How Quality Improvement Interventions for Depression Affect Stigma Concerns Over Time

A Nine-Year Follow-Up Study

Published in: Psychiatric services, v. 60, no. 2, Feb. 2009, p. 258-261

Posted on RAND.org on January 01, 2009

by Ruth Klap, Lingqi Tang, Terry L. Schell, Naihua Duan, Kenneth B. Wells, Jeanne Miranda, Cathy D. Sherbourne

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OBJECTIVE: This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care. METHODS: Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in regard to friends, health insurance, and employers. RESULTS: Individuals in QI-therapy were significantly less likely than those in usual care and QI-meds to report concerns about friends learning about a history of depression (odds ratio [OR]=.66 and .65, respectively), and those in QI-meds were more likely than those in QI-therapy and usual care to have concerns about getting insurance (OR=1.42 and 1.68, respectively). CONCLUSIONS: Quality improvement programs for depression can raise or lower stigma concerns, depending on program design and resources for specific treatments.

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