IMPACT OF IMPROVED DEPRESSION TREATMENT IN PRIMARY-CARE ON DAILY FUNCTIONING AND DISABILITY

Background. Few data are available regarding the impact of improved de pression treatment on daily functioning and disability. Methods. In tw o studies of more intensive depression treatment in primary care, pati ents initiating antidepressant treatment were randomly assigned to eit her usual care or to a collaborative management programme including pa tient education, on-site mental health treatment, adjustment of antide pressant medication, behavioural activation and monitoring of medicati on adherence. Assessments at baseline as well as 4 and 7 months includ ed several measures of impairment, daily functioning and disability: s elf-rated overall health, number of bodily pains, number of somatizati on symptoms, changes in work due to health, reduction in leisure activ ities due to health, number of disability days and number of restricte d activity days. Results. Average data from the 4- and 7-month assessm ents in both studies, intervention patients reported fewer somatic sym ptoms (OR 0.68, 95% CI 0.46, 0.99) and more favourable overall health (OR 0.50, 95% CI 0.28, 0.91). While intervention patients fared better on other measures of functional impairment and disability, none of th ese differences reached statistical significance. Conclusions. More ef fective acute-phase depression treatment reduced somatic distress and improved self-rated overall health. The absence of a significant inter vention effect on other disability measures may reflect the brief trea tment and follow-up period and the influence of other individual and e nvironmental factors on disability.