symptoms. They also reported that adherence to guideline treatment was fairly high for certain factors—such as patient education, disease detection, and acute care treatment—but low for many others—such as inquiry into suicide assessment, alcohol abuse, previous history of depression, as well as subsequent medication adjustment. In summary, guidelines for the management of depressed patients in primary care may be very influential in facilitating recovery. Adherence to accepted guidelines should be widely encouraged. The ultimate impact of guideline-based treatment cannot be observed, however, unless this approach is embedded in protocols featuring multiple interventions, as guideline adherence alone has not been demonstrated to improve depression outcomes.

Self-Help

As many clients have difficulty accessing the services of therapists or care managers, investigators have begun to look at methods to improve treatment of depressive illness through remote technology or self-guided protocols (e.g., bibliotherapy, computer programs). Theoretically, these approaches may be more cost-effective and promote a broader dissemination of interventions, but clients must also be sufficiently motivated and educated to persist with treatment.

Previous investigations of various self-help models for depression have met with varying degrees of success. A recent meta-analysis was conducted in an attempt to determine which moderators were associated with positive outcomes. The authors found that there were considerable differences in study methodology (i.e., heterogeneity) among the 34 investigations that were identified (Gellatly et al., 2007). The analysis featured 29 interventions with written materials of which 10 were computer-assisted (e.g., web-based). The researchers concluded that the following moderators were associated with superior outcomes: (1) recruitment of participants from nonclinical settings, (2) inclusion of participants who had an existing mood disorder at baseline (as opposed to prevention), and (3) some sort of expert “guidance.” CBT principles appeared to be more effective than education alone. No significant associations were demonstrated based on the duration of the intervention, the delivery mode, or the therapists’ background.

Telecare

Telecare involves extensive telephone follow-up, often delivered by trained care managers (e.g., nurses or pharmacists) who relay treatment outcomes and recommendations to referring providers. This type of intervention is relatively inexpensive and can be implemented fairly easily. Theoretically, it may be performed by adequately trained paraprofessionals at



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