The DAWN approach to collaborative depression care for women was tested in a randomized, controlled trial. Two academic urban obstetrics and gynecology clinics with different patient populations were selected:
- Underserved, racially and ethnically diverse, and largely uninsured or government insured women
- Mixed socioeconomic backgrounds, largely commercially insured women
The women were randomly assigned to either a 12-month DAWN intervention or the clinic’s usual care services.
To be eligible for the study, women 18 years and older had to:
- screen positive for major depression, dysthymia or both
- speak English
- have telephone access
Exclusionary criteria included multiple suicide attempts, lifetime schizophrenia or bipolar disorder, active substance abuse or dependency, severe domestic violence, or currently seeing a psychiatrist.
Women randomized to usual care received information about their diagnosis; education about depression, and their provider was informed about their diagnosis. They had access to social work, psychiatry referral and medication management by their care providers.
- an initial engagement session
- education about depression
- behavioral activation to increase positive or pleasurable activities the patient had stopped due to depression
- a patient choice for treatment of behavioral psychotherapy (Problem Solving Treatment-Primary Care and Behavioral Activation) or antidepressant medications
- patient contact (in-person or phone) by the depression care manager every 1-2 weeks for up to 12 months
- careful and consistent monitoring of treatment response, with appropriate adjustments to treatment (i.e. increase medication doses, add depression counseling, or start medications as needed)
Baseline data was collected on 205 participants with follow-up assessments conducted at 6, 12, and 18 months after enrollment. The primary outcomes for change at 12 months were depression and functional status. There were no demographic differences between the intervention and usual care groups: the average age was 39 years, 48% were married or living with a partner, 40% had commercial health insurance, and 44% were non-white.
Study results showed the DAWN approach was effective:
- Improvement in depression symptoms
- Improved functional abilities:
- Better treatment adherence, and
- Greater satisfaction with care
The DAWN care model is easily integrated into obstetrics and gynecology settings, even those with high rates of poverty and other complex psychosocial challenges and was shown to provide the greatest benefit among the most vulnerable women from socially disadvantaged backgrounds. The results compare favorably to interventions provided in primary care clinics, and the intervention can be implemented at modest cost (annual cost per patient is approximately equivalent to the cost of a pelvic MRI).