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The Journal of Behavioral Health Services & Research

Published in:

01-07-2015

An Evaluation of IMPACT for the Treatment of Late-Life Depression in a Public Mental Health System

Authors: Michael J. Penkunas, PhD, Stephen Hahn-Smith, PhD

Published in: The Journal of Behavioral Health Services & Research | Issue 3/2015

Abstract

IMPACT (Improving Mood—Promoting Access to Collaborative Treatment) has a large body of evidence demonstrating its effectiveness for treating late-life depression in clients enrolled in a clinical research study, but little is known about how well the collaborative care model translates into treatment provided in a public mental health setting. This evaluation examines the influence of clinical and demographic characteristics in 112 older adults treated for late-life depression through publicly funded IMPACT in a large San Francisco Bay Area county. Depression severity decreased for 85% of clients between enrollment and treatments’ end and 46% of clients realized a 50% reduction in symptom severity. Depression severity at enrollment, number of treatment sessions attended, ethnicity, and gender reliably predicted depression severity at the end of treatment. Men, clients attending more therapy sessions, and clients without substance abuse diagnoses had an increased likelihood of realizing a 50% reduction in symptoms. Results highlight the success of this evidence-based treatment program offered through the public mental health system but suggest that the demographic and clinical characteristics of the population being treated must be considered when adopting evidence-based practices.

Lyness JM, Caine ED, King DA, et al. Psychiatric disorders in older primary care patients. Journal of General Internal Medicine. 1999; 14: 249–254.PubMedCentralPubMedCrossRef

Bruce ML. Psychosocial risk factors for depressive disorders in late life. Biological Psychiatry. 2002; 52(3): 175–184.PubMedCrossRef

Krishnan KRR. Biological risk factors in late life depression. Biological Psychiatry. 2002; 52(3): 185–192.PubMedCrossRef

Krause N. Chronic financial strain, social support, and depressive symptoms among older adults. Psychology and Aging. 1987; 2(2): 185–192.PubMedCrossRef

Gum AM, Areán PA, Bostrom A. Low-income depressed older adults with psychiatric comorbidity: Secondary analyses of response to psychotherapy and case management. International Journal of Geriatric Psychiatry. 2007; 22: 124–130.PubMedCrossRef

Alexopoulos GS. Depression in the elderly. Lancet. 2005; 365(9475): 1961–1970.PubMedCrossRef

The U.S. Department of Health and Human Services. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC; 2012.

Byers AL, Areán PA, Yaffe K. Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatric Services. 2012; 63(1): 66–72.PubMedCentralPubMedCrossRef

Klap R, Unroe KT, Unützer J. Caring for mental illness in the United States: A focus on older adults. American Journal of Geriatric Psychiatry. 2003; 11(5): 517–524.

10.

Compton WM, Conway KP, Stinson FS, et al. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002. American Journal of Psychiatry. 2006; 163(12): 2141–2147.PubMedCrossRef

11.

Mickus M, Colenda CC, Hogan AJ. Knowledge of mental health benefits and preferences for type of mental health providers among the general public. Psychiatric Services. 2000; 51(2): 199–202.PubMedCrossRef

12.

Unützer J, Katon W, Callahan CM, et al. Depression treatment in a sample of 1,801 depressed older adults in primary care. Journal of the American Geriatrics Society. 2003; 51(4): 505–514.PubMedCrossRef

13.

Unützer J, Katon W, Williams JW, et al. Improving primary care for depression in late life: The design of a multicenter randomized trial. Medical Care. 2001; 39(8): 785–799.PubMedCrossRef

14.

Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting. Journal of the American Medical Association. 2002; 288(22): 2836–2845.PubMedCrossRef

15.

Gilmer TP, Stefancic A, Ettner SL, et al. Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry. 2010; 67(6): 645–652.PubMedCrossRef

16.

Bruckner TA, Yonsu K, Chakravarthy B, et al. Voluntary psychiatric emergencies in Los Angeles County after funding of California’s Mental Health Services Act. Psychiatric Services. 2012; 63(8): 808–814.PubMedCrossRef

17.

Brown TT, Chung J, Choi S-S, et al. The impact of California’s full-service partnership program on mental health-related emergency department visits. Psychiatric Services. 2012; 63(8): 802–807.PubMedCrossRef

18.

Saunders PA, Copeland JRM, Dewey ME, et al. Heavy drinking as a risk factor for depression and dementia in elderly men. Findings from the Liverpool longitudinal community study. The British Journal of Psychiatry. 1991; 159(2): 213–216.PubMedCrossRef

19.

Prigerson HG, Desai RA, Rosenheck RA. Older adult patients with both psychiatric and substance abuse disorders: Prevalence and health service use. Psychiatric Quarterly. 2001;72(1):1–18.PubMedCrossRef

20.

Braunholtz DA, Edwards SJL, Lilford RJ. Are randomized clinical trials good for us (in the short term)? Evidence for a “trial effect”. Journal of Clinical Epidemiology. 2001; 54(3): 217–224.PubMedCrossRef

21.

Vist GE, Hagen KB, Devereaux PJ, et al. Systematic review to determine whether participation in a trial influences outcome. British Medical Journal. 2005; 330: 1–7.CrossRef

22.

Miranda J, Azocar F, Burnam MA. Assessment of evidence-based psychotherapy practices in usual care: Challenges, promising approaches, and future directions. Administration and Policy in Mental Health. 2010; 37(3): 205–207.PubMedCentralPubMedCrossRef

23.

Ganju V. Implementation of evidence-based practices in state mental health systems: Implications for research and effectiveness studies. Schizophrenia Bulletin. 2003; 29(1): 125–131.PubMedCrossRef

24.

Painter K. Evidence-based practices in community mental health: Outcome evaluation. Journal of Behavioral Health Services & Research. 2012; 39(4): 434–444.CrossRef

25.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine. 2001; 16: 606–613.PubMedCentralPubMedCrossRef

26.

Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association. 1999; 282(18): 1737–1744.PubMedCrossRef

27.

Löwe B, Unützer J, Callahan CM, et al. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care. 2004; 42(12): 1194–1201.PubMedCrossRef

28.

Maxwell SE, Delaney HD. Designing Experiments and Analyzing Data: A Model Comparison Perspective. 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates; 2004.

29.

Gildengers AG, Houck PR, Mulsant BH, et al. Trajectories of treatment response in late-life depression. Journal of Clinical Psychopharmacology. 2005; 25: S8–S13.PubMedCrossRef

30.

Katon W, Unützer J, Russo J. Major depression: The importance of clinical characteristics and treatment response to prognosis. Depression and Anxiety. 2010; 27(1): 19–26.PubMedCrossRef

31.

Blazer DG. Depression in late life: Review and commentary. The Journal of Gerontology. 2003; 58(3): 249–265.

32.

Grigoriadis S, Robinson GE. Gender issues in depression. Annals of Clinical Psychiatry. 2007; 19(4): 247–255.PubMedCrossRef

33.

Hinton L, Zweifach M, Oishi S, et al. Gender disparities in the treatment of late-life depression: Qualitative and quantitative findings from the IMPACT trial. American Journal of Geriatric Psychiatry. 2006; 14(10): 884–892.PubMedCrossRef

34.

Sotsky M, Glass DR, Shea T, et al. Patient predictors of response to psychotherapy and pharmacotherapy: Finding in the NIMH Treatment of Depression Collaborative Research Program. American Journal of Psychiatry. 1991; 148(8): 997–1008.PubMedCrossRef

35.

United States Census Bureau. State and County Quickfacts: Contra Costa County, C.A. 2012. Available at: http://quickfacts.census.gov/qfd/states/06/06013.html. Accessed October 1, 2012.

36.

González HM, Haan MN, Hinton L. Acculturation and the prevalence of depression in older Mexican Americans: Baseline results of the Sacramento Area Latino Study on Aging. Journal of the American Geriatrics Society. 2001; 49(7): 948–953.PubMedCrossRef

37.

Blazer DG, Landerman LR, Hays JC, et al. Symptoms of depression among community-dwelling elderly African-American and White older adults. Psychological Medicine. 1998; 28(6): 1311–1320.PubMedCrossRef

38.

Areán PA, Ayalon L, Hunkeler E, et al. Improving depression care for older, minority patients in primary care. Medical Care. 2005; 43(4): 381–390.PubMedCrossRef

39.

Keefe SE, Padilla AM, Carlos ML. The Mexican-American extened family as an emotional support system. Human Organization. 1979; 38(2): 144–152.CrossRef

40.

Cooper LA, Gonzales JJ, Gallo JJ, et al. The acceptablitiy of treatment for depression among Afican-American, Hispanic, and White primary care patients. Medical Care. 2003; 41(4): 479–489.PubMed

41.

Reynen DJ, Kamigaki AS, Pheatt N, et al. The Burden of Cardiovascular Disease in California: A Report of the California Heart Disease and Stroke Prevention Program. Sacramento, CA: California Department of Public Health, 2007.

42.

Copeland JRM, Chen R, Dewey ME, et al. Community-based case-control study of depression in older people. Cases and sub-cases from the MRC-ALPHA Study. The British Journal of Psychiatry. 1999; 175(4): 340–347.PubMedCrossRef

43.

Oslin DW. Late-life alcoholism: Issues relevant to the geriatric psychiatrist. American Journal of Geriatric Psychiatry. 2004; 12(6): 571–583.PubMed

44.

Van Leeuwen Williams E, Unützer J, Lee S, et al. Collaborative depression care for the old-old: Findings from the IMPACT trial. American Journal of Geriatric Psychiatry. 2009; 17(12): 1040–1049.PubMedCrossRef

45.

Areán PA, Hegel M, Vannoy S, et al. Effectiveness of problem-solving therapy for older, primary care patients with depression: Results from the IMPACT project. The Gerontologist. 2008; 48(3): 311–323.PubMedCrossRef

46.

Alexopoulos GS, Buckwalter K, Olin J, et al. Comorbidity of late life depression: An opportunity for research on mechanisms and treatment. Biological Psychiatry. 2002; 52(6): 543–558.PubMedCrossRef

Title: An Evaluation of IMPACT for the Treatment of Late-Life Depression in a Public Mental Health System
Authors: Michael J. Penkunas, PhD
Stephen Hahn-Smith, PhD
Publication date: 01-07-2015
Publisher: Springer US
Published in: The Journal of Behavioral Health Services & Research / Issue 3/2015
Print ISSN: 1094-3412
Electronic ISSN: 2168-6793
DOI: https://doi.org/10.1007/s11414-013-9373-8

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An Evaluation of IMPACT for the Treatment of Late-Life Depression in a Public Mental Health System

Abstract

Keynote webinar | Spotlight on medication adherence

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