The following list of projects is a sample of work in progress or work recently completed. If you would like more information about Initiative projects, please email us.

Studies of Current Practices
(or How Physicians Approach Depression)

Standardized Patients and Clinical Competency
Patricia Carney, RN, PhD; Lee Badger, PhD; et. al. explored the current practices of primary care physicians (PCPs) in three regions of the country. Physicians received standardized patients, each portraying a specific presentation of depression. Nearly all physicians were able to identify depression cases involving insomnia and an inability to concentrate. Physicians found it harder to recognize depression in cases with somatic presentations and harder to recognize cases in men than in women. These findings were statistically significant.

HMO Treatment & Outcomes
for Medically Ill Patients with Mental Disorders

Stephen Bartels, MD, MS; Susan Horn, PhD; et. al. analyzed a data set of 12,997 medically ill patients with concurrent diagnoses of mental disorders. Findings that were statistically significant included that doctors were less likely to prescribe antidepressants for older patients and less likely to prescribe SSRIs in particular.

The Treatment Effectiveness Project
James E. Barrett, MD; Thomas E. Oxman, MD; et. al. are conducting a controlled clinical trial of paroxetine, a placebo, and Problem Solving Therapy for patients suffering from dysthymia and subthreshold depression. The study, which is being conducted in four regions of the country, is also looking at differences in outcomes for elderly versus non-elderly patients. (It is funded jointly by the Initiative and the Hartford Foundation.)

National Surveys of Primary Care Physicians
John W. Williams, MD, MSC; Allen J. Dietrich, MD; et. al. surveyed a national sample of 3,375 family physicians, general internists and obstetrician/gynecologists in primary care practices about their preferences and their practices in caring for depressed patients. Results showed statistically significant differences by physician specialty: General internists and family physicians were more likely to report asking depressed patients about suicidal feelings and prescribing antidepressants. Physicians across all specialties reported patient barriers to diagnosis and treatment.

Variations in Approaching the Diagnosis of Depression:
A Guided Focus Group Study

Patricia Carney, PhD, Lorna Rhodes, PhD, et. al., used guided focus groups with a purposeful sample of PCs to explore how they recognize and manage depression. Analysis was completed and identified three distinct clinical approaches: addressing physical symptoms first, addressing psychological symptoms first, and exploring mental and physical symptoms simultaneously. The results of this study were published in the Journal of Family Practice. Vol. 46, No.1, 1998.




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