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Randomized Controlled Trial
. 2016 Nov;24(11):964-974.
doi: 10.1016/j.jagp.2016.07.014. Epub 2016 Jul 20.

Two Behavioral Interventions for Patients with Major Depression and Severe COPD

George S Alexopoulos  1 , Jo Anne Sirey  2 , Samprit Banerjee  2 , Dimitris N Kiosses  2 , Cristina Pollari  2 , Richard S Novitch  3 , Amanda Artis  2 , Patrick J Raue  2
Affiliations
Randomized Controlled Trial

Two Behavioral Interventions for Patients with Major Depression and Severe COPD

George S Alexopoulos et al. Am J Geriatr Psychiatry. 2016 Nov.

Abstract

Objective: Personalized Intervention for Depressed Patients with COPD (PID-C), a treatment mobilizing patients to participate in their care, was found more effective than usual care. To further improve its efficacy, we developed a Problem Solving-Adherence (PSA) intervention integrating problem solving into adherence enhancement procedures. We tested the hypothesis that PSA is more effective than PID-C in reducing depressive symptoms. Exploratory analyses sought to identify patients with distinct depressive symptom trajectories and compare their clinical profiles.

Design: Randomized controlled trial.

Setting: Acute inpatient rehabilitation and community.

Participants: A total of 101 diagnosed with chronic obstructive pulmonary disease (COPD) and major depression after screening 633 consecutive admissions for acute inpatient rehabilitation.

Intervention: Fourteen sessions of PID-C versus PSA over 26 weeks.

Measurements: 24-item Hamilton Depression Rating Scale.

Results: PSA was not more efficacious than PID-C in reducing depressive symptoms. Exploratory latent class growth modeling identified two distinct depressive symptoms trajectories. Unlike patients with unfavorable course (28%) who remained symptomatic, patients with favorable course (72%) had a decline of symptoms during the hospitalization followed by a milder decline after discharge. Patients with unfavorable course were younger and had greater scores in disability, anxiety, neuroticism, and dyspnea related limitation in activities and lower self-efficacy scores.

Conclusions: Both interventions led to sustained improvement depressive symptoms. PID-C matches the skills of clinicians employed by community rehabilitation programs and can be integrated in the care of depressed COPD patients. Patients with severe disability, anxiety, neuroticism, and low self-efficacy are at risk for poor outcomes and in need of close follow-up and targeted interventions. .

Keywords: COPD; clinical trial; disability; dyspnea; geriatric depression; personalized intervention.

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Conflict of interest statement

Dr. Alexopoulos serves at the speakers’ bureaus of Takeda, Lundbeck, Otsuka, and Sunovion. No other authors report conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of participant progress through the phases of the randomized trial.
Figure 2
Figure 2. Distinct trajectories of depression severity of patients with major depression and severe COPD randomly assigned to receive PID-C or PSA
Legend to Figure 2: Latent class growth modeling (LCGM) identified two subgroups with distinct depression trajectories. Ham-D: 24-item Hamilton Depression Rating Scale
FIGURE 3
FIGURE 3. Distinct trajectories of depression severity of patients with major depression and severe COPD treated with PID-C (top) and PSA (bottom)
Legend to Figure 3: Latent class growth modeling (LCGM) identified subgroups with distinct depression trajectories in PID-C (top) and PSA (bottom) treated patients. Ham-D: 24-item Hamilton Depression Rating Scale
See this image and copyright information in PMC

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References

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