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

doi: 10.1097/AOG.0000000000000231
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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

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

Departments of Obstetrics and Gynecology, Psychiatry, and Psychiatry and Behavioral Sciences at Harborview Medical Center and University of Washington Medical Center, University of Washington School of Medicine; and Group Health Research Institute, Seattle, Washington.

Corresponding author: Susan D. Reed, MD, MPH, Director, Women's Reproductive Health Research Program, Professor, Department of Obstetrics and Gynecology, Epidemiology, University of Washington School of Medicine, Chief of Service, Obstetrics and Gynecology, Harborview Medical Center, Box 359865, 1959 NE Pacific Street, Seattle, WA 98195; e-mail: reeds@uw.edu.

Sources of Funding: National Institute of Mental Health R01-MH085668.

The authors thank Mr. Eddie Edmondson, Ms. Erin McCoy, Ms. Anna Harrington, Ms. Leiszle Ziemba, and Ms. Virginia Eader for assistance with data collection and tracking, and Dr. Lee Cohen for chairing the data and safety monitoring board. The authors also acknowledge Ms. Michal Inspektor and Ms. Julie Walwick (posthumously) for depression care management and Dr. Nancy Grote for training depression care managers in the engagement session.

Financial Disclosure Dr. Katon receives royalties reserved for research from The Depression Helpbook, Bull Publishing Co. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.