Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care

Enid M. Hunkeler, Wayne Katon, Lingqi Tang, John W. Williams, Kurt Kroenke, Elizabeth H B Lin, Linda H. Harpole, Pat Arean, Stuart Levine, Lydia M. Grypma, William A. Hargreaves, Jürgen Unützer

Research output: Contribution to journalArticle

242 Citations (Scopus)

Abstract

Objective: To determine the long term effectiveness of collaborative care management for depression in late life. Design: Two arm, randomised, clinical trial; intervention one year and follow-up two years. Setting: 18 primary care clinics in eight US healthcare organisations. Patients: 1801 primary care patients aged 60 and older with major depression, dysthymia, or both. Intervention: Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient's needs and preferences. Main outcome measures: Interviewers, blinded to treatment assignment, conducted interviews in person at baseline and by telephone at each subsequent follow-up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care. Results: IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months. One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained. Conclusions: Tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. Benefits include less depression, better physical functioning, and an enhanced quality of life. The IMPACT model may show the way to less depression and healthier lives for older adults.

Original languageEnglish
Pages (from-to)259-262
Number of pages4
JournalBMJ (Clinical research ed.)
Volume332
Issue number7536
DOIs
StatePublished - Feb 4 2006

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Primary Health Care
Depression
Quality of Life
Antidepressive Agents
Interviews
Therapeutics
Patient Preference
Self Efficacy
Secondary Prevention
Telephone
Psychotherapy
Psychiatry
Randomized Controlled Trials
Outcome Assessment (Health Care)
Organizations
Delivery of Health Care
Education

ASJC Scopus subject areas

  • Medicine(all)

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Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. / Hunkeler, Enid M.; Katon, Wayne; Tang, Lingqi; Williams, John W.; Kroenke, Kurt; Lin, Elizabeth H B; Harpole, Linda H.; Arean, Pat; Levine, Stuart; Grypma, Lydia M.; Hargreaves, William A.; Unützer, Jürgen.

In: BMJ (Clinical research ed.), Vol. 332, No. 7536, 04.02.2006, p. 259-262.

Research output: Contribution to journalArticle

Hunkeler, EM, Katon, W, Tang, L, Williams, JW, Kroenke, K, Lin, EHB, Harpole, LH, Arean, P, Levine, S, Grypma, LM, Hargreaves, WA & Unützer, J 2006, 'Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care', BMJ (Clinical research ed.), vol. 332, no. 7536, pp. 259-262. https://doi.org/10.1136/bmj.38683.710255.BE
Hunkeler, Enid M. ; Katon, Wayne ; Tang, Lingqi ; Williams, John W. ; Kroenke, Kurt ; Lin, Elizabeth H B ; Harpole, Linda H. ; Arean, Pat ; Levine, Stuart ; Grypma, Lydia M. ; Hargreaves, William A. ; Unützer, Jürgen. / Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. In: BMJ (Clinical research ed.). 2006 ; Vol. 332, No. 7536. pp. 259-262.
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AU - Lin, Elizabeth H B

AU - Harpole, Linda H.

AU - Arean, Pat

AU - Levine, Stuart

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AU - Unützer, Jürgen

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