Table 15Patient subgroup/comorbidity concerns

Outcome
Project Name or Author
MeasurementPatient CategoryComment
DEPRESSION DISORDERS
Social Factors
IMPACT, 2007 199 Process of care: use of antidepressants, psychotherapy, or any depression treatment. Mean SCL-20. SF-12 General health and PCS-12. Satisfaction with care.Preplanned contrasts between poor older depressed adults living at or below 30% of median income and older adults living above 30%Poor in intervention group had generally worse scores than not poor and lower program utilization. Poor showed significant improvement in depression symptoms, and general health. Improvement in physical quality of life showed by 12 months.
Poor N=576
Not Poor N=1,225
IMPACT, 2005 137 Process of care: use of antidepressants, psychotherapy, or any depression treatment. Mean SCL-20, treatment response and remission rates. SF-12 Overall functional impairment. Satisfaction with care.Minority versus non-minority elderly depression patientsNo significant interactions were found between intervention and ethnic groups in clinical outcomes, functioning, and process of care. Blacks had the largest intervention vs. control differences in depression score. Latinos showed largest impact of intervention on processes of care.
Non-minority N=1,388
Minority N=360
Partners in Care, 2004 6 Probable depression diagnosis, SF12 MCSMinority versus non-minority depression patientsQI-Therapy improved probable disorder and mental health quality of life at 5 years for Latino and African Americans but not Whites.
Total N=924, not reported by group
Asarnow, 2005 114 Although numbers were not reported by minority status, patient population was 56% Hispanic/Latino and 13% white. Significant findings for the intervention in this case support effectiveness at minimum for Latino adolescents
Comorbidity Factors
IMPACT, 2007 8 Treatment response: 50% improvement in SCL-20No/low pain versus high pain patient populationsPain was significantly associated with lower treatment response to collaborative care, including arthritis pain.
No/low pain N=1,163
High pain N=1,640
IMPACT, 2006 128 Graded chronic pain scale for arthritis pain severityLow versus high pain patient populationsThe effect size of the intervention on pain intensity was more than 8 times greater for patients with lower baseline pain severity.
Intervention group N=506
Usual care group N=495
Rost, 2007 200 Hospitalization ratesRural versus urban, patients from both QuEST and Partners in Care studies.Rural patients with depression were hospitalized significantly more frequently than urban patients, controlling for group assignment.
Rural N=304
Urban N=1,151
QuEST, 2006 138 SF-12 MCS across timeRural versus urban depression patientsIntervention did not improve mental health status for rural depression patients. Intervention showed a strong impact on urban depression patients.
Rural N=160
Urban N=319
PRISM-E, 2007 141 Mean CES-D scorePain severity, interference with work, and type of depression diagnosisPatients with higher pain severity or pain interference showed less improvement in depression symptoms, primarily driven by patients with major depression. For major depression, pain interference mediated pain severity over time on depression symptoms.
Integrated care N=275
Referral care N=249
IMPACT, 2005 10 Mean SCL-20, overall quality of life, SF-12 MCSPatients with high comorbid medical illness versus patients with low comorbid illnessPresence of multiple comorbid medical illnesses did not affect patient response to the intervention.
Intervention group N=906
Usual care group N=895
PROSPECT, 2005 11 Remission and treatment responseElderly patients with major depression and specified comorbid medical conditions versus patients without such impairmentsRemission and response rates differed for atrial fibrillation and chronic pulmonary disease patients receiving usual care but not intervention care. Infer that an association between medical comorbidity and treatment outcomes for major depression is determined by intensity of depression treatment.
Total N=324
IMPACT, 2004 142 Depression, functional impairment, diabetes self-care behaviorsPatients with diabetesIntervention patients showed improvement in depression scores and overall functioning. Weekly exercise increased, but other self-care behaviors were not different between intervention and control. No differences found in Hb1Ac levels, which were relatively low at baseline.
Diabetes subgroup N=417
Other N=1,384
Pathways, 2006 12 Mean SCL-20 scoreDiabetes patients with 2+ complications versus uncomplicated diabetes patientsPatients with 2+ complications showed significant improvements in depression scores versus patients with less, who showed effects similar to control group.
0 to 1 complications N=192
2+ complications N=137
PROSPECT, 2007 140 Remission and treatment responseElderly depression patients with cognitive impairments versus patients without such impairmentsIntervention improved depression response and remission rates regardless of cognitive impairments. Possible evidence that patients with lowest response inhibition may have had delayed responses to the intervention.
Total N=599
IMPACT, 2005 139 Mean SCL-20 score and treatment responseDepression patients with and without comorbid PTSD and other anxiety disordersPatients with PTSD showed a delayed response to intervention treatment, but were not significantly different from other intervention patients by 12 months.
Depression patient without comorbid PTSD N=1,610
Depression patients with comorbid PTSD N=191
Depression patients with comorbid panic disorder N=262
Depression patients without comorbid panic disorder N=1,539
TEAM, 2006 201 Quality of well-being scale, self-administered version. SF-12V MCS and PCSVA Depression patients with and without comorbid anxiety disorders, including PTSD69% of patients had at least one comorbid anxiety disorder. Anxiety disorders predicted quality of well-being beyond depression disorder alone. PTSD also predicted differences in PCS.
Depression patients with any anxiety comorbidities N=225
Depression patients without any anxiety comorbidities N=101
Individual Differences Factors
Pathways, 2006 143 Depression free daysIndependent versus interactive relationship styles (based on attachment theory)Intervention patients with independent relationship style showed significant improvement, while patients with interactive style showed no difference from usual care. Independent style patients received significantly more PST sessions than those with interactive relationship style.
Interactive relationship style N=134
Independent relationship style N=190
PROSPECT, 2005 135 Remission rateHopelessness and other predictors of remission rateFirst remission was earlier among intervention group. Physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness more likely to experience remission in intervention group.
Total N=215
Bush, 2004 202, 203 (data from Katon, 1995 and Katon, 1996)SCL-20 and treatment responsePredictors of patient treatment responseHigh neuroticism and history or recurrent major depression or dysthymia predicted poor outcomes in general. Age, gender, depression severity, medical and psychiatric comorbidity were not predictive. Patients with higher depression levels may require longer therapy continuation phase.
Low SCL=149
High SCL=79
Simon, 2004 84 Benefit of interventionPredictors of patient response, including depression severityPost-hoc analysis. Effects varied by depression severity. No apparent intervention effect among those with mild depression. Intervention effects generally similar for moderate or severe symptoms. Effects did not vary by age, sex, race/ethnicity, educational level, or marital status.
Telephone care management N=207
Telephone care management plus telephone psychotherapy N=198
Usual care N=195
Gender
Partners in Care, 2004 13 Probable depression, SF-12 MCS, Self-reported work state. Process of care: probable appropriate care, probable unmet needMale versus female patientsProbable depression did not differ by gender. SF-12 MCS differed by treatment group and gender over time, a 3-way interaction, with women delaying improvement in QI-Therapy, and improving faster in QI-Meds. Men showed opposite patterns. Men reported faster employment results from QI-Therapy, while women did for QI-Meds.
Women N=941
Men N=358
IMPACT, 2006 144 Receipt of depression care prior to study enrollmentMale versus female elderly patientsWomen more likely to have used antidepressants in past 3 months, or received any form of depression care in past 3 months or over their lifetimes. Qualitative interviews with study providers suggested gender differences in how men experience and express depression, traditional masculine values, and the stigma of chronic mental illness.
Women N=1,160
Men N=453
ANXIETY DISORDERS
CCAP, 2005 9 Anxiety and depression symptoms, disability, receipt of guideline concordant careAbove versus below median for chronic medical illness burdenSeverely medically ill did significantly more poorly on clinical and functional outcomes, although they showed improvement over time. Those with higher medical illness level had significantly higher use of guideline-concordant medication.
Below RxRisk median N=107
Above RxRisk median N=125
Roy-Byrne, 2001 204 Treatment responsePredictors of panic disorder patient treatment responseFinal regression model included, in addition to control condition, unemployment and emergency room visits as predictors of poor response.
Nonresponders N=42
Responders N=55
ADHD
Epstein, 2007 112 Reduction in DSM-IV symptomatologyMedication compliers versus non-compliers in intervention groupSymptom reduction in compliers was significantly lower than in non-compliers.
Compliers N=29
Non-compliers N=30
Medication compliers versus controlsSymptom reduction in compliers was significantly lower than in control. Compliers were also more likely to receive higher daily dosage, and controls more likely to receive lowest possible daily dosage.
AT RISK ALCOHOL
PRISM-E, 2006 145 Treatment initiation: attending initial visitPredictors of patient behaviorIntegrated care participants in pre-contemplative and contemplative stage more likely to initiate treatment than similar patients in referral care. Integrated care patients with no history or desire/attempt to cut down on drinking were more likely than referral care or integrated care patients with a history of desire/attempts.

From: 3, Results

Cover of Integration of Mental Health/Substance Abuse and Primary Care
Integration of Mental Health/Substance Abuse and Primary Care.
Evidence Reports/Technology Assessments, No. 173.
Butler M, Kane RL, McAlpine D, et al.

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