title: Effect of depression treatment on depressive symptoms in older adulthood: the moderating role of pain.
abstract: OBJECTIVE
  To investigate whether pain severity and interference with normal work activities moderate the effects of depression treatment on changes in depressive symptoms over time in older adults in primary care.
  
  
  METHODS
  Patient-randomized, clinical trial.
  
  
  METHODS
  Multisite: three clinics located in Veterans Affairs Medical Centers.
  
  
  METHODS
  Adults aged 60 and older (n=524) who screened positive for depression and participated in the Primary Care Research in Substance Abuse and Mental Health for the Elderly Study.
  
  
  METHODS
  Integrated care versus enhanced specialty referral care.
  
  
  METHODS
  Pain severity, the degree to which pain interferes with work inside and outside of the home, and depressive symptoms were examined at baseline and 3, 6, and 12 months.
  
  
  RESULTS
  Intention-to-treat analyses revealed that both treatment groups showed reduced depressive symptoms over time, although self-reported pain moderated reductions in depressive symptoms. At higher levels of pain severity and interference with work activities, improvements in depressive symptoms were blunted. Furthermore, pain interference appeared to have a greater effect on depressive symptoms than did pain severity; in individuals with major depression, pain interference fully accounted for the moderating effects of pain severity on changes in depressive symptoms over time.
  
  
  CONCLUSIONS
  Pain and its interference with functioning interfere with recovery from depression. Findings highlight the importance of addressing multiple domains of functioning (e.g., physical and social disability) and the degree to which pain and other forms of physical comorbidity may hinder or minimize treatment-related improvements in depressive symptoms.
authors.affiliation: Section of Geriatric Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA. smavanda@mail.med.upenn.edu
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Mavandadi
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ten Have
authors.forename: Ira R
authors.initials: IR
authors.lastname: Katz
authors.forename: U Nalla B
authors.initials: UN
authors.lastname: Durai
authors.forename: Dean D
authors.initials: DD
authors.lastname: Krahn
authors.forename: Maria D
authors.initials: MD
authors.lastname: Llorente
authors.forename: Joann E
authors.initials: JE
authors.lastname: Kirchner
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Olsen
authors.forename: William W
authors.initials: WW
authors.lastname: Van Stone
authors.forename: Susan L
authors.initials: SL
authors.lastname: Cooley
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008605:Mental Health Services; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement; D011320:Primary Health Care; D012017:Referral and Consultation; D014937:Work