The Design, Implementation, and Acceptance of a Primary Care-Based Intervention to Prevent Depression Relapse

Int J Psychiatry Med. 2000;30(3):229-45. doi: 10.2190/44LK-28E9-RRJ5-KQVW.

Abstract

Objective: This article describes the conceptual underpinnings, implementation, and participation rates of a twelve-month low-intensity primary care-based intervention to prevent depression relapse. The intervention was designed to address the inherent problems in delivery of effective maintenance treatment in a population based sample of primary care patients.

Methods: Patients at high risk of relapse based on psychiatric history who recovered from depression six to eight weeks after initiation of pharmacotherapy by their primary care physician were eligible; 194 were randomized to receive the intervention. The intervention combined education about depression, motivation-enhancing shared decision-making regarding the use of maintenance pharmacotherapy, and cognitive-behavioral strategies. The program included two visits with a Depression Prevention Specialist working in tandem with the primary care physician at the primary care clinic, with supervision and back up from a consulting psychiatrist, proactive follow-up telephone calls and mailed personalized feedback.

Results: Ninety-three percent of patients attended both in-person visits; 97 percent attended one visit. Eighty percent of patients completed all three follow-up telephone calls, and 85 percent returned at least one mailed feedback form; 48 percent returned all four forms. Offered a menu of options for self-management, most patients chose medication as well as a variety of behavioral strategies. At six months, 72 percent ofpatients and at twelve months 62 percent of patients remained on antidepressant medication.

Conclusions: We conclude that it is feasible to integrate a low intensity, twelve-month relapse prevention intervention for depression into a primary care clinic.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Counseling
  • Depression / drug therapy
  • Depression / prevention & control*
  • Depressive Disorder / drug therapy
  • Depressive Disorder / prevention & control*
  • Humans
  • Motivation
  • Patient Compliance
  • Patient Education as Topic
  • Primary Health Care / methods*
  • Random Allocation
  • Secondary Prevention*

Substances

  • Antidepressive Agents