Collaborative depression treatment in older and younger adults with physical illness: pooled comparative analysis of three randomized clinical trials.
OBJECTIVE
There have been few comparisons of the effectiveness of collaborative depression care between older versus younger adults with comorbid illness, particularly among low-income populations.


METHODS
Intent-to-treat analyses are conducted on pooled data from three randomized controlled trials that tested collaborative care aimed at improving depression, quality of life, and treatment receipt.


METHODS
Trials were conducted in oncology and primary care safety net clinics and diverse home healthcare programs.


METHODS
Thousand eighty-one patients with major depressive symptoms and cancer, diabetes, or other comorbid illness.


METHODS
Similar intervention protocols included patient, provider, sociocultural, and organizational adaptations.


METHODS
The Patient Health Questionnaire (PHQ)-9 depression, Short-Form Health Survey-12/20 quality of life, self-reported hospitalization, ER, intensive care unit utilization, and antidepressant, psychotherapy treatment receipt are assessed at baseline, 6, and 12 months.


RESULTS
There are no significant differences in reducing depression symptoms (p ranged 0.18-0.58), improving quality of life (t = 1.86, df = 669, p = 0.07 for physical functioning at 12 months, and p ranged 0.23-0.99 for all others) patients aged between >/=60 years versus 18-59 years. Both age group intervention patients have significantly higher rates of a 50% PHQ-9 reduction (older: Wald chi[df = 1] = 4.82, p = 0.03; younger: Wald chi[df = 1] = 6.47, p = 0.02), greater reduction in major depression rates (older: Wald chi[df = 1] = 7.72, p = 0.01; younger: Wald chi[df = 1] = 4.0, p = 0.05) than enhanced-usual-care patients at 6 months and no significant age group differences in treatment type or intensity.


CONCLUSIONS
Collaborative depression care in individuals with comorbid illness is as effective in reducing depression in older patients as younger patients, including among low-income, minority patients. Patient, provider, and organizational adaptations of depression care management models may contribute to positive outcomes.
Ell
Kathleen
K
School of Social Work, University of Southern California, Los Angeles, CA 90089–0411, USA. ell@usc.edu
Aranda
María P
MP
Xie
Bin
B
Lee
Pey-Jiuan
PJ
Chou
Chih-Ping
CP
D017677:Age Distribution; D000367:Age Factors; D003131:Combined Modality Therapy / Q000379:methods*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000628:therapy*; D048909:Diabetes Complications / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011203:Poverty; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic