New research finds that collaborative care, often conducted via telephone or in a telehealth environment, can benefit older adults with sub-threshold depression — those with some depressive symptoms but not a full-blown depression diagnosis.
Experts explain that depressive disorders are present in about 10 percent of primary care patients and account for more years lived with disability than any single disease. Nearly three-quarters of all outpatient visits for depression are to primary care clinicians rather than to mental health specialists.
Although depression is the second leading cause of disability worldwide, only one in seven older people meet criteria for depression. As such, effective therapeutic strategies are needed in older people with depressive symptoms.
Collaborative care is a therapeutic intervention in which behavioral health is integrated into primary care, most commonly using a nurse care manager to monitor depressive symptoms in depressed patients and adjust treatment under the supervision of a psychiatrist.
In the JAMA study, Simon Gilbody, Ph.D., of the University of York, England, and colleagues randomly assigned 705 adults age 65 years or older with subthreshold depression to collaborative care or usual primary care.
Collaborative care was coordinated by a case manager who assessed functional impairments relating to mood symptoms. Participants were offered behavioral activation and completed an average of six weekly sessions.
Many of the nurse contacts were conducted by telephone, thereby increasing the efficiency of collaborative care.
Collaborative care resulted in lower scores vs usual care at four month follow-up on measures of self-reported depression severity. The proportion of participants meeting criteria for depression were lower for collaborative care (17.2 percent) than usual care (23.5 percent) at four month follow-up, and at 12-month follow-up (15.7 percent vs 27.8 percent).
“Although differences persisted through 12 months, findings are limited by attrition, and further research is needed to assess longer-term efficacy,” the authors write.