Long-term Benefits of Short-Term Quality Improvement Interventions for Depressed Youths in Primary Care

Published in: The American Journal of Psychiatry, v. 166, no. 9, Sep. 2009, p. 1002-1010

Posted on RAND.org on December 31, 2008

by Joan Rosenbaum Asarnow, Lisa H. Jaycox, Lingqi Tang, Naihua Duan, Anne P. LaBorde, Luis R Zeledon, Martin Anderson, Pamela Murray, Chris Landon, Margaret M. Rea, Kenneth B. Wells

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OBJECTIVE: Quality improvement programs for depressed youths in primary care settings have been shown to improve 6-month clinical outcomes, but longer-term outcomes are unknown. The authors examined 6-, 12-, and 18-month outcomes of a primary care quality improvement intervention. METHOD: Primary care patients 13-21 years of age with current depressive symptoms were randomly assigned to a 6-month quality improvement intervention (N=211) or to treatment as usual enhanced with provider training (N=207). The quality improvement intervention featured expert leader teams to oversee implementation of the intervention; clinical care managers trained in cognitive-behavioral therapy for depression to support patient evaluation and treatment; and support for patient and provider choice of treatments. RESULTS: The quality improvement intervention, relative to enhanced treatment as usual, lowered the likelihood of severe depression (Center for Epidemiological Studies Depression Scale score 24) at 6 months; a similar trend at 18 months was not statistically significant. Path analyses revealed a significant indirect intervention effect on long-term depression due to the initial intervention improvement at 6 months. CONCLUSIONS: In this randomized effectiveness trial of a primary care quality improvement intervention for depressed youths, the main effect of the intervention on outcomes was to decrease the likelihood of severe depression at the 6-month outcome assessment. These early intervention-related improvements conferred additional long-term protection through a favorable shift in illness course through 12 and 18 months

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