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APHA Scientific Session and Event Listing

Domin Chan, MHS, PhC, Chuan-Fen Liu, PhD, Edmund Chaney, PhD, and Susan Hedrick, PhD. Northwest Health Services Research and Development, Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98102, 206-277-4159, dominc@u.washington.edu

Objective: To evaluate the effectiveness and cost-effectiveness of collaborative care depression treatment for primary care patients who screen positive for post-traumatic stress disorder (PTSD+). Methods: Veterans' Affairs depressed primary care patients with current depression were randomly assigned to collaborative care or enhanced usual care by provider group. Under collaborative care, a mental health team developed a treatment plan for primary care providers, a social worker telephoned patients to enhance adherence, and suggested treatment modifications. Depression and disability outcomes were measured at three and nine months by telephone interviews. Multivariate regression was used to detect differences in change scores, adjusting for baseline patient characteristics, and provider clustering. The cost-effectiveness ratios of additional depression treatment cost per depression-free day were calculated. Results: Depressed PTSD+ patients in collaborative care had significant improvement in SCL-20 depression score at 3 months (-0.26, p=.003) and at 9 months (-0.19, p=.016) compared to usual care. Collaborative care improved functioning for PTSD+ patients on the Sheehan Disability Scale by -0.87 (p=0.02) at 3 months, but not at 9 months. For depressed PTSD+ patients, total depression treatment costs for collaborative care were on average $323 more than usual care (95%CI $128-$579). Over nine months, collaborative care resulted in an additional 17 depression-free days (95%CI 0.7-33) compared to usual care. The incremental cost-effectiveness ratio for PTSD+ patients was $23 per depression-free day (95%CI $4-$103). Conclusions: Collaborative care resulted in higher functioning, sustained improvement in depression symptoms; greater depression-free days and moderately increased treatment costs for depressed PTSD+ veterans.

Learning Objectives:

• Describe and assess collaborative care treatment for depression in a primary care setting.
• Articulate and evaluate effectiveness of collaborative care treatment for depression in Veterans at risk for PTSD.

Keywords: Depression, Primary Care

Presenting author's disclosure statement:

Not Answered