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How Quality Improvement Interventions for Depression Affect Stigma Concerns Over Time: A Nine-Year Follow-Up Study

Dr. Klap, Dr. Tang, Dr. Wells, and Dr. Miranda are with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 (e-mail: ruth{at}soc.ucla.edu). Dr. Schell and Dr. Sherbourne are with the Department of Health, RAND, Santa Monica, California. Dr. Duan is with the Department of Biostatistics, Columbia University, New York City.

OBJECTIVE: This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care. METHODS: Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in regard to friends, health insurance, and employers. RESULTS: Individuals in QI-therapy were significantly less likely than those in usual care and QI-meds to report concerns about friends learning about a history of depression (odds ratio [OR]=.66 and .65, respectively), and those in QI-meds were more likely than those in QI-therapy and usual care to have concerns about getting insurance (OR=1.42 and 1.68, respectively). CONCLUSIONS: Quality improvement programs for depression can raise or lower stigma concerns, depending on program design and resources for specific treatments.

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