title: Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression: The CASPER Randomized Clinical Trial.
abstract: There is little evidence to guide management of depressive symptoms in older people.
  
  
  
  To evaluate whether a collaborative care intervention can reduce depressive symptoms and prevent more severe depression in older people.
  
  
  
  Randomized clinical trial conducted from May 24, 2011, to November 14, 2014, in 32 primary care centers in the United Kingdom among 705 participants aged 65 years or older with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) subthreshold depression; participants were followed up for 12 months.
  
  
  
  Collaborative care (n=344) was coordinated by a case manager who assessed functional impairments relating to mood symptoms. Participants were offered behavioral activation and completed an average of 6 weekly sessions. The control group received usual primary care (n=361).
  
  
  
  The primary outcome was self-reported depression severity at 4-month follow-up on the 9-item Patient Health Questionnaire (PHQ-9; score range, 0-27). Included among 10 prespecified secondary outcomes were the PHQ-9 score at 12-month follow-up and the proportion meeting criteria for depressive disorder (PHQ-9 score ≥10) at 4- and 12-month follow-up.
  
  
  
  The 705 participants were 58% female with a mean age of 77 (SD, 7.1) years. Four-month retention was 83%, with higher loss to follow-up in collaborative care (82/344 [24%]) vs usual care (37/361 [10%]). Collaborative care resulted in lower PHQ-9 scores vs usual care at 4-month follow-up (mean score with collaborative care, 5.36 vs with usual care, 6.67; mean difference, -1.31; 95% CI, -1.95 to -0.67; P < .001). Treatment differences remained at 12 months (mean PHQ-9 score with collaborative care, 5.93 vs with usual care, 7.25; mean difference, -1.33; 95% CI, -2.10 to -0.55). The proportions of participants meeting criteria for depression at 4-month follow-up were 17.2% (45/262) vs 23.5% (76/324), respectively (difference, -6.3% [95% CI, -12.8% to 0.2%]; relative risk, 0.83 [95% CI, 0.61-1.27]; P = .25) and at 12-month follow-up were 15.7% (37/235) vs 27.8% (79/284) (difference, -12.1% [95% CI, -19.1% to -5.1%]; relative risk, 0.65 [95% CI, 0.46-0.91]; P = .01).
  
  
  
  Among older adults with subthreshold depression, collaborative care compared with usual care resulted in a statistically significant difference in depressive symptoms at 4-month follow-up, of uncertain clinical importance. Although differences persisted through 12 months, findings are limited by attrition, and further research is needed to assess longer-term efficacy.
  
  
  
  isrctn.org Identifier: ISRCTN02202951.
authors.affiliation: Department of Health Sciences, University of York, Heslington, England2Hull York Medical School, University of York, Heslington, England.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Helen
authors.initials: H
authors.lastname: Lewis
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Joy
authors.initials: J
authors.lastname: Adamson
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds, England.
authors.forename: Katie
authors.initials: K
authors.lastname: Atherton
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Della
authors.initials: D
authors.lastname: Bailey
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, England.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Birtwistle
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Katharine
authors.initials: K
authors.lastname: Bosanquet
authors.affiliation: Northumberland Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle Upon Tyne, England.
authors.forename: Emily
authors.initials: E
authors.lastname: Clare
authors.affiliation: Leeds Community Healthcare NHS Trust, Leeds, England.
authors.forename: Jaime
authors.initials: J
authors.lastname: Delgadillo
authors.affiliation: Mental Health Research Group, University of Durham, Durham, England8Tees Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, England.
authors.forename: David
authors.initials: D
authors.lastname: Ekers
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Deborah
authors.initials: D
authors.lastname: Foster
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Rhian
authors.initials: R
authors.lastname: Gabe
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Samantha
authors.initials: S
authors.lastname: Gascoyne
authors.affiliation: Tees Esk and Wear Valleys NHS Foundation Trust, NIHR Clinical Research Network North East and North Cumbria, Research and Development Department, Middlesbrough, England.
authors.forename: Lesley
authors.initials: L
authors.lastname: Haley
authors.affiliation: Northumberland Tyne and Wear NHS Foundation Trust, NIHR Clinical Research Network (Mental Health) North East and North Cumbria, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle Upon Tyne, England.
authors.forename: Jahnese
authors.initials: J
authors.lastname: Hamilton
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds, England.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hargate
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, England.
authors.forename: John
authors.initials: J
authors.lastname: Holmes
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Ada
authors.initials: A
authors.lastname: Keding
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds, England.
authors.forename: Amanda
authors.initials: A
authors.lastname: Lilley-Kelly
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, England.
authors.forename: Shaista
authors.initials: S
authors.lastname: Meer
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Natasha
authors.initials: N
authors.lastname: Mitchell
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Karen
authors.initials: K
authors.lastname: Overend
authors.affiliation: Leeds and York Partnership NHS Foundation Trust, Leeds, England.
authors.forename: Madeline
authors.initials: M
authors.lastname: Pasterfield
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Jodi
authors.initials: J
authors.lastname: Pervin
authors.affiliation: Institute of Health Research, Medical School, University of Exeter, Exeter, England.
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, England.
authors.forename: Karen
authors.initials: K
authors.lastname: Spilsbury
authors.affiliation: Leeds Institute of Health Sciences, University of Leeds, Leeds, England.
authors.forename: Gemma
authors.initials: G
authors.lastname: Traviss-Turner
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Dominic
authors.initials: D
authors.lastname: Trépel
authors.affiliation: Department of Health Sciences, University of York, Heslington, England.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Woodhouse
authors.affiliation: Department of Urban Studies and Planning, University of Sheffield, Sheffield, England.
authors.forename: Friederike
authors.initials: F
authors.lastname: Ziegler
authors.affiliation: Department of Health Sciences, University of York, Heslington, England2Hull York Medical School, University of York, Heslington, England.
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D000071959:Case Managers; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011320:Primary Health Care; D011570:Psychiatry; D011788:Quality of Life; D018401:Sample Size; D057566:Self Report; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents