Engaging Depressed Patients

Depression is widespread and the nature of the condition makes it difficult to engage patients in acknowledging their need for treatment and to encourage them to communicate their symptoms to providers to improve the likelihood of receiving appropriate care.  A study published in the Journal of the American Medical Association looked at the use of two tools to improve engagement of depressed patients.  (JAMA Article)  The study covered 867 patients from seven primary care clinics in California.  About 60% the study participants were depressed.  The engagement tools were a short video and an interactive multimedia computer program.  Both tools were to some extent tailored to patient characteristics such as gender and income.  The outcomes were antidepressant prescribing and mental health visit referral.  The basic study hypothesis was that the tools would help patients acknowledge their depression and seek treatment.  Both tools contained an educational component on recognizing symptoms of depression as well as advice on potential steps to remedy depression.  The control group did not see these tools but saw other ones related to another health issue.  The patients utilized either the video or interactive program just before a regularly scheduled visit to a clinician.  The results indicated that the interactive program increased patient interaction with the clinician and the end outcome of more antidepressant prescribing and mental health referrals, but the video did not do so to a significant level.  And the patients depression symptoms did not appear to improve at a 12 week follow-up.  The results would suggest that the highly tailorable interactive program helped patients at least initiate discussions about possible depression and to get some treatment, but the treatment doesn’t appear to have been overly useful .  Engagement is important and these tailorable computer programs could assist in that goal, but ultimately, the treatment has to be effective to make a difference in patients’ health.