November 11, 2003
Better depression care for older adults also improves arthritis problems, study finds
Seattle—A large randomized trial of an innovative model for depression care in the elderly shows an added benefit: Effective depression treatment can improve problems related to arthritis—a condition that affects about half of people over age 65.
The study, published in the Nov. 12 issue of the Journal of the American Medical Association, focuses on enhancing the primary care team to provide systematic depression care for older adults. Those who also had arthritis and depression not only experienced improved mood; they also had less arthritis pain, enhanced functioning, and better quality of life.
"Older adults with depression commonly cope with several chronic illnesses on a daily basis," says principal investigator Elizabeth H. B. Lin, MD, MPH, a Group Health Cooperative family-medicine physician and scientific investigator at Group Health Center for Health Studies. "This research suggests that we can lessen their pain, improve their outcomes, and enhance their quality of life by re-organizing primary care practices to better treat their depression. We did not use any "magic bullet"—no new medication or technology. We simply used existing treatments more effectively. "
Lin's research was part of a large, multi-site study of depression care called the IMPACT study, led by Jürgen Unützer, MD, MPH, professor and vice chair of the Department of Psychiatry at the University of Washington. A total of 1,801 patients over age 60 were randomly assigned to two groups. One group received usual depression care—typically treatment with antidepressants and referral to psychiatric care as needed. The other group received care using the IMPACT model, where patients had access to a depression-care manager in their primary care physician's office. This specialized member of the primary-care team worked with each patient's primary-care doctor to provide education and follow-up of depression treatment and possible side-effects. Care managers also offered a brief course of psychotherapy focusing on solving day-to-day problems.
When Lin and her colleagues examined the subset of 1,001 patients who had both depression and arthritis, they found that IMPACT depression care not only improved symptoms of depression, it also lessened the patients' pain and impairment due to arthritis. These improvements continued for an entire year and were seen in a wide range of primary care settings.
"The good news is that more effective treatment for depression not only helped patients with arthritis to feel less depressed, but also to cope better with their arthritis pain, to be more active, and to have a higher quality of life," says Lin.
Lin's research and the IMPACT study are supported by grants from the John A. Hartford Foundation, the California HealthCare Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation. It is also received support from the South Texas and Central Texas Veterans Health Care Systems. The IMPACT study coordinating center is at the University of California, Los Angeles (Principal Investigator Jürgen Unützer, MD, MPH). Other IMPACT study centers include Duke University in Durham, North Carolina (PI Linda Harpole, MD, MPH; Co-PI Eugene Oddone, MD), Kaiser Permanente of Northern California/Division of Research/Hayward Medical Center (PI Enid Hunkeler, MA; Co-PI Patricia Arean, PhD); Desert Medical Group in Palm Springs, California (PI Mark Hoffing, MD; Co-PI, Stuart Levine, MD, MHA); Group Health Cooperative in Seattle in collaboration with the University of Washington (PI Wayne Katon, MD; Co-PI: Elizabeth Lin, MD, MPH); the Central Texas and South Texas Veterans Health Care Systems, and the University of Texas Health Science Center in San Antonio, Texas (PI John Williams, MD, MHS; Co-PI Polly Hitchcock-Noel, PhD); Kaiser Permanente of Southern California (Co-PI Lydia Grypma, MD; Co-PI Richard Della Penna, MD); Indiana University, Indianapolis, Indiana (PI Christopher Callahan, MD; Co-PI Hugh Hendrie; Co-PI Kurt Kroenke, MD).
Group Health Center for Health Studies
Founded in 1947, Group Health Cooperative is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. Group Health Cooperative is ranked "Highest in Member Satisfaction among Commercial Health Plans in the Northwest Region" by J.D. Power and Associates. For 25 years, the Group Health Center for Health Studies has conducted research on preventing, diagnosing, and treating major health problems. Government and private research grants provide its main funding.