Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care.
OBJECTIVE
Comorbid anxiety disorders may result in worse depression treatment outcomes. The authors evaluated the effect of comorbid panic disorder and posttraumatic stress disorder (PTSD) on response to a collaborative-care intervention for late-life depression in primary care.


METHODS
A total of 1,801 older adults with depression were randomized to a collaborative-care depression treatment model versus usual care and assessed at baseline, 3, 6, and 12 months, comparing differences among participants with comorbid panic disorder (N=262) and PTSD (N=191) and those without such comorbid anxiety disorders.


RESULTS
At baseline, patients with comorbid anxiety reported higher levels of psychiatric and medical illness, greater functional impairment, and lower quality of life. Participants without comorbid anxiety who received collaborative care had early and lasting improvements in depression compared with those in usual care. Participants with comorbid panic disorder showed similar outcomes, whereas those with comorbid PTSD showed a more delayed response, requiring 12 months of intervention to show a significant effect. At 12 months, however, outcomes were comparable. Interactions of intervention status by comorbid PTSD or panic disorder were not statistically significant, suggesting that the collaborative-care model performed significantly better than usual care in depressed older adults both with and without comorbid anxiety.


CONCLUSIONS
Collaborative care is more effective than usual care for depressed older adults with and without comorbid panic disorder and PTSD, although a sustained treatment response was slower to emerge for participants with PTSD. Intensive and prolonged follow-up may be needed for depressed older adults with comorbid PTSD.
Hegel
Mark T
MT
Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, CA, USA. mark.hegel@dartmouth.edu
Unützer
Jürgen
J
Tang
Lingqi
L
Areán
Patricia A
PA
Katon
Wayne
W
Noël
Polly Hitchcock
PH
Williams
John W
JW
Lin
Elizabeth H B
EH
D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004358:Drug Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*