Collaborative depression treatment in older and younger adults with physical illness: pooled comparative analysis of three randomized clinical trials

Am J Geriatr Psychiatry. 2010 Jun;18(6):520-30. doi: 10.1097/JGP.0b013e3181cc0350.


Objective: There have been few comparisons of the effectiveness of collaborative depression care between older versus younger adults with comorbid illness, particularly among low-income populations.

Design: Intent-to-treat analyses are conducted on pooled data from three randomized controlled trials that tested collaborative care aimed at improving depression, quality of life, and treatment receipt.

Settings: Trials were conducted in oncology and primary care safety net clinics and diverse home healthcare programs.

Participants: Thousand eighty-one patients with major depressive symptoms and cancer, diabetes, or other comorbid illness.

Intervention: Similar intervention protocols included patient, provider, sociocultural, and organizational adaptations.

Measurements: The Patient Health Questionnaire (PHQ)-9 depression, Short-Form Health Survey-12/20 quality of life, self-reported hospitalization, ER, intensive care unit utilization, and antidepressant, psychotherapy treatment receipt are assessed at baseline, 6, and 12 months.

Results: There are no significant differences in reducing depression symptoms (p ranged 0.18-0.58), improving quality of life (t = 1.86, df = 669, p = 0.07 for physical functioning at 12 months, and p ranged 0.23-0.99 for all others) patients aged between >/=60 years versus 18-59 years. Both age group intervention patients have significantly higher rates of a 50% PHQ-9 reduction (older: Wald chi[df = 1] = 4.82, p = 0.03; younger: Wald chi[df = 1] = 6.47, p = 0.02), greater reduction in major depression rates (older: Wald chi[df = 1] = 7.72, p = 0.01; younger: Wald chi[df = 1] = 4.0, p = 0.05) than enhanced-usual-care patients at 6 months and no significant age group differences in treatment type or intensity.

Conclusion: Collaborative depression care in individuals with comorbid illness is as effective in reducing depression in older patients as younger patients, including among low-income, minority patients. Patient, provider, and organizational adaptations of depression care management models may contribute to positive outcomes.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Distribution
  • Age Factors
  • Combined Modality Therapy / methods*
  • Comorbidity
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / therapy*
  • Diabetes Complications / epidemiology
  • Diabetes Complications / psychology*
  • Female
  • Home Care Services / statistics & numerical data
  • Humans
  • Male
  • Needs Assessment / statistics & numerical data
  • Neoplasms / epidemiology
  • Neoplasms / psychology*
  • Poverty
  • Quality of Life / psychology
  • Randomized Controlled Trials as Topic