Evaluation and Treatment of Depression (Part I)

Depression is one of the leading causes of disability worldwide, contributing to high medical expenditures, poor clinical outcomes, low productivity, and compromised quality of life. Efficacious treatments are available for the treatment of depression across a broad age range (children/adolescents to elderly). Care management initiatives that include these promising interventions ameliorate the impact of the disorder among patients receiving mental health services in primary care and behavioral healthcare settings. Part I of this two-part article series provides the reader with an overview of issues related to improving the treatment of depression. The approaches used to treat depression and strategies employed to evaluate treatment success are critical. Disease management is one strategy used for improving depression treatment that benefits the consumer and yields positive results for providers and payors.The most effective strategies are those with multiple components, including patient education, coordination of care between primary care and mental health specialists, and ongoing evaluation and feedback. Although the benefits of such interventions are profound in producing improvements in depressive symptoms, social and emotional functioning, and overall satisfaction, there have been few healthcare systems that have successfully integrated such programs into routine care. Despite indirect advantages to providers and payors, the costs of implementing such programs may present a larger barrier to system-wide adoption of disease management for depression. Certainly, the potential for healthcare cost reductions needs to be systematically examined, particularly the extent to which certain patient groups (the most interesting being those with the highest healthcare costs or catastrophic outcomes of their depression) will benefit from disease management programs. Subpopulations (e.g. children, adolescent and older adults) have associated extant barriers that impede progress with implementing disease management support services and programs.Part II provides an overview of quality improvement strategies demonstrated to be effective in improving depression treatment and discusses examples of programs implemented in various care settings.