General Hospital Psychiatry
Volume 27, Issue 2 , Pages 87-96 , March 2005

A direct comparison of presenting characteristics of depressed outpatients from primary vs. specialty care settings: preliminary findings from the STAR*D clinical trial

  • Bradley N. Gaynes, M.D., M.P.H.

      Affiliations

    • Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 919 966 8028; fax: +1 919 843 4370.
  • ,
  • A. John Rush, M.D.

      Affiliations

    • Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
  • ,
  • Madhukar Trivedi, M.D.

      Affiliations

    • Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
  • ,
  • Stephen R. Wisniewski, Ph.D.

      Affiliations

    • Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
  • ,
  • G.K. Balasubramani, Ph.D.

      Affiliations

    • Epidemiology Data Center, Graduate School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
  • ,
  • Donald C. Spencer, M.D., M.B.A.

      Affiliations

    • Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160, USA
  • ,
  • Timothy Petersen, Ph.D.

      Affiliations

    • Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
  • ,
  • Michael Klinkman, M.D.

      Affiliations

    • Department of Family Medicine, University of Michigan, Ann Arbor, MI 48109, USA
  • ,
  • Diane Warden, Ph.D.

      Affiliations

    • Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
  • ,
  • Robert K. Schneider, M.D.

      Affiliations

    • Department of Psychiatry, Medical College of Virginia, Richmond, VA 23220, USA
  • ,
  • Daniel B. Castro, M.D.

      Affiliations

    • Department of Family Medicine, UCLA School of Medicine, Harbor City, CA 90710, USA
  • ,
  • Robert N. Golden, M.D.

      Affiliations

    • Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160, USA

Received 19 April 2004 ,Accepted 28 October 2004.

References 

  1. Pincus H, Tanielian T, Marcus S, et al. Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA. 1998;279(7):526–531
  2. Zung WW, Magill M, Moore JT, George DT. Recognition and treatment of depression in a family medicine practice. J. Clin. Psychiatry. 1983;44(1):3–6
  3. Goldberg D, Kay C, Thompson L. Psychiatric morbidity in general practice and the community. Psychol. Med. 1976;6(6):565–569
  4. Johnstone A, Goldberg D. Psychiatric screening in general practice. A controlled trial. Lancet. 1976;1(7960):605–608
  5. Blackburn IM, Bishop S, Glen AI, Whalley LJ, Christie JE. The efficacy of cognitive therapy in depression: a treatment trial using cognitive therapy and pharmacotherapy, each alone and in combination. Br. J. Psychiatry. 1981;139:181–189
  6. Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000;283(2):212–220
  7. Simon GE, Von Korff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ. 2000;320:550–554
  8. Rost KM, Duan N, Rubenstein LV, et al. The quality improvement for depression collaboration: general analytic strategies for a coordinated study of quality improvement in depression care. Gen. Hosp. Psychiatry. 2001;23(5):239–253
  9. Katon W, Von Korff M, Lin E, et al. Stepped collaborative care for primary care patients with persistent symptoms of depression: a randomized trial. Arch. Gen. Psychiatry. 1999;56(12):1109–1115
  10. Hunkeler EM, Meresman JF, Hargreaves WA, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. [comment] Arch. Fam. Med. 2000;9(8):700–708
  11. Kroenke K, West SL, Swindle R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial. JAMA. 2001;286(23):2947–2955
  12. Schulberg HC, Pilkonis PA, Houck P. The severity of major depression and choice of treatment in primary care practice. J. Consult. Clin. Psychol. 1998;66(6):932–938
  13. Wagner HR, Burns BJ, Broadhead WE, et al. Minor depression in family practice: functional morbidity, comorbidity, service utilization, and outcomes. Psychol. Med. 2000;30(2):1377–1390
  14. Katzelnick D, Simon G, Pearson S, et al. A randomized trial of a depression management program in high utilizers of Med. Care. Arch. Fam. Med. 2000;9:345–351
  15. Miranda J, Duan N, Sherbourne C, et al. Improving care for minorities: can quality improvement interventions improve care and outcomes for depressed minorities? Results of a randomized, controlled trial. Health Serv. Res. 2003;38(2):613–630
  16. Williamson PS, Yates WR. The initial presentation of depression in family practice and psychiatric outpatients. Gen. Hosp. Psychiatry. 1989;11(3):188–193[discussion 216–21]
  17. Schwenk T, Coyne J, Fechner-Bates S. Differences between detected and undetected depressed patients in primary care and depressed psychiatric patients. Gen. Hosp. Psychiatry. 1996;18:407–415
  18. Cooper-Patrick L, Crum RM, Ford DE. Characteristics of patients with major depression who received care in general medical and specialty mental health settings. Med. Care. 1994;32(1):15–24
  19. Simon GE, Von Korff M. Recognition, management, and outcomes of depression in primary care. [comment] Arch. Fam. Med. 1995;4(2):99–105
  20. Simon GE, Lin EH, Katon W, et al. Outcomes of “inadequate” antidepressant treatment. [comment] J. Gen. Intern. Med. 1995;10(12):663–670
  21. Suh T, Gallo JJ. Symptom profiles of depression among general medical service users compared with specialty mental health service users. Psychol. Med. 1997;27(5):1051–1063
  22. Kroenke K, Price RK. Symptoms in the community. Prevalence, classification, and psychiatric comorbidity. Arch. Intern. Med. 1993;153(21):2474–2480
  23. Ohayon MM, Schatzberg AF. Prevalence of depressive episodes with psychotic features in the general population. Am. J. Psychiatry. 2002;159(11):1855–1861
  24. Simon GE, Von Korff M, Rutter CM, Peterson DA. Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch. Gen. Psychiatry. 2001;58(4):395–401
  25. Fava M, Rush A, Trivedi M, et al. Background and rationale for the sequenced treatment alternatives to relieve depression (STAR*D) study. Psychiatr. Clin. North Am. 2003;26(2):457–494
  26. Rush A, Fava M, Wisniewski S, et al. Sequenced Treatment Alternatives to Relieve Depression (STAR*D): rationale and design. Control. Clin. Trials. 2004;25(1):119–142
  27. Lavori P, Rush A, Wisniewski S, et al. Strengthening clinical effectiveness trials: equipoise-stratified randomization. Biol. Psychiatry. 2001;50(10):792–801
  28. Kobak KA, Greist JH, Jefferson JW, Mundt JC, Katzelnick DJ. Computerized assessment of depression and anxiety over the telephone using interactive voice response. MD Comput. 1999;16(3):64–68
  29. Hamilton M. A rating scale for depression. J. Neurol. Neurosurg. Psychiatry. 1961;23:56–61
  30. Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry. 1988;21(1):15–18
  31. Paykel ES, Hollyman JA, Freeling P, Sedgwick P. Predictors of therapeutic benefit from amitriptyline in mild depression: a general practice placebo-controlled trial. J. Affect. Disord. 1988;14(1):83–95
  32. Coyne JC, Klinkman MS, Gallo SM, Schwenk TL. Short-term outcomes of detected and undetected depressed primary care patients and depressed psychiatric patients. Gen. Hosp. Psychiatry. 1997;19(5):333–343
  33. Schulberg HC, Madonia MJ, Block MR, et al. Major depression in primary care practice. Clinical characteristics and treatment implications. Psychosomatics. 1995;36(2):129–137
  34. Khan A, Leventhal RM, Khan SR, Brown WA. Severity of depression and response to antidepressants and placebo: an analysis of the Food and Drug Administration database. J. Clin. Psychopharmacol. 2002;22(1):40–45
  35. Simon G. Evidence review: efficacy and effectiveness of antidepressant treatment in primary care. Gen. Hosp. Psychiatry. 2002;24:213–224
  36. Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J. Am. Geriatr. Soc. 1968;16(5):622–626
  37. Simon GE, Revicki D, Von Korff M. Telephone assessment of depression severity. J. Psychiatr. Res. 1993;27(3):247–252
  38. Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol. Med. 1996;26(3):477–486
  39. Sugar CA, Sturm R, Lee TT, et al. Empirically defined health states for depression from the SF-12. Health Serv. Res. 1998;33(4 Pt 1):911–928
  40. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol.Bull. 1993;29(2):321–326
  41. Mundt JC, Marks IM, Shear MK, Greist JM. The work and social adjustment scale: a simple measure of impairment in functioning. Br. J. Psychiatry. 2002;180:461–464
  42. Ackermann RT, Williams JW. Rational treatment choices for non-major depressions in primary care: an evidence-based review. J. Gen. Intern. Med. 2002;17(4):293–301
  43. Williams JW, Barrett J, Oxman T, et al. Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adults. [see comments] JAMA. 2000;284(12):1519–1526
  44. Coulehan JL, Schulberg HC, Block MR, Zettler-Segal M. Symptom patterns of depression in ambulatory medical and psychiatric patients. J. Nerv. Ment. Dis. 1988;176(5):284–288
  45. Gaynes BN, West SL, Ford CA, et al. Screening for suicide risk in adults: a summary of the evidence for the U.S. preventive services task force. Ann. Intern. Med. 2004;140(10):822–835
  46. Depression Guideline Panel. Depression in primary care: volume 1, diagnosis and detection. Clinical practice guideline, number 5. Vol. AHCPR publication No. 93-0550. Rockville (Md): U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1993.
  47. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J. Clin. Epidemiol. 1992;45(2):197–203
  48. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatr. Res. 1992;41(3):237–248
  49. Rochon PA, Katz JN, Morrow LA, et al. Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Med. Care. 1996;34(11):1093–1101
  50. Young AS, Klap R, Sherbourne CD, Wells KB. The quality of care for depressive and anxiety disorders in the United States. Arch. Gen. Psychiatry. 2001;58(1):55–61
  51. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med. Care. 2003;41(5):582–592
  52. McHorney CA, Tarlov AR. Individual–patient monitoring in clinical practice: are available health status surveys adequate?. Qual. Life Res. 1995;4(4):293–307

 This project has been funded in whole or in part with Federal funds from the National Institute of Mental Health, National Institutes of Health, under Contract N01MH90003. Dr. Gaynes was supported in part by an NIMH K23 Career Development Award (MH01951-03).

PII: S0163-8343(04)00132-X

doi: 10.1016/j.genhosppsych.2004.10.003

General Hospital Psychiatry
Volume 27, Issue 2 , Pages 87-96 , March 2005