Enhanced treatment for depression in primary care : first year results on compliance, self-efficacy, the use of antidepressants and contacts with the primary care physician

Objective: We describe the contents and feasibility of the Depression Recurrence Prevention (DRP)-Program, a structured psycho-educational self-management intervention based on an ongoing relationship between patient, prevention specialist and primary care physician. The DRP-Program consisted of three individual face-to-face sessions with a trained prevention specialist, followed by four telephone contacts per year. Methods: 267 primary care patients with a DSM-lV diagnosis of major depression were included and randomly assigned to care as usual (CAU; n = 72) or enhanced care (n = 195), which consisted of the DRP-Program either by itself or in combination with a psychiatric consultation or brief cognitive behavioral therapy. Result: DRP-program participation rates were high, both in the initial phase (92%) as during the first year of follow-up (95%) and patient evaluations were generally positive. Enhanced care patients were significantly more satisfied with effects of the depression care than CAU patients after three months. Perceived self-efficacy in dealing with depression was mostly similar in the four treatment groups. The use of antidepressants was lowest throughout the year in patients assigned to CBT plus DRP, who also kept less in touch with their PCP. Conclusion: The DRP-program proved to be feasible and appreciated.