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Computer program might not help depression in primary care setting

Sunday November 10, 2013
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Among depressed patients evaluated in a primary care setting, use of an interactive multimedia computer program immediately before a primary care visit resulted in the increased receipt of antidepressant prescription recommendation, mental health referral or both, according to a study.

However, the intervention did not result in improvement in mental health at 12-week follow-up, researchers reported in the Nov. 6 issue of the Journal of the American Medical Association.

In background information for the study, the authors wrote: “Despite progress, depression in primary care remains underrecognized and undertreated. Barriers to improvement include system, clinician and patient factors. System-level interventions are effective in increasing recognition and treatment of depression, but these interventions are difficult to disseminate.”

Richard L. Kravitz, MD, MSPH, of the University of California, Davis, and colleagues examined whether targeted and tailored communication strategies could enhance patient engagement and initial care for patients with depression; and the extent to which the interventions promoted prescribing or recommendation of antidepressant medication, depression-related discussion and antidepressant requests among patients who were not depressed.

The study cohort was 925 adult patients treated by 135 primary care clinicians (603 patients with depression and 322 patients without depression) from June 2010 through March 2012 at seven primary care clinical sites in California. Patients were randomized to a depression engagement video targeted to gender and income, an interactive multimedia computer program tailored to individual patient characteristics, or a sleep hygiene video, which was the control group.

Of the 925 eligible patients, 867 were included in the primary analysis (depressed, 559; nondepressed, 308). The researchers found that among depressed patients, rates of achieving the primary outcome of patient-reported antidepressant drug recommendation, mental health referral or both were 17.5% for the depression engagement video, 26% for the computer program and 16.3% among the control group.

Both the depression engagement video and the computer program increased patient-reported requests for information about depression. However, there were no improvements in mental health (as gauged by the Patient Health Questionnaire-9) at the 12-week follow-up in response to either intervention.

Among nondepressed patients, no evidence of harm was observed from either intervention for the outcome of clinician-reported antidepressant prescribing, but the authors could not exclude harm — defined as a higher rate of antidepressant prescriptions for nondepressed patients associated with each intervention — based on patient-reported antidepressant recommendation.

“Further research is needed to determine effects on clinical outcomes and whether the benefits outweigh possible harms,” the authors concluded.

Study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1764049


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