Improving depression outcomes in older adults with comorbid medical illness

Harpole, Linda H.; Williams, John W.; Olsen, Maren K.; Stechuchak, Karen M.; Oddone, Eugene; Callahan, Christopher M.; Katon, Wayne J.; Lin, Elizabeth H.; Grypma, Lydia M.; Unützer, Jürgen

doi:10.1016/j.genhosppsych.2004.09.004

« Previous Next »General Hospital Psychiatry
Volume 27, Issue 1 , Pages 4-12, January 2005

Improving depression outcomes in older adults with comorbid medical illness

Linda H. Harpole, M.D., M.P.H.
- Department of Medicine, Duke University Medical Center, Durham, NC 27709, USA
- Corresponding author. Tel.: +1 919 483 7434; fax: +1 919 315 0984.
John W. Williams Jr., M.D., M.H.S.
- Department of Medicine, Duke University Medical Center, Durham, NC 27709, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
Maren K. Olsen, Ph.D.
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27705, USA
Karen M. Stechuchak, M.S.
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
Eugene Oddone, M.D., M.H.S.
- Department of Medicine, Duke University Medical Center, Durham, NC 27709, USA
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
Christopher M. Callahan, M.D.
- Indiana University Center for Aging Research, Regenstrief Institute Inc., Indianapolis, IN 46202, USA
Wayne J. Katon, M.D.
- Department of Psychiatry, University of Washington, Seattle, WA 98195, USA
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
Elizabeth H. Lin, M.D., M.P.H.
- Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA
Lydia M. Grypma, M.D.
- Kaiser Permanente of Southern California, San Diego, CA 92120, USA
Jürgen Unützer, M.D., M.P.H.
- Department of Psychiatry, University of Washington, Seattle, WA 98195, USA

Received 19 April 2004; accepted 8 September 2004.

Abstract

Background

Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment.

Objective

To determine whether or not the presence of multiple comorbid medical illnesses affects patient response to a multidisciplinary depression treatment program.

Design, Setting and Participants

Preplanned analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from eight health care organizations in five states across the United States from July 1999 to August 2001.

Intervention

Intervention patients had access for up to 12 months to a depression care manager, supervised by a psychiatrist and a primary care expert, who offered education, care management and support of antidepressant management by the patient's primary care physician, or provided brief psychotherapy (Problem-Solving Treatment in Primary Care).

Measurements

Depression, quality of life (QOL; scale of 0–10) and mental health component score (MCS) of the Short-Form 12 assessed at baseline, 3, 6 and 12 months.

Results

Patients suffered from an average of 3.8 chronic medical conditions. Although patients with more chronic medical conditions had higher depression severity at baseline, the number of chronic diseases did not affect the likelihood of response to the IMPACT intervention when compared to care as usual. Intervention patients experienced significantly lower depression during all follow-up time points as compared with patients in usual care independent of other comorbid illnesses (P<.001). Intervention patients were also more likely to experience substantial response (at least a 50% reduction in depressive symptoms) regardless of the number of comorbidities, to experience improved MCS-12 scores at 3 and 12 months, and to experience improved QOL.

Conclusions

The presence of multiple comorbid medical illnesses did not affect patient response to a multidisciplinary depression treatment program. The IMPACT collaborative care model was equally effective for depressed older adults with or without comorbid medical illnesses.

Keywords: Depression, Comorbidity, Primary care