Depression Management: Collaborative Care vs Usual Care for Older Adults

A recent JAMA study found that collaborative care compared with usual care for subthreshold depression resulted in a statistically significant difference in depressive symptoms for older adults (2017;317[7]:728-737).

Authors Simon Gilbody, PhD, University of York (England), and colleagues conducted a randomized clinical trial from May 2011 to November 2014 in 32 primary are centers in the United Kingdom with 705 participants aged 65 years or older with subthreshold depression (defined by the Diagnostic and Statistical Manual of Mental Disorders-IV).
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Collaborative care (n = 344) was coordinated by a case manager who assessed functional impairments relating to mood symptoms. Participants were offered behavioral activation and completed an average of 6 weekly sessions. The control group received usual primary care (n = 361). Participants were followed for 12 months. The primary outcome was self-reported depression severity at 4-month follow-up on the 9-item Patient Health Questionnaire (PHQ-9; score range, 0-27). 

Authors found that collaborative care resulted in lower PHQ-9 scores vs usual care at 4-month follow-up (mean score with collaborative care, 5.36 vs with usual care, 6.67; mean difference, -1.31; 95% CI, -1.95 to -0.67; P < .001) and remained at 12 months. The proportions of participants meeting criteria for depression at 4-month follow-up were 17.2% (45/262) vs 23.5% (76/324), respectively, and at 12-month follow-up were 15.7% (37/235) vs 27.8% (79/284).

However, researchers are careful to note that their findings are “of uncertain clinical importance” and are limited by attrition; longer-term efficacy assessments are needed in future studies.—Amanda Del Signore