| Telephone Counseling to Reduce Depression Symptoms and Improve Medication Adherence
Who is the intervention targeting?
Hispanic and African American patients with depression
What intervention is being evaluated?
A six session, scripted telephone counseling protocol will be delivered by mental health clinicians to improve medication adherence and promote behavioral activation in ways that help patients experience sources of reward and pleasure in their lives. After each call, patients will receive a letter summarizing the discussion and a list of “homework” assignments to be completed before the next call. Primary care physicians will receive feedback on their patients' mental health diagnosis, depression severity levels, and updated disease management recommendations after every other counseling session.
Where is this intervention taking place?
Federally qualified health centers (FQHCs) that are part of a public safety net health care system
Partnering Organizations
Denver Health and Hospitals Foundation (Lead Organization)
University of Colorado, Denver
University of Colorado, Boulder
Why might this approach work?
The intervention is based on a Behavioral Activation approach in which patients learn to monitor their mood and daily activities and how to increase the number of pleasant activities and positive interactions with their environment. Behavioral Activation is a relatively simple intervention that is easy to understand for depressed patients and does not require difficult or complex skills to implement. All mental health clinicians participating in the intervention will receive training on how to provide culturally effective care. Additionally, bilingual mental health clinicians and culturally tailored print materials will be made available to Spanish-speaking participants.
How will this intervention be evaluated?
Patients who receive a new prescription for a SSRI medication from their primary care physician will be recruited to participate in a randomized control trial. Primary outcomes will be evaluated at 6, 12 and 24 weeks and include depression symptom improvement and remission based on PHQ9 and HSCL 20 scores. Secondary outcomes include:
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Changes in medication adherence and behavioral activation
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Cost offsets (urgent care and ED use and hospitalizations)
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Impact of moderating and mediating variables
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Assessment of depression severity and psychiatric comorbidity
Principal Investigators:
David S. Brody, MD
Medical Director, Denver Health
Jeanette Waxmonsky, PhD
Assistant Professor, University of Colorado-Denver School of Medicine
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