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OBJECTIVE To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. DESIGN Cluster randomised controlled trial. SETTING Five healthcare organisations in the United States and 60 affiliated practices. PATIENTS 405 patients, aged > or = 18 years, starting or(More)
OBJECTIVE The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. METHOD This multisite randomized trial included 10 sites consisting of primary care and specialty mental(More)
OBJECTIVE Despite high rates of co-occurring substance use disorder in people with severe mental illness, substance use disorder is often undetected in acute-care psychiatric settings. Because underdetection is related to the failure of traditional screening instruments with this population, the authors developed a new screen for detection of substance use(More)
The authors identified correlates of active suicidal ideation and passive death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Participants included 2,240 older primary care patients (age 65+), who were identified in three mutually exclusive groups on the basis of responses to the Paykel suicide questions: No(More)
CONTEXT Insufficient evidence exists for recommendation of specific effective treatments for older primary care patients with minor depression or dysthymia. OBJECTIVE To compare the effectiveness of pharmacotherapy and psychotherapy in primary care settings among older persons with minor depression or dysthymia. DESIGN Randomized, placebo-controlled(More)
Using a two-stage case identification process, patients from a rural primary care practice were assessed for psychiatric disorders (Research Diagnostic Criteria [RDC] categories) over a 15-month period. The prevalence of all psychiatric disorders was 26.5%; 10.0% were specific RDC depressive disorders, and 5.3% were disorders without depression, usually(More)
Speech samples from 71 patients in four diagnostic groups were analyzed by two quantitative methods of speech content analysis, the results of which were entered into a discriminant analysis to test whether patients could be accurately classified back into their appropriate diagnostic groups. These classifications were compared with classifications made by(More)
Minor depression is one of the most common types of depressive disorders, but the benefit of depression-specific treatments for minor depression is less clear than for major depression. The authors reviewed the available evidence-base for the treatment of Minor Depression as conceptualized in DSM-IV or RDC, conducting a computer literature search to(More)
The purpose of this study was to examine the relationship of social support and religion to mortality after elective open heart surgery in older patients. Of the 232 patients included in the study, 21 died within 6 months of surgery. Three biomedical variables were significant predictors of mortality and selected as adjustment variables for a multivariate(More)