OBJECTIVE: There have been few comparisons of the effectiveness of collaborative depression care between older versus younger adults with comorbid illness, particularly among low-income populations. DESIGN: Intent-to-treat analyses are conducted on pooled data from three randomized controlled trials that tested collaborative care aimed at improving depression, quality of life, and treatment receipt. SETTINGS: Trials were conducted in oncology and primary care safety net clinics and diverse home healthcare programs. PARTICIPANTS: Thousand eighty-one patients with major depressive symptoms and cancer, diabetes, or other comorbid illness. INTERVENTION: Similar intervention protocols included patient, provider, sociocultural, and organizational adaptations. MEASUREMENTS: The Patient Health Questionnaire (PHQ)-9 depression, Short-Form Health Survey-12/20 quality of life, self-reported hospitalization, ER, intensive care unit utilization, and antidepressant, psychotherapy treatment receipt are assessed at baseline, 6, and 12 months. RESULTS: There are no significant differences in reducing depression symptoms (p ranged 0.18-0.58), improving quality of life (t = 1.86, df = 669, p = 0.07 for physical functioning at 12 months, and p ranged 0.23-0.99 for all others) patients aged between >/=60 years versus 18-59 years. Both age group intervention patients have significantly higher rates of a 50% PHQ-9 reduction (older: Wald chi[df = 1] = 4.82, p = 0.03; younger: Wald chi[df = 1] = 6.47, p = 0.02), greater reduction in major depression rates (older: Wald chi[df = 1] = 7.72, p = 0.01; younger: Wald chi[df = 1] = 4.0, p = 0.05) than enhanced-usual-care patients at 6 months and no significant age group differences in treatment type or intensity. CONCLUSION: Collaborative depression care in individuals with comorbid illness is as effective in reducing depression in older patients as younger patients, including among low-income, minority patients. Patient, provider, and organizational adaptations of depression care management models may contribute to positive outcomes.
RCT Entities:
OBJECTIVE: There have been few comparisons of the effectiveness of collaborative depression care between older versus younger adults with comorbid illness, particularly among low-income populations. DESIGN: Intent-to-treat analyses are conducted on pooled data from three randomized controlled trials that tested collaborative care aimed at improving depression, quality of life, and treatment receipt. SETTINGS: Trials were conducted in oncology and primary care safety net clinics and diverse home healthcare programs. PARTICIPANTS: Thousand eighty-one patients with major depressive symptoms and cancer, diabetes, or other comorbid illness. INTERVENTION: Similar intervention protocols included patient, provider, sociocultural, and organizational adaptations. MEASUREMENTS: The Patient Health Questionnaire (PHQ)-9 depression, Short-Form Health Survey-12/20 quality of life, self-reported hospitalization, ER, intensive care unit utilization, and antidepressant, psychotherapy treatment receipt are assessed at baseline, 6, and 12 months. RESULTS: There are no significant differences in reducing depression symptoms (p ranged 0.18-0.58), improving quality of life (t = 1.86, df = 669, p = 0.07 for physical functioning at 12 months, and p ranged 0.23-0.99 for all others) patients aged between >/=60 years versus 18-59 years. Both age group intervention patients have significantly higher rates of a 50% PHQ-9 reduction (older: Wald chi[df = 1] = 4.82, p = 0.03; younger: Wald chi[df = 1] = 6.47, p = 0.02), greater reduction in major depression rates (older: Wald chi[df = 1] = 7.72, p = 0.01; younger: Wald chi[df = 1] = 4.0, p = 0.05) than enhanced-usual-care patients at 6 months and no significant age group differences in treatment type or intensity. CONCLUSION: Collaborative depression care in individuals with comorbid illness is as effective in reducing depression in older patients as younger patients, including among low-income, minority patients. Patient, provider, and organizational adaptations of depression care management models may contribute to positive outcomes.
Authors: Jürgen Unützer; Wayne Katon; Christopher M Callahan; John W Williams; Enid Hunkeler; Linda Harpole; Marc Hoffing; Richard D Della Penna; Polly Hitchcock Noël; Elizabeth H B Lin; Patricia A Areán; Mark T Hegel; Lingqi Tang; Thomas R Belin; Sabine Oishi; Christopher Langston Journal: JAMA Date: 2002-12-11 Impact factor: 56.272
Authors: Stephen J Bartels; Eugenie H Coakley; Cynthia Zubritsky; James H Ware; Keith M Miles; Patricia A Areán; Hongtu Chen; David W Oslin; Maria D Llorente; Giuseppe Costantino; Louise Quijano; Jack S McIntyre; Karen W Linkins; Thomas E Oxman; James Maxwell; Sue E Levkoff Journal: Am J Psychiatry Date: 2004-08 Impact factor: 18.112
Authors: Martha L Bruce; Thomas R Ten Have; Charles F Reynolds; Ira I Katz; Herbert C Schulberg; Benoit H Mulsant; Gregory K Brown; Gail J McAvay; Jane L Pearson; George S Alexopoulos Journal: JAMA Date: 2004-03-03 Impact factor: 56.272
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Authors: María P Aranda; David H Chae; Karen D Lincoln; Robert Joseph Taylor; Amanda Toler Woodward; Linda M Chatters Journal: Int J Geriatr Psychiatry Date: 2011-10-28 Impact factor: 3.485
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