Two Behavioral Interventions for Patients with Major Depression and Severe COPD

Am J Geriatr Psychiatry. 2016 Nov;24(11):964-974. doi: 10.1016/j.jagp.2016.07.014. Epub 2016 Jul 20.

Abstract

Objective: Personalized Intervention for Depressed Patients with COPD (PID-C), a treatment mobilizing patients to participate in their care, was found more effective than usual care. To further improve its efficacy, we developed a Problem Solving-Adherence (PSA) intervention integrating problem solving into adherence enhancement procedures. We tested the hypothesis that PSA is more effective than PID-C in reducing depressive symptoms. Exploratory analyses sought to identify patients with distinct depressive symptom trajectories and compare their clinical profiles.

Design: Randomized controlled trial.

Setting: Acute inpatient rehabilitation and community.

Participants: A total of 101 diagnosed with chronic obstructive pulmonary disease (COPD) and major depression after screening 633 consecutive admissions for acute inpatient rehabilitation.

Intervention: Fourteen sessions of PID-C versus PSA over 26 weeks.

Measurements: 24-item Hamilton Depression Rating Scale.

Results: PSA was not more efficacious than PID-C in reducing depressive symptoms. Exploratory latent class growth modeling identified two distinct depressive symptoms trajectories. Unlike patients with unfavorable course (28%) who remained symptomatic, patients with favorable course (72%) had a decline of symptoms during the hospitalization followed by a milder decline after discharge. Patients with unfavorable course were younger and had greater scores in disability, anxiety, neuroticism, and dyspnea related limitation in activities and lower self-efficacy scores.

Conclusions: Both interventions led to sustained improvement depressive symptoms. PID-C matches the skills of clinicians employed by community rehabilitation programs and can be integrated in the care of depressed COPD patients. Patients with severe disability, anxiety, neuroticism, and low self-efficacy are at risk for poor outcomes and in need of close follow-up and targeted interventions. .

Keywords: COPD; clinical trial; disability; dyspnea; geriatric depression; personalized intervention.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anxiety / psychology
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Dyspnea / etiology
  • Dyspnea / psychology
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Neuroticism
  • Problem Solving
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Self Efficacy
  • Severity of Illness Index
  • Treatment Outcome