Telephone improves depression outcomes

Symptoms decrease 50% when nurses call

It doesn’t always take the newest technology to make a big impact on patient outcomes. Kaiser Permanente in Oakland, CA, found that when primary care nurses maintain regular telephone contact with patients suffering from depression, patients improve. In fact, 18% more of those patients contacted by phone showed a 50% reduction in their depressive symptoms than did depressed patients who did not receive telephone calls.

"That 18% difference is almost as large as the difference seen in previous studies between placebo and prescribed antidepressants," says Enid Hunkeler, MA, a Kaiser Permanente researcher and lead author of the study published recently in the Archives of Family Medicine.1

A total of 302 patients starting antidepressant drug therapy seen at two managed care adult primary clinics were randomized into one of three groups. One group received usual care. One group received telehealth care, or telephone contact with a trained primary care nurse. The third group received telehealth care plus peer support.

Personalizing care

Patients in the telehealth group received emotional support and focused behavioral health interventions in 10 six-minute telephone calls from primary care nurses during a four-month period. Nurses also monitored medication compliance and offered suggestions about dealing with side effects. Patients in the telehealth and peer support group received the same scheduled telephone calls from a primary care nurse, plus in-person supportive contacts by trained health plan members who had successfully recovered from depression.

"This model uses the nurses already in primary care offices, and it builds on the bond patients already have with their doctors," says Hunkeler.

"Since the nurses work within the primary care setting, they can help a patient with depression improve and monitor their own overall health, not just their depression," adds study co-author Joel F. Meresman, PhD. "And the information the nurses can then relay to the patient’s physician helps complete the circle to their total health care."

Researchers found that 58% of the patients in the telehealth group showed a 50% reduction in their symptoms six months after baseline, compared with 37% of patients in the control group. Adding peer support to the nursing intervention did not improve primary outcomes.


  1. Hunkeler EM, Meresman JF, Hargreaves WA, et al. Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Arch Fam Med 2000; 9:700-708.