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Care management for depression and osteoarthritis pain in older primary care patients: a pilot study
- Authors:
- UNUTZER Jurgen, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1166-1171.
- Publisher:
- Wiley
This study aimed to establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late-life depression and osteoarthritis. Treatment development pilot study in three university affiliated primary care clinics in the United States. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months. Fourteen patients participated in the pilot program. Between baseline and 6 months, mean HSCL-20 depression scores, pain intensity scores and pain interference scores dropped. Patients also experienced improvements in self efficacy, in satisfaction with depression care, and in timed 8-m walk and transfer tests. The combined intervention was feasible and well-received by patients. Preliminary outcomes are promising and comparisons to an earlier trial of care management for depression alone suggest that the combined program may be equally effective for depression but more effective for pain.
Long-term effectiveness of collaborative depression care in older primary care patients with and without PTSD symptoms
- Authors:
- CHAN Domin, FAN Ming-Yu, UNUTZER Jurgen
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(7), July 2011, pp.758-764.
- Publisher:
- Wiley
Depressed patients with comorbid PTSD are more functionally impaired and may take longer to respond to treatment than those without PTSD. This study examined the long-term effects of PTSD on depression severity, treatment response, and health care costs among older adults. Patients were recruited from 18 primary care clinics in five US states. A total of 1801 patients aged 60 years or more with major depression or dysthymia were randomised to Improving Mood Promoting Access to Collaborative Treatment (IMPACT), a stepped care approach delivered by a multidisciplinary team, or usual care; 191 (10.6%) of subjects screened positive for PTSD. Depression severity (Hopkins Depression Symptom Checklist) was used to estimate depression-free days (DFDs) over 24 months. Total health care costs included inpatient, outpatient, and pharmacy costs. Comorbid patients had greater depression severity than patients without PTSD symptoms at baseline. Over 2 years, intervention patients with PTSD symptoms had similar benefits from collaborative care (99 more DFDs than usual care patients) as patients without PTSD (108 more DFDs than usual care). Total health care costs did not differ significantly between the groups. Depressed older adults with PTSD symptoms were more depressed at baseline, but collaborative care (compared to usual care) produced similar improvements in depression severity in both groups.
Prevalence, incidence, and persistence of major depressive symptoms in the Cardiovascular Health Study
- Authors:
- THIELKE Stephen M., DIEHR Paula, UNUTZER Jurgen
- Journal article citation:
- Aging and Mental Health, 14(2), March 2010, pp.168-176.
- Publisher:
- Taylor and Francis
This paper explores the association of major depressive symptoms with advancing age, sex, and self-rated health among older adults. The study analysed 10 years of annual assessments in a longitudinal cohort of 5888 Medicare recipients in the Cardiovascular Health Study. Self-rated health was assessed with a single question, and subjects categorised as healthy or sick. Major depressive symptoms were assessed using the Center for Epidemiologic Studies Short Depression Scale, with subjects categorised as nondepressed or depressed. Age-, sex-, and health-specific prevalence of depression and the probabilities of transition between depressed and nondepressed states were estimated. The results showed that the prevalence of a major depressive state was higher in women, and increased with advancing age. The probability of becoming depressed increased with advancing age among the healthy but not the sick. Women showed a greater probability than men of becoming depressed, regardless of health status. Major depressive symptoms persisted over 1-year intervals in about 60% of the healthy and 75% of the sick, with little difference between men and women. The article concludes that clinically significant depressive symptoms occur commonly in older adults, especially women, increase with advancing age, are associated with poor self-rated health, and are largely intransigent. In order to limit the deleterious consequences of depression among older adults, increased attention to prevention, screening, and treatment is warranted.
Chronic medical problems and distressful thoughts of suicide in primary care patients: mitigating role of happiness
- Authors:
- HIRSCH Jameson K., DUBERSTEIN Paul R., UNUTZER Jurgen
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.671-679.
- Publisher:
- Wiley
Chronic medical problems might amplify suicide risk in later life. Feelings of happiness may reduce this risk. The authors tested the hypothesis that happiness attenuates the association between number of self-reported chronic diseases and suicidal distress. A sample of 1,801 depressed, primary care patients, 60 years of age or older, entering a clinical trial, were assessed for the presence of positive emotion, suicidal distress and self-reported chronic medical problems. Results showed that chronic medical problems are associated with suicide ideation and, as hypothesised, happiness attenuates the relationship between self-reported diseases and suicidal distress. Decreased risk for distressing thoughts of suicide in the context of medical illness is predicted by the presence of positive emotions. The results suggest that treatments designed to help older primary care patients identify sources of joy and enhance happiness might decrease suicide risk.