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Pain limits the effectiveness of collaborative care for depression
Stephen M Thielke1, Ming-Yu Fan, Mark Sullivan
1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98115-6560, USA. sthielke@u.washington.edu
Summary
Collaborative care improved depression in older adults, but high baseline pain interfered with treatment success. Addressing pain is crucial for better depression outcomes in this population.
Area of Science:
- Geriatric Medicine
- Psychiatry
- Pain Management
Background:
- Depression is a common and serious condition in older adults.
- Pain frequently co-occurs with depression, potentially impacting treatment efficacy.
- Collaborative care models aim to integrate mental health services into primary care settings.
Purpose of the Study:
- To examine how baseline pain affects depression outcomes in older adults receiving collaborative care.
- To determine if pain is a barrier to successful depression treatment in this demographic.
Main Methods:
- Secondary analysis of 1,801 older adults from the Improving Mood: Providing Access to Collaborative Treatment trial.
- Comparison of depression outcomes based on high vs. no/low baseline pain interference.
- Analysis of treatment-as-usual and collaborative care intervention groups, including interaction effects.
Main Results:
- In the intervention group, higher pain interference was linked to poorer depression response (37.4% vs. 48.9%).
- Arthritis pain interference also showed a significant association with worse depression outcomes.
- A significant interaction indicated that pain differentially impaired depression response in collaborative care compared to usual care.
Conclusions:
- Collaborative care was more effective for older adults with less pain.
- Baseline pain may represent a significant barrier to depression improvement.
- Targeting pain management alongside depression treatment could enhance outcomes.
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