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Collaborative care for depression in older adults: How much is enough?
Toby Bonvoisin1, Lewis W Paton2, Catherine Hewitt2
1Department of Health Sciences, University of York, Heslington, YO10 5DD, UK; Hull University Teaching Hospitals NHS Trust, Hull, HU3 2JZ, UK.
Behaviour Research and Therapy
|October 1, 2020
Summary
Collaborative care effectively reduces depressive symptoms in older adults who adhere to treatment. The minimum effective dose for this intervention is five sessions, demonstrating its causal impact.
Area of Science:
- Gerontology
- Psychiatry
- Public Health
Background:
- Collaborative care is effective for subthreshold depression in older adults.
- The CASPER trial demonstrated the efficacy of collaborative care.
- Understanding treatment adherence and minimum effective dose is crucial.
Purpose of the Study:
- To reanalyze CASPER trial data using complier average causal effect (CACE) analysis.
- To determine the impact of adherence on collaborative care effectiveness.
- To identify the minimum effective dose of collaborative care for older adults.
Main Methods:
- Reanalysis of CASPER trial data from 705 participants.
- Utilized complier average causal effect (CACE) analysis.
- Defined 'compliance' as completion of five or more sessions; sensitivity analyses used 2-8 sessions.
Main Results:
- Compliers in the intervention group showed significantly lower 12-month PHQ-9 scores (1.75 lower, p=0.02).
- Effect size was greater than originally reported in the CASPER trial.
- Sensitivity analyses confirmed significant differences for those attending five or more sessions.
Conclusions:
- Collaborative care causally reduces subthreshold depressive symptoms in older adults who adhere to treatment.
- A minimum of five sessions appears to be the effective dose.
- Adherence significantly enhances the positive outcomes of collaborative care.
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