Depression screening and treatment in uninsured urban patients

Background: depression has been widely studied in primary care settings,yet studies of medically uninsured populations are lacking. we sought to determine whether depression screening and treatment improved depression scores of a medically uninsured,mostly african american primary care population. methods: the study was a prospective repeated-measures design that recruited uninsured patients. patients were screened for depression,and the rate of depression diagnosis was compared with baseline. patients who were diagnosed and accepted treatment were randomized to 1 of 4 treatment arms: (1) usual care; (2) usual care and psychotherapy; (3) usual care and education and psychotherapy; and (4) usual care and education. patients were then reevaluated at 8,12,and 24 weeks. results: a total of 674 patients participated. depression prevalence was significantly higher among those screened (38%) than at baseline (16%). all treatment groups showed a significant reduction in depression scores over a 6-month period,from a mean score of 15 at baseline to 8.3 at 24 weeks (p < .005). all treatment interventions were equally effective. conclusion: screening improves the rate of diagnosis of depression in an uninsured,primarily african american population,and subsequent treatment significantly reduces the burden of depression.