title: Two Behavioral Interventions for Patients with Major Depression and Severe COPD.
abstract: Personalized Intervention for Depressed Patients with COPD (PID-C), a treatment mobilizing patients to participate in their care, was found more effective than usual care. To further improve its efficacy, we developed a Problem Solving-Adherence (PSA) intervention integrating problem solving into adherence enhancement procedures. We tested the hypothesis that PSA is more effective than PID-C in reducing depressive symptoms. Exploratory analyses sought to identify patients with distinct depressive symptom trajectories and compare their clinical profiles.
  
  
  
  Randomized controlled trial.
  
  
  
  Acute inpatient rehabilitation and community.
  
  
  
  A total of 101 diagnosed with chronic obstructive pulmonary disease (COPD) and major depression after screening 633 consecutive admissions for acute inpatient rehabilitation.
  
  
  
  Fourteen sessions of PID-C versus PSA over 26 weeks.
  
  
  
  24-item Hamilton Depression Rating Scale.
  
  
  
  PSA was not more efficacious than PID-C in reducing depressive symptoms. Exploratory latent class growth modeling identified two distinct depressive symptoms trajectories. Unlike patients with unfavorable course (28%) who remained symptomatic, patients with favorable course (72%) had a decline of symptoms during the hospitalization followed by a milder decline after discharge. Patients with unfavorable course were younger and had greater scores in disability, anxiety, neuroticism, and dyspnea related limitation in activities and lower self-efficacy scores.
  
  
  
  Both interventions led to sustained improvement depressive symptoms. PID-C matches the skills of clinicians employed by community rehabilitation programs and can be integrated in the care of depressed COPD patients. Patients with severe disability, anxiety, neuroticism, and low self-efficacy are at risk for poor outcomes and in need of close follow-up and targeted interventions. .
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY. Electronic address: gsalexop@med.cornell.edu.
authors: George S
authors: GS
authors: Alexopoulos
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Jo Anne
authors: JA
authors: Sirey
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Samprit
authors: S
authors: Banerjee
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Dimitris N
authors: DN
authors: Kiosses
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Cristina
authors: C
authors: Pollari
authors: Burke Rehabilitation Hospital, White Plains, NY.
authors: Richard S
authors: RS
authors: Novitch
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Amanda
authors: A
authors: Artis
authors: Weill Cornell Institute for Geriatric Psychiatry, White Plains, NY.
authors: Patrick J
authors: PJ
authors: Raue
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D004417:Dyspnea / Q000209:etiology / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000075384:Neuroticism; D011340:Problem Solving; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D020377:Self Efficacy; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: COPD; clinical trial; disability; dyspnea; geriatric depression; personalized intervention