Strategies to Improve the Management of Depression in Primary Care

Primary Care - Clinics in Office Practice

Volumn 39, Issue 2, 2012, Pages 415-431

  Unützer, Jürgen ^a   Park, Mijung ^a  

^a UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE   (United States)

Author keywords

Collaborative care; Depression; Primary care

Indexed keywords

ANTIDEPRESSANT AGENT;

CASE FINDING; COST CONTROL; DEPRESSION; ELECTROCONVULSIVE THERAPY; EVIDENCE BASED MEDICINE; FOLLOW UP; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE FINANCING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HUMAN; INTERDISCIPLINARY COMMUNICATION; MAJOR DEPRESSION; MEDICAL SPECIALIST; PATIENT EDUCATION; PRACTICE GUIDELINE; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PSYCHOTHERAPY; REVIEW; SCREENING TEST;

ANTIDEPRESSIVE AGENTS; CHRONIC DISEASE; COOPERATIVE BEHAVIOR; DEPRESSION; DISEASE MANAGEMENT; EVIDENCE-BASED MEDICINE; HUMANS; MASS SCREENING; PATIENT SATISFACTION; PRIMARY HEALTH CARE;

EID: 84861171954     PISSN: 00954543     EISSN: 1558299X     Source Type: Journal    
DOI: 10.1016/j.pop.2012.03.010     Document Type: Review

References (119)

1. Moussavi S., Chatterji S., Verdes E., et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007, 370(9590):851-858.
2. Regier D.A., Goldberg I.D., Taube C.A. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry 1978, 35(6):685-693.
3. Barrett J.E., Barrett J.A., Oxman T.E., et al. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry 1988, 45(12):1100-1106.
4. Ansseau M., Dierick M., Buntinkx F., et al. High prevalence of mental disorders in primary care. J Affect Disord 2004, 78(1):49-55.
5. Leon A.C., Olfson M., Broadhead W.E., et al. Prevalence of mental disorders in primary care: implications for screening. Arch Fam Med 1995, 4(10):857-861.
6. Kroenke K., Spitzer R.L., Williams J.B., et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007, 146(5):317-325.
7. Sherbourne C.D., Jackson C.A., Meredith L.S., et al. Prevalence of comorbid anxiety disorders in primary care outpatients. Arch Fam Med 1996, 5(1):27-34. [discussion: 35].
8. Brienza R.S., Stein M.D. Alcohol use disorders in primary care. J Gen Intern Med 2002, 17(5):387-397.
9. Regier D.A., Narrow W.E., Rae D.S., et al. The de Facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 1993, 50(2):85-94.
10. Katon W., Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry 1992, 14(4):237-247.
11. Zung W., Broadhead W., Roth M. Prevalence of depressive symptoms in primary care. J Fam Pract 1993, 37(4):337-344.
12. Schubiner H., Tzelepis A., Wright K., et al. The clinical utility of the safe times questionnaire. J Adolesc Health 1994, 15(5):374-382.
13. Winter L.B., Steer R.A., Jones-Hicks L., et al. Screening for major depression disorders in adolescent medical outpatients with the Beck Depression Inventory for primary care. J Adolesc Health 1999, 24(6):389-394.
14. Johnson J.G., Harris E.S., Spitzer R.L., et al. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health 2002, 30(3):196-204.
15. Lyness J.M., Caine E.D., King D.A., et al. Psychiatric disorders in older primary care patients. J Gen Intern Med 1999, 14(4):249-254.
16. Stafford R.S., Ausiello J.C., Misra B., et al. National patterns of depression treatment in primary care. Primary Care Companion J Clin Psychiatry 2000, 2:211-216.
17. Harman J.S., Veazie P.J., Lyness J.M. Primary care physician office visits for depression by older Americans. J Gen Intern Med 2006, 21(9):926-930.
18. Klein D.N., Shankman S.A., Rose S. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression. Am J Psychiatry 2006, 163(5):872-880.
19. Alexopoulos G., Chester J.G. Outcomes on geriatric depression 1992, vol. 8. Elsevier, New York.
20. Iosifescu D.V., Nierenberg A.A., Alpert J.E., et al. Comorbid medical illness and relapse of major depressive disorder in the continuation phase of treatment. Psychosomatics 2004, 45(5):419-425.
21. Wang P.S., Demler O., Olfson M., et al. Changing profiles of service sectors used for mental health care in the United States. Am J Psychiatry 2006, 163(7):1187-1198.
22. Burns B.J., Costello E.J., Angold A., et al. Children's mental health service use across service sectors. Health Aff 1995, 14(3):147-159.
23. Kessler R.C., Birnbaum H., Bromet E., et al. Age differences in major depression: results from the National Comorbidity Survey Replication (NCS-R). Psychol Med 2010, 40(02):225-237.
24. Mauksch L.B., Tucker S.M., Katon W.J., et al. Mental illness, functional impairment, and patient preferences for collaborative care in an uninsured, primary care population. J Fam Pract 2001, 50(1):41-47.
25. Cunningham P.J. Beyond parity: primary care physicians' perspectives on access to mental health care. Health Aff 2009, 28(3):w490-w501.
26. Katon W.J. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry 2003, 54(3):216-226.
27. Simon G.E., VonKorff M. Somatization and psychiatric disorder in the NIMH epidemiologic catchment area study. Am J Psychiatry 1991, 148(11):1494-1500.
28. Henningsen P., Zimmermann T., Sattel H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med 2003, 65(4):528-533.
29. Gureje O., Von Korff M., Simon G.E., et al. Persistent pain and well-being. JAMA 1998, 280(2):147-151.
30. Van der Kooy K., van Hout H., Marwijk H., et al. Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 2007, 22(7):613-626.
31. Knol M., Twisk J., Beekman A., et al. Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 2006, 49(5):837-845.
32. Mezuk B., Eaton W.W., Golden S.H. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2009, 32(5):e57.
33. Bonnewyn A., Katona C., Bruffaerts R., et al. Pain and depression in older people: comorbidity and patterns of help seeking. J Affect Disord 2009, 117(3):193-196.
34. Cuijpers P., Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 2002, 72(3):227-236.
35. Katon W.J., Lin E., Russo J., et al. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 2003, 60(9):897-903.
36. Simon G., Ormel J., VonKorff M., et al. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 1995, 152(3):352-357.
37. Unützer J., Patrick D.L., Simon G., et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. JAMA 1997, 277(20):1618-1623.
38. Wells K., Stewart A., Hayes R., et al. The functioning and well-being of depressed patients. Results from the medical outcomes study. JAMA 1989, 262:914-919.
39. Alexopoulos G.S., Buckwalter K., Olin J., et al. Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry 2002, 52(6):543-558.
40. Kessler R.C., Ormel J., Demler O., et al. Comorbid mental disorders account for the role impairment of commonly occurring chronic physical disorders: results from the national comorbidity survey. J Occup Environ Med 2003, 45(12):1257-1266.
41. Barry L.C., Allore H.G., Bruce M.L., et al. Longitudinal association between depressive symptoms and disability burden among older persons. J Gerontol A Biol Sci Med Sci 2009, 64(12):1325-1332.
42. Ciechanowski P.S., Katon W.J., Russo J.E. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000, 160(21):3278-3285.
43. Lin E.H., Katon W., Von Korff M., et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 2004, 27(9):2154-2160.
44. Greenberg P.E., Kessler R.C., Birnbaum H.G., et al. The economic burden of depression in the United States: how did it change between 1990 and 2000?. J Clin Psychiatry 2003, 64(12):1465-1475.
45. Sewitch M.J., McCusker J., Dendukuri N., et al. Depression in frail elders: impact on family caregivers. Int J Geriatr Psychiatry 2004, 19(7):655-665.
46. Unützer J., Patrick D.L., Diehr P., et al. Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int Psychogeriatr 2000, 12(01):15-33.
47. Hahn S., Kroenke K., Spitzer R., et al. The difficult patient. J Gen Intern Med 1996, 11(1):1-8.
48. Callahan E., Bertakis K., Azari R., et al. The influence of depression on physician-patient interaction in primary care. Fam Med 1996, 28(5):346-351.
49. Ettner S.L., Azocar F., Branstrom R.B., et al. Association of general medical and psychiatric comorbidities with receipt of guideline-concordant care for depression. Psychiatr Serv 2010, 61(12):1255-1259.
50. Gonzalez H.M., Vega W.A., Williams D.R., et al. Depression care in the United States: too little for too few. Arch Gen Psychiatry 2010, 67(1):37-46.
51. Unützer J., Katon W., Callahan C.M., et al. Depression treatment in a sample of 1,801 depressed older adults in primary care. J Am Geriatr Soc 2003, 51(4):505-514.
52. Mojtabai R., Olfson M. Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Aff 2011, 30(8):1434-1442.
53. Screening for depression: recommendations and rationale 2002, U.S. Preventive Services Task Force, Available at:, Accessed October 30, 2011. http://www.uspreventiveservicestaskforce.org/3rduspstf/depression/depressrr.htm.
54. Watkins C.L., Lightbody C.E., Sutton C.J., et al. Evaluation of a single-item screening tool for depression after stroke: a cohort study. Clin Rehabil 2007, 21(9):846-852.
55. Kroenke K., Spitzer R.L., Williams J.B. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003, 41(11):1284-1292.
56. Mynors-Wallis L., Gath D., Day A., et al. Randomised controlled trail of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ 2000, 320:26-30.
57. Kuyken W., Byford S., Taylor R.S., et al. Mindfulness-based cognitive therapy to prevent relapse in recurrent depression. J Consult Clin Psychol 2008, 76(6):966-978.
58. Cuijpers P., van Straten A., Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev 2007, 27(3):318-326.
59. Health care guideline: major depression in adults in primary care 2009, Institute for Clinical Systems Improvement (ICSI), Bloomington (MN).
60. APA working group on major depressive disorder. Practice guideline for the treatment of patients with major depressive disorder 2010, American Psychiatric Association, Arlington (VA).
61. Dwight-Johnson M., Unutzer J., Sherbourne C., et al. Can quality improvement programs for depression in primary care address patient preferences for treatment?. Med Care 2001, 39(9):934-944.
62. Lin P., Campbell D., Chaney E., et al. The influence of patient preference on depression treatment in primary care. Ann Behav Med 2005, 30(2):164-173.
63. Trivedi M., Rush A., Wisniewski S., et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006, 163(1):28-48.
64. Hansen N.B., Lambert M.J., Forman E.M. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract 2002, 9(3):329-343.
65. Thase M., Haight B., Richard N., et al. Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors: a meta-analysis of original data from 7 randomized controlled trials. J Clin Psychiatry 2005, 66(8):974-981.
66. Simon G.E., Perlis R.H. Personalized medicine for depression: can we match patients with treatments?. Am J Psychiatry 2010, 167(12):1445-1455.
67. Rush A.J., Trivedi M.H., Wisniewski S.R., et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 2006, 163(11):1905-1917.
68. Unutzer J., Katon W., Sullivan M., et al. Treating depressed older adults in primary care: narrowing the gap between efficacy and effectiveness. Milbank Q 1999, 77(2):225-256. 174.
69. Young A.S., Klap R., Sherbourne C.D., et al. The quality of care for depressive and anxiety disorders in the United States. Arch Gen Psychiatry 2001, 58(1):55-61.
70. Duhoux A., Fournier L., Nguyen C.T., et al. Guideline concordance of treatment for depressive disorders in Canada. Soc Psychiatry Psychiatr Epidemiol 2009, 44(5):385-392.
71. Wells K.B., Schoenbaum M., Unutzer J., et al. Quality of care for primary care patients with depression in managed care. Arch Fam Med 1999, 8(6):529-536.
72. Henke R.M., Zaslavsky A.M., McGuire T.G., et al. Clinical inertia in depression treatment. Med Care 2009, 47(9):959-967. 910.
73. Unutzer J., Katon W., Callahan C.M., et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA 2002, 288(22):2836-2845.
74. Rush A.J., Trivedi M., Carmody T.J., et al. One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies. Biol Psychiatry 2004, 56(1):46-53.
75. Simon G.E., Von Korff M., Rutter C.M., et al. Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch Gen Psychiatry 2001, 58(4):395-401.
76. Hansen N. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract 2002, 9:329-343.
77. Tai-Seale M., McGuire T., Colenda C., et al. Two-minute mental health care for elderly patients: inside primary care visits. J Am Geriatr Soc 2007, 55(12):1903-1911.
78. Unutzer J., Schoenbaum M., Druss B.G., et al. Transforming mental health care at the interface with general medicine: report for the President's Commission. Psychiatr Serv 2006, 57(1):37-47.
79. Uebelacker L.A., Smith M., Lewis A.W., et al. Treatment of depression in a low-income primary care setting with colocated mental health care. Fam Syst Health 2009, 27(2):161-171.
80. Gilbody S., Bower P., Fletcher J., et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med 2006, 166:2314-2321.
81. Simon G. Collaborative care for depression. BMJ 2006, 332(7536):249-250.
82. Simon G. Collaborative care for mood disorders. Curr Opin Psychiatry 2009, 22(1):37-41.
83. Roy-Byrne P., Craske M.G., Sullivan G., et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care. JAMA 2010, 303(19):1921-1928.
84. Katon W.J., Lin E.H., Von Korff M., et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010, 363(27):2611-2620.
85. Katon W., Unutzer J. Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med 2006, 166(21):2304-2306.
86. Katon W., Unutzer J., Wells K., et al. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. Gen Hosp Psychiatry 2010, 32(5):456-464.
87. Katon W., Von Korff M., Lin E., et al. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen Hosp Psychiatry 2001, 23(3):138-144.
88. Von Korff M., Tiemens B. Individualized stepped care of chronic illness. West J Med 2000, 172(2):133-137.
89. Kroenke K., Spitzer R.L., Williams J.B. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16(9):606-613.
90. Löwe B., Unützer J., Callahan C.M., et al. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care 2004, 42(12):1194-1201.
91. Kupfer D.J., Frank E., Perel J.M., et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry 1992, 49(10):769-773.
92. Roy-Byrne P., Craske M.G., Sullivan G., et al. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA 2010, 303(19):1921-1928.
93. Williams J.W., Gerrity M., Holsinger T., et al. Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry 2007, 29:91-116.
94. IMPACT evidence-based depression care 2011, AIMS Center, Available at:, Accessed October 29, 2011. http://impact-uw.org.
95. Levine S., Unutzer J., Yip J.Y., et al. Physicians' satisfaction with a collaborative disease management program for late-life depression in primary care. Gen Hosp Psychiatry 2005, 27(6):383-391.
96. Richardson L., McCauley E., Katon W. Collaborative care for adolescent depression: a pilot study. Gen Hosp Psychiatry 2009, 31(1):36-45.
97. Dwight-Johnson M., Ell K., Lee P.J. Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. Psychosomatics 2005, 46(3):224-232.
98. Ell K., Xie B., Quon B., et al. Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 2008, 26(27):4488-4496.
99. Ell K., Katon W., Xie B., et al. Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care 2010, 33(4):706-713.
100. Katon W.J., Russo J.E., Von Korff M., et al. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care 2008, 31(6):1155-1159.
101. Gilmer T.P., Walker C., Johnson E.D., et al. Improving treatment of depression among Latinos with diabetes using project dulce and IMPACT. Diabetes Care 2008, 31(7):1324-1326.
102. Unutzer J., Katon W.J., Fan M.Y., et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care 2008, 14(2):95-100.
103. Katon W.J., Roy-Byrne P., Russo J., et al. Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder. Arch Gen Psychiatry 2002, 59(12):1098-1104.
104. Grypma L., Haverkamp R., Little S., et al. Taking an evidence-based model of depression care from research to practice: making lemonade out of depression. Gen Hosp Psychiatry 2006, 28(2):101-107.
105. Reiss-Brennan B., Briot P.C., Savitz L.A., et al. Cost and quality impact of Intermountain's mental health integration program. J Healthc Manag 2010, 55(2):97-113. [discussion: 113-4].
106. Glied S., Herzog K., Frank R. Review: the net benefits of depression management in primary care. Med Care Res Rev 2010, 67(3):251-274.
107. Mental health: a report of the Surgeon General-executive summary 1999, U.S. Department of Health and Human Services, Available at:, Accessed October 30 2011. http://www.surgeongeneral.gov/library/mentalhealth.
108. New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America, Final Report. Vol DHHS. PMID: SMA-03-3832.2003.
109. Engaging large employers regarding evidence-based behavioral health treatment 2010, National Business Group on Health, Available at:, Accessed October 31, 2011. http://www.businessgrouphealth.org/benefitstopics/et_mentalhealth.cfm.
110. Butler M., Kane R.L., McAlpine D., et al. Integration of mental health/substance abuse and primary care. Evid Rep Technol Assess (Full Rep) 2008, (173):1-362.
111. Wagner E.H., Austin B.T., Von Korff M. Organizing care for patients with chronic illness. Milbank Q 1996, 74(4):511-544.
112. Trivedi M.H., Daly E.J. Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice. Drug Alcohol Depend 2007, 88(Suppl 2):S61-S71.
113. Institute for Clinical Systems Improvement (ICSI). Available at: Accessed July 10, 2011. http://www.icsi.org/health_care_redesign_/diamond_35953/.
114. Korsen N., Pietruszewski P. Translating evidence to practice: two stories from the field. J Clin Psychol Med Settings 2009, 16(1):47-57.
115. MHIP for behavioral health (mental health integration program) 2011, AIMS Center, Available at:, Accessed October 30, 2011. http://integratedcare-nw.org/.
116. United States Department of Defenses' Deployment Health Clinical Center (DHCC). RESPECT-Mil. Available at: Accessed October 30, 2011. http://www.pdhealth.mil/respect-mil/index.asp.
117. Collaborative care for depression in the primary care setting 2008, US Department of Veterans Affairs, Health Services Research and Development Service. Washington (DC).
118. Kathol R.G., Butler M., McAlpine D.D., et al. Barriers to physical and mental condition integrated service delivery. Psychosom Med 2010, 72(6):511-518.
119. Unützer J., Choi Y., Cook I.A., et al. A web-based data management system to improve care for depression in a multicenter clinical trial. Psychiatr Serv 2002, 53(6):671-673. 678.