When late-life depression improves: what do older patients say about their treatment?
BACKGROUND
Experts speculate about the mechanisms through which depression interventions operate. However, little is known about what patients think are the "active ingredients" in depression treatment. Given the importance of patient-centered care,understanding this dimension of the provider-intervention-patient interaction provides a missing piece to designing interventions that are congruent with patients' beliefs and preferences about treatment initiation, treatment adherence, and treatment maintenance.


METHODS
The authors used a parallel mixed methods design to identify a purposive sample of 24 older adults with depression who participated in either an integrated care or an enhanced referral model of depression treatment. Open-ended semistructured interviews were used to identify patient perceptions about the benefits of depression treatment during the study. Quantitative assessments of depression status were made at the completion of participation in the treatment study and 6 months postparticipation.


RESULTS
Twelve of 24 participants achieved remission of their depression symptoms, with the remainder showing no improvement or a partial response to treatment. Participants who achieved and sustained a remission of their depression symptoms (N=7) attributed their improvement to clear psychoeducational support with their depression care providers and described an ability to affect the outcome of their treatment. Participants who improved but then relapsed described their treatment in vague terms, referring to social aspects of participation. Participants who did not achieve remission ascribed recognition and treatment of their depression to forces outside themselves and described few details about their treatment.


CONCLUSIONS
Clinicians should consider patient perceptions of the benefits of depression treatment as they discuss and implement therapeutic interventions with depressed older adults.
Barg
Frances K
FK
Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA. bargf@uphs.upenn.edu
Mavandadi
Shahrzad
S
Givens
Jane L
JL
Knott
Kathryn
K
Zubritsky
Cynthia
C
Oslin
David W
DW
D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005260:Female; D005852:Geriatric Psychiatry; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D010349:Patient Compliance; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011613:Psychotherapy; D012017:Referral and Consultation; D016896:Treatment Outcome