Improving depression care for older, minority patients in primary care

Patricia A. Areán, Liat Ayalon, Enid Hunkeler, Elizabeth H B Lin, Lingqi Tang, Linda Harpole, Hugh Hendrie, John W. Williams, Jürgen Unützer

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Objective: Few older minorities receive adequate treatment of depression in primary care. This study examines whether a collaborative care model for depression in primary care is as effective in older minorities as it is in nonminority elderly patients in improving depression treatment and outcomes. Study Design: A multisite randomized clinical trial of 1801 older adults comparing collaborative care for depression with treatment as usual in primary care. Twelve percent of the sample were black (n = 222), 8% were Latino (n = 138), and 3% (n = 53) were from other minority groups. We compared the 3 largest ethnic groups (non-Latino white, black, and Latino) on depression severity, quality of life, and mental health service use at baseline, 3, 6, and 12 months after randomization to collaborative care or usual care. Principal Findings: Compared with care as usual, collaborative care significantly improved rates and outcomes of depression care in older adults from ethnic minority groups and in older whites. At 12 months, intervention patients from ethnic minorities (blacks and Latinos) had significantly greater rates of depression care for both antidepressant medication and psychotherapy, lower depression severity, and less health-related functional impairment than usual care participants (64%, 95% confidence interval [CI] 55-72 versus 45%, CI 36-55, P = 0.003 for antidepressant medication; 37%, CI 28-47 versus 13%, CI 6-19, P = 0.002 for psychotherapy; mean = 0.9, CI 0.8-1.1 versus mean = 1.4, CI 1.3-1.5, P < 0.001 for depression severity, range 0-4; mean = 3.7, CI 3.2-4.1, versus mean = 4.7, CI 4.3-5.1, P < 0.0001 for functional impairment, range 0-10). Conclusions: Collaborative Care is significantly more effective than usual care for depressed older adults, regardless of their ethnicity. Intervention effects in ethnic minority participants were similar to those observed in whites.

Original languageEnglish
Pages (from-to)381-390
Number of pages10
JournalMedical Care
Volume43
Issue number4
DOIs
StatePublished - Apr 2005

Fingerprint

Primary Health Care
minority
Depression
Confidence Intervals
confidence
Hispanic Americans
Minority Groups
Ethnic Groups
Psychotherapy
Antidepressive Agents
national minority
psychotherapy
Mental Health Services
Random Allocation
medication
Randomized Controlled Trials
Quality of Life
Health
quality of life
ethnic group

Keywords

  • Collaborative care
  • Depression
  • Ethnic minorities
  • Older adults

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Areán, P. A., Ayalon, L., Hunkeler, E., Lin, E. H. B., Tang, L., Harpole, L., ... Unützer, J. (2005). Improving depression care for older, minority patients in primary care. Medical Care, 43(4), 381-390. https://doi.org/10.1097/01.mlr.0000156852.09920.b1

Improving depression care for older, minority patients in primary care. / Areán, Patricia A.; Ayalon, Liat; Hunkeler, Enid; Lin, Elizabeth H B; Tang, Lingqi; Harpole, Linda; Hendrie, Hugh; Williams, John W.; Unützer, Jürgen.

In: Medical Care, Vol. 43, No. 4, 04.2005, p. 381-390.

Research output: Contribution to journalArticle

Areán, PA, Ayalon, L, Hunkeler, E, Lin, EHB, Tang, L, Harpole, L, Hendrie, H, Williams, JW & Unützer, J 2005, 'Improving depression care for older, minority patients in primary care', Medical Care, vol. 43, no. 4, pp. 381-390. https://doi.org/10.1097/01.mlr.0000156852.09920.b1
Areán PA, Ayalon L, Hunkeler E, Lin EHB, Tang L, Harpole L et al. Improving depression care for older, minority patients in primary care. Medical Care. 2005 Apr;43(4):381-390. https://doi.org/10.1097/01.mlr.0000156852.09920.b1
Areán, Patricia A. ; Ayalon, Liat ; Hunkeler, Enid ; Lin, Elizabeth H B ; Tang, Lingqi ; Harpole, Linda ; Hendrie, Hugh ; Williams, John W. ; Unützer, Jürgen. / Improving depression care for older, minority patients in primary care. In: Medical Care. 2005 ; Vol. 43, No. 4. pp. 381-390.
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