Ell, K., Aranda, M.P., Xie, B., Lee, P.J., & Chou, C.P. (2010). Collaborative depression treatment in older and younger adults with physical illness: Pooled comparative analysis of three randomized clinical trials. American Journal of Geriatric Psychiatry, 18(6), 520–530.

To perform intent-to-treat meta-analyses on pooled data, to compare the effect of collaborative multidisciplinary care on depression in older adults to that received by younger adults

• This study did not involve database searches; authors analyzed three randomized trials. Search keywords were not provided.
• Authors selected trials with similar designs (i.e., similar intervention and measurements).
• The study provided no information about trial exclusion. One can note, however, that each of the three trials excluded participants for these factors: acute suicidality, high alcohol use scores, recent use of lithium or antipsychotic medications, life expectancy of fewer than six months, and significant cognitive impairment.
   

• Evaluation involved a no-scoring system applied to three clinical trials. Authors examined reanalyzed pooled data from the trials. The outcome measures were
  • Treatment responses (where a 50% reduction in the Patient Health Questionnaire-9 (PHQ-9) score from baseline was considered a clinically meaningful improvement in symptoms of depression).
  • Major depression (PHQ-9 ≥ 10).
  • Composite scores of quality-of-life subscales (the Short-Form Health Survey).
  • Health care utilization.
• The three studies employed similar collaborative care as an intervention. The intervention included antidepressant medication, problem-solving therapy, and by-telephone symptom monitoring and relapse prevention by telephone over 12 months. The intervention incorporated personalized multidiscipline collaborative care based on the structured algorithm for stepped care. For example, a clinical specialist in depression communicated with an antidepressant prescriber in regard to a patient’s medication.
• The control group in all three studies received enhanced usual care. The usual care included standard health system care, patient- and family-focused educational pamphlets on depression, and community resources. However, usual care in the studies differed slightly as the result of differences in setting.
• In all three studies, data were collected at baseline, 6 or 8 months, and 12 months.
   

• Samples from the three randomized controlled trials consisted of 1,081 patients with major depressive symptoms and comorbid illness. When combining data, authors excluded patients with dysthymia alone or patients with no depression.
• Sample range across studies:
  • Study 1: cancer trial, n = 472, age 18 and older
  • Study 2: diabetes trial, n = 387, age 18 and older
  • Study 3: homecare trial, n = 311, age 65 and older.
• Key sample characteristics:
  • Total sample: age 60 and older, n = 440; age 18–59, n = 641.       
  • Patients had diverse multiple diseases (cancer, diabetes, hypertension, heart disease, kidney disease, etc.).
  • Sites were oncology and primary care safety-net clinics and diverse home healthcare programs.

• Phase of care: long-term follow-up
• Clinical applications: late effects and survivorship, eldercare

• Comparing patients ≥ 60 years to patients 18–59 years revealed no significant differences with respect to reducing depression symptoms (p = 0.18–0.58) or improving quality of life (t = 1.86, df = 669, p = 0.07 for physical functioning at 12 months, and p = 0.23–0.99 for all others).
• At six months in both age groups, intervention patients had significantly higher rates of a 50% reduction of the PHQ-9 score (older patients: Wald chi [df = 1] = 4.82, p = 0.03; younger patients: Wald chi [df = 1] = 6.47, p = 0.02) and  a greater reduction in major depression rates (older patients: Wald chi [df = 1] = 7.72, p = 0.01; younger patients: Wald chi [df = 1] = 4.0, p = 0.05) than did patients receiving enhanced usual care.
• There was no significant age-group differences in treatment type or intensity.

Study findings indicate that collaborative depression care in individuals with diverse comorbid illness is as effective in reducing depression in older patients as it is in younger patients, including those in low-income, minority classifications.