Abstract
BackgroundDepressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated.Methods/DesignCC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36.DiscussionEarlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands.
Highlights
Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients
Half of all patients with chronic obstructive pulmonary disease (COPD) seem to experience clinically significant symptoms of depression and/or anxiety, and yet, comorbid major depressive disorder (MDD) is frequently not identified or appropriately treated [3,5] MDD can impair the ability to seek and adhere to treatment for other medical illnesses, which can be hazardous because MDD frequently occurs in combination with a variety of other physical illnesses, including heart disease, stroke, cancer, and diabetes [9]
The primary aim of the study is to assess the effectiveness of a collaborative care model for major depressive disorders in patients with diabetes mellitus (DM), cardiovascular diseases (CVD), and COPD in the general hospital outpatient setting
Summary
Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, selfcare, morbidity, and mortality. Among chronically ill patients in general hospitals, the prevalence of depression varies, ranging from 13% to 50% [3,4,5,6,7,8]. The presence of a comorbid depressive disorder has a strong influence on quality of life, self-care, adherence to medication regimens and general functioning. It raises morbidity, mortality and health care costs if combined with various chronic physical diseases [10,11,12,13,14,15,16]. A meta-analysis of twelve studies showed that the presence of MDD even triples the likelihood of non-adherence to medical treatment recommendations and increases the risk of subsequent physical illness, disability, and premature death [17,18]
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