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Randomized Controlled Trial
. 2016 Jun;24(6):433-43.
doi: 10.1016/j.jagp.2015.10.012. Epub 2015 Nov 17.

Challenges and Solutions for Depression Prevention Research: Methodology for a Depression Prevention Trial for Older Adults with Knee Arthritis and Emotional Distress

Jordan F Karp  1 , Mary Amanda Dew  2 , Abdus S Wahed  3 , Kelley Fitzgerald  4 , Chloe A Bolon  5 , Debra K Weiner  6 , Jennifer Q Morse  7 , Steve Albert  8 , Meryl Butters  5 , Ariel Gildengers  5 , Charles F Reynolds 3rd  9
Affiliations
Randomized Controlled Trial

Challenges and Solutions for Depression Prevention Research: Methodology for a Depression Prevention Trial for Older Adults with Knee Arthritis and Emotional Distress

Jordan F Karp et al. Am J Geriatr Psychiatry. 2016 Jun.

Abstract

Objective: To describe the methodology, challenges, and baseline characteristics of a prevention development trial entitled "Reducing Pain, Preventing Depression."

Methods: A sequential multiple assignment randomized trial (SMART) compared sequences of cognitive behavioral therapy (CBT) and physical therapy for knee pain and prevention of depression and anxiety. Participants were randomized to CBT, physical therapy, or enhanced usual care and followed for 12 months for new-episode depression or anxiety. Participants were age ≥ 60 with knee osteoarthritis and subsyndromal depression, defined as 9-item Patient Health Questionnaire (PHQ-9) score ≥1 (which included the endorsement of one of the cardinal symptoms of depression [low mood or anhedonia]) and no diagnosis of major depressive disorder per the Structured Clinical Interview for DSM-IV. Depression and anxiety severity and characterization of new episodes were assessed with the PHQ-9, Generalized Anxiety Disorder-7, and the PRIME-MD. Knee pain was characterized with the Western Ontario McMaster Arthritis Index. Response was defined as at least "Very Much Better" on a Patient Global Impression of Change.

Results: At baseline there were 99 patients with an average age of 71; 61.62% were women and 81.8% white. The average PHQ-9 was 5.6 and average Generalized Anxiety Disorder-7, was 3.2. Most were satisfied with the interventions and study procedures. The challenges and solutions described here will also be used in a confirmatory clinical trial of efficacy.

Conclusion: A SMART design for depression and anxiety prevention, using both CBT and physical therapy, appears to be feasible and acceptable to participants. The methodologic innovations of this project may advance the field of late-life depression and anxiety prevention.

Keywords: anxiety; depression; late life; pain; prevention.

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Conflict of interest statement

Conflicts of Interest: Receipt of medication supplies for investigator-initiated studies from Pfizer and Reckitt Benckiser. Dr. Butters served as a consultant for GlaxoSmithKline from whom she received remuneration for participating in cognitive diagnostic consensus conferences for a clinical trial; the remaining authors report no disclosures.

Figures

Figure 1
Figure 1
Study Design CBT: Cognitive Behavioral Therapy for Pain EUC: Enhanced Usual Care
Figure 2
Figure 2
Consort Diagram
See this image and copyright information in PMC

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