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Collaborative care for depression in patients with diabetes increased depression free days and had economic benefit

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 Q In outpatients with diabetes mellitus and depression, what is the incremental cost effectiveness of systematic depression treatment?

Clinical impact ratings GP/FP/Primary care ★★★★★☆☆ GP/FP/Mental health ★★★★★★☆ Internal medicine ★★★★★☆☆ Endocrine ★★★★★☆☆ Psychiatry ★★★★★★


Embedded ImageDesign:

randomised {allocation concealed*}, blinded (outcome assessors),* controlled trial with 24 month follow up (Pathways Study) and cost effectiveness and cost benefit analyses.

Embedded ImageSetting:

9 primary care clinics of a health maintenance organisation in Washington and Idaho, USA.

Embedded ImagePatients:

329 patients (mean age 58 y, 66% men) who were screened in 2 stages. Patients had diabetes mellitus and a Hopkins Symptom Checklist depression score ⩾1.1 (presence of at least moderate depressive symptoms) at the second screening. Exclusion criteria included recent psychiatric treatment, bipolar or psychotic disorder, cognitive impairment, or plans to move or leave the health plan. Follow up was 89% at 6 months, 88% at 12 …

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  • * See glossary.

  • Information provided by author.

  • For correspondence: Dr G E Simon, Center for Health Studies, Seattle, WA, USA. simon.g{at}

  • Source of funding: National Institute of Mental Health.