Service use and outcomes among elderly persons with low incomes being treated for depression.
OBJECTIVE
Older adults with low incomes rarely use mental health care, and untreated depression is a serious problem in this population. This study examined whether a collaborative care model for depression in primary care would increase use of depression treatment and treatment outcomes for low-income elderly adults as well as for higher-income older adults.


METHODS
A multisite randomized clinical trial that included 1,801 adults aged 60 years and older who were diagnosed as having depression compared collaborative care for depression with treatment as usual in primary care. Participants were divided into groups by income definitions on the basis of criteria used by the U.S. Census Bureau and the U.S. Department of Housing and Urban Development (HUD). A total of 315 participants (18%) were living below the poverty level by the U.S. Census criteria, 261 (15%) were living below 30% of the area median income (AMI) (HUD criteria) but above poverty, 438 (24%) were living between 30% and 50% of the AMI, 327 (18%) were living between 50% and 80% of the AMI, and 460 (26%) were not poor. The income groups were compared on service use, satisfaction, depression severity, and physical health at baseline and at three, six, and 12 months after being randomly assigned to collaborative care or usual care.


RESULTS
The benefits for low-income older adults were similar to those for middle- and higher-income older adults. At 12 months, intervention patients in all economic brackets had significantly greater rates of depression care for both antidepressant medication and psychotherapy, greater satisfaction, lower depression severity, and less health-related functional impairment than usual care participants.


CONCLUSIONS
Lower-income older adults can experience benefits from collaborative management of depression in primary care similar to those of higher-income older adults, although they may require up to a year to reap physical health benefits.
Areán
Patricia A
PA
Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA. pata@lppi.ucsf.edu
Gum
Amber M
AM
Tang
Lingqi
L
Unützer
Jürgen
J
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003299:Cooperative Behavior; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000628:therapy; D019263:Dysthymic Disorder / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data
D000928:Antidepressive Agents