A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people.
BACKGROUND
Depression is the most common mental health disorder in people aged over 65 years. Late-life depression is associated with chronic illness and disability.


OBJECTIVE
To investigate the feasibility of a collaborative care model for depression in older people in a primary care setting.


METHODS
Randomised controlled trial with 16-weeks follow up.


METHODS
A primary care trust in Manchester.


METHODS
Participants were 105 people aged 60 years or older who scored 5 or more on the Geriatric Depression Scale; 53 were randomly allocated to an intervention group and 52 to a usual care group. The intervention group received care managed by a community psychiatric nurse who delivered an intervention comprising a facilitated self-help programme with close liaison with primary care professionals and old-age psychiatry according to a defined protocol. The usual care group received usual GP care. A nested qualitative study explored the views of the health professionals and patients regarding the acceptability and effectiveness of the intervention.


RESULTS
The main outcome measure was recovery from depression. Patients in the intervention group were less likely to suffer from major depressive disorder at follow up compared with usual care (0.32, 95% confidence = interval = 0.11 to 0.93, P = 0.036). The qualitative component of the study demonstrated the acceptability of the intervention to patients.


CONCLUSIONS
A model of collaborative care for older people with depression, used in a primary care setting with a facilitated self-help intervention is more effective than usual GP care. This study demonstrates that the implementation of a collaborative care model is feasible in UK primary care and that the intervention is effective and acceptable to patients.
Chew-Graham
Carolyn A
CA
Primary Care Research Group, School of Community Based Medicine, University of Manchester.
Lovell
Karina
K
Roberts
Chris
C
Baldwin
Robert
R
Morley
Michael
M
Burns
Alistair
A
Richards
David
D
Burroughs
Heather
H
D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D012648:Self Care / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome