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Randomized Controlled Trial
. 2015 Dec;23(12):1307-1314.
doi: 10.1016/j.jagp.2015.04.005. Epub 2015 Apr 24.

Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults

Patricia A Areán  1 , Patrick J Raue  2 , Charles McCulloch  3 , Dora Kanellopoulos  2 , Joanna K Seirup  2 , Samprit Banerjee  2 , Dimitris N Kiosses  2 , Eleanor Dwyer  4 , George S Alexopoulos  2
Affiliations
Randomized Controlled Trial

Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults

Patricia A Areán et al. Am J Geriatr Psychiatry. 2015 Dec.

Abstract

Objective: To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability.

Methods: Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used.

Results: Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12.

Conclusion: CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).

Keywords: Disability; case management; late-life depression.

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Figures

Figure 1
Figure 1
Flow of Subjects into the Treatment Trial
Figure 2
Figure 2
WHODAS changes over time (adjusted means): Case Management (CM) vs. Case Management Integrated with Problem Solving Therapy (CM-PST)
See this image and copyright information in PMC

References

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