PubMed

Publication types

Substances