Format

Send to

Choose Destination
See comment in PubMed Commons below
Am J Geriatr Psychiatry. 2016 Jan;24(1):50-9. doi: 10.1016/j.jagp.2015.02.007. Epub 2015 Feb 17.

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial.

Author information

  • 1Department of Psychiatry, Weill Cornell Medical College, White Plains, NY. Electronic address: gsalexop@med.cornell.edu.
  • 2Department of Psychiatry, Weill Cornell Medical College, White Plains, NY.
  • 3Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
  • 4Department of Public Health, Weill Cornell Medical College, White Plains, NY.
  • 5Department of Psychiatry, University of California San Francisco, San Francisco, CA.

Abstract

OBJECTIVE:

To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression.

METHODS:

This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median.

RESULTS:

CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ(2) = 1.5, df = 1, p = 0.22 and χ(2) = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17).

CONCLUSION:

Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00540865.

KEYWORDS:

Case management; late-life depression; low income

PMID:
25794636
PMCID:
PMC4539297
DOI:
10.1016/j.jagp.2015.02.007
[PubMed - indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center