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The Effect of Targeted and Tailored Patient Depression Engagement Interventions on Patient–Physician Discussion of Suicidal Thoughts: A Randomized Control Trial

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ABSTRACT

BACKGROUND

Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low.

OBJECTIVE

To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control.

DESIGN

Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO).

PARTICIPANTS

Eight-hundred sixty-seven participants, with mean age 51.7; 43.9 % women, 43.4 % from a racial/ethnic minority group.

INTERVENTION

The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video.

MAIN MEASURES

Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]).

KEY RESULTS

Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95 % confidence interval = 1.5, 5.10, p = 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9.

CONCLUSIONS

Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.

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Funding

The work was supported by grant 1R01MH079387 from the National Institute of Mental Health.

Role of the Funding Source

The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or preparation, review, or approval of the manuscript.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. UC Davis Division of General Medicine and Center for Healthcare Policy and Research, 4501 X Street, Sacramento, CA, 95817, USA

    Ruby Shah MD, MPH & Richard L. Kravitz MD, MPSH

  2. UC Davis Department of Family and Community Medicine and Center for Healthcare Policy and Research, Sacramento, CA, 95817, USA

    Peter Franks MD & Anthony Jerant MD

  3. UC San Francisco Division of General Internal Medicine, San Francisco, CA, USA

    Mitchell Feldman MD, Phil, FACP

  4. University of Rochester Department of Psychiatry, Rochester, NY, USA

    Paul Duberstein PhD

  5. UC Davis Department of General Pediatrics and Center for Healthcare Policy and Research, Sacramento, CA, USA

    Erik Fernandez y Garcia MD, MPH

  6. Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA

    Ladson Hinton MD

  7. Sacramento VA Medical Center Department of General Internal Medicine, Sacramento, CA, USA

    Lorrie Strohecker MD, MPH

Authors
  1. Ruby Shah MD, MPH
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  2. Peter Franks MD
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  3. Anthony Jerant MD
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  4. Mitchell Feldman MD, Phil, FACP
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  5. Paul Duberstein PhD
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  6. Erik Fernandez y Garcia MD, MPH
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  7. Ladson Hinton MD
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  8. Lorrie Strohecker MD, MPH
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  9. Richard L. Kravitz MD, MPSH
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Corresponding author

Correspondence to Ruby Shah MD, MPH.

Additional information

Trial Registration: ClinicalTrials.gov Identifier NCT01144104

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Shah, R., Franks, P., Jerant, A. et al. The Effect of Targeted and Tailored Patient Depression Engagement Interventions on Patient–Physician Discussion of Suicidal Thoughts: A Randomized Control Trial. J GEN INTERN MED 29, 1148–1154 (2014). https://doi.org/10.1007/s11606-014-2843-8

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  • DOI: https://doi.org/10.1007/s11606-014-2843-8

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