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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.