Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 5/2008

01-05-2008 | Original Article

Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D

Authors: Bradley N. Gaynes, MD, MPH, A. John Rush, MD, Madhukar H. Trivedi, MD, Stephen R. Wisniewski, PhD, G.K. Balasubramani, PhD, Patrick J. McGrath, MD, Michael E. Thase, MD, Michael Klinkman, MD, Andrew A. Nierenberg, MD, William R. Yates, MD, Maurizio Fava, MD

Published in: Journal of General Internal Medicine | Issue 5/2008

Login to get access

Abstract

Background

Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown.

Objective

To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial.

Design

Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system.

Participants

A total of 2,876 previously established outpatients in primary (n = 1091) or specialty (n = 1785) with nonpsychotic depression who had at least 1 post-baseline measure.

Measurements and Main Results

Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR16]); response (QIDS-SR16); time to first remission (QIDS-SR16). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p = .40) and by QIDS-SR16 (32.5% PC vs 33.1% SC, p = .78) and response rates by QIDS-SR16 (45.7% PC vs 47.6% SC, p = .33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p = .12) and to response (5.5 weeks PC vs 5.4 weeks SC, p = .97) did not differ by setting.

Conclusions

Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.
Literature
1.
Williamson PS, Yates WR. The initial presentation of depression in family practice and psychiatric outpatients. Gen Hosp Psychiatry. 1989;113188–93. discussion 216–121.PubMedCrossRef
2.
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;18:407–15.PubMedCrossRef
3.
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.PubMedCrossRef
4.
Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care.[comment]. Arch Fam Med. 1995;4(2)99–105.PubMedCrossRef
5.
Simon GE, Lin EH, Katon W, et al.. Outcomes of "inadequate" antidepressant treatment.[comment]. J Gen Intern Med. 1995;10(12)663–70.PubMedCrossRef
6.
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 Psych. 2001;58(4)395–401.CrossRef
7.
Gaynes BN, Rush AJ, Trivedi M, et al.. A direct comparison of presenting characteristics of depressed outpatients from primary vs specialty care settings: preliminary findings from the STAR*D clinical trial. Gen Hosp Psychiatry. 2005;27(2)87–96.PubMedCrossRef
8.
Gaynes BN, Rush AJ, Trivedi MH, et al.. Major depression symptoms in primary care and psychiatric care settings: a cross-sectional analysis.. Ann Fam Med. 2007;5(2)126–34.PubMedCrossRef
9.
Depression guideline panel. Depression in primary care: Volume 2, Treatment of major depression. 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.
10.
Institute for Clinical Systems Improvement (ICSI). Major depression in adults in primary care. Vol May. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2004.
11.
12.
Kessler RC, Berglund P, Demler O, et al.. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23)3095–105.PubMedCrossRef
13.
Olfson M, Marcus SC, Tedeschi M, Wan GJ. Continuity of antidepressant treatment for adults with depression in the United States. Am J Psychiatry. 2006;163(1)101–8.PubMedCrossRef
14.
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)119–42.PubMedCrossRef
15.
Gaynes B, Davis L, Rush A, Trivedi M, Fava M, Wisniewski S. The aims and design of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Prim Psychiatry. 2005;12236–41.
16.
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)457–94.PubMedCrossRef
17.
18.
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6:278–96.PubMed
19.
Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry. 1988;2(1)115–18.PubMedCrossRef
20.
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 Dis. 1988;14(1)83–95.PubMedCrossRef
21.
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)333–43.PubMedCrossRef
22.
Hunkeler EM, Meresman JF, Hargreaves WA, et al.. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care [see comments] [comment]. Arch Fam Med. 2000;9(8)700–8.PubMedCrossRef
23.
Katzelnick D, Simon G, Pearson S, et al.. A randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000;9:345–51.PubMedCrossRef
24.
Schulberg HC, Madonia MJ, Block M, et al.. Major depression in primary care practice. Clinical characteristics and treatment implications. Psychosomatics. 1995;36(2)129–37.PubMed
25.
Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5)622–6.PubMed
26.
Trivedi MH, Rush AJ, Ibrahim HM, et al.. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med. Jan 2004;34(1)73–82.CrossRef
27.
Rush AJ, Trivedi MH, Ibrahim HM, et al.. The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54(5)573–83.PubMedCrossRef
28.
Rush AJ, Bernstein IH, Trivedi MH, et al.. An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression:a Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial report. Biol Psychiatry. 2006;59(6)493–501.PubMedCrossRef
29.
Zimmerman M, Mattia JI. A self-report scale to help make psychiatric diagnoses: the Psychiatric Diagnostic Screening Questionnaire. Arch Gen Psychiatry. Aug 2001;58(8)787–94.CrossRef
30.
Zimmerman M, Mattia JI. The Psychiatric Diagnostic Screening Questionnaire: development, reliability and validity. Compr Psychiatry42(3)175–189.
31.
First M, Spitzer , Gibbon M, Williams J. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, D.C: American Psychiatric Press, Inc.; 1996.
32.
Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatr Res. 1993;27(3)247–52.PubMedCrossRef
33.
Rush AJ, Gullion CM, Basco M, Jarrett RB, Trivedi MH. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med. 1996;26(3)477–86.PubMed
34.
Novick JS, Stewart JW, Wisniewski S, et al.. Clinical and demographic features of atypical depression in outpatients with major depressive disorder: preliminary findings from STAR*D. J Clin Psychiatry. 2005;66(8)1002–11.PubMedCrossRef
35.
Fava M, Alpert JE, Carmin CN, et al.. Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychol Med. 2004;34(7)1299–308.PubMedCrossRef
36.
Khan AY, Carrithers J, Preskorn SH, et al.. Clinical and demographic factors associated with DSM-IV melancholic depression. Ann Clin Psychiatry. 2006;18(2)91–98.PubMedCrossRef
37.
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)64–8.PubMed
38.
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)911–28.PubMed
39.
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;180:461–4.PubMedCrossRef
40.
Trivedi MH, Rush AJ, Wisniewski S, et al.. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163(1)28–40.PubMedCrossRef
41.
Trivedi MH, Rush AJ, Wisniewski S, et al.. Factors associated with health-related quality of life among outpatients with major depressive disorder: a STAR*D report. J Clin Psychiatry. 2006;67(2)185–95.PubMedCrossRef
42.
Nierenberg AA, Trivedi MH, Ritz L, et al.. Suicide risk management for the sequenced treatment alternatives to relieve depression study: applied NIMH guidelines. J Psychiatr Res. 2004;38(6)583–9.PubMedCrossRef
43.
American Psychiatric Association. Practice guideline for the treatment of patients with major depression (revision). Am J Psychiatry. 2000;157(suppl 4)1–45.
44.
45.
46.
Weilburg JB, O'Leary KM, Meigs JB, Hennen J, Stafford RS. Evaluation of the adequacy of outpatient antidepressant treatment. Psychiatr Serv. 2003;54(9)1233–9.PubMedCrossRef
47.
Sullivan PW, Valuck , Saseen J, MacFall HM. A comparison of the direct costs and cost effectiveness of serotonin reuptake inhibitors and associated adverse drug reactions. CNS Drugs. 2004;18(13)911–32.PubMedCrossRef
48.
Katon W, Schulberg H. Epidemiology of depression in primary care. Gen Hosp Psychiatry. 1992;14(4)237–47.PubMedCrossRef
49.
Katon W, Lin E, von Korff M, et al.. The predictors of persistence of depression in primary care. J Affect Disord. 1994;3(12)81–90.PubMedCrossRef
50.
Hirschfeld RM, Russell JM, Delgado PL, et al.. Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry. Dec 1998;59(12)669–675.
51.
Ezquiaga E, Garcia A, Bravo F, Pallares T. Factors associated with outcome in major depression: a 6-month prospective study. Soc Psychiatry Psychiatr Epidemiol. 1998;33(11)552–557. 1998/10//.PubMedCrossRef
52.
Leary D, Costello F, Gormley N, Webb M. Remission onset and relapse in depression: An 18-month prospective study of course for 100 first admission patients. J Affect Disord. 2000;57(1–3)159–71. /0 2000.CrossRef
53.
Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12)1097–1102.
54.
Von Korff M, Goldberg D. Improving outcomes in depression. BMJ. 2001;323(7319)948–949. Oct 27.CrossRef
55.
Katon W, Von Korff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen Hosp Psychiatry. 2001;23(31)38–44.PubMedCrossRef
56.
Wagner E, Grothaus L, Sandhu N, et al.. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001;24(4)695–700.PubMedCrossRef
57.
Wagner E, Austin B, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6)64–78.CrossRef
58.
Rothman AA, Wagner EH. Chronic Illness Management: What Is the Role of Primary Care? Ann Intern Med. 2003;138(3)256–261. February 4, 2003.PubMed
59.
Trivedi MH, Rush AJ, Gaynes BN, et al. Maximizing the Adequacy of Medication Treatment in Controlled Trials and Clinical Practice: STAR*D Measurement-Based Care. Neuropsychopharmacology. 2007/04/04/online 2007.
60.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success.10.1136/bmj.38398.500764.8F. BMJ. April 2, 2005 2005;330(7494):765-.
61.
Katon W, Robinson P, Von Korff M, et al.. A multifaceted intervention to improve treatment of depression in primary care. Arch Gen Psychiatry. 1996;53(10)924–32.PubMed
62.
Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality enhancement by strategic teaming. J Gen Intern Med. 2001;16(31)43–49.PubMedCrossRef
63.
Unutzer J, Katon W, Callahan CM, et al.. collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22)2836–45.PubMedCrossRef
64.
Bruce ML, Ten Have T, Reynolds CF III, et al.. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004;291(9)1081–91.PubMedCrossRef
65.
Dietrich AJ, Oxman TE, Williams JW J, et al.. Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial. BMJ. 2004;329(7466)602–5.PubMedCrossRef
66.
Katon WJ, Von Korff M, Lin EHB, et al.. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61(10)1042–9.PubMedCrossRef
67.
Landis SE, Gaynes BN, Morrissey JP, Vinson N, Ellis A, Domino ME. Generalist Care Managers for the Treatment of Depressed Medicaid Patients in North Carolina: A Pilot Study. BMC Family Practice. 2007;8(1)7. Mar 5.PubMedCrossRef
Metadata
Title
Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D
Authors
Bradley N. Gaynes, MD, MPH
A. John Rush, MD
Madhukar H. Trivedi, MD
Stephen R. Wisniewski, PhD
G.K. Balasubramani, PhD
Patrick J. McGrath, MD
Michael E. Thase, MD
Michael Klinkman, MD
Andrew A. Nierenberg, MD
William R. Yates, MD
Maurizio Fava, MD
Publication date
01-05-2008
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 5/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-008-0522-3

Other articles of this Issue 5/2008

Journal of General Internal Medicine 5/2008 Go to the issue

Original Article

Patient Safety and Telephone Medicine

Hospital Medicine

How Do Hospitalized Patients Feel About Resident Work Hours, Fatigue, and Discontinuity of Care?

Perspectives

Transforming Clinical Practice to Eliminate Racial–Ethnic Disparities in Healthcare

Populations at Risk

Patients with Depression are at Increased Risk for Secondary Cardiovascular Events after Lower Extremity Revascularization

Original Article

Discussing Weight with Obese Primary Care Patients: Physician and Patient Perceptions

Original Article

Depressive Symptoms, Bone Loss, and Fractures in Postmenopausal Women
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits