Treating depression in primary care in low-income women in Santiago, Chile: A randomised controlled trial

Ricardo Araya*, Graciela Rojas, Rosemarie Fritsch, Jorge Gaete, Maritza Rojas, Greg Simon, Tim J. Peters

*Autor correspondiente de este trabajo

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

339 Citas (Scopus)


Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile.

In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depression were allocated stepped care or usual care. Stepped care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. Data were analysed on an intention-to-treat basis. The primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation.

About 90% of randomised patients completed outcome assessments. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. The adjusted difference in mean HDRS score between the groups was −8·89 (95% CI −11·15 to −6·76; p<0·0001). At 6-months' follow-up, 70% (60–79) of the stepped-care compared with 30% (21–40) of the usual-care group had recovered (HDRS score <8).

Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme, which is being introduced across Chile. Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression.
Idioma originalInglés
Páginas (desde-hasta)995-1000
Número de páginas6
PublicaciónThe Lancet
EstadoPublicada - 22 mar. 2003


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