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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 8/2014

01-08-2014 | Original Research

The Effect of Targeted and Tailored Patient Depression Engagement Interventions on Patient–Physician Discussion of Suicidal Thoughts: A Randomized Control Trial

Authors: Ruby Shah, MD, MPH, Peter Franks, MD, Anthony Jerant, MD, Mitchell Feldman, MD, Phil, FACP, Paul Duberstein, PhD, Erik Fernandez y Garcia, MD, MPH, Ladson Hinton, MD, Lorrie Strohecker, MD, MPH, Richard L. Kravitz, MD, MPSH

Published in: Journal of General Internal Medicine | Issue 8/2014

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ABSTRACT

BACKGROUND

Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low.

OBJECTIVE

To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control.

DESIGN

Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO).

PARTICIPANTS

Eight-hundred sixty-seven participants, with mean age 51.7; 43.9 % women, 43.4 % from a racial/ethnic minority group.

INTERVENTION

The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video.

MAIN MEASURES

Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]).

KEY RESULTS

Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95 % confidence interval = 1.5, 5.10, p = 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9.

CONCLUSIONS

Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.
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Metadata
Title
The Effect of Targeted and Tailored Patient Depression Engagement Interventions on Patient–Physician Discussion of Suicidal Thoughts: A Randomized Control Trial
Authors
Ruby Shah, MD, MPH
Peter Franks, MD
Anthony Jerant, MD
Mitchell Feldman, MD, Phil, FACP
Paul Duberstein, PhD
Erik Fernandez y Garcia, MD, MPH
Ladson Hinton, MD
Lorrie Strohecker, MD, MPH
Richard L. Kravitz, MD, MPSH
Publication date
01-08-2014
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 8/2014
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-014-2843-8

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