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Cited by 304Mental Health Treatment and AccessTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Improving treatment of late life depression in primary care: a randomized clinical trial

Callahan, Christopher M., Hendrie, Hugh C., Dittus, Robert S., Brater, D. Craig, Hui, Siu L., Tierney, William M.·1994·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.1994.tb06555.x
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Abstract

OBJECTIVE : Facilitate primary care physicians' compliance with recommended standards of care for late life depression by reducing barriers to recognition and treatment. DESIGN : Randomized controlled clinical trial of physician‐targeted interventions. SETTING : Academic primary care group practice caring for an urban, medically indigent patient population. PATIENTS/PARTICIPANTS : Patients aged 60 and older who exceeded the threshold on the Centers for Epidemiologic Studies Depression Scale (CES‐D) and the Hamilton Depression Rating Scale (HAM‐D) and their primary care physicians. INTERVENTION : Physicians of intervention patients were provided with patient‐specific treatment recommendations during 3 special visits scheduled specifically to address the patient's symptoms of depression. In general, physicians were encouraged to establish a diagnosis of depression and educate their patient about the diagnosis, discontinue medications that can cause or exacerbate depressive symptoms, initiate antidepressants when appropriate, and consider referral to psychiatry. Guidelines for prescribing antidepressants were provided. Control physicians received no intervention, and control patients received usual care. MAIN OUTCOME MEASURES : Frequency of recording a depression diagnosis, stopping medications associated with depression, initiating antidepressant medication, and psychiatry referral; mean changes in HAM‐D and Sickness Impact Profile (SIP) scores. RESULTS : One hundred three physicians and 175 patients were involved in the clinical trial. Physicians of intervention patients were more likely to diagnose depression and prescribe antidepressants ( P < 0.01). There were no differences between the groups in the frequency of stopping medications associated with depression or referrals to psychiatry. Medications with the strongest cause and effect relationship to depression were infrequently used in this cohort of patients. Although both groups showed improvement in HAM‐D and SIP scores, we were unable to demonstrate significant differences in HAM‐D or SIP scores between the 2 groups. CONCLUSIONS : Intensive screening and feedback of patient‐specific treatment recommendations increased the recognition and treatment of late life depression by primary care physicians. However, we were unable to demonstrate significant improvement in depression or disability severity among intervention patients despite the informational support provided to their physicians. Efforts to improve the functional status of these patients may require more integrated interventions and more aggressive attempts to target psychosocial stressors traditionally outside the purview of primary care.

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Crossref · 10.1111/j.1532-5415.1994.tb06555.x

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  • For the seven studies that received no control intervention, the pooled odds ratio was 1.36 (95% CI 0.92 to 1.99, P = 0.099).

    “Of these, seven were suitable for inclusion in a meta‐regression, and the pooled odds ratio for the seven studies that received no control intervention was 1.36 (95% CI 0.92 to 1.99, P value = 0.099) (Avorn 1992; Callahan 1994; Flottorp 2002; Looijmans 2010; Murphy 2009; Scott 2013; Schouten 2007).”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Callahan 1994

  • The overall risk of bias for Callahan 1994 was unclear (5 criteria unclear risk).

    “Risk of bias overall Unclear risk 5 criteria unclear risk”

    From Tailored interventions to address determinants of practice (2015) · cites this paper as Callahan 1994

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Authors
Callahan, C. M., Hendrie, H. C., Dittus, R. S., Brater, D. C., Hui, S. L., & Tierney, W. M.
Affiliations
  • Regenstrief Institute (US)
  • Indiana University School of Medicine (US)
Corresponding author
Callahan, Christopher M.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
1994-08
Volume
42
Issue
8
Pages
839-846
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.1994.tb06555.x
OpenAlex
W2015771000
Cited by
304
References
49
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 9 · 2012: 9
FWCI
15.77
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 7574 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • School of Medicine, Indiana University
  • National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
geriatric depression, primary care, antidepressant prescribing, depression diagnosis, psychiatric referral, functional disability, older adults, medically indigent patients
MeSH terms
Aged, Antidepressive Agents, Depressive Disorder, Education, Medical, Continuing, Female, Humans, Male, Middle Aged, Primary Health Care, Prognosis, Psychiatric Status Rating Scales, Psychiatry, Referral and Consultation

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