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Cited by 126Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Effect of Collaborative Care vs Usual Care on Depressive Symptoms in Older Adults With Subthreshold Depression: The CASPER Randomized Clinical Trial

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Gilbody, Simon, Lewis, Helen, Adamson, Joy, Atherton, Katie, Bailey, Della, Birtwistle, Jacqueline, Bosanquet, Katharine, Clare, Emily, Delgadillo, Jaime, Ekers, David, Foster, Deborah, Gabe, Rhian, Gascoyne, Samantha, Haley, Lesley, Hamilton, Jahnese, Hargate, Rebecca, Hewitt, Catherine, Holmes, John, Keding, Ada, Lilley-Kelly, Amanda, Meer, Shaista, Mitchell, Natasha, Overend, Karen, Pasterfield, Madeline, Pervin, Jodi, Richards, David A., Spilsbury, Karen, Traviss-Turner, Gemma, Trépel, Dominic, Woodhouse, Rebecca, Ziegler, Friederike, McMillan, Dean·2017·JAMA
DOI 10.1001/jama.2017.0130
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Abstract

Importance: There is little evidence to guide management of depressive symptoms in older people. Objective: To evaluate whether a collaborative care intervention can reduce depressive symptoms and prevent more severe depression in older people. Design, Setting, and Participants: Randomized clinical trial conducted from May 24, 2011, to November 14, 2014, in 32 primary care centers in the United Kingdom among 705 participants aged 65 years or older with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) subthreshold depression; participants were followed up for 12 months. Interventions: Collaborative care (n=344) was coordinated by a case manager who assessed functional impairments relating to mood symptoms. Participants were offered behavioral activation and completed an average of 6 weekly sessions. The control group received usual primary care (n=361). Main Outcomes and Measures: The primary outcome was self-reported depression severity at 4-month follow-up on the 9-item Patient Health Questionnaire (PHQ-9; score range, 0-27). Included among 10 prespecified secondary outcomes were the PHQ-9 score at 12-month follow-up and the proportion meeting criteria for depressive disorder (PHQ-9 score ≥10) at 4- and 12-month follow-up. Results: The 705 participants were 58% female with a mean age of 77 (SD, 7.1) years. Four-month retention was 83%, with higher loss to follow-up in collaborative care (82/344 [24%]) vs usual care (37/361 [10%]). Collaborative care resulted in lower PHQ-9 scores vs usual care at 4-month follow-up (mean score with collaborative care, 5.36 vs with usual care, 6.67; mean difference, -1.31; 95% CI, -1.95 to -0.67; P < .001). Treatment differences remained at 12 months (mean PHQ-9 score with collaborative care, 5.93 vs with usual care, 7.25; mean difference, -1.33; 95% CI, -2.10 to -0.55). The proportions of participants meeting criteria for depression at 4-month follow-up were 17.2% (45/262) vs 23.5% (76/324), respectively (difference, -6.3% [95% CI, -12.8% to 0.2%]; relative risk, 0.83 [95% CI, 0.61-1.27]; P = .25) and at 12-month follow-up were 15.7% (37/235) vs 27.8% (79/284) (difference, -12.1% [95% CI, -19.1% to -5.1%]; relative risk, 0.65 [95% CI, 0.46-0.91]; P = .01). Conclusions and Relevance: Among older adults with subthreshold depression, collaborative care compared with usual care resulted in a statistically significant difference in depressive symptoms at 4-month follow-up, of uncertain clinical importance. Although differences persisted through 12 months, findings are limited by attrition, and further research is needed to assess longer-term efficacy. Trial Registration: isrctn.org Identifier: ISRCTN02202951.

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Authors
Gilbody, S., Lewis, H., Adamson, J., Atherton, K., Bailey, D., Birtwistle, J., Bosanquet, K., Clare, E., Delgadillo, J., Ekers, D., Foster, D., Gabe, R., Gascoyne, S., Haley, L., Hamilton, J., Hargate, R., Hewitt, C., Holmes, J., Keding, A., Lilley-Kelly, A., Meer, S., Mitchell, N., Overend, K., Pasterfield, M., Pervin, J., Richards, D. A., Spilsbury, K., Traviss-Turner, G., Trépel, D., Woodhouse, R., Ziegler, F., & McMillan, D.
Affiliations
  • University of York (GB)
  • Leeds and York Partnership NHS Foundation Trust (GB)
  • University of Leeds (GB)
  • Department of Health Sciences, University of York, Heslington, England
  • Cumbria Northumberland Tyne and Wear NHS Foundation Trust (GB)
  • Leeds Community Healthcare NHS Trust (GB)
  • Durham University (GB)
  • Tees, Esk and Wear Valleys NHS Foundation Trust (GB)
  • University of Exeter (GB)
  • Leeds Institute of Health Sciences, University of Leeds, Leeds, England
  • University of Sheffield (GB)
Corresponding author
Gilbody, Simon
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2017-02-21
Volume
317
Issue
7
Pages
728
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2017.0130
OpenAlex
W2591604163
Cited by
126
References
35
Citations by year
2026: 11 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 17 · 2021: 20 · 2020: 14 · 2019: 18 · 2018: 12 · 2017: 7
FWCI
20.02
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • TeesRep (Teesside University) (publishedVersion, other-oa)
  • Teesside University Research Portal (Teesside University) (publishedVersion, other-oa)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Open Research Exeter (University of Exeter) (acceptedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
  • Figshare (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
National Institute for Health and Care Research (NF-SI-0514-10037, NF-SI-0611-10203, 08/19/04)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
collaborative care, subthreshold depression, depressive symptoms, older adults, primary care, behavioral activation, case management, depression prevention, PHQ-9, treatment retention, loss to follow-up, depression severity, functional disability, mood symptoms
MeSH terms
Case Managers, Aged, Antidepressive Agents, Depression, Female, Follow-Up Studies, United Kingdom, Humans, Male, Patient Care Team, Patient Dropouts, Primary Health Care, Psychiatry, Quality of Life, Time Factors, Comorbidity, Sample Size, Self Report

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