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Phone Counseling for Depression Rings With Promise

Talk sessions plus psychotherapy offer most benefit, study finds

TUESDAY, Oct. 27, 2009 (HealthDay News) -- An intensive telephone counseling program for people with depression offers substantial benefits at moderate cost, U.S. researchers say.

They studied 600 people who were randomly assigned to one of three types of care for their depression. One group received telephone care management, which included five outreach calls for monitoring, support, feedback and care coordination. Another group received telephone care management plus psychotherapy, which added eight sessions of structured cognitive behavioral therapy over the phone with up to four additional reinforcement calls. The third group received usual care.

The two-year study found that telephone care management alone led to an average gain of 29 depression-free days and a $676 increase in outpatient health care costs, compared with usual care. Telephone care management plus psychotherapy led to a gain of 46 depression-free days and $397 in added outpatient costs.

The study appears in the October issue of Archives of General Psychiatry.

"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," wrote Dr. Gregory E. Simon and colleagues at the Group Health Research Institute in Seattle. "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."

This new study found that telephone care management alone had a negative net benefit even if the cost of a depression-free day was $20. However, telephone care management plus psychotherapy delivered a positive benefit if a depression-free day was valued at $9 or more.

"The primary goal of depression treatment is to relieve suffering and improve function, not to decrease health-care costs," the researchers wrote. "We certainly do not intend to imply that depression treatment is justified only if it is either cost neutral or cost saving. Our findings do, however, offer some guidance to insurers or health-care systems considering efforts to improve care for depression."

"The balance of added benefits and added costs was more favorable for the more intensive program. Efforts to improve depression treatment in primary care should consider incorporating structured psychotherapy interventions," they concluded.

More information

The U.S. National Institute of Mental Health has more about depression.

SOURCE: JAMA/Archives journals, news release, October 2009
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