MINOR DEPRESSION--PSYCHOSOCIAL TREATMENT IN PRIMARY CARE

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DESCRIPTION (Adapted from the Applicant's Abstract): The program of training and research outlined in this revised application for a Scientist Development Award for Clinicians (SDAC) focuses on developing the candidate's expertise in applying randomized clinical trails methodology to clinical services research in a primary care setting, with Herbert C. Schulberg, Ph.D., Professor of Psychiatry, Psychology, and Medicine, University of Pittsburgh School of Medicine, as Preceptor. The career development plans include training in psychiatric and medical epidemiology, psychometrics, health economics, and biostatistics. Planned tutorials are "Integrating Behavioral Interventions into Primary Health Care" and "Evaluating the Cost-Effectiveness of Psychiatric Treatment in Primary Care." The proposed research evaluates the efficacy of psychosocial treatment and course of recovery in primary care patients with minor depression. There is growing evidence that significant impairment in subjective well- being and functional status, and increased health care utilization are associated with minor depression. Yet, effective and feasible treatment options have received little attention. A randomized, clinical trial conducted at four urban health centers in Pittsburgh, PA is proposed to examine the efficacy of problem-solving therapy (PST) provided by nurse clinicians for primary care patients with minor depression. The outcomes of PST provided by nurse clinicians will be compared to the outcomes experienced by patients receiving usual care from their primary care physician. The integrity of the treatment provided by nurses will be evaluated with a scale to be developed by the candidate during the start-up phase of the study. The efficacy of PST will be assessed through multiple domains, including both symptomatic and functional changes following treatment. It is hypothesized that patients receiving PST will show greater symptomatic and functional improvement than those receiving usual care. Additionally, a pilot study of the cost- effectiveness of PST in primary care patients with minor depression will be undertaken during the award period.