Effect of Improving Depression Care on Pain and Functional Outcomes among Older Adults with Arthritis: A Randomized Controlled Trial

Elizabeth H B Lin, Wayne Katon, Michael Von Korff, Lingqi Tang, John W. Williams, Kurt Kroenke, Enid Hunkeler, Linda Harpole, Mark Hegel, Patricia Arean, Marc Hoffing, Richard Della Penna, Chris Langston, Jürgen Unützer

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Abstract

Context Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients, Objective To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis, Design, Setting, and Participants Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline. Intervention Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care), Main Outcome Measures Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. Results In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P=.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P=.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P=.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. Conclusions In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

Original languageEnglish
Pages (from-to)2428-2434
Number of pages7
JournalJournal of the American Medical Association
Volume290
Issue number18
DOIs
StatePublished - Nov 12 2003

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Arthritis
Randomized Controlled Trials
Depression
Pain
Quality of Life
Confidence Intervals
Primary Health Care
Health
Psychotherapy
Osteoarthritis
Antidepressive Agents
Health Status
Outcome Assessment (Health Care)
Organizations
Delivery of Health Care
Therapeutics
Population

ASJC Scopus subject areas

  • Medicine(all)

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Effect of Improving Depression Care on Pain and Functional Outcomes among Older Adults with Arthritis : A Randomized Controlled Trial. / Lin, Elizabeth H B; Katon, Wayne; Von Korff, Michael; Tang, Lingqi; Williams, John W.; Kroenke, Kurt; Hunkeler, Enid; Harpole, Linda; Hegel, Mark; Arean, Patricia; Hoffing, Marc; Della Penna, Richard; Langston, Chris; Unützer, Jürgen.

In: Journal of the American Medical Association, Vol. 290, No. 18, 12.11.2003, p. 2428-2434.

Research output: Contribution to journalArticle

Lin, EHB, Katon, W, Von Korff, M, Tang, L, Williams, JW, Kroenke, K, Hunkeler, E, Harpole, L, Hegel, M, Arean, P, Hoffing, M, Della Penna, R, Langston, C & Unützer, J 2003, 'Effect of Improving Depression Care on Pain and Functional Outcomes among Older Adults with Arthritis: A Randomized Controlled Trial', Journal of the American Medical Association, vol. 290, no. 18, pp. 2428-2434. https://doi.org/10.1001/jama.290.18.2428
Lin, Elizabeth H B ; Katon, Wayne ; Von Korff, Michael ; Tang, Lingqi ; Williams, John W. ; Kroenke, Kurt ; Hunkeler, Enid ; Harpole, Linda ; Hegel, Mark ; Arean, Patricia ; Hoffing, Marc ; Della Penna, Richard ; Langston, Chris ; Unützer, Jürgen. / Effect of Improving Depression Care on Pain and Functional Outcomes among Older Adults with Arthritis : A Randomized Controlled Trial. In: Journal of the American Medical Association. 2003 ; Vol. 290, No. 18. pp. 2428-2434.
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abstract = "Context Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients, Objective To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis, Design, Setting, and Participants Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56{\%}) reported coexisting arthritis at baseline. Intervention Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care), Main Outcome Measures Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. Results In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95{\%} confidence interval [CI], -0.92 to -0.14; P=.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95{\%} CI, -1.00 to -0.19; P=.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95{\%} CI, -0.41 to -0.10; P=.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. Conclusions In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.",
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T1 - Effect of Improving Depression Care on Pain and Functional Outcomes among Older Adults with Arthritis

T2 - A Randomized Controlled Trial

AU - Lin, Elizabeth H B

AU - Katon, Wayne

AU - Von Korff, Michael

AU - Tang, Lingqi

AU - Williams, John W.

AU - Kroenke, Kurt

AU - Hunkeler, Enid

AU - Harpole, Linda

AU - Hegel, Mark

AU - Arean, Patricia

AU - Hoffing, Marc

AU - Della Penna, Richard

AU - Langston, Chris

AU - Unützer, Jürgen

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N2 - Context Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients, Objective To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis, Design, Setting, and Participants Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline. Intervention Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care), Main Outcome Measures Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. Results In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P=.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P=.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P=.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. Conclusions In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

AB - Context Depression and arthritis are disabling and common health problems in late life. Depression is also a risk factor for poor health outcomes among arthritis patients, Objective To determine whether enhancing care for depression improves pain and functional outcomes in older adults with depression and arthritis, Design, Setting, and Participants Preplanned subgroup analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (≥60 years), which was performed at 18 primary care clinics from 8 health care organizations in 5 states across the United States from July 1999 to August 2001. A total of 1001 (56%) reported coexisting arthritis at baseline. Intervention Antidepressant medications and/or 6 to 8 sessions of psychotherapy (Problem-Solving Treatment in Primary Care), Main Outcome Measures Depression, pain intensity (scale of 0 to 10), interference with daily activities due to arthritis (scale of 0 to 10), general health status, and overall quality-of-life outcomes assessed at baseline, 3, 6, and 12 months. Results In addition to reduction in depressive symptoms, the intervention group compared with the usual care group at 12 months had lower mean (SE) scores for pain intensity (5.62 [0.16] vs 6.15 [0.16]; between-group difference, -0.53; 95% confidence interval [CI], -0.92 to -0.14; P=.009), interference with daily activities due to arthritis (4.40 [0.18] vs 4.99 [0.17]; between-group difference, -0.59; 95% CI, -1.00 to -0.19; P=.004), and interference with daily activities due to pain (2.92 [0.07] vs 3.17 [0.07]; between-group difference, -0.26; 95% CI, -0.41 to -0.10; P=.002). Overall health and quality of life were also enhanced among intervention patients relative to control patients at 12 months. Conclusions In a large and diverse population of older adults with arthritis (mostly osteoarthritis) and comorbid depression, benefits of improved depression care extended beyond reduced depressive symptoms and included decreased pain as well as improved functional status and quality of life.

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