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Randomized Controlled Trial
. 2019 Aug;27(8):883-893.
doi: 10.1016/j.jagp.2019.02.016. Epub 2019 Mar 1.

Effectiveness of Shared Decision-Making for Elderly Depressed Minority Primary Care Patients

Patrick J Raue  1 , Herbert C Schulberg  2 , Martha L Bruce  3 , Samprit Banerjee  2 , Amanda Artis  4 , Maria Espejo  5 , Idalia Catalan  6 , Sara Romero  7
Affiliations
Randomized Controlled Trial

Effectiveness of Shared Decision-Making for Elderly Depressed Minority Primary Care Patients

Patrick J Raue et al. Am J Geriatr Psychiatry. 2019 Aug.

Abstract

Objective: The authors assessed the impact of a shared decision-making (SDM) intervention among elderly depressed minority primary care patients not currently receiving treatment.

Methods: A total of 202 English and Spanish-speaking primary care participants aged 65 and older who scored positive on the Patient Health Questionnaire-9 (≥10) were randomized at the physician level to receive a brief SDM intervention or usual care (UC). Primary analyses focused on patient adherence to either psychotherapy or antidepressant medication, and reduction in depression severity (Hamilton Depression Rating Scale) over 12 weeks.

Results: Patients randomized to physicians in the SDM condition were significantly more likely than patients of physicians randomized to UC to receive a mental health evaluation or initiate some form of treatment (39% versus 21%), and to adhere to psychotherapy visits over 12 weeks. There were no differences between groups in adherence to antidepressant medication or in reduction of depressive symptoms.

Conclusion: Among untreated elderly depressed minority patients from an inner-city municipal hospital, a brief SDM intervention was associated with greater initiation and adherence to psychotherapy. However, low treatment adherence rates across both groups and the intervention's lack of impact on clinical outcomes highlight the need to provide focused and accessible mental health services to patients choosing active treatments.

Trial registration: ClinicalTrials.gov NCT01031134.

Keywords: Shared decision-making; depression; geriatrics; primary care.

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Conflict of interest statement

No authors report competing interests or conflicts of interest.

Figures

Figure 1:
Figure 1:
Consort Chart for Cliuical Trial of Shared Decision-Miking
See this image and copyright information in PMC

References

    1. American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd ed. Arlington, VA: American Psychiatric Association (APA), 2010
    1. Raue PJ, McGovern AR, Kiosses DN, et al. : Advances in psychotherapy for depressed older adults. Curr Psychiatry Rep 2017; 19:57. - PMC - PubMed
    1. Olfson M, Blanco C, Marcus SC: Treatment of adult depression in the United States. JAMA Intern Med 2016; 176:1482–1491 - PubMed
    1. US Department of Health and Human Services. National standards for culturally and linguistically appropriate services in health care. Washington, DC, US Department of Health and Human Services, 2001
    1. Institute of Medicine: Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: Institute of Medicine, 2002

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