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An Effective Intervention for Managing Depression in Primary Care

The inadequate treatment of depression in primary care settings continues to be a major public health problem despite efforts to improve care. “In primary care, most depressed patients have chronic or recurrent depression,” explains Michael S. Klinkman, MD, MS, “and many cases are further complicated by comorbid health disorders. Treatment protocols that are designed to improve the effectiveness of acute-phase care apply only to a small fraction of the depressed patients that are seen by primary care physicians [PCPs].” The DPC Intervention Dr. Klinkman and colleagues at the University of Michigan had a study published in the September/October 2010 Annals of Family Medicine in which the Depression in Primary Care (DPC) intervention was assessed. “The primary aim of the DPC project was to develop, implement, and evaluate the effectiveness and sustainability of a depression management program that could support how PCPs manage patients in both acute and chronic phases of treatment,” says Dr. Klinkman. The DPC clinical intervention included several components, including care managers who offered support at specific sites, disease monitoring and clinician feedback, patient activation and self-management assistance, and a clinical information system in which a secure email system enabled care managers, PCPs, and consultation-liaison psychiatrists to communicate efficiently to coordinate care. The DPC intervention consisted of a series of telephone calls and email exchanges between enrollees and care managers, care managers and referring physicians, and, on occasion, care managers and consultation-liaison psychiatrists (Table 1). Dr. Klinkman says “the primary goals were to increase enrollees’ self-management of depression and provide feedback to referring physicians about clinical progress and possible complications in treatment.” The intake telephone call, which required 20 to...

Psychological Intervention Improves Breast Cancer Survival

Recent research has demonstrated that stress-related psychosocial factors may be associated with the risk of recurrence and death in patients with breast cancer. Evidence has supported the use of psychological intervention programs for these patients to help them manage stress, improve health, and function more effectively. Other evidence suggests that these programs can lead to better survival rates among disease sufferers. However, past studies haven’t been designed to specifically evaluate the effect of psychological interventions on recurrence and survival rates. In the December 15, 2008 issue of Cancer, my colleagues and I published a study designed to evaluate these endpoints in patients with breast cancer who received a psychological intervention. In our investigation, over 200 newly-diagnosed patients who were surgically treated for regional breast cancer were randomized to receive a psychological intervention and assessment or only an assessment. We hypothesized that stress accompanying a cancer diagnosis may trigger psychological, behavioral, and biologic responses that are relevant to subsequent disease outcomes. An assessment of immunity was also included in the trial in order to evaluate the effects of psychological interventions on it. Currently available research evaluating the correlation between stress and cancer has focused on suppressed immune responses. The physiological link between stress and its effect on natural killer cells, however, requires further research. The Psychological Intervention The intervention used for our study in Cancer consisted of small group sessions led by clinical psychologists who discussed strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care for patients surgically treated for regional breast cancer. Patients were first educated on how stress manifested in...
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