title: Untangling therapeutic ingredients of a personalized intervention for patients with depression and severe COPD.
abstract: OBJECTIVE
  We developed a personalized intervention for depressed patients with COPD (PID-C) aimed to mobilize patients to participate in the care of both conditions. We showed that PID-C reduced depressive symptoms and dyspnea-related disability more than usual care over 28 weeks. This study focused on untangling key therapeutic ingredients of PID-C.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  138 patients who received the diagnoses of COPD and major depression after screening 898 consecutive admissions for acute inpatient pulmonary rehabilitation.
  
  
  METHODS
  Nine sessions of PID-C compared with usual care over 28 weeks.
  
  
  METHODS
  Primary outcome measures were the 17-item Hamilton Depression Rating Scale and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified. Other measures were adherence to rehabilitation exercise (≥2 hours per week) and adherence to adequate antidepressant prescriptions.
  
  
  RESULTS
  Low severity of dyspnea-related disability and adherence to antidepressants predicted subsequent improvement of depression. Exercise and low depression severity predicted improvement of dyspnea-related disability.
  
  
  CONCLUSIONS
  PID-C led to an interacting spiral of improvement in both depression and disability in a gravely medically ill population with a 17% mortality rate over 28 weeks and an expected deterioration in disability. The interrelationship of the course of depression and dyspnea-related disability underscores the need to target adherence to both antidepressants and chronic obstructive pulmonary disease rehabilitation. PID-C may serve as a care management model for depressed persons suffering from medical illnesses with a deteriorating course.
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY. Electronic address: gsalexop@med.cornell.edu.
authors: George S
authors: GS
authors: Alexopoulos
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Dimitris N
authors: DN
authors: Kiosses
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Jo Anne
authors: JA
authors: Sirey
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Dora
authors: D
authors: Kanellopoulos
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Joanna K
authors: JK
authors: Seirup
authors: Burke Rehabilitation Hospital, White Plains, NY.
authors: Richard S
authors: RS
authors: Novitch
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Samiran
authors: S
authors: Ghosh
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Samprit
authors: S
authors: Banerjee
authors: Weill Cornell Medical College, Institute for Geriatric Psychiatry, White Plains, NY.
authors: Patrick J
authors: PJ
authors: Raue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology* / Q000628:therapy; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: COPD; Clinical trial; disability; dyspnea; geriatric depression; personalized intervention
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