Research

Research

Team Approach Doubles Effectiveness of Treating Depression in Older Adults

A study of 1,801 depressed older adults in five states for one year concluded that a team care approach more than doubled the effectiveness of depression treatment.

Dr. Wayne Katon, professor and director of Health Services and Psychiatric Epidemiology of the Department of Psychiatry and Behavioral Sciences, and Dr. Elizabeth Lin, family physician at Group Health Cooperative's Center for Health Studies, were the principal investigators for the study.


	Treatment can help some depressed elders return to activities they enjoy.

Patients received their primary care at 18 clinics representing eight health care organizations in Washington, California, Indiana, North Carolina, and Texas. Half the participants received care as usual and the other half were assigned to a new model of team care called IMPAC, a contraction of Improving Mood - Promoting Access to Collaborative Treatment.

Under the IMPACT program, older patients suffering from major depression, chronic depression, or both were assigned to a depression care manager (a specially trained nurse or psychologist) in their usual primary care clinic. These specialists worked in close collaboration with the patients' regular physicians to educate and support patients, track symptoms and side effects, assist with changes in antidepressant treatment, and provide counseling. Patients and their physicians chose treatment that followed a stepwise approach, using antidepressant medications, psychotherapy, or both. A team psychiatrist also consulted on the care of all IMPACT patients.

Of the 31 million Americans age 65 or older, nearly 5 million experience symptoms of depression. Major depression can cause functional impairment, diminished quality of life, suffering for both patients and their families, increased health care costs, and deaths from illnesses and suicide.

While research has shown that late life depression can be treated successfully with antidepressant medications or psychotherapy, few older adults seek or receive effective treatment. These patients, their families and their physicians often view depression as a normal part of aging. Busy primary care providers focus on other medical problems and do not have time during a routine office visit to properly diagnose or treat depression.

The study found that the IMPACT care model was more effective than usual care in treating depression at each of the study sites. About half of participants assigned to the IMPACT program reported a reduction in depression symptoms of 50 percent or more at 12 months, compared with 19 percent of those in usual care. The study's authors hypothesize that factors such as chronic pain and the high incidence of other illnesses in older adults may tend to limit even greater improvements in symptoms of depression. In addition, it may be unrealistic to expect complete freedom from symptoms such as fatigue or lack of energy in elderly adults with multiple chronic medical illnesses.

IMPACT patients reported less impairment in day-to-day functioning and greater improvements in quality of life. They were more likely to receive desired counseling or psychotherapy.

The average cost of providing IMPACT services was $550 per person for 12 months. This compares favorably with total Medicare spending of around $6,000 per year for depressed older adults. Reducing depression provides an additional economic benefit because health care costs for older adults with depression are up to 50 percent higher than for older adults who are not depressed.

The study's results have been published in the Journal of the American Medical Association. IMPACT was recommended in an advisory committee's report to President Bush as one of seven model mental health care programs that should be integrated into Medicare.