[Collaborative care for co-morbid major depressive disorder in chronically ill outpatients in a general hospital].

Background: Depression is highly prevalent in patients with chronic physical illnesses. A promising intervention for this group of patients is the collaborative care treatment as developed in the us.
Aim: To demonstrate the prevalence of depression and the risk factors of depression in diabetes patients, to describe how the screening for depression can be carried out and to assess whether the collaborative care treatment in the Netherlands is effective.
Method: A questionnaire was completed every three months in order to determine whether there was an improvement in patients' depression and physical symptoms. The outcomes were analysed by means of the multilevel logistic regression analyses.
Results: On the basis of the Patient Health Questionnaire, about 26% of the diabetes patients were found to have a depression. This questionnaire was validated for the measurement of depression in diabetes patients, the best results being found at a cut-off point of 12. In cases of fairly severe depression, collaborative care had no effect on depressive symptoms but did reduce severe physical complications. In cases of more severe depression, collaborative care only had an effect on depressive symptoms, but was not found to have any effect on physical complications.
Conclusion: There is evidence that collaborative care can reduce depression and physical complications in chronically ill patients. However, more research is needed to find out whether collaborative care can become more effective if it is supplemented with digital methods and group therapy.