Depression: Usefulness of Patient Engagement Programs

Richard L. Kravitz, MD, MSPH Professor and Co-vice Chair (Research) Interim Director, UC Center Sacramento Co-Editor in Chief, Journal of General Internal MedicineMedicalResearch.com Interview with:
Richard L. Kravitz, MD, MSPH
Professor and Co-vice Chair (Research)
Interim Director, UC Center Sacramento
Co-Editor in Chief, Journal of General Internal Medicine

MedicalResearch.com: What is the background for your study?

Dr. Kravitz: Depression in the United States is both undertreated and overtreated. As the de facto mental health care system for many, primary care is at the nexus of this problem. Up to 30% of patients with major depression in primary care go undiagnosed. At the same time, partly as a result of marketing, lots of patients who don’t need meds are started on antidepressants. So we were interested in finding ways to get more truly depressed patients into treatment without overtreating patients who don’t need it.

MedicalResearch.com: What are the main findings of the study?

Dr. Kravitz: This was a randomized trial comparing a depression engagement video, a tailored interactive computer program, and a control video on patient behavior and outcomes in primary care. Both the video and the computer program roughly doubled the proportion of patients who asked their clinicians about depression. However, only the interactive computer program successfully increased the proportion of patients with significant depression symptoms who received an antidepressant prescription, mental health referral, or both. Neither intervention markedly increased the proportion of non-depressed patients who received meds or MH referrals, although we couldn’t rule out a small increase.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Kravitz: Given the impact of direct-to-consumer advertisements for antidepressants, we expected that the engagement videos would have more powerful effects. But in retrospect, we know that one way ads have impact is through repetition. Our intervention was administered once only.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Kravitz: Clinicians should be reminded that there’s a lot of untreated depression out there, and that patients sometimes need a small nudge to bring up their symptoms. They should also be on the lookout for high quality interactive tools (similar to the one tested here) that can help patients more forthrightly discuss mental health concerns. Patients should know that tools like this are coming – and they should be open to using them.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Kravitz: More work is needed to learn how to reinforce the effects of one-time exposure to these sorts of interventions, and to understand how the interventions might be integrated with other chronic disease management systems.

Citation:

Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care A Randomized Trial

Kravitz RL, Franks P, Feldman MD, et al. Patient Engagement Programs for Recognition and Initial Treatment of Depression in Primary Care: A Randomized Trial. JAMA. 2013;310(17):1818-1828. doi:10.1001/jama.2013.280038.