Pilot randomized trial of a cross-diagnosis collaborative care program for patients with mood disorders

Abstract

Objectives: Chronic care models improved outcomes for persons with mental disorders but to date have primarily been tested for single diagnoses (e.g. unipolar depression). We report findings from a pilot multisite randomized controlled trial of a cross-diagnosis care model for patients with mood disorders.

Methods: Patients (N = 60) seen in one of four primary care or mental health clinics affiliated with the National Network of Depression Centers were randomized to receive a mood disorder care model, Life Goals Collaborative Care (LGCC, N = 29) or usual care (N = 31). LGCC consisted of five group self-management sessions focused on mood symptom coping and health behavior change strategies followed by monthly patient and provider care management contacts for up to 6 months. Outcomes at 3 and 6 months included mood symptoms (Patient Health Questionnaire-PHQ-9, Internal State Scale-well-being, Generalized Anxiety Disorder scale) and health-related quality of life.

Results: Of the 60 enrolled, the mean age was 46.2 (SD = 13.2), 73.3% were female, 16.7% were non-white, and 36.8% had a bipolar disorder diagnosis. LGCC was associated with greater likelihood of depressive symptom remission in 6 months (respectively, 50% versus 19% had a PHQ-9 score ≤9 and 50% reduction in PHQ-9 score, P = .04) and improved well-being (β = 2.66, P ≤ .01, Cohen's D = 0.43).

Conclusions: LGCC may improve outcomes for patients regardless of mood diagnosis, potentially providing a feasible and generalizable chronic care model for routine practice settings.