Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial.
BACKGROUND
Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients.


OBJECTIVE
To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis.


METHODS
Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (> or =60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline.


METHODS
Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care).


METHODS
Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months.


RESULTS
In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P =.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P =.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P =.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months.


CONCLUSIONS
In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.
Lin
Elizabeth H B
EH
Center for Health Studies, Group Health Cooperative, Seattle, Wash 98101, USA. lin.e@ghc.org
Katon
Wayne
W
Von Korff
Michael
M
Tang
Lingqi
L
Williams
John W
JW
Kroenke
Kurt
K
Hunkeler
Enid
E
Harpole
Linda
L
Hegel
Mark
M
Arean
Patricia
P
Hoffing
Marc
M
Della Penna
Richard
R
Langston
Chris
C
Unützer
Jürgen
J
D000203:Activities of Daily Living; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications* / Q000523:psychology; D003863:Depression / Q000150:complications* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology* / Q000523:psychology; D011613:Psychotherapy; D011788:Quality of Life; D018434:Sickness Impact Profile
D000928:Antidepressive Agents