Showing papers in "Psychiatric Services in 2011"

What Does Recovery Mean in Practice? A Qualitative Analysis of International Recovery-Oriented Practice Guidance

Abstract: Objectives: Recovery is a multifaceted concept, and the need for operationalization in practice has been identified Although guidance on recovery-oriented practice exists, it is from disparate sources and is difficult to apply The aims of the study were to identify the key characteristics of recovery-oriented practice guidance on the basis of current international perspectives and to develop an overarching conceptual framework to aid the translation of recovery guidance into practice Methods: A qualitative analysis of 30 international documents offering recovery-oriented practice guidance was conducted Inductive, semantic-level, thematic analysis was used to identify dominant themes Interpretive analysis was then undertaken to group the themes into practice domains Results: The guidance documents were diverse; from six countries—the United States, England, Scotland, Republic of Ireland, Denmark, and New Zealand—and varied in document type, categories of guidance, and level of service user involvement in guidance development The emerging conceptual framework consists of 16 dominant themes, grouped into four practice domains: promoting citizenship, organizational commitment, supporting personally defined recovery, and working relationship Conclusions: A key challenge for mental health services is the lack of clarity about what constitutes recovery-oriented practice The conceptual framework contributes to this knowledge gap and provides a synthesis of recovery-oriented practice guidance (Psychiatric Services 62:1470–1476, 2011)

Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial.

Abstract: Objective: A randomized cluster controlled trial tested the hypothesis that weekly feedback to clinicians would improve the effectiveness of home-based mental health treatment received by youths in community settings. Methods: Youths, caregivers, and clinicians at 28 sites in ten states completed assessments of the youths’ symptoms and functioning every other week. Clinicians at 13 sites were provided with weekly feedback about the assessments, and clinicians at 15 sites received feedback every 90 days. Data were collected from June 1, 2006, through December 31, 2008. Intent-to-treat analyses were conducted with hierarchical linear modeling of data provided by youths, caregivers, and clinicians. Results: Assessments by youths, caregivers, and clinicians indicated that youths (N=173) treated at sites where clinicians could receive weekly feedback improved faster than youths (N=167) treated at sites where clinicians did not receive weekly feedback. A dose-response analysis showed even stronger effects when clinicians viewed more feedback reports. Conclusions: Routine measurement and feedback can be used to improve outcomes for youths who receive typical home-based services in the community. (Psychiatric Services 62:1423–1429, 2011)

Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review.

Abstract: Objective:Although military personnel are at high risk of mental health problems, research findings indicate that many military personnel and veterans do not seek needed mental health care Thus it is critical to identify factors that interfere with the use of mental health services for this population, and where possible, intervene to reduce barriers to care The overarching goal of this review was to examine what is known with regard to concerns about public stigma and personal beliefs about mental illness and mental health treatment as potential barriers to service use in military and veteran populations and to provide recommendations for future research on this topic Methods:Fifteen empirical articles on mental health beliefs and service use were identified via a review of the military and veteran literature included in PsycINFO and PubMed databases Results:Although results suggest that mental health beliefs may be an important predictor of service use for this population, several gaps were identifi

Effectiveness of Peer Support in Reducing Readmissions of Persons With Multiple Psychiatric Hospitalizations

Abstract: Objective:The study examined the feasibility and effectiveness of using peer support to reduce recurrent psychiatric hospitalizations. Methods:A randomized controlled design was used, with follow-up at nine months after an index discharge from an academically affiliated psychiatric hospital. Patients were 18 years or older with major mental illness and had been hospitalized three or more times in the prior 18 months. Seventy-four patients were recruited, randomly assigned to usual care (N=36) or to a peer mentor plus usual care (N=38), and assessed at nine months. Results:Participants who were assigned a peer mentor had significantly fewer rehospitalizations (.89±1.35 versus 1.53±1.54; p=.042 [one-tailed]) and fewer hospital days (10.08±17.31 versus 19.08±21.63 days; p<.03, [one tailed]). Conclusions:Despite the study's limitations, findings suggest that use of peer mentors is a promising intervention for reducing recurrent psychiatric hospitalizations for patients at risk of readmission. (Psychiatric Ser...

An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment.

Abstract: An intervention delivered in an emergency department was shown to improve rates of follow-up care among suicidal youths discharged from the department. The intervention involved a family-based cognitive-behavioral therapy session, later supplemented by care linkage telephone contacts after discharge.

Knowledge and attitudes as predictors of intentions to seek help for and disclose a mental illness.

Abstract: Objective:Individuals often choose not to seek help for or disclose their mental illness. This study examined whether having more positive attitudes and more knowledge about mental illness could predict intentions to seek help from a general practitioner and to disclose a mental illness to friends and family members. Methods:A Department of Health survey in England assessed knowledge about mental illness, attitudes toward people with mental illness, and level of contact with someone with a mental illness among 1,751 adults representative of the general population. Results:With controls for social grade and race-ethnicity, intentions to seek help were predicted by better knowledge about mental illness, tolerance and support for community care of mental illness, and older age. Willingness to disclose one's mental illness was associated with better knowledge. Conclusions:Initiatives that increase knowledge and positive attitudes about mental illness among the general population may improve the extent to whic...

Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women

Abstract: Objective:The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients. Methods:In a retrospective cohort study, administrative claims data from New Jersey's Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days). Results:Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment...

Mixed-Methods Designs in Mental Health Services Research: A Review

Abstract: Objective:Despite increased calls for use of mixed-methods designs in mental health services research, how and why such methods are being used and whether there are any consistent patterns that might indicate a consensus about how such methods can and should be used are unclear. Methods:Use of mixed methods was examined in 50 peer-reviewed journal articles found by searching PubMed Central and 60 National Institutes of Health (NIH)-funded projects found by searching the CRISP database over five years (2005–2009). Studies were coded for aims and the rationale, structure, function, and process for using mixed methods. Results:A notable increase was observed in articles published and grants funded over the study period. However, most did not provide an explicit rationale for using mixed methods, and 74% gave priority to use of quantitative methods. Mixed methods were used to accomplish five distinct types of study aims (assess needs for services, examine existing services, develop new or adapt existing servi...

National Guard families after combat: mental health, use of mental health services, and perceived treatment barriers.

Abstract: Objective:National Guard forces have deployed in large numbers to Iraq and Afghanistan since September 11, 2001. The purpose of this cross-sectional study was to assess mental health symptoms, utilization of mental health services, and perceived barriers to service use among National Guard members and their significant others (including spouses and others with whom they share a committed relationship) from a Midwestern state. Methods:Participants were recruited for the study at military-sponsored reintegration workshops, which took place 45–90 days after service members' return from deployment. A sample of 332 National Guard members and 212 significant others volunteered to complete a survey that assessed mental health symptoms, service utilization, and barriers to treatment. Results:Forty percent of National Guard members and 34% of significant others met the screening criteria for one or more mental health problems. Of those meeting the criteria, 53% reported seeking help of some kind (50% of soldiers; ...

Outcomes of a Randomized Study of a Peer-Taught Family-to-Family Education Program for Mental Illness

Abstract: Objective: The Family-to-Family Education Program (FTF) is a 12-week course offered by the National Alliance on Mental Illness (NAMI) for family members of adults with mental illness. This study evaluated the course’s effectiveness. Methods: A total of 318 consenting participants in five Maryland counties were randomly assigned to take FTF immediately or to wait at least three months for the next available class with free use of any other NAMI supports or community or professional supports. Participants were interviewed at study enrollment and three months later (at course termination) regarding problem- and emotion-focused coping, subjective illness burden, and distress. A linear mixed-effects multilevel regression model tested for significant changes over time between intervention conditions. Results: FTF participants had significantly greater improvements in problem-focused coping as measured by empowerment and illness knowledge. Exploratory analyses revealed that FTF participants had significantly enhanced emotion-focused coping as measured by increased acceptance of their family member’s illness, as well as reduced distress and improved problem solving. Subjective illness burden did not differ between groups. Conclusions: This study provides evidence that FTF is effective for enhancing coping and empowerment of families of persons with mental illness, although not for reducing subjective burden. Other benefits for problem solving and reducing distress are suggested but require replication. (Psychiatric Services 62:591–597, 2011)

Randomized Trial of Critical Time Intervention to Prevent Homelessness After Hospital Discharge

Abstract: Objective:This study assessed the effectiveness of a previously tested model, critical time intervention (CTI), in producing an enduring reduction in the risk of homelessness for persons with severe mental illness who were discharged from inpatient psychiatric treatment facilities. Methods:A total of 150 previously homeless men and women with severe mental illness and who were discharged from inpatient psychiatric hospitalization to transitional residences on the hospital grounds were randomly assigned to receive usual care or usual care plus CTI at the point of discharge to the community. The nine-month intervention aims to gradually pass responsibility to community sources for providing ongoing support after the intervention ends, thereby leading to a durable reduction in risk of future homelessness. After participants were discharged from the transitional residence (length of stay six to 937 days), their housing status was assessed every six weeks for 18 months via participant self-report collected by ...

Best practices: Strategic stigma change (SSC): five principles for social marketing campaigns to reduce stigma.

Abstract: This column describes strategic stigma change (SSC), which comprises five principles and corresponding practices developed as a best practice to erase prejudice and discrimination associated with mental illness and promote affirming behaviors and social inclusion. SSC principles represent more than ten years of insights from the National Consortium on Stigma and Empowerment. The principles, which are centered on consumer contact that is targeted, local, credible, and continuous, were developed to inform the growth of large-scale social marketing campaigns supported by governments and nongovernmental organizations. Future social marketing efforts to address stigma and the need for evidence to determine SSC's penetration and impact are also discussed.

Perceived Coercion and the Therapeutic Relationship: A Neglected Association?

Abstract: Objective:Increasing patient autonomy and decreasing coercion are frequently cited goals in mental health care. Research suggests that the therapeutic relationship and patients' experiences of coercion may be associated. This study investigated the association between the therapeutic relationship and perceived coercion in psychiatric admissions. Methods:Associations between perceived coercion and the therapeutic relationship and sociodemographic and clinical variables were examined by using data from structured interviews with 164 patients consecutively admitted to two psychiatric hospitals in Oxford, England. Results:High levels of coercion were experienced by 48% of voluntarily and 89% of involuntarily admitted patients. A high perceived coercion score was significantly associated with involuntary admission and a poor rating of the therapeutic relationship. The therapeutic relationship confounded legal status as a predictor of perceived coercion. Conclusions:Similar factors may influence patients' exper...

Racial-Ethnic Disparities in Substance Abuse Treatment: The Role of Criminal History and Socioeconomic Status

Abstract: Objective:Among persons with substance use disorders, those from racial-ethnic minority groups have been found to receive substance abuse treatment at rates equal to or higher than those of non-Latino whites. Little is known about factors underlying this apparent lack of disparities. This study examines racial-ethnic disparities in treatment receipt and mechanisms that reduce or contribute to disparities. Methods:Black-white and Latino-white disparities in any and in specialty substance abuse treatment were measured among adult respondents with substance use disorders from the 2005–2009 National Survey on Drug Use and Health (N=25,159). Three staged models were used to measure disparities concordant with the Institute of Medicine definition, assess the extent to which criminal history and socioeconomic indicators contributed to disparities, and identify correlates of treatment receipt. Results:Treatment was rare (about 10%) for all racial-ethnic groups. Odds ratios for black-white and Latino-white differe...

Serving Those Who Served: Retention of Newly Returning Veterans From Iraq and Afghanistan in Mental Health Treatment

Abstract: Objective:There are growing concerns about the mental health status of returning veterans from the recent conflicts in Iraq (Operation Iraq Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) and about retention in mental health treatment of veterans with posttraumatic stress disorder (PTSD). This study obtained data from veterans who had a new diagnosis of PTSD from fiscal year (FY) 2004 to FY 2007 and determined whether retention in PTSD treatment and the number of mental health visits were comparable among OIF-OEF veterans and veterans from other service eras. Methods:Data from the Department of Veterans Affairs and the Department of Defense were combined to identify veterans who were newly diagnosed as having PTSD (N=204,184) and their service era. Survival analysis assessed dropout from mental health treatment within one year from initial diagnosis, and Poisson regression assessed the association between war era and number of mental health visits. Results:Although a smaller proportion o...

Psychiatric Status and Work Performance of Veterans of Operations Enduring Freedom and Iraqi Freedom

Abstract: Objective:This cross-sectional study investigated the relationship between psychiatric diagnosis and impaired work functioning among American service members returning from Operation Iraqi Freedom-Operation Enduring Freedom (OEF-OIF). Methods:Participants were 797 OEF-OIF veterans, of whom 473 were employed. They were referred for further psychiatric assessment by primary care providers at six Veterans Affairs medical centers and underwent a behavioral health interview that assessed psychiatric and health status and work impairment as measured by the Work Limitations Questionnaire (WLQ). The four WLQ subscales (mental-interpersonal demands, time management, output, and physical demands) and an aggregated measure of productivity loss were considered in the analysis. Associations between patient characteristics, psychiatric status, and work impairments were investigated with regression models. Results:Major depressive disorder, posttraumatic stress disorder, and generalized anxiety or panic disorder were si...

Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital.

Abstract: Objectives:This study used an experimental design to examine the effect of systematic implementation of behavioral interventions on the rate of seclusion and restraint in an inpatient psychiatric hospital. Methods:With a variant of the multiple-baseline design, a model designed to reduce seclusion and restraint was implemented at a large state-funded hospital in the southeastern United States. The implementation schedule was established such that each of five inpatient units was randomly assigned to implement the intervention components in a different order, and each unit served as its own control. Participants were patients and staff, for a total of 89,783 patient-days over a 3.5-year period from January 2005 through June 2008. The components included trauma-informed care training, changes to unit rules and language, changes to the physical characteristics of the therapeutic environment, and involvement of patients in treatment planning. The rate of inpatient psychiatric seclusion and restraint (per pati...

International Variation in Treatment Procedures for ADHD: Social Context and Recent Trends

Abstract: Objective: Scientific and clinical interest in attention-deficit hyperactivity disorder (ADHD) is increasing worldwide. This article presents data from a cross-national workshop and survey related to questions of variability in diagnostic and, particularly, treatment procedures. Methods: Representatives of nine nations (Australia, Brazil, Canada, China, Germany, Israel, the Netherlands, Norway, and the United Kingdom), plus the United States, who attended a 2010 workshop on ADHD, responded to a survey that addressed diagnostic procedures for ADHD; treated prevalence of medication approaches, as well as psychosocial interventions; types of medications and psychosocial treatments in use; payment systems; beliefs and values of the education system; trends related to adult ADHD; and cultural and historical attitudes and influences related to treatment. Results: Use of both medication and psychosocial treatment for ADHD varies widely within and across nations. More expensive long-acting formulations of medications are becoming more widespread. Nations with socialized medical care provide a wide array of evidence-based interventions. Economic, historical, and political forces and cultural values are related to predominant attitudes and practices. Strong antipsychiatry and antimedication voices remain influential in many nations. Conclusions: There is considerable variation in implementation of care for ADHD. Recognition of the social context of ADHD is an important step in ensuring access to evidence-based interventions for this prevalent, chronic, and impairing condition. (Psychiatric Services 62:459–464, 2011)

Mental Health of Victims of Intimate Partner Violence: Results From a National Epidemiologic Survey

Abstract: Objective:This study assessed the national incidence and mental health correlates of recent intimate partner violence among adults interviewed by the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Methods:Data were collected about minor and severe forms of intimate partner violence among adults who reported being married, recently married, or in a romantic relationship in the past 12 months (N=25,626). Results:A total of 1,608 individuals reported being victims of intimate partner violence, including 5.8% of men and 5.6% of women. New onset of axis I disorders was significantly more common among victims of intimate partner violence than among nonvictims (22.5% and 9.7%, respectively; OR=2.6) and was related to frequency of violent acts. Conclusions:Intimate partner violence is common, and victimization, especially if recurrent, markedly increases the risk for developing several psychiatric disorders. (Psychiatric Services 62:959–962, 2011)

A Randomized Trial of Spiritual Assessment of Outpatients With Schizophrenia: Patients' and Clinicians' Experience

Abstract: Objective:Recovery-oriented care for patients with schizophrenia involves consideration of cultural issues, such as religion and spirituality. However, there is evidence that psychiatrists rarely address such topics. This study examined acceptance of a spiritual assessment by patients and clinicians, suggestions for treatment that arose from the assessment, and patient outcomes—in terms of treatment compliance and satisfaction with care (as measured by treatment alliance). Methods:Outpatients with psychosis were randomly assigned to two groups: an intervention group that received traditional treatment and a religious and spiritual assessment (N=40) and a control group that received only traditional treatment (N=38). Eight psychiatrists were trained to administer the assessment to their established and stable patients. After each administration, the psychiatrist attended a supervision session with a psychiatrist and a psychologist of religion. Baseline and three-month data were collected. Results:The spiri...

Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

Abstract: Objective:People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the response to specialized substance abuse treatments. Methods:The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? Results:Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course ...

Coercion in Psychiatric Care: Systematic Review of Correlates and Themes

Abstract: Objective:This study systematically examined the empirical literature on the themes and correlates of coercion as defined by the subjective experience of patients in psychiatric care. Methods:The study was a systematic review of the literature on coercion as covered in MEDLINE, PsycINFO, and CINAHL. From qualitative studies, themes that the authors identified were extracted. From quantitative studies, correlational and outcome data were extracted. Results:The final analysis included 27 articles. Themes related to perceived coercion were almost all negative. Correlation and outcome data were insufficiently homogeneous to allow meaningful combined statistical analysis. There was no strong quantitative evidence that the experience of coercion is negatively or positively associated with psychopathology or general well-being. Conclusions:Coercion was commonly felt by patients as dehumanizing. Compulsory actions likely to increase perceived coercion had mixed correlates, and it was therefore difficult to predic...

Underutilization of Mental Health Services Among Bereaved Caregivers With Prolonged Grief Disorder

Abstract: Objective:This study examined grief and mental health service use among 86 bereaved caregivers of advanced cancer patients. Methods:Caregivers were assessed before (median=3.1 months) and after (median=6.6 months) patients' deaths for prolonged grief disorder, axis I psychiatric disorders, mental health service use, suicidality, and health-related quality of life. Results:Sixteen percent of the bereaved sample met criteria for prolonged grief disorder, which was significantly associated with suicidality and poorer health-related quality of life, but not with mental health service use. The majority of bereaved caregivers with prolonged grief disorder did not access mental health services. In multivariable analyses, having discussed psychological concerns with a health care professional when the patient was ill was the only significant predictor of mental health service use during bereavement. Conclusions:Because bereaved caregivers with prolonged grief disorder underutilize mental health services, connecti...

A Randomized Controlled Trial of the Illness Management and Recovery Program for Persons With Schizophrenia

Abstract: Objective: The aim of the study was to evaluate the effects of the illness management and recovery (IMR) program on symptoms and psychosocial functioning of individuals with schizophrenia or schizo ...

Help-Seeking and Mental Health Service Utilization among College Students with a History of Suicide Ideation

Abstract: Objective:This study examined help seeking among 158 college students with a lifetime history of suicide ideation. Methods:Students were interviewed about episodes of psychological distress, formal treatment, and informal help seeking during adolescence and college. Results:Of the 151 students reporting any lifetime episodes of distress, 62% experienced the first episode in adolescence, and 54% had episodes in both adolescence and young adulthood. Overall, 87% received informal help, 73% received formal treatment, and 61% received both. Among the 149 who ever sought help or treatment, the most commonly reported sources of help were family (65%), friends (54%), psychiatrists (38%), and psychologists (33%). Of the 94 individuals who experienced suicide ideation in college, 44% did not seek treatment during young adulthood. Treatment barriers reflected ambivalence about treatment need or effectiveness, stigma, and financial concerns. Conclusions:Most students had some contact with treatment, but family and f...

Inpatient Psychiatric Care in the 21st Century: The Need for Reform

Abstract: Driven by financial pressures, the sole focus of psychiatric inpatient treatment has become safety and crisis stabilization. Data are lacking on outcomes of ultrashort-stay hospitalizations; however, such stays may diminish opportunities for a sustained recovery. In the absence of an evidence base to guide clinicians and policy makers, mental health professionals have an ethical obligation to promote what they consider to be best practice. This Open Forum focuses on the need to reconsider the current model of inpatient hospitalization in order to maximize positive outcomes and emphasize appropriate transition to the community and less intensive levels of care. A model of care is presented based on rapid formulation of diagnosis, goals, and treatment modalities before treatment begins. Three phases are described—assessment, implementation, and resolution—with specific principles to guide length-of-stay decisions and requirements for staffing. (Psychiatric Services 62:206–209, 2011)

Staff Perceptions and Organizational Factors as Predictors of Seclusion and Restraint on Psychiatric Wards

Abstract: Objective:Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. Methods:A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. Results:Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate ...

Telephone-Based Cognitive-Behavioral Therapy for Latino Patients Living in Rural Areas: A Randomized Pilot Study

Abstract: Objective:This pilot study tested the effectiveness of culturally tailored, telephone-based cognitive-behavioral therapy (CBT) for improving depression outcomes among Latino primary care patients living in rural settings. Methods:A total of 101 Latino patients at a rural family medical center who met criteria for probable major depression were randomly assigned to enhanced usual care or eight sessions of CBT delivered by phone by trained bilingual therapists from the community. Blinded study assistants assessed depression symptom severity, using the Hopkins Symptom Checklist (SCL) depression items and the Patient Health Questionnaire-9, and patient satisfaction after six weeks, three months, and six months. Mixed-effects models were used to estimate intervention effects over time. For cross-sectional analyses, attrition weights were used to account for missing data. Results:In intent-to-treat analyses, patients who received CBT by phone were more likely to experience improvement in depression scores over ...

One-Year Follow-Up of Collaborative Depression Care for Low-Income, Predominantly Hispanic Patients With Cancer

Abstract: Objective: This study assessed longer-term outcomes of low-income patients with cancer (predominantly female and Hispanic) after treatment in a collaborative model of depression care or in enhanced usual care. Methods: The randomized controlled trial, conducted in safety-net oncology clinics, recruited 472 patients with major depression symptoms. Patients randomly assigned to a 12-month intervention (a depression care manager and psychiatrist provided problem-solving therapy, antidepressants, and symptom monitoring and relapse prevention) or enhanced usual care (control group) were interviewed at 18 and 24 months after enrollment. Results: At 24 months, 46% of patients in the intervention group and 32% in the control group had a ≥50% decrease in depression score over baseline (odds ratio=2.09, 95% confidence interval=1.13–3.86; p=.02); intervention patients had significantly better social (p=.03) and functional (p=.01) well-being. Treatment receipt among intervention patients declined (72%, 21%, and 18% at 12, 18, and 24 months, respectively); few control group patients reported treatment receipt (10%, 6%, and 13%, respectively). Significant differences in receipt of counseling or antidepressants disappeared at 24 months. Depression recurrence was similar between groups (intervention, 36%; control, 39%). Among patients with depression recurrence, intervention patients were more likely to receive treatment after 12 months (34% versus 10%; p=.03). At 24 months, attrition (262 patients, 56%) did not vary by group; 22% were deceased, 20% declined further participation, and 14% could not be located. Conclusions: Collaborative care reduced depression symptoms and enhanced quality of life; however, results call for ongoing depression symptom monitoring and treatment for low-income cancer survivors. (Psychiatric Services 62:162–170, 2011)