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In Reply: Dr Coyne suggests that free medication and psychotherapy compromised the value of our intervention. In fact, our intervention addressed numerous barriers to adequate treatment, including both physician factors (eg, knowledge, competing demands) and patient factors (eg, denial, stigma, adverse effects). We also demonstrated the acceptability and effectiveness of using care managers to promote evidence-based treatment for in primary care. A next step is to increase patients' access to such care by reducing barriers affecting providers (eg, reimbursement) and practices (eg, organization, space).

Coyne also questions whether the differences in reduction of suicidal ideation translate into clinical benefits. We used the Scale for Suicidal Ideation because it has demonstrated predictive validity for actual suicide among psychiatric outpatients.¹ We agree that differences in levels of suicidal ideation at follow-up between intervention and usual care were modest; indeed, we specifically stated that there was no significant difference between groups with respect . . . [Full Text of this Article]

Martha L. Bruce, PhD, MPH; George S. Alexopoulos, MD; Herbert C. Schulberg, PhD
Weill Medical College of Cornell University
White Plains, NY

Thomas Ten Have, PhD; Ira R. Katz, MD
University of Pennsylvania
Philadelphia

Charles F. Reynolds III, MD
ReynoldsCF@upmc.edu
University of Pittsburgh
Pittsburgh, Pa

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