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Cited by 31Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial

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Alexopoulos, George S., Raue, Patrick J., McCulloch, Charles, Kanellopoulos, Dora, Seirup, Joanna K., Sirey, Jo Anne, Banerjee, Samprit, Kiosses, Dimitris N. +1 more·2016·The American Journal of Geriatric Psychiatry
DOI 10.1016/j.jagp.2015.02.007PMC PMC4539297
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Abstract

Objective To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression.Methods This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median.Results CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ(2) = 1.5, df = 1, p = 0.22 and χ(2) = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17).Conclusion Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy.

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  • Clinical case management reduced the severity of depression and improved disability in low-income, disabled elders suffering from major depression.

    “Clinical case management reduced the severity of depression and improved disability in low-income, disabled elders suffering from major depression168.”

    From Mechanisms and treatment of late-life depression (2019) · cites this paper as [168]

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  1. [18]First MB Spitzer RL Williams JBW Structured Clinical Interview for DSM-IV—Patient Version (SCID-P) 1995 American Psychiatric Press Washington, DC

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Authors
Alexopoulos, G. S., Raue, P. J., McCulloch, C., Kanellopoulos, D., Seirup, J. K., Sirey, J. A., Banerjee, S., Kiosses, D. N., & Areán, P. A.
Affiliations
  • Cornell University (US)
  • Weill Cornell Medicine (US)
  • University of California, San Francisco (US)
Corresponding author
Alexopoulos, George S.
ORCID
Venue
The American Journal of Geriatric Psychiatry
Publisher
Elsevier BV
Published
2016-01
Volume
24
Issue
1
Pages
50-59
ISSN
1064-7481 (ISSN-L)
DOI
10.1016/j.jagp.2015.02.007
PMC
PMC4539297
OpenAlex
W1967264382
Cited by
31
References
44
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 1 · 2019: 5 · 2018: 5 · 2017: 5 · 2016: 3 · 2015: 2
FWCI
6.21
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • American Journal of Geriatric Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institute of Mental Health (R01 MH075900, R01 MH075897, K24 MH074717, P30 MH085943, T32 MH019132)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
clinical case management, problem-solving therapy, major depressive disorder, older adults, low-income populations, disability, problem-solving skills, non-inferiority, social workers, treatment response and remission
MeSH terms
Aged, Aged, 80 and over, Antidepressive Agents, Major Depressive Disorder, Depressive Disorder, Major, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Poverty, Problem Solving, Psychiatric Status Rating Scales, Psychotherapy, Treatment Outcome, Case Management

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