A common approach in the treatment of depression is that of collaborative care (CC), which integrates primary care doctors, mental health professionals, and depression care managers to ensure that all physical, pharmacological, emotional, and social needs of a client are being addressed. The depression care manager (DCM) acts as a liaison between the client and professionals to provide guidance, assistance, and monitoring of treatment. Although this approach has been shown to be a highly effective one, the outcomes among minority individuals and African-Americans in particular, leave much to be desired. The social and financial barriers that are present for many African-Americans are difficult to overcome, even with the help of a DCM. Therefore, Lisa A. Cooper of the Johns Hopkins University School of Medicine in Maryland wanted to see if a tailored CC approach, designed specifically to meet the unique needs of African-Americans, would result in better depression and treatment outcomes.
In a recent study, Cooper followed 132 African-American participants with depression and 27 primary care doctors through treatment and beyond. She assessed them at baseline and then every six months for a year and half. She evaluated their levels of depression, treatment adherence, cognitive functioning, use of mental health services, and the clients’ ratings of care. Half of the participants were assigned to standard CC while the other half were provided with a DCM and assigned to the tailored CC which addressed specific concerns relative to African-American clients, including communication with doctors, negative views toward medication, and financial and insurance barriers.
Cooper found that overall both groups of participants had similar outcomes at 12 and 18 months, with all of the participants having similar levels of symptom reductions. But the participants in the standard CC had higher levels of treatment adherence, while those in the tailored CC group had higher levels of satisfaction, motivation, and higher DCM ratings. In particular, the tailored CC participants were more likely to rate their DCMs as helpful and reported higher levels of education, knowledge, and mental health counseling than the standard CC participants. Even though the DCMs were not licensed psychologists, they were able to provide much needed psychological support and guidance to the participants, especially those who would not normally go to a therapist. In sum, Cooper believes that standard CC may lead to better treatment adherence, but tailored CC leads to higher DCM ratings, which could improve treatment adherence in the long run. “However, our results do not justify advocating strongly for one approach over the other since there were minimal differences in clinical improvement between the two groups,” said Cooper.
Cooper, Lisa A., et al. Comparative effectiveness of standard versus patient-centered collaborative care interventions for depression among African Americans in primary care settings: The BRIDGE Study. Health Services Research 48.1 (2013): 150-74. Print.
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