The role of gender in moderating treatment outcome in collaborative care for anxiety.
OBJECTIVE
The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas.


METHODS
Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group.


RESULTS
Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful.


CONCLUSIONS
These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.
Dr. Grubbs and Dr. Dubbert are with the Mental Illness Research, Education, and Clinical Center (MIRECC) and Central Arkansas Veterans Healthcare System (CAVHS), North Little Rock (e-mail: kathleen.grubbs@va.gov ). Dr. Cheney, Dr. Fortney, and Ms. Han are with the Center for Mental Health Outcomes Research, CAVHS. They are also with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, where Dr. Sullivan is affiliated. Ms. Edlund is with MIRECC and the Department of Psychiatry, University of Arkansas for Medical Sciences. Dr. Sherbourne is with the Health Program of RAND, Santa Monica, California. Dr. Craske is with the Department of Clinical Psychiatry, University of California, Los Angeles. Dr. Stein is with the Department of Psychiatry and the Department of Family and Preventive Medicine, University of California, San Diego. Dr. Roy-Byrne is with the Department of Psychiatry, Harborview Medical Center, University of Washington School of Medicine, Seattle.
Kathleen M
KM
Grubbs
Ann M
AM
Cheney
John C
JC
Fortney
Carrie
C
Edlund
Xiaotong
X
Han
Patricia
P
Dubbert
Cathy D
CD
Sherbourne
Michelle G
MG
Craske
Murray B
MB
Stein
Peter P
PP
Roy-Byrne
J Greer
JG
Sullivan
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000628:therapy*; D001131:Arkansas; D002140:California; D003299:Cooperative Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation / Q000379:methods* / Q000706:statistics & numerical data; D012737:Sex Factors; D016896:Treatment Outcome; D014861:Washington; D055815:Young Adult