skip navigation

August 24, 2004

JAMA: Phone-based psychotherapy plus outreach work well for patients with depression, Group Health study finds

Seattle—A phone-based program combining outreach and psychotherapy can significantly improve symptoms of depression and satisfaction with care for patients beginning antidepressant treatment, according to a Group Health Cooperative study published in Aug. 25 issue of the Journal of the American Medical Association (JAMA).

"Our research shows that providing structured psychotherapy for depression over the telephone works," said Greg Simon, MD, MPH, a Group Health psychiatrist, researcher, and the lead author of the study. "Equally important, it shows that providing vigorous outreach can help depressed people who would otherwise not be served by therapy at all."

Previous research shows that antidepressant medication and structured psychotherapy are helpful for depression, but less than one-third of people with depressive disorders receive effective levels of either treatment. Barriers include feelings of discouragement, social stigma, and time constraints. Also, patients often need to be persistent to get the type and level of medication they need, and the benefits of treatment may not be apparent for several weeks.

"Depression is a condition defined by being easily discouraged, pessimistic, or fatigued—that’s the nature of it," said Simon. "So we designed an outreach program that’s really persistent in order to overcome that natural discouragement patients feel."

The study enrolled 600 Group Health patients with depression who were randomly assigned to receive:

1. Usual primary care;
2. Usual care plus a telephone-based care-management program that included three outreach calls, feedback to the treating physician, and care coordination; or
3. Usual care, plus care management combined with eight sessions of cognitive-behavioral psychotherapy delivered by phone.

The care-management program was provided by bachelors- or masters-prepared mental health clinicians who assessed patients’ symptoms, antidepressant medication use, and side-effects. They also coordinated doctor-patient communication and referred patients to mental health specialty care, if needed. The psychotherapy was provided by masters-prepared psychotherapists who provided eight, 30–40 minute sessions of structured cognitive-behavioral counseling.

The study excluded people who were already seeing a therapist or intending to see a therapist. "We were very interested in studying people who were not seeking that kind of treatment at all—people who would not be served otherwise," said Simon.

After six months, some 80 percent of those receiving the phone-based psychotherapy reported their depression was "much improved" or "very much improved." This compares to 66 percent in the group that received care management, and 55 percent in the group that received usual care.

Using a standard measure of depression (SCL depression score), the researchers also found that improvement was greatest in the phone-therapy group, intermediate in the care-management group, and least in the usual-care group. Satisfaction with treatment followed a similar pattern.

Telephone-based treatment lacks the "richness" of in-person therapy, Simon said. "But in most large mental health systems, about 20 to 25 percent of the people who call to request an appointments don’t show up. And of people who make one visit, about 20 to 25 percent of people never make a second visit. So although telephone treatment may not be as powerful as seeing someone in person, it’s more effective than not getting help at all."

The researchers acknowledge that efforts to improve management of depression "must consider resource limitations and pressures to control costs." They estimate that providing phone therapy would cost less than $50 per session. Simon also points out that fee-for-service health care systems are not currently equipped to reimburse providers for telephone-based care-management and psychotherapy.

Simon and his colleagues are now planning a study to compare the telephone-based treatment and outreach program to conventional psychotherapy visits.

In addition to Simon, authors of the study were Group Health researchers Evette Ludman, PhD, Belinda Operskalski, MPH, Michael Von Korff, ScD, and Steve Tutty, MA. The study was funded by grants from the National Institute of Mental Health.

Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants, the Center is located in Seattle, Washington. Group Health is a consumer-governed, nonprofit health care system that coordinates care and coverage. Based in Seattle, Group Health and Group Health Options, Inc. serve nearly 540,000 members in Washington and Idaho.

Top