Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study: design and practical implications of an intervention for comorbid pain and depression.

摘要: Abstract Objective Depression and pain are common comorbid conditions that have reciprocal adverse effects on disability treatment outcomes. The objective of this article is to describe a study tests the effectiveness stepped-care approach using combined medication–behavioral intervention. Method Stepped Care for Affective Disorders Musculoskeletal Pain (SCAMP) an NIMH-sponsored randomized clinical trial nested within prospective cohort study. A total 250 patients with clinically significant depression (PHQ-9 scores ≥10) musculoskeletal lower back or legs (hip knee) nondepressed similar enrolled, baseline serial follow-up assessments be conducted over 12 months. depressed either intervention group usual-care control group. Stepped-care receive weeks optimized antidepressant management (Step 1) followed by six sessions self-management (PSM) program next 2), all delivered nurse care manager who supervised physician specialist. Approximately two thirds contacts telephone. Results target sample 500 subjects has been successfully randomization resulted in balanced groups moderately severe depression. Mean SCL-20 severity 1.9, most meeting DSM-IV criteria major (76.3%) rest having dysthymia only (18.4%) minor (5.3%). about equally distributed between (53%) hip knee (47%). rational algorithmic selection dosing, as well overview PSM program, provided. Conclusions When completed, SCAMP will test whether improves outcomes produces additional benefits. findings important both primary mental health clinicians confronted prevalent depression–pain dyad.