Evidence-based models of integrated management of depression in primary care.

A variety of epidemiologic studies has demonstrated the high prevalence of depressive disorders in primary care [1–4]. Indeed, by patient preference, the majority of treated depressive episodes are in primary care practices [5,6]. This is particularly true for older persons [7,8]. Accordingly, it is not surprising that primary care clinicians place a high priority on recognizing and treating their depressed patients [9,10]. However, formidable obstacles impede appropriate treatment and the prevention of relapse or recurrence, including time pressures, the inclination of both clinicians and patients to focus on presenting symptoms and acute problems, the limits of reimbursement, and the lack of well-organized mental health systems capable of consulting about and treating patients in most primary care settings [9–13]. In response to these obstacles, first-generation health services research has produced multifaceted interventions. The interventions with collaborative care, inwhich an on-sitemental health specialist and the primary care clinician shared the care of depressed patients, most successfully overcame many of