COLLABORATION IS KEY
TO TREATING DEPRESSION IN ELDERLY

By Becky Ham, Staff Writer
Health Behavior News Service

In a diverse group of 906 adults 60 years and older, collaboration between patient and care manager cut depressive symptoms in half for 45 percent of the group, compared with 19 percent in a similar group of adults receiving conventional care for depression offered through their primary care provider.

Patients included in the intervention therapy groups received higher rates of depression treatment and reported more satisfaction with depression care and their quality of life than conventional care patients.

Although major depression and less disabling depressive disorders affect between 5 percent and 10 percent of older patients treated in primary care facilities, few depressed older adults receive effective treatment for their condition, say Jürgen Unützer, M.D., M.P.H., of the UCLA Neuropsychiatric Institute and colleagues.

The study is published in the Dec. 11 issue of the Journal of the American Medical Association.

Unützer and co-authors selected 1,801 depressed older adults from 18 primary care clinics from around the country to participate in the study. About half of the participants reported receiving depression treatment in the three months previous to the study.

For 12 months, half of the participants received the full range of intervention care for their depression, including collaboration between their primary care practitioner and specialists and regular assessment by a personal depression care manager, a nurse or psychologist specially trained for the purpose.

Along with their primary care practitioner, intervention patients could choose antidepressant medication or psychotherapy as their main treatment. The program also increased or switched medication, or included extra therapy, if patients didn't respond to the initial care plan.

Usual care patients received primary care or specialty mental health care services available to them as part of their traditional health plan, which could include antidepressive drugs and psychotherapy.

The researchers used questionnaires and follow-up phone interviews at three-, six- and 12-month intervals to track each participant's care and therapeutic progress. The researchers found that the intervention care patients steadily improved in all health measures during the 12-month period.

The cost of the intervention program was $553 a patient for 12 months, including visits by the depression care specialists and team psychiatrists. The patients or their insurers were responsible for all other health care costs, including the cost of antidepressive medications.

The price seems "relatively modest" to Unützer and colleagues, who note that "health care costs for depressed, older adults are up to 50 percent higher than for older adults without depression."

This study was supported in part by the John A. Hartford Foundation, the California Healthcare Foundation, the Hogg Foundation and the Robert Wood Johnson Foundation.

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