Psychological Medicine

Impact of improved depression treatment in primary care on daily functioning and disability 1

G. E. SIMON a1c1, W. KATON a1, C. RUTTER a1, M. VonKORFF a1, E. LIN a1, P. ROBINSON a1, T. BUSH a1, E. A. WALKER a1, E. LUDMAN a1 and J. RUSSO a1
a1 From the Center for Health Studies, Group Health Cooperative, and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA


Background. Few data are available regarding the impact of improved depression treatment on daily functioning and disability.

Methods. In two studies of more intensive depression treatment in primary care, patients initiating antidepressant treatment were randomly assigned to either usual care or to a collaborative management programme including patient education, on-site mental health treatment, adjustment of antidepressant medication, behavioural activation and monitoring of medication adherence. Assessments at baseline as well as 4 and 7 months included several measures of impairment, daily functioning and disability[ratio]self-rated overall health, number of bodily pains, number of somatization symptoms, changes in work due to health, reduction in leisure activities due to health, number of disability days and number of restricted activity days.

Results. Average data from the 4- and 7-month assessments in both studies, intervention patients reported fewer somatic symptoms (OR 0·68, 95% CI 0·46, 0·99) and more favourable overall health (OR 0·50, 95% CI 0·28, 0·91). While intervention patients fared better on other measures of functional impairment and disability, none of these differences reached statistical significance.

Conclusions. More effective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant intervention effect on other disability measures may reflect the brief treatment and follow-up period and the influence of other individual and environmental factors on disability.

c1 Address for correspondence: Dr Gregory E. Simon, Center for Health Studies, 1730 Minor Avenue 1600, Seattle, WA 98101-1448, USA.


1 This paper was presented at the 10th Annual NIMH Conference on Mental Health Problems in the General Health Care Sector, Bethesda, MD, 15–16 July 1996.