Treating Depression in the Community
Posted on October 19, 2007
Community-based research has real world relevance, says Charles F. Reynolds III (bio).
One way to [help people in the community] has been via models of community-based participatory research, or CBPR as it has come to be known. The essence of CBPR as I understand it is the partnership with people living in the community, the intended beneficiaries of the research that you’re doing. If I may give an example from my own experience as a geriatric mental health services researcher, several years ago we embarked upon a project of depression care management. That is to say using depression care managers to export evidence-based practices into primary care practices.
In my particular area, geriatric mental health, most older Americans with depression, if they get any treatment at all for depression, get it in the primary care setting. They don’t come to mental health specialists like me. So we were concerned with ways of getting good depression care practices into the primary care setting in ways that would improve the detection of depression and the use of evidence-based pharmacotherapy and depression-specific psychotherapies to relieve the burden of depression in older Americans.
So we teamed up with a total of 20 primary care practices in Pittsburgh, Philadelphia, and New York. The primary care docs became our partners. The practice mangers became our partners as we developed a model that was realistic for them to carry out in their practices.
The model worked very, very well. We were able to show that by deploying master’s level mental health specialists, nurses or social workers for example, into primary care practices to work shoulder to shoulder with the docs that the rates of depression recognition and treatment and treatment response improved dramatically in relation to control practices, our so-called usual care practices.
And of particular importance to me as a geriatric psychiatrist, we noted that rates of suicidal ideation decline substantially and decline much more rapidly in patients who were part of the intervention practices in our study as compared with the control usual care practices. Because of this partnership, we were able to do work that had enormous real world relevance.