Comments on “A Collaborative-Care Telephone-Based Intervention for Depression,Anxiety,and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial”

Dear sir,

It is with great interest that we read article titled, “A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial.” ¹ The study holds immense clinical relevance, particularly in the context of limited mental health resources and longer wait time to consult a psychiatrist and start counseling. With nearly 30% of patients attending primary care health settings having common mental health conditions such as depression, anxiety, and at-risk drinking, identifying the capacity of trained lay providers who can provide basic intervention would have great clinical implications. Moreover, the meticulous measures taken to ensure blinding in a multicenter nonpharmacological intervention trial deserve commendation.

However, as a reader, certain aspects of the study have piqued our curiosity, which we would like to bring to your attention. First, here is a lack of clarity regarding certain participant characteristics, such as the duration of psychiatric symptoms, educational background, and the duration of treatment. These variables could potentially exert a significant influence on adherence to and the outcomes of nonpharmacological interventions and counseling.^2,3 Moreover, the categorization of participants’ financial status into subjective labels such as “struggling” and “comfortable” merits further scrutiny, as these designations may be susceptible to the individual's psychological state. Secondly, given that patients seeking care in primary healthcare settings may present with a range of health issues beyond mental health concerns, it would be interesting to know the medical comorbidities that patients had.

We are also interested in gaining a better understanding of the intervention provided. Although it is mentioned that mental health technicians (MHTs) administered the intervention after a 6-week training period, it is not clear if the intervention followed standard modules provided to the MHTs, or if the intervention itself was validated. Additionally, we would like to know if adherence and potential adverse effects were monitored through structured scales. Furthermore, what measures were in place to ensure the fidelity and adequacy of the intervention? For instance, what percentage of “missed sessions” or “unanswered calls” was considered acceptable to still qualify as adequately delivered? While it is evident that research associates made 10 attempts to contact participants within a 4-week period and then informed primary care physicians, it is not clear how many attempts MHTs would make if their phone calls went unanswered, and whether this information was documented and analyzed.

Another question we have as readers pertains to the imputation analysis. Given that the dropout rate was close to 30%, which can pose challenges for imputation analysis and potentially increase the risk of type I errors, ⁴ we would appreciate further information on the missingness of data and the specific imputation techniques employed. This additional detail would enhance the reader's comprehension.

With these questions in mind, we would like to express our sincere appreciation to the authors for their insightful and clinically relevant trial. It undoubtedly serves as an inspiring catalyst, encouraging researchers to delve deeper into this field. Your valuable work has certainly sparked our interest and offers promising avenues for further exploration.