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Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000231
Contents: Original Research

Improving Care for Depression in Obstetrics and Gynecology: A Randomized Controlled Trial

Melville, Jennifer L. MD, MPH; Reed, Susan D. MD, MPH; Russo, Joan PhD; Croicu, Carmen A. MD; Ludman, Evette PhD; LaRocco-Cockburn, Anna MSW, MPH; Katon, Wayne MD

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Abstract

OBJECTIVE: To evaluate an evidence-based collaborative depression care intervention adapted to obstetrics and gynecology clinics compared with usual care.

METHODS: A two-site, randomized controlled trial included screen-positive women (Patient Health Questionnaire-9 score of at least 10) who met criteria for major depression, dysthymia, or both (Mini-International Neuropsychiatric Interview). Women were randomized to 12 months of collaborative depression management or usual care; 6-month, 12-month, and 18-month outcomes were compared. The primary outcomes were change from baseline to 12 months in depression symptoms and functional status. Secondary outcomes included at least 50% decrease and remission in depressive symptoms, global improvement, treatment satisfaction, and quality of care.

RESULTS: Participants were, on average, 39 years old, 44% were nonwhite, and 56% had posttraumatic stress disorder. Intervention (n=102) compared with usual care (n=103) patients had greater improvement in depressive symptoms at 12 months (P<.001) and 18 months (P=.004). The intervention group compared with usual care group had improved functioning over the course of 18 months (P<.05), were more likely to have at least 50% decrease in depressive symptoms at 12 months (relative risk [RR] 1.74, 95% confidence interval [CI] 1.11–2.73), greater likelihood of at least four specialty mental health visits (6-month RR 2.70, 95% CI 1.73–4.20; 12-month RR 2.53, 95% CI 1.63–3.94), adequate dose of antidepressant (6-month RR 1.64, 95% CI 1.03–2.60; 12-month RR 1.71, 95% CI 1.08–2.73), and greater satisfaction with care (6-month RR 1.70, 95% CI 1.19–2.44; 12-month RR 2.26, 95% CI 1.52–3.36).

CONCLUSION: Collaborative depression care adapted to women's health settings improved depressive and functional outcomes and quality of depression care.

CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01096316.

LEVEL OF EVIDENCE: I

© 2014 by The American College of Obstetricians and Gynecologists.

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