Is Collaborative Care for Depression in an Ob/Gyn Clinic Effective?

Collaborative care for depression that included psychiatrists, clinicians, and care managers working at an ob/gyn clinic was more effective than traditional depression care, new research suggested.

The randomized controlled trial involved about 200 women who had screened positive for major depression, dysthymia, or both. Half were assigned to receive the usual treatment, while the other half were placed in the collaborative care group. The women received care for 1 year, with outcomes measured at 6 months, 12 months, and 18 months. 

Pertinent Points

- A collaborative approach to treating depression in an ob/gyn outperformed a traditional treatment approach.

- Improvements included a decrease in depression symptoms, adequate antidepressant dosing, and patient satisfaction.

- The collaborative approach included clinicians, psychiatrists, and care managers.

Among the women who received treatment for depression-all of whom were treated at the same clinic-those who received collaborative care had fewer symptoms after treatment than those who received usual care, the researchers reported in the May 7 issue of the journal Obstetrics & Gynecology.

The collaborative care teams were established to include weekly patient progress reviews that allowed all involved to discuss treatment recommendations. Care managers then followed up with patients. The researchers found that women treated by the teams were, among other results, more likely to have at least a 50% decrease in depressive symptoms at 12 months (relative risk = 1.74; 95% confidence interval [CI], 1.11-2.73). In addition, those assigned to the collaborative approach were more likely than those in usual care to attend at least 4 specialty mental health visits, to have an adequate dose of antidepressant, and to experience greater satisfaction with care.

The study was conducted, in part, because approximately one-third of American women list an ob/gyn as their primary physician, and the study authors wanted to provide easier access to mental health services.

“The collaborative-care model could be adapted for other types of specialty care,” said Susan Reed, MD, MPH, a University of Washington professor of obstetrics and gynecology who co-led the study. “As we saw, the model was especially beneficial for women who faced barriers to healthcare, as collaborative care addressed multiple health concerns-not just obstetric and gynecologic health but also mental health-in one place.”

This collaborative care approach-called Depression Attention for Women Now (DAWN)-may have benefits beyond mental health.

“Collaborative care benefits the community not only be helping women with depression regain function in their lives, but also by lowering healthcare costs,” said Reed. “We anticipate fewer women will go to emergency rooms for acute care problems related to mental health, and more women will be able to rejoin the workforce.”