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Multimedia intervention increased antidepressant recommendation in primary care

Physician recommendations for antidepressant medications, a mental health referral or both increased for patients with depression after the use of an interactive multimedia computer program prior to a primary care visit, according to data published in JAMA.

The intervention did not result in improved mental health at 12 weeks, however.

Richard L. Kravitz, MD, MSPH, of the division of general medicine at the University of California, Davis, and colleagues conducted a randomized trial to determine whether initial depression care could be affected by a depression engagement video or a tailored interactive multimedia computer program vs. a sleep hygiene video (control) without increasing unnecessary antidepressant prescribing. The study included 559 adult patients with depression and 308 without depression who were treated by 135 primary care physicians at seven primary care sites in California from June 2010 to March 2012.

The primary endpoint was the composite of patient-reported antidepressant drug recommendation, mental health referral or both; the secondary endpoint was depression at 12 weeks of follow-up.

Patients in the interactive multimedia computer program group had a higher rate of achieving the primary endpoint (26%) compared with those in the depression engagement video (17.5%) and control groups (16.3%; video vs. control: P=.79; computer program vs. control: P=.02).

However, there was no effect on depression at 12 weeks, as measured by the Patient Health Questionnaire-8 (PHQ-8): difference in video vs. control, –0.2% (95% CI, –1.2 to 0.8); difference in computer program vs. control, 0.9% (95% CI, –0.1 to 1.9).

A noninferiority assessment was conducted for clinician- and patient-reported antidepressant medication recommendation among patients without depression. According to this analysis, clinician-reported antidepressant prescribing was noninferior to control in both intervention groups (video vs. control, P for noninferiority=.0499; computer grogram vs. control, P for noninferiority=.02). Noninferiority was not reached for patient-reported antidepressant recommendation (video vs. control, P for non-inferiority=.23; computer program vs. control, P for noninferiority=.16).

"Although there was no evidence of excess antidepressant prescribing among patients with minimal symptoms of depression as determined by the clinician-reported outcome, potential overtreatment cannot be excluded based on the patient-reported outcome," researchers wrote. "Further research is needed to determine effects on clinical outcomes and whether the benefits outweigh possible harms."

Disclosure: See the study for a full list of all researchers’ relevant financial disclosures.