title: Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults.
abstract: OBJECTIVE
  To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability.
  
  
  METHODS
  Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used.
  
  
  RESULTS
  Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12.
  
  
  CONCLUSIONS
  CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. Electronic address: parean@uw.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Areán
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Dora
authors.initials: D
authors.lastname: Kanellopoulos
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Seirup
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.affiliation: San Mateo Department of Public Health, San Mateo, CA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Dwyer
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000368:Aged; D019090:Case Management / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D011203:Poverty; D011340:Problem Solving; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Disability; case management; late-life depression