Participants:

1. People who are 18+ and looking for outpatient services in the Langley Porter Hospital and Clinics (LPPHC) at the University of California, San Francisco (UCSF) Medical Center.
2. Patients are referred by their insurance carrier, self-referred, or referred by the providers in their community.
3. The study was conducted in the Adult Psychiatric Clinic and Partial Hospitalization Program, two LPPHC programs.
4. The APC focuses on evaluation, psychotherapy, and medication management for patients with a range of mental health problems.
5. PHP: more intensive outpatient service where patients attend individual and group treatment for 5 hours daily for ten weeks.

Usual depression care:

1. All study participants received usual depression care based on current best practices for medication management and empirically supported forms of individual and group psychotherapy.
2. Treatment decisions were made collaboratively by clinicians and patients.
3. Selective serotonin reuptake inhibitors (SSRIs) were usually the medication of first choice in the clinic based on standards of care for depression.