Improving depression care for older, minority patients in primary care.
OBJECTIVE
Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes.


METHODS
A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care.


RESULTS
Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10).


CONCLUSIONS
Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.
Areán
Patricia A
PA
Department of Psychiatry, University of California, San Francisco, California 94143, USA. pata@lppi.ucsf.edu
Ayalon
Liat
L
Hunkeler
Enid
E
Lin
Elizabeth H B
EH
Tang
Lingqi
L
Harpole
Linda
L
Hendrie
Hugh
H
Williams
John W
JW
Unützer
Jürgen
J
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D008913:Minority Groups / Q000523:psychology*; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000592:standards*; D017060:Patient Satisfaction / Q000208:ethnology; D011320:Primary Health Care / Q000592:standards*; D011613:Psychotherapy; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents