# Improving Depression Management in Primary Care

> **NIH VA IK2** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2021 · —

## Abstract

Background: VA’s Primary Care–Mental Health Integration (PC-MHI) is rooted in evidence-based
collaborative care models, where care managers, mental health specialists, and primary care providers jointly
treat depression in primary care. While PC-MHI enabled specialists to support medication treatment in primary
care, timely and sufficient access to psychotherapy is unattainable. Alternative therapy modalities are needed.
Significance/Impact: Depression is disabling and affects one in five Veterans. Psychotherapy is preferred by
Veterans, but fraught with multilevel barriers (e.g., staff availability, patient travel to clinic, limited clinic hours).
Without enhancing existing PC-MHI models to enable better primary care patient access to effective
psychotherapies, Veteran engagement in depression treatment is unlikely to improve.
Innovation: This CDA aims to close the gap in psychotherapy access for VA primary care patients with
depression by adapting PC-MHI collaborative care models to improve uptake of computerized cognitive
behavioral therapy (cCBT). cCBT is accessible 24/7 via the internet and has effectively treated depression in
more than 30 trials. With modest specialist support, it is non-inferior to face-to-face psychotherapy. PC-MHI
can facilitate Veteran uptake of cCBT, using an evidence-based collaborative care model to provide the follow-
up care management and mental health specialist back-up that characterizes the most effective cCBT trials.
Specific Aims: This CDA will enable me to be a VA implementation scientist who designs, tests, implements,
and disseminates effective collaborative care model improvements to treat depression in primary care. My
Specific Aims are: (1) to adapt PC-MHI collaborative care to improve uptake of cCBT among VA primary care
patients with depression, based on input from multilevel stakeholders; (2) to pilot test the feasibility,
acceptability, and potential effects of cCBT-enhanced collaborative care on Veterans’ depression symptoms
and related outcomes in one primary care clinic, in preparation for a larger, multi-site hybrid effectiveness-
implementation trial; and (3) to establish expert consensus on the translation of pilot findings into a design for
cCBT-enhanced collaborative care that is feasible locally, regionally and nationally in VA.
Methodology: In Aim 1, I will use qualitative methods and elicit feedback from Veterans, VA providers, and
other key stakeholders of national experts and operations leaders (CDA advisory group) to adapt the PC-MHI
collaborative care model to improve cCBT uptake. In Aim 2, I will conduct a pilot randomized controlled trial
(RCT) to examine feasibility, acceptability, and potential effects on depression, patient activation, and health-
related quality of life in VA primary care patients with depression receiving either (1) cCBT-enhanced
collaborative care (n=32) or (2) usual care (n=32) in West Los Angeles VA, from baseline to 2-months (post-
intervention). This pilo...

## Key facts

- **NIH application ID:** 10186554
- **Project number:** 5IK2HX002867-02
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Lucinda B Leung
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10186554

## Citation

> US National Institutes of Health, RePORTER application 10186554, Improving Depression Management in Primary Care (5IK2HX002867-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10186554. Licensed CC0.

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