Telephone Psychotherapy Effective, Efficient in Treatment of Depression

From Medscape Medical News Psychiatry News

Janis C. Kelly

October 16, 2009 — Depressed patients gain more depression-free days if they are treated with telephone care management plus telephone psychotherapy than with care management alone.

In research published in the October issue of the Archives of General Psychiatry , Gregory E. Simon, MD, MPH, from the Center for Health Studies, Group Health Cooperative, Seattle, Washington, and colleagues report that compared with usual care, the telephone care management program added $676 to outpatient health care costs for a gain of 29 depression-free days, whereas the telephone care management plus psychotherapy program added $397 to outpatient costs but produced an additional 46 depression-free days.

Telephone care management plus psychotherapy was cost-effective if a depression-free day was valued at $9; telephone care management alone was cost-effective only if a depression-free day was valued at $20 or more.

"The care management plus psychotherapy program was a better bargain no matter what value we attach to an additional day free of depression," Dr. Simon told Medscape Psychiatry .

Multicenter Study

The study, which was conducted in 7 primary care clinics of the Group Health Cooperative, included 600 primary care patients starting antidepressant treatment for significant depressive symptoms. Patients were randomly assigned to usual care or to one of the experimental interventions.

Telephone care management involved up to 5 outreach calls for monitoring and support, feedback to treating physicians, and care coordination. Care management plus psychotherapy also included 8 sessions of structured cognitive behavioral therapy over the telephone, with up to 4 additional reinforcement calls.

The 8 sessions included 1 session of education about depression and depression treatment, 3 sessions focused on behavioral activation, 3 sessions on identifying and challenging recurrent negative thoughts, and 1 session on developing a long-term self-care plan.

Telephone assessments were conducted periodically during 24 months, and costs were measured using health plan accounting records.

"Willingness to pay for time free of depression is a simple (albeit far from perfect) method for summarizing various economic benefits of improved depression care," the authors write. "Our previous research suggests that primary care patients treated for depression are on average willing to pay approximately $10 (in 2000 U.S. dollars) for an additional day free of depression."

Quality of Life Not Measured

In the current study, telephone care management alone had a negative net benefit even if the cost of a depression-free day was placed at $20; however, the telephone care management plus psychotherapy program delivered a positive benefit if a depression-free day was valued at $9 or more.

"For patients starting antidepressant treatment in primary care, adding a brief, structured psychotherapy program yields significant long-term benefits with a small increase in overall costs.

"At this time, insurance systems do not cover or pay for telephone-based psychotherapy programs. But we hope that evidence like this will build the case that structured psychotherapy by phone is an effective and efficient model for treating depression," said Dr. Simon.

Connie Veazey, PhD, a psychologist who has studied telephone-administered cognitive behavioral therapy, said that these data are important in the context of providing mental healthcare to depressed primary care patients.

However, she said, the most interesting finding is that is although the telephone psychotherapy condition had the highest depression care costs in comparison with the other 2 groups, it had the lowest overall healthcare costs. This adds to other research that suggests that adequately treating depression improves other healthcare outcomes.

Dr. Veazey, who is assistant professor of psychology at the University of Louisiana at Lafayette, also noted that the study did not measure the effect of various treatments on patients' quality of life.

Dr. Simon has disclosed that he has received consulting fees from Wyeth Pharmaceuticals and from Bristol-Myers Squibb Company. This study was supported by the National Institute of Mental Health.

Arch Gen Psychiatry . 2009;66:1081–1089. Abstract

Authors and Disclosures

Journalist

Janis Kelly

Janis Kelly is a freelance writer for Medscape. She has been a medical journalist since 1976, with extensive work in rheumatology, immunology, neurology, sports medicine, AIDS and infectious diseases, oncology, and respiratory medicine.

-From http://www.medscape.com/viewarticle/710681 retrieved 10/19/09.

 

10/09