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Treating Depression in Primary Care: An Innovative Role for Mental Health Nurses

Department of Medicine and Department of Psychiatry and Behavioral Sciences, Duke University Medical Center in Durham, North Carolina

Linda H. Harpole, MD, MPH

Department of Medicine, Duke University Medical Center in Durham, North Carolina

David C. Steffens, MD, MHS

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center in Durham, North Carolina

Caryl D. Fulcher, RN, CS, MSN

Duke University Medical Center in Durham, North Carolina

Yvonne Porterfield, RN, CS, MSN

Kaiser Permanente Northern California in Union City, California

Rita Haverkamp, RN, CS, MSN

Kaiser Permanente Southern California in San Diego, California

Dena Kivett, RN

Desert Medical Group in Palm Springs, California

Jürgen Unützer, MD, MPH

Center for Health Services Research of the University of California at Los Angeles Neuropsychiatric Institute in Los Angeles, California

Late-life depression is common in primary care. However, because of barriers such as stigma and the assumption that depression in older adults is a normal part of aging, it is often under recognized and under treated. Further, most primary care providers do not have the time or resources to provide adequate follow-up depression care. By integrating a depression clinical specialist into the primary care setting, many of these barriers to effective treatment can be addressed. In this paper, a collaborative, stepped care treatment program with registered nurses practicing as depression clinical specialists is described. Additionally, three case reports illustrate the model. This intervention program offers a unique opportunity for mental health nurses to practice collaboratively in the primary care setting and to provide much needed care to an underserved population.

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