Depression is a common comorbidity in patients with complex, chronic illnesses, such as cancer, diabetes, and HIV-related disease, adversely affecting patients' responses to treatment. Increasingly, the primary source of health care for such patients is a facility dedicated to the treatment of specific physical illnesses. Therefore, there's considerable interest in developing effective collaborative care models that can be used to treat mental health problems, such as depression, in settings like HIV clinics.
Researchers led by Jeffrey M. Pyne of the University of Arkansas conducted a randomized comparison of an intervention—the HIV Translating Initiatives for Depression into Effective Solutions (HITIDES)—with usual care in three Veterans Administration HIV clinics. An off-site depression-care team consisting of an RN depression-care manager, a pharmacist, and a psychiatrist delivered the intervention and collaborated with on-site HIV and mental health clinicians. The participants were 249 predominantly middle-aged black men with mild-to-moderate HIV symptoms, all of whom had recently been treated for depression. Most were single, had a high school education, were of low-to-middle income, and had a history of mood disorders; 18% met criteria for at-risk drinking. Patients were randomly assigned to either the intervention group (n = 123) or usual care (n = 126).
The nurse communicated with patients by telephone (at first every two weeks, then monthly), and depression screenings were completed by the HIV clinician during most visits. The RN monitored patients' progress, provided patient education, assessed treatment barriers, and suggested resolutions. In telephone calls, the RN used prewritten scripts guided by a Web-based decision-support system. The whole team conferred weekly or as needed and communicated with on-site clinicians via an electronic medical record. Data collectors were blinded to treatment assignment.
At six months, HITIDES lessened depression severity in a third of those who received the intervention, compared with only 17.5% in the usual-care group. The intervention also increased the number of depression-free days and improved remission rates. HIV symptoms were also less severe in the intervention group. At 12 months, the usual-care group had caught up to the intervention group, in terms of remission rate and symptom severity.
The authors noted that their study may be the first effectiveness trial of a collaborative-care intervention to treat depression in a long-term specialty physical health care setting and are hopeful that HITIDES can "serve as a model for collaborative care interventions in other specialty physical health care settings."—James M. Stubenrauch