Resident Perceptions of Depression Care After Exposure to Depression Care Management

Internal medicine residents usually have few opportunities to see or participate in successful depression treatment. Care management models for mental health/primary care integration, in which evidence based primary care depression treatment is supported by a nurse depression care manager(DCM)and supervising psychiatrist, could provide such experiences. Relationships between resident experiences with care management, comfort and degree of difficulty in providing depression care were assessed using a web-based survey in 2005-2006. 59/149 eligible residents responded in two Southern California Veteran's Administration programs. 19% of residents had co-managed half or more of their depressed patients with a care manager; 33% had co-managed none. 32% of residents were very or moderately comfortable with managing depression versus 68% who found it only fairly or not at all comfortable. 36% were very or moderately comfortable treating with medications. 33% managed depression and 64% treated with medications with some or no difficulty versus the remainder who did these activities with much difficulty or did not do them. Residents who were more likely to co-manage depression with a care manager experienced less difficulty managing or treating depression (p<.05), but were no more comfortable with depression management. While the experience of working with a DCM neither increases or decreases comfort of providing depression care, participation in care management can reduce the perceived difficulty in providing treatment. Hence, additional training and methods of increasing comfort as residents take on greater responsibility for depression care are needed.